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Educating for rural nursing practice.

BACKGROUND: Rural hospitals in Australia, as in many countries, face challenges in ensuring that appropriate, quality services are provided. AIMS: The overall aim of this study was to explore the issues that impact on the ability of rural hospitals to provide effective health care. METHODS: We used a qualitative descriptive method and purposive sampling, and conducted interviews in hospitals in rural Victoria, Australia. The data collected enabled major issues that impact on hospital service delivery to be identified. Using thematic analysis, global themes were extracted and organized around a thematic network. FINDINGS: The workforce was an important theme. Whilst the impact of medical shortages on hospital function has been considered in other studies, little consideration has been given to the rural nursing workforce. The need to maintain an appropriately educated rural nursing workforce emerged as one of the major issues that impact on rural hospital service delivery. In Australia, there has been a great deal of discussion about the educational preparation required for rural nursing practice, with the emphasis on postgraduate study. However, the majority of rural nurses do not have postgraduate qualifications and face significant barriers in obtaining them. Although the vast majority of literature claims that postgraduate preparation is vital for rural nursing practice, this research suggests that the future rural nursing workforce will be recruited from undergraduate courses in regional universities. However, there is a need to include specific theoretical and operational preparation in undergraduate education, to enable nurses to make the transition to rural practice more readily. CONCLUSIONS: Rural nurses are central to the delivery of health services in rural hospitals. Future rural nursing recruitment and retention hinges on ensuring that they have the confidence, knowledge and skills to deliver safe, appropriate and effective care.

Curriculum↗

Public health job vacancies--who wants what, where?

This paper presents a snapshot of job vacancies in the public health workforce labour market. The analysis is based on 404 advertised public health jobs appearing in the press, and on-line job alerts over a 2-month period in mid 2003. The analysis reveals who was seeking employees, what formal qualifications and competencies were required, what salary and other conditions of employment were offered and where the vacant jobs were located. The study demonstrates the heterogeneity of the public health workforce, which limits definition of clear practice boundaries and complicates workforce planning. The findings further demonstrate the benefit of reviewing both the demand and the supply side of the labour market, and point to the value of repeated surveys of advertised jobs as part of an ongoing public health workforce monitoring and planning process.

Australia↗

Practice of pediatric critical care medicine: results of the Future of Pediatric Education II survey of sections project.

OBJECTIVE: To summarize the demographics and practice patterns of the current pediatric critical care workforce and to identify the key workforce issues that may affect the delivery of pediatric critical care services in the future. DESIGN: A questionnaire designed to analyze current pediatric critical care workforce demographics and future workforce trends. SUBJECTS: Pediatric critical care physicians from the United States were identified from the American Academy of Pediatrics Critical Care Section, from a list of physicians certified in pediatric critical care medicine (PCCM) by the American Board of Pediatrics, and from a list of pediatrician members of the Society for Critical Care Medicine. INTERVENTIONS: None. MEASUREMENTS: PCCM physicians were polled regarding board certification, practice characteristics, professional activities, referral patterns, patient profiles, competition, job satisfaction, and projected retirement age. MAIN RESULTS: A total of 805 PCCM physicians completed the survey. When grouped by age, 40% of the responding PCCM physicians were younger than 40 yrs, 49% were 40 to 49 yrs old, and only 11% were 50 yrs of age or older. The younger group had a higher percentage of female pediatricians than the older groups. For all age groups, the largest proportion of time was devoted to direct patient care time in pediatric critical care. This was especially true for the youngest age group that had the largest amount of patient care time devoted to critical care (43%). Time devoted to research was also significantly higher for the younger age group, although very few respondents reported that they have >50% of their time protected for research. For all age groups, those reporting increases in referral volume and referral complexity over the previous 12 months far outnumbered those reporting decreases. The majority of respondents reported being satisfied with their career choice. In general, respondents were more likely to report that too many rather than too few PCCM physicians were currently being trained. Approximately one third of respondents (34%) planned on leaving the field of critical care medicine before retiring from medicine completely. CONCLUSIONS: PCCM physicians were increasingly women and working for >65 hrs/wk, with a good level of job satisfaction. Competition from a variety of sources seems to affect the work of PCCM physicians. The relatively small percentage of time devoted to research, however, is a finding of great concern.

Adult↗

Hospital human resource planning in Slovakia.

