Drop in one-to-one nursing linked with infant mortality

A REDUCTION in one-to-one nursing in neonatal intensive care units has been linked in a new study to a higher death rate.

Evolving workplace flexibility for U.S. medical school tenure-track faculty

PURPOSE

The academic workplace has seen dramatic changes in recent decades, including growing faculty workloads, an increasingly demographically diverse faculty population, and changing expectations about workplace climate. Despite these significant changes, a typical medical faculty's career trajectory is often still quite linear and follows decades-old tenure policies. The authors describe the existence of flexible faculty policies related to tenure at U.S. medical schools to understand better the ways in which institutions are responding.

METHOD

Data primarily reflect responses from faculty affairs leaders at medical schools accredited by the Liaison Committee on Medical Education to a 2008 faculty personnel policies survey. These data are supplemented with results from the same survey fielded in previous years.

RESULTS

The number of medical schools that have lengthened their probationary periods for faculty has increased over time, and, in 2008, nearly half of the institutions offered a probationary period length of eight years or more to faculty. Over three-fourths of the schools in 2008 had a tenure-clock-stopping policy available, and a third had a policy allowing faculty to work less than full-time while remaining on a tenure-eligible track.

CONCLUSIONS

Findings suggest that many medical schools have made progress in making policy additions and modifications that acknowledge the changing academic workplace culture by adding flexibility to traditional tenure policies. Despite those efforts, significant opportunities remain for continued adoption of flexible policies so that faculty can achieve productive academic careers while balancing work, life, and family, and institutions can continue to recruit and retain high-quality faculty members.

The continued evolution of faculty appointment and tenure policies at U.S. medical schools

For the past several decades, financial uncertainty, changes in health care delivery and reimbursement, and changing workforce needs have prompted medical schools to continually refine their appointment and tenure policies. Studies during the past 30 years have examined the nature of these faculty appointment and tenure policies in U.S. medical schools, and in this article the authors present data from a 2005 survey on faculty personnel policies to extend this analysis. For both basic science and clinical faculty in U.S. medical schools, the authors describe tenure systems, trends in the number and percentage of full-time faculty on tenure-eligible tracks, the financial guarantee of tenure, and probationary period lengths. They review the status of flexible policies and highlight two current faculty policy changes that many institutions have made or are actively contemplating: the recognition of interdisciplinary and team science, and a broadening view of scholarship. Results show that although tenure systems remain well established in medical schools, the proportion of faculty on tenured or tenure-eligible tracks has continued to decline over time. Changes in the financial guarantee associated with tenure have transformed the fundamental concept of tenure at many medical schools, and the percentage of schools that have lengthened the probationary period for tenure-track faculty has steadily increased during the past 25 years. Tenure-clock-stopping policies and part-time tenure policies continue to exist at medical schools, though results indicate low faculty use of the policies, suggesting a disconnect between policy and practice.

Job dynamics of veterinary professionals in an academic research institution. I. Retention and turnover of veterinary technicians

The turnover of veterinary technicians within an animal resources program averaged 33% annually over 18 y, peaking at 67% in 1998 to 1999. Insufficient retention of veterinary technicians led to diversion of veterinarian effort to technical tasks and to increased allocation of administrative resources for supervising and managing an expanding team of veterinary technicians. To identify factors and trends related to poor retention, address any causes, and reduce turnover, a retrospective analysis of employment records was done. The retention of veterinary technicians was significantly greater for the 9 technicians hired from veterinary private practice rather than for any of 3 other general sources: promotions from the animal care staff, transfers from other research institutions, and miscellaneous sources. Veterinary technician turnover was reduced from a mean of 60% over 1995 to 1999 to an average of 26% during 2000 to 2004. Higher retention was associated with management practices that included renewed concentration on recruiting and interviewing strategies and emphasis on training and career development including merit raises for technician certification through the American Association for Laboratory Animal Science. Higher retention yielded correspondingly greater experience on the job as the mean tenure increased from 1.1 y in 2000 to 2.8 y in 2004. The most valued attributes related to employment by veterinary technicians as determined by survey were to do meaningful work, earn a good living, and have a committed team of coworkers.

The changing nature of work: workplace stress and strategies to deal with it

Workplace stress is costing the developed and developing world roughly between 5-10% of Gross National Product per annum in sickness absence, premature retirement due to ill health and lost productive value in terms of services and products. In addition, it is costing the health services of countries an additional burden in terms of treatment and incapacity benefits. A three prong approach to stress management and prevention is provided, exploring primary interventions (risk assessment), secondary interventions (training and development) and tertiary interventions (stress counselling and support).

