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PubMed1995

Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the influence of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. DESIGN: Data were collected prospectively over a 1-yr period (study year) and compared with previously collected prospective data recorded in our chronic obstructive pulmonary disease database during a 5-yr period. SETTING: The medical intensive care unit (ICU) of a university hospital. PATIENTS: Eighty-seven patients with chronic obstructive pulmonary disease. Fifteen patients had chronic obstructive pulmonary disease that required mechanical ventilation for acute exacerbation of their disease (study year), and 72 were patients with chronic obstructive pulmonary disease from the previously collected data. INTERVENTIONS: The ICU course (duration of mechanical ventilation, mortality) was recorded, as well as several respiratory parameters (pulmonary function tests and arterial blood gases in stable conditions, and nutritional status), and they were compared with an "index of nursing." MEASUREMENTS AND MAIN RESULTS: We developed an "index of nursing", comparing the effective workforce of the nurses (number and qualifications) with the ideal workforce required by the number of patients and the severity of their diseases. A value of 1.0 represented a perfect match between the needed and the effectively present nurses, whereas a lesser value signified a diminished available workforce. This index was compared with the complications and duration of weaning from mechanical ventilation. During the first 5 yrs, the duration of mechanical ventilation increased progressively from 7.3 +/- 8.0 to 38.2 +/- 25.8 days (p = .006). A significant inverse correlation between the duration of mechanical ventilation and the nursing index (p = .025) was found. In the sixth comparative year, the number of nurses increased (nursing index = 1.05) and the duration of mechanical ventilation decreased to 9.9 +/- 13 days (p < .001, yr 5 vs. yr 6). CONCLUSIONS: The quality of nursing appears to be a measurable and critical factor in the weaning from mechanical ventilation of patients with chronic obstructive pulmonary disease. Below a threshold in the available workforce of ICU nurses, the weaning duration of patients with chronic obstructive pulmonary disease increases dramatically. Therefore, very close attention should be given to the education and number of ICU nurses.

Aged↗

PubMedDate not supplied

Retaining the older nurse.

The nursing workforce is aging more rapidly than the workforce as a whole, and fewer young people are entering the profession. It is imperative that older nurses be retained, not only for their experience and expertise, but also to prevent worsening an already critical nursing shortage. A descriptive survey design was used to determine the knowledge base and plans for the aging RN workforce by North Carolina hospitals and nursing homes. Nurses over age 55 made up 14.1% of the respondents' RN staff. Most administrators are aware of the aging workforce and wish to retain older nurses. Unfortunately, 94% of facilities have no policies in place to address the needs of older nurses, and 87% admitted to having no immediate plans to do so. Specific recommendations are made to assist nurse managers in retaining the older RN.

Age Factors↗

PubMed2005

Matching documented training needs with practical capacity: lessons learned from Project Public Health Ready.

The Upper Midwest offers a distinct environment for identifying and addressing threat and preparedness scenarios. The population is often scattered, with residents using urban centers periodically. This has also led to the challenge of providing specific skills and cross-disciplinary awareness and coordination to the public health community. The Upper Midwest Center for Public Health Preparedness was established by a grant from the Centers for Disease Control and Prevention to assist in meeting the challenge of adding capacity to develop the preparedness workforce in the Upper Midwest. Project Public Health Ready (PPHR) provides an example of the role academic preparedness centers can play in partnering with local public health agencies to strengthen the public health workforce. The purpose of this article is to present the Iowa Systems Model for Workforce Development being utilized for workforce training and education, describe how the model has been applied in the example of PPHR, and discuss lessons learned from the PPHR experience.

Bioterrorism↗

PubMed2006

Challenges to dental access - England as a case study.

Access to dental services because of an insufficient workforce is a historic challenge faced by many developing countries. In recent years, however, it has become a major issue for many industrialized countries. The growing demand for cosmetic dentistry, an increase in patients' willingness to pay for dental treatment, and growing numbers of older dentate patients have all put pressure on dental systems. Ways of meeting these challenges and ensuring reasonable dental access will vary from country to country, but the solutions often lie in how the dental workforce is regulated. This case study of the dental reforms currently being implemented in England highlights progress at a particular point in time (Summer 2005). It is clear that it will take a number of years to find a new national dental payment system (the National Health Service) to replace the system which has changed little since 1948. However, the political pressure to address poor access to state-funded dental services calls for more immediate actions. The initial approach was to increase the dental workforce via international recruitment, and in the medium term to increase the number of dental students in training and to expand the numbers of other members of the dental team. An additional stratagem is to retain those already providing dental care under the National Health Service by the introduction of a new method of remuneration. England is trying to improve both access to care and the oral health of the population by creating a workforce more suitable to public demands and changing oral health needs.

