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The American Academy of Ambulatory Care Nursing (AAACN) recognizes a paradigm shift represented by the volume of health care delivery flowing from episodic acute care encounters to long-term relationships. This shift presents opportunities to further recognize and prepare nurse graduates for the complex and expanded role of the ambulatory care registered nurse (RN). This position paper discusses the current state of the RN role in ambulatory care and provides a vision for the future. The paper further identifies challenges, poses possible solutions, and highlights the AAACN position on the role of the ambulatory care RN. [ABSTRACT FROM AUTHOR]

A pilot study evaluated the change in charge nurses' perception of their leadership skills after engaging in a 4-month structured leadership program. Based on a self-assessment, multimodal education using authentic leadership tenets and an appreciative inquiry framework increased participants' confidence in their skills. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To increase your understanding of a variety of leadership models • To recognise the core elements of effective ward leadership • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Nurses who are responsible for a clinical area do not only have a management role but also, crucially, a leadership role. The role of ward leader is complex and demanding. Ward leaders are accountable for patient safety and the quality of patient care, act as role models, motivate staff and cascade organisational goals to them. They also ensure the correct skill mix on the ward, alleviate pressures on staff and provide opportunities for staff development. This article describes several leadership models which all have something to offer to nurses looking to develop their ward leadership skills. It discusses core elements of effective ward leadership, notably providing support and direction to the team through coaching and mentoring, developing the ward as a learning environment, understanding the wider care context and taking time for self-care. [ABSTRACT FROM AUTHOR]

There is a need to ensure that healthcare organisations enable their workforces to use digital methods in service delivery. This study aimed to evaluate the current level of digital understanding and ability in nursing, midwifery, and allied health workforces and identify some of the training requirements to improve digital literacy in these health professionals. Representatives from eight healthcare organizations in Victoria, Australia participated in focus groups. Three digital frameworks informed the focus group topic guide that sought to examine the barriers and enablers to adopting digital healthcare along with training requirements to improve digital literacy. Twenty-three participants self-rated digital knowledge and skills using Likert scales and attended the focus groups. Mid-range scores were given for digital ability in nursing, midwifery, and allied health professionals. Focus group participants expressed concern over the gap between their organizations' adoption of digital methods relative to their digital ability, and there were concerns about cyber security. Participants also saw a need for the inclusion of consumers in digital design. Given the widening gap between digital innovation and health workforce digital capability, there is a need to accelerate digital literacy by rapidly deploying education and training and policies and procedures for digital service delivery. [ABSTRACT FROM AUTHOR]

Care needs amongst 425,000 dependent older residents in English care homes are becoming more complex. The quality of care in these homes is influenced by staffing levels, especially the presence of registered nurses (RNs). Existing research on this topic, often US-focused and relying on linear assumptions, has limitations. This study aims to investigate the non-linear relationship between RN staffing and care quality in English care homes using machine learning and administrative data from two major care home providers. A retrospective observational study was conducted using data from two English care home providers. Each was analysed separately due to variations in data reporting and care processes. Various care quality indicators and staffing metrics were collected for a 3.5-year period. Regression analysis and machine learning (random forest) were employed to identify non-linear relationships. Ethical approval was obtained for the study. Using linear methods, higher skill mix – more care provided by RNs – was associated with lower incidence of adverse outcomes, such as urinary tract infections and hospitalisations. However, non-linear skill mix–outcome relationship modelling revealed both low and high skill mix levels were linked to higher risks. The effects of agency RN usage varied between providers, increasing risks in one but not the other. The study highlights the cost implications of increasing RN staffing establishments to improve care quality, suggesting a non-linear relationship and an optimal staffing threshold of around one-quarter of care provided by nurses. Alternative roles, such as care practitioners, merit exploration for meeting care demands whilst maintaining quality. This research underscores the need for a workforce plan for social care in England. It advocates for the incorporation of machine learning models alongside traditional regression-based methods. Our results may have limited generalisability to smaller providers and experimental research to redesign care processes effectively may be needed. RNs are crucial for quality in care homes. Contrary to the assumption that higher nurse staffing necessarily leads to better care quality, this study reveals a nuanced, non-linear relationship between RN staffing and care quality in English care homes. It suggests that identifying an optimal staffing threshold, beyond which increasing nursing inputs may not significantly enhance care quality may necessitate reconsidering care system design and (human) resource allocation. Further experimental research is required to elucidate resource-specific thresholds and further strengthen evidence for care home staffing. How much nursing care is needed to assure quality in care homes? Evidence from 2 English care home providers shows that nurse sensitive outcomes (an indicator of quality) are better when ~ 25 % of care is provided by nurses. Nurse shortages increase risks for residents. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To characterise the problem of missed nursing care in Chilean hospitals and to test associations with hospital organisational variables. Background: Missed nursing care is a common problem in different countries, but it has not been studied in Chile. Design: Multihospital cross‐sectional study (Supplementary file 1: STROBE guideline). Methods: Study population of 45 adult high‐complexity hospitals and 1853 registered nurses (RN) working on medical‐surgical units. Primary data were collected through a nurse survey. Nurses reported, out of a list of nursing care activities, the ones left undone during their last shift. The main independent variables were the work environment, measured through the Practice Environment Scale of the Nursing Work Index, patient‐to‐nurse ratios and RN skillmix. Adjusted logistic regression analyses were used to test associations, accounting for clustering of nurses working in the same hospital. Results: The hospital response rate was 88.9% and, for nurses, 88.1%. The mean patient‐to‐nurse ratio was 14.5 (range 6–23). The average skillmix was 31% RN. Eighty‐six percent of nurses missed at least one activity. The activities most frequently missed included patient education, comforting patients and surveillance. The adjusted model showed a significant association between the work environment, staffing ratios and missed care. The RN skillmix was not associated. Conclusions: Missed care is highly prevalent problem in Chilean hospitals. Clinical activities were the least missed. It is necessary to improve work environments and reduce the number of patients per nurse to improve the safety and quality of care. Relevance for clinical practice: The study results are relevant since they provide new data to Chile. Better work environments and adequate human resources are modifiable factors that can be addressed from a managerial perspective, with low‐cost strategies to effectively reduce missed care and improve safety and quality. [ABSTRACT FROM AUTHOR]

