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Petravić L, Bajec B, Burger E, Tiefengraber E, Slavec A, Strnad M. Emergency physician personnel crisis: a survey on attitudes of new generations in Slovenia. BMC Emerg Med 2024; 24:25. [PMID: 38355454 PMCID: PMC10865631 DOI: 10.1186/s12873-024-00940-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Emergency departments globally are overburdened, and emergency medicine residency is losing popularity among students and physicians. This raises concerns about the collapse of a life-saving system. Our goal was to identify the key workforce reasoning and question medical staff employment behavior. METHODS This was a prospective cross-sectional study. In December 2022, medical students and pre-residency doctors in Slovenia were invited to complete a web-based questionnaire. The data were analyzed using T-test, chi-square test, Mann‒Whitney-Wilcoxon tests, and principal component analysis. Open-ended questions were hand-categorized. RESULTS There were 686 participatns who clicked on the first page and 436 of those finished the survey. 4% of participants gave a clear positive response, while 11% responded positively regarding their decision to pursue emergency medicine residency. The popularity of emergency medicine decreases significantly among recent medical school graduates upon their initial employment. People who choose emergency medicine are less concerned about its complexity and pressure compared to others. Most respondents preferred 12-hour shift lengths. The preferred base salary range for residents was I$ 3623-4529, and for specialists, it was I$ 5435-6341. The sample's primary personal priorities are achieving a satisfactory work-life balance, earning respect from colleagues, and engaging in academic activities. Factors that attract individuals to choose emergency medicine include high hourly wages, establishment of standards and norms, and reduced working hours. CONCLUSIONS Our findings indicate that enhancing compensation, establishing achievable standards and norms, facilitating a beneficial work-life equilibrium, providing assistance with initial property acquisition, stimulating participation in deficit residency programs, fostering collegiality among peers, restricting the duration of shifts, and enabling pension accrual may be imperative in attracting more individuals to pursue emergency medicine residency.
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Affiliation(s)
- Luka Petravić
- Center for Emergency Medicine, University Medical Center Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia.
| | - Boštjan Bajec
- Department of Psychology, Faculty of Arts, University of Ljubljana, Aškerčeva 2, 1000, Ljubljana, Slovenia
| | - Evgenija Burger
- Faculty of Mathematics and Physics, University of Ljubljana, Jadranska ulica 19, 1000, Ljubljana, Slovenia
| | - Eva Tiefengraber
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia
| | - Ana Slavec
- InnoRenew CoE, Livade 6a, 6310, Izola, Slovenia
- Department of Applied Natural Sciences, University of Primorska, Glagoljaška 8, 6000, Koper, Slovenia
| | - Matej Strnad
- Center for Emergency Medicine, University Medical Center Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia
- Community healthcare center dr. Adolf Drolca, Prehospital unit, Ulica talcev 9, 2000, Maribor, Slovenia
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152
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Li X, Yao L, Yang X, Huang M, Zhang B, Yu T, Tang Y. Perceptions, barriers, and challenges of oral care among nursing assistants in the intensive care unit: a qualitative study. BMC Oral Health 2024; 24:235. [PMID: 38355476 PMCID: PMC10868102 DOI: 10.1186/s12903-024-03979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Although oral hygiene is closely related to various diseases, it is sub-optimal in the Intensive Care Unit (ICU). Oral care in the ICU is challenged by nursing workloads, low staffing, and higher acuity patients, there are few policies and written guidelines for oral care. Nurses often delegate oral care to nursing assistants (NAs) whose role is overlooked. This study is to explore the perspectives, obstacles, and challenges of NAs in the oral care of the ICU. METHODS A qualitative study and semi-structured interviews were conducted with NAs in three ICU units, and Colaizzi's phenomenological method was used to analyze the records. RESULTS Initially, 13 NAs met the inclusion criteria, and two did not participate in this study as they refused to be recorded. Finally, 11 ICU NAs were interviewed, with three receiving face-to-face interviews and eight receiving telephone interviews. Using Colaizzi's phenomenological method, two themes and eight subthemes emerged from the data, we examined the self-perception, barriers and challenges of NAs regarding oral care and identified the subthemes: (1) The target audience, frequency, and importance; (2) Role; (3) Evaluation; (4) Patient-related factors; (5) Oral care tools; (6) Psychology of NAs; (7) Lack of education and training; (8) Lack of team support. CONCLUSION Nursing assistants whose roles are overlooked by the nursing team are important members of the ICU team. Though oral care is closely related to disease prevention, it is rarely considered an essential task. Major barriers to implementing oral care in the ICU environment and patients include the psychological quality of participants, non-standard education and training, and inadequate team support. The expectation is that medical personnel will prioritize oral hygiene and recognize the significance of NAs in nursing work. Furthermore, future ICU oral care should investigate suitable tools and mouthwashes, simplified and standardized processes, standardized training, and multidisciplinary team collaboration.
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Affiliation(s)
- Xingru Li
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Lin Yao
- School of Clinical Medicine, Soochow University, Suzhou, Jiangsu Province, China
| | - Xinchen Yang
- Department of Nursing, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Meixia Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Bo Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Tao Yu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Yun Tang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China.
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153
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March MK, Dennis SM, Caruana S, Mahony C, Elliott JM, Polley S, Thomas B, Lin C, Harmer AR. Boosting inpatient exercise after hip fracture using an alternative workforce: a mixed methods implementation evaluation. BMC Geriatr 2024; 24:149. [PMID: 38350882 PMCID: PMC10865645 DOI: 10.1186/s12877-024-04730-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Hip fracture has a devastating impact on individuals and is an increasing burden for health systems and society. Compared to usual care, increased physiotherapy provision has demonstrated efficacy in improving patient and health service outcomes in this population. However, physiotherapy workforce challenges prevent sustained implementation. METHODS Our aim was to evaluate the safety, feasibility, acceptability, effectiveness and implementation cost of thrice daily physiotherapy for patients in the acute care setting after hip fracture at two public hospitals. We added twice-daily exercise implemented by an alternative workforce, to usual care consisting of daily mobility practice by a physiotherapist. Sites identified their preferred alternative workforce, with pre-registration physiotherapy students and allied health assistants chosen. We used a mixed methods approach, using the Consolidated Framework for Implementation Research (CFIR) as a determinant framework to guide implementation planning and data collection. We compared hospital length of stay data to a reference cohort. RESULTS We recruited 25 patients during the study period. Acute care hospital length of stay decreased from 11 days in the reference cohort to 8 days in the BOOST cohort (mean difference - 3.3 days, 95%CI -5.4 to -1.2 days, p = 0.003). Intervention fidelity was 72% indicating feasibility, no safety concerns were attributed to the intervention, and uptake was 96% of all eligible patients. The intervention was acceptable to patients, carers and healthcare providers. This intervention was cost-effective from the acute orthopaedic service perspective. CONCLUSION Higher daily frequency of physiotherapy can be safely, feasibly and effectively implemented by an alternative workforce for patients in the acute care setting following hip fracture surgery.
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Affiliation(s)
- Marie K March
- Physiotherapy Department, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, NSW, Australia.
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.
| | - Sarah M Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Sarah Caruana
- Physiotherapy Department, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Christopher Mahony
- Physiotherapy Department, Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - James M Elliott
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- The Kolling Institute, St Leonards, NSW, Australia
| | - Stephanie Polley
- Department of Rehabilitation and Aged Care, Blacktown Mt Druitt Hospitals, Western Sydney Local Health District, Blacktown, NSW, Australia
- Department of Aged Care, Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - Bijoy Thomas
- Department of Orthopaedic Surgery, Blacktown Mt Druitt Hospital, Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Charlie Lin
- Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - Alison R Harmer
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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de Saxe Zerden L, Ware OD, Lombardi BN, Lombardi BM. Harm reduction workforce, behavioral health, and service delivery in the USA: a cross-sectional study. Harm Reduct J 2024; 21:36. [PMID: 38336662 PMCID: PMC10858514 DOI: 10.1186/s12954-024-00952-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Despite recent financial and policy support for harm reduction in the USA, information on the types of workers within organizations who design, implement, and actualize harm reduction services remains nascent. Little is known about how variability in the harm reduction workforce impacts referrals and linkages to other community supports. This exploratory mixed-methods study asked: (1) Who constitutes the harm reduction workforce? (2) Who provides behavioral health services within harm reduction organizations? (3) Are referral services offered and by whom? (4) Do referrals differ by type of harm reduction worker? METHODS Purposive sampling techniques were used to distribute an electronic survey to U.S.-based harm reduction organizations. Descriptive statistics were conducted. Multivariate binary logistic regression models examined the associations (a) between the odds of the referral processes at harm reduction organizations and (b) between the provision of behavioral health services and distinct types of organizational staff. Qualitative data were analyzed using a hybrid approach of inductive and thematic analysis. RESULTS Data from 41 states and Washington, D.C. were collected (N = 168; 48% response rate). Four primary types of workers were identified: community health/peer specialists (87%); medical/nursing staff (55%); behavioral health (49%); and others (34%). About 43% of organizations had a formal referral process; among these, only 32% had follow-up protocols. Qualitative findings highlighted the broad spectrum of behavioral health services offered and a broad behavioral health workforce heavily reliant on peers. Unadjusted results from multivariate models found that harm reduction organizations were more than 5 times more likely (95% CI [1.91, 13.38]) to have a formal referral process and 6 times more likely (95% CI [1.74, 21.52]) to have follow-up processes when behavioral health services were offered. Organizations were more than two times more likely (95% CI [1.09, 4.46]) to have a formal referral process and 2.36 (95% CI [1.11, 5.0]) times more likely to have follow-up processes for referrals when behavioral health providers were included. CONCLUSIONS The composition of the harm reduction workforce is occupationally diverse. Understanding the types of services offered, as well as the workforce who provides those services, offers valuable insights into staffing and service delivery needs of frontline organizations working to reduce morbidity and mortality among those who use substances. Workforce considerations within U.S.-based harm reduction organizations are increasingly important as harm reduction services continue to expand.
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Affiliation(s)
- Lisa de Saxe Zerden
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St. CB #3550, Chapel Hill, NC, 27599, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Orrin D Ware
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St. CB #3550, Chapel Hill, NC, 27599, USA
| | - Brooke N Lombardi
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Brianna M Lombardi
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St. CB #3550, Chapel Hill, NC, 27599, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
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155
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Williams DKA, Christophers B, Keyes T, Kumar R, Granovetter MC, Adigun A, Olivera J, Pura-Bryant J, Smith C, Okafor C, Shibre M, Daye D, Akabas MH. Sociodemographic factors and research experience impact MD-PhD program acceptance. JCI Insight 2024; 9:e176146. [PMID: 38329127 DOI: 10.1172/jci.insight.176146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
The 2014 NIH Physician-Scientist Workforce Working Group predicted a future shortage of physician-scientists. Subsequent studies have highlighted disparities in MD-PhD admissions based on race, income, and education. Our analysis of data from the Association of American Medical Colleges covering 2014-2021 (15,156 applicants and 6,840 acceptees) revealed that acceptance into US MD-PhD programs correlates with research experience, family income, and research publications. The number of research experiences associated with parental education and family income. Applicants were more likely to be accepted with a family income greater than $50,000 or with one or more publications or presentations. Applicants were less likely to be accepted if they had parents without a graduate degree, were Black/African American, were first-generation college students, or were reapplicants, irrespective of the number of research experiences, publications, or presentations. These findings underscore an admissions bias that favors candidates from affluent and highly educated families, while disadvantaging underrepresented minorities.
