The Journal of nursing administration
-
Hospitals have joined other industries in the quest for quality improvement. Most healthcare organizations have processes in place to meet the quality assurance standards of the Joint Commission on Accreditation of Healthcare Organizations. The challenge is to integrate these two similar, but different, structures into one efficient and effective mechanism for quality. One hospital's effort to develop a pilot program to combine total quality management/quality improvement and quality assurance in a cost-effective and efficient manner is described.
-
Patients who require prolonged mechanical ventilation consume a disproportionately large share of healthcare resources and represent a significant financial burden for traditional acute care institutions. When these patients are evaluated as a population, trends that may facilitate medical and financial management emerge. This report examines the demographics, cost/reimbursement, and current management of patients who require prolonged mechanical ventilation. Recommendations for potential reduction of costs, revenue producing alternatives, or both in delivering healthcare to this aggregate are also explored.
-
The early hopes and expectations of organizational culture often fail to materialize because the nature of organizational culture is not understood. This article describes what culture is, explains where culture comes from, and analyzes the variety of subcultures that can exist in healthcare organizations. ⋯ Tools for assessing the work group culture of a nursing unit are presented. Part 2 (May 1993) will describe a five-step process to strengthen the forces that drive cultural change and overcome forces that resist innovation.
-
The development, implementation, and evaluation of a program that incorporates a registered nurse and licensed vocational nurse partnership model into the critical care practice setting is described. This model can be used by nurse executives to alleviate some of the immediate consequences of the nursing shortage and potentially to achieve a longer-range solution by expanding the pool of registered nurses. Evaluation of the program revealed statistically significant increases in nurse job satisfaction; perceptions of reduced workload and stress; a perception by registered nurses and physicians of increased nursing care quality; decreased registered nurse turnover and sick time; and a positive perception of the role of the licensed vocational nurse in the critical care unit.