The declining relative quality of the child care workforce

Assuring quality health care to all children is a challenge to the entire medical community. Working collaboratively in teams is a time-tested approach that brings together the expertise of diverse individuals. Intrinsic in the team concept is that health care is not reduced to an either-or-approach, but is all-inclusive, taking into account the physical, emotional, developmental, cultural, and psychosocial needs of the child and the family.The policy statement, “Scope of Practice Issues in the Delivery of Pediatric Health Care,”1 was developed to serve as an advocacy tool to assist when legislators, policy makers, and other stakeholders deliberate issues of nonphysician scope of practice. Although it is understandable that some would take issue with components of the statement, it is mandatory that such disagreement be founded on a truthful representation of the contents of the statement and on the facts related to education and training of physicians.Mundinger,2 in her commentary, “Toward a Quality Workforce,” mistakenly identifies the health care provided by pediatricians as solely disease-focused, and implies that pediatricians are inadequately educated about health promotion, school-related issues, home care, office-based care, and care in long-term settings. She inaccurately describes residency education as exclusively hospital-based with a focus on acutely and seriously ill children. Obviously, Dr Mundinger would readily acknowledge that pediatricians are the best trained to care for the sickest of children. What she has failed to acknowledge (or to be aware of) is that 50% of the 3 years of pediatric residency training occurs in the ambulatory setting. Residents are required to spend time in community sites, including schools, day care centers, private offices, and public health clinics. Experience in these arenas is not just the purview of nurse practitioners. Even as a resident over 30 years ago, I trained in the community, working in the welfare hotels in New York City as well as the settlement houses.Mundinger also misrepresents the information regarding malpractice suits and suggests that malpractice insurance premiums, which are higher for physicians, are a valid indicator of the potential harm that can accrue to patients from health care practitioners. I hope that Dr Mundinger will acknowledge that physicians care for children with significantly more complex problems, problems that intrinsically put both the physician and patient at greater risk for an adverse outcome.Mundinger also decries the role of telemedicine as a “supervisory method.” Telemedicine is a valuable resource that allows for consultation and advice when health care providers are not in geographic proximity. This tool has been used for years to augment one’s expertise. I would hope that Dr Mundinger would be open to the newer technologies that facilitate collaboration.Education and experience both contribute to the skill set of any clinician. There is no doubt that a pediatric nurse practitioner with 10 years of experience may be better prepared to care for some pediatric patients than a third-year medical student starting a pediatric clerkship.Nurse practitioners are a valuable resource to the entire health care community. Their work and patient care responsibilities should be determined by their skill sets, and institutions should review their credentials as they do the credentials of all practitioners. Nurses who choose to take advanced training including a clinical doctorate degree would expect that their scope of practice be different from those of their nurse practitioner colleagues without such a degree.Collaboration and dialogue will promote quality health care for all children. Let us not be trapped by the tyranny of the “or.” Teamwork, advice, and collaboration work better than fragmentation and factionalization.

The Committee on Pediatric Workforce published a policy statement in the February 2003 issue of Pediatrics that calls for high standards and clear accountability in the care of children.1 In a time when adequate care is threatened because of deteriorating economic resources and fragmented access, and when high-quality and optimal outcomes are increasingly sought by all patients, payors, and providers, a call for excellence is timely and appropriate. The proposed methods to achieve these worthy goals are, however, deeply flawed, particularly as concerns nurse practitioners. Team approaches to pediatric care are fundamental to providing the seamless, comprehensive care required by children and their families. There may be no other group of individuals so in need of the broad scope of care that only a team of diverse specialists can provide. A child’s health needs change as he grows and experiences challenges to optimal well-being; illness and disease are only a small part of those challenges. Therefore, the disease specialist—the pediatrician—merits leadership of the team only when disease is the major concern. At other times, it may be the nurse practitioner or the psychologist or learning specialist who directs the team. And perhaps most important, it may sometimes be the parent. The premise that all non-physician providers can be lumped together leads to several misinterpretations. Nurse practitioners are independently licensed and are distinctive in education and in scope of practice from other disciplines, including medicine. Whereas nursing and medicine have a great deal of overlap (diagnosis and treatment of initially undetected disease or ongoing care of chronic illness), nurse practitioners have additional intensive education in individual risk reduction and prevention strategies, health promotion, and health education, and they have significant supervised clinical training in community sites, schools, long-term care settings, and home care, as well as conventional hospital and office-based … Address correspondence to Mary O. Mundinger, DrPH, Columbia University School of Nursing, 630 W 168 St, Rm 139, New York, NY 10032. E-mail: mm44{at}columbia.edu

