1. RN Leaving/Staying at Bedside HSCI 730 SPRING 2005 J Y

2. Why Are Nurses Leaving? Frustrated with stress

3. Target Event Leaving the bedside nursing 1 year from now Instructor: Great topic. I can see this useful in many circumstances

4. Review of Clues 1. RN turnover ratios for year 2004 2. Vacancy Rates for year 2004 3. RN satisfaction Survey scores 4. RN Advancement and career opportunities 5. Autonomy 6. RN to RN daily interactions 7. Retention bonus Instructor: I think RN satisfaction depends on many of the factors you have listed here and therefore assumption of independence is violated

5. Clue levels ClueLevel of Clues A. RN Satisfaction A1. Enough Time with nursing Care A2. Better care with lower RN to patient ratio. A3. Have plenty of opportunity for patient care issues. A4. More time for each Patient B. RN to RN Interaction B1. Team work among nursing staff B2 Welcome new nurses on Unit B3 Interactions among RN to MD C. Autonomy C1 Sufficient input in care of patient C2 Ability to make good independent decisions in daily practice. C3 Free to adjust daily practice to fit patient needs. D. Professional Development D1 Career development opportunities D2 Preceptor Program D3 Flexible work schedule to attend higher level of education. Instructor: Clue levels are not mutually exclusive and exhaustive. Should be revised.

6. CluesIncrease the probability of eventsLikelihood Ratio ARN satisfaction A1. Enough Time with nursing Care A2. Better care with lower RN to patient ratio. A3. Have plenty of opportunity for patient care issues. A4. More time for each Patient 0.5 1 B RN to RN Interaction B1. Team work among nursing staff B2 Welcome new nurses on Unit B3 Interactions among RN to MD 0.3 1.0 1.5 C Autonomy C1 Sufficient input in care of patient C2 Ability to make good independent decisions in daily practice. C3 Free to adjust daily practice to fit patient needs. 0.5 1.5 D Professional Development D1 Career development opportunities D2 Preceptor Program D3 Flexible work schedule to attend higher level of education. 0.5 1.0 Instructor : Should also look at clues that decrease the probability of nurse leaving

7. Modeling uncertainty & Scenarios ScenariosExperts 1Expert 2Average Rating Model prediction 140484455 235504338 375807892 462475549 555374650 629221634 722302630 881757860 96768 54 1088496960

8. Correlation Graph Instructor: Should explore why this point is so far off.

9. Forecast Likelihood ratio: RN satisfaction = 3 RN to RN Interaction = 2.5 Autonomy = 3.5 Professional Development = 2 Odds of leaving = 3x2.5X3.5X2 = 11.00 Probability of leaving beside nursing = 11.00/(1+11.00) = 92% Instructor: Assumes conditional independence. But independence was not verified.

10. Evaluation Positive correlation indicates a good model Instructor: It might be useful to compare the model against objective data as I am not sure about a series of assumptions made in this analysis