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To explore the relationship between ethical climate (EC) and nurses' service behaviours (SB) and examine the moderating effect of nurses' employment type.As most public hospitals in China implement the "dual-track system" of nurses' employment, the two different types of nurses, contract-employed nurses and state-employed nurses, receive the different pay for the same work, which results in they providing different SB. It has become critical for hospital administrators and nursing managers to understand better the state of two groups of nurses and to find an effective method to improve the service level of the nursing workforce.Stepwise multiple regression analyses of survey data collected in June and July 2017 from Chinese nurses employed in three tertiary hospitals.Chinese nurses (298 of 350 [85.1%]) were interviewed using the Ethical Climate Scale and Nurses' Service Behaviour Scale. Data were analysed statistically using descriptive statistics, confirmatory factor analysis, correlation coefficients (Pearson), two-tailed t-test and stepwise multiple regression analyses were conducted to test the proposed hypotheses. Data were analysed using SPSS and AMOS.There were statistically significant correlations between EC and nurses' extra-role service behaviour (ERSB) and overall service behaviour and nurses' employment type moderated the proposed relationships.Healthcare institutions should pay more attention to cultivate EC and implement new incentive mechanism to better stimulate nurses to provide ERSB.目的: 探讨组织伦理氛围(EC)与护士服务行为(SB)之间的关系,评估护士雇佣类型的调节作用。 背景: 随着我国大多数公立医院实行护士雇佣“双轨制”,因此两种不同类型的护士,即合同聘用护士和国家雇佣护士,在同一项工作中所获得的报酬却不同,这导致他们提供不同种类的服务行为。如何更好地了解两种雇佣类型护士的状况,找到提高护理队伍服务水平的有效方法,已成为医院管理人员和护理管理人员需考虑的重要问题。 设计: 对2017年6月和7月三级医院聘用的中国护士的调查数据进行逐步多元回归分析。 方法: 采用组织伦理氛围量表和护士服务行为量表对350名中国护士中的298名(85.1%)进行调查。采用描述性统计、验证性因素分析、相关系数(Pearson)、双尾t检验对数据进行统计分析,并通过逐步多元回归分析检验所提出的假设。使用SPSS和AMOS来分析数据。 结果: EC与护士的角色外服务行为(ERSB)与整体服务行为之间存在显著的统计学关联,而护士的雇佣类型可缓和以上关系。 结论: 医疗机构应重视培养组织伦理氛围,实施新型激励机制,从而更好地鼓励护士提供角色外服务行为。.

The worldwide expansion in the use of private firms to deliver public services and infrastructure has promoted a substantial literature on public sector contract and relationship management. This literature is currently dominated by the notion that supplier relationships should be based upon trust. Less prominent are more sceptical approaches that emphasize the need to assiduously manage potential supplier exploitation and opportunism. This article addresses this imbalance by focusing upon the recent experience of the English National Health Service (NHS) in its dealings with its nursing agencies. Between 1997 and 2001, the NHS was subjected to considerable exploitation and opportunism. This forced managers to adopt a supply strategy based upon an assiduous use of e-auctions, framework agreements and quality audits. The article assesses the effectiveness of this strategy and reflects upon whether a more defensive approach to contract and relationship management offers a viable alternative to one based upon trust.

Aims and objectives. To investigate the impact of past government policy and legislation on the practice of district nursing in Australia. Background. Nurses have historically been politically passive and have not engaged in the political processes of policy development. However, legislation can have profound impacts on the daily work of nurses as demonstrated in this paper. Design. Historical analysis. Methods. The archival records of six district nursing services in Australia were analysed within the political, social and economic context of the 20th century, with particular focus on the 1950s and 1970s. Results. Two pieces of Federal legislation passed in 1956 and 1973, respectively, had critical effects on the work of district nurses. Both resulted in significant expansion of district nursing in Australia; neither was formulated with input from district nursing services. However, together these acts shifted district nursing from being a voluntary, charity based activity to one that was greatly controlled by government. Conclusions. Greater government funding allowed district nursing to expand beyond the capacity possible when funding was locally based, but with government funding came other restrictions related to accountability processes and expectations regarding services provided, and these had profound effects on nursing practice, including excess workloads to the point of unsafe practice. Relevance to clinical practice. Nurses need to engage with the political processes associated with government policy formulation and implementation if they are to avoid placing themselves and their clients in vulnerable situations as a result of government decisions.