Dental Health Services↗

PubMed1994

Clinical reactions to Aspergillus niger in a biotechnology plant: an eight year follow up.

The manufacture of citric acid by fermentation of molasses with Aspergillus niger has previously been described as a cause of occupational asthma in a factory. A longitudinal survey of the workforce of this factory has been carried out from 1984 to 1991. Over this period 160 of the original 278 workers left the workforce, together with 39 of 76 new recruits. Partial enclosure of the process and exhaust ventilation, installed in 1984, was effective in preventing any new cases of occupational asthma over the eight year period, and no new skin sensitisation was detected. Spore counts of A niger averaged about 100 times those in the outside air. Health in the 1984 survey had a striking influence on subsequent retiral; only 11 of the 79 with respiratory symptoms remained in 1991, compared with 90 of the 182 with no symptoms. In conclusion A niger is a weak antigen and simple hygiene measures protect the workforce. Exclusion of recruits with positive skin tests is not necessary if such measures are taken. The survey provided evidence of the selection factors operating within a workforce over this period contributing to retiral of the less healthy.

Aspergillosis, Allergic Bronchopulmonary↗

PubMed2003

Human resources for health policies: a critical component in health policies.

In the last few years, increasing attention has been paid to the development of health policies. But side by side with the presumed benefits of policy, many analysts share the opinion that a major drawback of health policies is their failure to make room for issues of human resources. Current approaches in human resources suggest a number of weaknesses: a reactive, ad hoc attitude towards problems of human resources; dispersal of accountability within human resources management (HRM); a limited notion of personnel administration that fails to encompass all aspects of HRM; and finally the short-term perspective of HRM.There are three broad arguments for modernizing the ways in which human resources for health are managed:bullet; the central role of the workforce in the health sector;bullet; the various challenges thrown up by health system reforms;bullet; the need to anticipate the effect on the health workforce (and consequently on service provision) arising from various macroscopic social trends impinging on health systems.The absence of appropriate human resources policies is responsible, in many countries, for a chronic imbalance with multifaceted effects on the health workforce: quantitative mismatch, qualitative disparity, unequal distribution and a lack of coordination between HRM actions and health policy needs.Four proposals have been put forward to modernize how the policy process is conducted in the development of human resources for health (HRH):bullet; to move beyond the traditional approach of personnel administration to a more global concept of HRM;bullet; to give more weight to the integrated, interdependent and systemic nature of the different components of HRM when preparing and implementing policy;bullet; to foster a more proactive attitude among human resources (HR) policy-makers and managers;bullet; to promote the full commitment of all professionals and sectors in all phases of the process.The development of explicit human resources policies is a crucial link in health policies and is needed both to address the imbalances of the health workforce and to foster implementation of the health services reforms.

Editorial↗

PubMed2002

Is Swedish pension reform the right medicine for aging Europe?

Following the Second World War, the idea of the life course with distinct periods of education, work, and retirement became popular as a result of the alliance of interests of unions and management, with politicians seizing the opportunity to accommodate them. These "social partners" implemented benefit rules and created practices for using old age and disability to ease the exit of older workers. Although justifiable at the time, now those rules and practices hinder individual and employer incentives to invest in human capital and work environments that enable older workers to remain in the workforce. The article argues that the workforce environment of the coming half-century, which is relevant for persons born around 2000, is much different from that a hundred years earlier, which determined the opportunities for people born around 1900. People are healthier and live much longer and work environments are friendlier. The article argues that it is no longer justifiable to subsidize exit from the workforce around the age of 60 for healthy workers, especially in view of the coming labor shortage in Europe. It also argues that the introduction of the principles of the Swedish NDC pension reform in Europe would provide possibilities for flexible exit from the workforce and remove impediments to labor mobility in Europe, which are embedded in many of Europe's present pension arrangements.

