Projecting shortages and surpluses of doctors and nurses in the OECD: what looms ahead

Small language models learn enhanced reasoning skills from medical textbooks

Small language models (SLM) offer promise for medical applications by addressing the privacy and hardware constraints of large language models; however, their limited parameters (often fewer than ten billion) hinder multi-step reasoning for complex medical tasks. This study presents Meerkat, a new family of medical SLMs designed to be lightweight while enhancing reasoning capabilities. We begin by designing an effective and efficient training method. This involves extracting high-quality chain-of-thought reasoning paths from 18 medical textbooks, which are then combined with diverse instruction-following datasets within the medical domain, totaling 441K training examples. Fine-tuning was conducted on open-source SLMs using this curated dataset. Our Meerkat-7B and Meerkat-8B models outperformed their counterparts by 22.3% and 10.6% across six exam datasets, respectively. They also improved scores on the NEJM Case Challenge from 7 to 16 and from 13 to 20, surpassing the human score of 13.7. Additionally, they demonstrated superiority in expert evaluations, excelling in all metrics-completeness, factuality, clarity, and logical consistency-of reasoning abilities.

'Mind the professional gap': exploring how doctors experience working in peripheral areas

BACKGROUND

The shortage of medical professionals in peripheral areas is an international challenge, not only in the developing world but also in developed countries. This jeopardises the quality and equity of care provision. Recent scholarship has started to investigate the factors that encourage doctors to practice in rural settings, but further research is required to address some shortcomings (Holloway et al., 2020). This exploratory study aims to expand current literature by specifically focusing on the professional and organizational factors that shape doctors working experience in peripheral areas.

METHODS

By adopting a qualitative research approach and drawing from the literature on medical professionalism, we aim to gain a deeper understanding of the multifaceted nature of professional drivers shaping at the individual level the experience of doctors working in peripheral areas, as well as the organizational factors supporting or hindering their motivation. We performed 22 interviews with professionals and managers in four Italian local health authorities managing small-sized hospitals in peripheral areas.

RESULTS

The findings from this study present intriguing insights that invite a reconsideration of the work experience of doctors in peripheral areas through the tenets of professionalism. The professional factors identified by the study unfold within a nuanced trade-off of ambiguity, wherein factors typically associated with preferences for urban working environments, like teaching hospitals and hubs, surprisingly unveil implications and advantageous prospects for peripheral work settings. This suggests the need to reconsider and broaden our understanding of the factors influencing professionals'work experience in peripheral healthcare settings, recognising that what may conventionally be seen as factors favouring complex and urban hospitals can present unique advantages when applied to peripheral contexts. Furthermore, the study identifies specific organizational factors that might support or hinder the individual perceptions of professional needs in peripheral areas.

CONCLUSIONS

The paper provides intriguing opportunities for tailoring employment propositions for professionals. Our research shows that policymakers and public healthcare managers should acknowledge a more nuanced scenario and craft policies specifically tailored to peripheral organisations, carefully considering professional needs.

Process evaluation of a co-design and implementation study to improve professional health literacy in a regional care hospital (PIKoG): a mixed-methods study

BACKGROUND

In connection with a hospital stay, patients have to make important health-related decisions. Adequately responding to the needs of patients requires good communication skills of healthcare professionals within healthcare organizations. The PIKoG project (As made for us - Improving professional health literacy in hospitals) aimed at improving professional health literacy by implementing participatory health literacy training and supporting measures in a hospital setting. This study aimed to analyze processes supporting and hindering the implementation of the complex intervention.

METHODS

A mixed-methods study was conducted, including focus group interviews and a paper-pencil survey with healthcare professionals. Data was combined and analyzed using categories derived from the Medical Research Council's guidance on process evaluation: (1) Implementation, (2) Mechanisms of impact, and (3) Context. Interview data were analyzed using structured qualitative content analysis according to Kuckartz. Survey data were analyzed descriptively.

RESULTS

One of three on-site, full-day health literacy training sessions was offered weekly. Supporting measures were implemented step by step over the course of a year. Both the training and the supporting measures were rated positively overall, but they could not be effectively integrated into daily routines. The COVID-19 pandemic as well as resource constraints adversely affected implementation by altering workflows, increasing stress levels and shifting priorities. The participatory approach and individual change agents fostered the implementation of the complex intervention. Nurses were reached the most, while physicians engaged least in the interventions. Adaptations during the implementation increased the use of the implemented measures and gave rise to ideas for future improvements.

CONCLUSION

The study highlights the challenges involved in implementing a complex intervention supporting professional health literacy in an organization and stresses the importance of considering available resources, recruiting opinion leaders, and being responsive to the needs of different groups. While the participatory co-design development approach was found to be valuable, it does not guarantee successful organizational change in times when hospitals face multiple challenges. Subsequent studies should therefore focus on investigating the capacities of healthcare organizations for organization-wide improvement processes and identify how healthcare organizations can be innovative and patient-centered even in the presence of extremely difficult contextual conditions.

TRIAL REGISTRATION

DRKS00019830, since 16th of April 2020.

Finding a balance: Using a pre-post test to evaluate the effectiveness of scenario based learning using a blended approach among undergraduate nursing students

BACKGROUND

While undergraduate education aims to provide student nurses with a level of competence for independent practice, criticisms exist surrounding the ability of these programmes to adequately prepare graduates for the clinical skills required to optimise care. Adopting virtual simulations into nursing curricula may support greater clinical preparedness due to the student-driven nature of this approach. However, learning is also cited as a social experience requiring teacher-student interaction. Therefore, a challenge exists to develop teaching strategies that balance interactive learning while also ensuring students achieve relevant competencies.

AIM

Using scenario-based learning in a blended environment, this research evaluates the impact of different teaching modalities (in-person vs virtual patient case simulations) on undergraduate student nurses' perceived learning gains and self-efficacy.

DESIGN

A pre and post-test design.

PARTICIPANTS

Eligible participants were Irish nursing students enrolled in a 5-credit European Credit Transfer System (ECTS) module (Autumn 2023 academic term) focusing on the care of persons with altered cardiovascular function at a large, urban university.

METHODS

An online survey investigated the impact of these different teaching modalities on students' perceived learning and self-efficacy. Scales were adapted from previous research and non-parametric tests explored changes in perceptions over time. Thematic analysis of open-text responses provided greater insight into student experiences.

RESULTS

The response rate was 57 % (n = 97) at baseline and 23 % (n = 39) at follow up. Students' perceptions of their learning gains and self-efficacy were scored positively for both in-person and virtual scenario-based teaching modalities. However, following participation with virtual simulation, meaningful, positive improvements to students' understanding, attitudes, and self-efficacy were identified. Three key themes were generated from participants' open-ended survey responses which revealed the core features of both teaching modalities and students' desire to further integrate more virtual activities into undergraduate curricula: 1) In-person accessibility and interactivity matters: 2) Virtual simulations: bringing content to life: 3) Online learning: the path forward.

CONCLUSION

By combining the advantages of in-person and online learning platforms, a blended approach can close the theory to practice gap and support diverse student cohorts to succeed within nursing education.

Health care providers' perceptions of burnout and moral distress during the COVID-19 pandemic: A qualitative study from Saskatchewan, Canada

OBJECTIVES

This study sought to describe feelings and perceptions of burnout and moral distress experienced by health care providers in the Canadian province of Saskatchewan during the COVID-19 pandemic.

METHODS

This study was part of a larger mixed methods project, and we here report on the qualitative results relating to burnout and moral distress experienced by medical doctors, registered nurses and respiratory therapists. We used an exploratory, qualitative descriptive design involving one-one-one interviews with 24 health care providers. Interview data were analysed using a reflexive thematic analysis approach.

RESULTS

We identified three overarching themes each for health care provider burnout and moral distress. Interviews revealed that providers experienced burnout through (i) increased expectations and (ii) unfavourable work environments, which led most of them to recognise (iii) a need to step back. Regarding moral distress, key themes were: (i) a sense of compromised care, (ii) feelings of bumping heads with authorities and patient families, and (iii) seeing patients make difficult decisions.

CONCLUSION

Our study found that medical doctors, registered nurses and respiratory therapists working during the COVID-19 pandemic experienced and continue to experience significant burnout and moral distress. This was often driven by both institution- and system-level factors. There is a need for sustained investment to build and support a motivated health care workforce to prepare for future pandemics and health emergencies.

Medical education in Poland: a descriptive analysis of legislative changes broadening the range of institutions eligible to conduct medical degree programmes

BACKGROUND

The expansion of medical schools is one of the proposed solutions to shortages in health workforces. Poland has been struggling with limited human resources in healthcare for years. The aim of the study was to provide an analysis of the current situation of medical education in Poland and to describe the impact of the government's ongoing measures to provide a new influx of doctors.

METHODS

A retrospective, cross-sectional study presents a descriptive and comparative analysis of official governmental documents, showing the latest legal amendments, changes in admission limits, and geographical distribution of Higher Educational Institutions (HEIs) for the period of 2013-2023. We referenced the current number of physicians in each voivodship and used a dynamic index to analyse the changes in quotas. We performed statistical tests where needed, considering a p-value < 0.05 to be statistically significant.

