This study tests the competing arguments that organizational turnover rates are positively associated with organizational inefficiency or, alternatively, that turnover rates are positively related to organizational inefficiency only in those organizations experiencing very high or very low rates of turnover. The findings strongly support the former argument: in a national sample of 407 hospitals, turnover among registered nurses was found to be positively and linearly associated with both operating and personnel costs per adjusted admission. However, subset analyses based on hospital size, location, and teaching status, suggest that the strength of the turnover-costrelationship is contingent upon the type of institution in which turnover occurs.
In light of current concerns over nursing shortages and productivity, turnover among hospital nurses in the United States has assumed renewed importance as a managerial issue. This study examines the thesis that the social organization of work in hospitals is an importnt determinate of voluntary turnover among among registered nurses. This perspective differed from previous work in this area in that both turnover and its determinants are conceptualized at the organizational rather than individual level, thus opening the way for adminisrtative intervention to reduce turnover. The conceptual model is tested using multiple regression techniques on a sample of 435 hospitals. Results suggest that both organizational characteristics and enviromental conditions are important contributors to turnover.
Development of a properly formed heart is vital to life and defects in cardiogenesis lead to congenital heart disease. Central to this process is the commitment and differentiation of cardiovascular cell types from pluripotent progenitors, which depends on activation of entire gene expression programs. Chromatin structure is essential for the modulation of gene expression, yet we know little about how chromatin is modified and regulated during cardiogenesis. We have described the changing chromatin landscape of cardiac differentiation and investigated how chromatin regulators, such as chromatin remodelers, impact gene expression during this process. Using an efficient directed differentiation of cardiomyocytes from embryonic stem cells, we identified four stages of cardiac differentiation and profiled genome-wide occupancy of histone modifications. We found multiple, distinct chromatin patterns and have demonstrated the relationship between these patterns and gene expression. In addition, we identified a novel pre-activation chromatin pattern found at many cardiac muscle genes. Using histone modification signature, we have identified numerous putative enhancer regions, which allowed for the discovery of novel transcriptional regulatory networks and the identification of transcriptional synergism between the transcription factors Gata4 and Meis1. Furthermore, we studied the role of the chromatin remodeling factor, Brg1, in cardiac differentiation. We determined that Brg1 is required for cardiac differentiation and early loss of Brg1 led to the derepression of many Polycomb target genes. Further investigation revealed that Brg1 is required for H3K27me3 levels at many derepressed genes, suggesting a potential cooperativity between Brg1 and Polycomb repressive complexes. Taken together, our studies provide an important framework for future study of chromatin and its regulatory factors in the developing heart.
The objective of this study was to assess the effect of four different nurse staffing strategies on hospital costs: Part-time RNs; RN temporary agencies; RN rich skill mix; and organizationally experienced RNs. Two regression equations were specified to consider the effect of these strategies on personnel and benefit costs and on non-personnel operating costs. A number of additional variables were also included in the equations to control for the effect of other organization and environmental causes of hospital costs. Consistent with the hypotheses, use of part-time RNs and experienced staff reduced personnel and benefit costs while the use of temporary agencies for RNs increased non-personnel operating costs. An RN rich skill mix was not related to either measure of hospital costs. The implications of our findings for hospital administration are discussed.
This paper advances the study of organizational demography and its relationship to organizational turnover by examining two of Blau's concepts of social structure: non-linear and multiform heterogeneity. In a sample of 383 community hospitals, nursing turnover was examined in relation to four dimensions of demographic heterogeneity among nursing staff in those hospitals. The form of the relationships between turnover and heterogeneity was specified to test whether heterogeneity relates to higher turnover in a linear fashion or, alternatively, whether heterogeneity affects turnover in an inverted U-shaped pattern. Results of multivariate analyses suggested strong support for the former proposition. Three of the four dimensions of demographic heterogeneity in hospital nursing staffs were positively and monotonically related to voluntary turnover among full-time registered nurses (RNs). No support was found for a curvilinear relationship, nor did mean levels of the demography measures, reflecting the locus of concentration, account for the observed relationship between demographic heterogeneity and turnover.
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