Insert title here in running head abbreviate if necessary

1. INSERT TITLE HERE IN RUNNING HEAD: ABBREVIATE IF
NECESSARY 1
INSERT ABBREVIATED TITLE OF 50 CHARACTERS OR
LESS
1
Annotated Bibliography
Claudia S. Sample
School of Education
Author Note
Claudia S. Sample
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to
Claudia S. Sample
Replace This Heading with the Philosopher’s Name You
Selected
Annotated Journal Articles on <Name of Your Philosopher>
Authorlastname1, A. B. (2019). Article title in regular font with
only the first word and proper nouns and proper adjectives, like
European, capitalized: Subtitles may or may not be used.
Journal Titles are Italicized and Capitalize All Major Words
Except for the Articles, Conjunctions, and Short Prepositions,
15(2), 41-50. https://doi.org/10.1037/rev0000126
After your first article reference above, write a 250-word
summary and analysis. Leave the paragraph fully indented so
that the author’s name is hanging over it above. The first
several sentences should summarize the article in your own

2. words. The last sentence or two should analyze an aspect of the
article through the lens of the textbook, course videos, and/or
biblical principles. Ensure you cite your sources in APA format.
Example: (Jones, 2020); if you choose to mention author names
in the body of the analysis, it should look like this: Jones
(2020). You are not required to mention their names in the body
of your analysis; it just depends on the point you are making.
Authorlastname2, C. (2019). Title of your second article on the
same philosopher. Journal Title, 9(1), 577-590.
https://doi.org/10.1016/j.midw.2013.07.007
As above, indent this entire paragraph. Notice that, although
everything is double spaced, there are no additional gaps or
lines throughout. Never add extra lines. Sometimes Microsoft
Word automatically inserts lines after headings, paragraphs, or
sections. If you do not know how to remove these, simply do an
internet search of your question: “How do I remove extra lines
in Microsoft Word?”
Authorlastname3, D. (2020). Title of third article on same
philosopher. Journal Title, 9, 577-590.
https://doi.org/10.1371/journal.pone.0225097
Enter your third summary and analysis here. Notice two things
about the above journal. It does not have an issue number
parenthetically inserted. That is because some journals do not
have issue numbers. If there is an issue number, however, it
must be inserted parenthetically with no space between the
volume number and the issue number. Also, the above journal
has a URL with a DOI (digital object identifier). If your article
has one, you must include it. All you need to do is to copy the
URL and to insert it at the end of the reference with no period
after it.
Synthesis of Articles on <Name of Your Philosopher>
Enter a synthesis statement here of at least 150 words. It is
formatted like a regular paragraph in a typical paper. The

3. synthesis is not like an abstract or a comprehensive summary. It
is to be based on your own conclusions and critical analysis
after having considered the ideas in the three articles on your
selected philosopher.
Preliminary Thesis Statement: <Name of Your Philosopher>
To avoid common errors, see the Annotated Bibliography
assignment instructions for more details. Write one or two
sentences that you anticipate may serve as the thesis statement
to your upcoming Philosopher Analysis assignment.
Replace This Heading with Your Selected Historical Topic
Annotated Journal Articles on <Selected Historical Topic>
Authorlastname4, D. E. (2019). Title of your fourth article: This
article is on your historical topic. Journal Title, 21(3), 97-104.
https://doi.org/10.1037/rev0000126
Enter your fourth summary and analysis here. This is on the
first article representing your selected historical topic.
Authorlastname5, F. G. (2020). Title of your fifth article.
Journal Title, 21(3), 97-104.
Enter your fifth summary and analysis. This is for the second
article on the historical topic.
https://doi.org/10.1037/rev0000126
Authorlastname6, H. (2020). Title of your sixth and last article:
It is on the same historical topic as the two articles above.
Journal Title, 21(3), 97-104.
https://doi.org/10.1016/j.midw.2013.07.007
Enter your sixth summary and analysis here.
Synthesis of Articles on <Selected Historical Topic>

