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Experiences in South Asia and Africa are compared, and a critical need for development of institutional capacities in Africa is identified. It is argued that in addition to investment in essential health services, there is a need for concerted effort among leaders in African governments, donor organizations, universities and professional bodies to develop a comprehensive plan of action for capacity development in the health sector.
The global community is in the midst of a growing response to health crises in developing countries, which is focused on mobilising financial resources and increasing access to essential medicines. However, the response has yet to tackle the most important aspect of health-care systems--the people that make them work. Human resources for health--the personnel that deliver public-health, clinical, and environmental services--are in disarray and decline in much of the developing world, particularly in sub-Saharan Africa. The reasons behind this disorder are complex. For decades, efforts have focused on building training institutions. What is becoming increasingly clear, however, is that issues of supply, demand, and mobility (transnational, regional, and local) are central to the human-resource problem. Without substantial improvements in workforces, newly mobilised funds and commodities will not deliver on their promise. The global community needs to engage in four core strategies: raise the profile of the issue of human resources; improve the conceptual base and statistical evidence available to decision makers; collect, share, and learn from country experiences; and begin to formulate and enact policies at the country level that affect all aspects of the crisis.
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The responsibility of obstetricians in encouraging the best use of available resources--both people and material--is addressed, stressing the need to "articulate" all components of the health team to bring about better coverage in the field of community and family health, especially maternal and child health care. The particular problems of developed countries where consumer demands call for review of obstetric care provision and training programmes are also discussed.
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This paper outlines a study exploring job advertisements for community children's nurses (CCNs). A post-structural approach was taken to illuminate the development of community children's nursing services (CCNS) and the profile of characteristics, skills and caseload within a workforce-planning context. An analysis of 100 advertisements looked at title, skills, caseload, qualifications and evolving roles. The analysis comprised an initial quantitative descriptive account of data, followed by further analysis of the text using thematic analysis and coding. The skills identified were compared to those identified by Proctor et al. (1999). The most commonly occurring skills were interpersonal (35%), multi-professional team working (33%), clinical (28%), management (18%) and leadership (16%). The analysis was limited, but provides a unique insight into employers' perceived needs in providing CCN services, evolving titles and roles and could inform practitioners, contribute to service evaluation, future service provision and workforce planning.
In this paper we examine approaches to undertaking nursing research and building research capacity in higher education institutions in the United Kingdom (UK). First we review some of the main responses in the literature to the last two Research Assessment Exercises (RAE), then we report findings from a small study of nursing departments which entered the last RAE and finally we speculate on the likely future of nursing research in the light of recent education and health policy. We suggest that many of the difficulties experienced are an effect of contradictory health and education policies and rival ways of assessing research performance. Nursing education is caught in the 'pincer movement' of stringency in both sectors. In addition, the challenges of the RAE and the necessity to earn income from contracting with National Health Service (NHS) education and training consortia for teaching represent an outworking of two rival views of the role of higher education, broadly an elitist view and one that sees higher education as a supplier of the workforce needs of industry. In addition to this, the NHS R&D (research and development) strategy provides an alternative arena for collaboration, funding and reputation to that constructed by the RAE.
Professional organizations offer healthcare quality management professionals a myriad of opportunities for professional development. Healthcare professionals taking a break from their careers can take advantage of these and other opportunities to build a program for professional development that is not job-specific, with a focus on reentry into the workforce. Options include continuing education via certificate, credentialing, and fellowship programs, writing, networking, doing volunteer work, and providing résumé or marketing services.
INTRODUCTION: A pilot return-to-work program based on the concept of work readiness and three-month job placement with support was developed to enable people with occupational deafness to return to the workforce. METHODS: A convenient sample of six male persons with occupational deafness completed the program. A Pretest-Posttest Single Group Design was utilized to measure the program outcome. Two instruments: the Chinese version of SF-36 Health Assessment Questionnaire and the Chinese version of Lam's Assessment of Stage of employment readiness were used to measure the participants' health status and their work readiness respectively. RESULTS: The preliminary findings indicated that the six participants showed improvement in their general health and work readiness. The employment outcome indicated that three of the participants had secured a job and another two participants had attained job offers. CONCLUSION: This pilot study suggested that a systematic vocational rehabilitation program can facilitate persons with occupational deafness to return to the workforce. Further research using a controlled investigation with larger sample size is recommended for evidence-based practice even though the results of this return-to-work program appear promising.
Many academic mentoring opportunities are available to neuroscience nurses when they interact with undergraduate students, or members of minorities or when they are serving as faculty. Opportunities with undergraduate students originate in an awareness of student perceptions. During rotations on neuroscience units, students may consciously or unconsciously be seeking a mentor-someone to emulate, a contact person, someone to have a chat with, a teacher, a guide, and an assessor or supervisor. Nurses who serve as formal or informal clinical instructors should recognize that students respond to mentors who project poise, verbal and nonverbal strength, and optimism. Mentoring is an important strategy neuroscience nurses should embrace to enhance, develop, and encourage members of minority groups to enter the nursing workforce. Interested applicants can be directed toward specific programs such as the LEAD project or project IMPART. Neuroscience nurses who serve as nursing faculty should be aware that when they mentor new faculty they should be available, have regular meetings to discuss questions, help the protégé learn to prevent and handle problems and prepare for first-time experiences, and help with implementation of teaching responsibilities. If a formal mentoring program is not in place, recommendations are available for establishing one.
