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2006 Nurse Employer Survey Study Design and Methods April, 2007 The North Carolina Center for Nursing Research Department staff: Linda M. Lacey Associate Director: Research Todd P. McNoldy Research Associate 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 1 Study Design A two page questionnaire was mailed to the population of nurse employers in North Carolina beginning in January, 2007. Non- respondents were contacted up to four times after the initial mailing, approximately every two weeks. An additional copy of the questionnaire was included with the first and third follow- up letters. Surveys were accepted through mid- March, 2007. The survey asked respondents questions about nursing issues affecting them in fiscal year 2006, which for most organizations ran from October 1st, 2005 to October 1st, 2006. Population of Nurse Employers Four different industry groups that rely on nurses as an integral part of their labor force were surveyed as part of the 2006 Employer Survey: hospitals, long term care facilities, Medicare-certified home health care and hospice agencies, and county- level public health departments. In addition, for the first time we surveyed all state prison facilities that employed nurses. Identified through Division of Facility Services directories for licensed health care facilities, or other sources as noted below, the entire population of organizations in each industry group was included in the study. Hospitals were identified through lists maintained by the Division of Facility Services ( DFS), which licenses all hospital facilities in the state, and from a list of North Carolina Hospital Association member organizations. The lists include acute care general hospitals as well as specialty, long- term acute care, and psychiatric hospitals. In addition, we include six hospitals that are part of the Department of Defense system: four Veterans Administration hospitals, the Naval Hospital at Camp Lejeune, and the Womack Army Medical Center at Fort Bragg. We also added Cherokee Indian Hospital, which is run through the Indian Health Service and not regulated by the DFS. These hospitals, although federally owned and operated, also draw upon the nursing labor force in the state. As part of the 2006 Nurse Employer Survey, we also sent a different psychiatric hospital survey to all four of the publicly- funded psychiatric hospitals and all three of the private psychiatric hospitals. We did not survey psychiatric facilities without in- patient services, nor did we survey in- patient psychiatric facilities that were units of general hospitals. A number of hospital and/ or health care systems exist within the state that include two or more hospitals under their jurisdiction or management umbrella. We contacted the Chief Nursing Officer ( CNO) in these systems to determine whether questionnaires could be completed separately for each hospital facility or whether nurse planning and budgeting is done centrally for the system. When possible, we requested that questionnaires be completed at the facility level rather than the system level. In several cases, however, we aggregated multiple facilities within a system on a single questionnaire in order to reduce the survey burden to the respondent. In all, we consolidated twenty- three hospitals into surveys sent to seven large hospitals systems – Carolinas HealthCare System, Cape Fear Valley Health System, Moses Cone Health System, the Nash General System, the New Hanover Regional Medical Center system, Presbyterian Hospitals, and the WakeMed hospital system. Our key informant at each hospital was the Chief Nursing Officer ( CNO). Some questions on the survey required coordination with Human Resource Departments, and some portions of the questionnaire may have been delegated at the discretion of the CNO. 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 2 All hospitals in the state, with the exceptions noted above, were included in the study and sent a survey questionnaire. The total number of hospitals ( including psychiatric hospitals) and hospital systems included in the study was 135. Long Term Care facilities were identified through a list developed and maintained by the Division of Facility Services. Every skilled nursing facility licensed to provide services in the state was included in the study. Although there are many chains or systems operating long term care facilities in North Carolina, most facilities are managed independently, as least in terms of their nursing staff. For that reason we asked each facility in the state to respond to the survey. Questionnaires were sent to the Directors of Nursing at each facility. The final population list included a total of 393 long term care skilled nursing facilities. One facility was removed from the list after we were unable to contact it. Home Health and Hospice agencies included in the 2006 Survey of Nurse Employers were identified through lists maintained by the Division of Facility Services. DFS manages two lists, one for home care and one for hospices, and from these we created a subset of only those agencies or facilities with Medicare/ Medicaid provider