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BACKGROUND: Nurses frequently are caught between the demands of work and family. While studies have explored this issue among staff nurses, none have compared nurse leaders to staff nurses. This study compares work-family conflict (WFC) and family-work conflict (FWC) among staff, managerial, and executive nurses. METHODS: In this survey design, 20% of registered nurses were randomly sampled across Florida with a 9% response rate. Survey questions included personal, professional, and work environment characteristics and perceptions of WFC/FWC. Analyses of variance tested the differences between- and within-group scores for WFC/FWC for staff, managerial, and executive nurses. Ordinary Least Squares regressions tested the relationships between personal, professional and work environment measures, focusing on the three different nursing roles, and WFC/FWC scores. FINDINGS: Nurses experienced more WFC than FWC. Staff nurses experienced significantly less WFC than nurse managers and nurse executives (analysis of variance mean difference -0.881 and -2.693, respectively). Nonwhite nurses experienced more WFC and FWC than white nurses. Longer shift length predicted greater WFC. FWC was lower with paid leave for childbirth. DISCUSSION: Higher WFC among nurse managers and executives may discourage nurses from taking on or staying in leadership roles. Efforts must be taken to decrease WFC/FWC among nurses in these roles.

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Conflict between work and family is a human resource management issue that is particularly relevant for nurses. Nursing is a demanding profession, and a high proportion of nurses are women, who tend to have greater family responsibilities than men. Little is known regarding work-family conflict among nurses, and even less is known about how this affects newly licensed registered nurses (NLRNs), who can be stressed from their new jobs and careers. This study empirically tests a model of antecedents and outcomes of work-family and family-work conflict among a sample of NLRNs. We developed a model of the relationships between personal and work environment characteristics, work-family and family-work conflicts, job satisfaction, and intent to leave the job and profession. We used structural equation modeling (Amos, IBM SPSS) to test the model with data from.a survey of NLRNs. We examined a number of latent variables, as well as direct and mediating relationships. The measurement models for all latent variables were validated. The final model indicated that age, health, and family responsibilities are antecedents of family-work conflict; job demands lead to work-family conflict; family-work conflict contributes to job difficulties, which lowers job satisfaction, which, in turn, increases the intent to leave the job and profession; and work-family conflict increases the intent to leave the job and profession (but does not directly affect job satisfaction). Policies to help NLRNs with family responsibilities could reduce family-work conflict, which might reduce job difficulties and improve satisfaction and retention. In addition, policies to reduce job demands could reduce work-family conflict and improve retention.

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BACKGROUND: The large number of uninsured individuals in the United States creates negative consequences for those who are uninsured and for those who are covered by health insurance plans. Young adults between the ages of 18 and 24 are the largest uninsured population subgroup. This subgroup warrants analysis. The major aim of this study is to determine why young adults between the ages of 18 and 24 are the largest uninsured population subgroup. METHODS: The present study seeks to determine why young adults between the ages of 18 and 24 are the largest population subgroup that is not covered by private health insurance. Data on perceived health status, perceived need, perceived value, socioeconomic status, gender, and race was obtained from a national sample of 1,340 young adults from the 2005 Medical Expenditure Panel Survey and examined for possible explanatory variables, as well as data on the same variables from a national sample of 1,463 from the 2008 Medical Expenditure Panel Survey. RESULTS: Results of the structural equation model analysis indicate that insurance coverage in the 2005 sample was largely a function of higher socioeconomic status and being a non-minority. Perceived health status, perceived need, perceived value, and gender were not significant predictors of private health insurance coverage in the 2005 sample. However, in the 2008 sample, these indicators changed. Socioeconomic status, minority status, perceived health, perceived need, and perceived value were significant predictors of private health insurance coverage. CONCLUSIONS: The results of this study show that coverage by a private health insurance plan in the 2005 sample was largely a matter of having a higher socioeconomic status and having a non-minority status. In 2008 each of the attitudinal variables (perceived health, perceived value, and perceived need) predicted whether subjects carried private insurance. Our findings suggest that among those sampled, the young adult subgroup between the ages of 18 and 24 does not necessarily represent a unique segment of the population, with behaviors differing from the rest of the sample.

