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Investing in Canada's nursing workforce: a comprehensive review to inform policy innovations and directions.

BACKGROUND: Health systems worldwide face persistent health workers challenges including nursing shortages, workforce strain, and inequities. In Canada, these challenges have prompted renewed national and provincial reforms to strengthen recruitment, retention, leadership, and sustainability. This paper compares nursing workforce policy directions across Canada, and international jurisdictions to inform policy and planning. METHODS: A cross-country comparative analysis of policies building on a comprehensive national funded review that included an umbrella review of 69 systematic reviews, a comparative policy review of nursing workforce strategies in five jurisdictions, and validation through national horizon-scanning and policy dialogues (n >100). Evidence was analyzed across system, organizational, and individual levels. RESULTS: At the system level, international jurisdictions demonstrate comprehensive, legislated approaches integrating data, governance, and multi-year funding have advanced key nursing strategies. In Canada, the advances show the importance of strategies to have national and provincial/territorial alignment emphasizing leadership, flexibility, and inclusion as key levers. Organizational and individual-level reforms such as mentorship, leadership development, and wellness initiatives are expanding but remain variably evaluated. Experts identified national workforce data strategies and policy integration with embedded evaluation as key enablers to inform scalability and sustainability of implemented strategies. CONCLUSIONS: Canada's nursing workforce reforms are advancing toward coordinated, equity-driven, and evidence-informed strategies. Continued investment in evaluation, leadership, and national integrated data systems along with integrating nursing workforce planning within broader intersectoral planning will consolidate these gains and position Canada as an international leader in sustainable nursing workforce policy.

Canada

The 2023 medical genetics workforce in the United States.

PURPOSE: To characterize the 2023 medical genetics and genomics workforce in the United States-comprising clinical geneticists, genetic counselors, genetic nurses, genetic physician assistants, laboratory geneticists, and metabolic dietitians-to inform genetics workforce efforts. METHODS: National genetics membership or board-certification organizations distributed an electronic survey to medical genetics professionals in early 2023. Questions were derived from prior workforce surveys and by a workgroup led by the National Coordinating Center for the Regional Genetics Networks. RESULTS: Of the 3070 medical genetics professionals who responded, 66.0% were genetic counselors, 15.4% were clinical geneticists, 12.2% were laboratory geneticists, 4.7% were metabolic dietitians, and 1.7% were genetic nurses or physician assistants. The respondents identified as White (76.1%) and women (84.7%); there were statistically significant differences between disciplines. Forty percent worked in academic centers; 55.3% worked 41+ hours per week. Nearly 11% of respondents provided services in a language other than English. Despite 34.7% of respondents experiencing some burnout, most had no plans to leave the field (94.4%) within the next year. CONCLUSION: The medical genetics community needs to advance workforce initiatives to support current personnel and attract new and diverse individuals to the field to serve patients and their families.

Humans

Present and future patterns of practice and workforce needs in oral and maxillofacial surgery.

Oral and maxillofacial surgeons have shown curiosity and concern for their present and future patterns of practice and workforce needs. Few oral and maxillofacial surgeons would not have an understanding of how they came to be, or opinions on where the specialty is and appears to be going. Such opinions, however, need to be rigorously tested against the best available information. Quantitative information is the substantive input to decisions on whether oral and maxillofacial surgeons wish to go where they appear to be going, and if so why, and if not, why not? The Oral and Maxillofacial Surgeons 1990 Workforce Study* aimed to provide information relevant to these questions. Oral and maxillofacial surgeons are surprising in both their heterogeneity in patterns of practice and homogeneity in most of the content of services provided. Projections of the workforce indicate that a status quo in recruitment is actually a steady decline in capacity to serve the community, a picture in contrast to the international comparative data and opinion that supports a broadening in the service role of oral and maxillofacial surgeons. The Oral and Maxillofacial Surgeons 1990 Workforce Study offers insights into present and future patterns of practice and workforce needs. Ultimately, however, decision-making in the specialty will reflect additional social, economic and dento-political factors to which the Australian and New Zealand Association of Oral and Maxillo-Facial Surgeons must be the major contributor.

