Future Workforce Planning Research Articles

A study to determine the three-dimensional (3D) facial shape characteristics for a successful FFP3 mask fit

A reported 20% of dental staff will fail their fit test for a disposable FFP3 respirator. This needs to be factored into future pandemic workforce and PPE supply planning. At present there are no scientifically or universally accepted facial shape criteria to design and produce facial masks that will fit the entire work force. This study presents differences in facial shape, volume and surface area between individuals who passed on several FFP3 masks (pass group) and participants who passed on only one FFP3 mask (fail group). Three dimensional images of 50 individuals, 25 in each group, were taken at rest and at maximum smile using a DI4D SNAP 6200 camera system. The images were processed, and four “average faces” were produced—pass group at rest, fail group at rest, pass group at maximum smile and fail group at maximum smile. Simple Euclidian linear and angular measurements, geodesic surface distances and volume and surface area enclosed within the mask were analysed. The results of the study show that individuals who are more likely to pass a mask fit test have longer faces, wider mouths, greater geodesic surface distances and a greater volume and surface area of soft tissue enclosed within the mask boundary. This would suggest that some manufactures masks may be too large, and they need to reduce the size of their masks or produce a category of sizes, accepting the fact that one size does not fit all.

Clinical care ratios for, and tasks undertaken by, allied health professionals: A scoping review of the literature.

With the increasing demand on the global health system and the presence of persistent healthcare disparities, it becomes imperative to utilize the full potential of the healthcare workforce, including allied health professionals (AHPs). To date, no review has mapped the literature on clinical care ratios (CCRs) for AHPs. This information is vital in guiding future work-force planning to address healthcare issues such as understaffed and at capacity hospitals. This scoping review mapped available evidence to offer a comprehensive insight into current AHP CCRs, enabling evidence-based decision-making that ensures optimal care and enhanced system efficiency. The scoping review was undertaken using the 'Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews' (PRISMA-ScR). The search was conducted using Ovid (MEDLINE, Embase, Emcare, PsycINFO), CINAHL, the Cochrane Library, Scopus, PEDro, OTseeker and grey literature. Two reviewers independently screened records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarize the data. Of the 7670 records identified, 18 studies were included in this review. Whilst there was variability between AHPs on direct clinical time spent with patients, considerable amount of time was also spent on activities beyond direct clinical care. To offset this, literature highlights opportunities for allied health assistants and students to undertake tasks which would free-up AHPs to undertake more direct and higher-level tasks. However, limitations of findings (variability in measurement, lack of coverage of some professions) limits generalisability. While the literature highlights considerable variability in CCRs among different AHP disciplines, it does appear nearly a nearly a third of time spent by AHPs are on tasks that are beyond direct clinical care. Future research could explore new workforce models which would free-up AHPs to undertake more direct and higher-level tasks.

A Cross-Sectional Study of the Current and Future Dental Hygiene and Dental Therapy Student Workforce in the UK and Ireland During 2022-2025: Considering Facilitators and Barriers to the Growth of This Workforce.

With evidence suggesting that dental hygienists (DH) and dental therapists (DThs) can undertake a significant proportion of routine clinical work, this paper explores the number of recent graduates and students currently in training in the UK and Ireland and considers whether there are sufficient DH and DTh registrants to positively impact on population needs. An online questionnaire survey was distributed by the Directors of Dental Hygiene and Therapy Group to all programme leads of dental hygiene and dental therapy programmes during December 2023. There was a 100% response rate. The majority of programmes award a Bachelor's degree, with a minority offering a Diploma or Foundation degree; one programme awards an MSc level qualification. The number of graduates in the 2022-2023 academic year was 429, registered with both the General Dental Council (GDC) and Dental Council of Ireland (DCI). The numbers of DH students expected to graduate in 2023-2024 academic year is likely to increase by 44% and in 2024-2025 this will increase by a further 12% compared to the previous year. The anticipated numbers of DTh graduates registering across the UK in 2023-2024 academic year is 312, representing in a slight decrease of 3% from the previous year; in 2024-2025 this figure is expected to remain static at 313. The results of this study demonstrate the numbers of students recently graduated and in training in the UK and Ireland, during 2022-2025. The numbers of registrants is slightly increasing, but there is a need for detailed information regarding working practices to inform future workforce planning; this will inform the need for increasing training numbers.

