For several months, nurses completed ratings of the degree to which certain events relevant to absence were present during each of their scheduled workdays. The event ratings for days when the nurses decided to be absent were then compared with those for days when the nurses attended. As expected, certain events, such as ill health and tiredness, tended to covary and proved to be consistently related to absenteeism across nurses. Also as expected, some events that were not especially relevant for the nurses as a whole, like having a sick family member or friend and concerns about previous poor attendance, nonetheless emerged as being relevant to the absence behavior of certain individuals. Finally, some events were consistently related to the nurses' expressed desire to be absent but not to actual absences. We discuss these differences from two perspectives, one emphasizing the role of attribution bias and the other, a two-stage process in which such bias has no major role.
The 1980-81 epidemic of influenza A/Bangkok 79 was responsible for increased absenteeism (1.7 times the rate for the corresponding period of the subsequent nonepidemic year) among selected hospital staff in Winnipeg's Health Sciences Centre. Retrospective study of employment records for 25 of the centre's largest departments showed excess sick-leave costs of about $24 500 during the 2-week period of peak absenteeism that included the epidemic. Although the centre was sampling prospectively for the virus the first positive results became available too late for chemoprophylactic measures to have been effective. The greater increase in absenteeism among nursing staff caring for patients with chronic respiratory disease and nurses working on general medical or pediatric acute infection/isolation wards suggested that these groups be targeted for influenza vaccination in hospitals.
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The phenomenon of patient homicides committed by health service employees has, in the previous years, repeatedly aroused much attention. The cases made known in Germany, the USA, Holland, Norway, and Austria appear to provide evidence to the effect that we are not only dealing with unique incidents. The scientific investigation of this especially sensitive taboo-topic is, to date, missing. The judicial trials carried out emphatically indicate that culprit motives, colleague behavior, but also to a large extent decisions made by superiors remain unclear. It remains controversial, what effect working conditions, strain of employees, their level of education and personal viewpoints over such criminal acts they possess. Finally, the long latency period between the first internal suspicions and the responsible parties' appropriate reactions requires duplicatable explanation. The following paper presents a German single-case study of patient homicide by a female nurse. The focus on causality rests on the presentation of developments up to the point where the long-fermenting suspicion could no longer be dismissed, and appropriate consequences took place. The account largely avoids the "definite" findings required during the judicial process. It concerns rather above all an open, uncertain, and possibly without external influence course of development which in stages each colleague in the health professions can trace, to the point where the uncertain and horrifying suspicion became a certainty. With this single-case study in hand it is made understandable in which ways personal circumstances and professional conditions at the worksituation can intertwine in such a way that the original motivation to help turns into its abysmal opposite. It is the author's intention to make preventive learning possible through this single case study. Every employee in the health professions should proceed on the assumption that such occurrences could also in his own field of work come to pass. In this respect, it is of considerable importance to differentiate between hasty and untenable incriminations and original increasing early-warning signs.
Within the context of neoliberal restructuring, accountability is primarily linked to efficiency, determined through standardized, numerically based technologies and focused on lengths of stay, utilization indicators, and the like. Disappearing from view in this approach is what is actually happening at the point of care for registered nurses. Grounded in semistructured interviews, this article casts a critical light on the tensions and contradictions experienced by nurses, arguing that instead of a more accountable, effective, or efficient system, this path is jeopardizing nurses' ability to provide needed care within healthy, supportive work environments, setting into motion a fundamental transformation of nursing practice.
In the emergency department (ED) Registered Nurses (RNs) often perform triage, i.e. the sorting and prioritizing of patients. The allocation of acuity ratings is commonly based on a triage scale. To date, three reliable 5-level triage scales exist, of which the Canadian Triage and Acuity Scale (CTAS) is one. In Sweden, few studies on ED triage have been conducted and the organization of triage has been found to vary considerably with no common triage scale. The aim of this study was to investigate the accuracy and concordance of emergency nurses acuity ratings of patient scenarios in the ED setting. Totally, 423 RNs from 48 (62%) Swedish EDs each triaged 18 patient scenarios using the CTAS. Of the 7,550 triage ratings, 57.6% were triaged in concordance with the expected outcome and no scenario was triaged into the same triage level by all RNs. Inter-rater agreement for all RNs was kappa = 0.46 (unweighted) and kappa = 0.71 (weighted). The fact that the kappa-values are only moderate to good and the low concordance between the RNs call for further studies, especially from a patient safety perspective.
The purpose of the present study was to determine the accuracy of nurses' self-reports of absence by examining: (1) the correlation, intra-class correlation, and Cronbach's alpha for self-reported absence and absence as reported in organizational records, (2) difference in central tendency for the two measures of absence and (3) the percentage of nurses who underestimate their absence.
Research on nurses' absenteeism has often relied on self-reports of absence. However, nurses may not be aware of their actual absenteeism, or they may underestimate it.
Self-reported absence from questionnaires completed by 215 Canadian nurses was compared with their absence from organizational records.
There is a strong positive correlation, a strong intra-class correlation and Cronbach's alpha for the two measures of absence. However, there is a difference in central tendency that is related to the majority of nurses in this study (51.1%) underestimating their days absent from work.
Research examining the predictors of absence may consider measuring absence with self-reports. Nevertheless, nurses demonstrated a bias to underestimate their absence.
Feedback interventions to reduce absenteeism can be developed to include providing nurses with accurate information about their absence.