PubMed Health⌕ Search

PubMed · 9372805

Understanding the unmanageable nursing unit with casemix data. A case study.

Abstract

The unmanageable nursing unit is one that has the reputation of being wastefully over budget, not using nursing resources well, not cost effective, and certainly not well managed. Serendipity led us to discover ways to understand the unmanageable unit in one institution. The nurse manager knew the unit was not working well, but had no way to describe this in clinical management terms that would be understood by others. When data from before and after major structural and system redesign initiatives became available, they showed a situation in which decisions were made without data that worked. How much better might it have been had the data that was now accessible been used? We suggest a design for using standard hospital data to define alleged problems of inefficient nursing units, the design is also the structure for monitoring the effects of management changes.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

D Diers, J Potter. 1997. Understanding the unmanageable nursing unit with casemix data. A case study.. https://doi.org/10.1097/00005110-199711000-00007

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Groundwater-surface water interaction and its role on TCE groundwater plume attenuation.

A field investigation of a TCE plume in a surficial sand aquifer shows that groundwater-surface water interactions strongly influence apparent plume attenuation. At the site, a former industrial facility in Connecticut, depth-discrete monitoring along three cross-sections (transects) perpendicular to groundwater flow shows a persistent VOC plume extending 700 m from the DNAPL source zone to a mid-size river. Maximum TCE concentrations along a transect 280 m from the source were in the 1000s of microg/L with minimal degradation products. Beyond this, the land surface drops abruptly to a lower terrace where a shallow pond and small streams occur. Two transects along the lower terrace, one midway between the facility and river just downgradient of the pond and one along the edge of the river, give the appearance that the plume has strongly attenuated. At the river, maximum TCE concentrations in the 10s of microg/L and similar levels of its degradation product cis-DCE show direct plume discharge from groundwater to the river is negligible. Although degradation plays a role in the strong plume attenuation, the major attenuation factor is partial groundwater plume discharge to surface water (i.e. the pond and small streams), where some mass loss occurs via water-air exchange. Groundwater and stream mass discharge estimates show that more than half of the plume mass discharge crossing the first transect, before surface water interactions occur, reaches the river directly via streamflow, although river concentrations were below detection due to dilution. This study shows that groundwater and surface water concentration measurements together provide greater confidence in identifying and quantifying natural attenuation processes at this site, rather than groundwater measurements alone.

Connecticut↗