This article illustrates the evolution of the MAPO method for quantifying the risk of musculoskeletal disorders associated with patient handling. The main factors that have influenced MAPO risk determinants include the rising number of disabled patients (D), growing understaffing, and the increased availability of equipment and training. Hospital wards and especially nursing homes have been provided with lifting equipment since 2008; however, 73.8% of the workforce in nursing homes is exposed to a high level of MAPO risk versus only 8.1% of hospital workers. This study presents organisational data in hospital wards (no.=528) and nursing homes (no.=214) involving 14,246 caregivers: the D/Op ratio in nursing homes is significantly higher compared to the corresponding ratio in hospital wards (p-value < 0.001). Moreover, the number of healthcare workers involved in manual patient handling activities over the night shift in nursing homes is much lower than the corresponding number in hospital wards. Practitioner summary: The purpose of this article is to illustrate organisational data from hospital wards and nursing homes, gathered over 20 years of implementing the MAPO method. The protocols for adapting the method to recent changes in care delivery are also presented. [ABSTRACT FROM AUTHOR]

Aims: To understand how COVID‐19 affected nurse staffing in intensive care units (ICUs) in England, and to identify factors that influenced, and were influenced by, pandemic staffing models. Design: Exploratory qualitative study. Methods: Semi‐structured, online interviews conducted July–September 2020 with regional critical care leaders including policy leads (n = 4) and directors/lead nurses (n = 10) across critical care networks in England. Findings: The six themes emerging from the framework analysis illustrate how the pre‐pandemic ICU culture influenced ICU staffing models during the pandemic. Changes in staffing impacted on the workforce and the care delivered, whilst it was necessary to learn from, and adjust to, a rapidly changing situation. Variation across and between networks necessitated variation in responses. The overwhelming outcome was that the pandemic has challenged the central tenets of ICU nurse staffing. Conclusions: Pandemic nurse staffing models resulted in changes to ICU skill‐mix and staffing numbers. Factors such as the impact of nurse staffing on care practices and on the workforce need to be taken into account when developing and testing future nurse staffing models for ICU. The extent to which ICUs will return to former staffing models is not yet known but there seems to be an appetite for change. Impact: In common with many countries, nurse staffing in English ICUs was adapted to address surge requirements during the COVID‐19 pandemic. Findings highlight the challenge COVID‐19 presented to pre‐pandemic ICU nurse staffing guidelines, the impact on patient and staff well‐being and the potential legacy for future staffing models. Study findings have implications for ICU nurse managers, researchers and policy makers: nurse staffing models need to be adaptable to the local context of care and future research should investigate the impact of different models on patients, staff and health service outcomes. [ABSTRACT FROM AUTHOR]

For various reasons, including the pandemic's toll, many nurses are preparing to exit their roles or leave the profession entirely. Addressing attrition requires health care systems to develop comprehensive workforce strategies to enhance the nursing pipeline. Health care systems must proactively address challenges through innovative workforce solutions using an academic–practice partnership model while incorporating high schools and post-secondary schools. This column will discuss how nurse leaders in a health care system address attrition through academic–practice partnership models, innovative strategies, and outcomes data. [J Contin Educ Nurs. 2023:54(2):53–55.] [ABSTRACT FROM AUTHOR]