numbers. This removed from the population list those home care agencies that do not specifically provide home health services and which do not employ nurses. We then cross- referenced the Medicare/ Medicaid- certified home health and hospice agencies with membership lists provided by the North Carolina Association for Home and Hospice Care and the Center for End- of- Life Care to verify and update agency names, addresses, and contacts. Surveying home health and hospice agencies presents some unique problems because of this industry group’s structure. Many agencies are operated by chains and systems, and unlike long term care facilities, in many cases these agencies are unable to report nurse staffing data at the facility level. We contacted the parent or corporate office of these chains to determine whether branch and/ or unit offices could complete separate surveys. Whenever possible, we surveyed chains at the facility- level. In 33 cases – or 17.3% of the organizations surveyed -- we combined parent, branch and unit locations on a single questionnaire at the request of the facility administrators. Most systems requesting aggregation in a single questionnaire operate in one region of the state, but a few of them have agencies stretching across the state. When this occurs the result is that these aggregated facilities must be dropped from any analysis using geographic identifiers such as AHEC region, or location in metropolitan areas. In two cases, respondents agreed to report staffing data separately for each region served by the system so that they could at least be included in regional analysis of the data. Most decisions to aggregate multiple facilities were agreed upon before the survey was put into the field. Home health and hospice surveys were directed to the person responsible for nursing staff planning – usually the facility administrator or the Director of Nursing if such was available. Unlike other industry groups in this study, home health and hospice agencies were offered an incentive for participation in the study. The North Carolina Association for Home and Hospice Care donated one free conference registration for their annual meeting, which we awarded to one randomly selected respondent. Mentions of the potential prize were included in the cover letter and all reminder mailings. The total number of home health and/ or hospice care agencies/ systems included in the study was 194. We reduced our final population list by three cases when one agency responded with aggregated data for itself and three other agencies in its system, for an adjusted N of 191. 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 3 Public Health Departments across the state were also included in the study. We used the ‘ white pages’ of the 2006 Directory of Nurses Employed in Local Health Departments in North Carolina, published by NC Department of Health and Human Services, to identify each facility location ( some health departments operate in multiple locations) and the Director of Nursing at each location. There are a six regional public health districts that organize and administer multiple county health departments. Where possible, we had facilities in each county of the conglomerate complete separate questionnaires. In five cases, a single questionnaire covered multiple facilities in a district. There were also cases where multiple physical facilities exist within a single county under the purview of a single health department. In all of these cases we asked the health departments to combine their multiple facilities and report the aggregated information. The total number of health departments and regional districts included in the study was 88. State Prisons were included for the first time on the 2006 survey. The North Carolina Department of Corrections Director of Nursing provided a complete list of state prison facilities that employ nursing personnel. Since facilities vary in size and in the level of care they provide – from no care in small level 1 prison facilities to acute medical, psychiatric, and skilled nursing care in very large, level 4 prison facilities – we sent the DON a separate survey for each prison rather than aggregating them all on one survey plus a survey covering the DOC nursing administrative office. The DON completed surveys for the central office and all but one of the 78 state prisons. Response Rates Response rates varied by industry group from a high of 98.7% for prisons to a low of 40.1% for long term care facilities. The table below reports the final response rates. The second column reports the number of cases in each industry group that were not deliverable ( bad addresses) or were aggregated into a single survey after the initial survey mailing. This number effectively reduces the size of the original group and is taken into account when calculating response rates. In all industry groups, except long term care, there were no undeliverable questionnaires. One unplanned aggregation was allowed for a home health and hospice agency that answered for all agencies in its system. Industry Group # of Surveys Sent Out # of non-deliverables/ aggregations # of Surveys Returned Adjusted Response Rate 1 