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Developing a neonatal workforce: role evolution and retention of advanced neonatal nurse practitioners.

BACKGROUND: Over the past decade more than 120 advanced neonatal nurse practitioners (ANNPs) have graduated from the Southampton based ANNP programme. OBJECTIVES: To determine the scope of practice and evolving role of ANNPs and to identify factors that may affect future recruitment and retention. METHOD: An open ended structured questionnaire on clinical role, working arrangements, retention and attrition, continuing education, and professional development was sent to 95 ANNPs. RESULTS: A response rate of 83% was achieved. There was an attrition rate of 14%, with most ANNPs remaining in their original seconding unit. Factors considered to be important for role satisfaction included a well defined role, working within a team of ANNPs, appropriate remuneration, and evidence of unit support for both role definition and continuing professional development. CONCLUSIONS: Although ANNPs are expensive to both train and employ, this evidence suggests that there is a good return on the investment in terms of retention to the unit and the specialty. Their role incorporates many features of advanced nursing practice as well as providing "value added" neonatal care by merging traditional medical and nursing roles and crossing professional boundaries. In 2004 the manpower challenges for neonatal units will be even more acute; these data confirm that there are effective options available but they require long term strategic planning and investment.

Adult↗

Variation in hospital morbidity in the male workforce of Western Australia.

The associations of hospital morbidity with occupation were studied in Western Australian men of working age in 1981-2. Data on hospital morbidity were derived from a population based system that covered all short stays in hospitals in the state. Occupations were grouped into 12 major categories and conditions were coded using the International Classification of Diseases. Armed services personnel had the highest overall rate of hospital admissions, followed by transport and communications workers and by administrative and managerial workers. Injuries were the most common cause of referral to hospital. Four occupational groups, farmers and allied workers, miners and quarrymen, transport and communications workers, and craftsmen, production workers, and labourers were often associated with injury. Diseases of the musculoskeletal system and connective tissue were the second most common cause for referral and were increased in transport and communications workers, and in craftsmen, production workers, and labourers. Several other associations between causes of hospital admission and major occupational groups were observed, including associations of circulatory system diseases with professional and technical work and with administrative and managerial work. The excess of hospital admissions due to factors associated with occupation was estimated to be 12,665 admissions a year or 24.9% of the total in working men.

Adolescent↗

The effect of smoking on the development of allergic disease and specific immunological responses in a factory workforce exposed to humidifier contaminants.

The effects of smoking on the development of work related asthma and on the production of specific IgE and IgG antibodies to antigen from a contaminated humidifier are described for a sample of 258 workers from a printing factory. Current smoking was associated with low production of IgG antibody but with higher production of IgE antibody. No dose response for either antibody was found when numbers of cigarettes or pack-years smoked were considered. Work related asthma was detected in 12 workers by peak flow recordings. Six were current smokers and one was an ex-smoker. One subject with work related asthma had a high (and one a marginal) concentration of specific IgE to humidifier antigen.

Air Conditioning↗

Work related musculoskeletal disorders and ergonomic stressors in the South African workforce.

OBJECTIVES: The main objective of this study was to investigate exposure-response relations between adverse musculoskeletal outcomes and ergonomic exposure variables. METHODS: A cross sectional analytical study was conducted in 11 factories from seven sectors of manufacturing industry in South Africa. Exposure to workplace ergonomic stressors was assessed in factory floor jobs (n = 46) with a simple low technology observational model. Repetition, force, static posture, dynamic movement, and other job exposures were measured. Data of adverse musculoskeletal outcome and data on potential confounders and effect modifiers were obtained from subjects (n = 401) randomly sampled from each job category with a questionnaire given by interviewers. RESULTS: High prevalences of regional musculoskeletal pain were found with substantial variability between industries. Sex was the only individual risk factor (after adjustment for potential confounders and effect modifiers) that was significantly associated with regional pain. Ergonomic exposures in the workplace were significantly associated with musculoskeletal pain of the neck and shoulders odds ratio (OR) 5.38 (95% confidence interval (95% CI) 1.16 to 25.0) for repetition, and OR 3.91 (95% CI 1.11 to 13.7) for seated compared with standing work; pain of the wrists and hands OR 10.2 (95% CI 1.39 to 75.6) for high summed score of dynamic postures of the wrist). CONCLUSIONS: This study indicates good predictive ability to reduce ergonomic stress with the exposure model, simple surveillance methods, and educational programmes in the workplace. Further study on sampling strategies and refinement of dimensions of ergonomic stressors are needed.

Cross-Sectional Studies↗

Health care workforce for the twenty-first century: the impact of nonphysician clinicians.

