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A recent verdict of the administrative court of Lazio Region abrogated a Decree that originally stated that nurse managers (and not the head of the medical department) should be responsible for the management of the nursing personnel, and that had set up the premises for the Nursing Departments. The verdict contrasts with a previous pronouncement of the same court (same members, same president) that supported the wards organized by intensity of care and run by nurses. The organization should be flexible and be shaped not by power struggles but by patients needs: while patients in acute care require mostly medical interventions, chronic patients require more educational and nursing interventions. The verdict is the occasion for reflections on the never ending contrasts between doctors and nurse, that often move to the background patients' priorities and care.

Objectives: To examine the degree to which states' work hour regulations for nurses-policies regarding mandatory overtime and consecutive work hours-decrease mandatory overtime practice and hours of work among registered nurses., Methods: We analyzed a nationally representative sample of registered nurses from the National Sample Survey of Registered Nurses for years 2004 and 2008. We obtained difference-in-differences estimates of the effect of the nurse work hour policies on the likelihood of working mandatory overtime, working more than 40 hours per week, and working more than 60 hours per week for all staff nurses working in hospitals and nursing homes., Principal Findings: The mandatory overtime and consecutive work hour regulations were significantly associated with 3.9 percentage-point decreases in the likelihood of working overtime mandatorily and 11.5 percentage-point decreases in the likelihood of working more than 40 hours per week, respectively., Conclusions: State mandatory overtime and consecutive work hour policies are effective in reducing nurse work hours. The consecutive work hour policy appears to be a better regulatory tool for reducing long work hours for nurses., (© Health Research and Educational Trust.)

In 2004, California became the first state to implement statewide minimum nurse-to-patient ratios in general hospitals. In spite of years of work to establish statewide staffing regulations, there is little evidence that the law was effective in attracting more nurses to the hospital workforce or improving patient outcomes. This paper examines the effects of this legislation on employment and wages of registered nurses. By using annual financial data from California hospitals, I show that nurse-to-patient ratios in medical/surgical units increased substantially following the staffing mandate. However, survey data from two nationally representative datasets indicate that the law had no effect on the aggregate number of registered nurses or the hours they worked in California hospitals, and at most a modest effect on wages. My findings suggest that offsetting changes in labor demand due to hospital closures, combined with reclassification of workers within hospitals, and mitigated the employment effects of California's staffing regulation. This paper cautions that California's experience with minimum nurse staffing legislation may not be generalizable to states considering similar policies in very different hospital markets., (Copyright © 2013 John Wiley & Sons, Ltd.)

Introduction: Workplace violence has been recognized as a violent crime that requires targeted responses from employers, law enforcement, and the community. According to data from the Bureau of Labor Statistics, the most common source of nonfatal injuries and illnesses requiring days away from work in the health care and social assistance industry was assault on the health care worker. What is not well understood are the precursors and sequelae of violence perpetrated against emergency nurses and other health care workers by patients and visitors. The purpose of this study was to better understand the experience of emergency nurses who have been physically or verbally assaulted while providing patient care in US emergency departments., Methods: The study was conducted using a qualitative descriptive exploratory design. The sample consisted of 46 written narratives submitted by e-mail by emergency nurses describing the experience of violence while providing care at work. Narrative analysis and constant comparison were used to identify emerging themes in the narratives., Results: "Environmental," "personal," and "cue recognition" were identified as the themes. Overall, nurses believed that violence was endemic to their workplace and that both limited recognition of cues indicating a high-risk person or environment and a culture of acceptance of violence were barriers to mitigation., Discussion: These findings are consistent with the extant literature but with an added contribution of clearly identifying an underlying cultural acceptance of violence in the emergency department, as well as a distinct lack of cue recognition, in this sample of emergency nurses., (Copyright © 2014 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.)

This column is designed to provide a nursing perspective on the new hospital quality measurements. Future articles will cover the various quality indicators hospitals face and the role of the nurse in meeting mandated benchmarks. Reader responses to this column are welcome and will help to make it more useful to nurses in meeting the challenges posed by health care reform and changing Medicare reimbursement programs.

