Retention Difficulties Research Articles

Narrations of race in STEM research settings: Identity formation and its discontents

AbstractThis paper discusses conceptions of identity in relation to science education and presents material from a series of interviews and focus groups with graduate students in science and technology. Given difficulties in retention and levels of significant participation by minority students indicated by aggregate data, the issue of race, as it informs critical interactions at a majority research university, is explored in terms of its effects on identity formation. It is argued that we need to look at “real‐time” science to see how subtle interactions affect minority graduate students. These interactions reveal how identity is established through the positioning inside or outside of the laboratory culture. Three themes were explored regarding the tensions of identity formation in the context of race and science education: (1) the issue of isolation, marginalization, and invisibility; (2) being valued through recognition of one's contributions to the community of scientists; and (3) reading race as an additional burden for minority students. Two participants' stories and their positioning as outsiders are explored in detail. The authors contrast building an identity as a scientist through one's educational experiences against being positioned as the “only one” representing his or her race at a primarily White institution. © 2008 Wiley Periodicals, Inc.Sci Ed93:485–510, 2009

Engaging participants in a complex intervention trial in Australian General Practice

BackgroundThe paper examines the key issues experienced in recruiting and retaining practice involvement in a large complex intervention trial in Australian General Practice.MethodsReflective notes made by research staff and telephone interviews with staff from general practices which expressed interest, took part or withdrew from a trial of a complex general practice intervention.ResultsRecruitment and retention difficulties were due to factors inherent in the demands and context of general practice, the degree of engagement of primary care organisations (Divisions of General Practice), perceived benefits by practices, the design of the trial and the timing and complexity of data collection.ConclusionThere needs to be clearer articulation to practices of the benefits of the research to participants and streamlining of the design and processes of data collection and intervention to fit in with their work practices. Ultimately deeper engagement may require additional funding and ongoing participation through practice research networks.Trial RegistrationCurrent Controlled Trials ACTRN12605000788673

Proactive recruitment in local government

AbstractNew ways of partnership working, new organisational structures, and new role and skill demands are among the challenges facing organisations engaged in commissioning and/or delivering services to local communities. Within this context, local councils have the additional challenges of an ageing workforce, and recruitment and retention difficulties in key service areas and leadership roles. As the pool of appropriately qualified and experienced people shrinks, a competitive market for key professionals has emerged, creating retention problems throughout the UK. Radical changes beyond the scope of individual councils have been required to tackle these shortages and workforce and succession planning have become increasingly important as a result. Supported by national activities, collaboration rather than competition is now occurring to increase supply locally and regionally. Individual employers are also reviewing their existing workforce and creating new pathways to progression in line with new ways...

Proactive recruitment in local government

New ways of partnership working, new organisational structures, and new role and skill demands are among the challenges facing organisations engaged in commissioning and/or delivering services to local communities. Within this context, local councils have the additional challenges of an ageing workforce, and recruitment and retention difficulties in key service areas and leadership roles. As the pool of appropriately qualified and experienced people shrinks, a competitive market for key professionals has emerged, creating retention problems throughout the UK. Radical changes beyond the scope of individual councils have been required to tackle these shortages and workforce and succession planning have become increasingly important as a result. Supported by national activities, collaboration rather than competition is now occurring to increase supply locally and regionally. Individual employers are also reviewing their existing workforce and creating new pathways to progression in line with new ways of working. Examples of national activities and case studies from social care, environmental health and planning are offered as illustrations of these proactive steps.