Abstract This paper studies the effects of changes in states' scope of practice (SOP) laws for advanced practice registered nurses (APRNs) on individual labor supply decisions. Restrictive SOP impose costs and other barriers to practice that may affect these decisions. Using survey data on APRNs, we analyze employment in nursing, work hours, part-time work status, multiple job holding, self-employment, wages, and migration. Results show that the level of SOP restrictions are not strong determinants of many labor market decisions but APRNs working in states without oversight requirements are much more likely to be self-employed and to work more hours. APRNs are also found to commute to less restrictive SOP environments when geographically feasible. Increases in the labor supply of nurses when regulatory environments are relatively free from physician oversight requirements can bring an important change to the delivery of health care in the United States. [ABSTRACT FROM AUTHOR]

Background: Globally, nurses are increasingly employed post-retirement, with task-shifting to nurses with lower competencies, a lack of knowledge being a barrier, all of which could lead to medication errors. Aim: To describe the impact of nurses' age, experience, training, and skill mix on the medication administration processes in long-term care facilities (LTCFs). Setting: Nurses (N=123) working in 28 LTCFs in the Western Cape province, South Africa. Methods: A quantitative non-experimental, cross-sectional descriptive design was used. The LTCFs were divided into funded (state-subsidised) and private (for profit) facilities using a stratified sampling method and each stratum thereafter randomised to obtain equal samples from each stratum. Self-administered questionnaires with close-ended statements were used, and statistical software (SPSS version 27) to perform descriptive and inferential analyses. Results: Respondents, (27%), had more than nine years of experience, with 15.8% aged 61- 70 years; and 3.5% aged 71-80 years. Some were 'very inexperienced' in computer use (29.3%), 35% received medication training longer than five years ago, and n=28 nurses administered medication outside their scope of practice. The highest sources of job pressure were an increase in workloads (75.6%), being under stress (42.3%), and being overworked (39.0%). Conclusion: The aging nursing workforce, although experienced, found the job demands, paperwork, and technology barriers. Outdated training and delegating medication administration to lower categories of nurses can lead to medication errors. Contribution: This study's findings can serve as a guideline for creating succession plans, recruiting procedures, development, and training of nurses, and improving clinical practices. [ABSTRACT FROM AUTHOR]

PURPOSE: The Oncology Nursing Society (ONS) formed a team to develop a necessary expansion of the 2019–2022 ONS Research Agenda, with a focus on racism and cancer care disparities. METHODS: A multimethod consensus-building approach was used to develop and refine the research priorities. A panel of oncology nurse scientists and equity scholars with expertise in health disparities conducted a rapid review of the literature, consulted with experts and oncology nurses, and reviewed priorities from funding agencies. RESULTS: Critical gaps in the literature were identified and used to develop priority areas for oncology nursing research, practice, and workforce development. SYNTHESIS: This is the first article in a two-part series that discusses structural racism and health inequities within oncology nursing. In this article, three priority areas for oncology nursing research are presented; in the second article, strategies to improve cancer disparities and equity and diversity in the oncology workforce are described. IMPLICATIONS FOR RESEARCH: Research priorities are presented to inform future research that will provide methods and tools to increase health equity and reduce structural racism in oncology nursing practice, research, education, policy, and advocacy. [ABSTRACT FROM AUTHOR]

Hospitals, nurses, thought leaders, and policymakers must address the potential long-range impacts of negative depictions of nurses and hospitals. We need to regroup and commit to fixing current and long-standing problems together, rethinking and planning for improving patient care in a post-COVID world, and supporting one another to achieve our aspirations for a better future. A Category 5 nursing shortage must be avoided to ensure the health of the nation, stability of healthcare delivery systems, and future growth of the nursing workforce. [ABSTRACT FROM AUTHOR]