Emerging trends on tenure policies and practices in nursing and allied health education

The tenure system in academia is under attack, and there is a need for empirical data on the emerging national trends relating to tenure. This comparative study investigated the emerging trends on tenure policies and practices in nursing and allied health education. We surveyed the deans of National League for Nursing-accredited programs and deans of allied health programs belonging to the Association of Schools of Allied Health Professions nationwide. The nursing (n = 187) and allied health (n = 75) deans completed a research questionnaire designed to capture the critical issues relating to tenure in higher education. We found no significant difference (p > 0.05) between the perceptions of the allied health and nursing deans on the policies and practices associated with tenure. The allied health and nursing deans had similar views on posttenure review, changes in traditional tenure, tenure quota practice, inducements for faculty to forego tenure, review of the tenure criteria, and the ranking of the primary criteria used in granting tenure. Both groups of deans expressed strong support for the tenure system. Overall, 72% of the allied health deans and 68% of the nursing deans indicated that a doctorate is the degree required for tenure in their institutions. The preponderance of allied health and nursing deans, 77% each, ranked teaching as the primary criterion used in tenure decision. On the other hand, only 22% of allied health deans and 19% of nursing deans rated research as the most important criterion used for tenure. Only 1% of allied health deans and 4% of nursing deans considered service as the most important criterion used in tenure decision. The role of clinical practice in tenure decision was not evaluated in our study and is worth investigating in follow-up studies.

Time for change: can empowerment be a solution to meet the perils of modern day working life?

Working life continues to undergo rapid change. This change creates greater demand and sophistication and causes employees to experience more pressure, professionally and personally. Thus, absences from work due to sickness and injuries increase. In Sweden, this problem has become serious. This article argues that psychological empowerment and individual control are two key factors that minimize the many perils faced by the modern worker and those seeking to return to the work force through the vocational rehabilitation process. The findings show that a shift in ideology is needed. Specifically, there must be a shift from scientific management and Weberian bureaucracy towards organizational structures, routines, and cultures that support and increase individual worker psychological empowerment and control.

Organizational practices, work demands and the well-being of employees: a follow-up study in the metal industry and retail trade

BACKGROUND

Rapid technological change and increased international competition have changed working life and work organizations. These changes may not be considered when researching employee work ability and well-being.

AIM

This study investigates the impact of organizational practices, work demands and individual factors on work ability, organizational commitment and mental well-being of employees in the metal industry and retail trade.

METHOD

A follow-up study was conducted to examine these connections among 1389 employees (mean age 42 years at baseline) in 91 organizations. The first survey was conducted in 1998 and was repeated in 2000.

RESULTS

Changes in organizational practices and the demands of work were strongly associated with changes in employee well-being. Work ability, organizational commitment and the mental well-being of employees were increased most if the opportunities for development and influence and the promotion of employee well-being were increased and if the supervisory support and organization of work were improved. Well-being also improved with less uncertainty at work and with decreasing mental and physical work demands. In addition physical exercise and affluence also had favourable effects.

CONCLUSIONS

The results confirm that several features of organizational practices are strongly associated with employees' well-being. Organizational development is an important method of improving employees' work ability, commitment and well-being.

Managing multidisciplinary departments

Today there a shortage of qualified health care professionals, and the current reshaping of the health care delivery system demands that quality care be provided at a lower cost. Many health care managers are finding that that they must re-think and change their traditional departmental concepts to become a multidisciplinary service. How department managers may better manage a multidisciplinary department in this new and changing work environment is the topic of this discussion.

Tenure in transition: trends in basic science faculty appointment policies at U.S. medical schools

This article-based on a 2002 survey of 125 U.S. allopathic medical schools, reviews of institutional policy documents, and interviews with medical school leaders-explores and analyzes three trends in appointment and tenure policies for basic science faculty at U.S. medical schools. First, the percentage of full-time, nontenure track basic science faculty has increased, from 12% in 1980 to 20% in 2000. More dramatically, by the late 1990s, the percentage of new basic science faculty hired on a nontenure track surpassed the percentage hired on a traditional tenure-track line. This development stems from the tendency of some schools to appoint faculty to nontenure-eligible "research scientists" faculty tracks, to hire junior faculty on 100% grant funding, and to allow nontenure-track faculty to switch to the tenure track as their research career progresses. The second trend is an alteration to the tenure financial guarantee. Historically, at most medical schools, it was assumed that tenure guaranteed total institutional salary for basic scientists. Schools have begun to redefine that commitment to less than full salary to protect against financial vulnerabilities and to provide a means to reduce faculty salaries, if warranted. The third trend is increased flexibility to pretenure policies. Schools have lengthened probationary periods, revised up-or-out provisions, instituted stopping-the-tenure-clock policies and less-than-full-time appointments, and permitted faculty to switch between the tenure and nontenure tracks. These policy modifications recognize the increased professional and personal demands on faculty time.