Aged↗

PubMed2003

Pilot study on the factors that influence learning by general practice registrars in central Australia.

INTRODUCTION: To counter a medical workforce shortage in rural and remote areas of Australia an increasing number of general practitioners are being trained in rural and remote areas. General practice (GP) registrars train in general practice as working apprentices alongside GP supervisors. GP registrars are allocated a training advisor to oversee their progress throughout their training. Central Australian GP registrars expressed concern to their training advisor regarding certain work partnerships with their GP supervisors. The study was carried out in response to these concerns, which were raised during a shortage of GPs in the area. The aim of the study was to explore factors in the interaction between GP registrars and GP supervisors in the context of their practices that impact on the quality of GP registrar learning in Central Australia. METHOD: A qualitative research method was used to explore the subtleties and issues in relationships between GP registrars, their GP supervisors and their practices. The interview schedule comprised pairs of polarised, provocative statements to generate discussion. Topics for the interview schedule were derived from the data from training advisor visits and the literature. GP registrars in Central Australia who had completed at least one six-month term in general practice were eligible for the study. Five female GP registrars participated in the study. Interviews were recorded, transcribed and checked by the participants before the interview material became the research record. RESULTS: The interview schedule generated considerable discussion as planned. The structures that determine GP income were seen as a barrier to GP registrar learning in Central Australia. The registrars reported that the fee-for-service model prevented them capitalising on learning opportunities both inside and outside their designated general practice. The GP registrars considered their training was compromised by the need to provide clinical service during a time of workforce shortage. Adaptation to a practice was seen as an important skill for GP registrars to learn, providing this did not compromise a registrar's own ethical and professional values. Learning was optimised by agreement between GP registrars and GP supervisors on the teaching subjects, and a mix of opportunistic and planned teaching sessions. Geographical isolation was perceived to have had a significant negative impact on GP registrar learning but one GP registrar discussed how this could be turned into a positive factor. CONCLUSION: GP registrars reported learning best by providing a clinical service with ready access to a supportive GP supervisor. Workforce pressures in Central Australia at the time of this pilot study reduced the GP supervisors' ability to support GP registrars, especially in a fee-for-service model of health care. GP registrars should be placed in practices where they will receive experience, training and education rather than be allocated to areas of workforce shortage. Changes to the remuneration system for GP registrars and GP supervisors could be considered to enable GP registrars to capitalise on the learning opportunities in remote clinical practice.

Journal Article↗

PubMed2004

Undergraduate pre-registration nursing education in Australia: a longitudinal examination of enrollment and completion numbers with a focus on students from rural and remote campus locations.