Background: Occupational health professionals (OHPs) are in a unique position to impact the health and well-being of employees at work and outside of work. One way of achieving this holistic health goal is to integrate the concept of Total Worker Health® (TWH) into the organization's culture. It is critical for OHPs to develop the ability to incorporate TWH into their practices, yet there are gaps in our understanding of OHP's attitudes toward change and toward TWH, their level of TWH knowledge, and the number of OHPs who have adopted TWH. Methods: An electronic survey was administered to a national sample of 4,777. This cross-sectional study used Qualtrics to record survey responses measuring knowledge of TWH, attitude toward change, resistance to change, transformational leadership ability, perception of organizational readiness, and leadership commitment. Findings: The total sample size was 253 (5.3%). Most respondents were bachelors prepared nurses (75.1%) with greater than 10 years' experience (71.5%) and employed in manufacturing (42.6%). Approximately 74% (n = 125) of respondents knew about TWH, but did not have a program in place or were unsure of the existence of one. A high percentage (74.0%) were open to implementing TWH, had favorable attitudes toward change (M = 3.9 on a 5-point Likert-type scale), but needed education on how to move forward (56.0%). Conclusions/Application to Practice: Findings suggest that most OHPs know about TWH, but generally have not adopted the TWH concept at their worksites. However, they are open to implementing TWH programs and have favorable attitudes toward change. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise that outcomes-driven acuity data provide a valid, objective and reliable measure of patient acuity and workload to support decisions about staffing • To acknowledge the critical need for nursing data to be used in the care process provided by nurses • To identify the requirement for nursing leaders to align the right number of resources, skills and competencies to individual patient care This article describes how driving evidence-based practice across the paediatric population using outcomes-driven acuity technology led to the formulation of a combined multihospital and health information technology acuity council. The cross-collaboration among acuity experts resulted in a pilot project being undertaken, implementing evidence-based practice using acuity data and expanding newborn and post-partum acuity outcome sets. The newborn acuity outcome set was expanded from four to seven outcomes, and the post-partum outcome set from nine to 12 outcomes. The revised outcome sets facilitate implementation of evidence-based practice to evaluate the effect of nursing care and practice on patient outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Leadership is critical in building quality work environments, implementing new models of care, and bringing health and wellbeing to a strained nursing workforce. However, the nature of leadership style, how leadership should be enacted, and its associated outcomes requires further research and understanding. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments. Methods The search strategy of this systematic review included 10 electronic databases. Published, quantitative studies that examined the correlations between leadership behaviours and nursing outcomes were included. Quality assessments, data extractions and analysis were completed on all included studies by independent reviewers. Results A total of 50,941 titles and abstracts were screened resulting in 129 included studies. Using content analysis, 121 outcomes were grouped into six categories: 1) staff satisfaction with job factors, 2) staff relationships with work, 3) staff health & wellbeing , 4) relations among staff, 5) organizational environment factors and 6) productivity & effectiveness. Our analysis illuminated patterns between relational and task focused leadership styles and their outcomes for nurses and nursing work environments. For example, 52 studies reported that relational leadership styles were associated with higher nurse job satisfaction, whereas 16 studies found that task-focused leadership styles were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes. Conclusions The findings of this systematic review provide strong support for the employment of relational leadership styles to promote positive nursing workforce outcomes and related organizational outcomes. Leadership focused solely on task completion is insufficient to achieve optimum outcomes for the nursing workforce. Relational leadership practices need to be encouraged and supported by individuals and organizations to enhance nursing job satisfaction, retention, work environment factors and individual productivity within healthcare settings. [ABSTRACT FROM AUTHOR]

This study investigated the prevalence of lookism through a content analysis of nursing recruitment advertisements in China. Lookism or physical appearance-based discrimination is prevalent in roles predominantly occupied by women. This attributive bias assumes greater significance in the context of a patriarchal society like China within industries such as nursing that are highly feminized. Nevertheless, few studies explore the existence of lookism within the nursing industry in China. Reporting on the intent of Chinese health care employers to discriminate based on physical appearance, this article argues for awareness of and sensitivity toward the implications of workplace lookism in China. [ABSTRACT FROM AUTHOR]

This article examines nurses' commentaries from a survey conducted in New Zealand that studied contradictions between quality assurance and work intensification in nursing care. Nurse managers were blamed for either avoiding or not recognizing work intensification affecting quality care delivery. However, the data illustrate key structural issues resulting in missed care that impact on patient safety, rather than a problem directly attributable to managers. Until these structural issues are addressed, missed care and adverse events will continue to affect the quality of care. [ABSTRACT FROM AUTHOR]

The article discusses developments and issues in healthcare governance worldwide, particularly in Australia, as of April 2017. Also cited are the growing use of nurse-sensitive indicators (NSI) to assess clinical practice and nursing performance, the widely accepted Donabedian framework to measure NSI associations with quality of care, and the works of such organizations as the National Database of Nursing Quality Indicators (NDNQI).