4. Enter a synthesis statement here of at least 150 words. It is
formatted like a regular paragraph in a typical paper. The
synthesis is not like an abstract or a comprehensive summary. It
is to be based on your own conclusions and critical analysis
after having considered the ideas in the three articles on your
selected historical topic.
Preliminary Thesis Statement: <Selected Historical Topic>
To avoid common errors, see the Annotated Bibliography
assignment instructions for more details. Write one or two
sentences that you anticipate may serve as the thesis statement
to your upcoming Historical Topic Analysis assignment.
References
Authorlastname, G. L. (2019). Sample book title: Sample
subtitle. Publisher Name.
· Do not repeat the six articles here that you have just
annotated.
· You may include other sources here that you have cited in
your analyses above.
· To cite videos, review this link on How to Cite Online Videos
in APA in APA. Though it focuses on YouTube videos, the
format will help you.
· Delete the bulleted list that you see here in red so that it does
not appear in your submitted assignment.
/
Printed by: [email protected] Printing is for personal, private
use only. No part of this book

5. may be reproduced or transmitted without publisher's prior
permission. Violators will be prosecuted.
Chapter 11
MANAGING HEALTH CARE PROFESSIONALS
Learning ObjectivesDistinguish between the education, training,
and credentialing of physicians, nurses, nurses’ aides, midlevel
practitioners, and allied health professionals.Identify 5 factors
impacting supply of and demand for healthcare
professionals.Analyze reasons for and costs of healthcare
professional turnover.
*
*
Learning ObjectivesPropose strategies for increasing retention,
preventing turnover of healthcare professionals. Define and
provide examples of conflict of interest.Discuss issues
associated with management of the worklife of MDs, RNs,
nurses’ aides, midlevel practitioners, and allied health
professionals.

6. *
Healthcare Industry Over 14.3 million jobs in 2008.Registered
nurses = 2.6 million jobs, 60% of which are in
hospitalsPhysicians = 661,000 majority working in metropolitan
areasPhysician assistants = 74,800 jobs, about 50% in physician
practices, 25% in hospitals, and the rest in outpatient care.
*
*
PhysiciansPre-medical students can obtain a degree in any
subject.Must graduate with a strong foundation in mathematics,
biology, chemistry and physics. Entry into medical school is
competitive; applicants must have high grade point averages and
high scores on the Medical College Admission Test (MCAT).
*
*
Residency Training National Residency Matching Program
(NRMP) matching process for graduating medical students for
Graduate Medical Education (GME).Length of the residency
training program from three years (for family practice) to ten
years (for cardio-thoracic surgery or neurosurgery). After
completion of residency, physicians are eligible to take their

7. board certification examinations and practice independently.
*
*
Residency Work HoursEffective July 1, 2011, all specialty and
subspecialty residency training programs required to limit
resident work hours to no more than 80 hours per week, and in-
house continuous duty can’t exceed 24 hours. No moonlighting
allowed for PGY-1s.Work restrictions mean increased use of
contract physicians or mid-level practitioners, physician
assistants and nurse practitioners. Healthcare organization may
need to hire ancillary staff and allied health professionals, to do
tasks previously covered by resident physicians.
*
*
Physician LicensureMost physicians are eligible to obtain a
license to practice medicine after one year of post-graduate
training. Licensure is granted by the state, required for
physicians, nurses and others to practice, and demonstrates
competency to perform a scope of practice. State Boards of
Physician Quality Assurance (BPQA) establish requirements for
medical licenses.
*

8. *
Criminal Background ChecksMajority of states now have
authority to require criminal background checks (CBCs) for
physician licensure.Reasons: increasing societal concerns about:
alcohol and drug abusers, sexual predators, and child and elder
abusers. If CBC shows convictions, boards review the
application, looking for level and frequency of criminal
behavior, basing their decision on that, along with other
materials submitted by the applicant, such as proof of alcohol
and drug rehabilitation.
*
*
Board CertificationPhysicians may voluntarily submit
documentation of education, training, and practice to an
American Board of Medical Specialists (ABMS) Member Board
for review. Upon approval of the medical specialty board and
successful completion of examinations, the physician is
designated as board certified in that specialty.
*
*

9. Board Certification (cont’d)Certificates are time-limited.
Physicians must demonstrate continued competency and re-take
the exam every six to ten years, depending on the
specialty.Board certification is a form of credentialing a
physician’s competency in a specific area.
*
*
Board Certified/Board EligibleFor staff privileges and hiring
purposes, most hospitals, HMOs, and other healthcare
organizations require a physician to be board certified or board
eligible, i.e., preparing to sit for the exams.Board certification
is used as a proxy for determining the quality of health
professional’s services. Assumption of quality is based on
research that more education and training leads to a higher
quality of service.
*
*
Continuing Medical EducationMost States require physicians to
complete a certain number of continuing medical education
(CME) credits to maintain state licensure and to demonstrate
continued competency. Hospitals may require CME credits for
their physicians to remain credentialed.Accreditation Council
for Continuing Medical Education (ACCME) establishes criteria
for determining which educational providers are quality CME

