Individual Nurse Productivity in Preparing Patients for Discharge Is Associated with Patient Likelihood of 30-Day Return to Hospital

Objective: Applied to value-based health care, the economic term “individual productivity” refers to the quality of an outcome attributable through a care process to an individual clinician. This study aimed to (1) estimate and describe the discharge preparation productivities of individual acute care nurses and (2) examine the association between the discharge preparation productivity of the discharging nurse and the patient’s likelihood of a 30-day return to hospital [readmission and emergency department (ED) visits]. Research Design: Secondary analysis of patient-nurse data from a cluster-randomized multisite study of patient discharge readiness and readmission. Patients reported discharge readiness scores; postdischarge outcomes and other variables were extracted from electronic health records. Using the structure-process-outcomes model, we viewed patient readiness for hospital discharge as a proximal outcome of the discharge preparation process and used it to measure nurse productivity in discharge preparation. We viewed hospital return as a distal outcome sensitive to discharge preparation care. Multilevel regression analyses used a split-sample approach and adjusted for patient characteristics. Subjects: A total 522 nurses and 29,986 adult (18+ y) patients discharged to home from 31 geographically diverse medical-surgical units between June 15, 2015 and November 30, 2016. Measures: Patient discharge readiness was measured using the 8-item short form of Readiness for Hospital Discharge Scale (RHDS). A 30-day hospital return was a categorical variable for an inpatient readmission or an ED visit, versus no hospital return. Results: Variability in individual nurse productivity explained 9.07% of variance in patient discharge readiness scores. Nurse productivity was negatively associated with the likelihood of a readmission (−0.48 absolute percentage points, P\u3c0.001) and an ED visit (−0.29 absolute percentage points, P=0.042). Conclusions: Variability in individual clinician productivity can have implications for acute care quality patient outcomes

Priorities for advancing nursing knowledge

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/88192/1/ketefian-priorities_advancing_nursing.pd

"A wealth of knowledge": A survey of the employment experiences of older nurses and midwives in the NHS

Background: The United Kingdom's National Health Service workforce is ageing, and the specific needs of this sector of its workforce need to be addressed. Nursing, and midwifery shortage is a worldwide issue, and with increasing demands for care the retention of older nurses and midwives is crucial. Objectives: To report on the employment experiences of nurses and midwives with it particular focus on issues relating to age, ethnicity, ill-health and disability. Design: The postal survey was developed following a literature review and analysis of National Health Service and Government policy documents. Settings: This was a UK-wide Survey of nurses and midwives working in National Health Service Trusts and Primary Care Trusts. Participants/methods: A postal Survey of nurses and midwives was undertaken between May and December 2005. National Health Service Trusts and Primary Care Trusts (n = 44) identified as having policies relevant to the Study were contacted regarding the procedure for seeking research governance approval. Thirteen National Health Service Trusts and Primary Care Trusts participated, with 2610 surveys distributed; 510 Surveys were returned (20% response rate). Results: Nurses and midwives aged 50 years and over had undertaken fewer Continuing Professional Development activities than nurses and midwives Under 50. Whilst not related to age, the study also found that 20% of the survey sample reported experiencing some form of discrimination. Nurses and midwives did not differ on either quality of life or psychological health using standard instruments. Having a disability did not lead to greater psychological morbidity but did have a negative effect on quality of life. Having a work-related illness had a negative impact on both quality of life and psychological morbidity. hi relation to ethnicity, black nurses and midwives reported lower psychological morbidity than other ethnic groups; that is, they enjoyed a higher level of mental well-being. Conclusion: The nursing and midwifery workforce is ageing worldwide with a significant proportion now approaching, or having already reached, potential retirement age. With the recent introduction of the age legislation the working lives of older nurses and midwives in the National Health Service have never been more relevant. Whilst access to Continuing Professional Development is pertinent to the retention of nurses and midwives of all ages, in this study, older nurses reported less access that younger nurses. (C) 2008 Elsevier Ltd. All rights reserved

Current practices of obesity pharmacotherapy, bariatric surgery referral and coding for counselling by healthcare professionals

Introduction Rates of obesity pharmacotherapy use, bariatric surgery and intensive behavioural counselling have been extremely low. Objectives The primary objective of this study was to survey healthcare provider beliefs, practice and knowledge regarding obesity management. Methods Primary care physicians (PCPs), OB‐GYN physicians and nurse practitioners (NPs) responded to a web‐based survey related to drug therapy practice, bariatric surgery referral and reimbursement coding practice. Results Rates of reported use of obesity pharmacotherapy appear to be increasing among PCPs, which is likely related to the approval of four new obesity pharmacotherapy agents since 2012. Rates of pharmacotherapy use among OB‐GYNs and NPs appear much lower. Similarly, few PCPs are averse to recommending bariatric surgery, but aversion among OB‐GYNs and NPs is significantly higher. Conclusion Together, these observations suggest that OB‐GYN and NP populations are important targets for education about obesity management. Very few PCPs, OB‐GYNs or NPs use behavioural counselling coding for obesity. Better understanding of why this benefit is not being fully used could inform outreach to improve counselling rates

