Retaining Healthcare Workers: A Systematic Review of Strategies for Sustaining Power in the Workplace

The National Physician Shortage: Disconcerting HRSA and AAMC Reports

Recent years have seen a rise in concerns regarding the future sufficiency of the national physician workforce. Recent studies have highlighted this anticipated shortage of physicians. The first, by the Health Resources and Services Administration (HRSA), projects a total shortage of 124,180, 167,030, and 187,130 physicians in 2027, 2032, and 2037, respectively. Shortages are anticipated to be most severe in nonmetro areas and in primary care disciplines. A report released by the Association of American Medical Colleges projects a total national shortage of between 13,500 and 86,000 physicians by 2036 and a coincident shortage of between 20,200 and 40,400 primary care physicians. These projections warrant a diverse range of actions. Among these are steps to increase the pipeline producing new physicians, both of US and international origin. Increasing the supply and scope of practice of non-physician providers, nurse practitioners and physician assistants, could ameliorate the effects of physician shortages. Actions to address equity in physician compensation and reduce administrative burden, including that associated with electronic health records, could improve physician retention and well-being. All of these strategies should be taken under consideration at the soonest possible time, given the magnitude and apparent inevitability of already present and increasing physician shortages.

Call to action to reduce the occupational hazard associated with patient handling for workforce preservation

BACKGROUND

Nursing injuries from overexertion decreased in recent years, but 2020 saw an increase. Reducing work-related injuries (WRI) through safe patient handling (SPH) can preserve the nursing workforce. Policies focused on workforce preservation are needed.

PURPOSE

We investigate an evidence-based SPH program initiated in 2002, in reducing injuries among nurses compared with national patterns, and offer a blueprint for replication.

METHODS

A three-step iterative, mixed-methods approach compares national data on WRI and lost workdays from overexertion with a case example.

FINDINGS

The case example outperforms national trends. Data demonstrate benefits from a comprehensive, evidence-based SPH program with steady reductions in Occupational Safety and Health Administration recordable WRI and median workdays lost. Fifty-eight implementation strategies promoted sustainability of SPH practices.

DISCUSSION AND CONCLUSION

SPH can reduce injuries and lost workdays but requires funding for SPH equipment across settings. Implications for organizations, research and technology development, policy, and workforce preservation are provided.

Working Conditions, Musculoskeletal Pain and Wellbeing Among Hospital Surgeons: A Cross-Sectional Study

Background/Objectives: Patient safety is directly linked with health and wellbeing of healthcare workers. In the UK, COVID-19 severely disrupted healthcare, with surgeons tackling prolonged waiting lists and working longer hours under high stress. This study explored the biomechanical and psychosocial demands on hospital surgeons, as well as their experience of pain and work-life balance post-pandemic. Methods: A questionnaire was developed combining validated tools assessing physical demands; modified job demand, control, and support; the WHO-5 wellbeing index; work-life balance from the Copenhagen Psychosocial Questionnaire; musculoskeletal pain; job satisfaction and retirement intentions. An online survey was developed using the Qualtrics© (Provo, UT, USA) platform and circulated through surgical networks using snowball sampling. Poisson regression modelling with robust confidence intervals was used to explore relationships between work-related factors and musculoskeletal pain, and associations with retirement intentions. Results: In total, 242 replies were received. Surgeons frequently reported strenuous occupational activities and work-life imbalance, and one in six reported job dissatisfaction. Only 17% reported no pain; the one-month prevalence of pain ranged from 46% at the lower back to 12% at the ankle, and pain was frequently disruptive. Better work-life balance had a protective effect for pain (PRR = 0.92, 95% CI = 0.85-0.99), while risk of pain increased with increasingly physically demanding activities at work (PRR = 1.04, 95% CI = 1.01-1.07) in the age- and sex-adjusted models. Job dissatisfaction was associated with intention to retire early (PRR = 1.83, 95% CI = 1.02-3.27). Conclusions: This study demonstrated high physical and mental demands among surgeons and poor work-life balance. Physical and emotional links to pain were identified. Fit surgeons ensure safe patient care. Our findings suggest that surgeons were facing health issues and work-life conflict post-pandemic, potentially limiting their job satisfaction and career span. A follow-up study is recommended.