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Affiliation(s)
- Darnell K Adrian Williams
- Albert Einstein College of Medicine, Medical Scientist Training Program, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
- American Physician Scientists Association, Westford, Massachusetts, USA
| | - Briana Christophers
- American Physician Scientists Association, Westford, Massachusetts, USA
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, New York, USA
| | - Timothy Keyes
- American Physician Scientists Association, Westford, Massachusetts, USA
- Stanford University Medical Scientist Training Program, Stanford, California, USA
| | - Rachit Kumar
- American Physician Scientists Association, Westford, Massachusetts, USA
- Perelman School of Medicine at the University of Pennsylvania, Medical Scientist Training Program, Philadelphia, Pennsylvania, USA
| | - Michael C Granovetter
- American Physician Scientists Association, Westford, Massachusetts, USA
- University of Pittsburgh-Carnegie Mellon University Medical Scientist Training Program, Pittsburgh, Pennsylvania, USA
| | - Alexandria Adigun
- American Physician Scientists Association, Westford, Massachusetts, USA
- Perelman School of Medicine at the University of Pennsylvania, Medical Scientist Training Program, Philadelphia, Pennsylvania, USA
| | - Justin Olivera
- Albert Einstein College of Medicine, Bronx, New York, USA
- American Physician Scientists Association, Westford, Massachusetts, USA
| | - Jehron Pura-Bryant
- Albert Einstein College of Medicine, Bronx, New York, USA
- American Physician Scientists Association, Westford, Massachusetts, USA
| | - Chynna Smith
- Albert Einstein College of Medicine, Medical Scientist Training Program, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
- American Physician Scientists Association, Westford, Massachusetts, USA
| | - Chiemeka Okafor
- American Physician Scientists Association, Westford, Massachusetts, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mahlet Shibre
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dania Daye
- American Physician Scientists Association, Westford, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Myles H Akabas
- Albert Einstein College of Medicine, Medical Scientist Training Program, Bronx, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
- Departments of Neuroscience and Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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156
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Alkan E, Cushen-Brewster N, Anyanwu P. Investigating healthcare workforce recruitment and retention: a mixed-methods study protocol. BMJ Open 2024; 14:e074100. [PMID: 38331865 PMCID: PMC10860040 DOI: 10.1136/bmjopen-2023-074100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/22/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Although the sustainability of the health workforce has been identified as essential to achieving health and wider development objectives, challenges with securing and retaining the healthcare workforce persist. In the UK, there are notable shortages across a wide range of National Health Service (NHS) staff groups, with a high staff turnover indicating retention issues in the healthcare workforce. In addition, gaps exist in understanding the root cause of individual organisation's workforce deficiencies and how their practice environment factors interact to impact workforce recruitment and retention. METHODS AND ANALYSIS An exploratory mixed-methods approach will be conducted to investigate the impact of organisational practice environment factors on healthcare workforce recruitment and retention in two Integrated Care Systems (ICS) in the East of England. We will conduct an online survey of newly qualified and established nurses and allied health professionals using a questionnaire adapted from two validated instruments. Our calculation suggests a sample size of 373 participants, we will aim to surpass this in our recruitment to strengthen the statistical analyses. Multilevel linear regression models will be fitted to evaluate the association between organisational practice environmental factors and staff recruitment and retention. The qualitative interviews will explore the experiences and perspectives of staff and senior leaders to explain the survey results and any significant associations therein. Also, the interviews will explore how to strengthen the partnership between higher education institutions, Health Education England, health and care service providers, NHS nursing and allied health professional staff to enhance recruiting and retaining staff. An exploratory inductive coding and analysis will follow Braun and Clarke's recommendations to generate key themes from transcribed interview data. ETHICS AND DISSEMINATION Ethical approval has been obtained through the University of Suffolk Research Ethics Committee (approval number: RETH(S)22/051). Findings from our work will be disseminated through publications in peer-reviewed journals; presentations at stakeholders' events, professional and academic conferences; and short reports for stakeholders, including participating ICSs.
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157
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Park YS, Yun I, Jang SY, Park EC, Jang SI. Association between nurse staffing level in intensive care settings and hospital-acquired pneumonia among surgery patients: result from the Korea National Health Insurance cohort. Epidemiol Infect 2024; 152:e62. [PMID: 38326273 DOI: 10.1017/s0950268824000232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
This study examined the association between the number of nursing staff in intensive care units (ICUs) and hospital-acquired pneumonia (HAP) among surgical patients in South Korea. Data were obtained between 2008 and 2019 from the Korean National Health Insurance Service Cohort Database; 37,706 surgical patients who received critical care services were included in the analysis. Patients with a history of pneumonia 1 year prior to surgery or those who had undergone lung-related surgery were excluded. The ICU nursing management fee is an admission fee that varies based on the grading determined by nurse-to-bed ratio. Using this grading system, we classified four groups from the highest to the lowest level based on the proportion of beds to nurses (high, high-mid, mid-low, and low group). HAP was defined by the International Classification of Disease, 10th revision (ICD-10) code. Multilevel logistic regression was used to investigate the relationship between the level of ICU nurse staffing and pneumonia, controlling for variables at the individual and hospital levels. Lower levels of nurse staffing were associated with a greater incidence of HAP than higher levels of nurse staffing (mid-high, OR: 1.33, 95% CI: 1.12-1.57; mid-low, OR: 1.61, 95% CI: 1.27-2.04; low, OR: 2.13, 95% CI: 1.67-2.71). The intraclass correlation coefficient value was 0.177, and 17.7% of the variability in HAP was accounted for by the hospital. Higher ICU nursing management fee grades (grade 5 and above) in general and hospital settings were significantly associated with an increased risk of HAP compared to grade 1 admissions. Similarly, in tertiary hospitals, grade 2 and higher ICU nursing management fees were significantly associated with an increased risk of HAP compared to grade 1 admissions. Especially, a lower level of nurse staffing was associated with bacterial pneumonia but not pneumonia due to aspiration. In conclusion, this study found an association between the level of ICU nurse staffing and HAP among surgical patients. A lower level of nurse staffing in the ICU was associated with increased rates of HAP among surgical patients. This indicates that having fewer beds assigned to nurses in the ICU setting is a significant factor in preventing HAP, regardless of the size of the hospital.
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Affiliation(s)
- Yu Shin Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Il Yun
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Knight KH, Simpson A, Hay J. Building the future workforce through indirect supervision. Br J Nurs 2024; 33:98. [PMID: 38335111 DOI: 10.12968/bjon.2024.33.3.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Affiliation(s)
- Kate H Knight
- Associate Professor and Head of Practice Education and Simulated Learning at Faculty of Health, Medicine and Society, University of Chester
| | - Angela Simpson
- Pro Vice-chancellor/Executive Dean at Faculty of Health, Medicine and Society, University of Chester
| | - Jonathon Hay
- Research Assistant at Faculty of Health, Medicine and Society, University of Chester
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159
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Fu Z, Madni GR. Unveiling the affecting mechanism of digital transformation on total factor productivity of Chinese firms. PLoS One 2024; 19:e0298428. [PMID: 38324579 PMCID: PMC10849404 DOI: 10.1371/journal.pone.0298428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024] Open
Abstract
The importance of digital transformation (DGT) for increasing productivity cannot be negated and Chinese firms are rapidly embracing the digital transformation for their sustainability. But the mechanism and impact of digital transformation on total factor productivity (TFP) of firms is still unclear and this study is intended to fill this gap using the data of 3112 listed firms of China during 2011 to 2022. We applied various econometric techniques like stepwise regression analysis, instrumental variable approach, differences in difference approach, and mediating analysis to determine the relationship between digital transformation and TFP and robustness of estimated findings. The findings indicate that DGT has a positive impact on overall TFP of firms in China while operating efficiency, cheaper costs, and a stronger capacity for innovation mediates this relationship. Moreover, it is explored that conventional information and communication technologies have not significant impact on TFP of firms. The findings of the study remain valid even applying many robustness checks and attempts to control the issue of endogeneity. To fully leverage the potential benefits of digital transformation on TFP, it is essential to focus on enhancing digital literacy and skills among the workforce. Governments and relevant stakeholders should prioritize and invest in comprehensive digital literacy and skills training programs to empower the workforce with the knowledge and expertise needed to navigate the digital age effectively.
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Affiliation(s)
- Zhiyuan Fu
- Institute of Electronic Commerce, Zhejiang Business College, Hangzhou, Zhejiang Province, China
| | - Ghulam Rasool Madni
- Department of Economics, Division of Management and Administrative Science, University of Education, Lahore, Pakistan
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160
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Czabanowska K, Rodriguez Feria P. Training needs assessment tools for the public health workforce at an institutional and individual level: a review. Eur J Public Health 2024; 34:59-68. [PMID: 37878815 PMCID: PMC10843943 DOI: 10.1093/eurpub/ckad183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The public health workforce (PHW) needs to have the necessary capacities to provide healthcare services and public health services. Training needs assessments (TNA) is necessary to assess and understand PHW and their capacities to provide services. This review attempts to identify and describe published studies on tools and methodologies for TNA of the workforce used in public health and health-related fields. METHODS A systematized review of literature was carried out in February 2022. Cochrane Handbook for systematic review version 5.2.0 and PRISMA 2020 statement were used to guide reporting. This review includes original research, reports and grey literature from the websites of public health organizations in English. RESULTS This review included 38 documents for evidence synthesis. Twenty-seven documents were indexed literature (71%) and 11 were grey documents (29%). TNA documents were published between 1999 and 2022. TNA was performed in many countries around the world. The organizations used either a validated questionnaire or created their own tools to perform organizational and individual self-assessments. The TNA tools were developed using different methods such as expert panels, literature reviews, stakeholder interviews and quantitative surveys. CONCLUSION TNA is useful for defining and characterizing the public health workforce in every organization. Workforces consist of individuals who have their own training needs to fulfill their tasks. Therefore, individual and organizational TNA should be combined to study the public health workforce and their capacities.
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Affiliation(s)
- Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute CAPHRI, FHML, Maastricht University, Maastricht, the Netherlands
- Department of Health Policy Management, Institute of Public Health, Jagiellonian University, Krakow, Poland
| | - Pablo Rodriguez Feria
- Department of International Health, Care and Public Health Research Institute CAPHRI, FHML, Maastricht University, Maastricht, the Netherlands
- Departamento de Salud Pública, Facultad de Medicina, Universidad de Los Andes, Bogota, Colombia
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Czabanowska K, Rodriguez Feria P, Kuhlmann E, Kostoulas P, Middleton J, Magana L, Sutton G, Goodman J, Burazeri G, Aleksandrova O, Piven N. Professionalization of the public health workforce: scoping review and call to action. Eur J Public Health 2024; 34:52-58. [PMID: 37793003 PMCID: PMC10843938 DOI: 10.1093/eurpub/ckad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The 'WHO-ASPHER Roadmap to Professionalizing the Public Health Workforce in the European Region' provides recommendations for strategic and systematic workforce planning around professionalization levers including: (i) competencies, (ii) training and education, (iii) formal organization, (iv) professional credentialing and (v) code of ethics and professional conduct as well as taxonomy and enumeration. It was based on a literature review till 2016. This scoping review aims to explore how the professionalization was documented in the literature between 2016 and 2022. METHODS Following the Joanna Briggs Institute guidelines, we searched Medline via PubMed, Web of Science, ERIC via EBSCO and Google Scholar and included studies on professionalization levers. Four critical appraisal tools were used to assess qualitative, quantitative, mixed methods studies and grey literature. The PRISMA Extension for Scoping Reviews (PRISMA-ScR) was used for reporting. RESULTS Eleven articles included in this review spanned 61 countries, targeting undergraduate, master's, doctoral degrees and continuing professional development. Most of these documents were reviews. About half provided a definition of the public health workforce; more than half covered the taxonomy and included information about competences, but the use of frameworks was sporadic and inconsistent. Formal organization and the necessity of a code of conduct for the public health workforce were acknowledged in only two studies. CONCLUSIONS In spite of some efforts to professionalize the public health workforce, this process is fragmented and not fully recognized and supported. There is an urgent need to engage policymakers and stakeholders to prioritize investments in strengthening the public health workforce worldwide.