RESULTS

The latest legislative changes enabled occupational HEIs to offer MD programmes. The mean distance between the two nearest HEIs decreased between 2013 and 2023. Total admission limits increased by 92.3%, reaching 10,289 available spots in 2023. The dynamic index was higher for quotas in private HEIs than in public institutions. The index was comparable, regardless of the teaching language. The number of students positively correlated with the number of physicians working in each voivodship.

CONCLUSIONS

This study highlights the uncontrolled expansion of medical education in Poland, driven by workforce demands but lacking a long-term strategy. Legislative inconsistencies hinder regulation, while new medical schools in rural areas may improve regional healthcare if properly planned. Recent policy changes emphasize the need for a national strategy based on demographic data and healthcare needs. Strengthening accreditation and quality control is crucial for sustainable medical education reform.

Effects of a gratitude intervention on job engagement among newly recruited nurses: A randomized clinical trial

BackgroundGratitude at work is defined as the tendency to notice and appreciate aspects of work, how it affects one's life. Studies show that gratitude education can alleviate individual burnout and increase the ability to resist pressure, but it is not clear whether gratitude intervention can improve individual job involvement.ObjectiveThe purpose of this study is to determine whether gratitude intervention can reduce stress, job burnout and enhance job involvement of new nurses.MethodsA randomized controlled trial was conducted from September 2020 to September 2021. A total of 118 new nurses in China were randomly divided into gratitude group and control group by random number table method. The control group received routine training for new nurses, and the intervention group received, in addition, a gratitude intervention for 2 months. The primary outcome measure was the Utrecht Work Engagement Scale-9 score (UWES-9). Secondary outcome indicators were Gratitude Questionnaire score (GQ-6), The Perceived Stress Scale score (PSS), and Maslach Burnout Inventory score (MBI). This study was reported using the CONSORT checklist.ResultsA total of 118 new nurses were included. The scores of UWES-9 scale of the gratitude group were significantly higher than those in the control group immediately after intervention, 3 months and 6 months after intervention, as the main observation index. Among the secondary outcome indicators, GQ-6 and MBI Personal Accompli-shment scores in the gratitude group were significantly higher than those in the control group immediately after intervention and 3 months after intervention. The PSS, MBI-Emotional Exhaustion and Depersonalization scores in the gratitude group were significantly lower than those in the control group immediately after intervention, 3 months and 6 months after intervention.ConclusionsGratitude intervention can effectively improve the level of job involvement and gratitude, reduce stress and burnout of new nurses. However, this was a relatively short follow-up period. Further studies are needed to assess the long-term effects for new nurses.

Expansion of medical school admission quotas in Korea, is it really necessary?

BACKGROUND

In 2024, the Korean Ministry of Health and Welfare enforced a policy to increase the number of medical school students by 2,000 over the next 5 years, despite opposition from doctors. This study aims to predict the trend of excess or shortage of medical personnel in Korea due to the policy of increasing the number of medical school students by 2035.

METHODS

Data from multiple sources, including the Ministry of Health and Welfare, National Health Insurance Corporation, and the Korean Medical Association, were used to estimate supply and demand. The inflow-outflow method was used for supply estimation, and assumptions were made regarding national medical examination pass rates, clinical physician consultation rates, mortality rates, and overseas emigration rates. Per capita medical use by gender and age group in 2022 was calculated for demand estimation of future medical use, and the results of future population projections were applied. The numbers of working days examined were 265, 275, 285, and 289.5 days.

RESULTS

The Korean government's prediction that there will be a shortage of 10,000 doctors in 2035 can be confirmed by the underestimation of the number of working days (265 days). However, if the actual number of working days, 289.5 days, is applied, not only will there be no shortage of doctors in 2035, but there could also be an oversupply of 3,000 doctors. If the number of medical school students has increased for five years and the public's medical use behavior and the number of working days for doctors are maintained at the current level, there is a possibility that there will be an oversupply of as many as 11,000 doctors by 2035.

CONCLUSIONS

Medical experts expressed concerns that the rapid increase in medical school enrollment would exacerbate the phenomenon of concentration, increase the cost of medical care, and collapse the medical system. In order to establish a reasonable plan for the supply and demand of medical personnel in the mid- to long-term, it is necessary to consider the future medical environment through discussions with medical providers and related organizations.

From classroom to workforce: a discrete choice analysis of Iranian nursing students' job preferences

AIMS

This study evaluates both financial and non-financial preferences of nursing students to choose a hospital for work in future.

BACKGROUND

In Iran's healthcare system, the persistent shortage and uneven distribution of nurses have been significant challenges. Addressing such issues requires attention to nurses' preferences, which can be instrumental in designing effective interventions.

METHODS

In this cross-sectional study, 500 nursing students from Kermanshah University of Medical Sciences (KUMS) were surveyed using a convenience sampling method to determine their preferences for selecting the type of hospital in which they wish to work in the future. The study was conducted during the second half of 2023 using a discrete choice experiment (DCE) approach. To identify the most influential components on future nurses' preferences, conditional logistic regression analysis was employed.

RESULTS

The study revealed that an ideal and preferred hospital for nursing students is one that offers a high monthly salary, is located close to their homes, provides Rasmi contracts, has adequate facilities and equipment, has a low workload, and requires less than three years for career advancement. Additionally, the results indicated that the highest willingness to pay (WTP) was associated with the type of employment in the hospital, with nursing students willing to reduce their monthly salary by 27,303,610 IRR to change their employment status from Gharardadi to Rasmi.

CONCLUSIONS

The study confirmed that both financial and non-financial factors significantly influence nursing students' choices regarding their future workplace. This research can serve as a valuable reference for future studies in this area. The findings can significantly aid in designing and implementing effective interventions aimed at retaining nurses in hospitals and attracting and keeping nursing staff in underserved areas.

Cultivation of Grit in Nursing Students: A Qualitative Descriptive Study "Cultivation of Grit"

Background

Predicted nursing deficits and low nursing student retention rates highlighted the need to investigate cultivation of grit, a malleable trait involving perseverance and passion to achieve long-term goals amidst challenges and difficulties.

Objective

The objective of this study was to identify how cultivation of grit and additional academic and non-academic strategies aided gritty second-year associate degree-seeking nursing students in addressing nursing program challenges and completing their nursing program.

Methods

Twenty-two second-year associate degree-seeking nursing students in rural central Arizona completed demographic and Grit-O Scale questions using Survey Monkey™ and participated in semi-structured interviews or focus group discussions held from September through December 2022. Research questions provided study foundation: RQ1: How do second-year nursing students with high levels of self-perceived grit of greater than 3.5 out of 5 as measured on the Grit-O Scale describe how grit was cultivated during their associate degree-seeking nursing program? RQ2: How do second-year nursing students with high levels of self-perceived grit describe how additional academic and non-academic strategies added to them in dealing with the challenges of their associate degree-seeking nursing program?

Design

Qualitative Descriptive Research.

Results

Inductive thematic analysis revealed six themes: importance of perseverance and passion, facets of grit; identification of program challenges and strategies used to deal with challenges; and the significance of support from nursing cohort, family, and friends, and nursing instructors.

Conclusions

Effective strategies for participating nursing student retention and program completion involved cultivation of grit and its facets of perseverance and passion and additional academic and non-academic strategies of nursing cohort and instructor support aided students in dealing with challenges faced during their associate degree-seeking nursing program at a rural, central Arizonan community college.

Development of a competency framework for advanced practice nurses: A co-design process

AIMS

The aim of the study was to develop a comprehensive competency framework for advanced practice nurses in Belgium.

DESIGN

A co-design development process was conducted.

METHODS

This study consisted of two consecutive stages (November 2020-December 2021): (1) developing a competency framework for advanced practice nurses in Belgium by the research team, based on literature and (2) group discussions or interviews with and written feedback from key stakeholders. 11 group discussions and seven individual interviews were conducted with various stakeholder groups with a total of 117 participants.

RESULTS

A comprehensive competency framework containing 31 key competencies and 120 enabling competencies was developed based on the Canadian Medical Education Directions for Specialists Competency Framework. These competencies were grouped into seven roles: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator and health promoter.

CONCLUSION

The developed competency framework has resemblance to other international frameworks. This framework emphasized the independent role of the advanced practice nurse and provided guidance in a clear task division and delegation to other professionals. It can provide a solid foundation for delivering high-quality, patient-centred care by advanced practice nurses in the years to come.

IMPLICATIONS FOR THE PROFESSION

This competency framework can guide further development of advanced practice nursing education in Belgium and represents a starting point for future evaluation of its feasibility and usability in education and clinical practice. Advanced practice nurses and healthcare managers can also use the framework as an instrument for personal and professional development, performance appraisal, and further alignment of these function profiles in clinical practice. Finally, this framework can inform and guide policymakers towards legal recognition of advanced practice nursing in Belgium and inspire the development of advanced practice nursing profiles in countries where these profiles are still emerging.

IMPACT

What problem did the study address? The absence of a detailed competency framework for advanced practice nurses complicates legal recognition, role clarification and implementation in practice in Belgium. A rigorously developed competency framework could clarify which competencies to integrate in future advanced practice nursing education, mentorship programs and practice. What were the main findings? The competency framework outlined seven roles for advanced practice nurses: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator, and health promoter. Differentiation from other expert nursing profiles and clinical autonomy of advanced practice nurses were pivotal. Where and on whom will the research have impact? The comprehensive competency framework for advanced practice nurses and the collaborative methodology used can inspire other countries where these profiles are still emerging. The competency framework can be used as an instrument for role clarification, performance appraisals, continuous professional development, and professional (e-)portfolios. The competency framework can guide policymakers when establishing Belgian's legal framework for advanced practice nurses.

