Nursing

The supply, distribution, certifications, and scope of practice of the 2.8 million RNs (including advanced practice RNs) and 690,000 licensed practical nurses currently in practice.

The Quality of Hospital Work Environments and Missed Nursing Care is Linked to Heart Failure Readmissions: a Cross-Sectional Study of U.S. Hospitals

Feb. 11, 2015

J. Margo Brooks Carthon, Karen B. Lasater, Douglas M. Sloane, Ann Kutney-Lee

In BMJ Quality & Safety, J. Margo Brooks Carthon and colleagues from Penn Nursing’s Center for Health Outcomes and Policy Research (CHOPR) look at the effect of missed nursing care on 30-day readmissions for heart failure patients. Missed care are those services that nurses regard as necessary but were left undone on their last shift due to a lack of time. The authors linked nurse survey data, hospital administrative data, and patient discharge data from three states to evaluate hospital-level nursing work environments, missed care, and readmissions. They found that missed care was an...

The Use of Health Information Technology to Improve Care and Outcomes for Older Adults

Jan. 18, 2015

Kathryn H. Bowles, Patricia Dykes, George Demiris

In a commentary in Research in Gerontological Nursing, Kathryn Bowles and colleagues look at how nurse scientists are using health information technology, such as electronic health records (EHR) and decision support, to improve care. They highlight positive research findings, including that integrated EHR systems reduced hospital-acquired pressure ulcers by 13 percent. Or how the use of a discharge decision support system helped to identify whether older adults were likely to need post-acute services, such as skilled home care or skilled nursing facility care. Use of the system,...

The Affordable Care Act and Minority Health: Part IV (Workforce Diversity)

Jan. 15, 2015

As the Affordable Care Act’s health insurance marketplaces begin their second year of open enrollment, LDI examines the current and potential impact of the ACA on the health of minority populations. This fourth post of a five-part series describes the current initiatives to diversify the health care workforce with greater minority participation.

Primary Care Shortages: More Than Just a Head Count

Nov. 21, 2014

A new LDI/INQRI Research Brief, written by Mark Pauly, PhD, Mary Naylor, RN, PhD, and me, reviews the evidence of an existing or looming primary care shortage in the wake of the ACA. Will the combined effects of an aging population, an increase in coverage and demand for care, and a decrease in the number of physicians going into primary care create widespread gaps in access? Who will treat the newly insured, and will this exacerbate existing workforce shortages?

Primary Care Shortages: More Than a Head Count

Issue Brief
Nov. 21, 2014

The existence of a primary care physician shortage, even prior to the ACA, is not universally accepted. A new report by the Institute on Medicine found “no credible evidence” that the nation faces a looming physician shortage in primary care specialties. There is greater consensus about a maldistribution of physicians, in terms of specialty, geography, and practice settings. 

Carrots and Sticks to Reduce Readmissions and Improve Home Health Care

Oct. 1, 2014

The Affordable Care Act has generated carrots and sticks for hospitals to reduce readmissions. With the goal of achieving the Triple Aim (improving quality of patient care, improving population health, and reducing overall cost of care), innovative care delivery models are being tested locally and nationally, including the roll-out of Accountable Care Organizations and bundled payment programs. These programs create incentives in terms of shared savings for health care systems that provide high quality, coordinated care.

Wage, Work Environment, and Staffing: Effects on Nurse Outcomes

Aug. 1, 2014

Matthew McHugh, Chenjuan Ma

In Policy, Politics, and Nursing Practice, Matthew McHugh and Penn Nursing colleague Chenjuan Ma look at the effects of wages on better nursing outcomes - less burnout, job dissatisfaction, and intention to leave the job. While prior studies have found links between work environment and staffing levels on nurse outcomes, they did not investigate the effects of wages. McHugh and Ma cross-analyze administrative data with a four-state survey. Logistic regression models, both with and without wage included, show that wage is associated with reported job dissatisfaction and intent to leave, but...

A ‘Quality Storm’ Brewing around NHS Nurses

May. 5, 2014

It seems that nurses are getting a lot of bad press in England lately, coming under fire recently for being “uncaring.” In an article published in Nursing Standard, Linda Aiken of Penn’s School of Nursing contends that this erosion of public trust is the result of high workloads and low investment in nursing education, rather than any attitudes held by English nurses.

Staffing Up To Avoid Hospital Readmissions Penalties?

Oct. 11, 2013

The Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries with acute myocardial infarction, heart failure, or pneumonia. In FY2013, the penalties reduced payments to hospitals by an estimated $280 million. The goal is to give hospitals a financial incentive to improve care and to curb the estimated $15 billion Medicare spends annually on these readmissions.

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