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Affiliation(s)
- Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute CAPHRI, FHML, Maastricht University, Maastricht, The Netherlands
- Department of Health Policy Management, Institute of Public Health, Jagiellonian University, Krakow, Poland
| | - Pablo Rodriguez Feria
- Department of International Health, Care and Public Health Research Institute CAPHRI, FHML, Maastricht University, Maastricht, The Netherlands
- Departamento de Salud Pública, Facultad de Medicina, Universidad de Los Andes, Bogota, Colombia
| | - Ellen Kuhlmann
- European Public Health Association Section Health Workforce Research (EUPHA-HWR), Utrecht, The Netherlands
- Institute of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany
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162
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Shawa KC, Hollingsworth B, Zucchelli E. A systematic review and meta-analysis on the effects of ill health and health shocks on labour supply. Syst Rev 2024; 13:52. [PMID: 38310288 PMCID: PMC10837878 DOI: 10.1186/s13643-024-02454-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/08/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Several studies have explored the effects of ill health and health shocks on labour supply. However, there are very few systematic reviews and meta-analyses in this area. The current work aims to fill this gap by undertaking a systematic review and meta-analysis on the effects of ill health and health shocks on labour supply. METHODS We searched using EconLit and MEDLINE databases along with grey literature to identify relevant papers for the analysis. Necessary information was extracted from the papers using an extraction tool. We calculated partial correlations to determine effect sizes and estimated the overall effect sizes by using the random effects model. Sub-group analyses were conducted based on geography, publication year and model type to assess the sources of heterogeneity. Model type entailed distinguishing articles that used the standard ordinary least squares (OLS) technique from those that used other estimation techniques such as quasi-experimental methods, including propensity score matching and difference-in-differences methodologies. Multivariate and univariate meta-regressions were employed to further examine the sources of heterogeneity. Moreover, we tested for publication bias by using a funnel plot, Begg's test and the trim and fill methodology. RESULTS We found a negative and statistically significant pooled estimate of the effect of ill health and health shocks on labour supply (partial r = -0.05, p < .001). The studies exhibited substantial heterogeneity. Sample size, geography, model type and publication year were found to be significant sources of heterogeneity. The funnel plot, and the trim and fill methodology, when imputed on the left showed some level of publication bias, but this was contrasted by both the Begg's test, and the trim and fill methodology when imputed on the right. CONCLUSION The study examined the effects of ill health and health shocks on labour supply. We found negative statistically significant pooled estimates pertaining to the overall effect of ill health and health shocks on labour supply including in sub-groups. Empirical studies on the effects of ill- health and health shocks on labour supply have oftentimes found a negative relationship. Our meta-analysis results, which used a large, combined sample size, seem to reliably confirm the finding.
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Affiliation(s)
- Ken Chamuva Shawa
- International Labour Organization (ILO), Regional Economic and Social Analysis Unit (RESA), Regional Office for Asia and the Pacific (ROAP), Bangkok, Thailand.
- Division of Health Research, University of Lancaster, Lancaster, UK.
| | | | - Eugenio Zucchelli
- Madrid Institute for Advanced Study (MIAS) and Department of Economic Analysis, Universidad Autónoma de Madrid, Madrid, Spain
- Lancaster University, Lancaster, UK
- IZA, Bonn, Germany
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163
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Auerbach DI, Buerhaus PI, Donelan K, Staiger DO. Projecting the Future Registered Nurse Workforce After the COVID-19 Pandemic. JAMA Health Forum 2024; 5:e235389. [PMID: 38363560 PMCID: PMC10873770 DOI: 10.1001/jamahealthforum.2023.5389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/16/2023] [Indexed: 02/17/2024] Open
Abstract
Importance Health care delivery systems rely on a well-prepared and adequately sized registered nurse (RN) workforce. The US RN workforce decreased by more than 100 000 in 2021 during the COVID-19 pandemic-a far greater single-year drop than observed over the past 4 decades. The implication for the longer-term growth of the RN workforce is unknown. Objective To describe recent trends in RN employment through 2023 and forecast the growth of the RN workforce through 2035. Design, Setting, and Participants Descriptive analysis of recent trends since the start of the COVID-19 pandemic in RN employment using data from the US Bureau of the Census Current Population Survey and including employed RNs aged 23 to 69 years from 1982 through 2023, and retrospective cohort analysis of employment trends by birth year and age to project the age distribution and employment of RNs through 2035. Main Outcome and Measures Annual full-time equivalent (FTE) employment of RNs by age, demographics, and sector of employment; forecast of RN workforce by age through 2035. Results The final sample included 455 085 RN respondents aged 23 to 69 years. After a sharp decline in 2021, RN employment recovered, and the total number of FTE RNs in 2022 and 2023 was 6% higher than in 2019 (3.35 million vs 3.16 million, respectively). Using data on employment, education, and population through 2022, the size of the RN workforce was projected to increase by roughly 1.2 million FTEs to 4.56 million by 2035, close to prepandemic forecasts. Growth will be driven primarily by RNs aged 35 to 49 years, who are projected to compose nearly half (47%) of the RN workforce in 2035, up from 38% in 2022. Conclusions and Relevance In this study, the rebound in the total size of the US RN workforce during 2022 and 2023 indicates that the earlier drop in RN employment during the first 2 years of the COVID-19 pandemic was likely transitory. Updated forecasts of the future RN workforce are very close to those made before the pandemic.
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Affiliation(s)
| | | | - Karen Donelan
- Institute on Healthcare Systems, Brandeis University, Waltham, Massachusetts
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164
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Bartmess MP, Myers CR, Thomas SP, Hardesty PD, Atchley K. Original Research: A Real 'Voice' or 'Lip Service'? Experiences of Staff Nurses Who Have Served on Staffing Committees. Am J Nurs 2024; 124:20-31. [PMID: 38212011 DOI: 10.1097/01.naj.0001006368.29892.c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Nurse staffing committees offer a means for improving nurse staffing and nursing work environments in hospital settings by giving direct care nurses opportunities to contribute to staffing decision-making. These committees may be mandated by state law, as is the case currently in nine U.S. states, yet little is known about the experiences of staff nurses who have served on them. PURPOSE AND DESIGN This qualitative descriptive study was conducted to explore the experiences of direct care nurses who have served on nurse staffing committees, and to better understand how such committees operate. METHODS Participants were recruited by sharing information about the study through online nursing organization platforms, hospital nurse leadership, state chapters of national nursing organizations, social media, and nonconfidential nursing email lists. A total of 14 nurses from five U.S. states that have had nurse staffing committee legislation in place for at least three years were interviewed between April and October 2022. RESULTS Four themes were identified from the data-a "well-valued" committee versus one with "locked away" potential: committee value; "who benefits": staffing committee beneficiaries; "not just the numbers": defining adequate staffing; and "constantly pushing": committee members' persistence. CONCLUSIONS The results of this study highlight the importance of actualizing staff nurse autonomy within nurse staffing committees-and invite further exploration into how staff nurses' perspectives can be better valued by nursing and nonnursing hospital leadership. Nurse staffing committees generally recommend staffing-related policies and practices that address the needs of patients and nurses, and work to find areas of compromise between nursing and hospital entities. But to be effective, the state laws that govern nurse staffing committees should be enforceable and evaluable, while committee practices should contribute to positive patient, nurse, and organizational outcomes; otherwise, they're just another form of paying lip service to change.
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Affiliation(s)
- Marissa P Bartmess
- Marissa P. Bartmess is clinical assistant professor at the College of Nursing, University of South Carolina, Columbia. Carole R. Myers is a professor emerita at the College of Nursing, University of Tennessee Knoxville (UTK), where Pamela D. Hardesty is a professor and Sandra P. Thomas is a professor and chair of the PhD program. Kate Atchley is director of the Executive MBA in Healthcare Leadership and the Physician Executive MBA programs at UTK's Haslam College of Business. Marissa P. Bartmess received study funding through a Sigma Small Grant from the Gamma Chi Chapter of Sigma Theta Tau International Honor Society of Nursing and the Sara Rosenbalm Croley Endowed Dean's Chair held by Victoria Niederhauser at UTK. Contact author: Marissa P. Bartmess, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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165
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Snelling P. Am I my students' nurse? Reflections on the nursing ethics of nursing education. Nurs Ethics 2024; 31:52-64. [PMID: 37769641 PMCID: PMC10898194 DOI: 10.1177/09697330231193858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Despite having worked in higher education for over twenty years, I am still, first and foremost, a practicing nurse. My employer requires me to be a nurse and my regulator regards what I do as nursing. My practice is regulated by the Code and informed by nursing ethics. If I am nurse, practicing nursing, does that mean that my students are my patients? This paper considers how the relationship that I have with my students can be informed by the ethics of the nurse/patient relationship. After some initial theoretical preparation concerning argument from analogy, the paper identifies some areas for comparison between the two relationships. Areas of similarity and difference identify two areas of concern: Nurse education and educators regularly engage in coercion and surveillance in an attempt to increase student success, both of which would be considered outside nursing ethics. It is concluded that these coercive practices are not conducive to an environment where character is cultivated. Despite current financial and workforce pressures, nurse lecturers and more especially their managers would do well to return to the professional ethics of nursing to question and guide their practice.
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166
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Berkowitz ST, Finn AP, Parikh R, Kuriyan AE, Patel S. Ophthalmology Workforce Projections in the United States, 2020 to 2035. Ophthalmology 2024; 131:133-139. [PMID: 37739231 DOI: 10.1016/j.ophtha.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023] Open
Abstract
PURPOSE To analyze ophthalmology workforce supply and demand projections from 2020 to 2035. DESIGN Observational cohort study using data from the National Center for Health Workforce Analysis (NCHWA). METHODS Data accessed from the Department of Health and Human Services, Health Resources and Services Administration (HRSA) website were compiled to analyze the workforce supply and demand projections for ophthalmologists from 2020 to 2035. MAIN OUTCOME MEASURES Projected workforce adequacy over time. RESULTS From 2020 to 2035, the total ophthalmology supply is projected to decrease by 2650 full-time equivalent (FTE) ophthalmologists (12% decline) and total demand is projected to increase by 5150 FTE ophthalmologists (24% increase), representing a supply and demand mismatch of 30% workforce inadequacy. The level of projected adequacy was markedly different based on rurality by year 2035 with 77% workforce adequacy versus 29% workforce adequacy in metro and nonmetro geographies, respectively. By year 2035, ophthalmology is projected to have the second worst rate of workforce adequacy (70%) of 38 medical and surgical specialties studied. CONCLUSIONS The HRSA's Health Workforce Simulation Model forecasts a sizeable shortage of ophthalmology supply relative to demand by the year 2035, with substantial geographic disparities. Ophthalmology is one of the medical specialties with the lowest rate of projected workforce adequacy by 2035. Further dedicated workforce supply and demand research for ophthalmology and allied professionals is needed to validate these projections, which may have significant future implications for patients and providers. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Sean T Berkowitz
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, Tennessee
| | - Avni P Finn
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, Tennessee
| | - Ravi Parikh
- Manhattan Retina and Eye Consultants, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York
| | - Ajay E Kuriyan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Shriji Patel
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, Tennessee.
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167
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Abstract
Approximately 30 million ill and injured children annually visit emergency departments (EDs) in the United States. Data suggest that patients seen in pediatric EDs by board-certified pediatric emergency medicine (PEM) physicians receive higher-quality care than those cared for by non-PEM physicians. These benefits, coupled with the continued growth in PEM since its inception in the early 1990s, have impacted child health broadly. This article is part of a Pediatrics supplement focused on predicting the future pediatric subspecialty workforce supply by drawing on the American Board of Pediatrics workforce data and a microsimulation model of the future pediatric subspecialty workforce. The article discusses the utilization of acute care services in EDs, reviews the current state of the PEM subspecialty workforce, and presents projected numbers of PEM subspecialists at the national, census region, and census division on the basis of this pediatric subspecialty workforce supply model through 2040. Implications of this model on education and training, clinical practice, policy, and future workforce research are discussed. Findings suggest that, if the current growth in the field of PEM continues on the basis of the increasing number and size of fellowship programs, even with a potential reduction in percentage of clinical time and attrition of senior physicians, the PEM workforce is anticipated to increase nationally. However, the maldistribution of PEM physicians is likely to be perpetuated with the highest concentration in New England and Mid-Atlantic regions and "PEM deserts" in less populated areas.
