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A shared governance model was implemented within the nursing service of the Durham Veterans Affairs Medical Center in 1997. In 1999, members of the Nursing Quality/Staff Education/Research Council examined facility nurses' perceptions of governance to determine the degree to which the model had been implemented. Results of the study indicate that although imperatives at the organizational level were incompatible with three aspects of shared governance, there were three shared governance dimensions pertaining to basic nursing practice that reached or surpassed governance thresholds. This study highlights the potential of nursing management innovation within highly bureaucratic organizations.
OBJECTIVE: To delineate the probability of contact between government agencies and youths who complete suicide, to investigate the nature of those contacts, and to identify new risk factors for suicide. METHOD: A descriptive epidemiological analysis of data from multiple Utah government agencies on consecutive youth suicides (n = 151) between August 1, 1996, and June 6, 1999, aged 13-21 years. Data were collected from four government agencies: Office of the Medical Examiner, Juvenile Justice, Department of Human Services, and the Department of Education. RESULTS: Utah descriptive data were similar to national statistics, with the majority of completers being male (89%) and firearms the most common method of suicide (58%). The data demonstrated an association between youth suicide and contact with Juvenile Justice. Sixty-three percent of youths who completed suicide in Utah had contact with Juvenile Justice, and there was a direct correlation between number of referrals and increased suicide risk. Suicide completers had multiple minor offenses over many years. A significant minority of school-age subjects could not be located within the school system. Few suicide completers had evidence of active psychiatric treatment. CONCLUSIONS: Juvenile Justice is identified as a novel site for the screening and identification of youths at risk for suicide.
The risk communication practitioner in a government agency has two essential, interdependent tasks. One is to help develop and monitor effective communication programs with various external public audiences. The other task is to do the same thing for the senior government managers whose support is a prerequisite to addressing the first audience. Hence, the second audience--the manager--is really the first. This paper addresses ways in which communication practitioners can satisfy this crucial audience. A profile of these managers suggests that they would find it highly beneficial to have more control over the public problems they encounter, especially in view of the growing pressures to do more with less and demonstrate "customer satisfaction." They would rather avoid crises than manage them. And they would rather have their bosses praise their successes than challenge their budgets or punish their perceived difficulties or failures. Communication practitioners who can help them attain such benefits will find their efforts in great demand. They would be helpful team members who provide timely insights that can make and show agency success. We offer ten ways for communication practitioners to be more useful which focus their current strengths on satisfying senior managers' needs by becoming more valuable members of the program team. By becoming more useful to the senior manager they serve both the agency and its publics.
UNLABELLED: As part of an effort to promote and protect breastfeeding among working mothers in Puerto Rico, Public Law 427 was passed in December 2000. This law grants a paid breastfeeding daily break for milk extraction in the workplace. In support of this initiative Public Law 155 was passed in 2002 ordering Secretaries, Directors, Presidents and Public Administrators of the government of Puerto Rico to designate breastfeeding spaces in the workplaces. OBJECTIVE: Describe the level of compliance with the dispositions of Law 155 in government agencies. METHODOLOGY: A cross sectional descriptive study was carried out. A sample of 28 government agencies was randomly selected, representing 25% of the total number of agencies, and a structured telephone interview was administered using an instrument made up of 6 premises. RSEULTS: All (100%) of the agencies had knowledge about the existence of this law, but only 50% had set up and equipped the spaces. Of these, all had a table, a chair, and an electric outlet, 43% had available running water, and 71% provided a refrigerator for milk storage. Fifty three percent of the agencies reported having received followup communications to verify whether they were complying with the law, and 61% reported having a written public policy in support of breastfeeding for working mothers. Only 54% of the agencies stated they had offered some type of orientation to their women employees regarding their breastfeeding rights. CONCLUSIONS: In spite of over two years since the passing of Law 155, the majority of government agencies in Puerto Rico have not complied with its legal dispositions. It is necessary that the responsible entities watch for the satisfactory compliance with this law since working mothers need a secure and accesible place for milk extraction during the working day.