10. providers and gives its seal of approval only to those
organizations meeting their standards.
*
*
Physician CredentialingPhysician credentialing is the process of
verifying information that a physician supplies on an
application for staff privileges at a hospital, HMO, or other
healthcare organization. Physician credentialing is a time
consuming, labor intensive, costly process that must be repeated
every two years. When physicians apply for privileges at a
hospital, they must specify what they want, not only by
specialty, but in the surgical specialties, by procedure.
*
*
Core and Specific PrivilegesCore privileges cover a multitude
of activities that a physician is allowed to do in a healthcare
services organization.Specific privileges would be those
activities outside the core privileges and would require
documentation of required additional training and expertise in a
procedure.
*

11. Physician CredentialingThe hospital must conduct diligent
research on that surgeon before granting privileges, or it can be
held liable in a court of law for allowing an incompetent
physician on its staff, should there be a bad outcome.It is
preferable to obtain primary verification and documentation,
i.e., to contact each place individually by phone and obtain
original documents, such as transcripts with raised seals.
*
*
Healthcare Manager’s RoleAs a healthcare manager, you may
find yourself working in the physician relations and
credentialing department and you may be responsible for
determining whether the credentials offered by a physician are
legitimate. Physician credentialing requires excellent
interpersonal skills, organizational skills, persistence, an eye
for details, and the ability to identify inconsistencies in data.VA
(2010) study underscores need for diligence.
*
*
No Gaps in ResumesSince physicians are tracked from the
moment they graduate from medical school, the first thing you
want to verify is that there are no gaps in their resumes.
Physicians rarely take time off “to find themselves.” A
significant gap between educational or employment placements

12. is a red flag and you need to question it. You will be
responsible for safe, effective patient care, and you must be
mindful about who is providing that care.
*
*
Physician ImpostersPhysician imposters, rare, potentially
dangerous individuals, can obtain fraudulent credentials from
medical schools in other countries, or even in the US. You must
have direct contact with the authorities at the institution where
the person claims to have been educated or employed.
*
*
Physician ImpostersYou will be required to handle telephone
inquiries with tact, to ensure that you obtain verification. If no
one at an institution knows the individual, or if the medical
school has “burned down, leaving no records,” alarm bells
should be ringing and you must notify your manager.
*
*

13. National Practitioner Data BankThe National Practitioner Data
Bank (NPDB) was created to have a system, to identify,
discipline, and report those who engage in unprofessional
behavior. The intent of the NPDB is to restrict the movement of
incompetent physicians and dentists from state to state without
disclosure. “The information contained in the NPDB should be
considered together with other relevant data in evaluating a
practitioner's credentials; it is intended to augment, not replace,
traditional forms of credentials review”(NPDB, 2010).
*
*
Physician Review of CredentialsAfter the physician
credentialing department does due diligence, the materials are
submitted to a department credentialing committee, made up of
physicians. Upon approval of that committee, documents are
forwarded to a Medical Executive Committee, a subcommittee
of the hospital Board of Directors (BOD). The subcommittee
makes a recommendation to the BOD, which approves or
disapproves the application. Time from submission of the
application to final approval can take 3 to 6 months. Problems
with the application can make the process even longer.
*
*

14. International Medical GraduatesInternational Medical Graduates
(IMGs), can be US citizens who attend school abroad, or
foreign-born nationals who come to the US. IMGs represent 26
percent of the US physician workforce. 60% of IMGs are in
Primary Care; 75% are in direct patient care. The top three
countries for sending foreign-born physicians to the US are
India, the Philippines, and Cuba.
*
*
IMGs Serve Poor & Inner CityIMGs provide services where US
medical graduates won’t go.Must pass English language,
clinical skills assessment and written exams before being
allowed to apply for residencies.Future US physician workforce
will have more US-born IMGs.
*
*
IMGs and Quality of CareA study examining quality of care
provided by IMGs in Pennsylvania found the quality of care
provided to be as good as care or better than that given by those
who graduated from US medical schools (Norcini, Boulet,
Dauphinee, Opalek, Krantz & Anderson, 2010).
*