Context Patients with heart conditions in rural areas may have different responses to health promotion-disease Self-management interventions compared to their urban counterparts. Purpose To estimate the impact of a multi-component health promotion nurse intervention on physical function and total health care expenditures among elderly adults with heart conditions and to examine the impact of rural residence on the intervention effect. Methods We analyzed data on 281 community-living Medicare beneficiaries with heart conditions from the Medicare Primary and Consumer-Directed Care Demonstration (a randomized controlled trial). We estimated ordinary least squares (OLS) models to determine the effect of the intervention on the change in functional status and log-linear models to determine the impact of the intervention on total health care expenditures over a 2-year period. Results The OLS models showed that the nurse intervention resulted in fewer impairments in Activities of Daily Living (ADL) (-0.307 on 0-6 scale, P = .055) at the end of 2 years. The effect of the intervention on ADL appeared to be stronger for rural than for urban participants (-0.490 vs -0.162, respectively). However, the difference was not statistically significant (P = .150). The effect of the intervention on Instrumental Activities of Daily Living (IADL) was not significant (P = .321). Average total health care expenditures were 6.5% ($1,981, 95% CI: -$8,048, $4,087) lower in the nurse group. Conclusions The nurse intervention led to better physical functioning and has potential to reduce total health care expenditures among high-risk Medicare beneficiaries with heart conditions.

