PubMed · 15600050
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2004-11-11. [EBM delayed, point again without value].. https://pubmed.ncbi.nlm.nih.gov/15600050/
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BACKGROUND: The United Kingdom (UK), alongside other industrialised countries, is experiencing a shortage of nurses partly due to low retention rates. Job satisfaction has been highlighted as a contributing factor to intent to leave and turnover, yet this is a complex area with many elements affecting its measurement. AIM: The aim of this paper is to explore the impact of job satisfaction components on intent to leave and turnover for hospital-based nurses in order to identify the most influential factors. METHODS: To achieve this, a systematic search of the literature was undertaken to identify relevant international research. Three databases (i.e. BNI, CINAHL and PsychInfo) were utilised, resulting in nine articles that met the inclusion criteria. Four recurrent themes were identified in the literature: leadership, educational attainment, pay and stress. FINDINGS: The key findings suggest that stress and leadership issues continue to exert influence on dissatisfaction and turnover for nurses. Level of education achieved and pay were found to be associated with job satisfaction, although the results for these factors were not consistent. CONCLUSION: Investigating possible changes over time in sources of dissatisfaction revealed that factors related to the work environment rather than individual or demographic factors were still of most importance to nurses' turnover intentions. The differences found to occur across work settings necessitates analysis of job satisfaction at ward level, and the contribution of qualitative methods to develop more detailed insight is emphasised. The inconsistent findings over time associated with the effects of educational attainment and pay on intent to leave suggest that it is imperative that sources of job satisfaction are reassessed in the light of ongoing changes.
BACKGROUND/OBJECTIVES: This research explored the adoption and the utilisation of telemedicine (TM) in two healthcare organizations (HCOs) in New Zealand (NZ). The research utilised the technological innovation theories, as a guiding theoretical framework, to develop a set of potential determinants which could assist in understanding the adoption and the depth of the TM phenomenon in the two HCOs. METHODOLOGY AND RESULTS: Using case studies design, the findings across the two cases revealed that TM was adopted according to its cost-benefit analysis. Although this approach was found to be important in assessing the adoption of TM, not considering the importance of other factors, highlighted in this research, such as the compatibility and the trialability aspects of the TM technology had a detrimental impact on the success of TM in both cases. CONCLUSION: This research stressed the need for the tight coupling between the roles of both the administrative and the clinical managers in HCOs in order to champion TM adoption and diffusion and to overcome many of the barriers that could hinder telemedicine success in HCOs in NZ. The research points to other implications with respect to the literature and highlights further research in this important area.
BACKGROUND: The difficulties with under-provision of doctors mean that alternative ways of providing services need to be developed. In the UK, some primary care doctors are now providing services traditionally only obtained through secondary care. The views of health care professionals, as well as patients, about these new services are currently unexplored. OBJECTIVES: To study the views of a variety of doctors, health managers and patients concerning the development of General Practitioners with special clinical interests. DESIGN: Qualitative using semi-structured audio-taped interviews. PARTICIPANTS: Health Service Managers, General Practice Registrars (GPRs), General Practitioners (GPs) with no special clinical interest, GPs with special clinical interests (GPSCIs), consultants (from specialties with and without GPSCIs) and patients who had attended a GPSCI clinic. SETTING: The North East of England. RESULTS: A range of positive benefits was identified for GPs with special clinical interests including enhanced job satisfaction and possibly increased recruitment and retention for general practice. They were expected to decrease hospital specialty waiting times and may address previously unmet needs. Patients appreciated the requirement of appropriate professional skill mixes for less serious conditions. Personal aspects of care were important for patients. Outcome measures appeared poorly defined. Negative aspects identified included a deskilling of the general pool of GPs and an increase in workload by treating previously untreated conditions. A variety of challenges in establishing these services (in particular proactive development of GPSCIs in areas of need, accreditation and governance) were uncovered and some potential solutions discussed. CONCLUSIONS: The impact of GPs with special clinical interests has not been studied in any detail, and measures of success for these schemes, where they exist, may fail to address the wide range of potential positive and negative effects. Their cost effectiveness has been questioned, and yet in the future more of these types of schemes seem likely. GPs with special interests may be part of an increasingly flexible career structure that sees GPs and secondary care doctors and consultants having much more interchangeable career paths. Patients' views on the services were generally positive.