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In large part due to current economic conditions and the political uncertainties of healthcare reform legislation, hospitals need to identify new sources of revenue. Two potentially untapped sources are inbound (international) and domestic (within the United States) medical tourists. This case study uses data from a large, urban healthcare system in the southeastern United States to quantify its potential market opportunities for medical tourism. The data were mined from electronic health records, and descriptive frequency analysis was used to provide a preliminary market assessment. This approach permits healthcare systems to move beyond anecdotal information and assess the relative market potential of their particular geographic area and the diagnostic services they offer for attracting inbound and domestic medical tourists. Implications for healthcare executives and guidance on how they can focus marketing efforts are discussed.

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This study looks at employee information sharing among hospitals, a topic that is underresearched, underreported, and under the radar for most healthcare leaders. We initiated the research under the assumption that executives in healthcare are reluctant to share employment reference information about staff beyond the employee's name, dates of employment, and position held. We believed executives take this precaution because they fear being sued by the employee for defamation. However, not obtaining the necessary and critical information to hire a competent employee can open the potential employer up to a negligence lawsuit if it hires someone who jeopardizes the safety of patients or staff. Hence, the hiring organization faces a double-edged sword: On one side, it cannot get the critical information on a potential applicant from the previous employer due to a culture of "fear in sharing" information; on the other side, if it unwittingly hires a poor or dangerous applicant who threatens safety, it runs the risk of a negligence lawsuit for failure to ascertain information before the hire. Prior studies demonstrate that the likelihood of a successful defamation lawsuit is low and information sharing of factual incidents is unlikely to result in successful lawsuits. Why, then, are healthcare executives unwilling to provide comprehensive references when they should be aware that sustaining a culture of silence increases the potential for hiring a bad employee and seriously jeopardizes the security and safety of patients, other staff, and the public? This article's primary contribution to the literature is to offer the first nationwide study to empirically test the current levels of employee information sharing among hospitals. It is also the first study to focus exclusively on healthcare. Furthermore, this research considers factors that might influence executives in their willingness to share employee reference information. The study reveals that a culture of silence is pervasive among hospitals. Although many hospital executives are reluctant to share information, they tend to overestimate the likelihood of being sued (successfully or otherwise) by previous employees for defamation. In addition, this study shows that some hospital executives share negative information about former employees but may do so off the record.

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Health literacy is a concept that describes a patient's ability to understand materials provided by physicians or other providers. Several factors, including education level, income, and age, can influence health literacy. Research conducted at one medical practice in Florida indicated that in spite of the patients' relatively low education level, the majority indicated a broad acceptance of personal health record (PHR) technology. The key variable explaining patient willingness to adopt a PHR was the patient's health literacy as measured by the eHealth Literacy Scale (eHEALS). Adoption and use rates may also depend on the availability of office staff for hands-on training as well as assistance with interpretation of medical information. It is hoped that technology barriers will disappear over time, and usefulness of the information will promote increased utilization of PHRs. Patient understanding of the information remains a challenge that must be overcome to realize the full potential of PHRs.

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The well-anticipated and well-documented demographic shift attributed to ageing of the baby boomer generation will place significant demands upon the health-care industry in the future. Significant resources such as the nurse workforce, will be needed to provide health-care services to this cohort. There is a looming shortage of professional and paraprofessional nurses. This paper evaluates strategies that can be utilized to decrease the rate of the nursing shortage, while retaining the current supply of nurses. Recommendations for solving the nursing shortage problem include enhancing the work environment through fostering open communication, improving technology, nurse empowerment, building long-lasting and fulfilling partnerships, and efficient workplace organization.