Clinical and urodynamic outcomes of pubovaginal sling procedure with autologous rectus fascia for stress urinary incontinence

We report the clinical and urodynamic outcomes of the pubovaginal sling procedure with autologous rectus fascia for stress urinary incontinence (SUI) and determined the urodynamic parameters that could predict the occurrence of postoperative voiding difficulty. Between 1998 and 2005, a total of 29 consecutive women with SUI underwent pubovaginal sling surgery with autologous rectus fascia. Patients were preoperatively and postoperatively evaluated with regard to symptoms and urodynamic findings including uroflowmetry (UFM), postvoid residual urine volume (PVR), filling cystometry (CMG) and pressure flow study (PFS). Overall SUI was cured in 23 patients (80%) and improved in 3 patients (10%). Three patients (10%) who developed persistent urinary retention or severe voiding difficulty after surgery underwent urethrolysis. Of 17 patients who had urgency before the pubovaginal sling, urgency was cured postoperatively in seven, while de novo urgency appeared in one patient. Maximum flow rate (Qmax) in UFM was significantly decreased (P < 0.05) and PVR was increased (P = 0.08) after surgery. PFS showed a significant increase in detrusor opening pressure and detrusor pressure at Qmax (P < 0.01) after surgery. Eight patients (28%) needed prolonged intermittent self-catheterization. Patients who had PVR >100 mL (P < 0.05) or Qmax < or = 20 mL/s (P = 0.09) in preoperative UFM were more likely to require prolonged intermittent catheterization after surgery. The pubovaginal sling procedure with autologous rectus fascia is an effective treatment for SUI. A comparison of preoperative and postoperative urodynamic parameters indicates an increase in urethral resistance after pubovaginal sling surgery. PVR >100 mL and Qmax < or = 20 mL/s before surgery are risk factors for postoperative voiding difficulty.

The impact of intermediate care services on job satisfaction, skills and career development opportunities

The purpose of this study was to examine, in depth, the impact of intermediate care services on staff job satisfaction, skills development and career development opportunities. Recruitment and retention difficulties present a major barrier to the effective delivery of intermediate care services in the UK. The limited existing literature is contradictory, but points to the possibility of staff deskilling and suggests that intermediate care is poorly understood and may be seen by other practitioners as being of lower status than hospital work. These factors have the potential to reduce staff morale and limit the possibilities of recruiting staff. The research is based on interviews with 26 staff from case studies of two intermediate care services in South Yorkshire. Participants reported high levels of job satisfaction, which was because of the enabling philosophy of care, increased autonomy, the setting of care and the actual teams within which the workers were employed. For most disciplines, intermediate care facilitated the application of existing skills in a different way; enhancing some skills, while restricting the use of others. Barriers to career development opportunities were attributed to the relative recency of intermediate care services, small size of the services and lack of clear career structures. Career development opportunities in intermediate care could be improved through staff rotations through acute, community and intermediate care to increase their awareness of the roles of intermediate care staff. The non-hierarchical management structures limits management career development opportunities, instead, there is a need to enhance professional growth opportunities through the use of consultant posts and specialization within intermediate care. This study provides insight into the impact of an increasingly popular model of care on the roles and job satisfaction of workers and highlights the importance of this learning for recruitment and retention of staff.

Neuromodulation for Lower Urinary Tract Dysfunction – An Update

The aim of this review is to provide an update on the use of neuromodulation using sacral nerve stimulation for the treatment of disorders of the lower urinary tract. Neuromodulation using the InterStim® system (Medtronic Inc.) is now accepted as an established therapeutic option for patients with detrusor overactivity, and for women with retention or severe voiding difficulties. However, the use of nerve stimulation in modulating lower urinary tract function has to be regarded as a technique that is in its infancy. Much has yet to be learned about the mechanism by which neuromodulation exerts its effects and there is a need to better define the clinical indications for the treatment. There is also work to be done in terms of optimising stimulation delivery, both in anatomical and electronic terms.

Factors shaping Aboriginal nursing students’ experiences

Motivated by a shortage of Aboriginal nurses and recurring difficulties in recruitment and retention of Aboriginal peoples in nursing education, a critical ethnography was conducted to examine the experiences of undergraduate Aboriginal nursing students in two Canadian schools of nursing. We conducted audiotaped interviews with Aboriginal nursing students (n=31), Aboriginal nurses (n=5), nursing faculty members (n=24), and individuals who were identified as knowledgeable about the context that might shape the experiences (n=16). Other data sources included reflexive and descriptive fieldnotes from 200h of fieldwork in classroom and laboratory practice sessions and 135 texts from the participating schools. Nursing textbooks, course syllabi, policies, procedures, clinical evaluation forms and websites were randomly selected and analyzed to explicate how texts shaped the students' experiences. In this paper, we discuss the findings of the study and briefly share our recommendations.