State publications

The lesser degree of institutionalization and formalization of HR-practices in small and medium-size enterprises (SMEs) usually leads to them being attested a severe (HR-)Management Deficit. However, the vast majority of these empirical investigations argues from a perspective dominated by the viewpoint of large corporations. As a consequence, the highly differentiated HRM-systems of larger organizations are seen as the desirable ideal for small and medium-size enterprises as well. On the basis of an empirical investigation into the recruitment practices of more than 300 professional service firms the study at hand tries to break from this deficit model. Instead, it is assumed that smaller organizations due to their - size-dependent - different preconditions resort to certain functional equivalents in accomplishing their elementary HR-requirements. It becomes apparent that first and foremost the quality of employee relations has a high impact on various measures of recruitment success in smaller organizations. This applies especially to those businesses that do not have implemented a separate HR-department. Key words: Small and Medium-Size Enterprises, Professional Service Firms, Recruiting 1. Introduction Following the basic argument proposed by the resource based mew, any sustainable competitive advantage will only be realized through the specific utilization and availability of such resources that are valuable, scarce or rare and not easily imitated or substituted by competitors (Barney 1991; Grant 1991; Wernerfelt 1984). In light of these resource characteristics it seems evident to accord a substantial strategic potential to the so called soft factors of management (such as organizational culture, social capital etc.) - and thus the respective human resources available (Colbert 2004; Wright et. al. 2001; Lado/ Wilson 1994). This consideration gains even further importance when looking at small and medium-si^ professional service firms (PSFs). On the one hand, because of their comparatively lesser endowment with material or financial resources, smaller businesses are often highly dependent on an above-averagely motivated and qualified workforce. On the other hand, in the professional service sector - as in no other industry - there exists an extraordinarily close connection between workforce quality and the quality of those external products (or more precisely: services) offered on the market (Alvesson 1995; Cappelli/Crocker-Hefter 1996). Therefore, one can legitimately assume that in these companies the human resources available constitute an especially important prerequisite for sustainable organizational success. Consequently, the recruitment policies deployed by knowledge-intensive professional service firms should be of above-average importance and thus deserve a high level of attention. Against the backdrop of these deliberations most of the pertinent empirical findings regarding recruitment practices in small and medium-size enterprises (SMEs) seem -at first sight - to reveal a substantial management deficit (Holliday 1995; Marlow/Patton 1993; Carroll et. al. 1999; Windolf 1983): Smaller companies often abstain from any systematic and professional approach when selecting new employees. They rarely use any long-term planning of manpower requirements, job profiles etc. and the usage of formal selection instruments is usually limited to the conducting of job interviews. However, the explanatory power of these empirical results has (at least) two major limitations: First, many studies are mainly focusing on SMEs in classic industries. In these companies a lot of jobs are of a relatively simple nature with accordingly less complex skill requirements. They might thus be mapped out quite easily by employing relatively simple recruitment patterns. Under these circumstances and at least from an economic perspective any elaborate and highly differentiated recruitment policy seems less expedient (Martin 1996; Williamson 1981, 1984). …

ABSTRACTCenter-based child care has been struggling with poor health and high turnover rates of child care staff and their adverse impact on care quality for decades. Yet little is known about personal and structural antecedents of job resources and job demands that are valid predictors of health and turnover in the child care workforce. Research Findings: This study investigated job resources and job demands among child care staff of different education levels (491 lead teachers and 310 assistant teachers) from Switzerland. Results from t-tests and hierarchical regression analyses indicated slightly higher job resources and job demands for lead teachers than for assistant teachers but similar antecedents of job resources and job demands. Overall, center characteristics shaped job resources and job demands more strongly than staff characteristics. More specifically, job resources were predicted by structural characteristics associated with professionalism in child care work, whereas job demands were primarily dependent on adequate staffing. Practice or Policy: The findings suggest that center characteristics (e.g., work environment and staffing levels) should be targeted in order to increase job resources and reduce job demands, which would in turn promote health and lower turnover rates among child care staff.

Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

In England, the overwhelming majority (78%) of under fives' nursery places, remains in the private, voluntary and independent (PVI) sector where there is no requirement to employ a qualified teacher. Compared to the maintained state sector early years workforce, this dominant PVI sector tends to be staffed by a poorly qualified workforce. From 2008 the English Government has attempted to raise the qualifications (and therefore the quality) of the PVI early years workforce with the establishment of a lead graduate professional known as the Early Years Professional Status (EYPS). However, Early Years Professionals are only allowed to work in the PVI sector and in Children's Centres (which are state funded) and not in the maintained sector. Based upon five focus group discussions with 26 EYPs and 51 questionnaires in one Local Authority in England, this research critically examines the dilemmas and tensions arising from this recent policy move. The findings suggest that although the status validates some Early Years Professional's pedagogical leadership, nonetheless their professional status remains ambiguous and problematic. The reasons for this include poor and declining pay; a misunderstood and ambiguous professional role and status and increased managerial responsibilities.