OBJECTIVES: To provide a review of federal government agencies that most directly affect cancer care and research and how cancer policy can be indirectly shaped or affected by federal and state programs. DATA SOURCES: Government reports and internet sources. CONCLUSIONS: The US government's role in cancer policy has grown substantially and involves ongoing dialogue among Congress, government agencies, and stakeholders in the cancer community. The government can be a powerful catalyst for progress or a seeming insurmountable barrier to high-quality cancer care and research. Working together can make a significant difference in the outcome of cancer policy. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are an important voice in the development of legislation, regulation, and other national policies for cancer care. It is important for cancer care professionals to be aware of these federal programs and participate in deliberations.
In 1993, I served as consultant to a Canadian government agency with responsibility for the characterization of chemical hazards. The work was divided into three tasks: (1) an extensive review of present priorities within the agency, (2) a survey of recognized experts to determine perceived "gaps" in the coverage of research on chemical hazards, and (3) preparation of a set of recommendations. The 23 perceived gaps identified by the expert panel cluster into three general groups: existing projects designed to protect the health of Canadians, practical solutions to concrete problems, and robust methods for dealing with chemical mixtures and generalizable research methodology. A specific set of priorities was recommended to the agency and several procedural changes were proposed: encouragement of working partnerships, a mechanism for ongoing review of priorities, and consideration of alternatives to dedicated research projects, such as emphasizing behavioral rather than toxicological studies on tobacco smoke. A research management system was also proposed based on a matrix organization in which accountability is not divided but which features research-driven cross-program interdisciplinary colloquia within the agency. The general approach and specific findings in this study may be useful in clarifying issues in the management of other, similar agencies.
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP),administered by the Centers for Disease Control and Prevention through grants to states, tribes, and territories, has successfully provided breast and cervical cancer screening and diagnostic services to low-income women since 1990. On October 24, 2000, Congress passed the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) authorizing states, if they chose, to provide Medicaid coverage for treatment services for women screened under theNBCCEDP. Under BCCPTA, uninsured women younger than age 65 who are screened through the NBCCEDP and found to have breast or cervical cancer (or precancerous conditions) may gain access to Medicaid services for and during their cancer treatment. Implementation of the BCCPTA requires collaboration and coordination among many government agencies, including the Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, state Medicaid directors, and directors of state and tribal grant programs. This article describes the implementation of the program and demonstrates to policy makers that coordinating resources among government agencies can facilitate the rapid adoption of public health programs as pathways for specific populations to gain access to publicly funded health insurance coverage.
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Tobacco settlement money can be allocated to nonprofit organizations or government agencies. Both have advantages and disadvantages. Nonprofit organizations may have relatively (a) more efficiency/flexibility, but less accountability; (b) narrower focus, but less experience; (c) more ability to advocate, but more obligations; (d) more independence from tobacco industry influence, but less funding; and, (e) more public trust, but less visibility. The present case study of the Partnership for a Healthy Mississippi focuses on six interconnected areas: education (school and community), raising awareness, advocacy, service, enforcement, and research. In 1999 and 2000, tobacco use declined in Mississippi, even compared to neighboring states. This unique partnership's multifaceted approach to social change probably facilitated this decline.
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Research in the burgeoning field of threat assessment has illuminated the importance of mental illness factors when considering risk of targeted violence-particularly related to government agencies and officials. The authors analyzed 127 cases investigated by a state law enforcement agency regarding threatening or other contacts toward public officials or state agency employees prompting security intervention. Univariate and discriminant analysis indicated that mentally ill subjects were significantly more likely to engage in more contacts as well as to make specific demands during such contacts. Mentally ill subjects were also more likely to articulate help-seeking concerns and employ religious themes, as opposed to using insulting, degrading, or ominous language toward the target or issuing complaints regarding policy issues. Contrary to other research, the mentally ill subjects within this sample were not significantly more likely to engage in approach behavior, a threshold for higher risk of violence. Implications for threat assessment activity are discussed.
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