The study is an attempt to provide empirical evidence, in the context of acute hospital care, of the current human resource practices in the health sector of the Slovak Republic. Using a sample of 72 acute care hospitals the research explored the perceived functions, typical customers and priorities of hospital human resource departments, ownership of a workforce plan, and the relationships between ownership of a workforce plan and type of hospital, as well as the degree to which different human resource activities are given priority. Cross-tabulation procedure revealed statistically significant relationships between ownership of a workforce plan and the degree of priority given to having a quick, efficient and cost-effective recruitment and selection system and, not surprisingly, the degree of priority given to ensuring that the human resource department has a workforce plan. The study evidence also indicates that, although the human resource staff in hospitals seem to be aware of their role in assisting hospital management in decision making, the human resource function in the Slovak hospitals still rather resembles that of a personnel administration than that of an important strategic human resource activity.

Health Services Research↗

The providers of dental services.

There has been a rapid increase in the number of providers in dental services in Australia. The relative increase of dentists has been at a greater rate than that of the population. There has been a marked increase in the number of operating dental auxiliaries employed as school dental therapists in government services and of self-employed denturists. Employment of dental hygienists by private dental practitioners is still limited. The active dentist workforce is approximately 80 per cent of the number of dentists on the registers and about 82 per cent of the active dentist workforce has been maintained with an increase in the proportion of women and of specialists. The number of dental graduates from Australian universities appears adequate to meet population increases and the loss of dentists from the registers. A very high rate of new registration of overseas dentists has created some oversupply in the private practice sector. Emphasis should be placed on the Australian dental schools for the continuing supply of dental graduates, specialist and continuing education to meet the needs of the Australian community. There is an urgent need for co-ordination of relevant registration authorities through national schedules and for the collection of information concerning the disposition of the Australian dental workforce to enable continuing evaluation of present and future workforce requirements.

Australia↗

Selected characteristics and data of psychiatrists in the United States, 2001-2002.

OBJECTIVE: To provide basic data about the physician workforce as a whole and the relative place of psychiatrists in the total workforce. To provide data on characteristics of psychiatrists' work activities in routine psychiatric practice. METHOD: Data were obtained from the American Medical Association's (AMA) Physician Characteristics and Distribution in the United States, 2002-2003 and the 2002 National Survey of Psychiatric Practice, a nationally representative survey of 2,000 randomly selected psychiatrists in the United States. RESULTS: Psychiatry is the fourth largest specialty in the United States. Since 1970, psychiatry has grown 86.7%, while child psychiatry has grown 194.6%. However, psychiatrists are distributed unequally across the country, are working fewer hours than in the past, and less of their time is spent in direct patient care activities. CONCLUSIONS: Psychiatry is a growing and significant part of the U.S. physician workforce. However, if trends that show the psychiatric workforce is aging and working fewer hours continue, it is unclear if its current rate of growth will be able to keep pace with the demand for psychiatric services.

Adult↗

Older community nurses: perspectives and prospects.

In common with the nursing workforces of the developed world, the NHS nursing workforce is ageing. Community nurses, in particular, tend to be older than their acute counterparts and this ageing could have a greater impact on this section of the workforce than on nurses in other sectors. This article reports on a study into the options, decisions and outcomes for nurses over the age of 50 years in the NHS. The study was funded by the Joseph Rowntree Foundation as part of a larger programme of work. Older nurses are a valuable part of the NHS workforce, being a repository of skill and wisdom. While this is generally recognized, and there are policies to support this, there is little recognition or action within the NHS. This study found that older nurses would like to see greater flexibility being shown towards them, in terms of their working hours and conditions of work, without harming their pension prospects. They would like to see return to practice courses and continuing professional development more geared towards their needs. Furthermore, they would like more information about their options. The article includes the experiences of some older nurses working in the community who remain, have left or have returned to the NHS.

Age Factors↗

In a different voice: the attitudes of licensed practical nurses towards the future.

In the fall of 1997, the Idaho Commission of Nursing and Nursing Education undertook a survey of Idaho nurses to collect data on future workforce and educational needs. The results of the survey demonstrated substantial attitudinal differences between licensed practical nurses and registered nurses in the areas of educational motivation, role differentiation, skills by type of nurse, trends in nursing supply, and educational preparation. Given that the Idaho workforce is comparable to the national nursing workforce in numbers, educational background, and age, these findings have implications for health policy planners and nursing educators throughout the country. This article presents the findings and then uses the data as a basis for suggesting their implications for nursing education and workforce planning.

Attitude of Health Personnel↗

Impact of health system factors on changes in human resource and expenditures levels in OECD countries.