Hospitals ( All) 135 0 86 63.7% Non- psychiatric 128 0 81 63.3% Psychiatric 7 0 5 71.4% Home Health/ Hospice 194 3 124 64.9% Long Term Care 393 1 157 40.1% Public Health 88 0 76 86.4% Prisons 79 0 78 98.7% 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 4 1 The response rate is adjusted by subtracting the number of non- deliverables from the total number of surveys sent out before calculating the response rate. Bias Analysis We conducted a bias analysis of the hospitals, home health and hospice agencies, and long term care facilities that did and did not respond to our survey in order to determine if any response bias exists. We were able to compare respondents and non- respondents in terms of their geographic regional location in the state ( East, Central, West), and the metropolitan status of their county location. We were also able to compare hospitals and long term care facilities in terms of size ( i. e. licensed beds) in 2006. All prisons responded to our survey, and only twelve public health departments did not respond to our survey, so a bias analysis was not necessary for these groups. Region For each industry group – hospitals, long term care facilities, and home health and hospice agencies -- respondent and non- respondent cases were assigned to their respective regional groups ( see the section below for how geographic regions in the state and metropolitan status were defined). We then compared the proportion of respondents and non- respondents in each region, using chi- square to test for statistically significant differences. A similar procedure was followed to test for differences by metropolitan status of the facility’s county. The results of this analysis showed no statistically significant differences between the organizations that responded to the survey and those that did not in terms of their geographic regional location or location in a metropolitan area for any of the industry groups on which we conducted bias analyses. Size Number of licensed beds in each hospital was obtained from the facility licensure data maintained by the NC Division of Facility Services. After running the analysis of difference with all cases, we also omitted the top and bottom 2% of cases in order to minimize the impact of extremely large and small outliers in the respondent and non- respondent groups. We then compared the average number of beds between the two groups, computing a 95% confidence interval around each mean. This t- test of difference between averages indicated no significant differences in size between our respondents and non- respondents for hospitals. We also attempted to categorize hospitals by size, first by cutting hospitals into three types based on the number of beds -- small, medium, and large – and then into just two sizes, small and large, using the median number of beds ( 136) as the cutpoint. We employed a chi- square to test for distribution differences between respondents and non- respondents for both the three- category and the two- category hospital sizes. The three- category chi- square revealed a significant difference in size between respondent and non- respondent groups with medium- sized hospitals comprising 53.86% of the non- respondents. However, the two- category chi- square did not indicate any significant differences between respondents and non- respondents. Since the two-category hospital size results matched those found in the more robust t- test of differences between respondents and non- respondents, we can feel confident in the generalizability of the hospital data. Licensed bed counts for long term care facilities in 2006 were obtained from the facility licensure data maintained by the NC Division of Facility Services. As with hospitals, we created three 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 5 categories for long term care facility size - small facilities had 90 or fewer beds, medium facilities had 91- 120 beds, and large facilities had 121 or more beds. In addition, we split long term care facility size into two categories, small and large, using the median number of beds ( 120) as the cutpoint. The average number of licensed beds in responding long term care facilities was not significantly different from the average number of beds in facilities that did not respond, and comparisons of the distribution across small, medium and large facilities as well as across small and large facilities did not reveal any response bias based on facility size. Geographic Definitions Each county in the state has been classified according to general region ( East, Central or West), Area Health Education Center ( AHEC) service areas, and metropolitan status. The table below lists each county’s regional, AHEC, and metro designation. Three regions of the state have been defined for analysis purposes based on Area Health Education Center ( AHEC) service areas. The Western region includes all of the counties served by the Mountain and Northwest AHECs. The Central part of the state includes all of the counties served by the Charlotte, Greensboro and Wake AHECs. The Eastern region includes all of the counties served by the Area L, Coastal, Eastern and Southern Regional AHECs. These