REPORTING METHOD

The authors have adhered to CONFERD-HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution in the design of the study. A patient advisory panel commented on the developed competency framework.

"The Whole Culture of Nursing Needs to Change": A Descriptive Phenomenology of Nurses Being Bullied

Workplace bullying impacts at least half of the nurses worldwide. Despite the link to increased nurse turnover, few intervention studies have addressed bullying in the workplace. Since most studies report cross-sectional designs that provide little insight into the complexities of this phenomenon, the purpose of this descriptive phenomenology was to describe the lived experiences of nurses as they were actively being bullied in the workplace. Semi-structured interviews were conducted through Skype until data adequacy was realized with 12 participant interviews. Giorgi's six-step method was used to analyze the data in Atlas.ti. A central theme, "The whole culture of nursing needs to change" described an organizational culture where managers were unable to identify or unwilling to respond to workplace bullying. The four themes identified from the data included "going to work can be really hard," "not good for patient care," "learning to live with bullying," and "changing the culture." Leaders of organizations should implement comprehensive anti-bullying programs to assess bullying in their workplace and to provide bullied nurses with reporting options. Nurse managers need to prevent workplace bullying by intervening when aware of bullying and cultivating a culture of mutual respect.

Dealing with the doctor shortage: a qualitative study exploring French general practitioners' lived experiences, difficulties, and adaptive behaviours

CONTEXT

The shortage of general practitioners (GPs) is a growing concern in Europe, especially in France. This problem is likely to continue until the end of the 2020s.

OBJECTIVES

To study the GPs' perceptions of access to care in medically underserved areas (i.e. with low physician density), its consequences on their working conditions, and how they cope with the resulting difficulties.

METHODS

Semi-structured individual interviews were conducted between May and August 2021 of 29 GPs practising in areas of southeastern France with a low physician density or at risk of a doctor shortage. Purposive sampling was used to include profiles of diverse physicians and diverse rural and urban areas. The interviews, conducted with an interview guide, were transcribed and analysed thematically.

RESULTS

The participants described a serious degradation of access to care in their areas. These issues also concerned urban areas, where they were, according to the participants, underrecognized. The participants' workloads were rising, at a rate often perceived as unsustainable: many participants, including the youngest group, reported they were exhausted. Their principal source of dissatisfaction was their impression that they could not do their work correctly. Participants reported that these difficulties required them to improvise and adapt without any official or formal method to keep their practice manageable.

CONCLUSION

These GPs were worried about the future of their profession and their patients. They expected strong measures by public policymakers and officials, but paradoxically seemed to have little interest in the solutions these officials are promoting.

Comparison of self-competency and executive (charge) nurse competency assessments of clinical nurses

AIM

This study compared nurses' self-competency assessments and their managers' nurse competence assessments.

BACKGROUND

Nurse competence is important for nursing care quality and patient safety. Executive (charge) nurses play a main role in the nurse competency assessment.

METHODOLOGY

In this study conducted at a university hospital between January and December 2020, the self-efficacy evaluations of nurses (n = 162) working in services other than the emergency department, operating room, and outpatient clinics of the university hospital were compared with the evaluations of nurse executives (charges) on these nurses (n = 21). Data were collected using the personal information form and the Nurse Competence Scale. A cross-sectional study design was used. The Strengthening the Reporting of Observational Studies in Epidemiology guideline was used for reporting.

RESULTS

Service nurses' self-assessments and nurses treating charge's assessment of clinical nurses evaluated the competence levels as excellent in both groups. The self-competency assessments of the nurses were higher than the charge nurses' competency assessments.

DISCUSSION

In this study, the lower competence assessment of nurses by the charge nurses was may be due to their ability to observe nurses in their teams in general and that they have more experience in evaluation.

CONCLUSION

It is suggested that professional development and competence programs be created to further develop the competencies of nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nurse competency assessments support planning to ensure patient safety. Patient care burden and planning of risky patients according to the nurse competency level will provide safe patient care.

Coming and going: A narrative review exploring the push-pull factors during nurses' careers

BACKGROUND

Shortages of nurses are one of the biggest challenges healthcare systems face around the world. Given the wide range of contexts and individuals working in nursing, a 'one-size-fits-all' retention strategy is unlikely to be effective. Knowing what matters most to nurses at different career stages would help employers and policy-makers who want to enhance nurse retention to design tailored strategies.

OBJECTIVE

To review and synthesise findings from recently published literature on the push-pull factors influencing nurses' decisions at the micro level, to enter and stay (or leave) at key career stages (i.e. pre-career, training, early-, mid- and late-career, and return to practice).

METHODS

We undertook a set of structured searches of the literature and a narrative synthesis to explore factors that motivate individuals to enter the nursing profession and the push-pull factors influencing nurse retention at different career stages. Electronic databases CINAHL, Medline, Scopus and Embase were searched in December 2022 (and updated in November 2023) for English language publications. Additional health workforce sources, such as King's Fund and Nuffield Trust, were also searched.

RESULTS

227 articles met the criteria for inclusion in the narrative review. Some push-pull factors were common to nurses across all career stages, including workplace support, flexible schedule patterns, opportunities for career advancement, fair treatment and salaries. In contrast, some challenges and push-pull factors were unique to each career stage. Students experienced difficulty in adjusting and balancing education and life; early-career nurses experienced transition shocks; mid-career nurses were frustrated by the lack of career advancement; late-career nurses desired more recognition; nurses returning to practice were discouraged by their lack of confidence and the cost of return-to-practice courses.

CONCLUSION

Our findings reinforce the view that factors influencing nurses' choices about whether to enter, continue or leave nursing jobs are multi-factorial and multi-dimensional. Policy and employment practices should be informed by research that has a more nuanced insight into what matters most to whom and at what career stage.

TWEETABLE ABSTRACT

Nuanced insight into motivations is needed to attract and retain a mix of nurse throughout their careers @ZEjebu @julia_philippou @JaneEball.

Acts of offensive behaviour and risk of disability pension in Danish female eldercare workers: prospective cohort with 11-year register follow-up

OBJECTIVES

To investigate whether acts of offensive behaviour (threats, violence, workplace bullying and sexual harassment) in the workplace and type of perpetrator (internal or external to the workplace) of the offensive behaviours predicted risk of disability pension in Danish eldercare workers.

METHODS

We merged survey responses from 8731 female eldercare workers with a national register on social transfer payments (Danish Register for Evaluation of Marginalisation (DREAM)), including all types of disability benefits. Using Cox proportional hazards models, we investigated the prospective association between self-reported exposures at baseline and the risk of receiving disability pension (any type of disability benefit payment) during 11 years of follow-up, while adjusting for potential confounders.

RESULTS

Self-reported exposure to threats (hazard ratio (HR) 1.14; 95% confidence interval (CI) 1.00-1.32), violence (HR 1.16; 95% CI 1.00-1.35) and bullying (HR 1.44; 95% CI 1.22-1.71) predicted increased risk of disability pension during follow-up, when adjusted for age and educational attainment. When further adjusted for psychosocial working conditions only bullying remained a statistically significant (HR 1.39; 95% CI 1.16-1.67) predictor of disability pension. The results indicated no elevated risk for participants reporting sexual harassment. Moreover, we observed stronger associations between self-reported exposure to threats, violence and workplace bullying and risk of disability pension when the perpetrator was internal to the workplace (i.e. colleagues, managers and/or subordinates), than when the perpetrator was reported to be external to the workplace (i.e. service users, and/or relatives of service users).

CONCLUSIONS

Results indicate that prevention of work-related exposure to threats, violence and workplace bullying may contribute to reduce involuntary early retirement in female eldercare workers.

The Healthcare Workforce Shortage of Nurses and Physicians: Practice, Theory, Evidence, and Ways Forward

The healthcare sector is ubiquitously plagued by workforce shortages in economies around the globe. The fragility of this structural shortage becomes apparent when external shocks, such as the COVID-19 pandemic, exacerbate the lack of workers in clinical practice. In this article, we summarize current trends in healthcare workforce development across the globe, review theoretical concepts of workforce shortages, and discuss policies to address them. In practice, developed countries often address workforce shortages with targeted migration policies. However, targeted workforce migration policies only intensify workforce shortages in low-and middle-income countries. Theoretical macroeconomic models suggest that supply shortages may result from too low wages, supply lagging behind demand, and social perception. Changes in the wage rate cannot sufficiently increase the supply of health professionals as scholars find inelastic wages for physicians and nurses. Nonpecuniary factors such as working conditions, job satisfaction, and intrinsic motivation are at least equally important as financial incentives. In conclusion, increased wages can only be part of a heterogeneous policy plan to address shortages. Migration and retirement levels of health professionals can temporarily mitigate workforce shortages but rarely change the underlying systemic issues. Increasing the number of places available in medical and nursing schools while also improving, both, financial and nonfinancial incentives for employees are long-term structural policy options.