Policy on new workforce roles: A discussion paper

Addressing workforce issues has increasingly become a central feature of the organisation and management of public sector services internationally. The introduction of new work roles to public services is one approach advocated in response to recruitment and retention difficulties with professional staff and to increasingly complex services. This paper aims to critically examine UK's new roles policy in a health care context and explore its wider relevance by drawing on findings from an action research Ph.D. study aimed at exploring one such new role. This deliberately flexible role was held by individuals without a recognised qualification but study findings illustrate that, over the time, the role came to include the complex discharge planning work with patients previously carried out by registered nurses (RNs). The analysis presented highlights shortcomings in current new roles policy including the unacknowledged influence of competing policy goals; the erroneous assumption that defining who does what is clear-cut in practice; the lack of longer-term review of new roles; and the incompatibility between role flexibility and needs for role clarity. Policy makers, managers and practitioners are urged to acknowledge the subtleties and complexities of new work roles in the public sector highlighted by this study.

Factors shaping Aboriginal nursing students’ experiences

Motivated by a shortage of Aboriginal nurses and recurring difficulties in recruitment and retention of Aboriginal peoples in nursing education, a critical ethnography was conducted to examine the experiences of undergraduate Aboriginal nursing students in two Canadian schools of nursing. We conducted audiotaped interviews with Aboriginal nursing students (n=31), Aboriginal nurses (n=5), nursing faculty members (n=24), and individuals who were identified as knowledgeable about the context that might shape the experiences (n=16). Other data sources included reflexive and descriptive fieldnotes from 200 h of fieldwork in classroom and laboratory practice sessions and 135 texts from the participating schools. Nursing textbooks, course syllabi, policies, procedures, clinical evaluation forms and websites were randomly selected and analyzed to explicate how texts shaped the students' experiences. In this paper, we discuss the findings of the study and briefly share our recommendations.

Academic Progress of Community College Nursing Aspirants: An Institutional Research Profile

The community college is a major site preparing students for nursing careers, an important role at a time of a national shortage. However, many of the low socioeconomic status (SES), minority students who aspire to associates degrees in nursing display low levels of academic preparedness. An analysis of 3-year institutional data from a single community college showed that a cohort of nursing aspirants were similar to students in other majors, but developmental-education outcomes differed for successful and unsuccessful students. To address serious difficulties in retention and academic performance found for the group as a whole, a nursing-specific tutoring, advisement, and counseling intervention is recommended.

Job-Housing Mismatch: Affordability Crisis in Surrey, South East England

Rising housing costs and lack of affordable housing in London are affecting labour recruitment and retention, particularly in the public sector—the ‘key-worker problem’ of recent government statements. But housing and labour-market problems are not confined to London. In this paper we highlight the extent and nature of affordability, recruitment, and retention problems in a high-cost location outside the capital: Surrey in South East England. We suggest that changes towards a more professional and managerial workforce have impacted on housing demand and hence prices. Planning and physical constraints have contributed to housing shortages and exacerbated rising housing costs. High housing costs are linked to recruitment and retention difficulties not only for public-sector employers but also for certain types of private-sector employers in Surrey. This raises problems for the sustainability of the local economy. Measures introduced to address these difficulties are helping ‘key workers’ to access housing locally, but this simply bids up house prices rather than increasing the overall supply of housing that is affordable.

Human resource barriers to partnership sourcing in China

Building on previous research on both buyer–supplier relations and human resource management in the PRC, interviews with managers in each of 47 UK-owned PRC subsidiaries were undertaken. The majority of firms are actively pursuing close and cooperative relationships with local suppliers, but there are substantial human resource barriers to the establishment of partnership sourcing arrangements. Grounded analysis reveals key HR barriers to partnership sourcing in the form of difficulties in staff recruitment and retention, problems in cross-cultural communication, poor working practices in supplier firms, and corrupt staff behaviour. This paper describes and analyses these problems, discusses measures that are being taken in an attempt to overcome the problems, and comments on the progress being made towards ‘ideal type’ partnership sourcing arrangements.

