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This article reports the findings of 1996, 1997, and 1998 patient satisfaction surveys administered to managed care enrollees in Utah. More than 14,000 managed care enrollees (both Medicaid and commercial) were selected randomly and contacted by telephone. The 38-question survey was based on Health Plan Employer Data and Information Set (HEDIS) and the National Committee for Quality Assurance (NCQA) measures. Demographic differences between the commercial and Medicaid population were identified. Medicaid enrollees were found to be higher users of health care services. Individuals reporting the greatest health plan satisfaction tended to be healthier. However, Medicaid enrollees reported greater overall health plan satisfaction than commercial enrollees.

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Nurse executives (NEs) in Utah acute care hospitals perceive that they are integrated into executive level administration. This perception is shared by NEs' career supporters and hinderers. To integrate NEs, influential colleagues used active methods, especially involvement. NEs add value to the administrative team by combining clinical and managerial expertise. NE integration is manifest in decision making, participation and interaction. Continued integration depends upon commitment from the chief executive officer (CEO), leadership in organizational change, addressing "glass ceiling" issues, and NEs' continuous demonstration of competence.

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Nurse executives have joined hospital administrative teams, but are they accepted as fully integrated team executives? Learn how nurse executives and their influential colleagues view integration and its influences.

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The investigators report validation of a survey tool called the Interview Guide to assist in the selection of nurses who will be effective as managers. Nurse administrators rated nurse managers at six months and two years after hire. The Interview Guide rated the management qualities "seeing the big picture" and potential for "rehire" as the best predictors of managerial success. After two years, a good "self-concept" or a "flexible attitude" was the best predictor. The ability to manage conflict was the most significant competency for predicting rehire at both six months and two years.

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OBJECTIVE: To evaluate the effect of implementing a Caring Model on patient satisfaction. BACKGROUND: Patient satisfaction has become an important indicator of quality care and financial success of healthcare institutions. Acknowledging the importance of nurse caring behaviors and the impact on patient satisfaction has been relatively recent. Based on a synthesis of the literature, five caring behaviors have been formulated into a model; no single study identified the five selected behaviors included in this study. METHODS: In an acute care setting, eight patient satisfaction attributes were incorporated into a Caring Model. Implementation of the model among nursing staff members included an educational in-service, printing of the behaviors on the name badge, reminders in monthly staff meetings and nursing rounds, and inclusion of the caring behaviors in patient care documentation, job descriptions, and performance appraisals. The impact upon patient satisfaction was compared 6 months' preintervention to 6 months' postintervention. RESULTS: Postintervention, the patient satisfaction attributes of Nurses Anticipating Needs and Responds to Requests significantly increased. Attributes that began preintervention as immediate priorities for improvement became major strengths postintervention. CONCLUSIONS/IMPLICATIONS: Results of this study provide evidence that nurse caring behaviors can influence patient satisfaction. For a Caring Model to be effective, it must become an integral part of strategic planning and be implemented throughout the entire organization. To sustain the effects of the model, there must be frequent reminders among staff members. Nurse caring is an important predictor of patient satisfaction. The authors discuss the effect of implementing a caring model on patient satisfaction. In an acute care setting, eight patient satisfaction attributes incorporated into five nurse caring behaviors were evaluated pre- and postintervention. Results of the study indicated the patient satisfaction attributes of Nurses Anticipating Needs and Responds to Requests significantly increased. Attributes that began as immediate priorities for improvement before intervention became major strengths after intervention.

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This article describes the outcome of a survey of 40 nurse executives and 56 influential colleagues. Both groups agreed that leadership was the most important quality for the executive role. The nurses' primary focus was resolution of patient care problems. Influential colleagues stated resource allocation and initiation of change were two qualities needing improvement. The nurses rated themselves high in confidence about their job responsibilities, scored relationships as the most satisfying attribute, and cited provision of quality health care as the greatest advantage of their position. The greatest disadvantage was lack of administrative support. The results suggest the educational preparation needed for nurse executives.

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OBJECTIVE: Patients' perceptions and satisfaction are areas of growing concern in health care research, but little has been reported from the perspective of elderly persons. The purpose of this study was to describe elderly patients' perceptions of care in the emergency department. METHODS: A qualitative, descriptive study design was used. Twelve elderly people were interviewed following a treatment episode in 1 of 3 emergency departments in the western United States and data were submitted to content analysis according to qualitative, interpretive methodology. FINDINGS: The following 5 themes emerged from the analysis: "needs for information," "observations of waiting time," "perceptions of professional competency and caring service," "concerns about process and facility design," and "personal tolerance." DISCUSSION: Findings support some aspects of existing literature and offer additional information regarding care of elderly persons in the emergency department. Results also support the need for more research in the area of the actual experience of elderly patients in the emergency department.

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This project was part of a collaborative model for nursing staff development and student education. Personal values and work satisfaction of 49 staff nurses working on three hospital units were compared. One of the units employed differentiated practice. Results revealed high similarity in personal values among all nurses. Work satisfaction was significantly higher among nurses working on the unit employing differentiated practice. The importance of assessing personal values of nurses emerged as an important aspect of staff development, and differentiated practice appeared to be related to staff nurse satisfaction.

