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PubMed2001

Patient care staffing patterns and roles in community-based family practices.

OBJECTIVES: Our study describes patient care staff patterns and roles in community-based family practices. STUDY DESIGN: We used a multimethod comparative case study design that included detailed descriptive field notes of the office environment of 18 family practices and of 1637 clinical encounters, as well as in-depth interviews of practice staff and physicians. Systematic analysis of these data provided detailed descriptions of patient care staff patterns and functions. POPULATION: We included physicians and staff in 18 community-based Nebraska family practices. RESULTS: Practices are staffed with a range of clinical personnel, including registered nurses, licensed practical nurses, certified medical assistants, radiology technicians, and trained and untrained medical assistants. Each of these has specific educational preparation that potentially qualifies them for different patient care roles; however, staff roles were determined primarily by local needs and physician expectations rather than by education, training, or licensure. Staffing patterns varied greatly; the majority of practices employed at least one registered nurse (10 of 18), one licensed practical nurse (5), or both (4). Still, the overall majority of practices used non-nursing personnel as the predominate patient care staff. Patient care staff-to-clinician ratios ranged from a low of 0.5 to a high of 3.3. CONCLUSIONS: Many recent recommendations about collaborative models of clinical care seem problematic when put into a context of the findings of current staffing patterns and use of personnel in family practices. Staff members often fulfill roles independent of training. Staff leadership is also potentially important for designing effective collaborative care models; however, we found leadership only occurred with the approval of clinic authorities. These practical issues are rarely addressed in normative recommendations about system change and intervention. Our findings indicate that there are considerable opportunities for better use of the nursing and other patient care staff in the delivery of clinical services. Developing a collaborative practice model should include formalizing expectations of staff to reflect training and experience, and explicitly configuring staff to meet the needs, values, and goals of a practice.

Community Health Services↗
PubMed1993

Recruiting and retaining registered nurses in home healthcare.

This study examined a personal and professional profile of registered nurses in home care to determine the most influential factors affecting their recruitment, job satisfaction, and retention. With the cooperation of a national, for-profit home healthcare organization in 1990, the authors randomly surveyed its registered nurses, licensed practical nurses, and home health aides in two Midwestern states. Findings for 107 home care registered nurses are presented and compared with responses of licensed practical nurses and home health aides.

Adult↗
PubMed1978

Veterans Administration hospital staff attitudes toward alcoholism.

Attitudes toward alcoholism among psychiatrists, psychologists, social workers, registered nurses, licensed practical nurses, and nursing assistants (464 subjects) were surveyed. A nine-factor questionnaire was utilized (emotional difficulties, character defect, social status, illness conception, harmless indulgence and addiction liability). All groups were homogeneous in their perceptions about emotional difficulties contributing to alcoholism, alcoholics not coming from the lower socioeconomic strata of society, and the belief that alcoholics did recover and could be helped by treatment. Age, sex, and special training in the treatment of alcoholism did not have any significant influence on attitudes. All groups believed that periodic excessive drinkers could be alcoholics. None of the groups believed that the alcoholic had a character defect. Psychologists disbelieved the concepts of illness and addiction liability. All groups disagreed with harmless indulgence. Nursing assistants tended to see the alcoholic as a harmless heavy drinker. Working on a special alcoholism treatment unit did not alter the perceptions of psychiatrists, psychologists and nursing assistants. Social workers and registered nurses showed only a minor trend toward a positive attitude change, while the trend went in the opposite direction for licensed practical nurses.

Adult↗
PubMed2005

Turnover begets turnover.

PURPOSE: This study examined the association between turnover of caregivers and turnover of nursing home top management. The top managers examined were administrators and directors of nursing, and the caregivers examined were registered nurses, licensed practical nurses, and nurse aides. DESIGN AND METHODS: The data came from a survey of 419 nursing facilities and the Online Survey, Certification, and Reporting system. Multinomial logistic regression analyses were used to examine the association between turnover of nursing home top management and turnover of caregivers. RESULTS: A 10% increase in top management turnover is associated (p <.05) with a 21% increase in the odds that a facility will have a high turnover rate of nurse aides and is associated (p <.05) with an 8% decrease in the odds that a facility will have a low turnover rate of nurse aides. A 10% increase in top management turnover is associated (p <.1) with a 30% increase in the odds that a facility will have a high turnover rate for registered and licensed practical nurses. IMPLICATIONS: This study provides preliminary evidence that the turnover of top managers may have an important influence on caregiver turnover in nursing homes.

Caregivers↗
PubMed1982

Scope of practice.

Physicians, paramedical personnel, registered nurses, licensed practical nurses, aides, technicians, therapists, and many other specialists deliver health care in the current system. The uncertainty is the division of authority and responsibility, the right of dominion and control, and the appropriate legal manner in which quality assurance can be achieved. The public needs to know to whom they may look for the purpose of response to needs, and responsibility for actions outside the scope of licensed and permitted activities. Practitioners also need to know--in order to avoid prosecution, conviction, fine, imprisonment, and loss of livelihood through loss of license.

Civil Rights↗
PubMedDate not supplied

Effect of three teaching methods on a nursing staff's knowledge of medication error risk reduction strategies.

The authors' purpose in this study was to (1) compare the effects of three teaching methods on registered nurses' and licensed practical nurses' knowledge of medication error risk reduction strategies, and (2) to compare registered nurses' and licensed practical nurses' knowledge of medication error risk reduction strategies using a pretest/posttest design. Registered nurses (n = 129) and licensed practical nurses (n = 21) employed by two hospitals constituted the study sample. Subjects were assigned alternately to three intervention groups: videotape (n = 50); instructional booklet (n = 50); and lecture (n = 50). A 38-item test, including true-false, multiple choice, matching items and dosage calculation problems, was administered to subjects in each group before and after the teaching intervention. On the basis of the results, there was no statistically significant difference in total knowledge scores for the three intervention groups (F = 2.07, P = 0.130). Staff development instructors should consider the advantages of a videotape and instructional booklet over the time-intensive lecture strategy.

Adult↗