Evapotranspiration Mapping for Forest Management in California's Sierra Nevada

We assessed the response of densely forested watersheds with little apparent annual water limitation to forest disturbance and climate variability, by studying how past wildfires changed forest evapotranspiration, and what past evapotranspiration patterns imply for the availability of subsurface water storage for drought resistance. We determined annual spatial patterns of evapotranspiration using a top-down statistical model, correlating measured annual evapotranspiration from eddycovariance towers across California with NDVI (Normalized Difference Vegetation Index) measured by satellite, and with annual precipitation. The study area was the Yuba and American River watersheds, two densely forested watersheds in the northern Sierra Nevada. Wildfires in the 1985-2015 period resulted in significant post-fire reductions in evapotranspiration for at least 5 years, and in some cases for more than 20 years. The levels of biomass removed in medium-intensity fires (25- 75% basal area loss), similar to magnitudes expected from forest treatments for fuels reduction and forest health, reduced evapotranspiration by as much 150-200 mm yr-1 for the first 5 years. Rates of recovery in post-wildfire evapotranspiration confirm the need for follow-up forest treatments at intervals of 5-20 years to sustain lower evapotranspiration, depending on local landscape attributes and interannual climate. Using the metric of cumulative precipitation minus evapotranspiration (P-ET) during multi-year dry periods, we found that forests in the study area showed little evidence of moisture stress during the 1985-2018 period of our analysis, owing to relatively small reliance on interannual subsurface water storage to meet dry-year evapotranspiration needs of vegetation. However, more-severe or sustained drought periods will push some lower-elevation forests in the area studied toward the cumulative P-ET thresholds previously associated with widespread forest mortality in the southern Sierra Nevada

A comparison of the nursing practice environment in mental health and medical-surgical settings

Purpose: To examine the differences between characteristics of the work environment of nurses working in mental health and general acute inpatient nursing settings.Design: Secondary analysis of data collected on 96 randomly selected medical and surgical (general) wards and six mental health wards in 24 public acute general hospitals across two Australian states between 2004 and 2006.Methods: All nurses on the participating wards were asked to complete a survey that included the Practice Environment Scale of the Nursing Work Index (NWI-PES). Responses were received from 2,556 nurses (76.3% response rate). Using the five-domain structure, comparisons were made between mental health and general nurses.Findings: Across the entire sample of nurses, those working in mental health settings scored more highly in regard to nurse-doctor relationships and staffing adequacy. Nurses in general wards reported more participation in hospital affairs, stronger leadership, and the presence of more of the foundations of nursing quality care such as access to continued education. Differences between the groups on each of the domains was statistically significant at p=05 or greater, but not for the composite practice environment scale. A wide range of responses was seen when data were aggregated to the ward level.Conclusions: The work environment of mental health nurses is different from that of their colleagues working in general settings. Specific areas of the mental health environment, such as participation in the hospital, leadership, and the foundations of quality, may be enhanced to improve nurses' job satisfaction and, potentially, other nurse and patient outcomes.Clinical Relevance: Factors in the medical and surgical nursing practice environment have been established as significant influences on nurse and patient outcomes. It is important to understand the existence and potential impact of these factors in mental health inpatient settings. © 2010 Sigma Theta Tau International

Testing the Nursing Worklife Model in Canada and Australia: A multi-group comparison study