Sam Foster, Chief Nurse, Oxford University Hospitals, looks at research on the impact of nursing team size and composition on patient mortality in hospitals [ABSTRACT FROM AUTHOR]

Aim This paper seeks to identify gaps within nursing collective agreements for opportunities to implement practices to sustain the nursing workforce. Background Since the majority of nurses in Canada are unionised, some of the strategies recommended in the literature to cope with nursing shortage may not apply to unionised nurses, making collective agreements a potential source for designing practices that can mitigate the impact of ageing nurses. Method Nine major collective agreements for registered nurses in each province governing the nursing employment relationship were analysed to see if different practices were already addressed in the collective agreements. Results Five such practices were identified, including: providing more mentorship opportunities; encouraging nurses who are eligible to retire to remain in the nursing workforce; attracting internationally trained nurses; implementing operational changes that include process improvements or new technologies; and empowering nurses through flexibility in work schedules. Conclusion If collective agreements are silent in any of the strategies identified in the literature, health-care organisations can adopt these practices without violating the collective agreements. Implications for nursing management Non-unionised health-care organisations can also benefit from learning about these policies and practices to assist in managing and sustaining an ageing nursing workforce. [ABSTRACT FROM AUTHOR]

Background: The need to retain health personnel is a policy challenge undermining health system reform of the 21st century. The need to resolve this global health workforce crisis resulted in the First Global Forum on Human Resources for Health in 2008 from which the Kampala Declaration and Agenda for Global Action was formulated. However, whilst there have been several studies exploring the retention of health personnel towards this end, available literature does not provide a detailed narrative on strategies used in peri-urban communities. The aim of this study was to explore retention strategies implemented in a Zimbabwean peri-urban community between 2009 and 2014 and implications for peri-urban communities towards the health system reform agenda.Methods: The study was carried out in Epworth, a peri-urban community in Harare, Zimbabwe. The research design was a cross-sectional survey, in which qualitative methods were used in sampling, data collection, reporting and analysis. Qualitative tools were used to collect data through in-depth interviews with purposively selected health personnel managers at 10 local clinics and sample interviews with purposively selected healthcare workers who included registered general nurses, state-certified nurses, midwives, environmental health technicians, nurse aids and community health volunteers at each clinic. Two focus group discussions were carried out with community health volunteers. Qualitative data was subjected to thematic analysis, with coding being performed manually.Results: A programme-specific strategic partnership between the government and donor community contributed towards the mobilisation of more health personnel, health facilities, worker development and remuneration. To complement this, the Ministry of Health intervened through the review and payment of salaries, support towards post-basic training and development, and protection. The local board, mission and donors contributed through the payment of top-up allowances and provision of non-monetary incentives.Conclusions: The review of salaries, engagement of international strategic partners, payment of top-up allowances, support towards post-basic training and development, mobilisation of more health personnel, non-monetary incentives and healthcare worker protection were critical towards the retention of health personnel in the Epworth peri-urban community between 2009 and 2014. [ABSTRACT FROM AUTHOR]

Background: The objective of the study was to better understand how hospitals use different types of RNs, LPNs, and nurse aides in proprietary (for-profit), nonprofit, and government-owned hospitals and to estimate the wages, cost, and intensity of nursing care using a national data set. Method: This is a cross-sectional observational study of 3,129 acute care hospitals in all 50 states and District of Columbia using data from the 2008 Occupational Mix Survey administered by the Centers for Medicare & Medicaid Services (CMS). Nursing skill mix, hours, and labor costs were combined with other CMS hospital descriptive data, including type of hospital ownership, urban or rural location, hospital beds, and case-mix index. Results: RN labor costs make up 25.5% of all hospital expenditures annually, and all nursing labor costs represent 30.1%, which is nearly a quarter trillion dollars ($216.7 billion) per year for inpatient nursing care. On average, proprietary hospitals employ 1.3 RNs per bed and 1.9 nursing personnel per bed in urban hospitals compared with 1.7 RNs per bed and 2.3 nursing personnel per bed for nonprofit and government-owned hospitals (P < .05). States with higher ratios of RN compared with LPN licenses used fewer LPNs in the inpatient setting. Conclusion: The findings from this study can be helpful in comparing nursing care across different types of hospitals, ownership, and geographic locations and used as a benchmark for future nursing workforce needs and costs. [ABSTRACT FROM AUTHOR]

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Nursing workforce retention is critical to provide quality healthcare, raising concern as nurse turnover rates continue to increase. In this study, we examined older Registered Nurse (RN) perceptions of their work experiences during the COVID-19 pandemic to identify facilitators and barriers in workplace environments that relate to RN workforce retention. The methods section describes our study population that included RNs aged 50 years and older (n=195) who completed surveys containing open and closed -ended questions between August 2020 and January 2021. Our study results indicate that most respondents (86.2%) worked during the COVID-19 pandemic in moderate-to-high patient acuity settings and felt their employers provided employees adequate Personal Protective Equipment (73.3%). The discussion section notes implications for nursing and study limitations. In conclusion, workforce retention facilitators included offering resources and implementations that made experienced, older RNs feel included, valued, supported, and protected. Workforce retention barriers were short/rushed workplace orientation, unsafe patient assignments, micromanaging, perceived ageist policies, and implementing pay and benefit-related policy changes without RN input. [ABSTRACT FROM AUTHOR]