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Affiliation(s)
- Maya S Iyer
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Nationwide Children's Hospital, Columbus, Ohio
| | - Joshua Nagler
- Department of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, Massachusetts
| | - Richard B Mink
- The Lundquist Institute for Biomedical Innovation at Harbor, University of California Los Angeles Medical Center, Torrance, California
| | - Javier Gonzalez Del Rey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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168
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Horowitz E, Hudak ML, Peña MM, Vinci RJ, Savich R. Child Health and the Neonatal-Perinatal Medicine Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678O. [PMID: 38300002 DOI: 10.1542/peds.2023-063678o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
In 2022, 3.7 million children were born in the United States, of whom ∼600 000 received care from a neonatologist. The dramatic growth of the neonatal-perinatal medicine (NPM) workforce from 375 in 1975 to 5250 in 2022 has paralleled exploding clinical demand. As newborn medicine continues to push the limits of gestational viability and medical complexity, the NPM workforce must advance in numbers, clinical capability, scientific discovery, and leadership. This article, as part of an American Board of Pediatrics Foundation-sponsored supplement that is designed to project the future of the pediatric subspecialty workforce, features a discussion of the NPM workforce's history and current status, factors that have shaped its current profile, and some plausible scenarios of the workforce's needs and configuration in the future. In the article, we use an analytical model that forecasts the growth trajectory of the neonatologist workforce from 2020 through 2040. The model uses recent data on the number of neonatologists and clinical work equivalents per 100 000 children and projects future workforce supply under several theoretical scenarios created by modifying key baseline parameters. The predictions of this model confirm the need for a greater sustainable clinical capacity of the NPM workforce. Several future trends indicate that there may be geographic shortages of neonatologists, similar to expected shortages in other pediatric subspecialties. We do not address what an appropriate target for workforce size should be with the model or this article because the current and projected geographic variability in the NPM workforce and risk-appropriate care suggest that a uniform answer is unlikely.
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Affiliation(s)
| | - Mark L Hudak
- University of Florida College of Medicine, Jacksonville, Florida
| | - Michelle-Marie Peña
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | - Robert J Vinci
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Renate Savich
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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169
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Pestana J, Frutuoso J, Costa E, Fonseca F. Heterogeneity in physician's job preferences in a dual practice context - Evidence from a DCE. Soc Sci Med 2024; 343:116551. [PMID: 38242030 DOI: 10.1016/j.socscimed.2023.116551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/26/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024]
Abstract
Many countries are facing challenges in recruiting and retaining physicians, particularly in regions where the public and private sectors compete for doctors. Understanding the factors influencing physicians' job choices can help inform policies aimed at attracting and retaining this valuable workforce. This study aims to elicit the strength of physicians' preferences regarding various job-related aspects, including earnings, time flexibility, discussion of clinical cases, frequency of facilities and equipment updates, training opportunities and autonomy in decision making. To achieve this, a Discrete Choice Experiment (DCE) was administered to 697 physicians. Each participant completed a series of eight choice tasks, where they had to choose between two hypothetical jobs differing in these attributes with levels mirroring positions in the public and private sectors in Portugal. The resulting choices were analysed using mixed logit, generalized multinomial logit and latent classes models to account for diverse unobserved variations in physicians' preferences and to explore preference heterogeneity across different observable characteristics. Jobs that offered more autonomy and training opportunities were strongly preferred, as physicians would require additional compensation to work with reduced autonomy (equivalent to 28.62% of gross income) or less frequent training (equivalent to 22.75%). This study also shows that the ranking of the job characteristics is similar between physicians working exclusively in the public sector and those engaged in dual practice. Nevertheless, public sector physicians place more emphasis on the availability of frequent training possibilities and frequent updates of facilities and equipment compared to their counterparts in dual practice. These findings contribute to existing knowledge by highlighting the significance of non-monetary attributes and shedding light on the preferences of physicians across various employment scenarios. They offer valuable insights for policy development aimed at influencing physicians' allocation of time between sectors.
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Affiliation(s)
- Joana Pestana
- Nova School of Business and Economics, Lisbon, Portugal.
| | - João Frutuoso
- Serviço de Medicina Intensiva do Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Eduardo Costa
- Nova School of Business and Economics, Lisbon, Portugal
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170
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Wang R. The hidden linkage of corporate efficiency and green innovation with human resource management practices: a newly perspective from China. Environ Sci Pollut Res Int 2024; 31:12511-12527. [PMID: 38233710 DOI: 10.1007/s11356-023-31554-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/03/2023] [Indexed: 01/19/2024]
Abstract
It is disappointing that despite having access to human resources at very little cost, rising countries' administrations are so ineffective. It is often believed that an organization's unheralded employees hold the keys to its success or failure. A person's mood and demeanor may be influenced by a variety of factors. Human resource management (HRM) methods have been created and used by scientists all over the globe in an effort to maximize the potential of their most important asset. Eco-friendly inventions are crucial to the survival of humanity and the prosperity of enterprises throughout the world. Therefore, the purpose of this research is to look at how green innovation affects both the environment and businesses. Green process metrics and green product metrics, for example, may have an impact on green innovation, which is why these metrics are important to track. The second primary goal of this research is to learn how the commitment and HR practices of top management shape the link between green innovation and economic and environmental success. A self-reported poll was taken by 370 employees in China's manufacturing industry. A partial least square structural equation modelling was used to examine the data collected between April 2021 and February 2022. This research employed confirmatory component analysis, a standard technique of structural equation modelling (SEM) for examining both overt and covert variables and indicators, to assess the reflecting indicators measurement model. The findings suggest that HRM has an effect on green innovation that is both positive and statistically significant. The environment and the economy benefit greatly from green innovations. Relationships between HRM and green innovation have no unfavorable implications on business results or the environment. However, human resource management has the potential to boost organizations' prosocial impact. In a three-way interaction (moderated moderation) model, organizational success is found to have a significant role, whereas environmental and organizational success play just a little one. To improve economic and environmental outcomes across all sectors, this study adds to the existing body of knowledge and argues for the wider implementation of green innovation practices. Human resource managers play a crucial role in developing a company's culture and values. The findings suggest that with leadership's blessing, green technologies may spread across a company.
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Affiliation(s)
- Ran Wang
- Department of Management, Shijiazhuang Information Engineering Vocational College, Shijiazhuang, 050000, Hebei, China.
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171
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Bray M, Turner J, Jones S, Miah T, Milberger S. Developing Workforce Skills and Capacity in Telehealth: What LEND Trainees Need to Know. Matern Child Health J 2024; 28:240-245. [PMID: 37889391 DOI: 10.1007/s10995-023-03794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION The COVID-19 pandemic significantly impacted the way health-related services are delivered, rapidly shifting from in-person to telehealth visits. To ensure that future healthcare providers are fully prepared to deliver services to families of youth with neurodevelopmental disabilities (NDD), understanding telehealth's advantages and barriers is vital. To this end, data were gathered to inform the development of a nationally available telehealth curriculum aimed at training future healthcare professionals from the Leadership Education in Neurodevelopmental Disabilities (LEND) network. METHODS Surveys were sent out nationally to current LEND trainees, practicing healthcare professionals, and family members of youth with NDD in November of 2020. Multiple choice and free response questions were completed and analyzed. A total of N = 208 surveys were completed (88 LEND trainees, 94 practicing professionals, 23 family members). RESULTS Most survey respondents reported having positive experiences with telehealth. LEND trainees and current healthcare professionals cited increased access to care and engagement as the top benefit of telehealth. Most family members reported using telehealth services (78%) and felt it was superior to in-person visits in terms of location of visit, scheduling, and meeting transportation needs. Trainees and professionals agreed the top barriers to telehealth for families were lack of broadband access and complexity of implementation and use. LEND trainees agreed telehealth basics should be included in LEND curriculum. DISCUSSION Trainees, professionals, and family members all agreed that knowing the basics of telehealth is essential for effective telehealth service delivery. Emerging healthcare professionals need to understand how those they will be serving engage with technology, their levels of experience in this area, and effective strategies for engaging children and youth with NDD through telehealth. This will bridge the engagement gap many families of children with disabilities face when not meeting in person. Findings from this study contributed to the design of learning materials that currently support LEND trainees across the country in developing these skills.
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Affiliation(s)
- Michael Bray
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA.
| | - Jane Turner
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA
| | - Sean Jones
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA
| | - Tazia Miah
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA
| | - Sharon Milberger
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA
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Orr CJ, Leslie LK, Schaechter J, Williams XJ, Montez KG, Deen JF, Evans YN, Russell CJ, Webb J, Gaona AR, Mendoza FS. Diversity, Equity, and Inclusion, Child Health, and the Pediatric Subspecialty Workforce. Pediatrics 2024; 153:e2023063678S. [PMID: 38300010 PMCID: PMC10852199 DOI: 10.1542/peds.2023-063678s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Using multiple metrics, the diversity of the pediatric population in the United States is increasing. However, recent data suggest significant disparities in both the prevalence and management of child health conditions cared for by pediatric subspecialists. These inequities occur across multiple dimensions of diversity, including race and ethnicity, country of origin, socioeconomic status, sex and gender, and disability. Research also suggests that attending to diversity, equity, and inclusion in the medical workforce may positively affect health outcomes. High-quality pediatric subspecialty care thus requires knowledge of these data, attention to the effects of social drivers, including racism and discrimination, on health and wellbeing, and interventions to improve pediatric health equity through educational, practice, policy, and research innovations. In this article, we review data on the diversity of the pediatric population and pediatric subspecialty workforce, suggest potential strengths, weaknesses, opportunities, and threats of current diversity, equity, and inclusion initiatives in academic pediatrics, and provide recommendations across 4 domains: education and training, practice, policy, and future research. The ultimate goal of pediatrics is to improve health equity for all infants, children, adolescents, and young adults cared for in the United States by pediatric subspecialists.
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Affiliation(s)
- Colin J. Orr
- Department of Pediatrics
- Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Kimberly G. Montez
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jason F. Deen
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Yolanda N. Evans
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | | | - Jonathan Webb
- American Board of Pediatrics, Chapel Hill, North Carolina
- Association of Women’s Health Obstetric and Neonatal Nurses, Washington, District of Columbia
| | | | - Fernando S. Mendoza
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, California
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Walton-Roberts M, Bourgeault IL. Health workforce data needed to minimize inequities associated with health-worker migration. Bull World Health Organ 2024; 102:117-122. [PMID: 38313146 PMCID: PMC10835628 DOI: 10.2471/blt.23.290028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 02/06/2024] Open
Abstract
A persistent challenge with health-worker migration is the inequities it creates. To minimize these inequities, systems of global governance of health-worker migration have arisen which include various global codes of practice, agreements and reporting requirements. Reporting that is rigorous, open and transparent, and subject to scrutiny from the public, researchers, civil society organizations and other interested stakeholders, is important. One element of these codes and agreements with perhaps the greatest potential to deal with the impact of health-worker migration is more robust planning of the health workforce to address the goal of self-sufficiency. Open platforms for data sharing enable engagement of the public and stakeholders with data on the distribution and national origin of health workers, and reveal policy strengths and weaknesses related to health-workforce planning. We explore recent policies directed at reducing the inequities from health-worker migration. While many of the examples used focus on nurses and doctors, the issues discussed are relevant to all cadres of internationally trained health workers.