INTRODUCTION: There is much evidence to indicate a shortage of Registered Nurses (RNs) in Australia and to suggest that the shortage may be more pronounced in rural and remote locations. Attracting RNs to work in rural and remote areas may not be as simple as increasing the intake of students into university undergraduate pre-registration nursing courses. There is some evidence indicating that student nurses may be more likely to enter the nursing workforce in rural and remote locations if they have existing associations with rural and remote areas and/or their undergraduate education provides opportunities to undertake supported placements in rural and remote settings. Two important difficulties have been associated with measuring outcomes in relation to rural and remote pre-registration nursing students. One is defining what constitutes a rural or remote location and the other is suspect data on the number of nursing students enrolled in, and completing, nursing courses. The aims of this study were to provide a longitudinal profile of the number of domestic students studying and completing undergraduate pre-registration nursing courses in Australia, with a particular emphasis on identifying those at rural and remote university campuses, and to compare results across States and Territories. METHODS: This study presents the combined findings from two investigative reports. Data on undergraduate pre-registration nursing student numbers were collected via electronic survey instruments completed by staff at all Australian educational institutions offering undergraduate pre-registration nursing education programs in 2001 and 2002. Australian domestic students were the focus of this study. Data included the total number of domestic students enrolled in undergraduate pre-registration nursing courses in 2001 and 2002, the number of domestic students who successfully completed courses in 1999, 2000 and 2001, and estimates for the number expected to complete in 2002. Surveys were sent to course coordinators or other staff nominated by heads of divisions of nursing at each institution. RESULTS: There was a 100% response rate. Twenty-four rural and remote campus locations were identified using an adjusted form of the Rural, Remote and Metropolitan Areas (RRMA) classification system. The Australian Capital Territory and the Northern Territory did not have any rural or remote campus locations. In contrast, undergraduate pre-registration nursing in Tasmania was offered at a rural campus only (for the first 2 years). From 2001 to 2002, there was an increase of just over 5% in the total number of domestic students enrolled in undergraduate pre-registration nursing courses in Australia (2002 total = 22,811 students). Rural and remote location students accounted for slightly more than 25% of these students in 2001, and almost 27% in 2002. The States Victoria, New South Wales and Queensland had the highest percentage of students enrolled at rural and remote campus locations, greater than the Australian average for both years. In contrast, South Australia and Western Australia had less than 11% of students enrolled at rural and remote campus locations for each year. Total undergraduate pre-registration course completions increased by approximately 16% across Australia between 1999 (n = 4868) and 2002 (n = 5667), although for 2002, the figure was projected. Of these total course completions, the percentage of students completing at rural and remote campus locations increased from almost 23% to nearly 28% during the same period. Of the States/Territories with both metropolitan and rural/remote campus locations, only Victoria and Queensland had more than 25% of their total student completions consisting of students enrolled at rural and remote campus locations for each year. In contrast, South Australia and Western Australia had approximately 6% of student completions consisting of students enrolled at rural and remote campus locations in 1999, increasing to approximately 12% projected for 2002. CONCLUSIONS: In this study, the authors attempted to improve the accuracy of data collection in relation to the number of domestic undergraduate pre-registration nursing students in Australia, which is representative of the potentially new Australian domestic RN workforce. There was a trend towards an increasing number of students being enrolled in undergraduate pre-registration nursing courses, and also toward an increasing number of course completions. From the perspective of the rural and remote RN workforce, the percentage of students enrolled and completing courses at rural and remote campus locations was found to be increasing. However, there may be some areas of concern for education and workforce planners in States and Territories that are providing a smaller percentage of their undergraduate pre-registration nursing courses in rural and remote areas. Several study limitations are discussed and suggestions made for future research.

Journal Article↗

PubMed1981

The necessity for trained advanced dental professionals.

The differentiation of the workforce in dentistry is discussed in terms of its history, the development of the specialties, and advanced education. The differentiations in the general practitioner workforce, through general practice residencies and the proposed advanced educational programs in general dentistry, are discussed. The possibility of further differentiation in the workforce by drastic changes in Section 18 of the Principles of Ethics of the American Dental Association (ADA) is analyzed and evaluated. The differentiations in the dental auxiliary workforce are noted and some conclusions and recommendations in all of these areas are presented.

Dental Auxiliaries↗

PubMed1998

Nurse practitioners, certified nurse midwives, and physician assistants in California.

California's health care industry includes workers prepared in many ways to perform many jobs. One significant group of health care workers prepared to provide care that often overlaps with physician-generated services is known as "nonphysician providers." Commonly, this label refers to nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs). In this article, we will describe this group in five main areas: (1) the characteristics of the current and projected workforce and programs preparing these professionals; (2) the current skill expectations and knowledge bases of each; (3) trends in the education of these health professionals; (4) innovative models of education of these health professionals; and (5) the inclusion of NPs, PAs, and CNMs in workforce planning in a changing health care system. We conclude that, particularly in light of the overlapping functions of this provider group with many physician functions, the NP, CNM, and NP workforces must be recognized and considered when planning for the future of the physician workforce.

California↗

PubMed1998

The changing face of work in the United States: implications for individual, institutional, and societal survival.

Changes in the world of work are posing major challenges to workers, institutions, and society. Not only has the nature of work been affected by the changing work environment, increased global competition, and technological revolutions, but the characteristics of the workforce can only be described as revolutionary. Societal forces have resulted in what the authors call the "changing complexion of the workforce", the "feminization of the workforce", and the "graying of the workforce". Traditional theories of work motivation, employer-employee relations, and the role of psychology must also evolve to accommodate this challenge. The collision of these structural and demographic forces has resulted in major upheaval in society and the world of work. The authors discuss implications of these changes and urge psychologists to use their accumulated knowledge and wisdom to positively impact social policy for the greater good of people, institutions, and society.