Enactment of hospital nurse staffing regulations was brought about by changes in the U.S. health care system that resulted in large-scale reductions in nurse staffing. These reductions came at a time when studies were highlighting inadequacies in care that caused negative patient outcomes and raised questions about the safety of hospitalized patients. Nurse staffing regulations were enacted to ensure that adequate numbers of nurses were available to provide high-quality and safe care. Although these regulations represent progress toward addressing staffing inadequacies, enforcement language is absent or weak and compliance data are either not collected or difficult to access. Explicit and funded enforcement measures need to be included in staffing regulations. Additionally, compliance monitoring and reporting are necessary to evaluate these types of staffing regulations and to determine if they actually achieve the goal of appropriate nurse staffing., (© The Author(s) 2014 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.)

Sometimes being on the front lines involves caring for our colleagues. "Assisting nurses to nurture and heal themselves" is a defined role of holistic nursing practice (AHNA & ANA, 2013, p. 8). Nothing can be more catastrophic for a nurse's career than the loss of her/his license to practice. In this dark hour a nurse will often need extra support and someone to walk alongside her/him in the healing process. This article describes a holistic nurse in North Carolina who is helping nurses in her region find the courage to rise up from the ashes and start anew.

Objective: To determine whether, following implementation of California's minimum nurse staffing legislation, changes in acuity-adjusted nurse staffing and quality of care in California hospitals outpaced similar changes in hospitals in comparison states without such regulations., Data Sources/study Setting: Data from the American Hospital Association Annual Survey of Hospitals, the California Office of Statewide Health Planning and Development, the Hospital Cost Report Information System, and the Agency for Healthcare Research and Quality's Health Care Cost and Utilization Project's State Inpatient Databases from 2000 to 2006., Study Design: We grouped hospitals into quartiles based on their preregulation staffing levels and used a difference-in-difference approach to compare changes in staffing and in quality of care in California hospitals to changes over the same time period in hospitals in 12 comparison states without minimum staffing legislation., Data Collection/extraction Methods: We merged data from the above data sources to obtain measures of nurse staffing and quality of care. We used Agency for Healthcare Research and Quality's Patient Safety Indicators to measure quality., Principal Findings: With few exceptions, California hospitals increased nurse staffing levels over time significantly more than did comparison state hospitals. Failure to rescue decreased significantly more in some California hospitals, and infections due to medical care increased significantly more in some California hospitals than in comparison state hospitals. There were no statistically significant changes in either respiratory failure or postoperative sepsis., Conclusions: Following implementation of California's minimum nurse staffing legislation, nurse staffing in California increased significantly more than it did in comparison states' hospitals, but the extent of the increases depended upon preregulation staffing levels; there were mixed effects on quality., (© Health Research and Educational Trust.)

The report of the Mid Staffordshire NHS Foundation Trust public inquiry has a statutory duty of candor at its heart and the requirement for openness and transparency running through most of its 290 recommendations. While many will consider such a legal duty essential if a repeat of the Mid Staffordshire scandal is to be avoided, the duty is unlikely to be effective unless nurses can discharge their obligations without fear of recrimination. This article argues that current protection for nurses who report poor practice is inadequate and must be improved if the openness and transparency recommended is to become a reality in the NHS.

This article clarifies how leader behavioral integrity for safety helps solve follower's double bind between adhering to safety protocols and speaking up about mistakes against protocols. Path modeling of survey data in 54 nursing teams showed that head nurse behavioral integrity for safety positively relates to both team priority of safety and psychological safety. In turn, team priority of safety and team psychological safety were, respectively, negatively and positively related with the number of treatment errors that were reported to head nurses. We further demonstrated an interaction effect between team priority of safety and psychological safety on reported errors such that the relationship between team priority of safety and the number of errors was stronger for higher levels of team psychological safety. Finally, we showed that both team priority of safety and team psychological safety mediated the relationship between leader behavioral integrity for safety and reported treatment errors. These results suggest that although adhering to safety protocols and admitting mistakes against those protocols show opposite relations to reported treatment errors, both are important to improving patient safety and both are fostered by leaders who walk their safety talk., ((c) 2012 APA, all rights reserved.)