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Affiliation(s)
- Margaret Walton-Roberts
- Department of Geography and Environmental Studies, Wilfrid Laurier University, 75 University Avenue West, Waterloo, OntarioN2L 3C5, Canada
| | - Ivy L Bourgeault
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, Canada
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174
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Hansel TC, Saltzman LY, Melton PA. Work Environment and Health Care Workforce Well-Being: Mental Health and Burnout in Medically Underserved Communities Prone to Disaster. Am J Public Health 2024; 114:156-161. [PMID: 38354340 PMCID: PMC10916726 DOI: 10.2105/ajph.2023.307478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 02/16/2024]
Abstract
Health care workers (n = 71) completed an online survey or participated in one of five focus groups. Clinical cutoff scores revealed concerning levels of depression (16%), anxiety, and burnout (49%). Qualitative responses (n = 172) yielded two themes: work environment and well-being. Addressing burnout requires an ecological systems mindset, which accounts for complex stressors present in individual providers' lives (large-scale disasters and personal stressors), agency-level factors (scheduling and workload), and larger social and contextual administrative factors (allocating time for self-care through scheduling and billing codes). (Am J Public Health. 2024;114(S2):S156-S161. https://doi.org/10.2105/AJPH.2023.307478).
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Affiliation(s)
- Tonya Cross Hansel
- Tonya Cross Hansel, Leia Y. Saltzman, and Pamela A. Melton are with the School of Social Work, Tulane University, New Orleans, LA
| | - Leia Y Saltzman
- Tonya Cross Hansel, Leia Y. Saltzman, and Pamela A. Melton are with the School of Social Work, Tulane University, New Orleans, LA
| | - Pamela A Melton
- Tonya Cross Hansel, Leia Y. Saltzman, and Pamela A. Melton are with the School of Social Work, Tulane University, New Orleans, LA
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175
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Boston-Leary K, Yakusheva O. It's Time! The Path for Nursing Reimbursement Reform. Creat Nurs 2024; 30:37-40. [PMID: 38351613 DOI: 10.1177/10784535241228546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Since the COVID-19 pandemic, nurses and nurse leaders are increasingly vocal about chronic understaffing and the impact the staffing crisis continues to have on nurses' well-being and patient outcomes. The American Nurses Association's Nurse Staffing Task Force addressed the importance of staffing standards as a critically needed step toward improving patient and population health outcomes. Against the backdrop of ongoing nursing shortages, hospital leaders have been hesitant to embrace staffing ratios, expressing concerns about their ability to hire and retain sufficient nursing staff, as operational revenue margins remain thin and nursing labor is costly. This article explicates structural issues within the current nursing reimbursement model that harms hospitals' business case for investments in nurse staffing and work environments. We argue that nurses must advocate for nursing reimbursement reform to increase the nursing workforce and improve nurse staffing and work environments. Such reform is necessary to support sustained hospital investments, financial philosophies, and approaches to meaningfully address and improve nurse staffing.
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Affiliation(s)
- Katie Boston-Leary
- Division of Nursing Practice and Work Environment, American Nurses Association, Silver Spring, MD, USA
| | - Olga Yakusheva
- School of Nursing, School of Public Health, University of Michigan, Ann Arbor, USA
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176
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Edwards MA. Diversity in the Cardiothoracic Surgery Workforce: What I Can Do. Thorac Surg Clin 2024; 34:89-97. [PMID: 37953057 DOI: 10.1016/j.thorsurg.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Within the cardiothoracic surgery workforce, there are significant gaps in the numbers of women and underrepresented in medicine minorities, but some progress has been made in gender diversity at the resident level. Individual surgeons play an important role in combatting discrimination and harassment, while also promoting women and minorities through mentorship and sponsorship. More importantly, a multifaceted and structured approach is needed to increase diversity at the institutional level with strategies to create a culture of inclusion, working to retain underrepresented minority and female surgeons, and eliminating bias in the recruitment process.
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Affiliation(s)
- Melanie A Edwards
- Cardiovascular & Thoracic Surgery, Trinity Medical Group Ann Arbor, 5325 Elliott Drive, Suite 102, Ypsilanti, MI 48197, USA.
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177
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Baum RA, Berman BD, Fussell JJ, Patel R, Roizen NJ, Voigt RG, Leslie LK. Child Health Needs and the Developmental-Behavioral Pediatrics Workforce Supply: 2020-2040. Pediatrics 2024; 153:e2023063678H. [PMID: 38300001 DOI: 10.1542/peds.2023-063678h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Developmental-behavioral pediatrics (DBP) subspecialists care for children with complex neurodevelopmental and behavioral health conditions; additional roles include education and training, advocacy, and research. In 2023, there were 1.0 DBP subspecialists per 100 000 US children aged 0 to 17 years (range 0.0-3.8), with wide variability in DBP subspecialist distribution. Given the prevalence of DB conditions, the current workforce is markedly inadequate to meet the needs of patients and families. The American Board of Pediatrics Foundation led a modeling project to forecast the US pediatric subspecialty workforce from 2020 to 2040 using current trends in each subspecialty. The model predicts workforce supply at baseline and across alternative scenarios and reports results in headcount (HC) and HC adjusted for percent time spent in clinical care, termed "clinical workforce equivalent." For DBP, the baseline model predicts HC growth nationally (+45%, from 669 to 958), but these extremely low numbers translate to minimal patient care impact. Adjusting for population growth over time, projected HC increases from 0.8 to 1.0 and clinical workforce equivalent from 0.5 to 0.6 DBP subspecialists per 100 000 children aged 0 to 18 years by 2040. Even in the best-case scenario (+12.5% in fellows by 2030 and +7% in time in clinical care), the overall numbers would be minimally affected. These current and forecasted trends should be used to shape much-needed solutions in education, training, practice, policy, and workforce research to increase the DBP workforce and improve overall child health.
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Affiliation(s)
- Rebecca A Baum
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill/North Carolina Children's Hospital, Chapel Hill, North Carolina
| | - Brad D Berman
- Division of Developmental-Behavioral Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Jill J Fussell
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas
| | - Rohan Patel
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill/North Carolina Children's Hospital, Chapel Hill, North Carolina
| | - Nancy J Roizen
- Division of Developmental and Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Robert G Voigt
- Michael R. Boh Centers for Child Development, Department of Pediatrics, Ochsner Health, and University of Queensland Medical School/Ochsner Clinical School, New Orleans, Louisiana
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178
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Managing a Multigenerational Workforce. AORN J 2024; 119:161-3. [PMID: 38275265 DOI: 10.1002/aorn.14083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/27/2024]
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179
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Vaterlaus Patten E, Vaterlaus JM, Anderson C, Borden R. Opting In and Out: A Qualitative Study Exploring Career Break Experiences of Registered Dietitian Nutritionists. J Acad Nutr Diet 2024; 124:181-193. [PMID: 37690622 DOI: 10.1016/j.jand.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Since 2002, an average of 17.5% of registered dietitian nutritionists (RDNs) have reported being out of the paid dietetics workforce, and approximately half of those report intention to return. With the Academy of Nutrition and Dietetics' focus on expanding workforce demand and capacity, understanding why and how dietitians opt in and out of the dietetics workforce may provide insights into how to potentially reduce the number of career breaks or expedite and enhance the reentry process. OBJECTIVE To explore the lived experiences and perspectives of dietitians who were taking (with intention to return) or had taken a career break and returned to the paid dietetics' workforce. DESIGN A qualitative study with semistructured interviews was conducted. PARTICIPANTS/SETTING Participants (n = 22) were recruited through purposive sampling over social media. They were required to be credentialed as RDNs, reside in the United States, and have either previously or currently (with intent to return) taken a break from the dietetics workforce. Interviews were conducted using Zoom videoconferencing technology during September 2021. DATA ANALYSIS Data were analyzed using a Coding Reliability Thematic Analysis approach. RESULTS The data are summarized in four themes: (1) motivations to leave and return, (2) staying connected with dietetics, (3) preparing to return and returning to the dietetics workforce, and (4) desired resources for career breaks and reentry. CONCLUSIONS Understanding the experiences of dietitians who take career breaks may help inform career reentry and help the profession meet the current and future workforce demand.
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180
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Peutere L, Pentti J, Ropponen A, Kivimäki M, Härmä M, Krutova O, Ervasti J, Koskinen A, Virtanen M. Association of nurse understaffing and limited nursing work experience with in-hospital mortality among patients: A longitudinal register-based study. Int J Nurs Stud 2024; 150:104628. [PMID: 37992652 DOI: 10.1016/j.ijnurstu.2023.104628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Although nurse understaffing and limited nursing work experience may affect hospital patients' risk of mortality, relatively little longitudinal patient-level evidence on these associations is available. Hospital administrative data could provide important information about the level of staffing, nurses' work experience and patient mortality over time. OBJECTIVE To examine whether daily exposure to nurse understaffing and limited nursing work experience is associated with patient mortality, using patient-level data with different exposure time windows and accounting for several patient-related characteristics. METHODS This longitudinal register-based study combined administrative data on patients (clinical database Auria) and employees (Titania® shift-scheduling) from one hospital district in Finland in 2013-2019, covering a total of 254,446 hospital stays in 40 units. We quantified nurse understaffing as the number of days with low nursing hours in relation to target hours (<90 % of the annual unit median), and limited work experience as the number of days with a low proportion of nurses with >3 years of in-hospital experience, and those aged over 25 (<90 % of the annual unit median). We used two survival model designs to analyze the associations between nurse understaffing and limited nursing work experience and the in-hospital mortality of the patients: we considered these exposures during the first days in hospital and as a cumulative proportion of days with suboptimal staffing during the first 30 days. RESULTS In total, 1.5 % (N = 3937) of the hospital stays ended in death. A 20 % increase in the proportion of days with nurse understaffing was associated with an increased, 1.05-fold mortality risk at the patient level (95 % confidence interval, 1.01-1.10). The cumulative proportion of days with limited nursing work experience, or the combination of nurse understaffing and limited work experience were not associated with increased risk of death among all patients. However, both indicators of limited nursing work experience were associated with an increased mortality risk among patients with comorbidities (HR 1.05, 95 % CI 1.02-1.08 and HR 1.05, 95 % CI 1.00-1.10, respectively). CONCLUSIONS Nurse understaffing was associated with a slight, but a potentially critical increase in patient in-hospital mortality. Limited nursing work experience was associated with increased in-hospital mortality in a subgroup of patients with comorbidities. Increased use of administrative data on planned and realized working hours could be a routine tool for reducing avoidable in-hospital mortality.
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Affiliation(s)
- Laura Peutere
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland; Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku, Finland
| | - Annina Ropponen
- Finnish Institute of Occupational Health, Helsinki, Finland; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland; Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Mikko Härmä
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Oxana Krutova
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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181
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Clayden S, Beks H, Alston L, Versace V. An underutilised resource: The evolving role of clinical nurses contributing to rural health research. Aust J Rural Health 2024; 32:193-197. [PMID: 38063290 DOI: 10.1111/ajr.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 02/16/2024] Open
Abstract
AIM We aim to discuss the advantages of supporting clinical nurses' involvement in place-based research in rural health services. CONTEXT Australian health services are currently struggling with increased demand in services from an aging population, chronic diseases and nursing workforce shortages. This impact is amplified in rural and remote regions of Australia. APPROACH Investment in place-based clinical nursing research provides opportunity for nursing recruitment, career and leadership development, and retention, while addressing local health issues and creating pathways for implementation of evidence-based practice. CONCLUSION Collaboration between rural health services, universities, policy makers and the Rural Health Multidisciplinary Training program will enable the opportunity for establishment and ongoing development of strong research programs in rural health services to address local health issues and workforce needs.