three regions of the state, while not equal in size or population coverage, roughly correspond to the distribution of health care market areas operating within the state. This study uses the 2000 federal Office of Management and Budget definition of counties as metropolitan, micropolitan, or neither. These classifications were developed using data from the 2000 Census. Metropolitan Statistical Areas have a core urban area with a population of at least 50,000 and include all counties with significant commuting and economic ties with the core. Micropolitan Statistical Areas have a core urban population cluster of more than 10,000 but less than 50,000 and include counties with ties to the core. Counties classified as neither metropolitan nor micropolitan do not have sufficient ties to an urban area to be included under its core- based statistical area umbrella. The metropolitan and micropolitan statistical areas standards do not equate to a classification of rural or urban since all counties in a metro or micro areas – as well as all other counties – contain both urban and rural territories and population. i 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 6 The table below contains the regional designation, AHEC area, and metropolitan status for every county in North Carolina. County Name Regional Designation AHEC Region Metropolitan Status ( 2000 OMB Definition) Alamance Central Greensboro Metropolitan Alexander West Northwest Metropolitan Alleghany West Northwest Neither Anson Central Charlotte Metropolitan Ashe West Northwest Neither Avery West Northwest Neither Beaufort East Eastern Micropolitan Bertie East Eastern Neither Bladen East Southern Regional Neither Brunswick East Coastal Metropolitan Buncombe West Mountain Metropolitan Burke West Northwest Metropolitan Cabarrus Central Charlotte Metropolitan Caldwell West Northwest Metropolitan Camden East Eastern Micropolitan Carteret East Eastern Micropolitan Caswell Central Greensboro Neither Catawba West Northwest Metropolitan Chatham Central Greensboro Metropolitan Cherokee West Mountain Neither Chowan East Eastern Neither Clay West Mountain Neither Cleveland Central Charlotte Micropolitan Columbus East Coastal Neither Craven East Eastern Micropolitan Cumberland East Southern Regional Metropolitan Currituck East Eastern Metropolitan Dare East Eastern Micropolitan Davidson West Northwest Micropolitan Davie West Northwest Metropolitan Duplin East Coastal Neither Durham Central Wake Metropolitan 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 7 Edgecombe East Area L Metropolitan County Name Region AHEC Metropolitan Status ( 2000 OMB Definition) Forsyth West Northwest Metropolitan Franklin Central Wake Metropolitan Gaston Central Charlotte Metropolitan Gates East Eastern Neither Graham West Mountain Neither Granville Central Wake Neither Greene East Eastern Metropolitan Guilford Central Greensboro Metropolitan Halifax East Area L Micropolitan Harnett East Southern Regional Micropolitan Haywood West Mountain Metropolitan Henderson West Mountain Metropolitan Hertford East Eastern Neither Hoke East Southern Regional Metropolitan Hyde East Eastern Neither Iredell West Northwest Micropolitan Jackson West Mountain Neither Johnston Central Wake Metropolitan Jones East Eastern Micropolitan Lee Central Wake Micropolitan Lenoir East Eastern Micropolitan Lincoln Central Charlotte Micropolitan Macon West Mountain Neither Madison West Mountain Neither Martin East Eastern Metropolitan McDowell West Mountain Neither Mecklenburg Central Charlotte Metropolitan Mitchell West Mountain Neither Montgomery Central Greensboro Neither Moore East Southern Regional Micropolitan Nash East Area L Metropolitan New Hanover East Coastal Metropolitan Northampton East Area L Micropolitan Onslow East Eastern Metropolitan Orange Central Greensboro Metropolitan Pamlico East Eastern Micropolitan 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 8 Pasquotank East Eastern Micropolitan Region AHEC Metropolitan Status ( 2000 OMB Definition) Pender East Coastal Metropolitan Perquimans East Eastern Micropolitan Person Central Wake Metropolitan Pitt East Eastern Metropolitan Polk West Mountain Neither Randolph Central Greensboro Metropolitan Richmond East Southern Regional Micropolitan Robeson East Southern Regional Micropolitan Rockingham Central Greensboro Metropolitan Rowan West Northwest Micropolitan Rutherford Central Charlotte Micropolitan Sampson East Southern Regional Neither Scotland East Southern Regional Micropolitan Stanly Central Charlotte Micropolitan Stokes West Northwest Metropolitan Surry West Northwest Micropolitan Swain West Mountain Neither Transylvania West Mountain Micropolitan Tyrrell East Eastern Neither Union Central Charlotte Metropolitan Vance Central Wake Micropolitan Wake Central Wake Metropolitan Warren Central Wake Neither Washington East Eastern Neither Watauga West Northwest Micropolitan Wayne East Eastern Metropolitan Wilkes West Northwest Micropolitan Wilson East Area L Micropolitan Yadkin West Northwest Metropolitan Yancey West Mountain Neither i See the Federal Register, December 27, 2000, for the standards used to define Metropolitan and Micropolitan Statistical Areas.