Code Lavender Pilot: An Emotional Support Intervention for Intensive Care Unit Staff

On-demand support is necessary to mitigate distress and attrition in healthcare staff. Healthcare chaplains' scope includes such support. This pilot studied the acceptability, feasibility, and effectiveness of a Code Lavender protocol utilizing chaplain support and stress-relief items. A post-hoc analysis examined the protocol's cost-effectiveness. The results indicated the protocol's acceptability, effectiveness, feasibility, and cost-effectiveness. Healthcare worker distress can be mitigated with this simple, on-demand support utilizing the specialized skills and training of healthcare chaplains.

Physician Turnover Increased In Private Equity-Acquired Physician Practices

Consolidation of physician practices by private equity (PE) firms has accelerated, raising concerns that PE's emphasis on short-term profitability may exacerbate physician turnover, with implications for care continuity. Despite their significance, evidence on how PE acquisitions affect physician turnover is limited. Using clinician-level data linked to practice acquisition data from the period 2014-21, we used a difference-in-differences design to examine changes to physician employment and turnover after PE acquisition of 200 ophthalmology practices with 1,980 clinicians. Relative to matched controls, PE-acquired practices increased the total number of clinicians by 46.8 percent through three years after acquisition. This growth was driven by increases in the numbers of both ophthalmologists and optometrists (30.7 percent and 36.2 percent, respectively). PE acquisitions also increased physician turnover, with the share of physicians leaving PE-acquired practices from one year to another increasing by 13 percentage points, or 265 percent, after acquisition, relative to non-PE-acquired practices. Findings highlight how PE acquisitions of physician practices are reshaping physician employment and workforce stability. As PE expands its footprint, policy makers should monitor the long-term implications of PE ownership on physician employment and turnover to mitigate potential undesirable effects on patient health.

Psychological safety, job satisfaction, and the intention to leave among German early-career physicians

BACKGROUND

Healthcare systems worldwide experience shortages of healthcare professionals. Retention of physicians is becoming an increasing problem. The psychological safety among physicians affects not only performance but also their emotional well-being and job satisfaction. This study aims to evaluate early career physicians' perception of psychological safety and its influence on job satisfaction and intention to leave.

METHODS

In a cross-sectional study, early career physicians, currently in fellowship programs in Germany were invited to fill in an electronic survey. The instrument consisted of demographic variables and sections from validated and well-established questionnaires. Psychological safety was evaluated on three levels-in relation to the team leader, team as a whole, and peers. Also, job satisfaction was assessed with standardized measures, and participants were asked if they were considering leaving their current employer. Participants were recruited via a nationwide learning platform-an online educational portal for medical students and early career physicians. Data analyses included descriptive, correlation analysis, and regression analyses to determine univariate and multivariate associations with job satisfaction and intention to leave.

RESULTS

The study sample consisted of 432 early career physicians. Most were fulltime employed (85.6%), female (78.2%), and in first 3 years of their postgraduate education (77.5%). A total of 47.2% indicated intention to leave their current employment. On a Likert-10 agreement scale, with high scores indicating greater psychological safety, the mean scores for leader-related, team-related, and peer-related psychological safety were 6.01 [95% confidence interval = 5.81-6.21), 7.30 (7.11-7.49), and 7.95 (7.78-8.12), respectively. In correlation analysis, all dimensions of psychological safety showed significant associations with job satisfaction and the intention to leave. In the multiple regression analyses, female gender (B = -0.10; P = .04) and age group (B = -0.08; P < .01) were associated with lower job satisfaction. High leader and team-related psychological safety were significantly associated with higher job satisfaction (B = 0.18, P < .01; B = 0.10, P < .01), and negatively related to intention to leave (OR = 0.53, P < 0.01; OR = 0.77, P < .01).

CONCLUSION

This survey enhances our understanding of the nuances of psychological safety among early career physicians. In Germany, they reported low-to-medium levels of psychological safety related to the leader and low job satisfaction. Almost every second participant indicated intention to leave the organization. Leader-related psychological safety had highest effect on job satisfaction and intention to leave. Our findings corroborate the eminent role of leadership, workplace, and safety culture for job satisfaction and retention of early career physicians, what consequently affects quality and safety of healthcare.