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Affiliation(s)
- Suzanne Clayden
- Deakin Rural Health, School of Medicine, Warrnambool, Victoria, Australia
- South West Healthcare, Warrnambool, Victoria, Australia
| | - Hannah Beks
- Deakin Rural Health, School of Medicine, Warrnambool, Victoria, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Warrnambool, Victoria, Australia
- Colac Area Health, Colac, Victoria, Australia
| | - Vincent Versace
- Deakin Rural Health, School of Medicine, Warrnambool, Victoria, Australia
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182
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Tulleners T, Taylor M, Campbell C. Contribution of peer group supervision to nursing practice: An interpretive phenomenological study. Nurse Educ Pract 2024; 75:103903. [PMID: 38271915 DOI: 10.1016/j.nepr.2024.103903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/15/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
AIM To provide insight into peer group supervision practices through understanding the lived experience of community health nurses. BACKGROUND The recent Covid-19 health crisis highlights the importance of supportive mechanisms to sustain and retain nurses in the workforce. While the support of quality clinical supervision for registered nurses is recognised, the benefits and challenges of peer group supervision are less clearly articulated. DESIGN Nurses' experiences of peer group supervision in an Australian tertiary health service were explored using a Gadamerian philosophical hermeneutic approach. METHOD Semi-structured in-depth interviews were conducted in 2021 and provided nurses with the opportunity to share their experiences of using the New Zealand Coaching and Mentoring Model of peer group supervision. The study included a total of 31 nurse participants across multiple community health contexts. Interview data were analysed using a hermeneutic approach from which themes arose. FINDINGS The findings demonstrated that strong peer group supervision foundations that include personal and professional preparation and active participation are essential. Dual pillars of "the unique individual" and "the unique group" with responsibilities identified in each pillar that enable interactions and worthiness in peer group supervision practice. The foundations and pillars support peer group supervision in nursing practice to provide a mechanism for reflection, support and professional guidance. CONCLUSIONS Peer group supervision is a worthy, contributory process in community health nursing when implementation processes are supported and teams are educated and prepared. Perceptions of peer group supervision are unique and varied across individuals. The individual experience has an impact on the group experience and vice versa. Knowledge of the process and group by participants is required to enable professional reflection through nursing peer group supervision.
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Affiliation(s)
- Tracey Tulleners
- School of Nursing and Midwifery, University of Southern Queensland, 11 Salisbury Rd, Ipswich 4305, Australia.
| | - Melissa Taylor
- School of Nursing and Midwifery, University of Southern Queensland, 11 Salisbury Rd, Ipswich 4305, Australia; Centre for Health Research, University of Southern Queensland, 11 Salisbury Rd, Ipswich 4305, Australia.
| | - Christina Campbell
- School of Psychology and Wellbeing, University of Southern Queensland, 11 Salisbury Rd, Ipswich 4305, Australia.
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183
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Adepoju P. Healthcare workforce shortages exacerbated by poaching from the global South. Nat Med 2024; 30:311-314. [PMID: 38200258 DOI: 10.1038/s41591-023-02698-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
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184
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Weidemann DK, Orr CJ, Norwood V, Brophy P, Leonard MB, Ashoor I. Child Health Needs and the Pediatric Nephrology Subspecialty Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678P. [PMID: 38300004 DOI: 10.1542/peds.2023-063678p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Pediatric nephrology is dedicated to caring for children with kidney disease, a unique blend of acute care and chronic longitudinal patient relationships. Though historically a small field, trainee interest has declined over the past 2 decades. This has led to growing alarm about the health of the pediatric nephrology workforce, although concerns have been hampered by a lack of available data to enable feasible projections. This article is part of a supplement that anticipates the future pediatric subspecialty workforce supply. It draws on existing literature, data from the American Board of Pediatrics, and findings from a model that estimates the future supply of pediatric subspecialists developed by the Carolina Health Workforce Research Center at the University of North Carolina Chapel Hill's Cecil G. Sheps Center for Health Services Research and Strategic Modeling Analytics & Planning Ltd. The workforce projections from 2020 to 2040 incorporate population growth, clinical effort, and geographic trends and model alternate scenarios adjusting for changes in trainee interest, clinical efforts, and workforce attrition. The baseline model predicts growth of clinical work equivalents by 26% by 2040, but further widening geographic disparities worsen the existing mismatch between supply, clinical need, and market demand. The worst-case scenario projects 13% growth by 2040 which, at best, maintains the status quo of an already strained workforce. The models do not account for many factors expected to heighten demand over the coming decades. Urgent reforms are necessary now. Proposed solutions require multipronged changes in education and training pathways, remuneration, clinical practice models, and government policy.
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Affiliation(s)
- Darcy K Weidemann
- Division of Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
- School of Medicine, University of Missouri, Kansas City, Kansas City, Missouri
| | - Colin J Orr
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Victoria Norwood
- Division of Nephrology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Patrick Brophy
- Division of Nephrology, Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York
| | - Mary B Leonard
- Division of Nephrology, Department of Pediatrics, Stanford University, Palo Alto, California
| | - Isa Ashoor
- Boston Children's Hospital, Department of Pediatrics, Boston, Massachusetts
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185
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Correll CK, Klein-Gitelman MS, Henrickson M, Battafarano DF, Orr CJ, Leonard MB, Mehta JJ. Child Health Needs and the Pediatric Rheumatology Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678R. [PMID: 38300008 DOI: 10.1542/peds.2023-063678r] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
The Pediatric Rheumatology (PRH) workforce supply in the United States does not meet the needs of children. Lack of timely access to PRH care is associated with poor outcomes for children with rheumatic diseases. This article is part of a Pediatrics supplement focused on anticipating the future pediatric subspecialty workforce supply. It draws on information in the literature, American Board of Pediatrics data, and findings from a model that estimates the future supply of pediatric subspecialists developed by the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, Strategic Modeling and Analysis Ltd., and the American Board of Pediatrics Foundation. PRH has a smaller workforce per capita of children than most other pediatric subspecialties. The model demonstrates that the clinical workforce equivalent of pediatric rheumatologists in 2020 was only 0.27 per 100 000 children, with a predicted increase to 0.47 by 2040. Although the model predicts a 72% increase in providers, this number remains inadequate to provide sufficient care given the number of children with rheumatic diseases, especially in the South and West regions. The likely reasons for the workforce shortage are multifactorial, including lack of awareness of the field, low salaries compared with most other medical specialties, concerns about working solo or in small group practices, and increasing provider retirement. Novel interventions are needed to increase the workforce size. The American College of Rheumatology has recognized the dire consequences of this shortage and has developed a workforce solutions initiative to tackle these problems.
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Affiliation(s)
- Colleen K Correll
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Marisa S Klein-Gitelman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Michael Henrickson
- Department of Pediatrics, College of Medicine, University of Cincinnati, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Colin J Orr
- Department of Pediatrics
- Cecil G. Sheps Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mary B Leonard
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jay J Mehta
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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186
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Khan N. Amidst a GP workforce crisis, where did all the jobs go? Br J Gen Pract 2024; 74:72-73. [PMID: 38272693 PMCID: PMC10824349 DOI: 10.3399/bjgp24x736233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Affiliation(s)
- Nada Khan
- Nada is an Exeter-based GP and clinical academic, and an Associate Editor for the BJGP.
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187
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Jordan KA, Gable EK, Morgan AP, McNeal-Trice K, Byerley JS. A Longitudinal Pediatric Primary Care Residency Tailored to Meet Workforce Need: A 10-Year Evaluation. J Grad Med Educ 2024; 16:80-83. [PMID: 38304590 PMCID: PMC10829916 DOI: 10.4300/jgme-d-23-00453.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/05/2023] [Accepted: 12/04/2023] [Indexed: 02/03/2024] Open
Abstract
Background We started a primary care residency program intended to prepare graduates for primary care and increase entry into primary care, using time-limited funds from the Health Resources and Services Administration (HRSA). Objective To compare the graduates of the primary care residency program to their categorical peers, and whether they remained in the state, began primary care careers, and whether they identified as underrepresented in medicine. Methods This is a retrospective study of a cohort of 39 residents who graduated from the University of North Carolina primary care residency program from 2014-2023. In 2016, HRSA grant funding expired and the program continued with ongoing financial support from the 2 institutions. Graduate demographics and career choices were compared to categorical residents (159 total) for graduate years 2014 to 2023. Results The primary care pediatrics residency has graduated 39 residents to date. Job placement data was obtained for all 39 graduates. Graduates of the program have 5.5-fold greater odds (95% CI, 2.5-12.5) of working in primary care roles following graduation than peer categorical residents. Most graduates (33 of 39, 85%) have taken jobs in general pediatrics (including primary care, urgent care, adolescent medicine, or hospital medicine). The program has recruited a large proportion of its residents (12 of 39, 31%) from groups historically underrepresented in medicine. Conclusions We developed an innovative primary care pediatric residency in collaboration with a community partner, spurred by HRSA funds, that has trained a diverse group of new primary care pediatricians.
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Affiliation(s)
- Katherine A. Jordan
- Katherine A. Jordan, MD, is Assistant Professor and Associate Program Director, Pediatric Residency Program, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth Kaye Gable
- Elizabeth Kaye Gable, MD, is Professor and Program Director, Pediatric Primary Care Residency, Pediatric Teaching Program, Cone Health, Greensboro, North Carolina, USA
| | - Andrew P. Morgan
- Andrew P. Morgan, MD, PhD, is Assistant Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Kenya McNeal-Trice
- Kenya McNeal-Trice, MD, is Professor and Vice Chair of Education, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA; and at the time of writing
| | - Julie S. Byerley
- Julie S. Byerley, MD, MPH, was Professor and Vice Dean for Academic Affairs and Chief Education Officer, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA, and is now Professor and President and Dean, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
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Halpern NA, Tan KS, Bothwell LA, Boyce L, Dulu AO. Defining Intensivists: A Retrospective Analysis of the Published Studies in the United States, 2010-2020. Crit Care Med 2024; 52:223-236. [PMID: 38240506 DOI: 10.1097/ccm.0000000000005984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVES The Society of Critical Care Medicine last published an intensivist definition in 1992. Subsequently, there have been many publications relating to intensivists. Our purpose is to assess how contemporary studies define intensivist physicians. DESIGN Systematic search of PubMed, Embase, and Web of Science (2010-2020) for publication titles with the terms intensivist, and critical care or intensive care physician, specialist, or consultant. We included studies focusing on adult U.S. intensivists and excluded non-data-driven reports, non-U.S. publications, and pediatric or neonatal ICU reports. We aggregated the study title intensivist nomenclatures and parsed Introduction and Method sections to discern the text used to define intensivists. Fourteen parameters were found and grouped into five definitional categories: A) No definition, B) Background training and certification, C) Works in ICU, D) Staffing, and E) Database related. Each study was re-evaluated against these parameters and grouped into three definitional classes (single, multiple, or no definition). The prevalence of each parameter is compared between groups using Fisher exact test. SETTING U.S. adult ICUs and databases. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 657 studies, 105 (16%) met inclusion criteria. Within the study titles, 17 phrases were used to describe an intensivist; these were categorized as intensivist in 61 titles (58%), specialty intensivist in 30 titles (29%), and ICU/critical care physician in 14 titles (13%). Thirty-one studies (30%) used a single parameter (B-E) as their definition, 63 studies (60%) used more than one parameter (B-E) as their definition, and 11 studies (10%) had no definition (A). The most common parameter "Works in ICU" (C) in 52 studies (50%) was more likely to be used in conjunction with other parameters rather than as a standalone parameter (multiple parameters vs single-parameter studies; 73% vs 17%; p < 0.0001). CONCLUSIONS There was no consistency of intensivist nomenclature or definitions in contemporary adult intensivist studies in the United States.
