Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Men and Women of the Corporation

Committee for assessing progress on implementing the recommendations of the institute of medicine report the future of nursing: leading change, advancing health

In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. However, more than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Care often is not patient-centered, many patients do not receive palliative care to manage their symptoms and side effects from treatment, and decisions about care often are not based on the latest scientific evidence. The cost of cancer care also is rising faster than many sectors of medicine--having increased to $125 billion in 2010 from $72 billion in 2004--and is projected to reach $173 billion by 2020. Rising costs are making cancer care less affordable for patients and their families and are creating disparities in patients' access to high-quality cancer care. There also are growing shortages of health professionals skilled in providing cancer care, and the number of adults age 65 and older--the group most susceptible to cancer--is expected to double by 2030, contributing to a 45 percent increase in the number of people developing cancer. The current care delivery system is poorly prepared to address the care needs of this population, which are complex due to altered physiology, functional and cognitive impairment, multiple coexisting diseases, increased side effects from treatment, and greater need for social support. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents a conceptual framework for improving the quality of cancer care. This study proposes improvements to six interconnected components of care: (1) engaged patients; (2) an adequately staffed, trained, and coordinated workforce; (3) evidence-based care; (4) learning health care information technology (IT); (5) translation of evidence into clinical practice, quality measurement and performance improvement; and (6) accessible and affordable care. This report recommends changes across the board in these areas to improve the quality of care. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis provides information for cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industry to reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality care delivery system. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.

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Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

A recent systematic review of research on the link between nurse staffing and patient outcomes in hospitals commissioned by the Agency of Healthcare Quality and Research concluded that a strong evidence base connects better nurse staffing to better outcomes.1 Three large recent studies show that better-educated hospital nurse workforces are associated with lower patient mortality.2-4 Research on magnet hospitals consistently demonstrates links between better care environments and superior nurse and patient outcomes.5-7 General reviews of the literature support the case that better nurse care environments are associated with better patient outcomes,8 but definitive evidence has been lacking.9 Skepticism remains among some stakeholders about whether nurse practice environments actually have a significant net impact on patient outcomes after patient-to-nurse staffing ratios are taken into account. This debate is practical as well as academic because it concerns the options available to nurse leaders for improving nurse retention and patient outcomes.

The purpose of this article was to empirically examine whether better hospital nurse care environments are associated with lower patient mortality and better nurse outcomes independently of nurse staffing and the education of the registered nurse (RN) workforce in hospitals. We also provide the first empirical evidence that the practice environment scale of the Nursing Work Index (PES-NWI),10,11 the measure selected as the National Quality Forum's standard for measuring hospital care environments, is associated with patient outcomes.

Effects of hospital care environment on patient mortality and nurse outcomes.

Developing competent and confident new graduate nurses who remain with their hospitals is a major challenge. A structured evidence-based RN residency was developed and implemented in hospitals across the United States. Outcomes data were collected from over 6000 new graduate nurses who completed the RN residency over a 10-year period. The results indicate an accelerated increase in competence and self-confidence and a significant decrease in turnover intent and actual turnover. This study provides persuasive evidence that both new graduate nurses and their organizations benefit from the implementation of a structured, clinical immersion RN residency.

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Improving Retention, Confidence, And Competence of New Graduate Nurses: Results from a 10-Year Longitudinal Database

Transition to Practice Study in Hospital Settings

A cost-benefit analysis was conducted to assess the economic outcomes of a new graduate registered nurse (NGRN) residency program utilizing turnover rate and contract labor usage data from a multi-site health care corporation. Secondary data analysis of NGRNs (n=524) was conducted including descriptive and step-wise regression analyses. Findings indicated a new graduate residency program was associated with a decrease in the 12-month turnover rate from 36.08% to 6.41% (p<0.05) and reduction in contract labor usage from $19,099 to $5,490 per average daily census (p<0.05). These cost-benefit analyses suggest net savings between $10 and $50 per patient day when compared to traditional methods of orientation. A NGRN residency program offers a cost-effective innovative approach and should be valued as an investment as opposed to an expense.

New graduate nurse residency program: a cost-benefit analysis based on turnover and contract labor usage

Objective To determine registered nurses' (RNs') views of the workplace environment. Background Numerous studies have shown relationships between work environment, RN satisfaction and retention, and patient safety and outcomes. In 2002, NurseWeek Publishing and the American Organization of Nurse Executives completed a national survey on the views of RNs on the nursing shortage, workplace environments, and their future career intentions, which revealed areas needing improvement. Results from the follow-up survey conducted in 2004 provide new information on RNs' views of the work environment and a comparison of results to the previous survey. Methods A nationally representative random sample of 3500 RNs licensed to practice in the United States was surveyed. Results In the views of RNs, there have been improvements in a number of aspects of the work environment of nurses. While there are no areas of decline, there are areas in which little or no progress is apparent. Conclusions/implications Some strategies designed to improve the work environment have resulted in positive outcomes, but creative solutions must be continuously developed and implemented to build on recent successes. Results of this survey help identify areas for continued improvement efforts.

How RNs view the work environment: results of a national survey of registered nurses.

National surveys of registered nurses, physicians, and hospital executives document considerable concern about the U.S. nurse shortage. Substantial proportions of respondents perceived negative imp...

Beth Ulrich

Papers

Improving Retention, Confidence, And Competence of New Graduate Nurses: Results from a 10-Year Longitudinal Database

Transition to Practice Study in Hospital Settings

New graduate nurse residency program: a cost-benefit analysis based on turnover and contract labor usage

How RNs view the work environment: results of a national survey of registered nurses.

Impact Of The Nurse Shortage On Hospital Patient Care: Comparative Perspectives