Cultural Diversity↗

PubMed1994

Generalist physicians in nonmetropolitan countries in Ohio.

OBJECTIVE: To identify by specialty (family practice, general internal medicine, and general pediatrics) the number and ratios of generalist physicians per 100,000 population in nonmetropolitan counties in Ohio and to describe the trends in these data from 1975 through 1990. DESIGN: The data were compiled on a country basis by physician census takers residing in each county in Ohio. The US Office of Management and Budget's definition of nonmetropolitan counties formed the basis of the calculations. RESULTS: In nonmetropolitan counties of Ohio, generalist physician numbers and ratios improved between 1975 and 1990 in general internal medicine (from 5.9 to 10.2 per 100,000 population) and general pediatrics (from 2.6 to 4.9 per 100,000 population) but not in family practice, which experienced a decrease from 31.0 to 28.7 per 100,000 population. Eight counties with no hospitals were unable to attract general internists or general pediatricians. CONCLUSIONS: The results of this study indicate the importance of characterizing generalist physician workforce data by specialty and practice location on a state-wide basis and suggest that increasing the supply of physicians does not greatly improve the geographic distribution of the medical workforce. These findings should affect the development of local, state, and federal physician workforce policies aimed at addressing the problem of physician geographic maldistribution.

Family Practice↗

PubMed1998

Employment-seeking experiences of resident physicians completing training during 1996.

CONTEXT: Studies analyzing the physician workforce have concluded that the United States is verging on a physician oversupply, yet we lack persuasive evidence that this is resulting in physician underemployment and/or unemployment. OBJECTIVE: To determine the degree to which graduating residents have difficulty finding or are unable to find employment in their primary career choices. DESIGN: Two 1-page surveys sent separately to residents and to program directors to collect information on the employment status of residents who were completing a graduate medical education program at the end of the 1995-1996 academic year. SETTING: A total of 25 067 resident physicians scheduled in the spring of 1996 to complete a residency program accredited by the Accreditation Council on Graduate Medical Education, and 4569 program directors in 31 specialties and subspecialties. MAIN OUTCOME MEASURE: Both the graduates' employment status and the degree of difficulty they experienced securing a practice position, as reported by resident physicians and program directors. RESULTS: After 6 months of data collection, 12135 (48.4%) of 25 067 resident physicians responded to the survey. Of the respondents, 11 200 had completed their training, and 7628 (68.1%) were attempting to enter the workforce, 28.4% were seeking additional training, and 3.5% were fulfilling their military obligations. Of the 7628 resident physicians who sought employment, 67.3% obtained clinical practice positions in their specialties, 15.5% took academic positions, 5.0% found clinical positions in other specialties, 5.1% had other plans, and 7.1% did not yet have positions but were actively looking. In addition, 22.4% of resident physicians who found clinical positions reported significant difficulty finding them. The subgroup reporting greater difficulty finding clinical positions included international medical graduates (more than 40%),those completing programs in the Pacific or East North Central region, and those in several specialties. The 1996 graduating residents reported significantly higher rates of difficulty finding suitable employment than program directors reported for their graduates (22.4% vs 6.0%); however, the percentage of graduates reported by both groups as entering the workforce was the same (68.1%). Program directors reported an unemployment rate of only 1.2%, for their 1996 graduates, which was less than the rate reported by the resident physicians (7.1%). CONCLUSIONS: Resident physicians' direct reports of their employment-seeking experiences differ from what program directors report. Program directors accurately determined the number of residents pursuing further training; however, they did not have complete information about the employment difficulties experienced by their graduates. Based on graduates' reports, we conclude that employment difficulties are greatest among international medical graduates and vary by specialty and geographic region.

Career Choice↗

PubMed2003

The consequences of premature abandonment of affirmative action in medical school admissions.