‘They survive despite the organizational culture, not because of it’: A longitudinal study of new staff perceptions of what constitutes support during the transition to an acute tertiary facility

Increasing difficulties of recruitment and retention of nursing staff strongly indicate that organizations should identify factors that contribute to successful transition of new staff to the workplace. Although many studies have identified problems facing new staff, fewer studies have articulated best practices. The purpose of this longitudinal study was to ascertain what new staff perceived as supportive elements implemented by the organization to assist their integration. Sixteen staff in Phase I and 12 staff in Phase II attended focus groups. The focus groups at 2-3 months provided specific information, with particular emphasis on negative interactions with other staff members and inadequate learning assistance and support. Different themes emerged within the focus groups at 6-9 months. Staff discussed being 'self-reliant' and 'getting to know the system'. Participants indicated that these skills might be beneficial to new staff in the development of organizational 'know how' and resourcefulness, rather than relying on preceptor support that, unfortunately, cannot be always guaranteed.

Delivering the English smoking treatment services

This paper describes how smoking treatment services in England were delivered beyond the initial set-up phase and explores key factors affecting their development. Services were expected to treat smokers in line with the evidence-base and were issued with government guidance regarding the type of interventions that should be offered. One factor complicating this was the issue of service funding. Funding was initially issued for a 3-year period and although this was extended on two occasions, these extensions were both announced close to the end of funding periods. To critically assess key elements in the delivery of the English cessation services, including the nature of treatments offered and the impact of short-term funding on staffing. A national postal survey of smoking cessation coordinators in April 2002. Semi-structured interviews with 50 smoking cessation staff in two health regions in autumn 2001, followed by further interviews with 28 staff in the same areas in the autumn of 2002. Treatment was delivered in a wide range of venues, ranging from primary care to local authority-owned premises such as town halls and libraries. Most services offered both one-to-one and group support, although interviewees reported an increase in demand for one-to-one support from clients. Pharmacotherapies were used widely; by 2002, 99% of coordinators reported that their advisers recommended nicotine replacement therapy (NRT) to clients, and 95% bupropion. However, prior to April 2001 bupropion was available on prescription, but NRT was not and this variable access to pharmacotherapies posed problems for services. Coordinators reported that the short-term nature of funding made recruiting and retaining staff difficult and interviews revealed that they believed a longer period of protected funding was required for services to demonstrate their effectiveness. As English smoking treatment services developed, lessons were learned that could inform the development of services in other health systems. First, early guidance from government can encourage services to adhere to evidence-based treatment. Secondly, treatment needs to be accessible to smokers and thus there must be a flexible approach to implementation at local level. Thirdly, the availability of nicotine addiction and behavioural therapies should be coordinated to minimize barriers and maximize uptake. Finally, fixed-term funding can exacerbate staff recruitment and retention difficulties and countries establishing treatment services need to consider carefully the initial funding period that is required for stable services to become established within their health systems.

Factors that influence the recruitment and retention of graduate nurses in rural health care facilities

Rural nursing is a distinct practice and rural nurses in Australia constitute the largest group in the rural health workforce. However, the rural workforce is ageing and the turnover of nurses in rural areas is high. In addition, rural health services are experiencing recruitment and retention difficulties; very little is known about the recruitment and retention of new graduates nurses in rural health areas and the potential long-term investment they could offer to rural health services. A qualitative study explored the journey of transition for new graduate nurses employed in graduate nurse transition programs in northern New South Wales. This paper presents two major themes from the study that describe the factors that influenced the new graduate nurse to seek and accept a graduate nurse position within a rural health setting and the factors that influenced their retention. Findings indicate that previous connection with a rural area and positive experiences in a rural health care facility during undergraduate preparation were significant factors influencing the graduate nurses' decision to pursue a rural graduate nurse position. No guarantee of a permanent appointment upon completion of the graduate program, and graduates' disappointment with graduate nurse programs, were important factors influencing their retention within rural health care facilities.