15. Physician WorkforceDemographic shifts now seen as forces
contributing to future shortage of physicians in the US.Experts
agree that the physician workforce will continue to be smaller,
younger and to work fewer hours per week regardless of gender
(Steiger, Auerbach, & Buerhaus, 2009; 2010).
*
Future Physician ShortageWill continue to see controversy of
US medical graduates vs. IMGs over the next decades. Role of
HCMN manager will be to ensure credentials of IMGs are
verified and that they are legally allowed to work in the US.
*
*
Employed PCPs and TurnoverIncreasing numbers of employed
MDs means they will no longer be independent contractors, but
employees of healthcare organizations.One recruiter reported
that in some communities as many as 90% of the physicians
may be employees (Butcher, 2008). Turnover of employed MDs
is of concern.
*
*

16. Direct Costs of PCP TurnoverEstimates of recruitment and
replacement costs for individual PCPs for three specialties (in
2001): $236,383 for Family Practice (FP); $245,128 for Internal
Medicine (IM); and, $264,645 for Pediatrics (Peds).
*
*
Indirect Costs of PCP TurnoverBur den of workload on
remaining PCPs;Decreased morale;Decreased productivity;Loss
of continuity of care; andLoss of clients and revenue stream.
*
*
MD Retention StrategiesWomen and older male MDs are more
likely to opt for part-time employment. One of the more
effective retention strategies found in a national survey was the
use of mentoring. “Setting clear expectations” for new hires was
also cited as another useful retention strategy (Cejka & AMGA,
2007, p.8).
*
Job Satisfaction and BurnoutEmployee turnover has been
clearly linked to job dissatisfaction and job burnout. Job
satisfaction is the pleasurable or positive emotional state

17. resulting from the appraisal of one’s job or job experiences. Job
burnout is a prolonged response to chronic emotional and
interpersonal stressors on the job. The organization is the
primary cause of job dissatisfaction and burnout. It is the
healthcare manager’s role to address these issues.
*
Employed MDs and
Conflict of InterestFears about the influence of gifts and other
financial incentives on MD prescribing practices and purchasing
behaviors. Some states enacted laws earlier than others to
prohibit pharmaceutical or medical device companies from
giving more than $100 in gifts to a physician organizations.
*
Conflict of Interest Conflict of interest (COI) is a term used to
describe when an individual can be influenced by money or
other considerations to act in a way that is contrary to the good
of the organization for whom he or she works or the patient for
whom he or she should be advocating in their best interests.
*
COI PoliciesMany health care organizations have specific
policies for physicians and executives regarding COI.Employees
must disclose any COIs for themselves or their family members,
including spouses. COI documents must be updated
annually.HCMN manager responsible for COI documentation
and policy enforcement.
*

18. Registered Nurses (RNs)RNs used to be trained in hospital -
based programs and received diplomas upon graduation,
essentially an apprenticeship, without a set curriculum. In 2010,
there were only 68 diploma nursing schools left in the US. The
majority of nursing education is now provided in degree-based
settings: community colleges, earning an associate degree in
two to three years, or university and college baccalaureate
programs for professional nursing practice, earning a Bachelors
of Science in Nursing (BSN) in four years.
*
*
Baccalaureate Nurses (BSNs)The undergraduate nursing school
curriculum (BSN) is rigorous, requiring a good understanding of
the biological sciences. Students are eligible to apply for
admission to the major only after completing a minimum of 42
undergraduate credits, including at least four laboratory
sciences and an English composition course. Admission is based
on GPA.
*
*
Nursing Faculty ShortageFewer nursing faculty mean fewer

19. slots for nursing students.Nursing students must be supervised
closely in clinical settings. Faculty supervisor can only have set
number of students.Otherwise, patient safety and faculty license
are jeopardized.
*
*
NCLEXNational Council Licensure Examination (NCLEX) must
be passed by nursing students to obtain nursing license.Pass
rates on NCLEX act as proxy for quality of nursing school
curriculum and the graduating nurse.Some states now require
CBCs for RN licensure, for the same reasons as MDs.
*
*
Transition to Nursing PracticeIn the past, hospitals (the major
employer of RNs) have thrown RNs into nursing units after a
minimal orientation period.Nursing turnover has resulted,
leading to massive costs to the organization, with up to $65K
per lost nurse.This becomes millions of dollars when multiplied
by the numbers of RNs quitting.
*
*

