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PubMed2001

Retaining a viable workforce: a critical challenge for nursing.

Nursing is facing a crisis nationally and internationall, with Australia, the United States, New Zealand, Canada, the United Kingdom and Western Europe experiencing critical shortages of nurses. Problems with recruitment, retention and an ageing workforce means that attempts to ensure a viable nursing workforce must be placed at the top of the professional agenda. Strategies currently used to manage the crisis, such as overseas recruitment, are not sustainable and are ethically dubious. The demographic timebomb is ticking and up to half the current nursing workforce will reach retirement age by 2020. It is vital that there are adequate numbers of skilled and qualified nurses to take their places. Nursing and nurses are facing unprecedented challenges and pressures in the workplace. Job satisfaction is threatened as nurses are pressured to do more with less, Nursing productivity has increased phenomenally over the past ten years in response to increased demands and decreasing numbers of staff. The nursing workplace has disturbingly high levels of occupational violence, and many nurses operate within a culture of blame and scapegoating. There is evidence that organizational change is imposed upon nurses with little or no consultation and the literature reveals that this has a direct and negative effect on job satisfaction and on retention of nurses. This paper explores some of the critical issues that nursing must confront to be successful in establishing and maintaining a vigorous, dynamic and viable workforce.

Humans↗
PubMedDate not supplied

Associate degree graduates and the rapidly aging RN workforce.

This second segment of a four-part series examines the inter-relationship between the growth in associate degree nursing programs and the aging of the RN workforce. A growing proportion of new RNs have entered the workforce via associate degree programs, increasing from 40% in 1977 to 60% in 1996. New graduates, as well as working RNs, are approximately 5 years older in 1996 than 20 years earlier. Findings suggest that the rapid aging of the RN workforce can not be directly attributed to the rise in the number of older-aged graduates of associate degree programs. Rather, the declining propensity of those born after 1960 to enter nursing has resulted in fewer young RNs, and therefore: (1) an aging workforce, and (2) fewer new grads from baccalaureate programs (which have always attracted younger RNs) relative to grads from associate degree programs (which have always attracted older RNs).

Adult↗
PubMed2001

Career retention in the dental hygiene workforce in Texas.

PURPOSE: The purpose of this study was to determine the factors that influence the retention and attrition of dental hygienists within the workforce in Texas. Respondents' perception of the role of employee benefits and practice of dental hygiene on career retention were explored. Demographic descriptors, including educational level, marital status, age, employment setting, and practice statuses, were also examined. METHODS: A questionnaire modified from the American Dental Hygienists' Association Extension Study: Retention of Dental Hygienists in the Workforce Final Report, April 1992, was mailed to a systematic sample of licensed Texas dental hygienists in March 1999. Descriptive statistics were computed for dental hygienists currently in practice in Texas and those not in practice at the time of the survey. Differences in demographics, benefits, and attitudes between dental hygienists currently in practice in Texas and dental hygienists not in practice at the time of the survey were tested using independent t-tests for interval data and chi-squared tests for categorical data. All statistical analyses were conducted using the Statistical Package for Social Scientists (SPSS v. 9, Chicago, Illinois). RESULTS: A response rate of 68.1% was obtained. Results revealed the primary reasons for remaining in the practice of dental hygiene were salary, family responsibility, professional collaboration, and variety of work. The primary reasons for leaving dental hygiene practice were family responsibility, boredom, salary, and lack of benefits. Secondary and tertiary reasons stated for staying in clinical practice revealed additional factors including benefits, participation in decision-making, and a safe environment. Dental hygienists in clinical practice were more likely to be employed by a dentist in a single practice and see more patients per day, have a certificate or associate's degree, be unmarried, have fewer children, and be younger than dental hygienists not in practice. CONCLUSION: The findings suggest that dental hygienists in Texas who remain in the workforce are positively influenced primarily by salary. Dental hygienists in Texas who had left the workforce were primarily influenced to leave practice because of family responsibility. Boredom and lack of benefits were also important factors in deciding to leave clinical practice. Employers of dental hygienists need to be aware of these factors in the hiring process. In addition, dental hygiene educators should prepare students in interviewing techniques for better communication regarding retention factors.