Mentorship for Non-academic, Mid-Career Hospitalist Physicians: The Journey Taken Less Often

Mentorship plays a crucial role in the professional development of hospitalists by offering guidance, support, and opportunities for career advancement. Multiple studies have reported that mentorship significantly contributes to improving job performance and cultivating happiness in medicine. Further, mentorship also leads to increased confidence in decision-making, and enhanced work-life balance. Additionally, mentees have reported greater engagement, reduced burnout, and commitment to their organizations. Most of these studies were performed on academic hospitalists and very little has been written about the foundation of non-academic organizations: mid-career hospitalists. Academic organizations have invested in mentorship programs, but little focus is given to mentorship of hospitalists, specifically mid-career hospitalists, outside of these settings. The lack of mentorship contributes to lack of professional development, burnout, low job satisfaction, worse patient outcomes, and increased turnover. By fostering a culture of mentorship, healthcare institutions can better retain talent, improve patient care, and ensure sustained career satisfaction among hospitalists. This article delves into the importance of mentorship, its empowering benefits, and strategies tailored to the specific needs of mid-career hospitalists working in non-academic institutions. Further, we advocate for integrating robust mentorship as a strategic initiative to bolster the professional trajectory of this vital group within the healthcare system.

Advancing Sustainable HIV Services Through Integration in Primary Healthcare in Sub-Saharan Africa: A Perspective on Practical Recommendations

Sub-Saharan Africa continues to bear a disproportionate burden of the global HIV epidemic. Integrating HIV services into primary healthcare is a crucial strategy to accelerate progress towards ending the epidemic. However, several challenges hinder effective integration, including underfunding, human resource shortages, infrastructure limitations, weak health systems, and sociocultural factors. With this perspective, we discuss strategies to address these challenges. A comprehensive, multi-faceted approach is necessary to overcome these barriers. Investing in human resources, improving infrastructure, and strengthening health information systems are essential for strengthening the health system. Implementing patient-centered care, integrated service delivery models, and community engagement can optimize service delivery. Utilizing digital health tools, such as mobile health applications and electronic health records, can enhance service delivery and data management. Mobilizing for an increase in domestic resources, aligning donor funding, and using cost-effective approaches are crucial for effective financing. Finally, robust monitoring and evaluation systems are necessary to track progress, identify challenges, and inform decision-making. With these strategies, among many others, sub-Saharan African countries can significantly improve the integration of HIV services into primary healthcare, leading to better health outcomes for people living with HIV and more sustainable HIV programs.

Retention of international nurses in receiving country: Voices of Indonesian nurses in Japanese healthcare facilities

Objectives

This study aimed to explore the voices of Indonesian migrant nurses on their retention in Japanese healthcare facilities.

Methods

A descriptive qualitative study was conducted between June and September 2023. The snowball sampling method was utilized to recruit 22 Indonesian nurses working in healthcare facilities in seven prefectures of Japan. Semi-structured interviews were conducted based on their shared experiences. All interview data were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.

Results

Six prominent themes and 15 subthemes emerged: 1) organizational factors (caring leader, involvement in decision making, career development, and participation in training); 2) social support systems (group support, colleagues support and friend support); 3) individual drive (lifelong learning and persistent); 4) national policies (government support in public service and flexibility in finding a comfortable placement); 5) family factors (positive support of child education and development and maintaining relationship with spouse); and 6) economic factors (staying due to high salary and increasing income streams).

Conclusions

Retention of Indonesian migrant nurses in Japan is a multifaceted challenge that hinges on various interconnected factors. This study has gone some way toward enhancing our understanding of international nurse retention in the receiving countries. Corresponding supports at the individual, family, organizational, economic, social, and national policy levels should be considered to keep them in their destination countries.

Stakeholder Perspectives on Retention Strategies for Rehabilitation Professionals: A Qualitative Study

There is a scarcity of health human resources worldwide. In occupational therapy (OT), physical therapy (PT), and speech-language pathology (S-LP), attrition and retention issues amplify this situation and contribute to the precarity of health systems. Therefore, we aimed to investigate retention strategies for rehabilitation professionals in Quebec. We present an analysis from individual interviews with rehabilitation professionals and focus groups with stakeholders. We used purposeful sampling (maximum variation approach) to recruit participants from Quebec, Canada. We conducted interviews with 51 OTs, PTs, and S-LPs (2019-2020) and four focus groups with managers, professional education programs, professional associations, and regulatory bodies (2022). Cultural-historical activity theory provided the theoretical scaffolding for these interpretive description studies. Inductive and deductive approaches and constant comparative techniques were used for data analysis. Five sets of retention strategies were developed: (1) ensuring that work aligns with values; (2) improving alignment of work parameters with needs and interests of rehabilitation professionals; (3) modifying physical, social, cultural, and structural aspects of a workplace; (4) addressing how the profession is governed; and (5) offering informal and formal benefits. Multi-systemic retention strategies with intersectoral partnerships were deemed essential to effectively change rehabilitation professionals' work and work environments and to increase public awareness of the added value of rehabilitation professionals. Our findings emphasize a critical need to design targeted, multi-systemic retention strategies to influence the work experiences of rehabilitation professionals and to ensure the availability of OTs, PTs, and S-LPs for present and future rehabilitation needs.