Intraprofessional cultural competence in nursing regulation: A critical content analysis of standards and codes in the United Kingdom, New Zealand and Australia

There is a global shortage of nurses, leading many countries to recruit internationally qualified nurses (IQNs) to fill the gap. However, IQNs encounter challenges in integrating into their new professional environment, particularly in their interactions with locally qualified nurses (LQNs). Intraprofessional cultural competence (IPCC), defined as 'a set of congruent behaviours and attitudes that enable professionals to work respectfully and effectively in cross-cultural situations', may be a strategy to address these challenges. Content analysis was used to examine nursing regulatory documents (Standards for Practice [Standards] and Codes of Conduct [Codes]) from the United Kingdom, New Zealand and Australia. Data were extracted and organised based on four key themes relevant to IPCC. The analysis revealed a focus on 'Mutual collaboration and professional relationships' in six regulatory documents, with explicit commitments to preventing racism and discrimination in the Australian and NZ Codes. However, issues such as racism, discrimination, bullying and harassment faced by IQNs are not comprehensively addressed, as the documents mainly prioritize culturally appropriate patient interactions over relationships between colleagues. Using regulatory documents to address IPCC may influence positive change such as improving communication, and preventing racism, bullying, discrimination and harassment within nursing.

Does being involved in a research project enhance the postgraduate taught student experience: A qualitative research case study

BACKGROUND

Postgraduate taught nursing students face many challenges, including lack of confidence in their own knowledge and skills which might create anxiety and impact on the development of research expertise. Therefore, to address and support the development and acquisition of student understanding it is important to explore and be cognizant of the student's experience. This will facilitate enhancement of the curriculum, whilst improving future career aspirations and the provision of evidence-based care in practice.

AIM

To evaluate the participation of a postgraduate taught nursing student in a research project.

DESIGN

Case study methodology was used to explore the lived experience of participating in a research project.

METHODS

Mixed qualitative methods were used which included a semi-structured interview and photo-elicitation whereby the participant provided a significant photograph for discussion during the semi-structured interview.

RESULTS

Analysis revealed 2 superordinate themes which focused on 1) The Impact of learning and 2) The Workplace Environment.

CONCLUSIONS

The participation in living research, as part of a collaborative team has the potential to nurture the confidence of the student in their own abilities to generate new knowledge which can inform the provision of care. The workplace needs to be invested in this journey with leadership valuing the contribution that participation in research can make to the delivery of care. Leaders of postgraduate taught programmes should consider ways which would benefit students to reflect participation in ongoing research.

Pharmacological treatment of ectopic pregnancy: Accuracy, safety and cost-effectiveness of day 1-7 β-hCG measurements

OBJECTIVE

The aim of the present study was to compare accuracy, safety and cost-effectiveness of three β-hCG measurements protocols, applied in managing ectopic pregnancies (EP) with methotrexate (MTX): (1) day 1 to 7 β-hCG levels, (2) day 1 to 4 β-hCG levels and (3) day 4 to 7 β-hCG levels.

METHODS

Cost-minimization analysis (CMA) based on a retrospective study of patients treated with single-dose MTX for EP, was evaluated at a single institution between January 2001 to May 2021. Successful MTX treatment was defined as no surgical intervention. We evaluated safety by analyzing cases of day 4 interventions and cases of inconsistency between the different protocols. Predicting accuracy was assessed by the area under the receiver operating characteristic (AUC) curve.

RESULTS

A total of 229 patients with single dose MTX treatment were included. Overall, 184 (80.3%) patients were treated successfully with a single dose of MTX. For days 1 and 7 the optimal cutoff point was 7% reduction in β-hCG levels with sensitivity, specificity and PPV of 76.6% (69.9-82.5, 95% CI), 75.5% (60.5-87.1, 95% CI) and 92.8% (88.4-95.6, 95% CI), respectively. There was no significant difference between the protocols' AUC. None of the patients had any change of management during their day 4 visit in our 20 years of records. The cost for each visit day (day 4 and 7) was calculated with a total cost of 251 USD per patient.

CONCLUSION

Patients treated with MTX for EP, measurement of day 1 and day 7 β-hCG serum levels has a cost minimization advantage and is not inferior to the traditional protocol for predictive accuracy and safety.

Primary health care coverage in Portugal: the promise of a general practitioner for all

BACKGROUND

Primary care is an essential pillar of health systems. Many countries have implemented different policies to improve access to primary care. However, persistent challenges remain. This paper offers a critical analysis of the evolution of primary care coverage in Portugal, focusing on the number of patients without an assigned general practitioner (GP).

METHODS

We collected and analyzed publicly available data from 2009 to 2023 to decompose primary care coverage in three components: the number of patients enrolled in primary care units (demand-side effect), the number of GPs measured in full-time equivalent (supply-side effect), and the average number of patients on each GP's list (patient-to-GP ratio, capturing a productivity effect). We provide national and local level estimates for these three components.

RESULTS

Between 2009 and 2023, there was an overall decline in the number of patients enrolled in primary health care units. Concurrently, there was also a net decrease of GPs measured in full-time equivalent. Additionally, there was a progressive reduction in the average number of patients on each GP's list. The rise in the number of patients without an assigned GP is attributed not only to a reduction in the number of physicians, but also to a decrease in the patient load per doctor.

CONCLUSIONS

Hiring additional GPs may not suffice to enhance coverage. Achieving higher coverage may imply revisiting patient load per doctor or considering alternative care models. Understanding the challenges related to GP coverage is critical for improving the efficiency of primary care.

Innovative nursing employment initiatives to strengthen and sustain the health workforce in Canada

Health systems worldwide are at a critical juncture due to an increasing demand for health services and a diminishing pool of health human resources. While COVID-19 exacerbated nursing deficits, the need to strengthen and sustain the health workforce in Canada was evident decades prior and supported by numerous studies that warned of significant shortages. Post pandemic, building health system capacity has become paramount. This article examines innovative nursing employment initiatives in Canada. It provides a snapshot of federal, provincial and territorial approaches, with a particular focus on Internationally Educated Nurses (IENs) due to burgeoning interest in and competition for their skills and services. However, recognizing that health human resource planning is a persistent challenge, further initiatives are suggested. These include complementary policy development to improve retention and policy frameworks that support proactive long-term strategies to address the cyclical shortage of nurses.

Barriers to Access to Cardiac Surgery: Canadian Situation and Global Context

Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Cardiovascular care spans primary, secondary, and tertiary prevention and care, whereby tertiary care is particularly prone to disparities in care. Challenges in access to care especially affect low- and middle-income countries (LMICs), however, multiple barriers also exist and persist across high-income countries. Canada is lauded for its universal health coverage but is faced with health care system challenges and substantial geographic barriers. Canada possesses 203 active cardiac surgeons, or 5.02 per million population, ranging from 3.70 per million in Newfoundland and Labrador to 7.48 in Nova Scotia. As such, Canada possesses fewer cardiac surgeons per million population than the average among high-income countries (7.15 per million), albeit more than the global average (1.64 per million) and far higher than the low-income country average (0.04 per million). In Canada, adult cardiac surgeons are active across 32 cardiac centres, representing 0.79 cardiac centres per million population, which is just above the global average (0.73 per million). In addition to centre and workforce variations, barriers to care exist in the form of waiting times, sociodemographic characteristics, insufficient virtual care infrastructure and electronic health record interoperability, and health care governance fragmentation. Meanwhile, Canada has highly favourable surgical outcomes, well established postacute cardiac care infrastructure, considerable spending on health, robust health administrative data, and effective health technology assessment agencies, which provides a foundation for continued improvements in care. In this narrative review, we describe successes and challenges surrounding access to cardiac surgery in Canada and globally.

What might make nurses stay? A protocol for discrete choice experiments to understand NHS nurses' preferences at early-career and late-career stages

INTRODUCTION

Like many countries, England has a national shortage of registered nurses. Employers strive to retain existing staff, to ease supply pressures. Disproportionate numbers of nurses leave the National Health Services (NHS) both early in their careers, and later, as they near retirement age. Research is needed to understand the job preferences of early-career and late-career nurses working in the NHS, so tailored policies can be developed to better retain these two groups.

METHODS AND ANALYSIS

We will collect job preference data for early-career and late-career NHS nurses, respectively using two separate discrete choice experiments (DCEs). Findings from the literature, focus groups, academic experts and stakeholder discussions will be used to identify and select the DCE attributes (ie, job features) and levels. We will generate an orthogonal, fractional factorial design using the experimental software Ngene. The DCEs will be administered through online surveys distributed by the regulator Nursing and Midwifery Council. For each group, we expect to achieve a final sample of 2500 registered NHS nurses working in England. For early-career nurses, eligible participants will be registered nurses who graduated in the preceding 5 years (ie, 2019-2023). Eligible participants for the late-career survey will be registered nurses aged 55 years and above. We will use conditional and mixed logit models to analyse the data. Specifically, study 1 will estimate the job preferences of early-career nurses and the possible trade-offs. Study 2 will estimate the retirement preferences of late-career NHS nurses and the potential trade-offs.

ETHICS AND DISSEMINATION

The research protocol was reviewed and approved by the host research organisation Ethics Committees Research Governance (University of Southampton, number 80610) (https://www.southampton.ac.uk/about/governance/regulations-policies/policies/ethics). The results will be disseminated via conference presentations, publications in peer-reviewed journals and annual reports to key stakeholders, the Department of Health and Social Care, and NHS England/Improvement retention leaders.

