The provision and utilisation of casemix and demographic data by nursing managers in seven hospitals.

The role of the nursing manager has evolved from clinician and bed manager to one with greater accountability for evidence based practice, benchmarking and more recently, budget liability. Casemix data are widely believed to be a means of providing essential information for effective decision making and financial management but have not been widely utilised by nursing managers (Diers & Bozzo, 1999). This paper will report the results of a survey of nursing managers in seven hospitals within a metropolitan area health service. The hospitals include tertiary referral hospitals, specialist public hospitals and an affiliated public hospital for aged care and rehabilitation services. The survey sought to establish what casemix and related data were provided to nurse managers, who provided these data and how supplied data were utilised by the nurse managers. Results demonstrated that the majority of nursing managers surveyed received minimal (if any) casemix and/or demographic data on a routine basis. Some were provided with data in response to specific requests. The information that was provided varied both within and across hospitals, and no consistent methods of data distribution were available. Few nursing managers believed that the information provided aided their decision-making processes partly due to the minimalist nature of provided data while some nursing managers demonstrated a lack of understanding of the potential benefit of casemix data as a resource to support management decision making

Patient transfers in Australia: Implications for nursing workload and patient outcomes

Aim To discuss the impact of patient transfers on patient outcomes and nursing workload. Background Many patient transfers are essential and occur in response to patients' clinical changes. However, increasingly within Australia transfers are performed in response to reductions in bed numbers, resulting in 'bed block'. Evaluation A discussion of the literature related to inpatient transfers, nursing workload and patient safety. Key issues Measures to increase patient flow such as short-stay units may result in an increase in patient transfers and nursing workload. Frequent patient transfers may also increase the risk of medication incidents, health-care acquired infections and patient falls. Conclusions The continuing demand for health care has led to a reactionary bed management system that, in an attempt to accommodate patients, has resulted in increased transfers between wards. This can have a negative effect on nursing workload and affect patient outcomes. Implications for nursing management High nursing workload is cited as one reason for nurses leaving the profession. Reductions in non-essential transfers may reduce nurse workload, improve patient outcomes and enhance continuity of patient care. © 2011 Blackwell Publishing Ltd

Intrahospital transfers and the impact on nursing workload

© 2017 John Wiley & Sons Ltd Aims and objectives: To determine the rate of patient moves and the impact on nurses’ time. Background: Bed shortages and strategies designed to increase patient flow have led to a global increase in patient transfers between wards. The impact of transferring patients between wards and between beds within a ward on nurses’ workload has not previously been measured. Design: A two-stage sequential study. Retrospective analysis of hospital data and a prospective observational-timing study. Methods: Secondary analysis of an administrative data set to inform the rate of ward and bed transfers (n = 34,715) was undertaken followed by an observational-timing study of nurses’ activities associated with patient transfers (n = 75). Results: Over 10,000 patients were moved 34,715 times in 1 year which equates to an average of 2.4 transfers per patient. On average, patient transfers took 42 min and bed transfers took 11 min of nurses’ time. Based on the frequency of patient moves, 11.3 full-time equivalent nurses are needed to move patients within the site hospital each month. Conclusion: Transferring patients is workload intensive on nurses’ time and should be included in nursing workload measurement systems. Relevance to clinical practice: Nurses at the site hospital spend over 1700 hr each month on activities associated with transferring patients, meaning that less time is available for nursing care

The consequences of executive turnover

The high rate of executive turnover in the healthcare industry is a major issue for health service organisations and their staff both in Australia and internationally. In the course of planning a research project examining nurse turnover at the clinical level within three Australian States/Territories, the researchers became aware of frequent executive turnover at all levels (State Department of Health, Area Health Service, hospital). Over a period of approximately 2 years there were 41 executives occupying 18 different positions, highlighting the scope of this issue in Australia. Few studies have examined the causes and consequences of this phenomenon in depth. Factors such as age, gender, education, lack of career advancement opportunities and remuneration have all been identified in the literature as important contributors to executive turnover. High turnover rates have been found to be associated with a number of negative consequences, including organisational instability, high financial costs, loss of human capital and adverse effects on staff morale and patient care. While the use of 'acting' roles may assist in filling executive positions on a temporary basis, consequences for the rest of the organisation are associated with their extended use. Steps which health services planners may take to attempt to minimise executive turnover include providing staff members with appropriate challenges and opportunities for growth and ensuring that a clear succession plan is in place to minimise the impact for the organisation and its staff. © The Author(s) 2011

The Community Nurse in Australia. Who are they? A rapid systematic review.