Adult

Migration intentions among nigerian neurosurgeons: a national survey of workforce retention.

Physician emigration from low- and middle-income countries creates critical workforce shortages. This study explored factors influencing migration intentions among Nigerian neurosurgeons and trainees. We conducted an anonymized survey of consultant neurosurgeons, fellows, and residents practicing in Nigeria. Invitations were sent by email and professional messaging platforms, and snowball sampling was used to increase participation. The survey included quantitative and open-ended questions on demographics, income, migration plans, and retention factors. Seventy-nine respondents participated (61.5 % consultants; 93.7 % male; median age: 44 years). Nearly all practiced general neurosurgery (97.3 %), and many also performed trauma (65.3 %) and spine (61.3 %) neurosurgery. Most (85.7 %) reported that their earnings were insufficient to support their families. Nearly 40 % were considering emigration, most often citing financial pressures (88.5 %) and poor working conditions (63.5 %) as push factors. By contrast, personal or family ties (63.0 %) and relocation costs (45.2 %) were cited as reasons to stay. Respondents identified higher salaries (58.1 %) and greater investment in the health sector (51.4 %) as key measures to improve retention. In univariable analyses, younger age, income insufficiency, income dissatisfaction, and feeling undervalued at work were associated with migration intention. Financial insecurity emerged as the dominant driver of migration intentions among Nigerian neurosurgeons. In addition to salary increases, sustained investment in healthcare infrastructure and workforce support is essential to improve retention. International partnerships may complement these efforts by building neurosurgical capacity and mitigating brain drain.

Humans

An estimate of the need for environmental health academicians in the workforce.

In July 1987, a workshop was held to evaluate the environmental health workforce. The workshop was sponsored by the Bureau of Health Professions. Health Resources and Services Administration of the Public Health Service. Participants were drawn from State and local agencies, Federal agencies, industry, and academia. Estimates of workforce needs were based on background information and informed consensus judgments of workshop participants. The final report of the workshop was published in January 1988. The authors synthesize some of the consensus judgements and review data from a position paper developed for the workshop. The supply, demand, and projected need for new academicians in environmental health on both graduate and undergraduate levels through 1992 are estimated. These estimates are based on the need for persons trained in the various environmental health subspecialties identified during the workshop. Outlined are the number and educational backgrounds of new faculty required. The types of new training programs that are required to meet the needs for environmental health specialists through 1992 are discussed.

Environmental Health

Hazards in the hospital: educating the workforce through its union.

The hospital workforce is exposed to many occupational hazards of which most hospital workers are unaware. The author and another health educator, both employed with the California State Department of Health, conducted occupational health and safety educational sessions for the membership of a hospital workers' union. These sessions taught nonprofessional workers how to recognize hospital hazards, how to eliminate or minimize these hazards, and informed workers of their legal rights under the California Occupational Safety and Health Act. We first had to convince the union health and safety officer that we had skills and information which would be of benefit to the union. Once that hurdle was crossed, we encountered some difficulty conducting an adequate needs assessment and including the target population in the planning of the educationals. Two series of educational sessions for rank-and-file members were conducted and were enthusiastically received by those attending, with a request for more sessions.

Accidents, Occupational

Dentistry--who is in charge? Workforce and training.

The quality of dental schools and of dental education in the 1990s will continue to influence the stature of the workforce and of the profession well into the 21st century. Undergraduate and postgraduate enrollments and related recurrent funding in universities are determined by the Department of Employment, Education and Training which identifies national priority areas, particularly those with export earning potential, for preferential development. Dental schools have not benefited from these initiatives. Political agendas will be increasingly important in altering the emphasis toward education and health in the future, and leaders of the profession must actively seek greater involvement with authorities and committees which are advisory to governments.