Reimagining hospital management: the balanced scorecard as a catalyst for employee retention and organizational excellence

Employee turnover in healthcare institutions is a critical issue affecting both quality of care and organizational costs. This study examines the potential impact of the Balanced Scorecard (BSC) as a communication tool on employee turnover rates in a Japanese hospital setting. A case study of Bethlehem Garden Hospital in Tokyo, Japan, was conducted to examine turnover rates before and after the implementation of BSC. The study also compares these rates to industry averages in Japan and the United States. The results show a significant reduction in turnover rates from 23.6% in 2015 to 3.4% in 2023 following the implementation of BSC, which is lower than both national and international industry averages. This reduction corresponded with increased employee engagement scores. The study suggests that the BSC when effectively implemented and communicated, can help reduce turnover by improving organizational alignment, employee engagement, and trust. Although the single case study design limits generalizability, these findings provide valuable insights into the potential of BSC as a strategic tool for addressing turnover in healthcare settings. Future research directions are suggested to validate these findings further in diverse healthcare environments.

Managing operational resilience during the implementation of digital transformation in healthcare organisational practices

PURPOSE

The aim of this study is to investigate ways in which healthcare organisations can successfully maintain operational resilience within intricate and varied engagements during digital transformation processes.

DESIGN/METHODOLOGY/APPROACH

The present research applied cultural-historical activity theory as the theoretical framework and the ethnographic account as an approach and strategy to interpret and understand the operational resilience of digital transformation tools in daily practices. Fieldwork was based on the research technique of shadowing, whereby the researcher closely accompanied the participants to record their conduct, activities and exchanges.

FINDINGS

Research results propose that effective operational resilience management in the implementation of digital transformation projects is based on (1) identifying and interpreting internal contradictions in everyday interactions as opportunities for capability developments; (2) navigating through multiple sites in fast and improvised movements, which derives in distributed and emergent practices; (3) interplaying between dyadic interactions and networked dependencies, which is achieved through the articulation of varied interests and (4) implementing novel intermediary tools, roles and regulations that facilitate the reduction of disturbances.

ORIGINALITY/VALUE

The propositions of the present study indicate that the management of operational resilience extends beyond conventional adaptive and socio-technical models in healthcare services. The study emphasises the significance of expressing and converting differing interests into mutual advantages. It additionally demonstrates the intricacy of this obstacle, as it entails navigating through uncertain information, concealed interpretations and conflicting interests.

Motivations of Israeli physicians to return, or not, to Israel after their fellowship abroad

BACKGROUND

Emigration of healthcare professionals, particularly physicians, is an unresolved "pandemic", influenced by various factors. In high-income countries, the training phase (fellowship) abroad is critical for career development, yet it poses challenges for the retention of these professionals upon their completion of training. This study aimed to identify the determinants influencing Israeli physicians' decisions to return to their home country after completing fellowship training abroad.

METHODS

This cross-sectional study conducted in early 2024, surveyed Israeli physicians with post-graduate training who pursued a fellowship abroad between 2013 and 2024. An anonymous survey included questions on demographics, training experience, and professional challenges. Analytical methods included descriptive statistics and regression analysis to explore factors associated with the decision to return.

RESULTS

Of the 323 individuals surveyed, 297 met the inclusion criteria. Among them, 141 (47.5%) have returned to Israel, while 156 (52.5%) currently reside abroad, 48 (31%) of them have completed their fellowship. Respondents identified several challenges, beginning with a complex application process prior to fellowship (47% stated this as a major challenge), substantial financial burdens averaging 35,546 USD in direct out-of-pocket expenses during, and job uncertainty, with only 55% having secured positions upon return. Of the 156 Israeli fellows still abroad, 107 (69%) reported medium to low confidence in returning. Factors associated with a higher likelihood of confidence in returning to Israel included a secured job position upon return (OR 8.6, 95% CI 3.1-28.9) and having an opportunity for a position that would utilize the skills gained during the fellowship (OR 3.5, 95% CI 1.3-10.2).