20. New Nursing GraduatesNew graduates worry about
communication with MDs, and about hurting patients. Nurse
residency programs (NRPs) are one year programs for ICUs,
CCUs, and trauma centers that give new grads more education
and training.Model NRPs have increased confidence in abilities,
increased retention, and reduced RN turnover.
*
*
CCNE Standards for NRPsIn 2008, the Commission on
Collegiate Nursing Education (CCNE) promulgated standards
for the accreditation of NRPs to be implemented in 2009
(Dracup & Morris, 2007; CCNE, 2008). NRPs desiring CCNE
accreditation must go through a number of procedures,
including a self-study and a site visit (CCNE, 2009).
*
Why Nurses LeaveRNs quit jobs where they feel overworked,
underpaid, and disrespected.RNs are concerned about: being
unable to physically continue to do the work; increases in their
daily workloads; and, the lack of ancillary staff to support them.
*
*

21. RNs and Patient MortalityOverwork of nurses and high patient-
to-nurse ratios lead to patient mortality, nurse burnout and job
dissatisfaction.The difference from 4 to 6 and from 4 to 8
patients per nurse was accompanied by 14% and 31% increases
in mortality, respectively (Aiken, Clarke, Sloane, Sochalski, &
Silber, 2002)
*
*
More Education, Better CareMore nurse education and training
leads to a higher quality of service and lower patient mortality.
It makes financial sense to employ more RNs per patient, and to
hire RNs with a baccalaureate level degree or higher.
*
Nurse-Physician RelationsIn the past, physicians had at least
twenty more years of formal education than the RNs they
worked with.The educational gap between the two healthcare
professional groups has diminished dramatically.Women have
also “come of age” since the women’s rights’ movement in the
1970’s. Nurses are no longer the doctor’s handmaiden.
*
*

22. Physicians and TeamworkMD resistance to acknowledge RNs as
professionals and colleagues leads to:poor teamwork;
interpersonal conflict; and, potentially poor patient outcomes.
Teamwork is essential to a culture of safety.
*
*
Disruptive BehaviorsIntimidating and disruptive behaviors
include “overt actions such as verbal outbursts and physical
threats as well as passive activities such as refusing to perform
assigned tasks or quietly exhibiting uncooperative attitudes
during routine activities” (The Joint Commission, 2008).
*
Sentinel EventDisruptive behavior (either MD or RN) is
considered a “sentinel event, i.e., an unexpected occurrence
involving death or serious physical or psychological injury, or
the risk thereof” (The Joint Commission, 2010). Trust and good
communication are central to excellence in healthcare delivery
and a culture of safety.
*
Organizational ClimateOrganizational climate is critical to

23. promoting job satisfaction and retention of nursing staff. Nurses
who perceive that they have access to opportunity, honest
relationships, open communication with peers, co-workers, and
managers, and trust their managers are more likely to be
retained and to have higher job satisfaction.
*
*
Hallmarks of the Professional Nursing Practice EnvironmentThe
American Association of Colleges of Nursing white paper
identifies attributes of hospitals with work environments that
support professional nursing practice, and provides a list of
questions a new graduate should ask. The questions posed by
the AACN challenge healthcare organizations to rise to higher
standards.
*
*
Certification for NursesNurses can specialize in practice areas
and take examinations that credential their competency.Some
examples of certification areas: Ambulatory Care, Cardiac
Rehabilitation, Cardiac Vascular, Case Management, Critical
Care, and Gerontological.Must demonstrate continuing
competency and renew certification on a periodic basis.
*

24. *
RN Continuing Education UnitsIn many states, nurses are
required to obtain nursing continuing education units (CEUs) to
renew and maintain their nursing license.Hundreds of providers
of nursing CEUs and multiple ways to obtain nursing CEUs, are
available. It is the responsibility of the RN to maintain her
license. The role of the healthcare manager: ensure that
resources, i.e., money and time, are available for nurses to
participate in these educational opportunities.
*
*
Foreign Educated NursesIn 2004, about 3.5% percent (100,791)
of the RNs practicing in the US received their basic nursing
education outside the US. Over 50% come from the Philippines.
About half have a baccalaureate degree or higher. Most US state
nursing boards have stringent requirements for foreign-educated
nurses, including completion of the Commission on Graduates
of Foreign Nursing Schools (CGFNS) certification program
(CGFNS, 2006).
*
*