Object Description
Description
Title | Nurse employer survey study design and methods. |
Other Title | Nurse employer survey study design and methods |
Date | 2007-04 |
Description | 2006 |
Digital Characteristics-A | 55 KB; 9 p. |
Digital Format | application/pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_borndigital\images_master\ |
Full Text | 2006 Nurse Employer Survey Study Design and Methods April, 2007 The North Carolina Center for Nursing Research Department staff: Linda M. Lacey Associate Director: Research Todd P. McNoldy Research Associate 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 1 Study Design A two page questionnaire was mailed to the population of nurse employers in North Carolina beginning in January, 2007. Non- respondents were contacted up to four times after the initial mailing, approximately every two weeks. An additional copy of the questionnaire was included with the first and third follow- up letters. Surveys were accepted through mid- March, 2007. The survey asked respondents questions about nursing issues affecting them in fiscal year 2006, which for most organizations ran from October 1st, 2005 to October 1st, 2006. Population of Nurse Employers Four different industry groups that rely on nurses as an integral part of their labor force were surveyed as part of the 2006 Employer Survey: hospitals, long term care facilities, Medicare-certified home health care and hospice agencies, and county- level public health departments. In addition, for the first time we surveyed all state prison facilities that employed nurses. Identified through Division of Facility Services directories for licensed health care facilities, or other sources as noted below, the entire population of organizations in each industry group was included in the study. Hospitals were identified through lists maintained by the Division of Facility Services ( DFS), which licenses all hospital facilities in the state, and from a list of North Carolina Hospital Association member organizations. The lists include acute care general hospitals as well as specialty, long- term acute care, and psychiatric hospitals. In addition, we include six hospitals that are part of the Department of Defense system: four Veterans Administration hospitals, the Naval Hospital at Camp Lejeune, and the Womack Army Medical Center at Fort Bragg. We also added Cherokee Indian Hospital, which is run through the Indian Health Service and not regulated by the DFS. These hospitals, although federally owned and operated, also draw upon the nursing labor force in the state. As part of the 2006 Nurse Employer Survey, we also sent a different psychiatric hospital survey to all four of the publicly- funded psychiatric hospitals and all three of the private psychiatric hospitals. We did not survey psychiatric facilities without in- patient services, nor did we survey in- patient psychiatric facilities that were units of general hospitals. A number of hospital and/ or health care systems exist within the state that include two or more hospitals under their jurisdiction or management umbrella. We contacted the Chief Nursing Officer ( CNO) in these systems to determine whether questionnaires could be completed separately for each hospital facility or whether nurse planning and budgeting is done centrally for the system. When possible, we requested that questionnaires be completed at the facility level rather than the system level. In several cases, however, we aggregated multiple facilities within a system on a single questionnaire in order to reduce the survey burden to the respondent. In all, we consolidated twenty- three hospitals into surveys sent to seven large hospitals systems – Carolinas HealthCare System, Cape Fear Valley Health System, Moses Cone Health System, the Nash General System, the New Hanover Regional Medical Center system, Presbyterian Hospitals, and the WakeMed hospital system. Our key informant at each hospital was the Chief Nursing Officer ( CNO). Some questions on the survey required coordination with Human Resource Departments, and some portions of the questionnaire may have been delegated at the discretion of the CNO. 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 2 All hospitals in the state, with the exceptions noted above, were included in the study and sent a survey questionnaire. The total number of hospitals ( including psychiatric hospitals) and hospital systems included in the study was 135. Long Term Care facilities were identified through a list developed and maintained by the Division of Facility Services. Every skilled nursing facility licensed to provide services in the state was included in the study. Although there are many chains or systems operating long term care facilities in North Carolina, most facilities are managed independently, as least in terms of their nursing staff. For that reason we asked each facility in the state to respond to the survey. Questionnaires were sent to the Directors of Nursing at each facility. The final population list included a total of 393 long term care skilled nursing facilities. One facility was removed from the list after we were unable to contact it. Home Health and Hospice agencies included in the 2006 Survey of Nurse Employers were identified through lists maintained