This article critically examines a feminist, collaborative research method that was intended to be political in standpoint, gendered in focus, reflexive in process, and transformative in outcome. By incorporating collaborative elements into a qualitative, three-step research design, the author hoped to challenge both what was known about nurses' job displacement and how that knowledge was produced. This article explores the contradictions between the author's best laid plans and the actual process of discovery. Recommendations for future research include considerations about the social and political context in which the research takes place, cautions about gender inclusivity in the research population and analytic frameworks, strategies for encouraging participants' critical thinking, and a caveat with regard to transformative outcomes.
To introduce health care production functions into human resources planning and to apply the approach to analysing the need for registered nurses in Ontario during a period of major reduction in inpatient capacity.
Measurement of changes in services delivered by acute care hospitals in Ontario between 1994/95 and 1998/99, and comparison with changes in the mix of human resources, non-human resources and patient needs.
Inpatient episodes per nurse fell by almost 2%. At the same time the number of beds was cut by over 20%. As a result, the number of patients per bed increased by 12%. Allowing for severity, there was a 20% reduction in beds per episode and a 3.7% reduction in nurses per episode.
The demands on nurses in acute care hospitals have increased as an increasing number of severity-adjusted episodes are served using fewer beds by a reduced number of nurses. Human resources planning traditionally only considers the effects of demographic change on the need for and supply of health care. Failure to recognize the variable and endogenous nature of other health care inputs leads to false impressions about the adequacy of existing supplies of human resources. Consideration of human resources in the context of the production function for health services provides a meaningful way of improving the effectiveness and efficiency of human resources planning.
This pilot project involved the application, in Canada, of the innovative 80/20 staffing model to a hospital in a small rural setting. The model provides the voluntary participants with 20% of their salaried time off from direct patient care in order to pursue various types of professional development activities. The project, overseen by a steering committee, lasted from June 2009 to February 2010 and involved 14 nurses on the pediatric unit of Royal Inland Hospital in Kamloops, British Columbia. It entailed a collaborative partnership of the British Columbia Nurses' Union, Interior Health Authority, Thompson Rivers University and the British Columbia Ministry of Health, and aimed to demonstrate how professional development opportunities can improve recruitment and retention of nurses, quality of work life and quality of patient care.
To identify the contribution of hospital, unit, staff characteristics, staffing adequacy and teamwork to missed nursing care in Iceland hospitals.
A recently identified quality indicator for nursing care and patient safety is missed nursing care defined as any standard, required nursing care omitted or significantly delayed, indicating an error of omission. Former studies point to contributing factors to missed nursing care regarding hospital, unit and staff characteristics, perceptions of staffing adequacy as well as nursing teamwork, displayed in the Missed Nursing Care Model.
This was a quantitative cross-sectional survey study.
The samples were all registered nurses and practical nurses (n = 864) working on 27 medical, surgical and intensive care inpatient units in eight hospitals throughout Iceland. Response rate was 69·3%. Data were collected in March-April 2012 using the combined MISSCARE Survey-Icelandic and the Nursing Teamwork Survey-Icelandic. Descriptive, correlational and regression statistics were used for data analysis.
Missed nursing care was significantly related to hospital and unit type, participants' age and role and their perception of adequate staffing and level of teamwork. The multiple regression testing of Model 1 indicated unit type, role, age and staffing adequacy to predict 16% of the variance in missed nursing care. Controlling for unit type, role, age and perceptions of staffing adequacy, the multiple regression testing of Model 2 showed that nursing teamwork predicted an additional 14% of the variance in missed nursing care.
The results shed light on the correlates and predictors of missed nursing care in hospitals. This study gives direction as to the development of strategies for decreasing missed nursing care, including ensuring appropriate staffing levels and enhanced teamwork.
By identifying contributing factors to missed nursing care, appropriate interventions can be developed and tested.
