Health Service Employers Research Articles

Examining the experiences of mid-career nurses in hospitals: a phenomenological study

Background The turnover of new and mid-career nurses has been increasing, leading to challenges in recruiting and retaining nursing staff. Objectives Securing and retaining mid-career nurses is crucial for ensuring high-quality care. However, little is known about mid-career nurses’ experiences regarding turnover. This study aimed to understand the experiences of mid-career nurses and identify strategies to enable mid-career nurses to maintain long-term employment in health services. Design Colaizzi’s phenomenological methodology was adopted to illuminate the subjective meaning derived from the work-related challenges of mid-career nurses, leading to turnover. Focus group interviews were conducted to delve into the work challenges faced by mid-career nurses. Method The participants were 23 mid-career nurses working in one tertiary hospital and six secondary hospitals across three Korean cities, recruited using purposive and snowball sampling. The inclusion criteria entailed a minimum of three years of nursing experience and current employment within a designated department or clinical area within the hospital environment, commonly known as a nursing unit. Such units encompassed a range of clinical settings, including medical-surgical units, intensive care units, and emergency rooms. The interview data were transcribed verbatim, and significant statements were extracted from abstract sentences to derive themes through an analytical process. Results Analysis of the work experiences of 23 mid-career nurses in medical institutions yielded 15 themes and 4 theme clusters derived from 353 meaningful statements. These theme collections were identified as ‘Difficulties endured as a mid-career nurse’, ‘Meaningless and regrettable new graduate nurses’ education’, ‘An inexpressibly poor work environment’, and ‘Systems and policies needed to remain in the hospital’. Conclusions Difficulties faced by mid-career nurses including the establishment of an education and career development system, provisions for guaranteed leave, a diverse and flexible work system, opportunities for effective communication, and engagement with the opinions of mid-career nurses should promptly be addressed.

Growing Employment And Managers In Australian Health Services: 2006-2021

Introduction: This research is a continuation of the authors past contributions on this important subject, that has included the first comprehensive analysis of the composition and characteristics of health service managers in Australia, in terms of their service, qualifications and other important attributes. Objectives: This article contains an analysis of the number and characteristics of health service managers in relation to health services provided in Australia in 2006 compared with that of 2021. Design: Design of the analyses follows specifications set by the authors for tabulations prepared by the Australian Bureau of Statistics (ABS) from the censuses of population conducted by ABS in 2006 and 2021. The analysis of health service managers in terms of growth in numbers and change in their characteristics will be reviewed. Findings: A substantial increase was found in the number of health service managers in relation to the population and people employed. Also, there have been considerable changes in the characteristics and qualifications of health service managers during the 15-year period. The study also reported on the nature of the changes in hospitals and medical and other health services, and the surge in the number of managers in medical and other services, that in 2021 outnumbered those in hospitals. Implications: The findings are relevant to policy development aimed at improving the health status of the population. There were implications as well to the planning of health services, training of their labour force and related educational resources. An agenda is also put forward for additional research in view of its findings.

The Living Well, Living Longer program: an integrated care strategy to improve the health of people living with severe mental illness.

Living Well, Living Longer (The Program) is an integrated care strategy to improve the physical health of people living with severe mental illness within a public mental health service. The significant life expectancy gap experienced by this cohort is largely attributed to higher rates of cardiovascular disease and modifiable risk factors. The Program addresses this by guiding people through the four stages of screening, detection, treatment initiation, and ongoing management of coexisting chronic health conditions. The Program adopted an integrated care approach to ensure the provision of appropriate and coordinated care across hospital and primary care services. Key care pathways include a cardiometabolic health assessment clinic, shared care with general practitioners, oral health services partnership and employment of peer support workers, dietitians, exercise physiologists, and smoking cessation to provide targeted community support and interventions. There has been strong engagement with the care pathways introduced since The Program's inception in 2013 and evaluation is currently underway to consider the impact on cardiometabolic health outcomes for participants. Critical to The Program's effectiveness has been engagement with lived experience expertise, multidisciplinary collaboration, and strong executive support. However, significant challenges persist amid an Australian public health crisis characterised by reducing rates of free primary healthcare access for people living with severe mental illness and enduring communication challenges between primary and secondary health services. With the implementation of MyMedicare and the imminent Single Digital Patient Record across NSW Health, we stand at a critical juncture. It is imperative to establish robust systems to enhance care for this vulnerable population.