by the Division of Facility Services. DFS manages two lists, one for home care and one for hospices, and from these we created a subset of only those agencies or facilities with Medicare/ Medicaid provider numbers. This removed from the population list those home care agencies that do not specifically provide home health services and which do not employ nurses. We then cross- referenced the Medicare/ Medicaid- certified home health and hospice agencies with membership lists provided by the North Carolina Association for Home and Hospice Care and the Center for End- of- Life Care to verify and update agency names, addresses, and contacts. Surveying home health and hospice agencies presents some unique problems because of this industry group’s structure. Many agencies are operated by chains and systems, and unlike long term care facilities, in many cases these agencies are unable to report nurse staffing data at the facility level. We contacted the parent or corporate office of these chains to determine whether branch and/ or unit offices could complete separate surveys. Whenever possible, we surveyed chains at the facility- level. In 33 cases – or 17.3% of the organizations surveyed -- we combined parent, branch and unit locations on a single questionnaire at the request of the facility administrators. Most systems requesting aggregation in a single questionnaire operate in one region of the state, but a few of them have agencies stretching across the state. When this occurs the result is that these aggregated facilities must be dropped from any analysis using geographic identifiers such as AHEC region, or location in metropolitan areas. In two cases, respondents agreed to report staffing data separately for each region served by the system so that they could at least be included in regional analysis of the data. Most decisions to aggregate multiple facilities were agreed upon before the survey was put into the field. Home health and hospice surveys were directed to the person responsible for nursing staff planning – usually the facility administrator or the Director of Nursing if such was available. Unlike other industry groups in this study, home health and hospice agencies were offered an incentive for participation in the study. The North Carolina Association for Home and Hospice Care donated one free conference registration for their annual meeting, which we awarded to one randomly selected respondent. Mentions of the potential prize were included in the cover letter and all reminder mailings. The total number of home health and/ or hospice care agencies/ systems included in the study was 194. We reduced our final population list by three cases when one agency responded with aggregated data for itself and three other agencies in its system, for an adjusted N of 191. 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 3 Public Health Departments across the state were also included in the study. We used the ‘ white pages’ of the 2006 Directory of Nurses Employed in Local Health Departments in North Carolina, published by NC Department of Health and Human Services, to identify each facility location ( some health departments operate in multiple locations) and the Director of Nursing at each location. There are a six regional public health districts that organize and administer multiple county health departments. Where possible, we had facilities in each county of the conglomerate complete separate questionnaires. In five cases, a single questionnaire covered multiple facilities in a district. There were also cases where multiple physical facilities exist within a single county under the purview of a single health department. In all of these cases we asked the health departments to combine their multiple facilities and report the aggregated information. The total number of health departments and regional districts included in the study was 88. State Prisons were included for the first time on the 2006 survey. The North Carolina Department of Corrections Director of Nursing provided a complete list of state prison facilities that employ nursing personnel. Since facilities vary in size and in the level of care they provide – from no care in small level 1 prison facilities to acute medical, psychiatric, and skilled nursing care in very large, level 4 prison facilities – we sent the DON a separate survey for each prison rather than aggregating them all on one survey plus a survey covering the DOC nursing administrative office. The DON completed surveys for the central office and all but one of the 78 state prisons. Response Rates Response rates varied by industry group from a high of 98.7% for prisons to a low of 40.1% for long term care facilities. The table below reports the final response rates. The second column reports the number of cases in each industry group that were not deliverable ( bad addresses) or were aggregated into a single survey after the initial survey mailing. This number effectively reduces the size of the original group and is taken into account when calculating response rates. In all industry groups, except long term care, there were no undeliverable questionnaires. One unplanned aggregation was allowed for a home health and hospice agency that answered for all agencies in its system. Industry