Separate but Equal: The Introduction and Integration of Policewomen in the Bermuda Police 1961–2002

This study examines the introduction, recruitment, and advancement of female sworn officers into the Bermuda Police Service from 1961 until 2002. Female sworn officers were initially appointed in 1961 but were limited to social work functions and later general patrol. Promotions were limited up to the rank of Inspector within a separate Police Women's Department. After 1977, the recruitment of female Bermudian officers increased in response to difficulties in recruitment and retention of Bermudian male officers. Female officers were mainstreamed and gained appointments in operational and support specialist departments. During the 1990s, the introduction of human rights legislation guaranteed female officers equal career opportunities and promotion to management ranks, and female officers were appointed to operational supervisory positions and also broke through the promotions ‘glass ceiling’ and attained command rank of Superintendent. Between 1999 and 2002 a rapid recruitment of female officers resulted in an influx of female junior officers into operational patrol as an integral part of the police service's operational response.

Storm Clouds on the Horizon: The Future of Hospital Pharmacy Management

2revealed that many managers in rural hospitals feel overwhelmed and unable to sufficiently utilize their managerial skills, that the work environment has had a negative impact on morale, that difficulties in recruitment and retention have had a negative impact on departments of pharmacy, and that directors perceive a need for more management training. A recent study confirmed that there are also gaps in the training of US health-system pharmacy managers. 4

Heat-Accelerated Fixation and Rapid Dissection of the Pediatric Brain at Autopsy: A Pragmatic Approach to the Difficulties of Organ Retention

We investigated whether it is possible to accelerate the examination of a pediatric brain at autopsy and thus facilitate its return to the body before a funeral without compromising the quality of the neuropathologic examination. Accelerated fixation and next-day dissection of the brain was performed in selected cases over a 2-year period by using a microwave histologic tissue processor (MicroMed T/T MEGA, Milestone, Sorisole, Italy). Direct comparison of the histologic appearance and immunohistochemical reactivity of 2 cases, 1 fixed by conventional methods and 1 fixed with the accelerated method, was performed in a blinded fashion by a specialist neuropathologist. Examination of rapidly fixed brain by conventional thin coronal sections was readily achieved. There was no appreciable difference between tissue sections stained with hematoxylin and eosin and prepared from conventional formalin-fixed cortical and cerebellar brain tissue and that fixed by rapid heat acceleration. Immunocytochemical studies were not adversely affected by the accelerated heat-fixation process of tissue. Heat-accelerated fixation is a potential method of speeding up the examination of the brain at autopsy without unduly compromising the quality of the neuropathologic examination.

Needs assessment of current pediatric guidelines for use by disaster medical assistance teams members in response to disasters and shelter care