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Affiliation(s)
- Neil A Halpern
- Department of Anesthesiology and Critical Care Medicine, Critical Care Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lilly A Bothwell
- Department of Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lindsay Boyce
- MSK Library, Technology Division, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alina O Dulu
- Department of Anesthesiology and Critical Care Medicine, Critical Care Center, Memorial Sloan Kettering Cancer Center, New York, NY
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Bullock-Palmer RP, Flores Rosario K, Douglas PS, Hahn RT, Lang RM, Chareonthaitawee P, Srichai MB, Ordovas KG, Baldassarre LA, Burroughs MS, Henderson CS, Woodard PK, Pressoir K, Swaminathan M, Blankstein R, Daubert MA. Multimodality Cardiac Imaging and the Imaging Workforce in the United States: Diversity, Disparities, and Future Directions. Circ Cardiovasc Imaging 2024; 17:e016409. [PMID: 38377238 DOI: 10.1161/circimaging.123.016409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Innovations in cardiac imaging have fundamentally advanced the understanding and treatment of cardiovascular disease. These advances in noninvasive cardiac imaging have also expanded the role of the cardiac imager and dramatically increased the demand for imagers who are cross-trained in multiple modalities. However, we hypothesize that there is significant variation in the availability of cardiac imaging expertise and a disparity in the adoption of advanced imaging technologies across the United States. To evaluate this, we have brought together the leaders of cardiovascular imaging societies, imaging trainees, as well as collaborated with national imaging accreditation commissions and imaging certification boards to assess the state of cardiac imaging and the diversity of the imaging workforce in the United States. Aggregate data confirm the presence of critical gaps, such as limited access to imaging and imaging expertise in rural communities, as well as disparities in the imaging workforce, notably among women and underrepresented minorities. Based on these results, we have proposed solutions to promote and maintain a robust and diverse community of cardiac imagers and improve equity and accessibility for cardiac imaging technologies.
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Affiliation(s)
- Renee P Bullock-Palmer
- Clinical Associate Professor, Department of Medicine, Division of Cardiology, Thomas Jefferson University, Philadelphia, PA (R.P.B.P.)
- Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.P.B.P., K.P.)
| | - Karen Flores Rosario
- Department of Medicine, Division of Cardiology (K.F.R., P.S.D., M.A.D.), Duke University Medical Center, Durham, NC
| | - Pamela S Douglas
- Department of Medicine, Division of Cardiology (K.F.R., P.S.D., M.A.D.), Duke University Medical Center, Durham, NC
| | - Rebecca T Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, NY (R.T.H.)
| | - Roberto M Lang
- Section of Cardiology, Heart and Vascular Center, University of Chicago, IL (R.M.L.)
| | | | - Monvadi B Srichai
- Department of Medicine and Radiology, Medstar Georgetown University Hospital, Medstar Heart and Vascular Institute, Washington, DC (M.B.S.)
| | - Karen G Ordovas
- Department of Radiology, University of Washington, Seattle, WA (K.G.O.)
| | - Lauren A Baldassarre
- Department of Medicine, Division of Cardiology, Yale School of Medicine, New Haven, CT (L.A.B.)
| | | | - Cory S Henderson
- Department of Medicine, Division of Cardiology, Department of Radiology, Boston Medical Center, MA (C.S.H.)
| | - Pamela K Woodard
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University, St Louis, MO (P.K.W.)
| | - Kathleen Pressoir
- Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.P.B.P., K.P.)
| | - Madhav Swaminathan
- Department of Anesthesiology, Cardiothoracic Division (M.S.), Duke University Medical Center, Durham, NC
| | - Ron Blankstein
- Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (R.B.)
| | - Melissa A Daubert
- Department of Medicine, Division of Cardiology (K.F.R., P.S.D., M.A.D.), Duke University Medical Center, Durham, NC
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190
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Ward S. Do physicians need tragic optimism? Intern Med J 2024; 54:348-351. [PMID: 38350660 DOI: 10.1111/imj.16315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/19/2023] [Indexed: 02/15/2024]
Abstract
In 2016, as a trainee doctor, I wrote a paper on changing the culture of medicine. I felt the medical system was broken back then, and it seems even less functional now, with higher rates of burnout, dropout and staff shortages nationally. As a result of a lack of resources, it feels impossible to provide the care to our communities expected of us, making our work challenging and disheartening. Until all stakeholders acknowledge the systemic issues faced by our workforce, service outcomes and physician well-being may not improve. We need to collaborate and innovate to reform the healthcare system taking a multifaceted, evidence-based approach, implementing an appropriate balance of systemic change and interventions to support individual well-being. As we collectively work towards these changes, tragic optimism may spur physicians to develop meaning and purpose despite the inevitable challenges. This may serve as the motivation and fuel required to survive and sustain our practice but also thrive working in careers of value.
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191
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Barreto TW, Taylor MK, Goldstein JT, Eden AR. Retaining the perinatal care workforce: Lessons learned from experienced physicians who no longer attend deliveries. Health Serv Res 2024; 59:e14224. [PMID: 37653276 PMCID: PMC10771905 DOI: 10.1111/1475-6773.14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE To inform policy supporting the retention of family physicians (FPs) in the perinatal care workforce by identifying physician characteristics that are associated with retention. DATA SOURCES AND STUDY SETTING We surveyed FPs who had been in practice for at least 11 years and reported attending deliveries as part of their practice. STUDY DESIGN We compared the characteristics of FPs who continue to provide perinatal care to those who have ceased and explored their reasons for no longer attending deliveries. DATA COLLECTION/EXTRACTION METHODS We estimated a probit regression with the dependent variable: whether the physician currently delivers babies. Open-ended survey responses were analyzed and close-coded using a conceptual content analysis approach. PRINCIPLE FINDINGS Of the FPs who received a survey, 1505 (37%) responded. Those who continue attending deliveries were more likely to receive a stipend or be paid per hour/shift in addition to their salary versus those paid a salary (percentage point difference = 13), and less likely to work part-time versus full-time (percentage point difference = -20). Those who ceased attending deliveries cite lifestyle (n = 208), call structure (n = 113), and delivery volume (n = 89) among the reasons for doing so. CONCLUSIONS Evidence-based policies aimed at preventing attrition from the perinatal care workforce, which might include targeting compensation models and work-life balance.
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Affiliation(s)
- Tyler W. Barreto
- Family Health AssociatesFamily Care NetworkBellinghamWashingtonUSA
| | | | | | - Aimee R. Eden
- American Board of Family MedicineLexingtonKentuckyUSA
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192
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Mulder L, Garcia E, Sirintrapun SJ, Kundu I, Soles R. Examining the role of diversity, equity, and inclusion in mitigating workforce burnout in laboratory medicine. Am J Clin Pathol 2024; 161:130-139. [PMID: 37793038 DOI: 10.1093/ajcp/aqad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVES The clinical laboratory workforce plays a crucial role in health care delivery, yet little is known about the unique pressures and challenges this workforce faces. The objective of this study was to identify factors that contribute to burnout, discrimination, exclusion, and inequity in pathology and laboratory medicine. METHODS A nationwide survey was conducted in 2 phases. In phase 1, 2391 laboratory professionals were surveyed over a 1-week period about their experiences with burnout, discrimination, and work-related stress. In phase 2, the survey was extended to 1 month and questions were added to elicit more detailed information about diversity, equity, and inclusion (DEI) as well as wellness. RESULTS Results showed a high prevalence of burnout, discrimination, and stress among laboratory professionals, with significant differences among certain demographic groups. Women, Black, indigenous, or people of color individuals and those with disabilities reported higher rates of discrimination. The study also showed a need for mentorship and resources to address educational barriers. CONCLUSIONS Findings from this study highlight the urgent need for interventions to address burnout, discrimination, exclusion, and inequity in the laboratory workforce. Initiatives to increase workforce diversity, promote mentorship and diversity training programs, and improve recognition of the laboratory workforce are recommended. The results underscore the pressing need to addressing the challenges and apprehensions laboratory professionals face, including enhancing recognition of their role in patient care, tackling systemic problems related to discrimination and equity, and enhancing the provision of support and resources for managing burnout and fostering well-being.
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Affiliation(s)
- Lotte Mulder
- Department of Organizational Development and Leadership, American Society for Clinical Pathology, Chicago, IL, US
| | - Edna Garcia
- Institute of Science, Technology and Policy, American Society for Clinical Pathology, Washington, DC, US
| | - S Joseph Sirintrapun
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, US
| | - Iman Kundu
- Institute of Science, Technology and Policy, American Society for Clinical Pathology, Washington, DC, US
| | - Ryan Soles
- Department of Learning and Educational Research, American Society for Clinical Pathology, Chicago, IL, US
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193
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Pierce L, Judson TJ, Mourad M. Finding the time: Hourly variation in average daily census on a hospital medicine service. J Hosp Med 2024; 19:108-111. [PMID: 37926952 DOI: 10.1002/jhm.13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
Monitoring the average daily census (ADC) is crucial for managing patient flow and allocating resources. This study analyzed hourly fluctuations in the ADC on a hospital medicine service at an academic medical center. Data from 8342 encounters and 6178 unique patients were collected over a year. The ADC peaked at 11 a.m. (164.1 patients/day) and was lowest at 7 p.m. (155.0 patients/day), accounting for a variation of up to 9.1 patients (5.5% of peak census) depending on the time of day the measurement was taken. Understanding how ADC changes throughout the day will help hospital medicine programs to partner with administrators to optimize resource allocation and staffing. Measuring ADC at midnight, as traditionally done, may underestimate workload and therefore contribute to staffing shortages and physician burnout. Hospitals should consider measuring ADC at its peak, between 7 a.m. and 11 a.m., to ensure adequate staffing and high-quality patient care.
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Affiliation(s)
- Logan Pierce
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Timothy J Judson
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Michelle Mourad
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
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194
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Villalobos Dintrans P, Oliveira D, Stampini M. Human Resources for Care in Latin America and the Caribbean: Current Needs and Future Demands. J Am Med Dir Assoc 2024; 25:232-236. [PMID: 37813366 DOI: 10.1016/j.jamda.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/09/2023] [Accepted: 08/24/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES To estimate the current gap and the necessary supply of human resources for care (HRC) for older people experiencing severe care dependence in Latin America and the Caribbean (LAC). DESIGN Simulation study using previous estimations of severe care dependence for LAC countries. SETTING AND PARTICIPANTS Older people (aged 65+) experiencing severe care dependence in 26 countries of LAC. METHODS We calculated the current gap and the necessary supply of HRC in 2020, 2035, and 2050 assuming a mix of complementary human resources, in line with regional standards for long-term care (LTC) schemes, and differing levels of care coverage. RESULTS Considering 100% coverage of LTC services for the population aged 65+ experiencing severe care dependence, the region will need almost 5 million people working full-time in the sector. This figure is expected to increase to more than 14 million by 2050. Nurse assistants and nurses will be the professional profiles in highest demand. In addition, the region requires 2 million rehabilitation professionals in 2020, and this figure will increase to more than 6 million in 2050. CONCLUSIONS AND IMPLICATIONS The rapid aging process in LAC will bring several challenges and opportunities to the region. Countries should start designing strategies to reduce the current gaps of HRC to meet older people's care needs in the coming years, in terms of both quantity and competencies, to help ensure that their human rights are met.
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Affiliation(s)
- Pablo Villalobos Dintrans
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santiago, Chile; Millennium Institute for Care Research (MICARE), Santiago, Chile.
| | - Déborah Oliveira
- Millennium Institute for Care Research (MICARE), Santiago, Chile; Facultad de Enfermería, Universidad Andrés Bello, Viña del Mar, Chile
| | - Marco Stampini
- División de Protección Social y Salud, Inter-American Development Bank, Washington, DC, USA
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195
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Karakachian A, Hebb A, Peters J, Vogelstein E, Schreiber JB, Colbert A. Moral Distress and Intention to Leave During COVID: A Cross-sectional Study on the Current Nursing Workforce to Guide Nurse Leaders for the Future. J Nurs Adm 2024; 54:111-117. [PMID: 38261642 DOI: 10.1097/nna.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The aim of this study was to investigate how the experience of caring for COVID-19 patients, nurses' moral distress, and the current practice environment impact nurses' intention to leave. BACKGROUND Caring for COVID-19 patients has been associated with an increase in nurses' moral distress and an increase in nurses' turnover. To date, research has focused on nurses' moral distress, the practice environment, and intentions to leave during the pandemic's peak. The current workplace climate, including those who stayed in their positions, has not been adequately assessed. METHODS This cross-sectional correlational study was conducted in a Magnet® hospital. RESULTS Moral distress related to team/system (B = 0.64, t = 3.86, P < 0.001), nurses' participation in hospital affairs (B = -2.21, t = -3.52, P < 0.001), and staffing (B = -1.91, t = -5.48, P < 0.001) are strongest predictors for nurses' intention to leave postpandemic. CONCLUSIONS Nurses in practice still report experiencing COVID-related moral distress; however; issues related to resources and staffing have the most substantial impact on intention to leave among the current nursing workforce.