REGISTRATION DETAILS

Registration on OSF http://doi.org/10.17605/OSF.IO/RDN9G.

The impact of train-the-trainer programs on the continued professional development of nurses: a systematic review

BACKGROUND

Train-the-trainer (TTT) programs are widely applied to disseminate knowledge within healthcare systems, but evidence of the effectiveness of this educational model remains unclear. We systematically reviewed studies evaluating the impact of train-the-trainer models on the learning outcomes of nurses.

METHODS

The reporting of our systematic review followed PRISMA 2020 checklist. Records identified from MEDLINE, Embase, CINAHL, and ERIC were independently screened by two researchers and deemed eligible if studies evaluated learning outcomes of a train-the-trainer intervention for trainers or trainees targeting nurses. Study quality was assessed with Joanna Briggs Institute's critical appraisal tools and data of study characteristics extracted (objective, design, population, outcomes, results). Heterogeneity of outcomes ruled out meta-analysis; a narrative synthesis and vote counting based on direction of effects (p < 0.05) synthesized the results. All records were uploaded and organized in EPPI-Reviewer.

RESULTS

Of the 3800 identified records 11 studies were included. The included studies were published between 1998 and 2021 and mostly performed in the US or Northern Europe. Nine studies had quasi-experimental designs and two were randomized controlled trials. All evaluated effects on nurses of which two also included nurses' assistants. The direction of effects of the 13 outcomes (knowledge, n = 10; skills, n = 2; practice, n = 1) measured in the 11 included studies were all beneficial. The statistical analysis of the vote counting showed that train-the-trainer programs could significantly (p < 0.05) improve trainees' knowledge, but the number of outcomes measuring impact on skills or practice was insufficient for synthesis.

CONCLUSIONS

Train-the-trainer models can successfully disseminate knowledge to nurses within healthcare systems. Considering the nurse shortages faced by most Western healthcare systems, train-the-trainer models can be a timesaving and sustainable way of delivering education. However, new comparative studies that evaluate practice outcomes are needed to conclude whether TTT programs are more effective, affordable and timesaving alternatives to other training programs.

TRIAL REGISTRATION

The protocol was registered in Research Registry ( https://www.researchregistry.com , unique identifying number 941, 29 June 2020).

Cross-cultural code-switching - the impact on international medical graduates in New Zealand

BACKGROUND

New Zealand relies on International Medical Graduates (IMGs); however, the retention of IMGs is not optimal. This research uses a lens of cross-cultural code-switching to explore how professional and cultural differences impact on International Medical Graduates' (IMGs') journeys to practise effectively and remain in New Zealand.

METHODS

Utilising theory-informing inductive analysis within a constructivist approach, framework analysis was conducted following 14 face-to-face interviews with IMGs. The analysis then explored the degree to which their experiences could be explained by cross-cultural code-switching's psychological challenges (authenticity, competence, and resentment).

RESULTS

Analysis showed there was an expectation for IMGs to code-switch. The greater the cultural and professional difference of IMGs (compared to New Zealand), the greater the intensity of psychological challenges experienced when switching. Moreover, IMGs received minimal support, making it difficult to overcome psychological challenges, especially the competence challenge. This led to feelings of frustration and vulnerability. Code-switching could also explain why complaints about IMGs were more likely when IMGs were stressed or tired.

CONCLUSION

Cross-cultural code-switching can be used to explain and identify how cultural differences cause psychological challenges. These findings inform how programmes can better support IMGs in orientation and ongoing training. Additionally, establishing, and allocating IMG cultural mentors would assist in addressing IMGs' vulnerability and isolation. With this support, the journey may prove more manageable and encourage IMGs to continue practising in their adopted country.

Optimizing rural healthcare through improved team function: a case study of the Rural Surgical Obstetrical Networks programme

We explored enablers and mechanisms of optimal team function within rural hospital teams, and the impact of these factors on health service sustainability in British Columbia. The data were drawn from interviews and focus groups with healthcare providers and administrators (n = 169) who participated in the Rural Surgical Obstetrical Networks (RSON) initiative to support low-volume rural surgical and obstetrical services in British Columbia, Canada. The 5-year programme (2018-2022) provided evidence-based system interventions across eight rural sites with the objective of providing sustainable, quality health services to meet population needs. To explore the impact of RSON interventions on local team function, we performed a scoping review, to assess the current literature surrounding enablers of effective rural hospital teamwork. Through inductive thematic analysis of interview data, we identified five enablers of good team function at RSON sites, including emphasis on local leadership, shared direction, commitment to sustainability, respect and solidarity among colleagues, and meaningful communication. The RSON project led to a shift in team culture in participating sites, improved team function, and contributed to improved clinical processes and patient outcomes. The findings have implications for rural health policy and practice in British Columbia and other jurisdictions with similar health service delivery models and geographic contexts.

Country-Level Factors Associated With Nurse Salaries: Empirical Evidence From Organisation for Economic Co-operation and Development Countries and Taiwan

BACKGROUND

Salary impacts nurse retention rates and thus is a factor affecting the nursing shortage both in Taiwan and around the world. Nurses in Taiwan earn a low salary compared with other health professionals and may be undervalued compared with their international counterparts.

PURPOSE

This study was designed to analyze the factors associated with nurse salary (NS) in Organisation for Economic Co-operation and Development (OECD) countries and to compare NS in Taiwan with those in OECD member states.

METHODS

Data were extracted from the OECD statistics database and official statistics for Taiwan. For the 28 OECD member countries considered in this study and Taiwan, 21 indicators characterizing healthcare systems, including demographics, socioeconomic status, health behaviors and risks, healthcare resources, health financing, healthcare utilization, health outcomes, and economic inequality, were examined for the period of 2009-2018. A random-effects model (REM) and a fixed-effects model (FEM) were used to investigate the associations between these indicators and annual NS levels. The expected annual NS for Taiwan was estimated and compared with the actual NS for Taiwan using the REM.

RESULTS

In the REM, higher NS in OECD countries was shown to be positively associated with gross domestic product per capita (0.49, 95% confidence interval [CI] [0.41, 0.56]), proportion of population aged 65 years and over (2.72, 95% CI [2.17, 3.26]), crude birth rate (1.02, 95% CI [0.56, 1.49]), number of computerized tomography scanners per million population (0.26, 95% CI [0.17, 0.35]), alcohol consumption per person (0.94, 95% CI [0.26, 1.61]), and prevalence of obesity (0.64, 95% CI [0.40, 0.89]) and to be in inversely associated with infant mortality rate (-3.13, 95% CI [-3.94, -2.32]), bed density (-0.99, 95% CI [-1.72, -0.25]), number of hospital discharges (-0.08, 95% CI [-0.11, -0.05]), household out-of-pocket expenditure as a percentage of health expenditure (-0.34, 95% CI [-0.56, -0.11]), and the Gini coefficient (-0.25, 95% CI [-0.50, -0.01]). The FEM results were similar to those of the REM. The predicted annual NS for Taiwan based on the REM rose from 29,390 U.S. dollars (corrected for purchasing power parity; 95% CI [22,532, 36,247]) in 2009 to 49,891 U.S. dollars (95% CI [42,344, 57,438]) in 2018. The actual annual NS in Taiwan in 2018 was approximately 12% lower than the model-predicted value.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Taiwan has a lower NS compared with its OECD counterparts. These findings may help policymakers, healthcare managers, and nurse organizations develop effective strategies to improve the remuneration system for nurses in Taiwan.

Predictive analytics for cardio-thoracic surgery duration as a stepstone towards data-driven capacity management

Effective capacity management of operation rooms is key to avoid surgery cancellations and prevent long waiting lists that negatively affect clinical and financial outcomes as well as patient and staff satisfaction. This requires optimal surgery scheduling, leveraging essential parameters like surgery duration, post-operative bed type and hospital length-of-stay. Common clinical practice is to use the surgeon's average procedure time of the last N patients as a planned surgery duration for the next patient. A discrepancy between the actual and planned surgery duration may lead to suboptimal surgery schedule. We used deidentified data from 2294 cardio-thoracic surgeries to first calculate the discrepancy of the current model and second to develop new predictive models based on linear regression, random forest, and extreme gradient boosting. The new ensamble models reduced the RMSE for elective and acute surgeries by 19% (0.99 vs 0.80, p = 0.002) and 52% (1.87 vs 0.89, p < 0.001), respectively. Also, the elective and acute surgeries "behind schedule" were reduced by 28% (60% vs. 32%, p < 0.001) and 9% (37% vs. 28%, p = 0.003), respectively. These improvements were fueled by the patient and surgery features added to the models. Surgery planners can benefit from these predictive models as a patient flow AI decision support tool to optimize OR utilization.

Critical care nursing workforce in crisis: A discussion paper examining contributing factors, the impact of the COVID-19 pandemic and potential solutions

AIMS AND OBJECTIVES

The critical care nursing workforce is in crisis, with one-third of critical care nurses worldwide intending to leave their roles. This paper aimed to examine the problem from a wellbeing perspective, offering implications for research, and potential solutions for organisations.

DESIGN

Discursive/Position paper.