For many years, nonphysician clinicians (NPCs) have participated in the care of patients. However, their numbers were small and their licensed prerogatives were narrow. Over the past decade, these characteristics have changed in three important ways. First, training in many of the NPC disciplines has increased substantially, and the growth of these disciplines is accelerating. Second, state laws and regulations have expanded both the practice prerogatives of NPCs and their autonomy from physician supervision. Third, payers have increased their access to reimbursement. As a consequence, NPCs are undertaking many elements of care that previously were provided by physicians. Their participation is generally cost-effective and is met with a high degree of patient satisfaction. This presents both opportunities and challenges to physicians as they forge new relationships with NPCs and as their own spectrum of responsibilities evolves.

Chiropractic↗

Self-assessment in the measurement of public health workforce preparedness for bioterrorism or other public health disasters.

OBJECTIVE: The purpose of this study was to examine effective ways to evaluate public health workers' competence for preparedness. METHODS: The Public Health Ready project, developed by the National Association of County and City Public Health Officials and the Centers for Disease Control and Prevention, is a pilot program designed to prepare local public health agencies to respond to emergency events. Workers at a Public Health Ready site (N=265) rated their need for training and their competence in meeting generic emergency response goals. Cluster analysis of cases was conducted on the self-assessed need for training. RESULTS: Three groups of workers emerged, differing in their overall ratings of need for training. A given worker tended to report similar needs for training across all training goals. CONCLUSIONS: In this study, workers' ratings of need for training may reflect an overall interest in training rather than need for training in a particular area. Caution should be exercised in interpretation when generic goals and self-assessment are used to measure need for training. Future assessments of training needs may be more effective if they use objective measures of specific local plans.

Attitude of Health Personnel↗

The Road Map to Preparedness: a competency-based approach to all-hazards emergency readiness training for the public health workforce.

Facing limited time and budgetary resources, state and local health departments need a practical, competency-based training approach to meet the all-hazards readiness requirements of their employees. The Road Map to Preparedness is a training tool designed to assist health departments in providing comprehensive, agency-tailored readiness instruction to their employees. This tool uses an incentive-based, game-like, experiential learning approach to meet the Centers for Disease Control and Prevention's nine core competencies for all public health workers while facilitating public health employees' understanding and acceptance of their emergency response roles. A corresponding evaluation tool, the Road Map to Preparedness Evaluation, yields metrically-driven assessments of public health employee readiness competencies. Since its pilot in 2003, the Road Map to Preparedness has met with enthusiastic response from participating health departments in the mid-Atlantic region. In addition to its public health impact, the Road Map offers future promise as a tool to assist organizational emergency response training in private sector and non-public health first-responder agency settings.

Competency-Based Education↗

Common mental disorders in the workforce: recent findings from descriptive and social epidemiology.

OBJECTIVE: To review the recent descriptive and social epidemiology of common mental disorders in the workplace, including prevalence, participation, work disability, and impact of quality of work, as well as to discuss the implications for identifying targets for clinical and preventive interventions. METHOD: We conducted a structured review of epidemiologic studies in community settings (that is, in the general population or in workplaces). Evidence was restricted to the peer-reviewed, published, English-language literature up to the end of June 2005. We further restricted evidence to studies that used recent classification systems; then, if evidence was insufficient, we reviewed studies that used standardized psychiatric screening scales. To distinguish this article from recent reviews of health and work quality, we focused on new areas of investigation and new evidence for established areas of investigation: underemployment, organizational justice, job control and demand, effort-reward imbalance, and atypical (nonpermanent) employment. RESULTS: Depression and simple phobia were found to be the most prevalent disorders in the working population. The limited data on rates of participation suggested higher participation among people with depression, simple phobia, social phobia, and generalized anxiety disorder. Depression and anxiety were more consistently associated with "presenteeism" (that is, lost productivity while at work) than with absenteeism, whether this was measured by cutback days or by direct questionnaires. Seven longitudinal studies, with an average sample size of 6264, showed a strong association between aspects of low job quality and incident depression and anxiety. There was some evidence that atypical work was associated with poorer mental health, although the findings for fixed-term work were mixed. CONCLUSIONS: Mental health risk reduction in the workplace is an important complement to clinical interventions for reducing the current and future burden of depression and anxiety in the workplace.

Adolescent↗

Absenteeism in the workforce, Klang Valley, Malaysia--preliminary report.

The aim of this study was to determine the prevalence of sickness absenteeism among the three types of agencies, government, semi-government (boards) and private (public) companies. The methodology involved eliciting retrospective data on medical leave over the year 1990 by requesting the agencies to fill up a questionnaire (Appendix I), and calculating the indices of absenteeism from this data. The results show that the private agencies scored higher for all the indices but only the "lost time" percentage was significantly increased. Females also had significantly higher severity of sickness absenteeism rates in all the agencies. Overtime work was associated with higher absenteeism indices, markedly noted in the private agencies. In conclusion, agencies showed work out their own indices of absenteeism so that it could be compared with national rates.

Absenteeism↗