In order to gain further insight into the system factors responsible for changes in the health workforce, this study undertook an empirical examination of the determinants of the size of the health workforce and overall health expenditures across fifteen OECD countries. Specifically, using the latest release of OECD data, the analysis estimated and evaluated the effects of variables such as the proportion of female physicians and the elderly, expenditures on ambulatory care, enrollment levels in training programs, level of public financing, and per capita income on the size of the health workforce and level of health spending between 1970-1991. The findings of this study help to place the problem of the changing health workforce within the context of the complexity of health systems. It confirms any understanding of what accounts for changes in the size of the health labor force and expenditures require disentangling the effects of variables which needs to be taken into account when considering health system reforms.

Australia↗

Oral healthcare systems in the extended European union.

UNLABELLED: This article reports a survey of the systems for the provision of oral healthcare in the 28 member and accession states of the EU/EEA in 2003. Descriptions of the systems were collected from the principal dental advisers to governments in the individual states. In many states these were the Chief Dental Officers (CDOs). In states without a CDO, descriptions were gathered from CDO equivalents or senior academics. A template (model description) was used to guide all respondents. Additional statistical information on oral healthcare costs and workforce was collected from the Council of European Chief Dental Officers, WHO and World Bank websites. The study showed that in broad terms there were six patterns (Beveridgian, Bismarkian, The Eastern European (in transition), Nordic, Southern European and Hybrid) for the administration and financing of oral healthcare in the expanding EU. The extent and nature of government involvement in planning and coordinating oral healthcare services and the numbers and pay of the oral healthcare workforce varied between the different models. The biggest recent changes in European oral healthcare were found to have occurred in Eastern Europe, where there has been wide scale privatization of the previously public dental services. However, most of the EU accession (Eastern European) states seemed to be slowly developing insurance systems to cover oral health treatment costs. In the existing EU/EEA, the public dental services such as those in the Nordic countries still have strong political support and some expansion has occurred. In Southern Europe public dental services seemed to have gained some acceptance for the treatment of children and special needs groups. In UK, which has a unique public dental service system, there are plans to make big changes in the delivery, commissioning and remuneration of dental services in the near future. Some EU member states which operate the Bismarkian system with health insurances offering wide population coverage, comprehensive treatment and benefits connected with frequent dental visits, were reported to be experiencing financial problems. The study also indicated that at present, with the exception of Portugal and Spain, where there is dynamic growth in the numbers of dentists, the overall size of the EU/EEA oral health workforce is expanding fairly slowly. Only a minority of member states appeared to collect data on uptake of services and care costs and there were great difficulties in assessing outcomes of care. The data on costs appeared to show wide variations from member state to member state in per capita spending on oral healthcare. In the majority of states, however, costs, especially those in the private sector, could only be estimated. Nevertheless, at a 'macro' level, the study indicated that, in 2000, the 28 member and accession states of the EU/EEA had a total population of 456 million and an oral health workforce of 900,000 (some 300,000 of whom were dentists) and that the cost of oral healthcare was about EUR 54,000,000,000. CONCLUSION: The study showed wide variations in oral healthcare provision systems between EU/EEA member and accession states and no evidence of harmonization in the past.

Adult↗

The Barcelona International Symposium (21-23 April 2005). Synthesis reports.

The Symposium was held in Barcelona, Spain, with the Institut d'Estudis de la Salut acting as host. It gathered 51 participants working in 34 institutions based in 18 countries. The main objective of the Symposium was to create an opportunity for assessing the past trends and forecasting the future developments of health workforce within the various national health systems. The Symposium was composed of 5 sessions devoted to presentations of the papers freely contributed by the participants and 5 discussion sessions devoted to the following themes : (i) Supply of and demand for health workforce, (ii) Future trends and forecasting methods ; (iii) Strategies for managing and planning health workforce ; (iv) Health workforce in underserved areas; (v) International migration of health workers. Each discussion session was conducted by a discussion leader whose the synthesis report is displayed here below.

Adult↗

Are the recommendations of the AAMC's task force on the generalist physician still valid?

A few years ago, most opinion leaders and workforce analysts believed that the number of generalist physicians in the United States was much too low. The AAMC responded to this concern by convening a task force to review the evidence bearing on the U.S. supply of generalist physicians and to make recommendations for action by the AAMC and its member institutions. In 1992, the task force called for at least half the graduates of U.S. allopathic medical schools to enter practice as generalists and for medical schools to design their educational programs to promote an affinity for generalism among their students. Since that time, however, research findings have suggested that the current size of the country's generalist physician workforce in relation to projected need may indeed be adequate. In light of these recent observations, the authors asked whether the task force's major recommendations remain valid. In this article, they state their reasons for thinking that it definitely does. After reviewing the recent research findings mentioned above, the authors show that simply to maintain the current size of the generalist physician workforce, a marked increase will be needed in the number of U.S. medical school graduates who choose to become generalists. In the aggregate, this amounts to roughly half the graduating classes of LCME-accredited medical schools, as called for by the AAMC in 1992. (The authors predict that international medical graduates will not make up a significant percentage of the country's generalist workforce, and that U.S. medical school graduates will be the predominant source of these physicians in the future.) Equally important, the new educational approaches being created by medical schools to embed generalism in their curricula are necessary to ensure that all graduates, regardless of their specialty choices, be well grounded in the principles and skills of "general physicians" so they can function well in the new health care system that is rapidly evolving.