METHOD

The discussion is based on the nursing and wellbeing literature. It is guided by the authors' collaborative expertise as both clinicians and researchers. Data were drawn from nursing and wellbeing peer-reviewed literature, such as reviews and empirical studies, national surveys and government and thinktank publications/reports.

RESULTS

Critical care nurses have been disproportionately affected by the COVID-19 pandemic with studies consistently showing critical care nurses to have the worst psychological outcomes on wellbeing measures, including depression, burnout and post-traumatic stress disorder (PTSD). These findings are not only concerning for the mental wellbeing of critical care nurses, they also raise significant issues for healthcare systems/organisations: poor wellbeing, increased burnout and PTSD are directly linked with critical care nurses intending to leave the profession. Thus, the wellbeing of critical care nurses must urgently be supported. Resilience has been identified as a protective mechanism against the development of PTSD and burnout, thus offering evidence-based interventions that address resilience and turnover have much to offer in tackling the workforce crisis. However, turnover data must be collected by studies evaluating resilience interventions, to further support their evidence base. Organisations cannot solely rely on the efficacy of these interventions to address their workforce crisis but must concomitantly engage in organisational change.

CONCLUSIONS

We conclude that critical care nurses are in urgent need of preventative, evidence-based wellbeing interventions, and make suggestions for research and practice.

Earnings, job satisfaction, and turnover of nurse practitioners across employment settings

Nurse practitioners (NPs) are an important part of the health care workforce. However, little information is available on NP earnings, job satisfaction, or turnover. National survey data from 2018 offer a pre-COVID-19 baseline for ongoing NP workforce monitoring. We found evidence that NPs earned approximately $92 500 annually, ranging from $82 800 in long-term care to $95 600 in hospital settings. Wages increased with tenure in the workforce and varied considerably by geography. Approximately 1 in 5 NPs switched jobs annually, with some net in-flow to ambulatory settings. Both NPs who left their position or considered leaving reported better pay and benefits, burnout, management role, stressful work environment, career advancement, and inadequate staffing as the primary explanations. These findings were augmented by analysis of 2012-2022 Bureau of Labor Statistics data that illustrated substantial growth in the NP workforce. Improving NP job satisfaction has the direct benefit of supporting a critical and growing segment of the health workforce; it has the additional benefit of reducing job turnover and the associated costs, potentially increasing earnings for NPs. Policies that improve working conditions for NPs in different employment settings will not just increase immediate job satisfaction but also ideally strengthen the longer-term labor market to improve patient outcomes.

A successful nursing education promotes newly graduated nurses' job satisfaction one year after graduation: a cross-sectional multi-country study

BACKGROUND

Job satisfaction is a key factor for the successful transition of newly graduated nurses (NGNs) and for retaining NGNs in their workplaces. However, there is limited evidence of the relationship between satisfaction regarding the nursing education program and NGNs' job satisfaction in the first year after graduation. Therefore, this study aims to examine the association of the nursing education related factors and NGNs' job satisfaction.

METHODS

A cross-sectional study design with the utilization of data collected from the same respondents one year earlier as educational factors was applied. The data were collected from NGNs (n = 557) in 10 European countries using an electronic survey between February 2019 and September 2020, and analyzed in detail for four countries (n = 417). Job satisfaction was measured with three questions: satisfaction with current job, quality of care in the workplace, and nursing profession. Nursing education related factors were satisfaction with nursing education program, level of study achievements, nursing as the 1st study choice, intention to stay in nursing, and generic nursing competence. The data were analyzed statistically using logistic regression.

RESULTS

Most of the NGNs in the 10 countries were satisfied with their current job (88.3%), the quality of care (86.4%) and nursing profession (83.8%). Finnish, German, Lithuanian and Spanish NGNs' satisfaction with the nursing education program at graduation was statistically significantly associated with their job satisfaction, i.e., satisfaction with their current job, the quality of care, and the nursing profession. Moreover, NGNs who had fairly often or very often intention to stay in nursing at graduation were more satisfied with their current job, with the quality of care, and with the nursing profession compared with NGNs who had never or fairly seldom intention to stay in nursing at graduation.

CONCLUSIONS

Nursing education plays a significant role in NGNs' job satisfaction one year after graduation, indicating the importance to start career planning already during nursing education. Both nursing education providers and healthcare organizations could plan in close collaboration a transition program for NGNs to ease the transition phase and thus increase the NGNs' job satisfaction and ultimately the high-quality care of the patients.

The Crisis in the Nursing Labour Market: Canadian Policy Perspectives

The labour market for care professionals has experienced significant changes, resulting in critical shortages globally. Nurses represent the largest share of health workers worldwide; nonetheless, an estimated 13 million more nurses will be needed over the next 10 years. Prior to the pandemic, the domestic supply of nurses in Canada had not kept pace with the ever-increasing demand for services. Pre-pandemic age- and needs-based forecasting models have estimated shortages in an excess of 100,000 nurses nationwide by 2030. While COVID-19 has accelerated the demand for and complexity of service requirements, it has also resulted in losses of healthcare professionals due to an increased sick leave, unprecedented burnout and retirements. This paper examines key factors that have contributed to nursing supply issues in Canada over time and provides examples of policy responses to the present shortage facing the healthcare system. To provide adequate care, the nursing workforce must be stabilized and-more importantly-recognized as critical to the health of the population.

What are the job attribute preferences of physicians and nurses in Türkiye? Evidence from a discrete choice experiment

BACKGROUND

In Türkiye, as in other countries, the maldistribution of the health workforce is a serious concern. Although policymakers have developed various incentive packages, this problem has not been thoroughly addressed yet. Discrete choice experiment (DCE) is a valuable method to provide evidence-based information for these incentive packages to attract healthcare staff for rural jobs. The main aim of this study is to investigate the stated preferences of physicians and nurses when choosing a job region.

METHODS

A labelled DCE was conducted to assess job preferences of physicians and nurses from two hospitals one of which is urban, and the other is in a rural region in Türkiye Job attributes included wage, creche, infrastructure, workload, education opportunity, housing, and career opportunity. Mixed logit model was used to analyse the data.

RESULTS

The strongest attribute associated with job preferences was region (coefficient - 3.06, [SE 0.18]) for physicians (n = 126) and wages (coefficient 1.02, [SE 0.08]) for nurses (n = 218). According to the Willingness to Pay (WTP) calculations, while the physicians claimed 8627 TRY (1,813 $), the nurses claimed 1407 TRY (296 $) in addition to their monthly salaries to accept a rural job.

CONCLUSION

Both financial and non-financial factors did affect the preferences of physicians and nurses. These DCE results provide information for policymakers about what characteristics might increase the motivation of physicians and nurses to work in rural areas in Türkiye.

The Effect of Herbal Medicine on Suicidal Behavior: A Protocol for Systematic Review and Meta-Analysis

Suicide is an important social and medical problem worldwide, including in countries that use traditional East Asian medicine (TEAM). Herbal medicine (HM) has been reported to be effective against several suicide-related conditions. This systematic review aimed to investigate the efficacy and safety of HM in reducing suicidal behavior including suicidal ideation, attempts, or completed suicide. We conduct a comprehensive search in 15 electronic bibliographic databases from inception to September 2022. All types of prospective clinical studies-including randomized controlled clinical trials (RCTs)-involving HM without or with routine care are included. The primary outcomes of this review are validated measures of suicidal ideation including the Beck scale for suicidal ideation. The revised Cochrane's risk of bias tool and other tools including the ROBANS-II tool are used to assess the methodological quality of RCTs and non-RCTs, respectively. A meta-analysis is performed using RevMan 5.4 in cases of homogeneous data from controlled studies. The results of the systematic review provide high-quality evidence to determine the efficacy and safety of HM for suicidal behavior. Our findings are informative for clinicians, policymakers, and researchers, aimed at reducing suicide rates, especially in countries that use TEAM.

Artificial intelligence for secondary prevention of myocardial infarction: A qualitative study of patient and health professional perspectives

BACKGROUND

Artificial intelligence (AI) has potential to improve self-management of several chronic conditions. However, the perspective of patients and healthcare professionals regarding AI-enabled health management programs, which are key to successful implementation, remains poorly understood.

PURPOSE

To explore the opinions of people with a history of myocardial infarction (PHMI) and health professionals on the use of AI for secondary prevention of MI.

PROCEDURE

Three rounds of focus groups were conducted via videoconferencing with 38 participants: 22 PHMI and 16 health professionals.

FINDINGS

We identified 21 concepts stemming from participants' views, which we classified into five categories: Trust; Expected Functions; Adoption; Concerns; and Perceived Benefits. Trust covered the credibility of information and safety to believe health advice. Expected Functions covered tailored feedback and personalised advice. Adoption included usability features and overall interest in AI. Concerns originated from previous negative experience with AI. Perceived Benefits included the usefulness of AI to provide advice when regular contact with healthcare services is not feasible. Health professionals were more optimistic than PHMI about the usefulness of AI for improving health behaviour.

CONCLUSIONS

Altogether, our findings provide key insights from end-users to improve the likelihood of successful implementation and adoption of AI-enabled systems in the context of MI, as an exemplar of broader applications in chronic disease management.

What Are the Factors That Influence Job Satisfaction of Nurses Working in the Intensive Care Unit? A Multicenter Qualitative Study

Aim

To explore and describe the factors that influence the job satisfaction of nurses working in the intensive care unit (ICU).

