Are Rural and Urban Newly Licensed Nurses Different? A Longitudinal Study of a Nurse Residency Programme

Aim This study aimed to compare rural and urban nurse residency programme participants’ personal and job characteristics and perceptions of decision-making, job satisfaction, job stress, nursing performance and organisational commitment over time. Background Nurse residency programmes are an evolving strategy to foster transition to practice for new nurses. However, there are limited data available for programme outcomes particularly for rural nurses. Method A longitudinal design sampled 382 urban and 86 rural newly licensed hospital nurses during a 12-month nurse residency programme. Data were collected at the start of the programme, at 6 months and the end of the programme. Results At the end of the programme, rural nurses had significantly higher job satisfaction and lower job stress compared with urban nurses. Across all time-periods rural nurses had significantly lower levels of stress caused by the physical work environment and at the end of the programme had less stress related to staffing compared with urban nurses. Perceptions of their organisational commitment and competency to make decisions and perform role elements were similar. Conclusions Differences in these outcomes may be result from unique characteristics of rural vs. urban nursing practice that need further exploration. Implications for nursing management Providing a nurse residency programme in rural and urban hospitals can be a useful recruitment and retention strategy

A Comparison of Quality of Care in Critical Access Hospitals and Other Rural Hospitals

Purpose: The United States has about 2100 rural hospitals. Approximately 1300 are Critical Access Hospitals (CAHs) with 25 beds or less. CAHs receive cost-based reimbursement through the federal Flex program with the goal to improve quality and access to health care. Reports on quality of care (QOC) and factors that influence quality in CAHs are mixed. This study compared QOC and factors that influence QOC in CAHs and other rural hospitals. Sample: 385 staff nurses in 6 CAHs and 9 other rural hospitals in North Carolina and Virginia. Method: Descriptive cross-sectional design using nurse surveys aggregated to the hospital level, data from provider of services file, and the United States Department of Agriculture, Economic Research files. Variables on community, hospital, and nursing unit characteristics, the nurse work environment, nurse rated QOC and community perception of hospital quality were compared using t-test or chi-square. Findings: There were no differences in the majority of factors influencing QOC. A culture of safety, the nurse work environment, and QOC were rated high in all hospitals. Compared to other rural hospitals CAHs tend to be located in communities with better economic status and their nurses had more years of nursing experience. More nurses in CAHs felt their community recognized their hospital as a good place for minor health issues and would recommend the hospital to family and friends. Conclusions: The high ratings of QOC were accompanied with the presence of safety cultures and work environments rated as highly as in Magnet hospitals. The lower poverty levels in communities with CAHs suggest possible community financial benefits from CAHs. More studies are warranted to explore these relationships. Further reporting to public quality indicator databases by all CAHs should be encouraged and QOC measures relevant for small rural hospitals should be developed

The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units

The aim of the present study was to determine whether there are differences in hospital characteristics, nursing unit characteristics, the nurse work environment, job satisfaction and turnover rates in rural and urban nursing units

Self-management of type 2 diabetes mellitus in pregnancy and breastfeeding experiences among women in Thailand: Study protocol

Women with type 2 diabetes mellitus are at a higher risk of pregnancy complications. Although traditional beliefs and practices influence diabetes management and breastfeeding, recommendations integrating Thai cultural beliefs in maternal care are lacking. The purpose of this study is to describe diabetes self-management in pregnancy and breastfeeding experiences in women with preexisting type 2 diabetes mellitus from Thailand. A convergent parallel mixed-methods study will be conducted. Data will be collected from 20 pregnant women with preexisting type 2 diabetes mellitus in Thailand who are either primigravida or multigravida, aged 20–44 years old, speak the Thai language, and provide consent. The National Institute on Minority Health and Health Disparities Framework’s sociocultural and behavioral domains guides the research aims. Data will be collected two times. The first time is during pregnancy (T1); study participants will complete questionnaires and engage in an interview about diabetes self-management, breastfeeding confidence, and breastfeeding intention. The second time is at 4–6 weeks postpartum (T2); study participants will be interviewed about their breastfeeding experiences. We will review and extract maternal health outcomes including body mass index, gestational weight gain, and glycated hemoglobin for T1 as well as fasting plasma glucose for T2. Qualitative data will be analyzed using directed content analysis. Quantitative data will be analyzed using descriptive statistics. Data sources will be triangulated with relative convergence in the results. This proposed study is significant because the findings will be used as a preliminary guide to developing a culturally tailored approach to enhance health outcomes of Thai women with diabetes in pregnancy and postpartum periods

Government chief nursing officers\u27 perceptions of barriers to using research on nurse staffing: An international e-mail survey