Adult↗
PubMed2001

Training the health workforce of tomorrow.

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a small group of grantmakers and national experts concerned about health workforce issues. This roundtable - held on October 31, 2001, in Washington, DC - explored various issues related to the supply, composition, and competency of the health workforce, and the role that these factors play in maintaining and improving the health status of individual patients and broader populations. The session also highlighted the current activities of and future opportunities for foundations.This Issue Brief synthesizes key points from the day's discussion with a background paper prepared for roundtable participants. It includes quantitative and qualitative information on workforce issues and profiles public sector and grantmaker strategies for addressing workforce problems.

Clinical Competence↗
PubMedDate not supplied

The effect of workforce issues on patient safety.

The workforce of any health care organization is vital to its continued survival, but a highly competent and committed workforce is vital to its success. The evidence is clear: employees influence not only the financial performance of the organization, but also the safety and quality of the clinical care provided to patients. Health care organizations must understand these important linkages and have in place corporate strategies to manage workforce issues with a systems focus that ensures excellent leadership and operational processes, a healthy culture, and optimum patient outcomes. New levels of knowledge, resources, and implementation are needed to move health care in the United States to the next level of quality performance. Staff satisfaction and retention should be at the heart of the clinical improvement strategies. Such an approach will allow organizations to cope and thrive in an environment of workforce shortages and increasing consumer demand for quality. To quote Robert Waller, MD, of the Mayo Clinic, "The goal is the best care for every patient, every day. Our patients deserve nothing less.

Benchmarking↗
PubMed2004

Rural GPs' ratings of initiatives designed to improve rural medical workforce recruitment and retention.

INTRODUCTION: Since the early 1990s, Australian governments have recognised the problems of rural medical workforce recruitment and retention and have implemented a range of programs and incentives designed to improve the supply of, and access to, doctors in rural and remote areas. Some incentives involve differential payments according to degree of rurality or remoteness. Since these programs involve considerable costs to governments, some assessment of their impact on recruitment or retention is warranted. The objective of this study is to examine the effectiveness of different recruitment and retention incentives from the perspective of the rural GP. Doctors practising in rural and remote communities were, therefore, asked to rank the relative importance of different interventions in terms of their impact on recruitment to and retention of GPs in their communities. METHODS: Six possible interventions were selected to cover the major objectives underpinning rural workforce programs most relevant to doctors currently in rural practice. Respondents assigned a rank to indicate the relative importance of each item with respect to each of the two questions: "What would help most to attract more GPs to this community?" and "What would help most to retain GPs in this community?" The data were collected as part of a national study into the viability of rural general practice undertaken jointly by the Rural Doctors Association of Australia and Monash University School of Rural Health Bendigo. The Rural, Remote and Metropolitan Areas (RRMA) classification was used as the rurality indicator. Analysis involved the calculation of mean ranks for each item. Item means were then ranked to indicate most to least important items in total, and within each RRMA category. RESULTS: Thirty-five percent of all GPs practising in rural and remote Australia responded to the national survey, representing 53% of all practices in those areas. Of these, 1050 doctors who nominated themselves as a principal, partner or associate in their practice were eligible for inclusion in this analysis. The results showed a high degree of agreement in the responses to both questions, with the possible interventions being ranked in the same overall order. 'Better remuneration for Medicare consultations' and 'Improved after-hours and on-call arrangements' were ranked as the most important interventions for both attracting and retaining GPs, whereas 'Better education and professional support activity' and 'Improved availability of allied health professional services' were ranked as least important of the options presented. 'Better locum availability' and 'Capital funding to improve practice infrastructure/enable GPs to set up practice' ranked in between. Results within each RRMA category were very similar to the overall rankings, confirming the significance of the improved remuneration and workload arrangements, regardless of geographical location. CONCLUSIONS: Ensuring professional support, workforce supply, income and infrastructure support are all relevant to the recruitment and retention of GPs in rural and remote areas. However, from the perspective of GPs practising in such areas, specific initiatives that increase the core income of rural practices, and which address those medical workforce supply issues which impact most on workload, are considered those which are most likely to assist in the recruitment and retention of GPs to Australia's rural and remote communities.