This major community, workload, staffing and quality study is thought to be the most comprehensive community staffing project in England. It involved over 400 staff from 46 teams in 6 localities and is unique because it ties community staffing activity to workload and quality. Scotland was used to benchmark since the same evidence-based Safer Nursing Care Tool methodology developed by the second-named author was used (apart from quality) and took into account population and geographical similarities. The data collection method tested quality standards, acuity, dependency and nursing interventions by looking at caseloads, staff activity and service quality and funded, actual, temporary and recommended staffing. Key findings showed that 4 out of 6 localities had a heavy workload index that stretched staffing numbers and time spent with patients. The acuity and dependency of patients leaned heavily towards the most dependent and acute categories requiring more face-to-face care. Some areas across the localities had high levels of temporary staff, which affected quality and increased cost. Skill and competency shortages meant that a small number of staff had to travel significantly across the county to deliver complex care to some patients. [ABSTRACT FROM AUTHOR]

Aim To explore the debate on the development of the nurse practitioner profession in the Netherlands. Background In the Netherlands, the positives and negatives of nurse practitioners working in the medical domain have been debated since the role was introduced in 1997. The outcome of the debate is crucial for nurse practitioners' professional development and society's justification of their tasks. Method Review of 14 policy documents, 35 opinion papers from nurses, 363 opinion articles from physicians and 24 Dutch research papers concerning nurse practitioners from 1995 to 2012. Results Two discourses were revealed: one related to efficiency and one to the development of the profession. In both, the nurse practitioner role was presented as a solution for healthcare and workforce problems, while arguments differed. The efficiency discourse seemed most influential. Opinions of nurse practitioners were underrepresented; taking up new responsibilities was driven by the wish to improve patient care. While most physicians were willing to delegate tasks to nurse practitioners, they wished to retain final responsibility for medical care. Limitations All available publications were extensively studied, which could not include unpublished policy documents from the government or influential parties. This may have led to some selectivity. Conclusion The case of the Netherlands shows that nurses in developing their advanced role are facing barriers, similar to those in other countries. The dominance of efficiency arguments combined with protection of medical autonomy undermines the development towards nursing care that really benefits patients. Implications for nursing and health policy Nurse practitioners should strive to obtain positions in which they are allowed to make their own decisions and wise use of healthcare resources for the good of patients and society. Nurse practitioners should aim to become members of influential healthcare Boards in their countries, in which they can raise their voices and be involved in policy making. [ABSTRACT FROM AUTHOR]

The recent commitment to investment in continuing care services demands a sound grasp of workforce utilization in continuing care facilities. This article examines workforce utilization in continuing care as a key component of effective service delivery. We used a case study design with three continuing care facilities in Alberta, Canada. Data were collected over one year through interviews, group discussions and observations. The data revealed workforce issues around staff mix, responsibilities and role clarity that negatively affect staff and residents. Using an ecological framework, we developed 'upstream' workforce strategies targeting barriers that can be influenced by the three facilities. Limited research exists on how regulated and unregulated healthcare providers are organized and deployed in different continuing care environments. In our sociological analysis of workforce utilization at three continuing care facilities, we illuminated the relations between staff and the contextual elements surrounding them. [ABSTRACT FROM AUTHOR]

Purpose: In this paper issues and challenges of the workforce policy for nursing were explored and appropriate policy responses identified. Results: Many countries, including South Korea, are facing a shortage of nurses. In South Korea, the number of practicing registered nurses is about half the average for Organization for Economic Cooperation and Development (OECD) member countries. The shortage of nurses is not necessarily a shortage of individuals with nursing qualifications but also includes complex issues, such as lack of well-educated nurses, shortage of nurses willing to work, and geographical imbalances of nurses. The present nurse workforce policies are to increase number of nursing schools, to reduce the length of training, and to replace nurses with nursing assistants. However, the findings of many studies have shown that these attempts resulted in a worsening of patient outcomes and increasingly low quality of care. Conclusion: The findings in this study indicate that nurse workforce policy should have a multi-faceted approach in order to address the many factors affecting nurse shortages. [ABSTRACT FROM AUTHOR]

Emeritus Professor Alan Glasper, from the University of Southampton, discusses two recent policy reports which indicate a potential crisis in mental health and learning disability nursing [ABSTRACT FROM AUTHOR]

The article describes a different approach to consider various components of work undertaken by nurses that could help to reduce workforce pressures. It is noted that there need to be no local manipulation of the identified nursing/midwifery resource from the figures embedded in the evidence-based tool used. It is noted that the concept of organizational labor was created as a legitimate part of nursing work. [ABSTRACT FROM PUBLISHER]

The article discusses how shared governance and technology systems integration can help build effective workforce management practices. Some factors contributing to the success of a shared governance model include increased nurse investment and participation. Examples of successful shared governance in nursing are provided. The growth in the health care technology market created data integration and business analytics to address quality and cost concerns of health care organizations.