Summary Objectives To present first findings of a cost-of-illness (COI) information system implemented in Nouna health district, Burkina Faso. The entire project will include household and provider tangible COI, whereas this article concentrates on the development of a provider cost information system in rural first-line health facilities. Method Special forms and reports are prepared to routinely collect capital and recurrent costs of first-line facilities. Inventory lists are designed, and buildings and equipment are assessed by engineers. Total, fixed, variable and average costs are calculated for 15 rural health centres with five cost centres: general outpatient consultation, ambulatory nursing care, deliveries, immunization and other services (neonatal consultation, child care and family planning). Results In 2003, the average costs per service unit were 1.34 US$ for a general consultation, 0.51 US$ for ambulatory nursing care, 6.73 US$ per delivery, 3.64 US$ per vaccination and 1.11 US$ per service unit of other care. On average, a health centre consumes 29 900 US$ per year for a catchment population of 10 000 inhabitants. Conclusions The major share of costs is fixed and does not depend on the workload of the health centre. Consequently, the costs of first-line facilities will hardly increase if the demand for health services rises. These findings can be used to improve the health financing in Nouna health district, Burkina Faso. Objectifs Presenter les 1ers resultats du systeme d'information des couts de sante mis en place dans le district de Nouma au Burkina Faso. Le projet en sa globalite inclura les couts de sante des menages et des fournisseurs de soin. Cet article se concentre sur le developpement d'un systeme d'information des couts des fournisseurs de soins dans des centres ruraux de sante de 1 ere ligne. Methode Des formulaires speciaux et des rapports ont ete prepares pour collecter en routine les couts capitaux et recurrents des centres de 1ere ligne. Des listes d'inventaire ont ete concues; les bâtiments et l’equipement ont eteevalues par des ingenieurs. Au total, les couts fixes, variables et moyens ont ete calcules pour 15 centres de sante ruraux en tenant compte de 5 types de prestations: consultation generale, soins infirmiers ambulatoires, accouchements, vaccination et autres services (consultation neonatale, assistance a l'enfance et planning familial). Resultats En 2003, les couts moyens par unite de service etaient 1,34 $ pour une consultation generale, 0,51 $ pour des soins infirmiers ambulatoires, 6,73 $ par accouchement, 3.64 $ par vaccination et 1.11 $ par unite de service autre. En moyenne, un centre de sante couvrant une population de 10 000 habitants depense, par an, 29 000 $. Conclusions La part principale des couts est fixe et ne depend pas du volume de travail du centre de sante. Par consequent, les couts d’equipements des centres de 1ere ligne augmenteront peu si la demande de soin augmente. Ces resultats peuvent etre employes pour ameliorer le financement des structures de sante dans la zone sanitaire de Nouna, Burkina Faso. Objetivos Presentar las primeras conclusiones de un sistema de informacion de costos de enfermedades, implementado en el distrito de salud de Nouna, en Burkina Faso. El proyecto completo incluira sustanciales costos de enfermedades del grupo familiar y del proveedor, mientras que el trabajo se concentra en el desarrollo de un sistema de informacion de costos del proveedor en locales sanitarios de primera linea en areas rurales. Metodo Formularios y reportes especiales estan preparados para recoger rutinariamente costos recurrentes y de capital en locales de primera linea de atencion. Estan disenadas listas de inventarios, y los edificios y equipos son evaluados por ingenieros. Son calculados los costos fijos, los costos variables y los costos promedio en 15 centros de salud rurales, centrado en 5 costos: consultas externas generales, atencion en ambulatorios, alumbramientos, inmunizacion y otros servicios (consulta neonatal, atencion infantil y planificacion familiar). Resultados En 2003, los costos promedios por unidad de servicio fueron de 1.34 dolares por una consulta general, 0.51 dolares por atencion medica en ambulatorio, 6.73 dolares por parto, 3.64 dolares por vacunacion y 1.11 dolares por atencion de otro tipo de servicio. Promedialmente, un centro de salud consume 29.900 dolares por ano en una poblacion captada de 10.000 habitantes. Conclusiones La mayor parte de los costos es fija, y no depende en la carga de trabajo del centro de salud. En consecuencia, los costos de los centros de primera linea dificilmente aumentaran si la demanda de servicios medicos aumenta. Estas conclusiones pueden ser utilizadas para mejorar la financiacion sanitaria en el distrito sanitario de Nouna, en Burkina Faso.

Background: The International Council of Nurses (ICN) has elaborated an international terminology for nursing practice [International Classification of Nursing Practice (ICNP)] that can be useful to catalogue the problems of a nursing nature in diagnosis and also find a system for the classification of nursing activities. ICNP is also the reason why the Italian association Consociazione, representing Italian Nurses at ICN, through the School of Advanced Nursing of the University ‘La Sapienza’ of Rome, has set up a working group for the translation and experimentation of the ICNP version Beta 2. Content: In this article the ICNP beta translation and validation into Italian is considered with some scenarios of how benefit could be derived by its utilization for nursing's visibility. The visibility of nursing care can be measured not only through patient outcomes but also by studying the existing data of patient care documentation. To have a common language and terminology in nursing is important for a universal understanding. Results: Some philosophical reasoning on the genesis and development of ICNP is discussed along with arguments for and against nursing classification systems. Some findings on Italian experimentation for nursing documentation as well as economical analysis are reported along with a vision for future development and utilization.