© 2014 Elsevier Ltd. Study aim: To test a model derived from the Nursing Worklife Model linking elements of supportive practice environments to nurses' turnover intentions and behaviours in Canada and Australia. Background: With the worldwide shortage of nurses, retaining nurses within fiscally challenged health care systems is critical to sustaining the future of the nursing workforce and ultimately safe patient care. The Nursing Worklife Model describes a pattern of relationships amongst environmental factors that support nursing practice and link to nurse turnover. This model has been tested in north American settings but not in other countries. Methods: A secondary analysis of data collected in two cross-sectional studies in Canadian and Australian hospitals ( N= 4816) was conducted to test our theoretical model. Multigroup structural equation modelling techniques were used to determine the validity of our model in both countries and to identify differences between countries. Results: The hypothesized model relationships were supported in both countries with few differences between groups. Components of supportive professional practice work environments, particularly resources, were significantly linked to nurses' turnover intentions and active search for new jobs. Leadership played a critical role in shaping the pattern of relationships to other components of supportive practice environments and ultimately turnover behaviours. Conclusion: The Nursing Worklife Model was shown to be valid in both countries, suggesting that management efforts to ensure that features of supportive practice environments are in place to promote the retention of valuable nursing resources

Leadership skills for nursing unit managers to decrease intention to leave

Aim: To examine specific elements of nursing leadership linked to intention to leave, in public acute care hospitals. Background: Nurse turnover is a global issue receiving widespread attention due to prolonged and projected workforce shortages. Nurse management and leadership qualities have been associated with intention to leave and turnover of nurses. The role of the nurse unit managers in the retention of nurses is becoming increasingly important, particularly because of their strong influence on the quality and stability of the work environment. Methods: Data were collected from 6 2 medical, surgical, and mixed units across eleven public acute care hospitals in three Australian states (September 2 008 to August 2 010). A total of 1 ,673 nurses completed a nurse survey that included measures of intention to leave and leadership aspects of the practice environment. Analyses explored specific leadership characteristics that were associated with turnover intent. Results: The role of nursing unit managers was confirmed to be a major factor in nurses’ intention to remain or leave their current workplace. Nurses valued “human” skills more highly than other leadership characteristics, including their manager’s connection with nurses’ concerns, clarity, participation in decisions, and encouragement. Conclusion: Strong leadership qualities in the nursing unit manager have been associated with greater job satisfaction, reduced turnover intention among nursing staff, and improved patient outcomes. Nurse leaders need to be supported in an effort to retain nurses given ongoing workforce issues and to ensure high-quality patient care

The relationship between the work environment and therapeutic commitment of nurses working in mental health

University of Technology, Sydney. Faculty of Nursing, Midwifery and Health.The therapeutic relationship is the central focus of nursing work in mental health (Peplau, 1992, 1997). However, there is currently little research that has examined influences on the nurses’ capacity to effectively engage in this relationship. This study investigated the impact of nurse, patient and work environment factors on the willingness and ability of nurses to engage in therapeutic relationships. This attribute of the nurse, identified as therapeutic commitment, is essential for an effective therapeutic relationship (Lauder, et al., 2000; Rogers, 1957), which has been identified by users of mental health services as the foundation of their care (Forchuk & Reynolds, 2001). The therapeutic relationship is central to nursing in mental health and has been linked to improved patient outcomes (Horvath, 2005). Environmental factors hypothesised to impact the nurse’s therapeutic commitment included leadership, collegial nurse-doctor relationships, participation in hospital affairs, the foundations of quality nursing, clinical supervision, staffing, skill mix and patient turnover (Aiken, et al., 2008; Duffield, et al., 2009a; Estabrooks, et al., 2002; Kramer & Schmalenberg, 2004; Lake & Friese, 2006; McGillis-Hall & Doran, 2004; Needleman, et al., 2002; Proctor, 1986). These factors, together with measures of the nurse’s qualifications and experience, were assembled into an hypothesised model, based on an earlier framework that included the nurse’s perception of support, adequacy and legitimacy in their role along with their therapeutic commitment (Lauder, et al., 2000; Shaw, et al., 1978). Data were collected from 76 nurses across six mental health wards in general acute hospitals in New South Wales. A nurse survey collected the identified factors using the Practice Environment Scale of the Nursing Work Index (Lake, 2002), the Mental Health Problems Perception Questionnaire (Lauder, et al., 2000), and other questions. A ward profile was used to collect staffing, skill mix and patient movement data. Partial least squares path modelling was applied to the model in order to identify the most influential relationships. The most significant factors in the model were the foundations for quality care, nurse experience, participation in hospital affairs and clinical supervision. Services should enhance the support provided to clinical nurses in mental health through improved access to preceptorship, continued education and clinical supervision. In addition, the therapeutic commitment of nurses in mental health can be increased through improved continuity of care, access to career development opportunities such as the involvement of mental health nurses in the governance of the hospital, and improved responsiveness of administration to the needs of nurses in mental health. Engagement in these supportive activities should be enacted through structured mechanisms that both facilitate involvement and encourage evaluation. This study provides a basis on which to modify the operation of mental health services in general hospitals in order to improve the nursing work environment