25. Foreign RNs and HCMN ManagerThe CGFNS Certification
Program removes a major burden, however, the healthcare
manager must ensure that foreign-educated nurses have fulfilled
all the requirements of the State Board of Nursing, and that they
are legally allowed to work in the US. Different cultures bring
varying expectations to the work setting. Excellent
interpersonal skills, conflict management, cultural competency
and sensitivity to diversity issues are critical for you to be able
to be an effective healthcare manager for these employees.
*
*
LPNs/LVNsIn 2008, about 753,600 Licensed Practical Nurses
(LPNs) or Licensed Vocational Nurses (LVNs) worked under
the supervision of physicians and nurses in the US. About 25%
employed in hospitals, 25% in nursing care facilities, and 12%
in physician’s offices. After graduation from high school, LPNs
are trained in one year, state-approved programs, then must pass
the LPN licensing exam, the NCLEX-PN.
*
*
LPNs/LVNs (cont’d)LPNs do basic nursing functions, such as
vital signs, and observing patients, assisting patients with

26. activities of daily living (ADLs), like bathing, dressing, and
feeding. With additional training, where state laws allow, they
can also administer medications.
*
*
LTC and LPNsLPN’s are the backbone of the long-term care
(LTC) sector of the healthcare industry, providing around the
clock care and supervision of certified nurse’s aides (CNAs) in
nursing homes and convalescent centers. Many LPNs go on to
earn their RN, and in some states, LPNs can take challenge
examinations to earn their RN licensure. LPNs are important
members of the healthcare team, and should be included in the
healthcare manager’s tuition assistance plans.
*
*
Nurses’ Aides (NAs)In 2008, there were about 1.5 million
nursing and psychiatric aides employed in nursing and
residential care facilities, hospitals, psychiatric and subs tance
abuse facilities (BLS, 2010). Nursing aides, nursing assistants,
certified nursing assistants (CNAs), orderlies, and other
unlicensed patient attendants work under the supervision of
physicians and nurses, answering call bells, and assisting
patients with ADLs.Regardless of employment setting, aides are
front line healthcare personnel.

27. *
*
CBCs and NAsIn the past, CNAs were not required to have
criminal background checks (CBCs), and elder abusers, sexual
predators, and thieves preyed upon the elderly. Now the
majority of states and employers require CBCs. A clean CBC
doesn’t guarantee that the person hasn’t or won’t abuse a
patient. The healthcare organization must have policies about
neglect and abuse prevention in place, and the healthcare
manager must be vigilant and enforce them.
*
*
CNAs and TurnoverCNAs are trained on-the-job in 75 hours of
mandatory training, and required to pass a competency
examination. CNAs provide direct care to patients over long
periods of time.Estimates of CNA turnover from LTC facilities
ranged from 40% to 166%, with indirect and direct costs per
lost worker ranging from $951 to $6,368, with a minimum
direct cost of $2,500 per lost worker.The job of the healthcare
manager is to improve retention to slow down or stop turnover
by addressing the quality of worklife.
*

28. *
Home Health AidesIn 2008, there were 1.7 million home health
and personal care aides employed in the US (BLS, 2010).
Hospitals are discharging patients quicker and sicker, which
means more and more health care that used to be provided
strictly in hospital settings is now given at home (Landers,
2010).
*
Home Health GrowthIn addition, due to the demographic
tsunami of aging baby-boomers who wish to age in place (i.e.,
at home) and due to the increasing longevity of individuals with
chronic diseases and disability, this area of employment is
expected to grow dramatically over the next decade—and
hospitals will be in this business, too.
*
Assessing Quality of WorklifeThe healthcare manager needs to
assess the quality of the work environment, including employee
job burnout and satisfaction. Some of the items to be included
are:Job autonomy, variety and significance; Fairness of pay and
benefits;Opportunities for promotion and advancement;
Relationships with supervisors;Relationships with co-
workers;Level of job burnout; and,Overall job satisfaction.
*
*

29. Midlevel PractitionersMidlevel practitioners work mid-way
between the level of an RN and that of an MD. Advanced
Practice Nurses (APNs), such as Nurse Practitioners (NPs),
Clinical Nurse Specialists (CNS), and Nurse Anesthetists, Nurse
Midwives. Physician Assistants (PAs).
*
Midlevel Practitioners (cont’d)Serve in a variety of settings:
hospital emergency rooms or departments, covering hospital
floors for physicians, community health clinics, physician
offices and health maintenance organizations. Are usually less
expensive than physicians, often replacing MDs at a 2:1 ratio.
Are much sought after by healthcare organizations because they
can provide many of the same services as physicians, at a lower
cost.
*
Advanced Practice Nurses (APNs)In 2008, an estimated 250,527
RNs reported that they were prepared as an advanced practice
nurse in one or more advanced specialties or fields, an increase
of 4.2 percent from 2004, when there were 240,460 prepared for
advanced practice” (HRSA, 2010, p. 19)
*
Advanced Practice NursesNurse Practitioners (NPs) prepared in
either an NP MSN program or in a post-master certificate and

