Christine T Kovner

Abstract

OBJECTIVES: To describe sleep duration and work characteristics among registered nurses ("nurses") across health care settings and unit types and determine the association between sleep duration and quality of care and patient safety.DESIGN: We used an observational, retrospective design. Survey data were collected from two cohorts of nurses in 2015 and 2016.SETTING: Health care and community settings across the United States, primarily acute care hospitals.PARTICIPANTS: Nurses working in a staff or general duty position (N=1,568).MEASUREMENTS: The independent variable was nurses' sleep duration before work and nonwork days. The two dependent variables were nurse reported quality of care (single item rating) and overall patient safety, measured by the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture.RESULTS: Nurses reported an average of 414 minutes, or just less than 7 hours, of sleep before a work day and 497 minutes, or just over 8 hours, before a nonwork day. Short sleep duration was statistically significantly associated with lower ratings of quality of care (p=.002) and patient safety (p=.000).CONCLUSIONS: Nurses are sleeping, on average, less than recommended amounts before work, which may be impacting their health and performance on the job. Health care managers may consider interventions to support nurses' sleep to improve patient care. Further research is warranted.

Abstract

Background: Readiness of the nursing workforce in quality and safety competencies is an essential indicator of a health system's ability to deliver high-quality and safe health care. A previous study identified important quality and safety education gaps between associate- and baccalaureate-prepared new nurses who graduated between 2004 and 2005. The purpose of this study was to assess changes in nursing workforce quality and safety education preparedness by examining educational gaps between associate and bachelor's degree graduates in two additional cohorts of new nurses who graduated between 2007–2008 and 2014–2015. Methods: A cross-sectional, comparative design and chi-square tests were used to trend the quality and safety educational preparedness differences between associate and bachelor's degree nurse graduates from 13 states and the District of Columbia licensed in 2007–2008 (N = 324) and 2014–2015 (N = 803). Results: The number of quality and safety educational gaps between bachelor's and associate degree nurse graduates more than doubled over eight years. In the 2007–2008 cohort, RNs with a bachelor's degree reported being significantly better prepared than RNs with an associate degree in 5 of 16 topics. In the 2014–2015 cohort, bachelor's degree RNs reported being significantly better prepared than associate degree RNs in 12 of 16 topics. Conclusion: Improving accreditation and organizational policies requiring baccalaureate education for all nurses could close quality and safety education gaps to safeguard the quality of patient care.

Abstract

Purpose: It is reported that while immigrants are, initially, healthier than the native-born upon resettlement, this advantage erodes over time. In the United States, uninsured aging immigrants are increasingly experiencing severe complications of cardiovascular disease (CVD). The purpose of this study was to compare overall CVD risk and explore the importance of health insurance coverage on CVD risk relative to other health access barriers, from 2007 to 2012, in recent and long-term immigrants >50 years of age. Methods: This study was based on secondary cross-sectional analysis of the National Health and Nutrition Examination Survey (N = 1,920). The primary outcome, CVD risk category (high or low), was determined using the American College of Cardiology and American Heart Association Pooled Cohort equation. Differences between immigrant groups were examined using independent-samples t tests and chi-square analysis. The association between insurance and CVD risk was explored using a hierarchical block logistic regression model, in which variables were entered in a predetermined order. Changes in pseudo R 2 measured whether health insurance explained variance in cardiac risk beyond other variables. Results: Recent immigrants had lower overall CVD risk than long-term immigrants but were twice as likely to be uninsured and had higher serum glucose and lipid levels. Based on regression models, being uninsured contributed to CVD risk beyond other health access determinants, and CVD risk was pronounced among recent immigrants who were uninsured. Conclusions: Health insurance coverage plays an essential part in a comprehensive approach to mitigating CVD risk for aging immigrants, particularly recent immigrants whose cardiovascular health is susceptible to deterioration. Clinical Relevance: Nurses are tasked with recognizing the unique social and physical vulnerabilities of aging immigrants and accounting for these in care plans. In addition to helping them access healthcare coverage and affordable medication, nurses and clinicians should prioritize low-cost lifestyle interventions that reduce CVD risk, especially diet and exercise programs.