Australia

Prevalence of diabetes mellitus and impaired glucose tolerance in a New Zealand multiracial workforce.

A cross sectional survey was carried out among a multiracial workforce of 5677 staff aged 40 to 64 years at worksites in Auckland and Tokoroa to determine the prevalence of diabetes mellitus and impaired glucose tolerance (IGT). The prevalences of diabetes mellitus and IGT were both similar for men and women, but increased with age. The relative risks for diabetes mellitus and for IGT were both inversely associated with gross annual household income, independent of age and ethnicity, being 1.61 (95% Cl = 1.10, 2.37) and 1.80 (95% Cl = 1.21, 2.67) respectively, in the lowest income group (less than $30,000) compared with the highest (greater than $40,000). Compared with Europeans, the relative risk of diabetes mellitus was significantly increased among Maori (3.63; 95% Cl = 2.48, 5.32), Pacific Islanders (2.34; 95% Cl = 1.50, 3.66) and Asians (5.97; 95% Cl = 2.61, 13.65), after controlling for age, income and body mass index. The increased prevalence of diabetes mellitus among Maori and Pacific Islanders, but not in Asians, could be partly attributed to their increased levels of obesity compared with Europeans. However, other factors, in addition to obesity, explain the increased diabetes prevalence in nonEuropean groups.

Adult

Workforce Representation in Ophthalmology Oral Board Examiners and Examinees.

PURPOSE: To evaluate the characteristics of the American Board of Ophthalmology (ABO) oral board examiners and examinees as well as trends in examiner and examinee gender over time. DESIGN: Retrospective cohort study. SUBJECTS: ABO oral board examiners and examinees. METHODS: We utilized data from the American Board of Ophthalmology (ABO) and Association of American Medical Colleges (AAMC) to assess board examiner and examinee demographic characteristics from 2011 to 2024. Examiner characteristics included gender, years of experience, initial certification year and average examiner score. Examinee characteristics included gender, years since residency graduation and exam outcome (pass/fail). We utilized logistic regression to examine temporal trends in examiner and examinee gender from 2013 to 2024. MAIN OUTCOME MEASURES: Gender distribution of examiners and examinees. RESULTS: Overall, the proportion of women examiners increased over the study period. Notably, the most pronounced increase occurred following the transition from in-person to virtual oral board exam administration in 2020, rising from 31.3% (95% CI: 24.1%-38.4%) in 2019 to 49.1% (95% CI: 43.8%-54.4%) in 2024 (p < .001). The percentage of women examinees remained stable (41.7% [95% CI: 37.6%-45.8%] in 2019; 37.5% [95% CI: 33.0%-42.0%] in 2024, p-value: .019). CONCLUSIONS: The representation of women among the ABO oral board examiners has increased significantly following the transition to virtual exams while the proportion of examinees remained stable. Strategies to increase flexibility in scheduling exams may be beneficial in continuing to improve examiner representation.

Humans

A hidden workforce.

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Attitude of Health Personnel

GP workforce.

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Australia

Cervical cytology screening convenient for the workforce.

The study describes the demographic details and smear results of women attending a Well Woman Clinic in an Occupational Health setting over a two year period. The clinic is located close to the place of work, run during working hours, and operated by a doctor and nurse. Charging fees acceptable to women attending or their employers, the service has made a modest profit and offers scope for increasing the income against fixed costs. The age range attending is older than commonly found at screening clinics. The abnormal smear detection rate, 115 per 1000 is high while the proportion of inadequate results at 50 per 1000 compares favourably with other clinics. In an area with 13 per cent Asian population, only 5 per cent of attenders were Asian but of these one fifth had abnormal smears. A cervical cytology screening facility timed and located for the convenience of the working woman is found to attract a group of women in the older age range who have a high abnormal smear rate, and those who fail to attend elsewhere.

Adult

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