Reflections on the Prospective Outcomes of Injury Study (POIS; 2006-2023): how population-based research can address Māori outcomes and governance.

Injury is a leading cause of disability. Twenty years ago, we knew financial costs of injury were high but little was known about the short, medium and long-term outcomes after injury. In 2006, a Pilot Study and engagement with Māori across the country was undertaken to discuss the planned main study to understand how best to design a study that was meaningful and beneficial to Māori and policy-makers. Between 2007-2009, 2,856 injured New Zealanders (including 20% Māori) with an Accident Compensation Corporation (ACC) entitlement claim were recruited to the Prospective Outcomes of Injury Study (POIS). Participants shared detailed information (at 3, 12 and 24 months, and 12-years post-injury) about a broad range of topics including: the injury, socio-demographics, health, health services access, employment and wellbeing. Administrative data about injury-related hospitalisations, the sentinel injury and subsequent injuries were also collected, as well as in-depth qualitative interviews. This paper focuses on the why, how and impacts of POIS, especially in relation to Māori design and approaches, capability and capacity building, and leadership. Focusing on these aspects for Māori within POIS over time has ensured delivery of findings capable of informing and improving outcomes and policy. In particular, POIS has had considerable impact, influencing ACC's research strategy and outcomes' focus, and has provided disability, health, and wellbeing outcomes knowledge previously unavailable, especially for Māori.

한국 고용 구조의 변화 (2000∼2021년)

This study analyzes changes in the employment structure from 2000 to 2021 according to the job-based methodology. The results show that Employment in higher-paid jobs increased between 2000 and 2009. Employment polarization, on the other hand, emerged between 2009 and 2019. This study quantitatively identifies the labor demand and supply shocks using sign restrictions. The results show that the demand for high-income ICT and science and technology experts has increased significantly since 2000 suggesting that technology changes have had a significant impact. Deindustrialization, trade growth, and population aging had a significant impact on employment changes for low- and middle-income jobs. As the population ages rapidly in the 2010s, employment in health and social work services is increasing rapidly. In addition, changes in government policies related to non-regular workers and the expansion of the welfare system affected changes in employment type.

Understanding the non-professional needs of early career doctors: An interview-based study.

Speciality colleges and health services are often well attuned to professional factors, but non-professional needs are less acknowledged and are the focus of this study. This likely relates to limited research about the non-professional needs of early career doctors. This study aimed to describe the non-professional needs of doctors in their early postgraduate career, including how they intersect with career and training experiences. Semi-structured interviews were conducted with 32 male and female medical graduates working across all Australian states and territories, spanning a variety of speciality areas and early career stages. Participants were asked about their career journey to date including non-professional factors related to their experiences. This study identified important non-professional needs, that strongly interplayed with career and training experiences, including: children's education; partner's career needs; family stability; major life stages; proximity to the extended family; and spending time with immediate family. Results suggested clear gender differences, with female doctor's needs orientated to partner work and carer responsibilities, while male doctor's needs were oriented to spending time with family and meeting the family's needs. Non-professional needs should be considered as legitimate needs within health service employment and speciality training arrangements enabling early career doctors to realise their full potential.

Epidemiology of physical–mental multimorbidity and its impact among Aboriginal and Torres Strait Islander in Australia: a cross-sectional analysis of a nationally representative sample

ObjectivesThis study aimed to examine the differences in multimorbidity between Aboriginal and Torres Strait Islander people and non-Indigenous Australians, and the effect of multimorbidity on health service use and work...

Iranian nongovernmental organizations' initiatives in COVID-19 pandemic.