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Affiliation(s)
- Angela Karakachian
- Author Affiliations: Assistant Professor of Nursing (Dr Karakachian), Duquesne University, Pittsburgh; Manager of Nursing Quality and Patient Experience (Dr Hebb), Allegheny Health Network Jefferson Hospital; and Chief Nursing Officer (Dr Peters), Allegheny Health Network Jefferson and Canonsburg Hospital, Jefferson Hills; and Associate Professor (Dr Vogelstein), School of Nursing and Department of Philosophy, and Professors (Drs Schreiber and Colbert), School of Nursing, Duquesne University, Pittsburgh, Pennsylvania
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196
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Mir HA, Liu Q, Rosca O, Blakeslee E. Factors That Influence the Tenure of Direct Support Professionals in New York State Provider Agencies. Intellect Dev Disabil 2024; 62:14-26. [PMID: 38281514 DOI: 10.1352/1934-9556-62.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/27/2023] [Indexed: 01/30/2024]
Abstract
The New York State Office for People With Developmental Disabilities seeks to better understand the direct support professional (DSP) workforce and offer data-informed strategies for DSP retention. We used the 2018 NCI-IDD Staff Stability Survey (now called State of the Workforce Survey) to investigate agency-level factors influencing DSP tenure. A total 303 provider agencies completed the survey in New York State, representing 72,252 DSPs. Multiple linear regression analysis revealed that selected agency-level variables explained 12.6% of the variance in DSP tenure, R2 = .16, Radj2 = .126, F (11, 260) = 4.54, p < .05. This study yielded strong empirical evidence consistent with existing national reports and research on the role that wages, benefits, and supervisory support play on DSP tenure.
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Affiliation(s)
- Hirah A Mir
- Hirah A. Mir, Qingyang Liu, Oxana Rosca, and Emily Blakeslee, New York State Office for People With Developmental Disabilities
| | - Qingyang Liu
- Hirah A. Mir, Qingyang Liu, Oxana Rosca, and Emily Blakeslee, New York State Office for People With Developmental Disabilities
| | - Oxana Rosca
- Hirah A. Mir, Qingyang Liu, Oxana Rosca, and Emily Blakeslee, New York State Office for People With Developmental Disabilities
| | - Emily Blakeslee
- Hirah A. Mir, Qingyang Liu, Oxana Rosca, and Emily Blakeslee, New York State Office for People With Developmental Disabilities
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197
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Stevens MWR, Ivers R, Telenta J, Ali RL. Building workforce capacity to address substance use in primary health care: preliminary results from a mixed-methods pilot program. Aust J Prim Health 2024; 30:NULL. [PMID: 38123163 DOI: 10.1071/py23148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Primary health care is critical to the prevention of alcohol, tobacco and other drug-related harms. Scaling-up screening, brief intervention and referral to treatment (SBIRT) within primary health care can reduce the burden of substance-related diseases, and improve downstream healthcare services. Building knowledge, skills and confidence among general practitioners (GPs), particularly in rural, regional and remote areas, to deliver SBIRT is an essential step. Therefore, this study aimed to pilot test a skills-based training program for GPs designed to build capacity for SBIRT delivery. METHODS This pilot study investigated the acceptability of a structured, educational skills-based training program among GPs, as well as its preliminary effectiveness in inducing changes in confidence to deliver SBIRT, and in increasing knowledge about low-risk alcohol guidance. The training package was designed by experts in addiction medicine and public health, and involved a series of online webinars and in-person workshops at four locations across the South Eastern NSW Primary Healthcare Network catchment. RESULTS A total of 18 GPs registered for the training, with six completing the final webinar. The GPs who completed all sessions demonstrated increases in confidence to deliver SBIRT and alcohol guidance knowledge from baseline. Qualitative feedback found the program acceptable, and GPs were able to successfully implement learnings into practice, and promote to colleagues. CONCLUSIONS The results indicated the potential of this program at a national level, but highlighted the need for a range of additional incentives to encourage uptake and ongoing implementation.
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Affiliation(s)
- Matthew W R Stevens
- Department of Pharmacology, School of Biomedicine, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Joanne Telenta
- COORDINARE - Southeastern NSW PHN, Wollongong, NSW 2500, Australia
| | - Robert L Ali
- Department of Pharmacology, School of Biomedicine, The University of Adelaide, Adelaide, SA 5000, Australia
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198
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Benson J, Prentice S, Need P, Pitot M, Elliott T. 'A sense of self, empowerment and purposefulness': professional diversification and wellbeing in Australian general practitioners. Aust J Prim Health 2024; 30:NULL. [PMID: 37939485 DOI: 10.1071/py23090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Burnout and workforce shortages comprise a vicious cycle in medicine, particularly for Australian general practitioners (GPs). Professional diversification, whereby individuals work multiple roles across their week, may help address this problem, but this strategy is under-studied. METHODS We surveyed 1157 Australian GPs using qualitative and quantitative questions examining professional diversification, values, autonomy, and wellbeing. Quantitative data were analysed using inferential statistics, whilst qualitative data were analysed using inductive thematic analysis. We triangulated the data by using the qualitative findings to inform further quantitative testing. RESULTS Approximately 40% of the sample had diversified. Although diversifying was not significantly associated with wellbeing, the qualitative data indicated that diversification supported GPs' wellbeing by enhancing career sustainability, accomplished through various pathways (e.g. value fulfilment, autonomy, variety). Subsequent quantitative analyses provided evidence that these pathways mediated the relationship between diversification and wellbeing. To diversify, GPs needed particular personal qualities, external supports, flexibility, and serendipity. Barriers to diversifying mirrored these factors, spanning individual (e.g. skillset) and situational levels (e.g. autonomy, location). CONCLUSIONS Diversification can support GPs' wellbeing if it meets their needs. Organisations should focus on publicising opportunities and accommodating requests to diversify.
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Affiliation(s)
- Jill Benson
- The University of Adelaide, Adelaide, SA, Australia; and The Royal Australian College of General Practitioners, East Melbourne, Vic., Australia
| | - Shaun Prentice
- The University of Adelaide, Adelaide, SA, Australia; and General Practice Training Research Department, Royal Australian College of General Practitioners, East Melbourne, Vic., Australia
| | - Penny Need
- The Royal Australian College of General Practitioners, East Melbourne, Vic., Australia
| | - Michelle Pitot
- The Royal Australian College of General Practitioners, East Melbourne, Vic., Australia
| | - Taryn Elliott
- The Royal Australian College of General Practitioners, East Melbourne, Vic., Australia
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Gupta S, Grewal A, Jain K. Obstetric anaesthesiology: manpower and service provision issues in India. Int J Obstet Anesth 2024; 57:103928. [PMID: 37858417 DOI: 10.1016/j.ijoa.2023.103928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/20/2023] [Accepted: 09/07/2023] [Indexed: 10/21/2023]
Abstract
Obstetric anaesthesiologists play a pivotal role as peripartum physicians steering the team of obstetric healthcare providers towards a continuum of medical education, enhanced training and safer patient care. However, in resource-limited countries, deficiency of human resources and hence services available poses challenges to those attempting to reduce maternal mortality rates. Measures to fill the gap include creating a cadre of uniformly well-trained and certified non-physician anaesthesia providers (NPAPs) supervised by a physician obstetric anaesthesiologist and well-equipped rural and urban health care facilities. The Association of Obstetric Anaesthesiologists of India needs to upscale their outreach programs with regular knowledge updates and practical skill training to the NPAPs, medical graduates and postgraduate doctors in these regions. A combination of strong local administrative will, legislation for the provision of essential supplies and a global collaborative effort using checklists and protocols may help to stem gaps in the provision of safe maternal care.
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Affiliation(s)
- S Gupta
- Department of Anesthesiology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - A Grewal
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India.
| | - K Jain
- Department of Anaesthesia and Intensive Care, Post-Graduate Institute of Medical Science and Research (PGIMER), Chandigarh, India
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Pineda R, Lisle J, Ferrara L, Knudsen K, Kumar R, Fernandez-Fernandez A. Neonatal Therapy Staffing in the United States and Relationships to Neonatal Intensive Care Unit Type and Location, Level of Acuity, and Population Factors. Am J Perinatol 2024; 41:317-329. [PMID: 34695863 DOI: 10.1055/a-1678-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to (1) estimate the total pool of neonatal therapists (occupational therapists, physical therapists, and speech-language pathologists who work in the neonatal intensive care unit [NICU]) and the average number represented in each U.S. based NICU, and (2) investigate the relationships between the number and type of neonatal therapy team members to NICU/hospital, population, and therapy factors. STUDY DESIGN This study used several methods of data collection (surveys, phone calls, and web site searches) that were combined to establish a comprehensive list of factors across each NICU in the United States. RESULTS We estimate that there are 2,333 full-time equivalent (FTE) positions designated to neonatal therapy coverage, with 4,232 neonatal therapists covering those FTEs. Among 564 NICUs with available neonatal therapy staffing data, 432 (76%) had a dedicated therapy team, 103 (18%) had pro re nata (as the circumstances arise; PRN) therapy coverage only, and 35 (6%) had no neonatal therapy team. Having a dedicated therapy team was more likely in level-IV (n = 112; 97%) and -III (n = 269; 83%) NICUs compared with level-II NICUs (n = 51; 42%; p < 0.001). Having a dedicated therapy team was related to having more NICU beds (p < 0.001), being part of a free-standing children's hospital or children's hospital within a hospital (p < 0.001), and being part of an academic medical center or community hospital (p < 0.001). Having a dedicated therapy team was more common in the Southeast, Midwest, Southwest, and West (p = 0.001) but was not related to the proportion of the community living in poverty or belonging to racial/ethnic minorities (p > 0.05). There was an average of 17 beds per neonatal therapy FTE, a good marker of therapy coverage based on NICU size. Three-hundred U.S. based NICUs (22%) had at least one Certified Neonatal Therapist (CNT) in early 2020, with CNT presence being more likely in higher acuity NICUs (59% of level-IV NICUs had at least one CNT). CONCLUSION Understanding the composition of neonatal therapy teams at different hospitals across the U.S. can drive change to expand neonatal therapy services aimed at optimizing outcomes of high-risk infants and families. KEY POINTS · We estimated that there are 4,232 neonatal therapists working in NICUs in the United States.. · Dedicated therapy teams for the NICU are more common in large, high acuity NICUs.. · An average of 17 beds per neonatal therapy FTE was observed.. · In 2020, 22% of NICUs had CNTs, and CNTs were more common in large and high acuity NICUs.. · Benchmarking neonatal therapy staffing can aid in expanding NICU therapy services where needed..
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, Los Angeles, California
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California
- Program in Occupational Therapy, Washington University, St. Louis, Missouri
| | - Julia Lisle
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Louisa Ferrara
- Department of Pediatrics, NYU Langone Hospital - Long Island, Mineola, New York
- Department of Communication Sciences and Disorders, Molloy College, Rockville Centre, New York
| | - Kati Knudsen
- Neonatal Intensive Care Unit, Women's and Children's Division, Providence St. Vincent Medical Center, Portland, Oregon
| | - Ramya Kumar
- Department of Rehabilitation Services, Banner Thunderbird Medical Center, Glendale, Arizona
| | - Alicia Fernandez-Fernandez
- Physical Therapy Department, Dr. Pallavi Patel College of Health Care Sciences, Nova Southeastern University, Fort Lauderdale, Florida
- Neonatal Intensive Care Unit, Rehabilitation Department, South Miami Hospital, Miami, Florida
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