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

Nursing churn and turnover in Australian hospitals: Nurses perceptions and suggestions for supportive strategies

Background: This study aimed to reveal nurses' experiences and perceptions of turnover in Australian hospitals and identify strategies to improve retention, performance and job satisfaction. Nursing turnover is a serious issue that can compromise patient safety, increase health care costs and impact on staff morale. A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories.Method: A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories.Results: Key factors affecting nursing turnover were limited career opportunities; poor support; a lack of recognition; and negative staff attitudes. The nursing working environment is characterised by inappropriate skill-mix and inadequate patient-staff ratios; a lack of overseas qualified nurses with appropriate skills; low involvement in decision-making processes; and increased patient demands. These issues impacted upon heavy workloads and stress levels with nurses feeling undervalued and disempowered. Nurses described supportive strategies: improving performance appraisals, responsive preceptorship and flexible employment options.Conclusion: Nursing turnover is influenced by the experiences of nurses. Positive steps can be made towards improving workplace conditions and ensuring nurse retention. Improving performance management and work design are strategies that nurse managers could harness to reduce turnover. © 2014 Dawson et al.; licensee BioMed Central Ltd

The rate and cost of nurse turnover in Australia

© 2014 Australian College of Nursing Ltd. Nurse turnover is a critical issue facing workforce planners across the globe, particularly in light of protracted and continuing workforce shortages. An ageing population coupled with the rise in complex and chronic diseases, have contributed to increased demands placed on the health system and importantly, nurses who themselves are ageing. Costs associated with nurse turnover are attracting more attention; however, existing measurements of turnover show inconsistent findings, which can be attributed to differences in study design, metrics used to calculate turnover and variations in definitions for turnover. This paper will report the rates and costs of nurse turnover across three States in Australia

Instability in patient and nurse characteristics, unit complexity and patient and system outcomes

© 2014 John Wiley & Sons Ltd. Aims: To explore key factors related to nursing unit instability, complexity and patient and system outcomes. Background: The relationship between nurse staffing and quality of patient outcomes is well known. The nursing unit is an important but different aspect that links to complexity and to system and patient outcomes. The relationship between the instability, complexity and outcomes needs further exploration. Design: Descriptive. Methods: Data were collected via a nurse survey, unit profile and review of patient records on 62 nursing units (wards) across three states of Australia between 2008-2010. Two units with contrasting levels of patient and nurse instability and negative system and patient outcomes, were profiled in detail from the larger sample. Results: Ward A presented with greater patient stability (low occupancy, high planned admissions, few ICU transfers, fewer changes to patient acuity/work re-sequencing) and greater nurse instability (nurses changing units, fewer full-time staff, more temporary/casual staff) impacting system outcomes negatively (high staff turnover). In contrast, Ward B had greater patient instability, however, more nurse stability (greater experienced and permanent staff, fewer casuals), resulting in high rates for falls, medication errors and other adverse patient outcomes with lower rates for system outcomes (lower intention to leave). Conclusion: Instability in patient and nurse factors can contribute to ward complexity with potentially negative patient outcomes. The findings highlight the variation of many aspects of the system where nurses work and the importance of nursing unit managers and senior nurse executives in managing ward complexity