BACKGROUND:With the outbreak of the COVID-19 virus crisis worldwide, including Iran, the need for corona prevention and treatment has become a national priority. With many businesses closed in the wake of COVID-19 and job losses and declining incomes, vulnerable individuals' and families' access to the minimum wage and healthcare facilities is falling, and their health is exposed to a great risk. In Iran, a significant number of vulnerable groups are supported by nongovernmental organizations (NGOs). This study is designed to understand the performance of NGOs after the onset of the COVID-19 crisis.MATERIALS AND METHODS:This study was carried out based on qualitative research between June and September 2020 in Tehran. This study was conducted using individual interviews with 33 managers and experts of 24 active NGOs providing services to vulnerable groups and a member of an NGO network. Data were analyzed using content analysis.RESULTS:Two main themes of service initiatives were extracted: (a) service initiatives to protect the target population against COVID-19 infection and its aftermath and (b) management initiatives to retain staff, finance, and adapt the organization to crisis situations. Service initiatives included five categories of health service initiatives, livelihood, employment, education, and leisure initiatives, while organizational management initiatives include human resource management, financial management, and communication with organizations.CONCLUSION:The COVID-19 breadth and its special features have set it apart from other crises and have led NGOs to work hard on several fronts to care for the most vulnerable people against the epidemic and its consequences and maintain the performance of their organizations. The unique role of cyberspace has made it one of the definitive pillars of the activities of NGOs, not only during the epidemic but also after its end.

I speak a little Arabic: Nursing communication in a cross-cultural context.

This study investigated the challenges of cross-cultural communication among internationally qualified nurses, and the impact on nurse-to-nurse and nurse-to-patient relationships. Open and authentic communication between nurses and patients is required as a foundation of patient-centred practice; however, this may be a challenge in cross-cultural settings. An exploratory qualitative study with an inductive approach. Semi-structured, face-to-face interviews explored the influences on communication and practice of 21 internationally qualified nurses practising in the United Arab Emirates. Manual and software-driven processes guided coding and analysis of data. Caring theory guided the analysis of themes; while COREQ criteria guided research conduct and reporting. Four key themes emerged; (a) Challenges in communication, (b) The science versus art of nursing; (c) The impact of ineffective communication and (d) Strategies for coping. Eleven sub-themes are reported within these themes. Overall, nurses felt they had sufficient language and nursing skills to undertake the technical or scientific aspects of their work; however, they reported experiencing restricted ability to participate in complex cross-cultural conversations, such as providing explanations and reassurance about treatment options or discussing end of life and treatment decisions. This limitation diminished the nurses' ability to engage in the art of nursing and left them unable to employ themselves therapeutically to attain a sense of true presence with patients and their families. This article highlights the need for language and communication support, and Arabic-speaking advocates as partners in care for expatriate nurses. Internationally qualified nurses in this Middle Eastern setting lack cultural orientation and language skills to fully enact the art and true presence of nursing. Findings indicate that health service employers need to increase the employment of Arabic-speaking nurses and provide additional language for other expatriate nurses.

Is it discriminatory to require hospital staff to be clean shaven to facilitate the effective wearing of personal protective equipment?

National Health Service employers are subject to legal duties to protect the health and safety of their employees and third parties who come into contact with their staff. In order to discharge these duties, National Health Service employers must implement a range of protective measures to mitigate risk. One such measure is to require staff to wear personal protective equipment, including respiratory protective equipment, in certain circumstances. This is of particular importance during the Covid-19 pandemic. However, the presence of facial hair has a negative impact on the effectiveness of respiratory protective equipment. This article discusses whether a requirement to be clean shaven could amount to discrimination under the Equality Act 2010.

