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Background: The advent of a more planned approach to workforces has led to increased interest in knowing exactly what workforces do, how much they cost and who their members are. Heightened interest in health human resources has highlighted the need for accurate definitions of nurse and nursing role and emphasized the importance of accurate, valid and timely workforce data., Aim: This commentary addresses some of the statements made in this issue by Currie and Carr-Hill (pp. 67-74) who ask, 'What is a nurse? Is there an international consensus?' General remarks about the importance of nursing health services data are also provided., Discussion: It is not surprising that nursing is struggling with standardization of definitions and role descriptions within and across countries. Globalization has intensified the need to understand complex relationships between systems such as education, finance and health that often differ from country to country., Conclusion: Professional and/or regulatory nursing associations can facilitate standardization of definitions and strengthen data collection; both of which are imperative. The more titles we create, the more difficult it becomes to have a generalized taxonomy of nursing services locally, nationally and internationally. Working closely with agencies like the International Council of Nurses and the World Health Organization may lead to a much-needed consensus on common indicators within and across countries. Given the large size of the nursing workforce worldwide, nurses can play an important role in the creation of comparable data that can be used to set policies that will affect the delivery of quality health care., (© 2013 The Author. International Nursing Review © 2013 International Council of Nurses.)

To mitigate nurse shortages, health care decision makers tend to employ retention strategies that assume nurses employed in full-time, part-time, or casual positions and working in different sectors have similar preferences for work. However, this assumption has not been validated in the literature. The relationship between a nurse's propensity to exit the nurse profession in Ontario and employment status was explored by building an extended Cox Proportional Hazards Regression Model using a counting process technique. The differential exit patterns between part-time and casual nurses suggest that the common practice of treating part-time and casual nurses as equivalent is misleading. Health care decision makers should consider nurse retention strategies specifically targeting casual nurses because this segment of the profession is at the greatest risk of leaving. Nurse executives and nurse managers should investigate the different work preferences of part-time and casual nurses to devise tailored rather than "one-size fits all" nurse retention strategies to retain casual nurses.

In many parts of Canada, nursing care is provided by registered nurses (RNs) and licensed/registered practical nurses (L/RPNs). The profession, regulatory bodies and employers are struggling to define their similarities and differences in their attempts to ensure patients are receiving the right care by the right care provider. An understanding of the decision making of nurses presents one way of differentiating between their overlapping roles. Nursing decision-making is a complex cognitive process. Assessment occurs and problems are postulated. Possible alternatives, with their risks and benefits, outcomes and likelihood of outcomes are identified. Preferences and values are considered, and an intervention is selected. The best way to implement an intervention is determined, implementation follows and evaluation takes place. In this research, a triangulated design was used to examine and compare the decision-making process of RNs and L/RPNs. Analysis revealed that nurses consider themselves to be frequently involved in elements that are part of the decision-making process. Nurses attribute the difficulty encountered to the context within which decision making occurs. Differences exist between the RN and L/RPN in the frequency of their involvement with most of the elements of the process. Differences in difficulty encountered with these elements were less pronounced.

Context: Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses' work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique requirements of nurses in rural practice environments. Purpose: To investigate whether nurses receive the resources and supports necessary to meet the challenges of rural practice. Methods: Semi-structured interviews were conducted with 21 managers and 44 staff nurses in 19 selected rural hospitals in Ontario, Canada. The interviews were taped and transcripts interpreted through a thematic analysis. Major worklife themes were identified and analyzed within a healthy work environment model based on the work of Kristensen. Findings: Three interrelated dimensions of the model were relevant to workforce sustainability: the balance between demands and the resources of the person, the level of social support, and the degree of influence. The availability of resources and supports affected whether the nurses perceived challenges as stimulating or overwhelming. Deficits interfered with practice and the well-being of the nurses and patients. Conclusions: The nurses felt frustrated and powerless when they lacked resources, support, and influence to manage negative situations. Strategies to achieve workforce sustainability include resources to reduce stress in the workplace, education to meet the needs of new and experienced nurses, and offering of employment preferences to the workforce. Addressing resources, support, and influence of rural nurses is essential to alleviate workplace challenges and sustain the rural nursing workforce. (Contains 2 tables.)

Aim: Identify and map international evidence regarding innovations led by or involving advanced practice nurses in response to COVID‐19. Background: COVID‐19 necessitated unprecedented innovation in the organization and delivery of healthcare. Although advanced practice nurses have played a pivotal role during the pandemic, evidence of their contributions to innovations has not been synthesized. Evidence is needed to inform policies, practices, and research about the optimal use of advanced practice nurses. Methods: A scoping review was conducted and reported using the PRISMA‐ScR checklist. Electronic databases were searched for peer‐reviewed articles published between January 2020 and December 2021. Papers were included that focused on innovations emerging in response to COVID‐19 and involved advanced practice nurses. Results: Fifty‐one articles were included. Four themes were identified including telehealth, supporting and transforming care, multifaceted approaches, and provider education. Half of the articles used brief and mostly noncomparative approaches to evaluate innovations. Conclusion: This is the first synthesis of international evidence examining the contributions of advanced practice nurses during the pandemic. Advanced practice nurses provided leadership for the innovation needed to rapidly respond to healthcare needs resulting from COVID‐19. Innovations challenged legislative restrictions on practice, enabled implementation of telehealth and new models of care, and promoted evidence‐informed and patient‐centered care. Implications for practice: Advanced practice nurses led, designed, implemented, and evaluated innovations in response to COVID‐19. They facilitated the use of telehealth, supported or transformed models of care, and enabled health providers through education, mentorship, and mental health support. Implication for policy: Advanced practice nurses are a critical resource for innovation and health system improvement. Permanent removal of legislative and regulatory barriers to their full scope of practice is needed. [ABSTRACT FROM AUTHOR]