WP4.19 - The Emergency General Surgeon: what is their current operative role?

Abstract Aims Determine the current operative role of dedicated Emergency General Surgery (EGS) surgeons in the United Kingdom (UK) and the Republic of Ireland (ROI). Methods A live interactive online survey, designed and endorsed by ASGBI, was completed by attendees at two ASGBI conferences in 2023. The study was conducted according to CHERRIES and exempt from REC according to HRA. Consent was obtained from study participants, who were asked which surgeons usually perform the most common EGS operations in their hospital. Results The survey was completed by 156/371 eligible participants, of which 132 responses were analysed once duplicate responses (n=16), and non-UK/ROI respondents (n=8), were excluded. Participants included consultants (34%), surgical trainees (42%), and other doctors (23%), 61% were male and 39% were female, aged between 25 and 69. The general surgeon on-call – or a dedicated EGS surgeon, where such service exists – operates on the majority of EGS pathology through an un-selected take. A surgeon with the relevant sub-specialty interest usually operates on emergency non-traumatic complex upper gastrointestinal or colorectal pathology. These include emergency colonic resections for cancer or inflammatory bowel disease, and operations for gastric volvulus, bariatric complications, and Boerhaaves. Acute cholecystectomy forms a major part of a dedicated EGS surgeon’s practice. Conclusions Dedicated EGS surgeons deliver a wide variety of operations, in addition to the peri-operative management of acute surgical patients. Future curriculum design and NHS workforce planning should reflect this service delivery pattern, should EGS become a recognised specialty interest.

Exploring the relationship between cultural and structural workforce issues and retention of nurses in general practice: A qualitative study protocol.

The aim of this study is to understand factors that challenge retention and support nurses to stay in general practice. One in four general practice nurse positions in England expected to be left unfilled within the next 10 years. Cultural and structural issues associated with working in general practice have been linked with nurses leaving general practice, re-evaluating their professional futures, adjusting work-life balance and bringing forward retirement. This has implications for the future of the general practice nursing workforce and patient care more broadly. Exploratory qualitative interview study funded by the General Nursing Council Trust for England and Wales. University of York ethics approval (Ref: HSRGC/2023/586/A) was gained in September 2023. The study will be conducted between September 2023 and August 2024. Qualitative interviews will be conducted with a range of nurses working in, or who have worked in, general practice as well as nurse leaders associated with general practice across England and Wales. Recruitment will be via professional and social media networks and snowballing techniques. We aim to purposively recruit 30-40 participants for maximum variation. Cultural and structural influences which may contribute to retention decisions will be explored. Data will be analysed following framework analysis. This study will explore how underpinning cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention. By exploring factors that support or discourage nurses to remain in general practice, retention strategies can be better planned on order to address the general practice nursing workforce crisis. What problem did the study address? This study will address the retention crisis in nursing in general practice by exploring how cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention. Where and on whom will the research have an impact? From the study findings, recommendations will be developed to inform future policy and practice. Key factors to address attrition will be generated to support employers and policy makers in future primary care workforce planning, as well as supporting nurses, at an individual level, in negotiating their roles in practice. Standards for Reporting Qualitative Research (O'Brien etal., 2014). As this is a workforce study protocol, there is no patient or public contribution.

Understanding attrition of early career midwives in Australia

ProblemThere is a lack of understanding of the experiences of early career midwives which lead to workforce attrition. BackgroundIn the Australian midwifery setting, workforce attrition in conjunction with the ageing profile of the workforce is of increasing concern. Midwives in the earliest stages of their career are most vulnerable to career attrition, however limited research specifically engages with this cohort. AimTo understand the professional and social circumstances that led early career midwives to leave clinical practice, how their midwifery background influenced career trajectories, and what would compel them to return to clinical practice. MethodsSemi-structured interviews were conducted with 11 early career midwives who had left the profession within 5 years of qualification. Transcripts underwent thematic analysis. FindingsThree themes described early career midwives’ experiences: transition to professional practice, an untenable workplace culture, mental health impacts of early clinical midwifery practice. Two further themes emerged about experiences post-midwifery careers: influence of midwifery on subsequent career, and conditions for re-entry. DiscussionChallenges with transitioning to professional midwifery practice in conjunction with untenable workplace culture led to such deterioration in wellbeing that remaining within the profession became unfeasible for early career midwives. Desire to remain within health care was apparent, however re-entry to the profession was deemed by most to be out of the question. ConclusionEarly workforce retention strategies should be the focus of future workforce planning and policy. Larger scale inquiry foregrounding early career midwives is necessary to inform strategies for midwifery workforce retention in Australia.