30. must graduate from an accredited program that includes both
didactic and clinical components and a minimum number of
hours (specified by the specialty) of supervised clinical practice
in the specialty area. Can become certified in specific areas of
care.Must pass a certification exam and maintain their
competency through continuing nursing education, and/or re-
certification exams.
*
NPs and Independent PracticeOnly eleven states permit nurse
practitioners to practice independently, i.e., without physician
supervision. However, in light of looming physician shortages,
these laws may soon change (Christian, Dower, & O’Neil,
2007).
*
Clinical Nurse Specialist (CNS)Has in-depth education in the
clinical specialty area at a Master’s degree level and must have
all of the same educational qualifications as an NP, but in their
area of focus, plus a minimum number of specified hours of
supervised clinical practice in their specialty area. Can become
certified in specific areas of care.Must pass a certification exam
and maintain their competency through continuing nursing
education, and/or re-certification exams.
*
Certified Registered Nurse Anesthetists (CRNAs)Specialize in
providing anesthesia, working in cooperation with
anesthesiologists, surgeons, dentists, and other healthcare
professionals. To become a CRNA, in addition to having a BSN

31. and an RN, and having worked at least one year as an RN in an
acute care setting, the nurse must graduate from an accredited
master’s degree nurse anesthesia program. CRNAs must also
pass a national certification examination.
*
Nurse Anesthetists’
Quality of CareA review of six years of data from the Centers
for Medicare & Medicaid Services (CMS) found no adverse
outcomes in states where nurse anesthetists were allowed to
practice solo, i.e., without the supervision of physicians
(Dulisse & Cromwell, 2010). Cheaper, more available than MDs
and equally safe—who would you hire?
*
Certified Nurse Midwives (CNMs)Licensed as independent
practitioners in all 50 states. Must be RNs, with at least 1-2
years of nursing experience, and graduate from a nurse-
midwifery education program accredited by the American
College of Nurse-Midwives (ACNM) Division of Accreditation
(DOA) and pass a national certification examination.Over 80%
of all nurse midwives have master’s degrees; another 7% have
doctoral degrees.
*
Physician Assistants (PAs)In 2008, there were 74,800 PAs
employed in the US (BLS, 2010).Over 140 accredited
educational programs as varied as certificate programs,
associate degrees, baccalaureate degrees, and masters’ degrees.

32. Take the Physician Assistant National Certifying Examination
and must demonstrate competency, to be recertified every six
years, and earn 100 CME hours every two years PAs are
versatile, valuable members of the healthcare team and are
highly sought after by physician practices, hospitals, and other
employers.
*
Allied Health ProfessionalsMore than 2000 programs in over
twenty health science occupations.Assist physicians and nurses
in providing care to in a variety of settings. Many of the
occupations have grown from the unmet demand for help in the
highly specialized operating room environment. Others have
grown out of the technological boom and the need for people to
operate highly specific equipment.
*
Allied Health ShortagesRespiratory therapy is particularly
affected, along with radiology technologists and certified
nursing assistants.One survey found all three groups were
dissatisfied with current worklife, and claimed inadequate
staffing was the “number one problem they face.” They felt
healthcare professional shortages compromised patient care, and
that turnover was impacting retention and recruitment.
*
Allied Health Shortages (cont’d)Recommendations included:
increased salaries, improved staffing ratios, better health
benefits, more input into decisions, …

33. Chapter 12
STRATEGIC MANAGEMENT OF HUMAN RESOURCES
DefinitionHuman Resources Management:Addresses the need to
ensure that qualified and motivated personnel are available to
staff the business units operated by the health service
organization (Hernandez et al., 1998)
HR ExampleA large physician practice is in need of hiring
someone to head up their information management area. The
practice has grown from seven to 23 physicians in the past five
years, and the practice administrator has realized that the
clinical and financial records needs of the practice have
outpaced current administration expertise. The administrator
wants to define the job and then recruit.
HR includes activities that are:StrategicCompete for labor and
want to have an adequate supply and the proper mix of high
quality staffHSO staff should be viewed as a “strategic asset” to
gain competitive advantageOrganizational performance depends
on individual performance

