Interviews with 30 rural Veterans about their experiences receiving VHA-purchased community mental health care, highlighting both improved access and persistent quality and continuity concerns.
A national study of inpatient RN turnover across rural and urban VHA hospitals, finding that individual RN characteristics and care delivery structure, not rurality itself, drive most of the variation in turnover.
Using national VHA data on 9,272 RNs, we show that nurses assigned more patients spend substantially more total time on medication administration, compensating with only modest per-patient time reductions.
A national, longitudinal analysis of VHA inpatient nurse staffing and medication-pass workload from 2019-2022 showing higher RN workload emerging by 2022 relative to prepandemic levels.
We compare risk-adjustment scores calculated from VA-only, Medicaid-only, and combined diagnostic data for Veterans dually enrolled in VA and Medicaid, finding substantial non-overlap between the two data sources.
Measuring and assessing the relationship between inpatient nurse staffing and workload because it is challenging to systematically observe inpatient workload is difficult at the unit level in large samples. The objective of this study was to apply a novel measure of inpatient nurse workload to estimate the relationship between inpatient nurse staffing and nurse workload at the unit level during a key nursing activity, the peak-time medication pass. We found a negative relationship between the RN-to-patient ratio and average peak time medication pass duration after adjusting for unit-level patient volume and average patient severity of illness and other unit-level factors. This relationship was non-linear, the marginal effect of staffing on workload decreased as staffing increased.As unit-level nurse staffing increased, average RN workload decreased. This result suggests that interventions to improve nurse staffing may have larger non-linear effects for units with lower staffing levels.
VHA facilities with a higher volume of VHA-purchased screening colonoscopies and more rural enrollees had more non-VHA physicians providing care. Geographic variation in referral networks may also explain differences in the effects of the MISSION Act on access to care and patient outcomes.
The VHA-share of screening colonoscopies among VHA enrollees fell in the 9 months immediately after the passage of the MISSION Act. This decline was larger for VHA enrollees who were targeted for eligibility due to a longer drive time. These results suggest that the MISSION Act led to more VHA-purchased care among targeted VHA enrollees, though it is unclear whether total utilization increased.
Measuring and assessing the relationship between inpatient nurse staffing and workload because it is challenging to systematically observe inpatient workload is difficult at the unit level in large samples. The objective of this study was to apply a novel measure of inpatient nurse workload to estimate the relationship between inpatient nurse staffing and nurse workload at the unit level during a key nursing activity, the peak-time medication pass. We found a negative relationship between the RN-to-patient ratio and average peak time medication pass duration after adjusting for unit-level patient volume and average patient severity of illness and other unit-level factors. This relationship was non-linear, the marginal effect of staffing on workload decreased as staffing increased.As unit-level nurse staffing increased, average RN workload decreased. This result suggests that interventions to improve nurse staffing may have larger non-linear effects for units with lower staffing levels.