What is the appropriate measure of radiology workload: Study or image numbers?

Previous studies assessing the volume of radiological studies rarely considered the corresponding number of images. We aimed to quantify the increases in study and image numbers per radiologist in a tertiary healthcare network to better understand the demands on imaging services. Using the Picture Archiving and Communication System (PACS), the number of images per study was obtained for all diagnostic studies reported by in-house radiologists at a tertiary healthcare network in Melbourne, Australia, between January 2009 and December 2022. Payroll data was used to obtain the numbers of full-time equivalent radiologists. Across all modalities, there were 4,462,702 diagnostic studies and 1,116,311,209 images. The number of monthly studies increased from 17,235 to 35,152 (104%) over the study period. The number of monthly images increased from 1,120,832 to 13,353,056 (1091%), with computed tomography (CT) showing the greatest absolute increase of 9,395,653 images per month (1476%). There was no increase in the monthly studies per full-time equivalent radiologist; however, the number of monthly image slices per radiologist increased 399%, from 48,781 to 243,518 (Kendall Tau correlation coefficient 0.830, P-value < 0.0001). The number of monthly images per radiologist increased substantially from 2009 to 2022, despite a relatively constant number of monthly studies per radiologist. Our study suggests that using the number of studies as an isolated fundamental data set underestimates the true radiologist's workload. We propose that the increased volume of images examined by individual radiologists may more appropriately reflect true work demand and may add more weight to future workforce planning.

Understanding the factors associated with nurse employment in clinics: Experiences in Taiwan.

The shortage and distribution of nurses affect healthcare access in aging societies. Limited research has explored the nursing workforce in clinics, which is vital for healthcare delivery. This study aimed to investigate the shortage and distribution of nurses in clinics in Taiwan, considering geographical, institutional, and specialty variations. We conducted a cross-sectional analysis of the national nursing workforce in Western medicine clinics in Taiwan using open government data. The nursing practice rate (NPR) was calculated. The ratio of clinics employing nurses (RCN) was determined by calculating the percentage of clinics with nurses in each category. A logistic regression model was fitted to examine the factors associated with nurse employment, including urbanization level and different specialty clinics. Adjusted odds ratios (OR) and 95% CIs were calculated. The study revealed an overall NPR as low as 59.1%, and a decreasing trend with age. Among the 11 706 clinics in the study, nearly a quarter did not employ nurses, with an overall RCN of 72.3%. Urbanization level and clinic specialty were associated with nurse employment ( p < 0.05). After adjusting for urbanization level, the fitted regression model identified the top three specialties as plastic surgery (OR = 11.37, RCN = 96.8%), internal medicine (OR = 1.94, RCN = 84.1%), and orthopedics (OR = 1.89, RCN = 83.6%), while the bottom three were otolaryngology (OR = 0.59, RCN = 61.5%), psychiatry (OR = 0.49, RCN = 57.1%), and rehabilitation medicine (OR = 0.30, RCN = 45.2%). Nurses were more likely to be employed in areas at urbanization level 1 (OR = 1.17), 3 (OR = 1.37), and 6 (OR = 1.48), which represent highly urbanized areas within the urban, suburban, and rural categories, respectively, than in urbanization level 4. Clinics in Taiwan showed nursing shortages and maldistribution, with 72.3% RCN and variations based on urbanization and specialty. These factors may be considered in nursing research conducted in other countries to inform future workforce planning.

Reducing general anaesthetic episodes: 'piggyback' procedures - Birmingham Children's Hospital experience.

