Purpose. To determine the extent to which homeless persons in the United States use the emergency department (ED), the extent to which they use it for non-urgent care and the factors that are predictive of ED use for non-urgent care. Background. The homeless population has a higher morbidity and mortality than the U.S. population in general. Use of the ED for non-urgent care results in poor health outcomes and in ED overcrowding. Delay in emergency care due to overcrowding results in increased morbidity and mortality and contributes to the increasing cost of health care. Methods. Secondary analysis of the National Hospital Ambulatory Medical Care Survey 2005 examines variables from the perspective of predisposing, enabling and need factors that predict non-urgent use of the ED. Results. Chi-square confirmed that homeless people have a significantly higher likelihood of visiting the ED than not homeless (p = 0.007). However, in reference to the extent to which they use the ED for non-urgent visits, Pearson's chi-square test did not indicate a rejection of the null hypothesis (p = 0.763). This finding does not provide support for the hypothesis that urgency of the ED visit is dependent on the housing status of the patient. Multiple logistic regression revealed gender (p = 0.120), race/ethnicity (p = 0.003), season (p = 0.030), health insurance (p< 0.000), physician diagnosis (p< 0.000) and age (p< 0.000) as predictors of ED use for non-urgent care. Discussion. This is the first known study to examine use of the ED by homeless persons in the United States at the national level using empirically derived ED data. Two very important findings emerged from this study: 1) homeless people use the ED in significantly greater proportion than not homeless people, however, they do not use it for non-urgent care in greater magnitude and 2) lack of health insurance significantly increases the likelihood of making a non-urgent visit to the ED.

The current nurse shortage is a significant public health problem that hinders the delivery of health care, and is associated with poor health outcomes, poor patient satisfaction, poor working conditions and greater administrative costs. Although the number of nurses working is increasing, the demand for nursing care is increasing even faster, and the shortage of nurses is worsening. It is predicted to reach 340,000 by 2020. According to economic theory, in times of shortage, wages go up and motivate greater labor participation.

The primary purpose of this research project was to increase the understanding of the effect of wages on the level of participation of staff nurses working in California. The secondary purposes were (a) to describe nurse wages across the state and (b) to assess their effect on the number of hours worked, accounting for gender, age, race/ethnicity, marital status, other income, level of education, location of education, location of employment, position held, and region of residence within the state. In order to achieve these goals, cross-sectional analyses were conducted using secondary data collected by the California State University, Chico on behalf of the California Board of Registered Nursing in 2004. Data were collected via an anonymous survey submitted to a random sample of nurses with active licenses in the state.

Using analysis of variance, mean wages were compared across the 10 regions of the state. Post-hoc comparisons found that the Bay Area Region had significantly higher wages than the other regions, while North Counties had significantly lower wages. Using multiple regression and Two-stage-least-squared regression with instrumental variables, wage effects were calculated for the entire sample (n=1638) and for 28 subgroups within the sample. Wages were found to have a non-significant effect on the number of hours nurses work once they are licensed and employed. Findings corroborate the conclusion drawn in previous studies. Theoretical and analytical models need to be broaden in order to more fully represent the decisions made by the nurse population about the number of hours worked.

In the hospital setting, the underlying causes of poor quality of patient care and the failures that jeopardize patient safety have resulted in catastrophic patient outcomes and dissatisfaction with safety systems among care providers. This quantitative study compared hospitalized patients' perceived experiences of care with the perceptions of patient safety culture among care providers. Two instruments in common use, the Consumers Assessment of Healthcare Providers and Systems-Hospital version (HCAHPS) and the Hospital Survey on Patient Safety Culture (HSOPSC) were statistically analyzed using a negative binomial regression model. Results demonstrated that several provider variables were significant predictors of patient outcomes on all six or five of six HCAHPS subscales including: Organizational learning and quality improvement, overall perceptions of safety, teamwork within the unit, staffing, supervisor and manager support for safety, and teamwork across units (p < .001). Research applications for this study include development of a model for comparing data from the two instruments and a framework for the examination of the forces that affect patient and provider perceptions of quality, care outcomes, and failures.