Journal Article↗
PubMedDate not supplied

Accommodating the needs of the aging registered nurse workforce.

The average age of registered nurses is 45, according to the 2000 national Sample Survey of Registered Nurses as shown in results released in February 2002. With the nursing workforce aging and few young people entering the profession administrators will need to entertain ideas that will aid in retention of the older nurses. A descriptive survey design was used to determine the awareness of and any plans for the aging Registered Nurse (RN) workforce by Alabama nursing administrators in hospitals and nursing homes. The average of all responding facilities for employed RNs over the age of 55 is 11.78%, with hospitals average being 11.68% and nursing homes being 11.43%. Fifty-four percent of administrators were at least moderately aware of the aging workforce. There was a higher percentage noted in nursing homes (57%) than hospitals (40%). All administrators responded that they wished to retain older RNs. Unfortunately, 96.3% of Alabama hospitals and nursing homes have no policies currently in place to address the needs of the aging registered nurse workforce.

Age Factors↗
PubMed2001

Too few or too many dermatologists? Difficulties in assessing optimal workforce size.

Discussions of the dermatology workforce have been dominated in the last 3 decades by concerns of an impending surplus. The aim of this article is to provide new data on the supply of dermatologists and to reassess estimates of future demand in light of growing anecdotal evidence suggesting a shortage. The US supply of dermatologists has risen to 3.3 per 100 000 population, and this growing workforce continues to be geographically maldistributed. A number of factors, including a possible increase in the number of surgical and cosmetic procedures being performed, might make this growing supply less available for the care of medical dermatology patients, complicating any supply projections. Precise estimates of future demand are also difficult because changes in disease prevalence, medical technology, and the health care delivery system are not always predictable. In an era when regulatory bodies are making more centralized decisions about residency training, the field must attempt to estimate and anticipate future needs. Simply allowing others to make decisions about the future size of the workforce based on outdated data risks an oversupply or undersupply, either of which will have detrimental effects on dermatologists and their patients.

Dermatology↗
PubMedDate not supplied

Health workforce imbalances in times of globalization: brain drain or professional mobility?

The health workforce is of strategic importance to the performance of national health systems as well as of international disease control initiatives. The brain drain from rural to urban areas, and from developing to industrialized countries is a long-standing phenomenon in the health professions but has in recent years taken extreme proportions, particularly in Africa. Adopting the wider perspective of health workforce balances, this paper presents an analysis of the underlying mechanisms of health professional migration and possible strategies to reduce its negative impact on health services. The opening up of international borders for goods and labour, a key strategy in the current liberal global economy, is accompanied by a linguistic shift from 'human capital flight' and 'brain drain' to 'professional mobility' or 'brain circulation'. In reality, this mobility is very asymmetrical, to the detriment of less developed countries, which lose not only much-needed human resources, but also considerable investments in education and fiscal income. It is argued that low professional satisfaction and the decreasing social valuation of the health professionals are important determinants of the decreasing attraction of the health professions, which underlies both the push from the exporting countries, as well as the pull from the recipient countries. Solutions should therefore be based on this wider perspective, interrelating health workforce imbalances between, but also within developing and developed countries.

Delivery of Health Care↗
PubMed2004

Naturopathic and Western herbal medicine practice in Australia-a workforce survey.

BACKGROUND: Despite substantial growth in the use of complementary medicine, no comprehensive national study has been undertaken of the naturopathic and Western herbal medicine component of the healthcare workforce in Australia. This study aimed to examine the nature of these practices and this currently unregulated workforce in Australia. METHODS: A comprehensive survey questionnaire was developed in consultation with the profession and distributed nationally to all members of the naturopathic and Western herbal medicine workforce. RESULTS: The practices of herbal medicine and naturopathy make up a sizeable component of the Australian healthcare sector, with approximately 1.9 million consultations annually and an estimated turnover of $AUD 85 million in consultations (excluding the cost of medicines). A large proportion of patients are referred to practitioners by word of mouth. Up to one third of practitioners work in multidisciplinary clinics with other registered sectors of the healthcare community. The number of adverse events associated with herbal medicines, nutritional substances and homoeopathic medicines recorded in Australia is substantial and the types of events reported are not trivial. Data suggest that practitioners will experience one adverse event every 11 months of full-time practice, with 2.3 adverse events for every 1000 consultations (excluding mild gastrointestinal effects). CONCLUSION: These data confirm the considerable degree of utilisation of naturopathic and Western herbal medicine practitioners by the Australian public. However, there is a need to examine whether statutory regulation of practitioners of naturopathy and Western herbal medicine is required to better protect the public.