The increase in global health care problems has emphasized the need for health policy planners, including chief nursing officers (CNOs) to use best available evidence when planning and advising on how to deliver quality health care. CNOs are nurses in high ranking government positions. Current problems include a global nursing shortage causing low nurse staffing. Studies have found that low nurse staffing is associated with poor patient and nurse outcomes. Research utilization remains slow despite the increase in dissemination of research findings through many private and governmental organizations and more options and technology to share research evidence globally. In this study, an electronic information message about the impact of nurse staffing on patient and nurse outcomes was presented to CNOs from 110 countries. The CNOs\u27 perceptions of local barriers to utilizing these research findings were then assessed in an electronic survey. The study was guided by the five stage model of diffusion of innovations. The study examined the four factors that influence the first two stages: Knowledge/Awareness and Persuasion. The four factors, characteristics of the adopter, organization, innovation, and communication, were measured using an adapted version of the BARRIERS scale. Barriers to utilization of research on nurse staffing were found in all four characteristics. The top barrier was lack of reports and studies in one place. Other barriers were lack of cooperation within the organization and lack of awareness of the research findings. The study also found that nursing shortages, not educating enough nurses, and inadequate budget to employ enough nurses were major problems. Differences according to Gross National Income (GNI) were also noted. The identified barriers and other factors can be used by CNOs and other health policy advisors in subsequent planning for and implementation of adequate nurse staffing. The study also uncovered methodological issues that should be considered in future studies using international e-mail surveys such as language barriers and the increased burden caused by e-mail attachments

Government chief nursing officers\u27 perceptions of barriers to using research on nurse staffing: An international e-mail survey

The increase in global health care problems has emphasized the need for health policy planners, including chief nursing officers (CNOs) to use best available evidence when planning and advising on how to deliver quality health care. CNOs are nurses in high ranking government positions. Current problems include a global nursing shortage causing low nurse staffing. Studies have found that low nurse staffing is associated with poor patient and nurse outcomes. Research utilization remains slow despite the increase in dissemination of research findings through many private and governmental organizations and more options and technology to share research evidence globally. In this study, an electronic information message about the impact of nurse staffing on patient and nurse outcomes was presented to CNOs from 110 countries. The CNOs\u27 perceptions of local barriers to utilizing these research findings were then assessed in an electronic survey. The study was guided by the five stage model of diffusion of innovations. The study examined the four factors that influence the first two stages: Knowledge/Awareness and Persuasion. The four factors, characteristics of the adopter, organization, innovation, and communication, were measured using an adapted version of the BARRIERS scale. Barriers to utilization of research on nurse staffing were found in all four characteristics. The top barrier was lack of reports and studies in one place. Other barriers were lack of cooperation within the organization and lack of awareness of the research findings. The study also found that nursing shortages, not educating enough nurses, and inadequate budget to employ enough nurses were major problems. Differences according to Gross National Income (GNI) were also noted. The identified barriers and other factors can be used by CNOs and other health policy advisors in subsequent planning for and implementation of adequate nurse staffing. The study also uncovered methodological issues that should be considered in future studies using international e-mail surveys such as language barriers and the increased burden caused by e-mail attachments

A payer perspective estimate of the costs of urinary tract and skin and soft tissue infections in adults with diabetes and their relationship to oral antidiabetic (OAD) medication non-adherence.

Background: Controlling costs and improving quality outcomes are important considerations of the triple aim in health care. Medication adherence to oral antidiabetic (OAD) medications is an outcome measure for those with diabetes. However, there is little research reporting the costs associated with OAD medication adherence among adults with diabetes and comorbid infections. Objective: To provide nationally representative cost and utilization estimates from a payer perspective of 2 common comorbid infections: urinary tract infection (UTI) and skin and soft tissue infection (SSTI) among adults with diabetes in relation to OAD medication nonadherence to quantify cost per outcome. Methods: A retrospective observational study for years 2010-2015 used longitudinal panel data in the public domain from the Medical Expenditure Panel Survey (MEPS). The study included individuals aged ≥ 18 years with diabetes (excluding gestational diabetes) who were prescribed OAD medications and then stratified by infection status, that is, without infection versus with UTI and/or SSTI. Outcomes measured included medication adherence, defined as medication possession ratio (MPR); treated prevalence of UTI and SSTI; and associated direct medical costs paid by insurers. Results: 4,633 adults with diabetes were included; of those, 12% reported a UTI or SSTI, with the weighted sample representing 2.2 million U.S. residents. The mean MPR was 0.61 and 0.63 in the infection and noninfection groups, respectively. Less than 35% in each group were adherent to OAD medications. Having a UTI or SSTI increased the adjusted total health expenses by 53.7% (P < 0.001), but adherence to OAD medications did not significantly affect total health care costs. Conclusions: In adults with diabetes, a UTI or SSTI diagnosis did not influence medication adherence to OAD medication but increased health care utilization and costs significantly