Scaling Up: Bringing the Transitional Care Model Into the Mainstream

Describes features of an innovative care management intervention to facilitate elderly, chronically ill patients' transitions among providers and settings; the adopting organization; and the external environment that affect its translation into practice

Medical Migration to the U.S.: Trends and Impact

The United States is in the midst of a prolonged nursing shortage, one that could reach a deficit of 800,000 registered nurses (RNs) by 2020. Increasingly, foreign-trained nurses are migrating to the U.S., particularly from low-income countries, seeking higher wages and a higher standard of living. Increased reliance on immigration may adversely affect health care in lower-income countries without solving the U.S. shortage. This Issue Brief analyzes trends in medical migration, and explores its short and long-term effects on the health care workforce in the U.S. and in developing countries

Cause for Concern: Nurses’ Reports of Hospital Care in Five Countries

According to most experts, the U.S. faces a growing shortage of registered nurses, threatening the quality of care hospitals can provide. In the setting of nurse shortages and simultaneous concern about patient safety, nurses’ job satisfaction and their assessment of quality of care become critical. This Issue Brief highlights a crossnational survey that describes nurses’ perceptions of their hospital work environment, and identifies core problems in work design and workforce management in five countries

Organization and Outcomes of Inpatient AIDS Care

The establishment of AIDS hospitals and AIDS units within hospitals has been controversial. Unlike other specialty care, AIDS care arrangements were initially developed as much to segregate AIDS patients from other patients and staff as to provide the best possible care. Ten years after many of these units opened, little evidence was available about whether the benefits of aggregating AIDS patients outweighed the potential hazards of segregating people from the mainstream of hospital care. This Issue Brief describes a national study to determine how different organizational settings affect the outcomes of inpatient AIDS care

Analysis of nursing costs in the intensive care unit.

The specific aims of this study were to: (1) describe nursing costs for patients having a stay in the intensive care unit (ICU), with respect to severity of illness, length of stay (LOS), operative status, and age; (2) determine the relationship between these patient factors and nursing costs for patients having an ICU stay, and (3) analyze the variance in per diem nursing costs using these patient factors. The convenience sample comprised 437 patients admitted to the surgical and medical intensive care units at the University of Michigan Hospital. Patients who were older, had longer ICU stays, higher severity of illness scores, or undergone surgery, were found to incur significantly higher nursing costs. Severity of illness alone accounted for 35 percent of the nursing cost variation. ICU length of stay and post-operative status contributed significantly to the variation in nursing costs after taking into account patient severity. The distribution of total nursing costs was extremely skewed, with five percent of patients incurring 33 percent of total nursing costs during the study period. The results of the study indicate a need to continue efforts to disaggregate nursing cost variation and to examine its relationship with severity and other patient characteristics.Ph.D.NursingUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/161864/1/8812993.pd

The migration of nurses: trends and policies

This paper examines the policy context of the rise in the international mobility and migration of nurses. It describes the profile of the migration of nurses and the policy context governing the international recruitment of nurses to five countries: Australia, Ireland, Norway, the United Kingdom, and the United States. We also examine the policy challenges for workforce planning and the design of health systems infrastructure. Data are derived from registries of professional nurses, censuses, interviews with key informants, case studies in source and destination countries, focus groups, and empirical modelling to examine the patterns and implications of the movement of nurses across borders. The flow of nurses to these destination countries has risen, in some cases quite substantially. Recruitment from lower-middle income countries and low-income countries, as defined by The World Bank, dominate trends in nurse migration to the United Kingdom, Ireland, and the United States, while Norway and Australia, primarily register nurses from other high-income countries. Inadequate data systems in many countries prevent effective monitoring of these workforce flows. Policy options to manage nurse migration include: improving working conditions in both source and destination countries, instituting multilateral agreements to manage the flow more effectively, and developing compensation arrangements between source and destination countries. Recommendations for enhancements to workforce data systems are provided