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Title. Retaining older nurses in primary care and the community. Aim. This paper is a report of a study conducted to examine issues associated with the impact of age on the retention of female primary and community care nurses in the National Health Service in England. Background. Little is known about why older nurses in the primary and community care workforce leave and what might encourage them to stay. Methods. A cross-sectional survey using a semi-structured postal questionnaire was carried out during 2005. Responses were received from 485 (61%) district nurses, health visitors, school nurses and practice nurses in five primary care trusts in England. Data were analysed to test for associations. Results. Older nurses were more likely than younger ones to report that their role had lived up to expectations ( P = 0·001). Issues important for older nurses were feeling valued and being consulted when change was implemented. Important factors encouraging nurses to stay were pension considerations, reduced working hours near retirement, and reduced workload. For those with degree-level qualifications, enhanced pay was a factor encouraging retention ( P = 0·044). Nurses might leave in response to high administrative workloads, problems in combining work and family commitments ( P <= 0·001), and lack of workplace support ( P = 0·029). Retirement and pensions advice was not widely available. Conclusion. Since two-thirds of nurses were generally happy in their role, it is important that the conditions necessary to maintain this level of satisfaction are continued throughout a nurse's working life. Nurses may all too easily consider leaving prematurely unless policy makers and managers ensure that their working environment reflects the issues nurses consider to be conducive to retention. [ABSTRACT FROM AUTHOR]

Background: Policymakers use clinical and cost-effectiveness evidence to support decisions about health service commissioning. In England, the National Institute for Health and Care Excellence (NICE) recommend that in cost-effectiveness analyses "effectiveness" is measured as quality-adjusted life years (QALYs), derived from health utility values. The impact of perinatal death (stillbirth/neonatal death) on parents' health utility is currently unknown. This knowledge would improve the robustness of cost-effectiveness evidence for policymakers., Objective: This study aimed to estimate the impact of perinatal death on parents' health utility., Methods: An online survey conducted with mothers and fathers in England who experienced a perinatal death. Participants reported how long ago their baby died and whether they/their partner subsequently became pregnant again. They were asked to rate their health on the EQ-5D-5L instrument (generic health measure). EQ-5D-5L responses were used to calculate health utility values. These were compared with age-matched values for the general population to estimate a utility shortfall (i.e. health loss) associated with perinatal death., Results: There were 256 survey respondents with a median age of 40 years (IQR 26-40). Median time since death was 27 months (IQR 8-71). The mean utility value of the sample was 0.774 (95% CI 0.752-0.796). Utility values in the sample were 13% lower than general population values (p < 0.05). Over 10 years, this equated to a loss of 1.1 QALYs. This reduction in health utility was driven by anxiety and depression., Conclusions: Perinatal death has important and long-lasting health impacts on parents. Mental health support following perinatal bereavement is especially important., (© 2024. The Author(s).)

Background: Following a perinatal death, a formal standardised multi-disciplinary review should take place, to learn from the death of a baby and facilitate improvements in future care. It has been recommended that bereaved parents should be offered the opportunity to give feedback on the care they have received and integrate this feedback into the perinatal mortality review process. However, the MBRRACE-UK Perinatal Confidential Enquiry (2015) found that only one in 20 cases parental concerns were included in the review. Although guidance suggests parental opinion should be sought, little evidence exists on how this may be incorporated into the perinatal mortality review process. The purpose of the PARENTS study was to investigate bereaved parents' views on involvement in the perinatal mortality review process., Methods: A semi-structured focus group of 11 bereaved parents was conducted in South West England. A purposive sampling technique was utilised to recruit a diverse sample of women and their partners who had experienced a perinatal death more than 6 months prior to the study. A six-stage thematic analysis was followed to explore parental perceptions and expectations of the perinatal mortality review process., Results: Four over-arching themes emerged from the analysis: transparency; flexibility combined with specificity; inclusivity; and a positive approach. It was evident that the majority of parents were supportive of their involvement in the perinatal mortality review process and they wanted to know the outcome of the meeting. It emerged that an individualised approach should be taken to allow flexibility on when and how they could contribute to the process. The emotional aspects of care should be considered as well as the clinical care. Parents identified that the whole care pathway should be examined during the review including antenatal, postnatal, and neonatal and community based care. They agreed that there should be an opportunity for parents to give feedback on both good and poor aspects of their care., Conclusion: Parents were unaware that a review of their baby's death took place in the hospital. Parental involvement in the perinatal mortality review process would promote an open culture in the healthcare system and learning from adverse events including deaths. Further research should focus on designing and evaluating a perinatal mortality review process where parental feedback will be integral.

Purpose: Research Governance has been introduced to regulate research involving National Health Service (NHS) patients and staff but the process is lengthy and bureaucratic and has improved little since its introduction. The paper seeks to investigate changes over time., Design/methodology/approach: A comparison between two studies, one in 2003-2004 and the second in 2004-2005, provided the opportunity of observing the process of Research Governance as it was developing. Both studies included postal questionnaire surveys and interviews with study participants., Findings: In order to achieve Research Governance approval, application forms have to be completed, reviews undertaken, sponsors and indemnity information identified and honorary contracts from individual PCTs applied for. Honorary contracts can require references and health and Criminal Records Bureau checks. The process reduces the time available for research and employs large numbers of people, yet is still inefficient. Some of the requirements reduce the quality of the research and researchers' rights are marginalised., Research Limitations/implications: The studies took place in a rapidly changing research environment. Further studies should continue to assess the situation and report any progress in making Research Governance less onerous for researchers., Practical Implications: There is an urgent requirement to investigate how procedures can be simplified and made less bureaucratic and costly, and to protect the rights of researchers. Without this, primary care research will be seriously disadvantaged and may become impossible to pursue., Originality/value: The study compares process over time and shows that achieving Research Governance approval is seriously limiting research in primary care.