Over the last decade diabetes teams have seen many changes, including the use of new treatments and the recent shift back to older insulins. A move to structured education programmes has also occurred, with a rise in expert patients, community nurse-led clinics, hospital interventions and implementation of new guidelines. There has been a need to review old roles whilst implementing new roles and maintaining a high standard of care which meets the targets set in the National Service Framework for diabetes (Department of Health, 2002). This article aims to explore the "changing work force" for the current diabetes team where roles have been removed, reviewed and implemented in order to provide a diabetes service that meets the demands of the community in Peterborough. [ABSTRACT FROM AUTHOR]

Objective: This paper describes a study undertaken to examine the visions of nurse managers and leaders for succession planning and to examine the associated policies and practices for Saudi Arabian and expatriate nurse managers in Saudi Arabian hospitals. The factors that play a direct role in preparing future nurse managers to guide nursing services in the future for that country are explored. Design: Many definitions of succession planning can be identified in both nursing and business literature and an underlying theme is that good succession planning retains the best people for an organisation. This may seem to be stating the obvious at first glance, but the complexities for the sample and the 'social world' in this setting was such that a mixed methods approach was utilised to gain an in-depth understanding. A sequential explanatory research design was used in two phases. The first phase was a survey, which explored demographics, organisational succession planning, the importance of competencies in the development of nurse managers and the use of open-ended questions to elicit qualitative information. The focus of the second phase was qualitative and explored the themes of management styles and quality, the development of managers, organisational issues and human resource issues. At the participating hospitals, 11 nurse managers/ nurse executives took part in semi-structured interviews. Setting: The study was conducted in seven Saudi Arabian hospitals with a range of approaches to succession planning. Fundamental to the study was the ethical and professional responsibility of the Kingdom of Saudi Arabia (the Kingdom) to provide an Islamic focus in the delivery of quality healthcare and effectively continue to implement the Saudisation policy for nursing. Outcome: Although effective succession planning is built on the framework of solid organisational vision and policy, this was not reflected in practice in the Saudi Arabian hospitals in this study. Conclusion: Recruitment and retention of more Saudi nurses is both desirable from a population perspective and required from the government's policy perspective on Saudisation of the workforce. Effective succession planning for nurse managers is one factor which may modify attrition rates and enhance recruitment; however it remains a major challenge for health services. [ABSTRACT FROM AUTHOR]

Background: Changes to the workforce and organisation of general practice are occurring rapidly in response to the Australian health care reform agenda, and the changing nature of the medical profession. In particular, the last five years has seen the rapid introduction and expansion of a nursing workforce in Australian general practices. This potentially creates pressures on current infrastructure in general practice. Method: This study used a mixed methods, 'rapid appraisal' approach involving observation, photographs, and interviews. Results: Nurses utilise space differently to GPs, and this is part of the diversity they bring to the general practice environment. At the same time their roles are partly shaped by the ways space is constructed in general practices. Conclusion: The fluidity of nursing roles in general practice suggests that nurses require a versatile space in which to maximize their role and contribution to the general practice team. [ABSTRACT FROM AUTHOR]

An update to the standards of practice for culturally competent nursing care is presented. It explains that culturally competent nursing care is based on the principles of social justice and human rights and the need for cultural standards was prompted by the worldwide shortage of nurses and the global migration of both nurses and population. Topics included in the standards are knowledge of cultures, cross-cultural communication and evidence-based practice and research.

attree m., flinkman m., howley b., lakanmaa r-l., lima-basto m. & Uhrenfeldt L. (2011) Journal of Nursing Management 19, 786-802 A review of nursing workforce policies in five European countries: Denmark, Finland, Ireland, Portugal and United Kingdom/England Aim Review nursing workforce policies in five European countries: Denmark, Finland, Ireland, Portugal and the United Kingdom. Background Imbalances in registered nurse (RN) supply and demand is a global, significant and recurring issue that impacts on healthcare systems, organizations, staff and patients. Method Policy Review using resources located by a systematic search of relevant healthcare databases and policies in Danish, English, Finnish and Portuguese over the time period 2003-2007. Content analysis was used to identify themes and compare policies. Results Common nursing workforce policy themes were identified across the five countries: (1) improving retention through effective human resource management, improving the practice environment and nurses' working lives and (2) improving recruitment through attracting more new recruits and RNs back to practice, and international recruitment. The present study also identified methodological issues relating to data quality and quantity. Lack of an agreed definition and standardized measures of nursing need and shortage makes comparison and evaluation of policy effectiveness and impact difficult. Implications for Nursing Management Healthcare systems and organizations need to identify and implement effective policies that promote the retention of RNs in the workforce, or risk threats to healthcare system sustainability, as well as patient care quality and safety. [ABSTRACT FROM AUTHOR]