Group # of Surveys Sent Out # of non-deliverables/ aggregations # of Surveys Returned Adjusted Response Rate 1 Hospitals ( All) 135 0 86 63.7% Non- psychiatric 128 0 81 63.3% Psychiatric 7 0 5 71.4% Home Health/ Hospice 194 3 124 64.9% Long Term Care 393 1 157 40.1% Public Health 88 0 76 86.4% Prisons 79 0 78 98.7% 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 4 1 The response rate is adjusted by subtracting the number of non- deliverables from the total number of surveys sent out before calculating the response rate. Bias Analysis We conducted a bias analysis of the hospitals, home health and hospice agencies, and long term care facilities that did and did not respond to our survey in order to determine if any response bias exists. We were able to compare respondents and non- respondents in terms of their geographic regional location in the state ( East, Central, West), and the metropolitan status of their county location. We were also able to compare hospitals and long term care facilities in terms of size ( i. e. licensed beds) in 2006. All prisons responded to our survey, and only twelve public health departments did not respond to our survey, so a bias analysis was not necessary for these groups. Region For each industry group – hospitals, long term care facilities, and home health and hospice agencies -- respondent and non- respondent cases were assigned to their respective regional groups ( see the section below for how geographic regions in the state and metropolitan status were defined). We then compared the proportion of respondents and non- respondents in each region, using chi- square to test for statistically significant differences. A similar procedure was followed to test for differences by metropolitan status of the facility’s county. The results of this analysis showed no statistically significant differences between the organizations that responded to the survey and those that did not in terms of their geographic regional location or location in a metropolitan area for any of the industry groups on which we conducted bias analyses. Size Number of licensed beds in each hospital was obtained from the facility licensure data maintained by the NC Division of Facility Services. After running the analysis of difference with all cases, we also omitted the top and bottom 2% of cases in order to minimize the impact of extremely large and small outliers in the respondent and non- respondent groups. We then compared the average number of beds between the two groups, computing a 95% confidence interval around each mean. This t- test of difference between averages indicated no significant differences in size between our respondents and non- respondents for hospitals. We also attempted to categorize hospitals by size, first by cutting hospitals into three types based on the number of beds -- small, medium, and large – and then into just two sizes, small and large, using the median number of beds ( 136) as the cutpoint. We employed a chi- square to test for distribution differences between respondents and non- respondents for both the three- category and the two- category hospital sizes. The three- category chi- square revealed a significant difference in size between respondent and non- respondent groups with medium- sized hospitals comprising 53.86% of the non- respondents. However, the two- category chi- square did not indicate any significant differences between respondents and non- respondents. Since the two-category hospital size results matched those found in the more robust t- test of differences between respondents and non- respondents, we can feel confident in the generalizability of the hospital data. Licensed bed counts for long term care facilities in 2006 were obtained from the facility licensure data maintained by the NC Division of Facility Services. As with hospitals, we created three 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 5 categories for long term care facility size - small facilities had 90 or fewer beds, medium facilities had 91- 120 beds, and large facilities had 121 or more beds. In addition, we split long term care facility size into two categories, small and large, using the median number of beds ( 120) as the cutpoint. The average number of licensed beds in responding long term care facilities was not significantly different from the average number of beds in facilities that did not respond, and comparisons of the distribution across small, medium and large facilities as well as across small and large facilities did not reveal any response bias based on facility size. Geographic Definitions Each county in the state has been classified according to general region ( East, Central or West), Area Health Education Center ( AHEC) service areas, and metropolitan status. The table below lists each county’s regional, AHEC, and metro designation. Three regions of the state have been defined for analysis purposes based on Area Health Education Center ( AHEC) service areas. The Western region includes all of the counties served by the Mountain and Northwest AHECs. The Central part of the state includes all of the counties served by the Charlotte, Greensboro and Wake AHECs. The Eastern region includes all of the counties served by the Area L, Coastal, Eastern and Southern Regional