Duke University School of Nursing, Duke University Medical Center, Durham, NC 27710, USA.
Nurs Res. 2012 Jan-Feb;61(1):28-38. doi: 10.1097/NNR.0b013e31823a8cc2.
In the context of declining registered nurse (RN) staffing levels in nursing homes, professional nursing jurisdiction over nursing care systems may erode.
The aim of this study was to develop a typology of professional nursing jurisdiction in nursing homes in relation to characteristics of RN staffing, drawing upon Abbott's tasks and jurisdictions framework.
The study was a cross-sectional, observational study using the 2004 National Nursing Home Survey (n = 1,120 nursing homes). Latent class analysis was used to test whether RN staffing indicators differentiated facilities in a typology of RN jurisdiction and compared classes on key organizational environment characteristics. Multiple logistic regression analysis related the emergent classes to presence or absence of specialty care programs in eight clinical areas.
Three classes of capacity for jurisdiction were identified, including low capacity (41% of homes) with low probabilities of having any indicators of RN jurisdiction, mixed capacity (26% of homes) with moderate to high probabilities of having higher RN education and staffing levels, and high capacity (32% of homes) with moderate to high probabilities of having almost all indicators of RN jurisdiction. High-capacity homes were more likely to have specialty care programs relative to low-capacity homes; such homes were less likely to be chain-owned and more likely to be larger, provide higher technical levels of patient care, have unionized nursing assistants, have a lower ratio of licensed practical nurses to RNs, and have an administrator with higher education level.
Findings provide preliminary support for the theoretical framework as a starting point to move beyond extensive reliance on staffing levels and mix as indicators of quality. Furthermore, findings indicate the importance of RN specialty certification.
在养老院注册护士（RN）人员配备水平下降的情况下，专业护理管辖权可能会侵蚀护理服务系统。
本研究旨在根据 RN 人员配备的特点，利用 Abbott 的任务和管辖权框架，为养老院的专业护理管辖权制定一种分类法。
这是一项横断面、观察性研究，使用了 2004 年全国养老院调查（n=1120 家养老院）的数据。采用潜在类别分析来检验 RN 人员配备指标是否能区分出具有不同 RN 管辖权类型的机构，并比较各分类在关键组织环境特征上的差异。多元逻辑回归分析将新出现的类别与八个临床领域的专科护理计划的存在与否联系起来。
确定了三种管辖权能力类别，包括低能力（41%的机构），其具有 RN 管辖权的可能性较低，中等至高能力（26%的机构）具有较高的 RN 教育和人员配备水平，以及高能力（32%的机构）具有中等至高的可能性，几乎所有 RN 管辖权的指标。高能力的机构比低能力的机构更有可能开展专科护理计划；这些机构更不可能是连锁所有，更有可能更大，提供更高水平的技术护理，有工会化的护理助手，有更低的注册护士与执业护士比例，以及有更高学历的管理人员。
研究结果初步支持了这一理论框架，为超越对人员配备水平和组合作为质量指标的过度依赖提供了一个起点。此外，研究结果表明了 RN 专业认证的重要性。