The article explores competences for practitioners in infection prevention and control. These competences are made for a number of people, such as organizations seeking expert to guide them on safety and quality agenda, managers of health and social-care services, and educational commissioners and providers. Among the cited competences are the development of policies that address infection, application of improvement methodologies, sharing of best practice through the dissemination of evidence and knowledge.

Hospital restructuring policies and an impending nursing workforce shortage have threatened the nation's emergency preparedness. Current emergency response plans rely on sources of nurses that are limited and overestimated. A national investment in nursing education and workforce infrastructure, as well as incentives for hospitals to efficiently maximize nurse staffing, are needed to ensure emergency preparedness in the United States. This review highlights the challenges of maintaining hospital nursing surge capacity and policy implications of a nursing shortage. [ABSTRACT FROM AUTHOR]

The article discusses the historical views on nursing shortage. The continued scarcity of nurses is attributed to recruitment and retention problems, public image distortion and negative work environment. According to some experts, solutions must be developed in the areas of education, health care delivery systems, policy, regulation and image to attain sustainable and assured supply of personnel.

The article provides information on the International Centre for Human Resources in Nursing (ICHRN). The Centre is an initiative launched by the International Council of Nurses (ICN) and the Florence Nightingale International Foundation (FNIF) to facilitate global solutions for nursing workforce challenges. Doctor Hiroko Minami, president of ICN and FNIF, said crisis in the global health workforce is marked by critical imbalances. The ICHRN aims to build capacity in nursing human resource planning and management.

An editorial is presented on nursing leaders have relied on estimates of workforce projections of supply and demand from government agencies, academicians, economists, and other third-party vendors. Topics include academic institutions are left wondering if they need to increase or decrease the number of nurses that are being educated in the U. S. To improve the accuracy of projections of the nursing workforce; and nursing would benefit immensely from having a Nursing Masterfile.

Background: Migration of nurses has taken center stage as a human resource issue in global discussion. Migration of nurses is associated with shortage of manpower, HIV/AIDS and the expanded roles of nurses. Purpose: To examine reasons behind migration and to argue that there are greater incentives for migrating than staying. Results: There are greater incentives for migrating than staying. Conclusion: Migration will remain an option until governments put in place professional mechanisms and incentives that will counteract various push factors. [ABSTRACT FROM AUTHOR]

Abstract: We all work in a multigenerational workforce. With extremes in generations, skills are needed to foster understanding among staff. There are many myths and realities about the age-related generations. While there are challenges in working in a multigenerational workforce, the generational differences tend to be exaggerated while the similarities are overlooked. A better understanding of these generations allows us to prevent communication breakdown and to close the communication gaps where they exist, creating a unit of harmony rather that discontent. [Copyright &y& Elsevier]

Aims: To conduct a needs assessment of public hospitals in Mexico to determine workforce specific capacity building needs in the care of older people. Background: The older population in Mexico is growing rapidly. The healthcare system and workforce may not be prepared to handle the needs of older people, especially those with chronic illnesses who are also disadvantaged socioeconomically. Determining workforce and system needs is important to strategically develop capacity. Methods: A needs assessment using a pragmatic qualitative approach structured this study. Semi‐structured interviews and focus groups were conducted with healthcare professionals at five public hospitals in Mexico. Directed content analysis techniques analysed the data. Results: Ninety‐two healthcare professionals participated in the study. Three themes emerged, including geriatric service delivery, social changes and human resources for health. Participants reported a lack of gerontology knowledge and related clinical skills deficits to provide care for hospitalised elders and expressed emotional distress related to the lack of resources in their institutions. All healthcare professionals expressed strong concern at the social toll the ageing population had on families. The support of government organisations emerged as a facilitator for adoption of geriatric care principles. Conclusions: This qualitative study uncovered important data to inform the implementation of quality improvement and capacity building models for older people care in Mexico. There appears to be strong potential for a culturally appropriate translation of high‐income country older people care models within the Mexican healthcare context. Implications for practice: Findings suggests there is a need to increase geriatric capacity building among helathcare professionals in Mexico. This will be an important step in improving care for hospitalised older people. [ABSTRACT FROM AUTHOR]