CONCLUSION

The decision to return to Israel after a fellowship abroad is influenced by a mix of professional, personal, and geopolitical factors. To counteract the critical issue of brain drain, it is essential to enhance occupational certainty for returning physicians. These findings highlight the urgent need for healthcare policies that provide robust support for returning professionals and address their specific challenges.

Retaining Healing Hands: A Transnational Study on Job Retention Interventions for the Healthcare Workforce

Healthcare organizations worldwide face challenges in retaining their healthcare workforce, with individual and organizational factors influencing their intentions to leave. This study conducted eight online co-creation workshops and four Delphi sessions to gain qualitative and in-depth insights into job retention interventions, involving healthcare workers, hospital managers, and policymakers. A thematic analysis was conducted, resulting in multiple interventions that were clustered in four pre-defined themes: professional and personal support, education, financial incentives, and regulatory measures. Professional and personal support interventions included regular interprofessional team meetings, leadership training programs, self-scheduling and sabbaticals, support for administrative and non-clinical work, and the provision of psychological counselling. Educational interventions encompassed facilitating development opportunities, periodic evaluations, onboarding, mentorship programs, and peer support groups. Financial incentives included the provision of competitive salaries, adequate infrastructure, extra benefits, transport possibilities, and permanent employment contracts. Regulatory measures addressed the need for complementary legislation across various levels, fixed healthcare worker-to-patient ratio, and instruments to monitor workload. To optimize retention strategies, healthcare organizations should tailor these interventions to address the unique factors influencing their workforce's intentions to leave within their specific context. The study concludes that combining personal and professional support, educational opportunities, financial incentives, and regulatory measures is necessary because there is no one-size-fits-all solution.

Nursing unions: A scoping review of outcomes for employees, patients, and administrators

BACKGROUND

Nursing labor organization is consequential to many stakeholders, but collective evidence for outcomes associated with nurse unionization is lacking.

PURPOSE

To synthesize evidence of associations between nursing unions and nurse, patient, and system outcomes.

METHODS

A scoping review.

FINDINGS

Twenty-four articles spanning nearly 50years were abstracted. Most studies (n = 16; 67%) included nurse outcomes, usually remuneration (n = 10; 42%). Patient and system outcomes were less common (for each: n = 7; 29%). Union wage premiums were modest. Evidence for other nurse outcomes (e.g., job satisfaction, retention) was limited and mixed. Unionization was associated with improvements in many but not all patient outcomes studied, and with operational differences, including decreased staffing and labor substitution.

DISCUSSION

Collective bargaining outcomes may help administrators understand nurses' needs and concerns and thereby improve nurse recruitment and retention. For example, modest wage effects may signal nonwage priorities among nurses, which are understudied and worthy subjects of future research.

Spaced Digital Education for Health Professionals: Systematic Review and Meta-Analysis

BACKGROUND

Spaced digital education applies digital tools to deliver educational content via multiple, repeated learning sessions separated by prespecified time intervals. Spaced digital education appears to promote acquisition and long-term retention of knowledge, skills, and change in clinical behavior.

OBJECTIVE

The aim of this review was to assess the effectiveness of spaced digital education in improving pre- and postregistration health care professionals' knowledge, skills, attitudes, satisfaction, and change in clinical behavior.

METHODS

This review followed Cochrane's methodology and PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) reporting guidelines. We searched MEDLINE, Embase, Web of Science, ERIC, PsycINFO, CINAHL, CENTRAL, and ProQuest Dissertation and Theses databases from January 1990 to February 2023. We included randomized controlled trials (RCTs), cluster RCTs, and quasi-RCTs comparing spaced digital education with nonspaced education, spaced nondigital education, traditional learning, or no intervention for pre- or postregistration health care professionals. Study selection, data extraction, study quality, and certainty of evidence were assessed by 2 independent reviewers. Meta-analyses were conducted using random effect models.