Career Choice↗

Cost of lost productive work time among US workers with depression.

CONTEXT: Evidence consistently indicates that depression has adversely affected work productivity. Estimates of the cost impact in lost labor time in the US workforce, however, are scarce and dated. OBJECTIVE: To estimate the impact of depression on labor costs (ie, work absence and reduced performance while at work) in the US workforce. DESIGN, SETTING, AND PARTICIPANTS: All employed individuals who participated in the American Productivity Audit (conducted August 1, 2001-July 31, 2002) between May 20 and July 11, 2002, were eligible for the Depressive Disorders Study. Those who responded affirmatively to 2 depression-screening questions (n = 692), as well as a 1:4 stratified random sample of those responding in the negative (n = 435), were recruited for and completed a supplemental interview using the Primary Care Evaluation of Mental Disorders Mood Module for depression, the Somatic Symptom Inventory, and a medical and treatment history for depression. Excess lost productive time (LPT) costs from depression were derived as the difference in LPT among individuals with depression minus the expected LPT in the absence of depression projected to the US workforce. MAIN OUTCOME MEASURE: Estimated LPT and associated labor costs (work absence and reduced performance while at work) due to depression. RESULTS: Workers with depression reported significantly more total health-related LPT than those without depression (mean, 5.6 h/wk vs an expected 1.5 h/wk, respectively). Eighty-one percent of the LPT costs are explained by reduced performance while at work. Major depression accounts for 48% of the LPT among those with depression, again with a majority of the cost explained by reduced performance while at work. Self-reported use of antidepressants in the previous 12 months among those with depression was low (<33%) and the mean reported treatment effectiveness was only moderate. Extrapolation of these survey results and self-reported annual incomes to the population of US workers suggests that US workers with depression employed in the previous week cost employers an estimated 44 billion dollars per year in LPT, an excess of 31 billion dollars per year compared with peers without depression. This estimate does not include labor costs associated with short- and long-term disability. CONCLUSIONS: A majority of the LPT costs that employers face from employee depression is invisible and explained by reduced performance while at work. Use of treatments for depression appears to be relatively low. The combined LPT burden among those with depression and the low level of treatment suggests that there may be cost-effective opportunities for improving depression-related outcomes in the US workforce.

Adult↗

Why the changing American economy calls for twenty-first century learning: answers to educators' questions.

While struggling with the current pressures of educational reform, some educators will ask whether their efforts make economic sense. Questioning the future makeup of the nation's workforce, many wonder how the educational system should be tempered to better prepare today's youth. This chapter answers educators' and parents' questions around the effect of fluctuations in the American economy on the future of education. The authors offer reassurance that good jobs will always be available, but warn that those jobs will require a new level of skills: expert thinking and complex communication. Schools need to go beyond their current curriculum and prepare students to use reading, math, and communication skills to build a deeper and more thoughtful understanding of subject matter. To explain the implications of the nation's changing economy on jobs, technology, and therefore education, the authors address a range of vital questions. Citing occupational distribution data, the chapter explores the supply and range of jobs in the future, as well as why changes in the U.S. job distribution have taken place. As much of the explanation for the shift in job distribution over the past several decades is due to the computerization of the workforce, the authors discuss how computers will affect the future composition of the workforce. The chapter also addresses the consequences of educational improvement on earnings distribution. The authors conclude that beyond workforce preparedness, students need to learn how to be contributing members of a democracy.

Adolescent↗

Stillbirths among offspring of male radiation workers at Sellafield nuclear reprocessing plant.