Background

High turnover and dropout rates of nurses currently put pressure on the accessibility and quality of ICU care. Job satisfaction is an important predictor for turnover. However, there is little knowledge about the factors that enhance or frustrate the job satisfaction of ICU nurses.

Methods

A qualitative descriptive study was conducted from March to July 2022. Semistructured interviews were held with 23 registered nurses who were purposively sampled from the ICU in four hospitals in the Netherlands. Interview transcripts were analyzed by using a thematic content analysis approach.

Results

Six themes emerged: (1) being part of a solid team; (2) professional autonomy; (3) competence development; (4) appreciation of work by others; (5) work content; and (6) human resource management. Interviewees described the importance of being part of a team, having professional autonomy and opportunities to develop and remain challenged as a professional. In practice, these needs are often not met. Interviewees expressed their own role in meeting these needs by taking charge in situations, being eager to learn, and actively looking for ways to keep work attractive. Recognition and appreciation for their work are important catalysts for staying motivated. Monotonous work, poor leadership, and bureaucracy reduced their job satisfaction.

Conclusion

Our findings provide deeper insight into a range of factors that influence the job satisfaction of ICU nurses and may also apply to nurses in other settings. Practical recommendations are given for keeping the nursing profession attractive for the current and future generation. Implications for Nursing Management. Findings emphasize the importance of optimizing nurses' work conditions by investing in their social embeddedness, professional autonomy, opportunities for competence development, and appreciation of work.

Association between better night-shift nurse staffing and surgical outcomes: A retrospective cohort study using a nationwide inpatient database in Japan

INTRODUCTION

Although many studies have investigated the relationship between patient outcomes and the level of nurse staffing, little is known about the association between increased night-shift nurse staffing and patient outcomes. In the Japanese universal health insurance system, a new scheme of additional financial incentives for acute care hospitals was launched in 2012 to increase the number of nurses during the night shift in general wards. The objective of this study was to investigate whether an additional financial incentive to increase night-shift nurse staffing in general wards was associated with better patient outcomes.

DESIGN

Adoption of the above-mentioned scheme of additional financial incentives was used as a natural experiment, and the difference-in-differences method was conducted to evaluate the effect of the scheme. The study was performed using a nationwide inpatient database and hospital information in Japan.

METHODS

To conduct a difference-in-differences analysis, first, hospitals with and without increased night-shift nurse staffing were matched using propensity score matching. A patient-level difference-in-differences analysis was then conducted. The intervention group comprised the hospitals that adopted the new scheme of additional financial incentives. The outcome measures were in-hospital mortality, failure to rescue, and length of hospital stay.

RESULTS

Subjects were 403,971 adult patients who underwent planned major surgeries in Japanese acute care hospitals from April 2012 to March 2018. The adjusted difference-in-differences estimates were not significant for in-hospital mortality (odds ratio: 0.83; 95% confidence interval: 0.68 to 1.01; p = 0.07) or failure to rescue (odds ratio: 0.92; 95% confidence interval: 0.73 to 1.14; p = 0.44). The adjusted difference-in-differences estimate for length of hospital stay was significant (percent change: -3.2%; 95% confidence interval: -6.1 to -0.3%; p = 0.029), indicating that the adoption of the scheme was associated with a decreased length of hospital stay.

CONCLUSIONS

Increased night-shift nurse staffing was not associated with a decrease in in-hospital mortality or failure to rescue, but it was associated with a reduction in the length of hospital stay. It may be necessary to consider changes in policy content to make the policy more effective. The findings of this study are potentially useful for medical policymakers considering nurse staffing to decrease the length of stay, which may decrease costs.

CLINICAL RELEVANCE

This study showed that increased night-shift nurse staffing was not associated with a decrease in in-hospital mortality or failure to rescue, but it was associated with a reduction in the length of hospital stay. The examination of the effectiveness of increasing nurse staffing during a specific shift in acute care hospitals is potentially useful for health policymakers worldwide in their considerations of future nurse staffing policies.

Solutions for improved hospital-wide patient flows - a qualitative interview study of leading healthcare providers

BACKGROUND

Hospital productivity is of great importance for patients and public health to achieve better availability and health outcomes. Previous research demonstrates that improvements can be reached by directing more attention to the flow of patients. There is a significant body of literature on how to improve patient flows, but these research projects rarely encompass complete hospitals. Therefore, through interviews with senior managers at the world's leading hospitals, this study aims to identify effective solutions to enable swift patient flows across hospitals and develop a framework to guide improvements in hospital-wide patient flows.

METHODS

This study drew on qualitative data from interviews with 33 senior managers at 18 of the world's 25 leading hospitals, spread across nine countries. The interviews were conducted between June 2021 and November 2021 and transcribed verbatim. A thematic analysis followed, based on inductive reasoning to identify meaningful subjects and themes.

RESULTS

We have identified 50 solutions to efficient hospital-wide patient flows. They describe the importance for hospitals to align the organization; build a coordination and transfer structure; ensure physical capacity capabilities; develop standards, checklists, and routines; invest in digital and analytical tools; improve the management of operations; optimize capacity utilization and occupancy rates; and seek external solutions and policy changes. This study also presents a patient flow improvement framework to be used by healthcare managers, commissioners, and decision-makers when designing strategies to improve the delivery of healthcare services to meet the needs of patients.

CONCLUSIONS

Hospitals must invest in new capabilities and technologies, implement new working methods, and build a patient flow-focused culture. It is also important to strategically look at the patient's whole trajectory of care as one unified flow that must be aligned and integrated between and across all actors, internally and externally. Hospitals need to both proactively and reactively optimize their capacity use around the patient flow to provide care for as many patients as possible and to spread the burden evenly across the organization.

A critical race analysis of structural and institutional racism: Rethinking overseas registered nurses' recruitment to and working conditions in the United Kingdom

Language tests for overseas registered nurses (ORN) working outside their home country are essential for patient safety, as communication competency needs to be established in any workforce. We argue that the current employment of existing language tests is structurally and institutionally racist and disadvantages ORNs from non-European Union (EU) and non-White countries seeking to work in the United Kingdom. Using Critical Race Theory (CRT), we argue that existing English language tests for ORNs seeking registration in the United Kingdom are discriminatory due to the UK's racist migration policies and a regulatory body for nursing and midwifery that fails to acknowledge and understand its own institutionally racist practices.

How Do Shifts in Patients with Mental Health Problems' Formal and Informal Care Utilization Affect Informal Caregivers?: A COVID-19 Case Study

(1) Background: This study investigated how potential shifts in patients' formal and informal care utilization during the COVID-19 pandemic impacted their informal caregivers in terms of their subjective burden, psychological wellbeing, and happiness. (2) Methods: A retrospective cohort study design was employed for a panel of Dutch informal caregivers of persons with mental health problems (n = 219) in June 2020. Descriptive statistics and differences between means were determined for the patients' informal and care utilization and informal caregivers' subjective burden, happiness, and psychological wellbeing. Three mediation analyses were conducted using the PROCESS macro. (3) Results: Informal caregivers reported significantly worse happiness and subjective burden scores during the COVID-19 pandemic compared with before the lockdown. There were minimal shifts in patient's care utilization reported, with the exception of a decrease in significant emotional and practical support provided by the informal caregiver. In the mediation analyses, there was not a significant indirect effect of shifts in patients' formal care utilization on informal caregivers' subjective burden, psychological wellbeing, and happiness through shifts in patients' informal care utilization. (4) Discussion and conclusion: Whilst we found that shifts in patients' care utilization during the first wave of the pandemic did not affect the informal caregiver in the short term, it is unclear what the long-term impact of the pandemic might be on informal caregivers. More research should be conducted to understand the implications of short- and long-term impact of substitution on informal caregivers of persons with mental health problems, with special consideration of the COVID-19 context and uptake of e-health technology.

Predictors of the intentions to leave among nurses in an academic medical center

Aim

Nurses are an essential human resource for the healthcare system. However, high turnover of nurses is a current issue. Reducing the high turnover of nurses is crucial for facilitating the sustainable provision of care in hospitals. The purpose of this study was to explore the factors affecting nurses' intentions to leave among nurses in an advanced medical center.

Methods

Using a cross-sectional design, we conducted a questionnaire survey of nurses working at an academic medical center in August 2020. Of the 1063 distributed questionnaires, there were 821 (77.2%) valid responses. The questionnaire included items on the Kessler 6 (K6), New Brief Job Stress Questionnaire (New BJSQ), Organizational Justice Questionnaire (OJQ), and intention to leave a hospital job.

Results

Overall, the mean age of the nurses was 34.3 ± 10.1 years and 87.8% (721/821) of them were female. Among respondents, 19.5% (160/821) had a strong intention to leave. After adjusting for all the variables, a logistic regression analysis revealed that longer working hours, job rank (staff nurse), work-self-balance positive (imbalance), workplace harassment (no bullying), and interactional justice (unfair supervisor) were determinants associated with strong intentions to leave.

Conclusions

Approximately one-fifth of nurses working at advanced medical center had a strong intention to leave. However, our findings can help managers predict the turnover of nurses by understanding occupational characteristics. Managing work-self-balance and treating staff fairly could improve work environments. Further research focusing on the outcome of actual turnover rather than intention to leave is needed.