Obstacles to returning to work with chronic pain: in-depth interviews with people who are off work due to chronic pain and employers

BackgroundThe global burden of chronic pain is growing with implications for both an ageing workforce and employers. Many obstacles are faced by people with chronic pain in finding employment and returning to work after a period of absence. Few studies have explored obstacles to return-to-work (RTW) from workers’ and employers’ perspectives. Here we explore views of both people in pain and employers about challenges to returning to work of people who are off work with chronic pain.MethodsWe did individual semi-structured interviews with people who were off work (unemployed or off sick) with chronic pain recruited from National Health Service (NHS) pain services and employment services, and employers from small, medium, and large public or private sector organisations. We analysed data using the Framework method.ResultsWe interviewed 15 people off work with chronic pain and 10 employers. Obstacles to RTW for people with chronic pain spanned psychological, pain related, financial and economic, educational, and work-related domains. Employers were concerned about potential attitudinal obstacles, absence, ability of people with chronic pain to fulfil the job requirements, and the implications for workplace relationships. Views on disclosure of the pain condition were conflicting with more than half employers wanting early full disclosure and two-thirds of people with chronic pain declaring they would not disclose for fear of not getting a job or losing a job. Both employers and people with chronic pain thought that lack of confidence was an important obstacle. Changes to the job or work conditions (e.g. making reasonable adjustments, phased return, working from home or redeployment) were seen by both groups as facilitators. People with chronic pain wanted help in preparing to RTW, education for managers about pain and supportive working relationships.ConclusionsPeople with chronic pain and employers may think differently in terms of perceptions of obstacles to RTW. Views appeared disparate in relation to disclosure of pain and when this needs to occur. They appeared to have more in common regarding opinions about how to facilitate successful RTW. Increased understanding of both perspectives may be used to inform the development of improved RTW interventions.

Analysis on College Nursing Students’ Cognition for Community Health Services

Objective: To understand college nursing students’ cognition for community health services, improve junior college students’ overall quality and promote the development of community health services. Method: The independently designed questionnaire entitled College Nursing Students' Cognition for Community Health Services was issued to those students, and the data were statistically analyzed through SPSS22.0. Results: Students' cognition for community health services mainly comes from internship (practice), followed by class teaching; college nursing students' cognition for community health services is lower; junior college students' willingness to become a volunteer or internship or to work in the community is stronger than that of undergraduate and graduate students; the proportion of the undergraduate nursing students who hold the opinion that the employment in community health services is closely related to the major is lower than that of junior college students and undergraduate students. Conclusion: College nursing students’ cognition for community health services is lower as limited by cognition source; the willingness to participate in community health services varies with nursing students with different educational backgrounds. As a result, schools shall strengthen publicity of relevant community services knowledge, combine theories and practice and correctly guide nursing students on their employment attitude towards community nursing.

Benefit-cost analysis of SBIRT interventions for substance using patients in emergency departments

Screening, brief intervention, and referral to treatment (SBIRT) has been widely implemented as a method to address substance use disorders in general medical settings, and some evidence suggests that its use is associated with decreased societal costs. In this paper, we investigated the economic impact of SBIRT using data from Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED), a multisite, randomized controlled trial. Utilizing self-reported information on medical status, health services utilization, employment, and crime, we conduct a benefit-cost analysis. Findings indicate that neither of the SMART-ED interventions resulted in any significant changes to the main economic outcomes, nor had any significant impact on total economic benefit. Thus, while SBIRT interventions for substance abuse in Emergency Departments may be appealing from a clinical perspective, evidence from this economic study suggests resources could be better utilized supporting other health interventions.

Social Risk Factors and Performance Under Medicare's Value-Based Purchasing Programs.