34. ….and….AdministrativeThere are a number of administrative
functions and action steps carried out in support of the human
resources of the HSO to ensure high levels of performance
Employees as Drivers of PerformanceCore services provided by
HSOs—patient care services—are highly dependent on the
capabilities and expertise of the employees of the
organizationHSOs are service organizations, unlike traditional
businesses or manufacturing firmsThey are highly specialized
organizations that provide a range of care using individual
employee expertiseHealth care workers from different
departments and units must work together to provide the overall
service for each patient
Environmental Forces Affecting HRDeclining
reimbursementLow supply of workersIncreasing population
needsIncreasing competition among HSOsExternal pressure on
HSOs for accountability and performance
Impact of Environmental Forces Fewer resources to recruit,
compensate and develop workforceShortage of skilled workers,
changes in recruiting and staffing specialized services, lower
satisfaction of workersIncreased volumes of patients and
workload for HSOsCompetition for healthcare workers and
pressure for higher wages/benefitsHR must ensure high
performance in HSO

35. Selected Key Federal Legislation Affecting HR1938: Fair Labor
Standards Act1964:Civil Rights Act1967:Age Discrimination in
Employment Act1973: Rehabilitation Act of 19731974:
Employee Retirement Income Security Act1986: Immigration
Reform and Control Act1993: Family Medical and Leave
Act2003: Health Insurance Portability and Accountability
Act2010: Patient Protection and Affordable Care Act
HR DomainsWorkforce Planning/Recruitment:Determine the
future staff needed and acquire themEmployee Retention:Care,
support and development of the staff
HR Functions: Workforce Planning/RecruitmentJob
AnalysisWorkforce PlanningEstablishing Job
DescriptionsRecruitment Interviewing, Selection, Negotiation
and HiringOrientation
HR Functions: Employee RetentionEmployee Relations and
EngagementTraining and DevelopmentCompensation and
BenefitsEmployee Assistance ProgramAssessing
PerformanceLabor RelationsLeadership DevelopmentEmployee
Suggestion Program
Responsibilities of HR Staff in RecruitmentHR Staff:Prepares
Position DescriptionJob PricingPrepares
advertisements/recruitment materialsKeeps track of
applicants/maintains HR info systemChecks applicant
referencesKeeps personnel filesNarrows candidate pool

36. Responsibilities of Line Managers in RecruitmentLine
Staff:Clarifies job function/pr ovides input into Position
DescriptionInterviews candidatesRanks candidatesSelects
candidateNegotiates with and hires candidate
CompensationBase pay:Tied to knowledge, skills, experience
and basic expectations for a specific jobIncentive
compensation:Designed to improve organizational performance
by motivating employees to higher levels of achievement and
performance
Benefits“Benefit” is defined as compensation provided in a
form other than salary or direct wages, paid for totally or in part
by employer (Jenks and Zevnik, 1993)
Major Types of BenefitsSick leaveVacationHolidaysHealth
InsuranceLife Insurance Retirement planFlexible spending
accounts
Uses of Performance AppraisalsCompare absolute and relative
performance of staffDetermine a plan for improving
performance for those employees in need of
improvementDetermine what additional training and
development activities are needed to improve employee

37. performance
Uses of Performance Appraisals (Cont’d)Use the findings to
clarify employee’s interests and desiresDocument performance
in those cases where termination or re-assignment is
necessaryDetermine adjustments to compensation based on
performanceDetermine promotional or other advancement
opportunities for the employee
ConclusionsPerformance of HSOs is tied directly to the
motivation, commitment and skills of clinical, administrative
and support staffHR actions are undertaken for both strategic
and administrative reasonsHR staff are responsible for
coordinating HR management; serve as a support for line
managers
Conclusions (Cont’d)HR management is being assessed for
contribution to organizational performanceHR management will
increase in importance in the future due to heightened external
and internal pressures to recruit and retain committed and high
performing staff
/
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use only. No part of this book
may be reproduced or transmitted without publisher's prior
permission. Violators will be prosecuted.

38. /
Printed by: [email protected] Printing is for personal, private
use only. No part of this book
may be reproduced or transmitted without publisher's prior
permission. Violators will be prosecuted.
/
Printed by: [email protected] Printing is for personal, private
use only. No part of this book
may be reproduced or transmitted without publisher's prior
permission. Violators will be prosecuted.