Workforce and process quality in early childhood education and care

Not enough of a good thing

At a time of major expansion in `child care' services, the workforce becomes a major issue. Drawing on a number of linked studies of the child care workforce, the article first provides an analysis of the situation of the current workforce, including the highly gendered nature of the work, low pay and high job satisfaction, and how the work is understood. It then considers whether, at a time of increasing demand for workers in both child care and social care work and increasing alternative job opportunities for women, the current situation is sustainable in the longer term. Finally, the article contrasts the reformatory approach of current government policy with a transformatory policy involving another way of understanding and structuring the work, and the emergence of a new `core' early childhood worker to work with children from 0—6 years. This is discussed in the context of the recent integration of responsibility for child care and early education within the education system, and in relation to workforces in other countries that have adopted this integrated approach to policy and provision.

AUSTRALIA IS CURRENTLY WITNESSING considerable change in conceptualisation of the role of child care. This is a response to the strong evidence from developmental science that demonstrates the lifelong impact of early experiences. The recent commitment made by the Council of Australian Governments (COAG) (Communiqué, December 2009a) to improved qualifications and quality of those working in child care is a manifestation of this shift and highlights the importance of the childcare workforce. This study focused on the considerations of a third year cohort of B.Ed (EC) preservice teachers (n = 55), about entering the childcare workforce. It examines their willingness to work in child care and identifies barriers and incentives for so doing. Our results indicate that, although attitudes to maternal work and child care were largely positive, few would prefer to work in child care under the current conditions. Key barriers were the pay and work conditions, particularly as they compare to other forms of potential employment. Incentives were the opportunity for leadership, creativity and a commitment to advocate for the rights of children. Those more willing to consider work in child care were distinguished from those less willing by altruism—foregoing personal gain to advocate for improved quality as a child's right.

Call for Papers - Innovative Professional Learning in Early Childhood Education and Care: Inspiring Hope and Action

ABSTRACTLow retention in the child care workforce is a persistent challenge that has been associated with negative outcomes for children, staff, and centers. This article reviews the empirical literature, identifying common correlates or predictors of retention for child care workers. Searches were conducted using several databases, and articles that presented quantitative or qualitative data on retention for center-based child care workers in the United States were reviewed in detail. Seven themes emerged as potential predictors of retention: wages and benefits, job satisfaction, organizational characteristics, alternative employment opportunities, demographic characteristics, job characteristics, and education and training. Although some of the findings were mixed, increased retention was generally associated with the following: working in a publicly operated or nonprofit center that meets accreditation or policy standards, being older, maintaining a higher-level position, having more tenure and experience, receiving higher wages, and reporting higher job satisfaction. Based on these studies, child care centers should seek to increase pay, recruit staff with more experience, and aim to improve job satisfaction among staff to help increase retention. In addition, government-funded professional development incentive programs may help child care centers meet the goals of a high-quality, educated, and stable workforce.

The paper presents findings from research aimed at identifying effective approaches to the recruitment and retention of child care workers, conducted to assist the UK Government's Childcare Strategy. The paper explores the practices and views of child care employers, Early Years Development and Childcare Partnerships (EYDCPs) and child care workers in a range of settings (including day nurseries, playgroups and out-of-school care). Two key issues explored in the paper are the need for greater employer responsibility for increasing diversity in the child care workforce; and for a stronger emphasis on staff retention, through improved human resource practices in parts of the child care sector.

Current US policies call for a child care teacher workforce that can support program quality and enhance infants’, toddlers’, and preschoolers’ learning and development. Given minimal state pre-hire requirements, this context has implications for the workforce’s in-service training. Yet, there is limited research on who participates in training, the focus of what is offered, and variations in participation rates across topics. Also needed is a better understanding of the role online training might play in meeting the workforce’s in-service needs. To address these interrelated issues, I present descriptive analyses of a convenience sample of aggregate data from a US-wide online child care training provider. Enrollees’ ages and education levels reflect the larger child care workforce. The majority of the offered training is at the beginner level and 1 h in duration. Since 2010, enrollees completed an average of 10–12 online training hours annually. Roughly one-third of the completed training was related to planning a safe, healthy learning environment. These findings suggest the need for more rigorous research on child care workforce participation in training, particularly related to the extent to which online training can respond to policies aimed at enhancing workforce capacity to support program quality and young children’s learning and development.