Study objectives: We evaluate the needs of disaster medical assistance teams (DMAT) about personnel recruitment/retention/training, curriculum, and equipment with regard to pediatric patients. Methods: A written survey was mailed to all DMAT teams in the United States in July 2003, with a follow-up mailing in November 2003. Responses were entered into a computerized database and analyzed by SPSS software. Results: Responses were obtained from 38 DMAT team leaders (88.3%, 38/43). Team levels were 1 (77.8%), 2 (11.1%), and 3 (11.1%); 28.9% were members of DMAT specialty teams, including pediatric, burn, cold weather, International Medical Surgical Response Team (IMSuRT), National Medical Response Team (NMRT), NMRT-Hazmat, surgical, and surgical pediatric burn. Responses (mean±SEM) are listed according to a Likert scale of 1 to 6 (1=not at all to 6=a great degree). Responses were as follows. Use Web-based National Disaster Medical Systems (NDMS) curriculum: 4.44 (±0.24). NDMS curriculum meets needs of pediatric patients: 4.71 (±0.30). Team uses standardized curriculum: yes 57.9%. Standardized curriculum meets needs of pediatric patients: 3.33 (±0.25). Include pediatric patients in disaster drill scenarios: 68.6%. Team's preparedness for pediatric patients: 3.91 (±0.22). Medical providers work with pediatric patients daily: 86.1%. How well team responds to a disaster with pediatric patients: 3.94 (±0.31). How well equipped to respond to a disaster with pediatric patients: 3.22 (±0.24). How well is pediatric equipment organized: 3.08 (±0.29). Agree that system needs more pediatric specialty teams: 3.37 (±0.31). Agree that current teams need more pediatric training: 3.68 (±0.34). Pediatric protocols in addition to Jump START (simple triage and rapid treatment): yes 36.1%. How well are pediatric guidelines developed: 3.69 (±0.33). Percentage of providers working with children daily: physicians 44.1% (±6.4), nurses 40.0% (±4.7), midlevel providers (nurse practitioners, physician assistants) 44.1% (±6.4), paramedics 59.2% (±6.1), respiratory therapists 51.9% (±7.3). Additional responses are listed in Tables 1 through 5. Conclusion: Emergency physicians compose about three quarters of all the DMAT physicians. Most DMAT team leaders and DMAT teams use the NDMS curriculum but believe that the curriculum in regard to pediatrics could be improved. Recruitment of medical personnel at all levels is difficult, although once they are involved, retention is still a concern but somewhat less of a problem. Although most DMAT providers work with pediatric patients daily (86.1%) and include pediatric patients in disaster drill scenarios (68.6%), some pediatric topics are missing from the curriculum (are included only 27.8% to 41.7% of the time), and there are needs for various pediatric equipment with some equipment (eg, pediatric backboards) only available 37.8% of the time.Table 1, abstract 112.Difficulty in recruitment of DMAT team membersMedical Staff in General, Mean (±SEM)Medical Staff With Pediatric Experience, Mean (±SEM)Physicians4.31 (±0.28)4.29 (±0.30)Nurses3.53 (±0.24)3.74 (±0.25)Midlevel providers3.77 (±0.26)4.15 (±0.23)Paramedics2.72 (±0.27)3.85 (±0.27)Respiratory therapists3.75 (±0.24)4.00 (±0.30) Table 2, abstract 112.Difficulty in retention of DMAT team members.Medical Staff in General, Mean (±SEM)Medical Staff With Pediatric Experience, Mean (±SEM)Physicians3.94 (±0.31)3.94 (±0.31)Nurses3.29 (±0.27)4.00 (±0.30)Midlevel providers3.41 (±0.28)3.50 (±0.30)Paramedics3.10 (±0.29)3.10 (±0.29)Respiratory therapists3.63 (±0.31)3.63 (±0.31) Table 3, abstract 112.Physician specialization of DMAT physicians.Field% of Physicians Specialized in the Following Fields, Mean (±SEM)RangeEmergency medicine74.2 (±3.9)(0–100)Pediatric emergency medicine35.1 (±7.3)(0–100)Pediatrics25.5 (±9.8)(0–100)Family medicine19.5 (±5.1)(0–100)General surgery26.9 (±7.4)(0–100)Pediatric surgery30.7 (±8.6)(0–100)Orthopedics15.4 (±7.1)(0–100)Pediatric psychiatry22.2 (±7.6)(0–100)Anesthesiology with pediatric experience20.8 (±8.6)(0–100)Pediatric intensivist14.4 (±7.7)(0–100) Table 4, abstract 112.Pediatric equipment that the DMAT team has.EquipmentYes, %No, %Airway/intubation83.816.2Backboard37.862.2Cervical collars62.237.8Pediatric IV73.027.0Interosseous devices73.027.0Pediatric medications62.237.8Broslow tape54.145.9 Table 5, abstract 112.Pediatric topics missing from the DMAT team's curriculum.^∗TopicYes, %No, %Pediatric airway and respiratory issues27.882.2Pediatric trauma and shock33.366.7Disaster triage for pediatrics36.173.9Pediatric burn management41.768.3Pediatric pain management41.768.3Psychosocial/mental health issues41.768.3Pediatric mock code practice41.768.3∗Other: General pediatric medicine, developmental milestones.