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Currently, the debate over the addition of the midlevel provider position for dental hygienists rages on. The midlevel provider (similar to the physician's assistant) in dentistry exists in a handful of states in various forms, but is hotly contested in many other states. This is the second half of a 2-part study undertaken to add to the current body of knowledge by addressing the clinical needs changing in our population and the associated demand study for additional educational degrees for dental hygienists to address these changing needs. Part 1 addressed a literature update on oral health and systemic correlations contributing to our populations' declining health conditions, whereas part 2 illustrates the results of the demand study. It attempts to benchmark "adequate demand" and applies the stakeholder theory as its theoretical framework.

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The debate over the addition of the midlevel provider position for dental hygienists currently rages on. The midlevel provider (similar to the physician's assistant) in dentistry exists in a handful of states but is hotly contested in many other states. This is a 2-part study to add to the current body of knowledge by addressing the changing clinical needs in our population and the associated demand study for additional educational degrees for dental hygienists to address these changing needs. Part 1 addresses a literature update on oral health and systemic correlations contributing to our populations' declining health conditions, whereas part 2 illustrates the results of the demand study.

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This chapter summarizes the major determinants of health insurance coverage rates among young adults. Socioeconomic status, demographics, actual and perceived health status, perceived value, and perceived need are all examined in order to determine what the literature reveals regarding each variable and how each variable impacts a young adult's decision to purchase health insurance. Results indicate that socioeconomic status, demographics, perceived value, and perceived need were the most significant determinates of health insurance status of young adults. A conceptual framework is also examined and used to illustrate theoretical implications. Managerial implications for marketing health plans to young adults are also addressed. Finally, policy implications concerning the new Patient Protection and Affordable Care Act are addressed.

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The purpose of this research was to explore the effect work environment has on the intent to leave the profession for rural hospital bedside registered nurses (RNs). Subscales of autonomy, control over the practice setting, nurse-physician relationship and organizational support were incorporated into the analysis to determine which aspects of work environment directly affect the intent to leave the profession. An explanatory cross-sectional survey was distributed to 259 direct care bedside RNs employed at a rural system-affiliated hospital in Central Florida between February 2007 and June 2007. Anonymity was assured. A questionnaire containing demographic questions, the Nursing Work Index-Revised and Blau's intent to leave scale was distributed to all direct care nurses. A 32.8% response rate was achieved for a total of 85 complete and usable surveys. Data analysis shows that the work environment in general is negatively related to intent to leave. In addition, each of the four subscales was also negatively related to the intent to leave the profession. The results of this study support several recommendations for practice and education, including the promotion of professional practice environments, fostering inter-departmental relationships, and increasing the managerial training of RN managers.

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As health care organizations expand and move into global markets, they face many leadership challenges, including the difficulty of leading individuals who are geographically dispersed. This article provides global managers with guidelines for leading and motivating individuals or teams from a distance while overcoming the typical challenges that "virtual leaders" and "virtual teams" face: employee isolation, confusion, language barriers, cultural differences, and technological breakdowns. Fortunately, technological advances in communications have provided various methods to accommodate geographically dispersed or "global virtual teams." Health care leaders now have the ability to lead global teams from afar by becoming "virtual leaders" with a responsibility to lead a "virtual team." Three models of globalization presented and discussed are outsourcing of health care services, medical tourism, and telerobotics. These models require global managers to lead virtually, and a positive relationship between the virtual leader and the virtual team member is vital in the success of global health care organizations.

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BACKGROUND: Volunteers have been present in health care settings for centuries. However, there is little empirical evidence regarding the impact that volunteers make on hospital performance. Since the 1990s, hospitals in the United States have had a great deal of pressure to produce high-quality care at minimum expense. These pressures have enhanced the benefits of using volunteers in a hospital setting. PURPOSE: This study utilized multiple regression analysis to explore the impact of the use of volunteers and the level of professionalism of volunteer programs on cost effectiveness and patient satisfaction in hospitals. METHODOLOGY/APPROACH: Hospitals throughout the state of Florida were invited to participate in the study by completing a brief questionnaire about their volunteer programs. Performance indicators of volunteer cost savings and patient satisfaction scores for 50 Florida hospitals were analyzed using data sets from the American Hospital Association and Agency for Health Care Administration along with data obtained from a questionnaire. FINDINGS: Results indicate that the use of volunteers offers significant cost savings to hospitals and enhances patient satisfaction scores. DISCUSSION: Larger volunteer programs appear to enhance patient satisfaction while containing costs. Future research opportunities related to the impact of volunteers and volunteer professionalism on other hospital performance measures are suggested.