AimTo profile the community nurse in Australia.BackgroundThe need for nurses in the community health care sector is increasing in response to shorter hospital stays, an ageing population and chronic disease. The increase in demand has not been followed by appropriate workforce planning, leading to structural issues and lack of qualified nursing workforce in the community sector.EvaluationMEDLINE and ProQuest Public Health and grey literature were searched for records published between 2010-2020 relative to the profile of the community nurse in Australia. Twenty-five records (21 publications, two databases and two reports) were included in the review. Abstracted data followed the principles of workforce planning, and included demographics, qualifications and roles.Key issuesInconsistent definitions, self-reported data and a focus on practice nurses have contributed to data irregularities. Little is known about the specific aspects of community nursing work.ConclusionA lack of concrete data has over-shadowed a community nursing workforce crisis with implications for patients' health and safety across the lifespan.Implications for nursing managementThere is urgent need for nurse managers globally to refocus nursing recruitment to the community sector to maintain quality and ensure sustainability of the nursing workforce

Probing stellar winds and accretion physics in high-mass X-ray binaries and ultra-luminous X-ray sources with LOFT

This is a White Paper in support of the mission concept of the Large Observatory for X-ray Timing (LOFT), proposed as a medium-sized ESA mission. We discuss the potential of LOFT for the study of high-mass X-ray binaries and ultra-luminous X-ray sources. For a summary, we refer to the paper.Comment: White Paper in Support of the Mission Concept of the Large Observatory for X-ray Timing. (v2 few typos corrected

Identification of patients at risk for early death after conventional chemotherapy in solid tumours and lymphomas

1–5% of cancer patients treated with cytotoxic chemotherapy die within a month after the administration of chemotherapy. Risk factors for these early deaths (ED) are not well known. The purpose of this study was to establish a risk model for ED after chemotherapy applicable to all tumour types. The model was delineated in a series of 1051 cancer patients receiving a first course of chemotherapy in the Department of Medicine of the Centre Léon Bérard (CLB) in 1996 (CLB-1996 cohort), and then validated in a series of patients treated in the same department in 1997 (CLB-1997), in a prospective cohort of patients with aggressive non-Hodgkin's lymphoma (NHL) (CLB-NHL), and in a prospective cohort of patients with metastatic breast cancer (MBC series) receiving first-line chemotherapy. In the CLB-1996 series, 43 patients (4.1%) experienced early. In univariate analysis, age > 60, PS > 1, lymphocyte (ly) count ≤ 700 μl−1 immediately prior to chemotherapy (d1), d1-platelet count ≤ 150 Gl−1, and the type of chemotherapy were significantly correlated to the risk of early death (P ≤ 0.01). Using logistic regression, PS > 1 (hazard ratio 3.9 (95% Cl 2.0–7.5)) and d1-ly count ≤ 700 μl−1 (3.1 (95% Cl 1.6–5.8)) were identified as independent risk factors for ED. The calculated probability of ED was 20% (95% Cl 10–31) in patients with both risk factors, 6% (95% Cl 4–9) for patients with only 1 risk factor, and 1.7% (95% Cl 0.9–3) for patients with none of these 2 risk factors. In the CLB-97, CLB-NHL and MBC validation series, the observed incidences of early death in patients with both risk factors were 19%, 25% and 40% respectively and did not differ significantly from those calculated in the model. In conclusion, poor performance status and lymphopenia identify a subgroup of patients at high risk for early death after chemotherapy. © 2001 Cancer Research Campaignhttp://www.bjcancer.co

Two years of monitoring Supergiant Fast X-ray Transients with Swift

We present two years of intense Swift monitoring of three SFXTs, IGR J16479-4514, XTE J1739-302, and IGR J17544-2619 (since October 2007). Out-of-outburst intensity-based X-ray (0.3-10keV) spectroscopy yields absorbed power laws with by hard photon indices (G~1-2). Their outburst broad-band (0.3-150 keV) spectra can be fit well with models typically used to describe the X-ray emission from accreting NSs in HMXBs. We assess how long each source spends in each state using a systematic monitoring with a sensitive instrument. These sources spend 3-5% of the total in bright outbursts. The most probable flux is 1-2E-11 erg cm^{-2} s^{-1} (2-10 keV, unabsorbed), corresponding to luminosities in the order of a few 10^{33} to 10^{34} erg s^{-1} (two orders of magnitude lower than the bright outbursts). The duty-cycle of inactivity is 19, 39, 55%, for IGR J16479-4514, XTE J1739-302, and IGR J17544-2619, respectively. We present a complete list of BAT on-board detections further confirming the continued activity of these sources. This demonstrates that true quiescence is a rare state, and that these transients accrete matter throughout their life at different rates. X-ray variability is observed at all timescales and intensities we can probe. Superimposed on the day-to-day variability is intra-day flaring which involves variations up to one order of magnitude that can occur down to timescales as short as ~1ks, and whichcan be explained by the accretion of single clumps composing the donor wind with masses M_cl~0.3-2x10^{19} g. (Abridged)Comment: Accepted for publication in MNRAS. 17 pages, 11 figures, 8 table