AHECs. These three regions of the state, while not equal in size or population coverage, roughly correspond to the distribution of health care market areas operating within the state. This study uses the 2000 federal Office of Management and Budget definition of counties as metropolitan, micropolitan, or neither. These classifications were developed using data from the 2000 Census. Metropolitan Statistical Areas have a core urban area with a population of at least 50,000 and include all counties with significant commuting and economic ties with the core. Micropolitan Statistical Areas have a core urban population cluster of more than 10,000 but less than 50,000 and include counties with ties to the core. Counties classified as neither metropolitan nor micropolitan do not have sufficient ties to an urban area to be included under its core- based statistical area umbrella. The metropolitan and micropolitan statistical areas standards do not equate to a classification of rural or urban since all counties in a metro or micro areas – as well as all other counties – contain both urban and rural territories and population. i 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 6 The table below contains the regional designation, AHEC area, and metropolitan status for every county in North Carolina. County Name Regional Designation AHEC Region Metropolitan Status ( 2000 OMB Definition) Alamance Central Greensboro Metropolitan Alexander West Northwest Metropolitan Alleghany West Northwest Neither Anson Central Charlotte Metropolitan Ashe West Northwest Neither Avery West Northwest Neither Beaufort East Eastern Micropolitan Bertie East Eastern Neither Bladen East Southern Regional Neither Brunswick East Coastal Metropolitan Buncombe West Mountain Metropolitan Burke West Northwest Metropolitan Cabarrus Central Charlotte Metropolitan Caldwell West Northwest Metropolitan Camden East Eastern Micropolitan Carteret East Eastern Micropolitan Caswell Central Greensboro Neither Catawba West Northwest Metropolitan Chatham Central Greensboro Metropolitan Cherokee West Mountain Neither Chowan East Eastern Neither Clay West Mountain Neither Cleveland Central Charlotte Micropolitan Columbus East Coastal Neither Craven East Eastern Micropolitan Cumberland East Southern Regional Metropolitan Currituck East Eastern Metropolitan Dare East Eastern Micropolitan Davidson West Northwest Micropolitan Davie West Northwest Metropolitan Duplin East Coastal Neither Durham Central Wake Metropolitan 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 7 Edgecombe East Area L Metropolitan County Name Region AHEC Metropolitan Status ( 2000 OMB Definition) Forsyth West Northwest Metropolitan Franklin Central Wake Metropolitan Gaston Central Charlotte Metropolitan Gates East Eastern Neither Graham West Mountain Neither Granville Central Wake Neither Greene East Eastern Metropolitan Guilford Central Greensboro Metropolitan Halifax East Area L Micropolitan Harnett East Southern Regional Micropolitan Haywood West Mountain Metropolitan Henderson West Mountain Metropolitan Hertford East Eastern Neither Hoke East Southern Regional Metropolitan Hyde East Eastern Neither Iredell West Northwest Micropolitan Jackson West Mountain Neither Johnston Central Wake Metropolitan Jones East Eastern Micropolitan Lee Central Wake Micropolitan Lenoir East Eastern Micropolitan Lincoln Central Charlotte Micropolitan Macon West Mountain Neither Madison West Mountain Neither Martin East Eastern Metropolitan McDowell West Mountain Neither Mecklenburg Central Charlotte Metropolitan Mitchell West Mountain Neither Montgomery Central Greensboro Neither Moore East Southern Regional Micropolitan Nash East Area L Metropolitan New Hanover East Coastal Metropolitan Northampton East Area L Micropolitan Onslow East Eastern Metropolitan Orange Central Greensboro Metropolitan Pamlico East Eastern Micropolitan 2006 Nurse Employer Survey: Study Design and Methods April, 2007 North Carolina Center for Nursing Page 8 Pasquotank East Eastern Micropolitan Region AHEC Metropolitan Status ( 2000 OMB Definition) Pender East Coastal Metropolitan Perquimans East Eastern Micropolitan Person Central Wake Metropolitan Pitt East Eastern Metropolitan Polk West Mountain Neither Randolph Central Greensboro Metropolitan Richmond East Southern Regional Micropolitan Robeson East Southern Regional Micropolitan Rockingham Central Greensboro Metropolitan Rowan West Northwest Micropolitan Rutherford Central Charlotte Micropolitan Sampson East Southern Regional Neither Scotland East Southern Regional Micropolitan Stanly Central Charlotte Micropolitan Stokes West Northwest Metropolitan Surry West Northwest Micropolitan Swain West Mountain Neither Transylvania West Mountain Micropolitan Tyrrell East Eastern Neither Union Central Charlotte Metropolitan Vance Central Wake Micropolitan Wake Central Wake Metropolitan Warren Central Wake Neither Washington East Eastern Neither Watauga West Northwest Micropolitan Wayne East Eastern Metropolitan Wilkes West Northwest Micropolitan Wilson East Area L Micropolitan Yadkin West Northwest Metropolitan Yancey West Mountain Neither i See the Federal Register, December 27, 2000, for the standards used to define Metropolitan and Micropolitan Statistical Areas. |
OCLC number | 319705679 |