RESULTS

We included 23 studies evaluating spaced online education (n=17, 74%) or spaced digital simulation (n=6, 26%) interventions. Most studies assessed 1 or 2 outcomes, including knowledge (n=15, 65%), skills (n=9, 39%), attitudes (n=8, 35%), clinical behavior change (n=8, 35%), and satisfaction (n=7, 30%). Most studies had an unclear or a high risk of bias (n=19, 83%). Spaced online education was superior to massed online education for postintervention knowledge (n=9, 39%; standardized mean difference [SMD] 0.32, 95% CI 0.13-0.51, I2=66%, moderate certainty of evidence). Spaced online education (n=3, 13%) was superior to massed online education (n=2, 9%) and no intervention (n=1, 4%; SMD 0.67, 95% CI 0.43-0.91, I2=5%, moderate certainty of evidence) for postintervention clinical behavior change. Spaced digital simulation was superior to massed simulation for postintervention surgical skills (n=2, 9%; SMD 1.15, 95% CI 0.34-1.96, I2=74%, low certainty of evidence). Spaced digital education positively impacted confidence and satisfaction with the intervention.

CONCLUSIONS

Spaced digital education is effective in improving knowledge, particularly in substantially improving surgical skills and promoting clinical behavior change in pre- and postregistration health care professionals. Our findings support the use of spaced digital education interventions in undergraduate and postgraduate health profession education. Trial Registration: PROSPERO CRD42021241969.

TRIAL REGISTRATION

PROSPERO CRD42021241969; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=241969.

Filling the gaps in the COVID-19 pandemic response: medical personnel in the US military health system

BACKGROUND

The COVID-19 pandemic was an unprecedented public health emergency that heavily affected the healthcare workforce. Although the Military Health System (MHS) has robust capabilities and was able to deploy medical staff to support civilian hospitals during the crisis, it too was adversely impacted by personnel issues. We aimed to identify and address gaps in understanding the impact of the COVID-19 pandemic on healthcare personnel in the MHS.

METHODS

We conducted semi-structured key informant interviews with 28 MHS stakeholders, including policymakers, program managers, and healthcare providers. We recruited respondents using purposive and snowball sampling until we reached thematic saturation. Interviews were conducted virtually from December 2022 to March 2023 and coded by deductive thematic analysis using NVivo.

RESULTS

Burnout and mental health concerns across the workforce increased during the pandemic, although some felt military culture facilitated resilience. Reduction in personnel was noted and slow hiring processes and noncompetitive wages hindered hiring, contributing to staffing shortages. Initial disruptions occurred in training and skills readiness, although these issues were reduced over time. Concerns remain about newer trainees' preparedness and teaching staff's availability in the MHS.

CONCLUSION

This study uniquely assessed the impact of the COVID-19 pandemic response on the MHS healthcare workforce through in-depth key informant interviews. Multi-pronged strategies are needed to promote personnel well-being in complex healthcare systems like the MHS.

Adaptation of the Nursing Activities Score in Latvia

This study focuses on the adaptation and validation of the Nursing Activities Score (NAS) for use in Latvian intensive care units (ICUs) to measure nursing workload. The NAS, widely used internationally, was selected for its comprehensive ability to reflect 81% of ICU nursing activities, making it a suitable tool for assessing nursing workload in the Latvian healthcare context. The study followed a two-phase methodology: (1) expert validation using the Content Validity Index (CVI) and (2) a pilot study to assess the psychometric properties of the adapted tool. In the first phase, 10 ICU nursing experts assessed the translated NAS items, resulting in revisions to three specific paragraphs (4a, 14, and 20) based on low CVI scores. After refinement, CVIs improved from 0.6 to 0.8 for paragraphs 4a and 14, and from 0.5 to 0.9 for paragraph 20. The final CVI for all items reached 0.909. In the second phase, a pilot study was conducted in a Latvian ICU with 42 patients and 226 NAS assessments. The psychometric evaluation showed strong reliability and validity, confirming the NAS's suitability for measuring nursing workload in this context. Cronbach's alpha for the scale was 0.973. The adapted NAS provides a standardised method for workload assessment in Latvian ICUs, offering potential improvements in nurse resource management and patient care.

A plea for urgent action: Addressing the critical shortage of cardiothoracic surgical workforce in the COSECSA region

BACKGROUND

The College of Surgeons of East, Central, and Southern Africa (COSECSA) comprises 14 countries, many of which currently grapple with an increasing burden of cardiothoracic surgical (CTS) diseases. Health and economic implications of unaddressed CTS conditions are profound and require a robust regional response. This study aimed to define the status of CTS specialist training in the region (including the density of specialists, facilities, and active training posts), examine implications, and proffer recommendations.

METHODS

A desk review of COSECSA secretariat documents and program accreditation records triangulated with information from surgical societies was performed in May 2022 and September 2023 as part of education quality improvement. A modified nominal group process involving contextual experts was used to develop a relevant action framework.