Role of nurse practitioners in caring for patients with complex health needs

Objective: To estimate trends in the percentage of Medicare beneficiaries cared for by nurse practitioners from 2012-2017, to characterize beneficiaries cared for by nurse practitioners in 2017, and to examine how the percentage of beneficiaries cared for by nurse practitioners varies by practice characteristics. Design: Observational study of 2012-2017 Medicare fee-for-service beneficiaries’ ambulatory visits. We computed the percentage of beneficiaries with one or more ambulatory visits from nurse practitioners and the percentage of beneficiaries receiving the plurality of their ambulatory visits from a nurse practitioner versus a physician (i.e. predominant provider). We compared beneficiary demographics, clinical characteristics, and utilization by predominant provider. We then characterized the predominant provider by practice characteristics. Key Results: In 2017, 28.9% of beneficiaries received any care from a nurse practitioner and 8.0% utilized nurse practitioners as their predominant provider – an increase from 4.4% in 2012. Among beneficiaries cared for by nurse practitioners in 2017, 25.9% had three or more chronic conditions compared with 20.8% of those cared for by physicians. Beneficiaries cared for in practices owned by health systems were more likely to have a nurse practitioner as their predominant provider compared with those attending practices that were independently owned (9.3% vs. 7.0%). Conclusions: Nurse practitioners are caring for Medicare beneficiaries with complex needs at rates that match or exceed their physician colleagues. The growing role of nurse practitioners, especially in health care systems, warrants attention as organizations embark on payment and delivery reform

The context, influences and challenges for undergraduate nurse clinical education: Continuing the dialogue

Introduction – Approaches to clinical education are highly diverse and becoming increasingly complex to sustain in complex milieu Objective – To identify the influences and challenges of providing nurse clinical education in the undergraduate setting and to illustrate emerging solutions. Method: A discursive exploration into the broad and varied body of evidence including peer reviewed and grey literature. Discussion - Internationally, enabling undergraduate clinical learning opportunities faces a range of challenges. These can be illustrated under two broad themes: (1) Legacies from the past and the inherent features of nurse education and (2) Challenges of the present, including, population changes, workforce changes, and the disconnection between the health and education sectors. Responses to these challenges are triggering the emergence of novel approaches, such as collaborative models. Conclusion(s) – Ongoing challenges in providing accessible, effective and quality clinical learning experiences are apparent

Where are we now? Practice-Level Utilization of Nurse Practitioners in Comparison with State-Level Regulations

Background. Full practice authority for NPs is optimal for high-quality, cost-effective healthcare. However, a complete picture of utilization after states have adopted full practice authority needs to be determined. Objective. To review the evidence regarding practice-level utilization (PLU) of Nurse Practitioners (NP) PLU in comparison to state-level regulations (SLR). Data Sources. Studies published in English and based on US populations were identified through PubMed, CINAHL, and SCOPUS (January 1, 1989 - December 31, 2018), and bibliographies of retrieved articles. Of the 419 articles identified with these limits, 19 (5%) met all inclusion and exclusion criteria. Conclusions. Four categories of PLU were identified; billing practices, level of supervision, privileges, and prescriptive authority. Significant differences were seen between urban versus rural NPs and primary care versus specialty NPs. Thirteen of the 19 studies did not specifically address the state-level regulation of the included sample. Implications. No studies described the type of NP certification, practice specialty, utilization, and compared all to the SLR. There is a need for more evidence concerning PLU of NPs across the tiers of SLR. Only then can health care organizations, political leaders and other stakeholders, have the information needed to proceed with beneficial practice-model changes. Key Words. Nurse practitioner, full scope of practice, utilization, restriction, rol

Ensuring and sustaining a pandemic workforce

Current efforts to fight the Covid-19 pandemic aim to slow viral spread and increase testing, protect health care workers from infection, and obtain ventilators and other equipment to prepare for a surge of critically ill patients. But additional actions are needed to rapidly increase health workforce capacity and to replenish it when personnel are quarantined or need time off to rest or care for sick family members. It seems clear that health care delivery organizations, educators, and government leaders will all have to be willing to cut through bureaucratic barriers and adapt regulations to rapidly expand the U.S. health care workforce and sustain it for the duration of the pandemic