Introduction Birmingham Children's Hospital (BCH) has a well-established care pathway for joint procedures - 'piggybacks' - under general anaesthetic (GA). The premise behind these joint procedures is that dental treatment is undertaken at the same time as another planned GA, usually completed by the patient's primary medical or surgical specialty, or another speciality attending a dental GA list.Aim The aim of this paper is to share the recent BCH experience of joint procedures and provide a model for secondary and tertiary care providers across the UK to develop their own collaborative working approaches.Method Data were collected retrospectively from May 2021 to May 2023 on the department of paediatric dentistry at Birmingham Children's Hospital. Patients were included if they had any joint procedure undertaken.Results In total, 93 patients were treated as a 'piggyback' procedure during this period. The average age of patient treated was nine years and three months. A total of 39 patients had extractions only during this period, while 19 had scaling only and 12 had both scaling and extractions. Additionally, 269 primary teeth and 22 permanent teeth were extracted during this period.Conclusion BCH has a well-established pathway of care for 'piggyback' procedures. Future workforce planning and patient care pathways should consider joint procedures and further explore this initiative to continue to streamline patient care and reduce waiting lists and risks associated with GA.

The role of multidisciplinary team meeting histopathology review and its impact on revised reports: Analysis of a national quality improvement program.

We conducted the first Irish national study assessing the value of multidisciplinary team meeting review in pathology practice and its impact on error detection before treatment. Public and private pathology laboratories across Ireland capture their quality activities using standardized codes and submit their data to a centralized database (National Quality Assurance Intelligence System) overseen by the National Histopathology Quality Improvement (NHQI) program. A total of 1,437,746 histopathology and cytopathology cases submitted to the NHQI program over a 60-month period (January 2017 to December 2021) were included in this study. Cases were analyzed with respect to multidisciplinary team meeting peer review and the presence of a revised report (amended or corrected report), a surrogate marker for error detection before treatment. Across all cases assessed, 13.74% (197,587) underwent multidisciplinary team meeting discussion. Cases discussed at review had a statistically significantly higher rate of revised reports (1.25% [2470]) than cases not discussed at review (0.16% [1959]) (Pearson χ2, 6619.26; P < .0001; odds ratio, 8.00 [95% CI, 7.54-8.49]). Overall, multidisciplinary team meeting review made it 8 times more likely to detect an error before treatment. Cancer resections had the highest rate of review at 55.29% (46,806), reflecting the prioritization of oncology case discussion at review meetings. The multidisciplinary team meeting review process plays a valuable role in pathology error detection. A pathologist's participation in the review process comes with a clinically significant workload that needs to be recognized for future workforce planning. This study highlighted the positive role pathologists play in enhancing patient safety.

Global Nursing Shortage: Future Challenges

The global nursing shortage poses a significant challenge to future healthcare workforce planning, highlighting the urgent need for strategic endeavors to address this issue. The shortage of nurses is exacerbated by a significant increase in the shortage of nurses and the elderly nursing workforce. Furthermore, many health problems in the healthcare industry affect their well-being and negatively affect their performance. Moreover, there is a recognized worldwide shortage of nurse educators. The search for workable solutions for nurses' health can significantly improve morale, recruitment, and retention. A short-term and long-term solution is now needed to prevent the escalation of the shortage of nursing staff. This article delves into the myriad factors contributing to the increasing deficit of nurses on a global scale, the implications of these deficiencies on patient care, and the multifaceted challenges that we can expect to encounter in the future. The article aims to catalyze policymakers, healthcare providers, and leaders across the globe to navigate the complex world of healthcare staffing and provide plans for effective reform.

Safeguarding nursing homes in a pandemic: lessons learnt and implications for future workforce planning and development.