Aim. This paper reports a study examining the outcome of personnel costs and quality of care after implementing the skill mix practice model for nursing. Background. In response to ever-tightening government budgets and changes in health insurance reimbursement, it may be necessary for hospitals to reassess their practice models to remain competitive and maintain quality of care. Method. Using a pre- and post-test quasi-experimental design with questionnaires, participants were recruited at a teaching hospital in Taiwan. Questions were included on both patient satisfaction with nursing care and nurse satisfaction with nursing aides. The data were collected in 2003. Results. The cost of implementing the skill mix practice model with 22 nurses and seven nursing aides was 2·7% lower than when only using 25 nurses. In addition, there was a statistically significant difference in patient satisfaction and in nurse satisfaction with the performance of the aides. There was no statistically significant difference in the pre- and post-test outcome measures of both the incidence of falls and the medication error rate. Conclusion. To decrease costs and increase quality of care, the skill mix practice model is worthy of consideration for clinical nursing care. This study presents an investigation of the first hospital implementation of the skill mix practice model for nursing in Taiwan, and the results of which can serve as a reference model for hospital nursing practice reform.

PURPOSE. To provide a means for calculating the cost of nursing care using the Clinical Care Classification System™ (CCCS). DATA SOURCES. Three CCCS indicators of care components, actions, and outcomes in conjunction with Clinical Care Pathways (CCPs). DATA SYNTHESIS. The cost of patient care is based on the type of action time multiplied by care components and nursing costs. CONCLUSIONS. The CCCM for the CCCS makes it possible to measure and cost out clinical practice. IMPLICATIONS FOR PRACTICE. The CCCM may be used with CCPs in the electronic patient medical record. The CCPs make it easy to track the clinical nursing care across time, settings, population groups, and geographical locations. Collected data may be used many times, allowing for improved documentation, analysis, and costing out of care. BUT. Fournir des moyens de calculer le cout des soins infirmiers a l'aide du systeme de Classification des soins cliniques (SCSC). SOURCES. Les indicateurs inclus dans le dossier de soin ainsi que les Chemins cliniques (CC). SYNTHESE DES DONNEES. Le cout des soins dispenses au patient est base sur le type d'action, multiplie par les composants du soin et par le cout des soins infirmiers. CONCLUSIONS. La methode d'evaluation des couts des soins pour le SCSC permet de mesurer les couts de la pratique clinique. IMPLICATIONS POUR LA PRATIQUE. La methode d'evaluation des couts des soins peut etre utilisee conjointement au CC dans le dossier patient electronique. Les CC permettent de reperer les soins infirmiers en fonction du temps, des milieux cliniques, des groupes de population et des lieux geographiques. Les donnees collectees peuvent etre utilisees plusieurs fois, permettant une amelioration de la documentation, de l'analyse et du cout des soins. OBJETIVO. Oferecer um meio de calcular o custo da assistencia de enfermagem utilizando o Sistema de Classificacao do Cuidado Clinico (CCCS™). FONTES DE DADOS. Tres componentes, acoes e resultados de indicadores de cuidado do CCCS™ em conjunto com protocolos de cuidados clinicos (CCPs). SINTESE DOS DADOS. O custo do cuidado do paciente e baseado no tempo de realizacao de cada tipo de acao, multiplicado pelos componentes do cuidado e custos de enfermagem. CONCLUSAO. O Metodo de Avaliacao de Custos do Cuidado Clinico (CCCM) para o CCCS™ torna possivel mensurar e estabelecer o custo da pratica clinica. IMPLICACOES PARA A PRATICA. O CCCM pode ser utilizado com CCPs no prontuario eletronico do paciente. Os CCPs facilitam o acompanhamento do cuidado clinico de enfermagem ao longo do tempo e em diferentes ambientes de cuidado, grupos da populacao e localizacoes geograficas. Os dados coletados podem ser utilizados varias vezes, possibilitando a melhor documentacao, analise e avaliacao do custo da assistencia.

'Nurses have never been compensated in accordance with their central role in health care' (Schreiber 1994), reflecting the generalized and well-documented under-valuing of the work of women (Schreiber 1993). Pay equity legislation, passed in Ontario, Canada in 1987, designed to correct gender wage discrimination, created great optimism that the under-valuing of nurses' work might be ending. Nonetheless, this has not been the case, as the social, political, and economic climate has not kept pace with the speed and enormity of social change necessary to enact the intent of the legislation. Indeed, gains in nurses' wages have been directly offset by significant lay-offs. In this paper, we examine the issues surrounding the implementation of pay equity legislation in Ontario, Canada, along with analysis and implications of these issues, drawn from 10 years of experience. In addition, we highlight lessons that can be learned from the Ontario experience.