Factors affecting nurses' decision to undergo a specialist education and to choose a specialty

AIMS

The aims of the study were to identify factors affecting nurses' decision to undergo specialist education and choose a specialty and to describe differences between specialization areas with different types of care.

DESIGN

A descriptive cross-sectional design.

METHODS

A survey was conducted among specialist nurse students in three nursing colleges in Sweden (n = 227). Instruments such as Big Five Inventory and RAND-36 and items earlier used by Bexelius and Olsson were included. Survey data were analysed by using descriptive and analytical statistics, and for open-ended question qualitative content analysis was used.

RESULTS

Wage benefit during the education was regarded by 47% as an incentive to start studies. Most of the specialist nurse students considered an opportunity for new tasks (75%), new areas of responsibility (75%), intellectual challenges (72%) and higher wages (71%) to be of high importance when choosing a specialty. However, the students in specialization areas with transitory care-rated challenges regarding the practical skills (84%) and the occurrence of acute events (82%) higher.

CONCLUSION

Although higher wages were important to make nurses feel that they will get value from the education, there were also other important aspects, such as opportunity for new tasks, new areas of responsibility and intellectual challenges that influenced nurses' willingness to undergo a specialist education. Our findings provide employers with the useful information to guide and influence nurses' decisions to enter specialist education and their choice of specialist area.

Indian psychiatrists in the Australian workforce - From brain drain to brain exchange

Worldwide doctors have been migrating from low- and middle-income countries to high-income countries for decades. This contributes to dearth of doctors, especially psychiatrists, in low- and middle-income countries - often referred to as 'brain drain'. Australia has a fair share of psychiatrists of Indian origin in its workforce. This article endeavours to re-formulate the migration phenomenon as 'brain exchange' through the experiential insight of the authors along with published literature and discusses the contribution of substantial number of psychiatrists of Indian origin to the Australian society. Furthermore, the article highlights the potential for the Royal Australian and New Zealand College of Psychiatrists to be a leader in this area by facilitating globally responsible practice by giving back to countries from which psychiatrists originate. The key observations and recommendations are transferrable to other similar countries and equally to other medical specialities.

Graduating Nursing Students’ Empowerment and Related Factors: Comparative Study in Six European Countries

New nurses are needed in healthcare. To meet the role expectations of a registered nurse, nursing students must feel empowered at graduation. However, there are only a few studies focusing on nursing students’ empowerment. This study aims to describe and analyze graduating nursing students’ level of empowerment in six European countries and potential related factors. A comparative and cross-sectional study was performed in the Czech Republic, Finland, Italy, Portugal, Slovakia, and Spain with graduating nursing students (n = 1746) using the Essential Elements of Nurse Empowerment scale. Potentially related factors included age, gender, a previous degree in health care, work experience in health care, graduation to first-choice profession, intention to leave the nursing profession, level of study achievements, satisfaction with the current nursing programme, clinical practicums, theoretical education, and generic competence measured with the Nurse Competence Scale. The data were analysed statistically. Graduating nursing students’ self-assessed level of empowerment was moderate, with statistical differences between countries. Those with high empowerment had no intention to leave the nursing profession, had a higher level of study achievements, and a higher self-assessed generic competence level. The results suggest that empowerment needs to be enhanced during nursing education. Further research is needed to understand the development of empowerment during the early years of a nursing career.

Patient Perceptions on Receiving Vaccination Services through Community Pharmacies

(1) Introduction: Pharmacists are medical professionals who play an active role in the protection of public health. Since 2021, pharmacists with an appropriate certification have been authorised to administer vaccines against COVID-19. (2) Objective: The objective of this study was to ascertain the perceptions of patients about receiving vaccinations through community pharmacies. (3) Material and methods: This study was conducted in 2021. The research tool was an anonymous questionnaire published on the websites of patient organisations. Ultimately, 1062 patients participated in this study. (4) Results: This study shows that most of the respondents find community pharmacies more accessible than outpatient clinics (85.3%). Sixty-one percent of the respondents stated that getting vaccinated at pharmacies would be less time consuming than at outpatient clinics. Nearly every third respondent (29.5%) declared that they would get vaccinated if they received such a recommendation from a pharmacist. Fifty-six percent of the respondents were of the opinion that the administration of vaccines by pharmacists would relieve the burden on medical staff and the healthcare system. (5) Conclusions: Polish patients participating in the study have a positive attitude towards the implementation of vaccination services in community pharmacies as an effective way of combating infectious diseases.

Nurses' use of social media during the COVID-19 pandemic-A scoping review

BACKGROUND

During the COVID-19 pandemic, nurses stand in an unknown situation while facing continuous news feeds. Social media is a ubiquitous tool to gain and share reliable knowledge and experiences regarding COVID-19. The article aims to explore how nurses use social media in relation to the COVID-19 pandemic.

METHOD

A scoping review inspired by Arksey and O'Mally was conducted by searches in Medline, CINAHL, Academic Search Complete and Web of Sciences. Empirical research studies investigating nurses' use of social media in relation to COVID-19 were included. Exclusion criteria were: Literature reviews, articles in languages other than English, articles about E-health, and articles investigating healthcare professionals without specification of nurses included. Articles, published in January-November 2020, were included and analysed through a thematic analysis. The PRISMA-ScR checklist was used.

RESULTS

Most of the eleven included studies were cross-sectional surveys, conducted in developing countries, and had neither social media nor nurses as their main focus of interest. Three themes were identified: 'Social media as a knowledge node', 'Social media functioned as profession-promoting channels' and 'Social media as a disciplinary tool'. Nurses used social media as channels to gain and share information about COVID-19, and to support each other by highlighting the need for training and changes in delivery of care and redeployment. Further, social media functioned as profession-promoting channels partly sharing heroic self-representations and acknowledgment of frontline persons in the pandemic, partly by displaying critical working conditions. Finally, nurses used social media to educate people to perform the 'right 'COVID-19' behaviours in society.

CONCLUSION

This review provided snapshots of nurses' uses of social media from various regions in the world, but revealed a need for studies from further countries and continents. The study calls for further multi-methodological and in depth qualitative research, including theoretically framed studies, with a specific focus on the uses of social media among nurses during the pandemic.

Salutogenesis at Work as a Facilitator for Implementation? An Explorative Study on the Relationship of Job Demands, Job Resources and the Work-Related Sense of Coherence within a Complex Healthcare Programme

BACKGROUND

The implementation of complex healthcare programmes can be challenging for respective service providers (SPs) in implementation settings. A strong work-related sense of coherence (Work-SoC) promotes creation of job resources and potentially facilitates coping with demands that may arise during implementation. In this study, we analyse how SPs' Work-SoC is influenced by job resources and demands during programme implementation and identify relevant implementation strategies to ensure a salutogenic implementation process.

METHODS

Qualitative data were collected during the implementation of a new complex psycho-oncological care programme called isPO. Four focus groups and four interviews were conducted with SPs. All were audiotaped, transcribed and content analysis was applied, whilst ensuring inter- and intra-rater reliability.

RESULTS

Each Work-SoC component was influenced by specific job resources and demands. In particular, comprehensibility and manageability interacted. Manageability affected assessment of the programme's feasibility. High meaningfulness positively affected the programme's acceptance and overall assessment among SPs. Furthermore, it buffered low manageability and was strongly associated with project identification.

CONCLUSION

We found that Work-SoC could be used to assess SPs' work environment, and therefore programme feasibility. It may be worthwhile to use Work-SoC as an implementation outcome or as an indicator for possible programmes.

Profiling resilience: A latent profile analysis of German nurses' coping and resilience

Introduction

Because of the shortage of nurses, it becomes crucial for organizations and health systems to keep nurses in their workforce. As individual resilience is positively associated with organizational commitment and negatively with mental disorders, it may reduce nurses' intention to leave the profession. Thus, individual resilience gained attention in research. Nevertheless, there is no common conceptualization of individual resilience in the literature. Rather, three prevalent understandings exist. Due to these multiple understandings, the role of coping in the context of resilience remains unclear. Against this background, the aim of this study is to analyze the relationship between nurses' resilience and coping based on a person-centered approach.

Methods

This study presents a latent profile analysis based on a survey of 210 German nurses. The profiles were generated based on the Brief Resilience Scale and Brief COPE. The Perceived Workload of Nurses' Scale and sociodemographic data were considered as explanatory factors using nominal logistic regression. Further, the relation with possible consequences was tested by χ²-test using the Irritation Scale and KUT Commitment Measure.

Results

The study identifies four different profiles of coping and resilience. The profiles "resistant" and "social-active" show rather low irritations and high organizational commitment. The "passive" profile has lower irritation scores than the "solitary" profile does, but the "passive" profile is associated with more irritation than the "resistant" or the "social-active" profile. Whereas the other profiles include characteristics of resilience, the "solitary" profile has a vulnerable nature. The analysis shows that more coordination and information problems, higher age, and not being in a leadership role are associated with a higher probability of belonging to the "solitary" profile. The chance of belonging to the "solitary" profile is significantly higher for women than for men, whereas women have a significantly lower chance of belonging to the "resistant" profile, compared to men.

Conclusion

The analysis shows that the three prevalent understandings of resilience are appropriate but it also indicates that future scientific debate requires more precision in defining individual resilience. The study contributes to sharpening the definition of resilience as well as to understanding the link between coping and resilience.