Attitude of Health Personnel↗
PubMed2004

The dermatology workforce shortage.

BACKGROUND: While many dermatology workforce projections over the past two decades forecasted an impending oversupply, more recent reports have begun to suggest a shortage of dermatologic services. METHODS: Anonymous surveys administered to practicing dermatologists and to recent training graduates were examined for surrogate indicators of the supply and demand for dermatologic services. RESULTS: The mean wait time for new patient appointments with dermatologists was 36 calendar days, but ranged widely based on location (means ranged from 9-120 days by state). About half (49%) of practicing dermatologists feel that they need more dermatologists in their communities, while only 20% describe the local supply as too high. The reported need for medical and general dermatologists is far more acute than for dermatologic subspecialists. Many practices (33%) are looking for new associates, and not surprisingly, most new graduates entering the workforce over the past 4 years (86-93%) do not describe any difficulty finding desirable positions. Fewer than 10% of recent graduates are dissatisfied with their current jobs. CONCLUSION: Based on survey data examining wait times, physician perception, use of physician extenders, searches for new employees, and experience of recent graduates entering the workforce, it appears there is an inadequate supply of dermatologists to meet the demand for services.

Adult↗
PubMed2005

Progressive specialization within general surgery: adding to the complexity of workforce planning.

BACKGROUND: Although most general surgeons receive comparable training leading to Board certification, the services they provide in practice may be highly variable. Progressive specialization is the voluntary narrowing of scope of practice from the breadth of skills acquired during training; it occurs in response to patient demand, rapid growth of medical knowledge, and personal factors. Progressive specialization is increasingly linked to fellowship training, which generally abruptly narrows a surgeon's scope of practice. This study examines progressive specialization by evaluating trends in fellowship training among general surgeons. STUDY DESIGN: Because no database exists that tracks trainees from medical school matriculation through entrance into the workforce, data from multiple sources were compiled to assess the impact of progressive specialization. Trends in overall number of trainees, match rates, and proportion of international medical graduates were analyzed. RESULTS: The proportion of general surgeons pursuing fellowship training has increased from > 55% to > 70% since 1992. The introduction of fellowship opportunities in newer content areas, such as breast surgery and minimally invasive surgery, accounts for some of the increase. Meanwhile, interest in more traditional subspecialties (ie, thoracic and vascular surgery) is declining. CONCLUSIONS: Progressive specialization confounds workforce projections. Available databases provide only an estimate of the extent of progressive specialization. When surgeons complete fellowships, they narrow the spectrum of services provided. Consequently, as the phenomenon of progressive specialization evolves, a larger surgical workforce will be needed to provide the breadth of services encompassed by the primary components of general surgery.

Adult↗
PubMed2005

Mind the gap: developing the PH workforce in the North East and Yorkshire and Humber regions: a scoping stakeholder study.

OBJECTIVES: The aim of this study was to identify key issues around public health workforce development in the North of England, considering the gap between need and current capacity and the training requirements to deliver the public health and health improvement agenda. METHODS: Interviews were carried out with over 50 professionals in a variety of stakeholder organizations, seeking their views on priorities for workforce development and perceived opportunities and threats to the development of a good public health workforce. RESULTS: There was general recognition of a gap between current public health resources and what is needed to meet the public health agenda. Priorities included both increasing capacity at the specialist end of public health and raising general public health awareness at all levels of public organizations. Major barriers identified to meeting these needs included organizational difficulties, professional barriers and shortages of appropriate training and resources. Opportunities were seen to be presented by the increased amount of joint working and by national and local raising of awareness of public health issues. CONCLUSIONS: Across the health sector, local authorities, training organizations and voluntary sectors, similar issues and expectations were mentioned at both specialist and practitioner levels. However, it has not been possible in North East England to translate this finding into practical programmes in the absence of nationally identified resources to address the issue.