Thriving in chaos: Educating the nurse leaders of the future

Nurse educators are challenged to prepare students to become effective leaders in a time of chaos. The last two decades have heralded many changes that have an impact on health care delivery, including changes in health care financing, the information explosion, the recognition of quality chasms, and the composition of the workforce. Nurses continue to be at the forefront of health care delivery and they must orchestrate care for their patients in an increasingly complex health care system. Our goal is to provide nurse educators with strategies to help students blend leadership and management techniques to lead the new generation of knowledge workers. Educators have the opportunity and the challenge to empower their students to master an eclectic set of management and leadership tools, including the best from historical management strategies and embracing the latest theories of leadership. This article presents thoughts and ideas to ponder as well as strategies to consider and implement as we create the curriculum and the learning environment for our students and the future leaders of our profession.

Taking care of business: self-help and sleep medicine in american corporate culture

This article argues that corporate management in the United States has expanded its scope beyond office walls and encompasses many aspects of workers' daily lives. One new element of corporate training is the micromanagement of sleep; self-help books, newspaper reports, magazine articles, and consulting firms currently advise workers and supervisors on optimizing productivity by cultivating certain sleep habits. Although consultants and self-help books make specific recommendations about sleep, most medical research is inconclusive about sleep's benefits for human performance. Using the ideas of Michel Foucault and Gilles Deleuze as a philosophical backdrop, this article examines the complex and often contradictory links between self-help, medicine, and corporate governance.

In praise of boundaries. A conversation with Miss Manners. Interview by Diane L. Coutu

The past three decades have been a time of increasing informality in the American workplace. It's easy to characterize this growing comfort with the casual as a positive step for workplace culture, an outgrowth of the American democratic belief in workers' equality. Informal environments are said to be more trusting and open, and workers who are free to express their personalities are more comfortable and thus more creative--right? According to etiquette guru Judith Martin--known far and wide as Miss Manners--informality in the workplace may do more harm than good. Without some formality in social intercourse, Miss Manners argues, human interactions end up being governed by laws, which are too heavy-handed to serve as a guide through the nuances of personal--or professional--behavior. Since our earliest beginnings, we have developed formal rules to accompany shared human experiences, such as eating and mourning. Yet, says Miss Manners, something in us rebels against form and etiquette, and every so often, an anti-manners movement takes hold, and people come to believe that following etiquette is unnatural. One recent such movement has led to the belief that a distinction between our work life and our professional life is unnecessary. If we hope to reassure our customers that we are indeed professional, however, we need to be aware of the boundaries of professional behavior. On the whole, Miss Manners argues, informality in the workplace leads to a host of problems, from making employees feel pressured to "socialize" with coworkers during weekends and evenings to sexual harassment. Despite the shortcomings of informality in the American workplace, though, Miss Manners believes that we have the best code of manners the world has ever seen-in theory. In practice, American etiquette is undoubtedly still a work in progress.

Emergency nursing

Building upon a historical context, the current and future roles of the clinical emergency nurse are reviewed. For several reasons, emergency nurse availability is expected to be insufficient to meet staffing demands in the near future. Emergency physicians can partner with emergency nurses and hospital administrators to pursue the following strategies for addressing the nursing shortage: (1) improve the workplace environment by improving nurse-to-patient ratios and avoiding the boarding of admitted patients in the emergency department (ED); (2) refocus the emergency nurse job description to patients and their families; (3) promote mutually supportive relationships and comradeship between emergency nurses and physicians; (4) create an environment that allows unique solutions to staff scheduling and accommodates shiftwork; (5) increase nursing wages, and recognize special contributions of emergency nurses with financial reward; (6) identify and promote the personnel of the hospital ED as members of an elite unit; (7) develop preceptorships and internships for nurses new to emergency nursing and invest in clinical specialists or nurse-mentors to assist in "on-the-job" instruction of nurses with previous experience; and (8) invest in nursing education. Taking these steps today will strengthen the ED health care safety net for decades to come.

A different age for leadership, part 1: new context, new content

This is Part 1 of a 2-part article on the new and emerging characteristics and elements of leadership for changing, fast-paced organizations. As we leave the 20th century workplace and are increasingly driven by innovation and technological transformation, new roles are demanded from everyone. Leadership expression now calls for a different emphasis and skill set from those that predominated in the past century. The first article focuses on the context of leadership affecting what leaders do and how they must now behave. Part 2 will center on the activities of leadership and the new learning and skill set development that will increasingly be required of leaders in a fundamentally altered work environment.

A flexible nursing workforce: realities and fallouts

While policy-makers are increasingly concerned about a looming nursing shortage, almost half of Canada's nursing workforce is currently employed on a part-time or casual basis. Why are so many nurses not working full-time and providing the nursing care that would help to alleviate such shortages in our healthcare organizations? Do nurses want to work part-time, or are they driven into this by labour market forces, life demands, poor working conditions and policy decisions external to them? The answers to these questions are critical to ensure that care will be there for all of us. This article presents a brief analysis of flexible employment arrangements in nursing, particularly part-time and casual work, and the impact on nurses, patients and the healthcare system as a whole. Given the sharp increases in these work arrangements in Canada during the last decade, the limited discussion of these trends in the literature is both surprising and troublesome.

