TABLE II.—Number of nursing home beds in Minneapolis by grádés [Includes adjustments for homes closed and new homes opened in the interval between the specified

scoring dates]

(See fig. I in pt. I of this article for a reproduction of the scoring sheets.) When data obtained through the Minneapolis scoring system were tabulated so that all nursing homes in Minneapolis were included much useful statistical information was extracted. For instance an overall picture of the general attitudes and efficiency of administrators was obtained by adding separately all points scored in each of these areas. This was then converted into percentages by using the maximum of 2 points per home as 100 percent. Since on September 1, 1959, there were 65 nursing homes in the city, the highest possible aggregate score in each area on that date was 130, which was taken as 100 percent. Table III shows the aggregate scores in these two administration areas in percentages on the dates mentioned. This table shows that on a citywide basis the attitude of administrators improved from a score of 65 percent on September 1, 1959, to 81.7 percent on January 1, 1961, and efficiency of administrators shifted from 55 percent to 71.7 percent. This, on the whole, is a very satisfactory showing and speaks well for the quality of administrators who are managing nursing homes in Minneapolis. It also reflects the cooperation administrators are giving the Minneapolis Health Department in efforts being made to improve nursing homes in the city. It also indicates that administrators on the whole are making adjustments for the better.

By relating turnover of employees to attitudes and efficiency of administrators it should be possible to show the effect of good administration on turnover. On the basis of incomplete returns, enough information has been obtained in Minneapolis to suggest that turnover in nursing homes with poor administration may run on the average as much as three times as high as in nursing homes with good administration.

TABLE III.—Aggregate scoring of attitudes and efficiency of administrators in all nursing homes in Minneapolis in percent of the maximum at 4-month intervals beginning Sept. 1, 1959

[2 points multiplied by the total number of nursing homes operating on the dates of scoring gives the 100percent aggregate]

Figure II shows graphically the relationship of administration to grades. For this graph only the most recent evaluation was used. It depicts the relationship on January 1, 1961. For this graph the two areas of scoring of administra tion (attitudes and efficiency) were combined. By multiplying the number of nursing homes in each grade by 4 an aggregate figure is obtained which represents 100 percent. By adding together the number of points scored in administration in each grade separately, we obtain a figure which can be converted into a percentage of the maximum aggregate for the grade. For example, on January 1, 1961, there were 26 homes in grade C (see table I). A score of 4 each in administration makes a possible aggregate of 104. The total points actually scored in administration, in the 26 homes, was 63 which is 61 percent. Figure II clearly shows that good administration has a direct relationship to better grades. The fact that, even in grade C, the scoring of administration is better than the acceptable 50 percent indicated that administration is, on the whole, quite good. FIGURE II.-RELATIONSHIP OF GRADES A, B, AND C, TO PERCENTAGE SCORES OF ADMINISTRATORS ON JANUARY 1, 1961

Figure III is a similar percentage graph showing the relationship between the one area of inservice training and grades A, B, and C on January 1, 1961. (For numbers in the various grades see table I.) It is obvious that the best job of inservice training is being done in grade A homes and the poorest in grade C homes. Since this graph shows that inservice training is generally unsatisfactory in grade C homes, and not much above 50 percent in grade B homes, the natural conclusion is that program emphasis needs to be turned in this direction.

FIGURE III.-RELATIONSHIP OF IN-SERVICE TRAINING TO GRADES A, B, AND C, ON JANUARY 1, 1961 94.48

Grade A

50%

Figure IV is a similar percentage graph showing the relationship between the one area of rehabilitation nursing and grades A, B, and C on January 1, 1961. Grade A homes are doing a good job in this particular area of nursing, while grades B and C are not. Here again the need for program emphasis in this direction is well demonstrated.

FIGURE IV.-RELATIONSHIP OF REHABILITATION NURSING TO GRADES A, B, and C ON JANUARY 1, 1961

t

Figure V shows how the qualifications of the nurse in charge affect the grades. In this graph the percentage of homes served by registered nurses in charge is compared with the percentage served by licensed practical nurses in charge. Each of the grades A, B, and C is depicted separately. Figure V percentages represent the situation in Minneapolis on January 1, 1961. The percentage of registered nurses is shown in black and the percentage of licensed practical nurses in gray. In the evaluation of performance made through use of the Minneapolis scoring system no weight is given which would favor the registered nurse. Therefore, figure V simply shows that registered nurses do a better job of managing a nursing service than licensed practical nurses. Obviously their good work helps to raise the grade of nursing homes.

FIGURE V.-EFFECT OF THE SUPERVISOR'S TRAINING ON GRADES

State

Based on training of the nurses-in-charge and the grades on January 1, 1961. law requires that the nurse-in-charge must be either a registered nurse or a licensed practical nurse. The percentage with registered nurse training is represented in solid black and licensed practice nurse training in grey.