Marketing can no longer be considered vulgar commercialism. Ethically applied, marketing is in fact one of the necessary building stones and development tools for the future development of nursing. In the new competitive environment being created in health sectors to improve efficiency and cost-effectiveness, the nursing profession must learn to use marketing techniques to survey the needs, identify gaps in services and develop products and services that will be relevant for today's empowered consumer.

This paper is a study of the clinical grading policy for nurses in the United Kingdom and the extent to which the participating groups in the policy development process realized their objectives. The study is based on the literature available at the time of the research and the results of structured interviews with a range of individuals involved in the policy process. The results expose the cleavages between the different representative groups on the staff side. They also shed light on the differing power bases of the groups involved. In particular, they expose the weakness of nursing as a professional pressure group and the strength of the state and its agents in determining the outcomes of policy in the public arena. It is suggested that this weakness vis-à-vis the state is responsible for the failure of nurses to achieve a reward system which recognizes the value of clinical nursing expertise, and that the 'clinical grading' system, in practice, is having the opposite effect. The policy is explored from its origins, its acceptance on to the political agenda, its negotiation and agreement, its contentious implementation, the final outcomes, and its failure to establish a valid 'clinical' pay structure.

Nursing roles are expanding in all health care settings; however, the majority of nurses will continue to practice in hospitals for the foreseeable future. Yet hospital nursing is experiencing great ferment and turmoil. Nurses are dissatisfied increasingly with hospital practice, and vacancy and turnover rates are high enough to raise major concerns about adverse consequences for patients. This paper focuses on the nature and causes of the current problems in hospital nursing and advances recommendations for charting a new course for hospital nursing.

Nursing turnover is of great concern to patients, management and the profession, and numerous studies have been conducted to increase understanding about this phenomenon. Most of these, however, have focused on staff nurses in the public sector; little is known about nurse manager turnover or the characteristics of nurses leaving the private hospital sector. The purpose of this study was to examine turnover of staff nurses and nurse managers in both the public and private hospital sectors. Variables which appeared to have a consistent relationship with nurse turnover were identified from the literature, and multiple regression methods were used to attempt to identify variables which could be used to predict turnover behaviour of staff nurses and nurse managers. This study encountered methodological difficulties similar to those which have plagued previous studies; nevertheless, a clearer picture of nursing turnover is emerging.

Nurses' professional obligations to their patients include financial accountability. Whether nurses best provide this through self-insurance, coverage by an employer's insurance policy, or by purchase of an individual policy remains a personal decision. Changes in law and the health care market, however, should prompt a revisiting of this decision because the relative costs and benefits of each option may have changed. The pace of these changes, the unexpected consequences of some of the legal changes, and the individual differences in each nurse's situation may require seeking legal counsel to identify and evaluate the risk/benefits in that situation. The cost of that counsel may well exceed the cost of the policy premium.

WHAT IS JOB EVALUATION? Job evaluation is not a scientific tool, rather it is a systematic and orderly way of gathering factual information about jobs and classifying these jobs to determine equitable salaries. Actually, we classify many things to simplify everyday activities. Consider what a chore it would be to buy a pound of potatoes if you had to pick them from a bin containing a mixture of potatoes, onions, apples and oranges. On the other hand, consider how simple it is to locate a store which sells uniforms by using the “yellow pages.” In the same way, job evaluation in its simplest form is the classification of like jobs into categories called classes or grades. The main force which led to the development of job evaluation systems was the desire and the demand of employees to receive salaries which were fair and equitable. Job evaluation makes it possible for management to divide the money available for salaries so that each individual employee receives his share, based on his ability to contribute. In this way the