Introduction: COVID-19 posed formidable challenges to Singapore’s nursing home (NH) sector. Singapore’s swift implementation of non-pharmaceutical interventions, staff management protocols, and rapid rollout of vaccinations and therapeutics successfully limited COVID-19 mortality and morbidity in the sector. Additionally, the pandemic highlighted the need to strengthen workforce resilience in a crisis. In this study, we identify challenges, opportunities and ways forward to inform the NH sector’s preparation for future outbreaks and ensure sustainability of actions. Here, we present findings on workforce capacity and capability-building.&#x0D; Methods: We conducted a qualitative study in two parts to characterise the pandemic response in NHs in Singapore: (i) A rapid review of peer-reviewed and grey literature, including media reports, policy documents, and advisories to synthesise the public health measures implemented from Jan 2020 to Jun 2021 and (ii) n=42 semi-structured in-depth interviews with key stakeholders working in the NH, public health, healthcare, and integrated care sectors, with interview data thematically analysed. &#x0D; Findings: The key challenges identified were NH sector reliance on foreign manpower, early introduction of interventions to curb transmission risks that were maintained for longer than restrictions in community settings, and high resource demands to facilitate implementation of and compliance to restrictions. Care staff reported fatigue, fear, and anxiety. Alongside, strict border controls, quarantine measures, and staff segregation policies limited the NH sector’s ability to flexibly respond to manpower attrition. &#x0D; To cope with these challenges, NHs upskilled junior staff and cross-trained non-nursing staff to take on reassigned tasks and built new capabilities across surveillance and testing. Public hospital manpower supported the NH sector with infection prevention and control advice, tele-consultations, and knowledge-sharing on case management and diagnostics. &#x0D; Opportunities for COVID-19 collaboration between the NH sector and health and integrated care agencies were grounded in social capital accumulated over many years of inter-agency partnerships and collaboration. Boundarylessness and open communication between organisations/agencies facilitated timely decision-making, information sharing, and flexible deployment of resources, including additional funding support. &#x0D; Ways forward: Moving forward, findings pointed to the pandemic providing impetus to build a strong local manpower core, invest in schemes to boost competitiveness and attractiveness, consider a review of existing staffing models, and increase resourcing support to enable the NH sector to keep up with policy changes and future demands. Findings also suggested the importance of greater investment into supporting healthier work environments and prioritising staff mental and physical health.

The MidPIC study: Midwives’ knowledge, perspectives and learning needs regarding preconception and interconception care

Preconception and interconception care improves health outcomes of women and communities. Little is known about how prepared and willing Australian midwives are to provide preconception and interconception care. The aim of this study was to explore midwives’ knowledge, perspectives and learning needs, and barriers and enablers to delivering preconception and interconception care. We conducted a cross-sectional exploratory study of midwives working in any Australian maternity setting. An online survey measured midwives’ self-rated knowledge; education needs and preferences; attitudes towards pre and interconception care; and views on barriers, enablers; and, future service and workforce planning. Quantitative data were analysed descriptively and demographic characteristics (e.g., years of experience, model of care) associated with knowledge and attitudes regarding pre- and interconception care were examined using univariate logistic regression analysis. Qualitative data were captured through open-ended questions and analysed using inductive content analysis. We collected responses from (n = 338) midwives working across all models of care (full survey completion rate 96%). Most participants (n = 290; 85%) rated their overall knowledge about pre and interconception health as excellent, above average or average. Participants with over 11 years of experience were more likely to report above average to excellent knowledge (OR 3.11; 95% CI 1.09, 8.85). Online e-learning was the most preferred format for education on this topic (n = 244; 72%). Most (n = 257; 76%) reported interest in providing pre and interconception care more regularly and that this is within the midwifery scope of practice (n = 292; 87%). Low prioritisation in service planning was the most frequently selected barrier to providing preconception and interconception care, whereas continuity models and hybrid child health settings were reported as enablers of pre and interconception care provision. Findings revealed that midwives are prepared and willing to provide preconception and interconception care. Pre and post registration professional development; service and funding reform; and policy development are critical to enable Australian midwives’ provision of pre and interconception care.

Rural longitudinal integrated clerkships and medical workforce outcomes: A scoping review

Introduction Internationally the medical workforce is suffering from a persistent geographic and specialist maldistribution. Longitudinal models of rural medical education such as longitudinal integrated clerkships (LIC) have been one of the strategies employed to redress this issue. Aim To map and synthesise the evidence on the medical workforce outcomes of rural LIC graduates, identifying gaps in the literature to inform future research. Methods This review followed Arksey and O’Malley’s methodological steps. Databases searched included Medline, CINAHL Complete (EBSCOhost), Scopus, Embase (Elsevier), and ISI Web of Science. Results A total of 9045 non-duplicate articles were located, 112 underwent a full review, with 25 articles meeting the inclusion criteria. Studies were commonly cohort-based (84%), with data collected by database tracking and data linkage (52%). Five themes were identified to summarise the studies: (i) Overall geographic workforce outcomes (ii) influence of non-LIC medical training, (iii) remaining in region and level of rurality, (iv) medical speciality choice and rurality, and (v) selection and preferences. Conclusion Synthesis of the evidence related to workforce outcomes of rural LIC graduates provides directions for future rural medical workforce planning and research. While rural LIC graduates were found to be more likely to work rurally and in primary care specialities compared to graduates from other training pathways there is evidence to suggest this can be enhanced by strategically aligning selection and training factors.