BACKGROUND: Ionising radiation is a known mutagen, but few studies have examined transgenerational effects of paternal exposure in human beings. The workforce at the Sellafield nuclear reprocessing plant in the county of Cumbria, UK, is the most highly exposed workforce in western Europe and North America. This study, which is part of a larger programme of work investigating the health of the children of the Sellafield workforce, set out to find whether there was evidence of an association between stillbirth risk and paternal exposure to ionising radiation. METHODS: We collected details from birth registration documents for all singleton 248,097 livebirths and 3715 stillbirths in the county of Cumbria 1950-89. Within this cohort the 130 stillbirths and 9078 livebirths to partners of male radiation workers employed at Sellafield were identified. Logistic regression was used to analyse the relation between stillbirth risk and father's preconceptional radiation exposure, with adjustment for social class, year of birth, father's age, and birth order. FINDINGS: A significant positive association was found between the risk of a baby being stillborn and the father's total exposure to external ionising radiation before conception (adjusted odds ratio per 100 mSv 1.24 [95% CI 1.04-1.45], p=0.009). The risk was higher for stillbirths with congenital anomaly and was highest for the nine stillbirths with neural-tube defects. The statistical models predicted that, were the association to be interpreted as causal, between 0 and 31.9 of the 130 stillbirths to the workforce may be attributable to father's radiation exposure. INTERPRETATION: The findings of an increased risk of stillbirth with increasing paternal occupational exposure to external radiation are qualitatively consistent with those from animal models, though the risk estimate is higher. Although we cannot exclude the possibility of an unmeasured risk factor for stillbirth, confounded with paternal preconceptional irradiation, extensive checks confirmed that the statistical models were a good fit to the data and there was not statistical evidence of unmeasured factors.

Adult↗

The nursing shortage in the United States of America: an integrative review of the literature.

AIM: The aims of this paper are to review the literature to determine what factors are contributing to the nursing shortage in the United States of America (USA) and discuss possible solutions to this current and future nursing shortage. BACKGROUND: The need for nurses is often depicted as cyclical in nature. Throughout history, the USA has experienced a series of nursing surpluses and shortages. However, the current shortage has been characterized as being unlike those experienced in the past. Trends of an ageing Registered Nurse (RN) workforce and limited supply to fill the impending vacancies are some of the unique aspects that bring a new dimension to an old problem. Today's nursing shortage will not be resolved by simply returning to the solutions of yesteryear, and strategies to reduce its impact will have to be more creative and focus on the long-term. METHODS: Integrative literature review of published literature on the current nursing shortage in the USA from 1999 to 2001. DISCUSSION: Four main areas were identified as the major contributors to the nursing shortage in the USA: the ageing RN workforce; declining enrollment; the changing work climate; and the poor image of nursing. Solutions to the shortage followed similar themes to the contributing factors and encompassed four main areas: exploring recruitment efforts; exploring retainment efforts; improving the image of nursing; and supporting legislation that helps to rectify the shortage. CONCLUSION: There is firm evidence that the USA amidst a nursing shortage. Much is known about the many contributing factors but now nurses need to become proactive to help secure the future of their workforce. By forming partnerships within the profession and with other influential parties, nurses can be in the forefront of resolving their workforce issues.

Delivery of Health Care↗

Critical factors in career decision making for women medical graduates.

BACKGROUND: Within the next 30 years there will be equal numbers of women and men in the medical workforce. Indications are that women are increasing their participation in specialties other than general practice, although at a slower rate than their participation in the workforce as a whole. To inform those involved in training and employment of medical women, this study investigated the influencing factors in career decision making for female medical graduates. METHODS: A total of 305 women medical graduates from the University of Auckland responded to a mail survey (73% response rate) which examined influences on decision making, in both qualitative and quantitative ways, as part of a larger survey. RESULTS: Most women were satisfied with their careers. The principal component analysis of the influencing factors identified four distinct factors important in career choice - interest, flexibility, women friendliness and job security, although the first two of these were rated more highly than the others. CONCLUSIONS: Barriers to full participation by medical women in training and employment need to be systematically examined and removed. This is not only to allow women themselves to reach their full potential, but for workforce and socio-economic reasons. Initiatives that allow and value more flexible training and work practices, particularly through the years of child raising, are necessary for women and the health care workforce at large.

Adult↗

Economic indicators and involvement of health professionals at worksite health services in a developing country.

Identification of accurate source lists for workplace health service research is problematic. Using the national list of health professionals registered to dispense medicines at 981 worksites in South Africa, a third of questionnaires were undelivered. A 33 per cent response rate was obtained to delivered questionnaires. Non-responders appeared to lack the information required. Although the number of employees at a worksite may influence sickness absenteeism, it does not appear to affect the absolute cost per employee nor the relative expenditure on different categories of costs incurred by worksite health services. Expenditure on staff and consumables accounts for nearly 80 per cent of worksite health service costs, regardless of workforce size. In 1988, the average cost of registered workforce health services at which medicines were dispensed and information was available, was R125 (35 pounds) per employee per year. Establishing standards and applying them to intra and inter industrial economic evaluation of workforce health services using sickness absenteeism and percentage breakdown of costs appears feasible in South African industries with both large and small workforces, provided that health professionals have access to adequate management information systems.

Absenteeism↗