RESULTS

Only 6 of 14 (43%) of COSECSA countries offered active training programs with annual intake of only 18 trainees. Significant training gaps existed in Burundi, Botswana, Malawi, Rwanda, South Sudan, Zambia, and Zimbabwe. Country specialist density ranged from 1 per 400,000 (Namibia) to 1 per 8,000,000 (Ethiopia). Overall, the region had 0.2 CTS specialists per million population as compared with 7.15 surgeons per million in High-Income Countries. Surgical education experts proposed an action framework to address the training crisis including increasing investments in CTS education, establishing regional centers of excellence, retention incentives and opportunities for women, and leveraging international partnerships.

CONCLUSION

Proactive investments in infrastructure, human resources, training, and collaborative efforts by national governments, regional intergovernmental organizations, and international partners are critical to expanding regional CTS training.

Smart Nursing Wheelchairs: A New Trend in Assisted Care and the Future of Multifunctional Integration

As a significant technological innovation in the fields of medicine and geriatric care, smart care wheelchairs offer a novel approach to providing high-quality care services and improving the quality of care. The aim of this review article is to examine the development, applications and prospects of smart nursing wheelchairs, with particular emphasis on their assistive nursing functions, multiple-sensor fusion technology, and human-machine interaction interfaces. First, we describe the assistive functions of nursing wheelchairs, including position changing, transferring, bathing, and toileting, which significantly reduce the workload of nursing staff and improve the quality of care. Second, we summarized the existing multiple-sensor fusion technology for smart nursing wheelchairs, including LiDAR, RGB-D, ultrasonic sensors, etc. These technologies give wheelchairs autonomy and safety, better meeting patients' needs. We also discussed the human-machine interaction interfaces of intelligent care wheelchairs, such as voice recognition, touch screens, and remote controls. These interfaces allow users to operate and control the wheelchair more easily, improving usability and maneuverability. Finally, we emphasized the importance of multifunctional-integrated care wheelchairs that integrate assistive care, navigation, and human-machine interaction functions into a comprehensive care solution for users. We are looking forward to the future and assume that smart nursing wheelchairs will play an increasingly important role in medicine and geriatric care. By integrating advanced technologies such as enhanced artificial intelligence, intelligent sensors, and remote monitoring, we expect to further improve patients' quality of care and quality of life.

Improving the Recruitment and Retention of Unlicensed Assistive Personnel: A Quality Improvement Initiative

With increasing demands for unlicensed assistive personnel, strategies for optimizing recruitment and retention are paramount. The purpose of this quality improvement project was to increase the recruitment and retention of unlicensed assistive personnel in a nonprofit healthcare organization. Initiatives included expanding academic affiliations enhancing pipeline, developing a tailored onboarding program, and introducing a clinical ladder. Results indicate increases in numbers of academic affiliations and hiring, with unlicensed assistive personnel turnover rates below national averages.

Individual, organizational, and policy strategies to enhance the retention and a sense of belonging for health care professionals in rehabilitation medicine

The retention of physicians and other health care professionals in rehabilitation medicine is a critical issue that affects patients' access to care and the quality of the care they receive. In the United States and globally, there are known shortages of clinicians including, but not limited to, physicians, nurses, physical therapists, occupational therapists, and speech-language pathologists. These shortages are predicted to worsen in the future. It is known that attrition occurs in a variety of ways such as a clinician reducing work hours or effort, taking a position at another organization, leaving the field of medicine altogether, stress-related illness, and suicide. Retention efforts should focus on stay factors by creating a positive culture that supports a sense of belonging as well as addressing a myriad of push and pull factors that lead to attrition. In this commentary, we provide a roadmap that includes examples of stay strategies for individuals and organizations to adopt that are aimed at enhancing the retention of rehabilitation medicine professionals.

Building an Interprofessional Health Workforce through Pathways, Training, and Retention

Population growth in North Carolina is contributing to health care workforce shortages, particularly in rural and underserved areas. Professions affected most include pub-lic health, nursing, behavioral health, and direct care. We describe efforts to grow this workforce by promoting health professions careers, aligning training with current trends, and improving job satisfaction and retention.