Expectations of radiographer reporting roles: A multimethod evaluation across a single imaging network

IntroductionPrior studies have demonstrated inconsistent development and utilisation of radiographers in the reporting of radiographs, and there is ongoing consideration of the level at which such radiographers should be educated to and operating at. This study aimed to explore and evaluate expectation and utilisation of radiographers currently, or training in, reporting in projection radiography across one integrated care system (ICS). MethodsA multi-method approach was utilised, with document analysis of projection radiography reporting role job descriptions and person specifications and an online survey of managers and clinical leads. A single ICS in the north of England formed the setting for the study. ResultsThis study demonstrated variation in implementation and utilisation of the role across trusts within the ICS. Inconsistencies in scope, expected underpinning education and role activity were identified. Radiographers autonomously reporting in projection radiography were titled advanced practitioners, however are not expected to achieve national educational standards for such roles and are not empowered to work at this level of practice by their employers. It was acknowledged that staffing pressures hinder appropriate role utilisation and reporting capacity. ConclusionInconsistent development and utilisation of radiographers in such roles may hamper collaboration and service delivery across a network. Identifying variation and working towards role standardisation could promote cross-organisational working and improve career progression opportunities. Implications for practiceScoping the reporting radiographer workforce may assist and guide future imaging service and workforce planning.

Experiences of nurses and midwives with disabilities: A scoping review.

To identify the extent and type of evidence exploring the workplace experiences of nurses and midwives with disabilities. Scoping Review. Four electronic databases were systematically searched in February 2022 to identify studies discussing the experiences of nurses and midwives with disabilities, published between 2012 and 2022. Google Scholar and Theses Global were also searched. All search results, irrespective of their format, were uploaded to Covidence to assist with the selection of evidence. Studies discussing the experiences of nurses and midwives with disabilities were included. Two reviewers conducted screening and data extraction independently, and a third reviewer resolved conflicts. Searches identified 130 studies. After screening for title and abstract, full-text review identified 23 studies for data extraction and analysis. Data were summarized and presented in tabular form under two categories (1) workplace experiences and (2) impact in the workplace. Results were presented in a descriptive, narrative form with accompanying tables. The nurse or midwife can be impacted significantly by disability. Currently, little is known about the workplace experiences of nurses and midwives with disabilities. Therefore, a better understanding of the experiences of the nurse and midwives with disabilities is important to increase diversity, equity, accessibility, and inclusion. Shortage of nurses and midwives worldwide highlights the need to understand why nurses and midwives with disabilities decide to leave the profession. Further research exploring the experiences of nurses or midwives with disabilities will help identify support requirements, develop frameworks for reasonable adjustment accommodations, and assist with future workforce planning. The EQUATOR guidelines for PRISMA have been met. No Patient or Public Contribution.

Experiences of nurse practitioners working during the COVID-19 pandemic: A metasynthesis of qualitative studies.

The impact of the COVID-19 pandemic forced global changes to how nurses practice. Nurse practitioners deviated from their scope, changed how they delivered their service, and worked with limited resources. For some services, patient access was also compromised. To synthesize, combine, and present current evidence on the experiences of nurse practitioners working during the COVID-19 pandemic. CINAHL, Embase, and MEDLINE electronic databases were used to perform a structured search strategy. During the COVID-19 pandemic, health care services had to leverage their workforce skills to accelerate COVID-19 identification, treatment, and care. Nurse practitioners rapidly found themselves at the forefront and were concerned about infecting others. They also identified the need for support and were able to adapt to the changing environment. Nurse practitioners also recognized the impact on their well-being. Having insight into nurse practitioner's experiences during the pandemic is valuable for future health care workforce planning. Understanding how they coped will help with critical preparedness and response actions to other health care crises. Having insight into nurse practitioner's experiences during the pandemic is valuable for future health care workforce planning because, as we know, the nurse practitioner workforce is one of the most rapidly growing professions in primary health care. Any future work in this space will help inform future nurse practitioner education and also help by informing critical preparedness and response actions to future health care crises, whether global or local or clinical or nonclinical.

