The effect of the total amount of work hours and the benefits of a shortening is frequently debated, but very little data is available. The present study compared a group (N = 41) that obtained a 9 h reduction of the working week (to a 6 h day) with a comparison group (N = 22) that retained normal work hours. Both groups were constituted of mainly female health care and day care nursery personnel. The experimental group retained full pay and extra personnel were employed to compensate for loss of hours. Questionnaire data were obtained before and 1 year after the change. The data were analyzed using a two-factor ANOVA with the interaction term year*group as the main focus. The results showed a significant interaction of year*group for social factors, sleep quality, mental fatigue, and heart/respiratory complaints, and attitude to work hours. In all cases the experimental group improved whereas the control group did not change. It was concluded that shortened work hours have clear social effects and moderate effects on well-being.
Retention and recruitment strategies are essential to address nursing workforce supply and ensure the viability of healthcare delivery in Canada. Knowledge transfer between experienced nurses and those new to the profession is also a focus for concern. The Multi-Employer/United Nurses of Alberta Joint Committee attempted to address these issues by introducing a number of retention and recruitment (R&R) initiatives for nurses in Alberta: in total, seven different programs that were introduced to some 24,000 nurses and employers across the province of Alberta in 2001 (the Transitional Graduate Nurse Recruitment Program) and 2007 (the remaining six R&R programs). Approximately 1,600 nurses participated in the seven programs between 2001 and 2009. Of the seven strategies, one supported entry into the workplace, two were pre-retirement strategies and four involved flexible work options. This project entailed a retrospective evaluation of the seven programs and differed from the other Research to Action (RTA) projects because it was solely concerned with evaluation of pre-existing initiatives. All seven programs were launched without a formal evaluation component, and the tracking of local uptake varied throughout the province. The union and various employers faced challenges in implementing these strategies in a timely fashion, as most were designed at the bargaining table during negotiations. As a result, systems, policy and procedural changes had to be developed to support their implementation after they became available.Participants in the programs indicated improvements over time in several areas, including higher levels of satisfaction with work–life balance, hours worked and their current practice and profession. The evaluation found that participation led to perceived improvements in nurses' confidence, greater control over their work environment, decreased stress levels, increased energy and morale and perceived improved ability to provide high-quality care. However, no formal implementation plan had been developed or made available to assist employers with implementation of the programs. The findings highlight the need for more discipline in communicating, implementing and evaluating initiatives such as those evaluated retrospectively in this project. In particular, key performance indicators, baseline data, monitoring mechanisms and an evaluation plan need to be developed prior to implementation.
In Ontario, Canada, hemodialysis services are organized in a "hub and spoke" model comprised of regional centers (hubs), satellites, and independent health facilities (IHFs; spokes). Rarely is a nephrologist on site when dialysis treatments take place at satellite units or IHFs. Situations occur that require transfer of the patient back ("fallbacks") to the regional center that necessitate either in- or outpatient care. Growth in the satellite dialysis population has led to an increased burden on the regional centers. This study was carried out to determine the incidence, nature, and outcome of such fallbacks to aid resource planning.
Data were collected on 565 patients from five regional centers over 1 yr. These regional centers controlled 19 satellite dialysis centers including 7 IHFs.
There were 681 fallbacks in 328 patients: 1.21 incidents per patient or 2.1 incidents per patient year. Multiple fallbacks occurred in 170 patients. Fallback episodes lasted a mean of 10.3 d, requiring 4.6 dialysis treatments. Forty-five percent of fallbacks required hospitalization with a mean stay of 16.7 d. Access-related problems (33%) and nondialysis medical causes (32%) were the major causes of fallback. Resolution of the problem occurred in 87.8%, with the patient returning to the satellite. By the end of the study 77.3% were still satellite patients, 10.8% died, 3.8% returned to the regional center, 3.4% were transplanted, and 4.7% were transferred to other treatment modalities.
Fallbacks are common, yet the model operates well.
Comment In: Clin J Am Soc Nephrol. 2009 Mar;4(3):523-419261831
Hospital wards need to be staffed by nurses round the clock, resulting in irregular working hours for many nurses. Over the years, the nurses' influence on the scheduling has been increased in order to improve their working conditions. In Sweden it is common to apply a kind of self-scheduling where each nurse individually proposes a schedule, and then the final schedule is determined through informal negotiations between the nurses. This kind of self-scheduling is very time-consuming and does often lead to conflicts. We present a pilot study which aims at determining if it is possible to create an optimisation tool that automatically delivers a usable schedule based on the schedules proposed by the nurses. The study is performed at a typical Swedish nursing ward, for which we have developed a mathematical model and delivered schedules. The results of this study are very promising and suggest continued work along these lines.
The aim of the study was to explore the possibilities of benchmarking with the RAFAELA system. In this study, comparisons are made between: (1) costs for one nursing care intensity point; (2) the nursing care intensity per nurse; (3) the relationship between nursing care intensity per nurse and (4) the optimal nursing care intensity.
During the period from 1994 to 2000 a new system for patient classification, the RAFAELA system, was developed in Finland.
86 wards from 14 different hospitals in Finland took part in the study.
The costs for one nursing care intensity point on the adults' wards were on average 7.80euro. The average workload was 25.2 nursing care intensity points per nurse. The optimal nursing care intensity was exceeded during 49.5% of the days and under during 20% of the days.
The study shows that benchmarking with the RAFAELA system provides many opportunities for the nurse managers' resource allocation and their personnel administration.
In 1987, nursing administrators effected radical changes on a pediatric psychiatry ward: A bachelor's degree in nursing science became mandatory for nursing staff, family systems nursing was introduced, and postdischarge nursing follow-up was instituted. To convey how they accomplished the changes, a case history of change on the ward is presented. It suggests that there were many driving forces. Factors most important to nursing's success included a strong vision of nursing, sufficient pain or discomfort to motivate change, the ability to recognize and seize opportunities, and the linking of change to existing institutional practices, policies, and values.
This case study describes an ongoing demonstration project that engages nurses and nurse leaders in decision-making with respect to workload management issues at eight practice sites within British Columbia (two per healthcare sector: acute care, long-term care, community health and community mental health). The primary goal of this project is to promote high-quality practice environments by empowering front-line nurses and their leaders: giving them the means to systematically examine and act upon factors that influence their workloads. Examples from practice sites illustrate tangible benefits from the project.
The Canadian Organ Replacement Register annual report (1998) provides insightful trends in renal replacement treatment modalities, comparing data from 1981 to 1996. The purpose of reviewing this report was to look at the scope of change over time in the distribution of treatment modalities and Canadian patient demographics: age, gender, dwelling (alternate care facilities, home and in-hospital), and medical conditions (vascular access, communicable diseases, diagnosis, and cause of death). Discussion focuses on the impact of these and other changes in the practice setting and describes the Canadian Association of Nephrology Nurses and Technologists' (CANNT) initiatives to support nephrology nurses and technologists.