The US Supreme Court recently accepted on appeal 2 cases from the University of Michigan regarding the constitutionality of race-conscious decision making in higher education admissions. The consequences of the Court's decision will directly affect the future of medicine in the United States. Medical schools have a societal obligation to select and educate the physician workforce of the future. To outlaw the use of affirmative action in the admissions process would cripple the profession's ability to achieve racial and ethnic diversity. Preserving this diversity in medical school admissions programs is important for 4 major reasons (1) adequate representation among students and faculty of the diversity in US society is indispensable for quality medical education; (2) increasing the diversity of the physician workforce will improve access to health care for underserved populations; (3) increasing the diversity of the research workforce can accelerate advances in medical and public health research; and (4) diversity among managers of health care organizations makes good business sense. This article explores these reasons in detail, reviews the history and effectiveness of affirmative action in medical school admissions programs, and explains why alternatives to affirmative action are unworkable.

College Admission Test↗

PubMed2001

Requirements for radiation oncology physics in Australia and New Zealand.

This Position Paper reviews the role, standards of practice, education, training and staffing requirements for radiation oncology physics. The role and standard of practice for an expert in radiation oncology physics, as defined by the ACPSEM, are consistent with the IAEA recommendations. International standards of safe practice recommend that this physics expert be authorised by a Regulatory Authority (in consultation with the professional organization). In order to accommodate the international and AHTAC recommendations or any requirements that may be set by a Regulatory Authority, the ACPSEM has defined the criteria for a physicist-in-training, a base level physicist, an advanced level physicist and an expert radiation oncology physicist. The ACPSEM shall compile separate registers for these different radiation oncology physicist categories. What constitutes a satisfactory means of establishing the number of physicists and support physics staff that is required in radiation oncology continues to be debated. The new ACPSEM workforce formula (Formula 2000) yields similar numbers to other international professional body recommendations. The ACPSEM recommends that Australian and New Zealand radiation oncology centres should aim to employ 223 and 46 radiation oncology physics staff respectively. At least 75% of this workforce should be physicists (168 in Australia and 35 in New Zealand). An additional 41 registrar physicist positions (34 in Australia and 7 in New Zealand) should be specifically created for training purposes. These registrar positions cater for the present physicist shortfall, the future expansion of radiation oncology and the expected attrition of radiation oncology physicists in the workforce. Registrar physicists shall undertake suitable tertiary education in medical physics with an organised in-house training program. The rapid advances in the theory and methodology of the new technologies for radiation oncology also require a stringent approach to maintaining a satisfactory standard of practice in radiation oncology physics. Appropriate on-going education of radiation oncology physicists as well as the educating of registrar physicists is essential. Institutional management and the ACPSEM must both play a key role in providing a means for satisfactory staff tuition on the safe and expert use of existing and new radiotherapy equipment.

Accreditation↗

PubMed2007

Recruitment.

Child and adolescent psychiatry has long been recognized as a shortage specialty by various national studies. The workforce has never increased to the extent that meets society's demand, however. The workforce crisis has continued with declining funding for residency, declining clinical revenues, and declining recruitment of trainees. This article reviews the historical trend of recruitment, recruitment dynamics (training programs and trainees), workforce models, and future direction. It concludes with hope and excitement in the field for recruitment, including the American Academy of Child and Adolescent Psychiatry's 10-year recruitment initiative that has been generating the support of medical/psychiatric educators, governmental agencies, and the public at large, to improve the profession's recruitment efforts to provide access to quality care and needed services to the nation's children and adolescents and their families.

Adolescent↗

PubMed2004

Demand outstrips supply of US pediatric dermatologists: results from a national survey.

BACKGROUND: The US pediatric dermatology workforce was last examined in 1986 when limited employment opportunity was found. OBJECTIVE: We sought to re-examine pediatric dermatology workforce issues. METHODS: US dermatology chairpersons and residency program directors were surveyed for: (1) agreement with pediatric dermatology workforce statements; and (2) pediatric dermatology faculty and fellow numbers. RESULTS: Respondents agreed that having a pediatric dermatologist or dermatologists on faculty is important, and that a shortage of pediatric dermatologists exists, but did not agree that increasing pediatric dermatology training requirements will increase this shortage. Almost half of the programs (45/94) employed a full-time pediatric dermatologist, and 24 programs had currently been recruiting a pediatric dermatologist for more than 1 year. Only 6 pediatric dermatology fellows were in training. CONCLUSION: Given that open pediatric dermatology faculty positions greatly exceed the number of fellows in training and that formal training requirements will be increasing, the shortage of pediatric dermatologists will likely continue.

Data Collection↗