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Violence in the health care workplace is occurring in a covert fashion; it is occurring at the patient bedside. However, data on workplace violence tend to be underreported and relatively scarce. This article identifies and examines the phenomenon of unreported and underreported workplace violence against nursing staff that is virtually hidden. Health care executives need to be attuned to this type of violence because it may significantly affect their ability to recruit and retain nursing staff. This article provides a synthesis of literature and data from health services administration and nursing and human resources, as well as the experience of the first author. Workplace violence in health care is a critical issue that must be addressed from legal, financial, ethical, and human resources management perspectives. It is a problem for staff providing direct care services to patients with Alzheimer disease. This article suggests strategies and offers a framework for meeting the challenges of managing hidden workplace violence. In addition to the more discrete consequences of violence including physical injury, physical disability, trauma, or even death, the complementary organizational effects call for thoughtful managerial planning and critical thinking. Guidelines for preventing and addressing workplace violence in health care organizations are also published by the Occupational Safety and Health Administration.

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This exploratory survey examines the relationship between selected dimensions of spirituality and self-perceived effective leadership practices of health-care managers. Kouzes and Posner's Leadership Practices Inventory and Beazley's Spiritual Assessment Scale were administered to a sample of health-care managers. Significant statistical relationships were found between and among the dimensions of both subscales. Analysis of variance revealed a statistically significant difference in three effective leadership practices by 'more spiritual than non-spiritual' managers. The confirmatory factor analysis of our theory-based model revealed a moderately positive correlation between spirituality and leadership (r = 0.50). The paper concludes with a conceptual theory postulating a rationale for the relationship between spirituality and effective leadership.

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Among 10,384 rural Colorado female patients who received MDC 14 (obstetric services) from 2000 to 2003, 6,615 (63.7%) were admitted to their local rural hospitals; 1,654 (15.9%) were admitted to other rural hospitals; and 2,115 (20.4%) traveled to urban hospitals for inpatient services. This study is to examine how network participation, service scopes, and market competition influences rural women's choice of hospital for their obstetric care. A conditional logistic regression analysis was used. The network participation (p < 0.01), the number of services offered (p < 0.05), and the hospital market competition had a positive and significant relationship with patients' choice to receive obstetric care. That is, rural patients prefer to receive care from a hospital that participates in a network, that provides more number of services, and that has a greater market share (i.e., a lower level of market competition) in their locality. Rural hospitals could actively increase their competitiveness and market share by increasing the number of health care services provided and seeking to network with other hospitals.

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Doctoral education is gaining increasing attention as new programs proliferate and enrollment grows. Presently there is no standardization of degrees programs, limited aggregated information about health administration education doctoral programs, and an absence of national policy. The general, doctoral education literature presents a variety of issues and challenges for doctoral health administration education including data trends, supply and demand for doctoral graduates, credential inflation, attrition and degree completion, organizational efforts to improve doctoral education, and strategies for the future. Following the literature review, survey results for a sub-sample of AUPHA affiliated doctoral programs are presented along with related implications.

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Among health administration programs, doctoral education has been a low priority for decades. Programs which are profitable from an economic perspective tend to be maintained or expanded while less profitable programs tend to be reduced. For a variety of reasons, doctoral programs tend to be viewed as less profitable than other programs. This paper analyses why doctoral programs are a low priority, the symptoms of this low priority, implications for the future of health administration education, and recommendations for enhancing that future.

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