England↗
PubMed1997

Key issues in emergency medicine workforce planning.

The goal of workforce planning should be to match the supply of providers with the nation's demand. Whatever workforce planning process evolves, it will be necessary for the specialty to portray accurately our workforce needs. Because this portrait requires a clear understanding of the development of and funding mechanisms for graduate medical education and specific data describing both the supply and demand for emergency physicians, we address these issues.

Education, Medical, Graduate↗
PubMed2001

Periodic tallies by regulatory boards: a vital tool for tracking supply in the psychology workforce.

Regulatory boards in psychology and other mental health professions are in key positions to address workforce supply issues. Board data provide real time estimates of the growth within the health professions they regulate. The authors recommend that periodic tallies of the psychology workforce be undertaken through surveys of psychology boards. This will require that boards adopt efficient and standard methods for tracking licensees. Better data from boards would provide longitudinal and cross-jurisdictional comparisons that may enhance efforts to balance supply and demand in the professional workforce and the distribution of psychologists.

Data Collection↗
PubMed2005

Factors influencing decisions about the state in which doctors plan to practise: additional results from the 2002 Australian Medical Workforce Advisory Committee national survey.

As a result of growing doctor shortages, postgraduate doctor recruitment and retention within Australian states and territories has become an issue of concern. Australia's policy of national self-sufficiency in health workforce supply implies that state medical schools will, at a minimum, enroll a sufficient number of locally born students to meet future medical workforce requirements. This article focuses on factors influencing the state or territory in which doctors plan to practise medicine, identified through a national survey. Independent variables of interest were birth place, medical school and vocational training location because of their importance to medical workforce policy. The study found that the career location plans of Australian-born and overseas-born doctors in vocational training were similar and that 5% of doctors planned to work overseas. Of Australian-born doctors who planned to work in Australia, 88% graduated from a medical school in the state in which they were born, while 78% and 65%, respectively, were undertaking vocational training in, and proposed to work in, the state in which they were born. The study concludes that trainee-doctor decisions about the state or territory in which they will practise medicine when they are fully qualified are more complex than location of birth.

Adult↗
PubMed1997

Coordinating rural divisions: the workforce window.

Divisions of General Practice have been established to alleviate the professional isolation which general practitioners face by being excluded from involvement in other parts of the health care system. Divisions facilitate the development of local communication networks and cooperative activities which improve the integration of general practice with other elements of the health system. Coordination of communication is one of the strengths of divisions at the local level and Rural Divisions Co-ordinating Units at the State level. This strength is being effectively utilised to target general practice workface issues. Given the significant proportion of general practitioners in the medical workforce, particularly in rural and remote areas, this has implications for broader medical workforce issues. Australia faces a maldistribution in its general practitioner workforce, with an excess supply in urban areas and a significant shortfall in rural and remote areas. Since 1995-96, the General Practice Rural Incentives Program, which targets the recruitment and retention of rural doctors, has devolved funding to the Rural Divisions Co-ordination Units to coordinate the statewide provision of practical assistance to rural general practitioners, through their divisions, in relation to continuing medical education and the provision of locums. There is potential to build on the success of these initiatives and also to work with urban divisions through the state-based organisational structures which are currently being developed.

Australia↗
PubMed2004

The adolescent addiction treatment workforce: status, challenges, and strategies to address their particular needs.

Treating youth with substance use problems presents unique challenges, distinct from those of adults, that add to the complexity of recruiting and retaining a qualified adolescent treatment workforce. Youth who need treatment are often involved in an array of systems (i.e., health, legal, and social) and use substances for a variety of reasons, requiring providers to have a unique set of treatment practices and proficiencies. The intent of this article is to highlight the current understanding of the issues facing the alcohol and other drug treatment workforce and to provide an overview of strategies people are or could be using to build and maintain a workforce that can effectively deliver care for adolescents.

Adolescent↗