An Exploratory Analysis of the Association Between Hospital Labor Costs and the Quality of Care.

The competent healing touch of a caregiver is a critical component to the care patients receive. The more skilled the provider, the higher the likelihood outcomes will be delivered in a safe and effective manner. Unfortunately, in recent years, hospitals in the United States have faced immense financial pressures that are threatening their economic sustainability and patients' access to care in the future. Through the recent COVID-19 pandemic, the cost of delivering healthcare has continued to escalate, while the demand for patient care has exceeded many hospitals' capacity. Most troubling is the impact that the pandemic has had on the healthcare workforce, which has resulted in many hospitals struggling to fill vacancies at ever-increasing cost - all while under immense pressure to deliver quality patient care. What remains uncertain is whether the increase in labor costs has been matched with a commensurate rise in the quality of care or if quality has deteriorated as the labor force mix has changed to include more contract and temporary staff. Thus, in the enclosed study, we sought to determine what association, if any, exists between hospitals' cost of labor and the quality of care delivered. Drawing from a representative national sample of nearly 3214 short-term acute care hospitals' common quality measures from the year 2021, we examined the labor cost-quality relationship via multivariate linear and logistic regression and found there is a persistent negative association across all quality outcome variables studied. These findings lead us to believe simply paying more for hospital labor does not, by itself, ensure a positive patient outcome. We contend cautious use of temporary staff, measured adoption of short-term financial incentives, and robust staff development all should be considered as features of future workforce planning.

Measuring gerontological nursing competencies among aged care nurses: Cultural adaptation and psychometric validation.

Existing gerontological nursing competencies include the requisite knowledge and skills required for aged care nursing. What were not previously considered were legal and ethical aspects and access to technology, e-health and social media. This study aimed to validate an Australian gerontological nursing competencies scale and assess the factors associated with for aged care nurses in Taiwan. A methodological study design was used to validate the scale with a sample of 369 aged care nurses from aged care settings including nursing homes, long-term care facilities and aged care wards in Taiwan. The cultural adaptation and psychometric validation were evaluated. The content validity, construct validity through exploratory factor analysis and the internal consistency of the scale were assessed. The exploratory factor analysis extracted two levels of gerontological nursing practice, 'essential' and 'enhanced', which accounted for 80.8% of the total variance. The internal consistency, split-half reliability and test-retest reliability were excellent. Aged care nurses with higher levels of education, aged care education as their highest degree and continued education within 6 months, and certified long-term care education had higher gerontological nursing competencies scores than those who did not. This validated gerontological nursing competencies scale is a reliable and valid tool that can be implemented in future workforce planning, research and postgraduate and undergraduate curriculum and education in Taiwan and other Mandarin-speaking locales. Using validated gerontological nursing competencies scales to explain different levels of specialist practice is crucial for addressing negative views about aged nursing and explicitly demonstrate the possibilities for career pathways in gerontological nursing.

Ethical Considerations of Replacing Clinical Hours With Simulation in Undergraduate Nursing Education: Means to an End, or an End in Itself?

In the current health-care environment, undergraduate nursing programs are expected to provide high-quality clinical experiences for students despite increasing difficulty accessing clinical placements. Expectations for newly graduated nurses have increased in the last few years, with an emphasis on "work-ready" graduates. At the same time, the availability of a variety of clinical practicum placements has decreased in some areas, increasing the difficulty of meeting the increasing numbers of nursing students required for future workforce planning, a situation exacerbated by the ongoing COVID-19 global pandemic. Nursing educators are caught between industry requirements for clinically prepared students and the regulatory requirements of their educational institutions. One solution being espoused internationally is substituting simulation for clinical practicum hours. Simulation offers many advantages, especially for patient safety, providing students with opportunities to link theory to practice in a controlled environment. This article discusses the ethical considerations of substituting simulation for clinical hours in undergraduate nursing education. Is this substitution justified as a means to an end or an end in itself?