The employee turnover rate of nurses at our hospital has been higher than the national average. To stabilize the nursing workforce and to decrease the employee turnover rate, we participated in promotion of the 2012 Work Life Balance (WLB) Program organized by the Japanese Nursing Association. In this study, we examined the work-life-study balance (WLSB), adding the activity of “study” to WLB, by evaluating the three activities over a 2-year period. Members tasked with promoting and addressing the issues of WLSB consisted of those in the operation improvement team, Partnership Nursing System (PNS) team, and labor management team. A committee supervised the progress of each team, conducted an index surveillance and a satisfaction survey, and observed changes among nurses who were complaining. A WLSB training course was held for leaders among the staff members. As a result of the PDCA (plan-do-check-act) management cycle being run every 2 months, we achieved the objectives to improve operations and the rate of fulfilling a &ldqup;no overtime day” was improved from 0% to 70-80%. In addition, a &ldqup;birthday day off” and a long vacation were taken systematically, the rate of taking paid vacation improved because of the introduction of paid half-days off, and trainees on the WLSB training course appeared to change, now finding their work worthwhile and enjoyable. The PNS was also introduced. Staff members realized that these results of actions taken were successful, and a positive work climate has been created. The actions taken likely created a comfortable work environment for nurses and accelerated the rate of feeling settled in the workplace by decreasing factors creating dissatisfaction and increasing levels of satisfaction.

Objective：To assess the risk for hyperkalemia caused by treatment with angiotensin Ⅱ Type 1 receptor blockers （ARB） in clinical practice with Japanese medical database.Design：A cohort study in patients treated with ARB alone and those treated with calcium channel blockers （CCB） alone as control.Methods：The Diagnosis Procedure Combination （DPC） database provided by Medical Data Vision Co., Ltd. was used to identify patients who received a diagnosis of hypertension (ICD-10 codes, I10 to I15) and were treated with ARB or CCB from April 2008 to June 2017. A logistic regression model was applied to estimate adjusted odds ratios （OR） and their 95％ confidence intervals （CI） in these patients. The outcome in the logistic model was hyperkalemia （serum potassium≧5.5 mEq/L） and the covariates were sex, age, renal insufficiency, hepatic insufficiency, and baseline serum potassium levels. And, subgroup analysis was also performed in patients with and without renal insufficiency.Results：The incidence of hyperkalemia （per 1000 person-years） with ARB was 39.4 and that with CCB was 32.6. And, median periods from the index date to the date of occurrence of hyperkalemia for both exposure and control groups were 36 days （Min-Max：12-85） and 51.5 days（Min-Max：8-88）respectively. However, treatment with ARB was not associated with occurrence of hyperkalemia （OR 1.26, 95％CI： 0.58-2.75). The risk for hyperkalemia among those with renal insufficiency was higher （OR 3.31, 95％CI： 1.39-7.88）and as baseline serum potassium increased, the risk increased as well （OR 9.20, 95％CI： 3.52-24.10). And, the subgroup analysis also showed that rare occurrence of hyperkalemia by ARB and elevation risk for hyperkalemia by baseline serum potassium.Conclusion：The clinical data showed rare occurrence of hyperkalemia caused by ARB, indicating that renal insufficiency and baseline serum potassium levels affected the onset of the disease in clinical practice. Previous studies also reported the effects of renal insufficiency and other factors on the onset of hyperkalemia. ARB should be prescribed carefully in patients with these factors, as is conventionally done.