Spanning the ages: meeting the needs of different generations

Never before has the health care profession been challenged like it is today. With competitive pressures of increased customer awareness, regulatory compliance and staffing concerns, there are also challenges related to various generational/diversity issues.

Responding to nursing's agenda for the future. Where do we stand on recruitment and retention?

How can the nursing profession address the escalating shortage of registered professional nurses? A multifaceted approach is important to ensure success. One domain of Nursing's Agenda for the Future (American Nurses Association [ANA], 2002) is recruitment and retention. Through the Agenda, creative strategies are being sought to attract and retain qualified nurses. This article describes one institution's response to addressing this critical shortage. Strategies were developed to present a continuum of learning and advancement opportunities across the career span of the professional nurse. They include recruiting student nurses, increasing NCLEXRN pass rates, providing financial support for further education or specialty certification, and using shared governance to increase retention. Institutions must look to their own resources as well as federal and state resources to offer these opportunities to nursing staff. The goal is to build an environment that both attracts nurses and supports them in their career and life goals.

Avoiding crisis: right-sizing staffing for the future

Workforce issues, especially recruitment and retention of qualified laboratory staff, are major strategic issues that will continue to face laboratory managers over the next 10 years. Major factors affecting the laboratory labor market in the next decade include increased health-care and laboratory testing needs of an aging population, the graying of the laboratory workforce as baby boomers retire, and new technology development. At least two of these factors will increase the demand for qualified laboratory professionals. Vacancy rates for laboratory professionals are increasing at a significant rate and will continue over the next 10 years. Planning will require creativity in staff recruitment and retention strategies and in human resources. Laboratorians no longer will have the luxury of using medical technologists for nonspecialized testing assignments and will need to develop more creative recruiting approaches using fewer highly qualified testing personnel. This article proposes a staffing deployment model that will use medical technologist education and skills more appropriately, will improve retention of medical technologists, and will alleviate the shortage of medical technologists by reducing dependence on them as routine laboratory testing personnel.

Spotting management fads

Business fads can change companies, for better or worse. They can introduce useful ideas but often fail to deliver on promises. So how can managers tell a fad from a tool that might endure? For one thing, beware of suspiciously simple techniques. If they seem too easy, they probably are.

Why in the world would anyone want to work for you?

Why in the world would someone want to work or keep working at your facility? If you can't answer this question, you will have a very difficult time finding and keeping the people you need to grow your agency. Home care managers agree that keeping good people is a top strategy. What is needed are clear strategies, concrete action plans, and methods to measure the results.

New workplace challenges. One year after September 11

The political and social response to September 11 has required home health employers to address new and sometimes unfamiliar personnel matters. Home care employers must be mindful of certain legal obligations, some imposed quite recently, designed to protect the rights of employees both on the job and if called away to duty.

Embracing the young employee: the key to the future of health care

With staffing problems a common concern throughout health care, it has become critical for today's health care businesses to start taking proactive steps in recruitment and retention efforts. Many organizations are putting recruitment, selection and retention teams together to assist with their efforts toward consistent service delivery. These teams have begun to address the issues associated with the new work force. This is particularly important as it relates to dealing with younger employees joining today's organizations. If we want an organization in the future that delivers service in a quality manner on a consistent basis, without undue worry, we must tackle the young employee opportunity.

New Zealand pathologists: a case study in occupational control

This paper examines the progressive exertion of external managerial control over New Zealand pathologists as the country's New Public Management health reforms were implemented during the 1990s. Perspectives on professionalism, and its role in the effective use of resources, are discussed as part of the examination of this shift in decision-making power from pathologists to external management. Our analysis, based on a range of archived and interview data collected over the period 1997-2000, suggests that publicly unacceptable compromises in pathology service quality were risked by the pursuit of tight bureaucratic and free market controls over pathology practice. The paper concludes with suggestions for a health professional control model facilitative of maximal health gain.

Taking the pulse of personalized and online employee communication strategies: the second annual survey of major employer trends

In their efforts to build workforce commitment, many employers are using personalized communication to reach out to employees. Benefacts, the personalized communication service of Aon Consulting, recently surveyed employers nationwide regarding their uses of personalized communication, especially in the online environment. The survey looked at organizations' current online and print communication strategies as well as their future plans. This article describes the needs of employees to understand organizational purpose and to find a balance between work and their personal lives. This examination of the uses of personalized communication to meet these needs and the analysis of current industry trends will help benefit professionals focus on their own communication plans as they strive to meet the challenges of today's workforce.