Workplace violence against nurses is a significant global occupational health problem, with incidents of violence increasing in frequency since the COVID-19 pandemic began. In this article, we provide a review of recent legislative amendments meant to bolster workplace safety in health care in Canada, analyze legal cases where nurses were the victims of violence, and discuss what these legal reforms and decisions reveal about how nurses' work is treated within the Canadian legal system. Under criminal law, the limited number of cases we could find with oral or written sentencing decisions show that, historically, the fact a victim was a nurse was not always considered an aggravating factor on sentencing. Recent legislative amendments make this a specified aggravating factor and it is important to track the impact of these amendments when judges exercise their discretion in sentencing. Under employment law, it appears that, despite the government's efforts to increase the deterrence factor under legislation with significantly increased fines for employers who fail to protect their employees from injury, courts remain reluctant to impose such sanctions. In these cases, it is also important to track the impact of harsher penalties. We conclude that combating the widespread normalization of workplace violence in health care, and specifically against nurses, is acutely needed to help ensure that these ongoing legal reforms aimed at improving the safety of health workers are effective. [ABSTRACT FROM AUTHOR]

This article provides a commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres (PANMCC). The objectives are to present an overview of the formation and evolution of the network, its impact on education, research, policy and communication and the benefits of membership. The advantages of international networks as a mechanism to strengthen nursing and midwifery workforces and improve health systems are also highlighted. The Pan American Health Organization (PAHO), the World Health Organization (WHO) Office in the Americas, oversees collaborating centres in the Region. Established in 1999, PANMCC consists of 17 centres situated in universities and schools of nursing. These centres provide crucial nursing and midwifery input to PAHO/WHO. The network supports global engagement and capacity building via collaboration, resource sharing and research colloquia. The linkages within the network enhance professional development, increase capacity building and heighten visibility of PANMCC and the work of its members. [ABSTRACT FROM AUTHOR]

Title. The Professionalism and Environmental Factors in the Workplace Questionnaire®: development and psychometric evaluation. Aim. The aim of this paper is to describe the development and testing of a questionnaire intended to determine key professionalism attributes and key environmental attributes that influence the professionalism of nurses in their practice environments. Background. Rapid changes in the healthcare sector and human resource shortages have had an impact on the stability of global work environments, making maintaining professionalism a challenge. The literature consists of descriptive research, opinion and theoretical papers. Method. The Professionalism and Environmental Factors in the Workplace Questionnaire® was developed and tested from 2005 to 2007 in three phases: item generation, pretesting and pilot testing. Convenience sampling was used to obtain representative samples of the target population in the pretest and pilot test. Mailed survey methodology was used in the pretest and pilot test. Sample sizes for the pretest and pilot test were 46 and 848 respectively. Results. Psychometric testing indicated preliminary instrument validity and reliability. Factor analysis resulted in stable factors that mirrored the conceptual basis of the questionnaire. The results summarize nurses’ ratings of professionalism and environmental attributes that play a role in their work lives. Conclusion. The questionnaire helps nurses reflect on their practice and provides a starting point for discussion, planning and implementation of methods to support professionalism in practice and healthy work environments. It is internationally relevant because professionalism is a construct that transcends culture. Confirmatory factor analysis is needed to validate the results of this study. Testing with populations in different settings and additional validity and reliability testing will strengthen the questionnaire. [ABSTRACT FROM AUTHOR]

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In the 1990s, many health care organizations adopted restructuring strategies that were inappropriate to an industry in which the effective use of workers' knowledge, skills and social relations was essential to productivity. Workforce cuts and the withdrawal of workplace supports without sufficient consideration of human consequences led to a demoralized and short-staffed workforce rather than cost containment. This paper uses two neo-capitalist perspectives to illustrate the impact of restructuring initiatives on nursing, the most numerous health care profession. It describes how reconsideration of strategies adopted during restructuring has led to a search for new approaches to institutional change that make optimum use of human and social capital. [ABSTRACT FROM AUTHOR]

Abstract: Workplaces vary in their ability to recruit and retain workers. We introduce two new concepts which can be used as proxy measures of the relative attractiveness of a particular setting, where setting can be defined narrowly (e.g., a particular organization) or broadly (e.g., a sub-sector). “Stickiness” is defined as the transition probability that an employee stays in a given setting; “inflow” as the proportion of new employees. Using a longitudinal dataset of all nurses registered with the College of Nurses of Ontario, Canada 1993–2003, employment site was used to define consistent sectors and sub-sectors. Each nurse was assigned to one sector/sub-sector per year. Stickiness and inflow values were calculated for each sub-sector, and the trends across time were analyzed. Results show that despite shrinkage in the hospital sub-sectors, hospitals remained highly sticky. The expanding sub-sectors, in general, appear relatively unattractive to nurses; they couple medium/low stickiness with high inflow. Considerable variability across sub-sectors was evident. Stickiness and inflow were found to be useful as proxy measures of the relative attractiveness of the various sub-sectors of nursing employment over time. The concepts may be used for other workforces for which linked longitudinal data are available. [Copyright &y& Elsevier]

Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing. [ABSTRACT FROM AUTHOR]