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Background and Objectives The coronavirus disease 2019 pandemic negatively affected nursing home administrators (NHAs). This study explores licensed and employed NHA's perceptions about what work stress events would drive their turnover intentions (TI) in year 3 of the pandemic. Research Design and Methods As part of a larger survey-based research project collecting numerical and textual data, this study conducted content analysis with qualitative data. Narrative data from 3,859 discrete responses of 1,139 NHAs, from 50 states and Washington, DC, on 2 open-ended electronic survey questions asking about their work stress and TI were collected from February to March 2022. Categories and subcategories were counted and discussed in context as themes. Results We identified 4 main narrative categories with subcategories about NHA's stress about the regulatory system (e.g. excessive, conflicting, changing regulations), staffing (e.g. insufficient, agency staff), organizational pressures (e.g. work overload), and macro system stressors (e.g. media representation of nursing homes). Three main TI categories with subcategories were identified: the long-term care (LTC) setting and system (e.g. regulatory demands, staffing, facility surveys); personal factors (e.g. stress, career opportunities); and others (e.g. "I would never quit" or "I already decided to quit"). Discussion and Implications Whole community disaster planning, person-centered surveyor training, improved regulatory guidance, simplified reporting, adequate guidance assistance, and adequate staff could mitigate NHA stress and TI during crises. Administrator resilience should be recognized. Solutions for supporting NHAs can include long-term care industry participation in public health disaster preparedness coalitions, consistent regulatory guidelines with established communication channels, and ongoing crisis leadership training for administrators. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic created challenges for U. S. nursing home administrators (NHA) and staff. This study explored organizational and psychological factors associated with NHA stress, dissatisfaction, and turnover intent (TI) during the third year of the pandemic. Results from a nationwide, cross-sectional survey of 1139 NHAs were merged with Centers for Medicare and Medicaid Services nursing home survey deficiency, staffing, complaint, and other operations data. A hierarchical, generalized estimating equations model with ordered logit link found that NHAs with higher COVID stress (AOR = 1.65, 95% CI = 1.22, 2.23), higher use of agency/contract staff (AOR = 1.50, 95% CI = 1.08.2.09) and higher role conflict were more likely to indicate TI. NHAs with higher job satisfaction in workload, work content, and rewards were less likely to hold TI. Industry leaders should create strategies to reduce NHA's job stress and role conflicts and provide opportunities for improving staff recruitment and retention, reducing reliance on agency staffing. [ABSTRACT FROM AUTHOR]

There is a great variation across states in nurse practitioner (NP) scope of practice moderated by state regulations. The purpose of this study was to synthesize the evidence from studies of the impact of state NP practice regulations on U.S. health care delivery outcomes (e.g., health care workforce, access to care, utilization, care quality, or cost of care), guided by Donabedian's structure, process, and outcomes framework. This systematic review was performed using Medline, CINAHL, PsycINFO, and PubMed according to Preferred Reporting Items for Systematic and Meta-Analysis on the literature from January 2000 to August 2019. The results indicate that expanded state NP practice regulations were associated with greater NP supply and improved access to care among rural and underserved populations without decreasing care quality. This evidence could provide guidance for policy makers in states with more restrictive NP practice regulations when they consider granting greater practice independence to NPs. [ABSTRACT FROM AUTHOR]

This study examines how job satisfaction in six subscales and select stressors and demographic covariates influence nursing home administrator's (NHA) intentions to quit. Quantitative and qualitative data were collected from 311 NHAs in five states. Adjusted odds ratios and 95% confidence intervals for the ordered logistic regression models indicated that NHAs with satisfying work demands, rewards, and coworkers, and who experienced less role conflict and had fewer prior nursing home jobs had lower turnover intentions. Although generally satisfied, roughly 24% reported intending to quit. Surprisingly, NHAs reporting higher job skills were more likely to consider leaving, suggesting that talented NHAs may choose career advancement eased by stigma-free job-hopping in an industry with high mobility norms. Qualitative data suggested that job satisfaction/dissatisfaction was influenced by a more nuanced interpretation of satisfying and more taxing job facets and quitting triggers, including themes such as helping residents and struggling with regulations. [ABSTRACT FROM AUTHOR]

Objective: Little is known about how nurse practitioner independent practice authority (NP-IPA) influences patient care. This study examined the effect of NP-IPA on patterns of mental health-related visits provided by NPs in U.S. community health centers (CHCs).Methods: State NP regulatory information was linked to National Ambulatory Medical Care Survey data on NP- and physician-provided visits (N=61,457) in CHCs from 2006 through 2011. The proportion of NP-provided versus physician-provided mental health-related visits in states with NP-IPA was compared with the proportion in states without NP-IPA. The adjusted odds of mental health-related visits in CHCs provided by NPs in states with and without NP-IPA were compared by using multiple logistic regression models while accounting for the complex survey design.Results: Between 2006 and 2011, the odds of NP- versus physician-provided mental health-related visits in CHCs were more than two times greater in states with NP-IPA than in states with no NP-IPA (adjusted odds ratio [OR]= 2.43, 95% confidence interval [CI]=1.12-4.60). In contrast, no significant difference between states with and without NP-IPA was noted in non-mental health-related CHC visits provided by NPs. Among all mental health-related visits, the odds of visits in which psychotropic medications were prescribed by an NP were more than three times higher in states with NP-IPA than in those without NP-IPA (adjusted OR=3.14, CI=1.50-6.54).Conclusions: Compared with physicians, NPs provided proportionally more CHC mental health-related visits in states with NP-IPA than in states without NP-IPA. [ABSTRACT FROM AUTHOR]

Purpose of the Study: To examine the relationship between certified nursing assistant (CNA) training requirements and resident outcomes in U.S. nursing homes (NHs). The number and type of training hours vary by state since many U.S. states have chosen to require additional hours over the federal minimums, presumably to keep pace with the increasing complexity of care. Yet little is known about the impact of the type and amount of training CNAs are required to have on resident outcomes., Design and Methods: Compiled data on 2010 state regulatory requirements for CNA training (clinical, total initial training, in-service, ratio of clinical to didactic hours) were linked to 2010 resident outcomes data from 15,508 NHs. Outcomes included the following NH Compare Quality Indicators (QIs) (Minimum Data Set 3.0): pain, antipsychotic use, falls with injury, depression, weight loss and pressure ulcers. Facility-level QIs were regressed on training indicators using generalized linear models with the Huber-White correction, to account for clustering of NHs within states. Models were stratified by facility size and adjusted for case-mix, ownership status, percentage of Medicaid-certified beds and urban-rural status., Results: A higher ratio of clinical to didactic hours was related to better resident outcomes. NHs in states requiring clinical training hours above federal minimums (i.e., >16hr) had significantly lower odds of adverse outcomes, particularly pain falls with injury, and depression. Total and in-service training hours also were related to outcomes., Implications: Additional training providing clinical experiences may aid in identifying residents at risk. This study provides empirical evidence supporting the importance of increased requirements for CNA training to improve quality of care., (© The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: This study was designed to examine the effects of an assertive training program on interpersonal relations, and psychiatric symptoms in patients with a mental disorder., Method: The study employed a quasi experimental design. The subjects included 44 patients with a mental disorder, 20 in the experimental group, and 24 in the control group. Data was collected using structured questionnaires over a 3 month period., Results: There were greater significant increases in scores of interpersonal relations and content of communication in the experimental group than the control group. Also, there was a greater significant decrease in the score of psychiatric symptoms in the experimental group than the control group., Conclusion: Assertive training has an effect on increasing content of communication and decreasing psychiatric symptoms.