From morbidity reduction to cost-effectiveness: Enhanced recovery after surgery (ERAS) society recommendations in minimal invasive liver surgery

PURPOSE

Minimal-invasive liver surgery (MILS) reduces surgical trauma and is associated with fewer postoperative complications. To amplify these benefits, perioperative multimodal concepts like Enhanced Recovery after Surgery (ERAS), can play a crucial role. We aimed to evaluate the cost-effectiveness for MILS in an ERAS program, considering the necessary additional workforce and associated expenses.

METHODS

A prospective observational study comparing surgical approach in patients within an ERAS program compared to standard care from 2018-2022 at the Charité - Universitätsmedizin Berlin. Cost data were provided by the medical controlling office. ERAS items were applied according to the ERAS society recommendations.

RESULTS

537 patients underwent liver surgery (46% laparoscopic, 26% robotic assisted, 28% open surgery) and 487 were managed by the ERAS protocol. Implementation of ERAS reduced overall postoperative complications in the MILS group (18% vs. 32%, p = 0.048). Complications greater than Clavien-Dindo grade II incurred the highest costs (€ 31,093) compared to minor (€ 17,510) and no complications (€13,893; p < 0.001). In the event of major complications, profit margins were reduced by a median of € 6,640.

CONCLUSIONS

Embracing the ERAS society recommendations in liver surgery leads to a significant reduction of complications. This outcome justifies the higher cost associated with a well-structured ERAS protocol, as it effectively offsets the expenses of complications.

Relational Coordination at the Primary-Secondary Care Interface: Insights from a Cross-Sectional Survey in the South Tyrolean Healthcare System

Understanding the dynamics of teamwork and communication among healthcare professionals is crucial in the face of evolving healthcare challenges. This study assessed relational coordination among healthcare professionals in the South Tyrolean healthcare system in Italy, focusing on communication and teamwork dynamics in a cross-sectional survey. Using the validated Relational Coordination Survey (RCS) instrument and 525 completed online responses, the questionnaire aimed to understand the implications of different levels of relational coordination ratings by general practitioners, hospital physicians, nurses, and administrative personnel (response rate 26%). The demographics of the participants revealed a predominance of female professionals (64%), with an average age of 50 and 18 years of service. The resulting RCS scores varied significantly across professional groups, with nurses reporting the highest within-group scores, indicating moderate coordination, and administrators reporting the lowest scores, reflecting areas of weak coordination. Between-group relational coordination was generally perceived as weak across professional groups, with the least weakness observed between general practitioners and nurses. German or Italian language and health district affiliation emerged as significant factors influencing relational coordination ratings, highlighting the need for differentiated understanding and strategies in multilingual and diverse regional settings. Assessments of interdisciplinary feedback and referral practices highlight the variation in teamwork and communication weaknesses and underscore the need for targeted interventions to improve relational coordination. This study provides insights into the complexity of relational dynamics in health care settings. This suggests that improving relational coordination through tailored strategies could significantly improve team effectiveness, quality of patient care, and overall system efficiency.

Investigation of differences in xenophobia, prosociality level, and sociodemographic characteristics in nursing students

AIMS

This study aimed to examine differences in xenophobia, prosocial behavior tendency, and sociodemographic characteristics among nursing students.

MATERIALS & METHODS

The participants were 227 nursing students (29.1% male, 70.9% female) attending the nursing department in the spring semester of the 2019-2020 academic year. We used a personal identification form, xenophobia scale, and prosocial behavior tendency scale to collect the data.

RESULTS

Among the participants, 24.7% were in first year, 30.4% were in second year, 21.6% were in third year, and 23.3% were in fourth year. Female students had higher prosocial behavior disposition, altruistic, and submissive scores than their male counterparts. The second-year students' prosocial behavior scores were higher than those of the third-year students. The male students' hatred, humiliation, and xenophobia scores were higher than those of the female students.

DISCUSSION

The xenophobia scores were higher in those with two living parents and lower in those whose mothers had secondary education. We used the Kolmogorov-Smirnov test, Shapiro-Wilk test, and graphical assessments to test the quantitative data's compliance with normal distribution. We also employed the Student's t-test and one-way analysis of variance for data showing a normal distribution and Mann-Whitney U and Kruskal-Wallis tests for data showing non-normal distribution. To evaluate the relationships among variables, we used the Pearson correlation analysis for normally distributed variables and Spearman's correlation analysis for non-normally distributed variables.

CONCLUSION

Women's prosocial behavior tendency total score was higher than men's, and men's xenophobia total score was higher than women's. There was a weak negative correlation between the positive behavior tendency and xenophobia total scores.