AIM: This paper reports a study exploring issues arising from the introduction of innovative nursing and midwifery roles from the perspective of healthcare managers. BACKGROUND: In recent years, the number of innovative roles in nursing and midwifery has increased dramatically across all areas of health care. A comprehensive literature review has shown that there is a scarcity of empirical studies to inform policy or the organizational context of this rapidly changing situation. METHOD: Semi-structured interviews were conducted with all Directors of Nursing, Chief Nurses and Directors of Primary Care in the Health and Social Services Trusts and Boards in Northern Ireland. This study formed the first phase of a larger exploration of innovative roles. Data were collected from July to October 2004. FINDINGS: The findings confirm that in recent years there has been a considerable increase in the number and type of innovative nursing and midwifery roles. Themes that emerged from the data included professional identity and number of innovative roles; stimuli for role development; service commissioning; infrastructure support; and perceived value for money. CONCLUSION: Analysis of the impact of innovative nursing and midwifery roles on other members of staff, notably healthcare assistants, is needed. The internationally increasing number of innovative roles need to be evaluated further with regard to their effect on care outcomes for patients, their families and communities, their cost-effectiveness and to how best to secure the support and commitment of colleagues. Further study should also be undertaken to determine whether innovative role-holders are pioneers in the development of future nursing, or whether they are responding to the workforce needs of the medical profession or to the requirements of the health service to cut costs.
Changes in market-driven health care economics are rapid and of great magnitude. This report describes a study of some of these changes in regard to children's health issues. We used a survey tool to assess long-range plans (next 10 years) and marketing strategies for major free-standing children's hospitals in different regions of the United States. We then used these assessments to draw conclusions about the impact of the plans and strategies on the practice of pediatric physicians and their workforce requirements. This may allow pediatric specialists and their programs to develop strategic plans and to take actions to contend with these market-driven economic changes. The tool was a questionnaire mailed to chief executive officers of 30 randomly chosen but geographically well-distributed children's hospitals. Seventeen children's hospitals responded (57%), providing information concerning each hospital and its current medical economic environment. The data were analyzed and trends were then identified from their responses. All institutions in this study expected to have fewer physicians on staff in the future. These institutions plan: (1) to improve quality and (2) to reduce costs. Quality will be improved by utilizing Continuous Quality Improvement (CQI) and/or Benchmarking to Best Practices, both of which encourage physicians to follow standardized treatment protocols. Costs will be reduced by decreasing hospital staff size. Some children's hospitals have merged or will merge with larger, full-service adult hospitals, but most plan to remain autonomous. Many expect a continued decrease in revenues, and almost all expect to downsize both bed number and staff. Restructuring will reduce the number of specialists, particularly in the fields of hematology-oncology, psychiatry, endocrinology, nephrology, and cardiology, and will also reduce the number of surgical specialists. The administrators predicted that more nurse practitioners will be employed at these hospitals in the 21st century, serving the role of physician extenders, if not physician substitutes. To ensure their own survival, physicians must develop their own strategic plans as have the hospitals in which they practice. Optimally they should embrace those activities that parallel their hospital's efforts such as Quality Improvement (CQI, Benchmarking), cost containment, and practice mergers.
Recent commentators have suggested that academic knowledge is irrelevant to nursing practice and may actually undermine nursing's traditional caring ethos. Furthermore, by making nursing more academic, it is claimed that 'natural' but non-academic carers are prevented from pursuing a career in nursing. Debates about the relationship between nursing, knowledge and practice have a long history and have to be understood in terms of wider political and economic issues relating to nursing, its status within society and the changing role of nurses within the health services division of labour. One crucial issue is nursing's status as women's work. Critics of developments in nurse education draw an ideological equation between nursing work and the traditional female role. From this perspective the qualities that make a good nurse cannot be taught, rather they are founded on 'natural' feminine skills. Irrespective of whether caring is 'natural' or not, it is questionable as to whether, for today's nurses, being caring is sufficient. The shape of nursing jurisdiction is a long way removed from its origins in the Victorian middle-class household. In addition to their traditional caring role, contemporary nurses may also have complex clinical, management and research responsibilities, as well as being crucial coordinators of service provision. It is suggested that these and future developments in health services make the need for an educated nursing workforce even more pressing. In order to adequately prepare nurses for practice, however, it is vital that nurse education reflects the reality of service provision.
Employers must face the fact that some of their employees may eventually develop AIDS. Yet many organizations still have not developed a comprehensive policy that addresses the issues of educating the workforce about this disease, testing for the virus, and pressuring insurance carriers to change their policies to allow more cost-effective forms of care for people who have AIDS.
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