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The authors present a leadership profile of employed nurse executives (NEs). Interviews and survey data show that the typical NE is a married, middle-aged woman who has a masters degree in clinical nursing and extensive clinical experience. When comparing NEs' and influential colleagues' perceptions of the effectiveness of NEs leadership skills, the former rate themselves higher than the latter, and both groups perceive that NEs' leadership styles are more "task motivated" than "relationship motivated." The authors apply these findings to the career planning of NEs, chief executive officers, and educators in healthcare fields.

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This article examines the involvement of Utah acute care hospital nurse executives (NEs) in financial management roles. The authors surveyed NEs and their career supporters and hinderers. Findings suggest that NFs: 1. lack financial management skills, support, involvement, and satisfaction; 2. recognize financial management's importance and desire to improve performance; and 3. consider chief executive officers (CEOs) as their major supporters and chief financial officers (CFOs) their major hinderers in financial management. These "supporters" and "hinderers" of NEs showed consensus regarding the primacy of NEs' leadership and patient advocacy roles. These findings contrast with major professional association policy directives and expert opinions that advocate expanded financial management roles for NEs that will enable them to fully realize their executive potential. CEOs are positioned to establish norms that balance the traditional leadership-patient advocacy roles of NEs with newer financial management roles. CEOs can offer NEs and CFOs opportunities to improve NEs' financial management participation and performance. CEOs can provide empowerment and encourage CFOs to offer NEs "power tools" (for example, information, expertise, resources, and support). The three groups, however, must negotiate reasonable expectations for NEs in financial management and adequate preparation for these consequent responsibilities. Together, CEOs, CFOs, and NEs can successfully take hospitals into the future by leading them in ongoing learning and change.

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The authors describe the Healing Web, a partnership between nursing service and education that encourages the best use of nurses education clinical experience and personal competencies. Based on differentiated practice and education of nursing students in multi-level roles the Healing Web partnership is demonstrating at multiple institutions, that education and nursing service can work collaboratively to position the profession of nursing for maximum effectiveness in the 21st century.

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Care coordination/case management models provide a method to measure expenditures within the context of health-care outcomes. High costs are predictable in a high skill, technology-intensive service industry such as academic medical centers. A care-coordination model provides a means to reduce the cost per case and influence patient satisfaction. In this article, the authors describe a Care-Coordination Model for neurologically impaired patients in an academic medical center. The Care-Coordination Model serves as a structure for cost containment within a diagnostic reimbursement grouping (DRG) category and provides an opportunity to develop alternative care programs to support those disabled in their community setting. Clinical and financial outcomes are presented as well as follow-up in the form of a patient survey. The results demonstrate cost savings in several charge categories, a reduction in the length of stay, a reduction in the variation of clinical treatment, and an increase in patient satisfaction regarding discharge preparation.

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Significant variations and inconsistency in both the physician's and nurse's approach to the treatment of neonates with a "rule-out sepsis" (R/O sepsis) diagnosis is seen as both high cost and low quality. Because R/O sepsis is seen as a diagnostic dilemma for practicing clinicians, there has been a widespread tendency to readily initiate antibiotic treatment, without adequate consideration of the high financial and morbidity costs associated with the complications of treating the noninfected infant. This study demonstrates that the use of an agreed upon risk profile facilitated the collaborative standardization of diagnosis and treatment of the R/O sepsis patient, improved quality, and reduced costs (by minimizing over treatment) without increasing risk. This collaborative approach enhanced nurse-physician relationships, resulting in significant cost savings as well as diminished anxiety and confusion among the parents of neonates diagnosed with R/O sepsis.

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The article presents guidelines for nurses who must evaluate research reports and interpret authors' findings. The described strategy is particularly useful for advanced practice nurses who seek practical outcomes that are applicable to their clinical practice.

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Nurse-patient interactions were examined to identify elements of interpersonal competence among nurses from the perspective of patients. Forty patients and 12 nurses participated in this qualitative study at a private acute care hospital. Two-hundred and forty-five observations were completed. Open-ended questions were utilized in 85 audio-taped semi-structured interviews. Data collection and analysis occurred simultaneously using the constant comparative method. Four major processes emerged from the data to provide the framework for the themes: 'translating', 'getting to know you', 'establishing trust', and 'going the extra mile'. In the 'translating' theme, patients expressed satisfaction with the nurse-patient interaction when nurses informed, explained and instructed on specific aspects of treatment, and taught general principles of care. The nurses' personal sharing, kidding and clicking appeared as important processes in 'getting to know you'. Patients reported confidence and trust when nurses took charge and appeared to enjoy their work. The theme of 'going the extra mile' included friendship and providing care beyond that expected. The processes provide a framework for an emerging theory of interpersonal competence.

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Hiring effective nurse managers is key to the success of today's healthcare institutions. The authors describe the development of a pre-employment interview guide to assist in the selection process of nurse managers. Characteristics and competencies of effective nurse managers are delineated from the qualitative data.

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Establishing standards for the desired quality of nursing care requires identifying clear expectations for professional practice and evaluating related performance by objective, quantifiable criteria. The authors describe development of a job description/evaluation tool, the analysis of that process, and the initial findings of pilot testing.

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This study establishes the actual cost of nursing care for 13 diagnosis related groups (DRGs) at one hospital and relates them, within the limits of available statistics, to other published data. The impact of acuity levels involving both direct and indirect factors in nursing and of "outliers" is emphasized as critical in working within the preset reimbursement schedule of DRGs. More clearly defining these highly variable components of nursing care costs can assist nurse administrators to determine inadequate practice patterns and, by revising them, to decrease costs.

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