Report to Congress: Social Risk Factors and Performance Under Medicare’s Value-based Purchasing Programs.1 US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. December 21, 2016. ### Policy Context Value-based purchasing (VBP), or pay-for-performance, comprises a growing portion of Medicare payment and the changes in physician payment enacted in the Medicare and Children's Health Insurance Program Reauthorization Act are likely to accelerate these trends even further.2 Simultaneously, there is growing consensus that social risk factors—such as income, race and ethnicity, and community environment—play a major role in health.3–5 Persistent and meaningful gaps exist in health and even in life expectancy based on these factors.6–9 These 2 issues intersect in VBP. If beneficiaries with social risk factors have worse health outcomes because of factors beyond providers’ control, providers could be unfairly disadvantaged under VBP. On the contrary, if beneficiaries with social risk factors have worse health outcomes because the providers serving them provide low-quality care, the financial incentives and accountability of VBP could be an important strategy for improving care and reducing disparities. In 2014, Congress passed the Improving Medicare Postacute Care Transformation Act (IMPACT),10 which required that the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the US Department of Health and Human Services complete an empirical report addressing the issue of social risk in Medicare’s current VBP programs to assist Congress in further decision making on this issue. The report covered here is the first component of the required work, which was submitted to Congress in December 2016. The ASPE report may have particular salience to cardiovascular clinicians, who practice every day in an environment significantly impacted by VBP. Many current quality measures in inpatient and outpatient VBP programs are cardiovascular in nature; patients …

The NHS needs you - and it has to work harder than ever to keep you.

The number of employers in the NHS paying extra to attract or retain staff in England is falling.

Nursing staffs' emotional well-being and caring behaviours.

To examine the relationships between structural factors (work stressors), individual factors (demographics and the personal resources of resilience and social support) and transactional factors (appraisals and coping), and nursing staffs' levels of burnout, psychological distress and caring behaviours. A further aim was to examine the relationships between nursing staffs' levels of burnout and psychological distress and their caring behaviours. Burnout and psychological distress levels have been found to be high in National Health Service nursing staff and furthermore this emotional distress has been found to affect patient care. In a National Health Service striving to provide high-quality patient-centred care, it is essential that factors affecting nursing staffs' well-being and their caring behaviours are examined. A cross-sectional correlation-based survey design. A sample of 102 nursing staff from an Acute National Health Service Trust were recruited in 2010. Participants completed the questionnaires: Nursing Stress Scale, Social Support Questionnaire-Short Form, Connor and Davidson Resilience Scale-2, Occupational Coping Self-Efficacy Scale for Nurses, PsychNurse Scale, Maslach Burnout Inventory, The Hospital Anxiety and Depression Scale and Caring Behaviours Inventory-revised. Due to the nonparametric nature of part of the data, Spearman's Rho correlations were used for analysis. Demographics were not found to be regularly correlated with nursing staffs' burnout, psychological distress or caring behaviours. Work stressors, coping strategies and self-efficacy were found to be significantly correlated with nursing staffs' burnout and psychological distress. Caring behaviours were also correlated with coping strategies and self-efficacy. Importantly, correlations were found between caring behaviours and nursing staffs' burnout and psychological distress. It is extremely important that the emotional well-being of nursing staff is supported, both for them, and for the effect this has on patient care. Action points are suggested for National Health Service employers to enable this to happen. To address the poor emotional well-being found, it is suggested that changes are needed within current clinical practice, for example through provision of enhanced training, use of model-based clinical supervision and reviews conducted on staffing levels and workload issues.

"No one has yet properly articulated what we are trying to achieve": a discourse analysis of interviews with revalidation policy leaders in the United Kingdom.

To analyze prevailing definitions of revalidation (i.e., a recently instituted system of ongoing review for all physicians in the United Kingdom), the circumstances of their origin, and proposed applications, after a protracted and sometimes difficult decade in development. This was to support a more consensual approach to revalidation policy before its launch in 2012. In 2010 and 2011, the authors carried out a critical discourse analysis of interviews with 31 medical and legal revalidation policy makers. These individuals represented the main stakeholder bodies, including the General Medical Council, Academy of Medical Royal Colleges, British Medical Association, National Health Service Employers, and the departments of health from across the United Kingdom. The authors identified two overarching discourses: regulation and professionalism, held together by patients as "discursive glue." Regulation frames revalidation as a way to identify "bad apples," requiring a summative approach and minimum standards. Professionalism looks to revalidation as a process by which all doctors improve, requiring evolving standards and a developmental model. These two discourses were not mutually exclusive; indeed, most interviewees used them interchangeably. However, they are in some regards at odds. Their coexistence has been supported by a shared discursive formation around patients. Yet the authors found little patient-centered policy in revalidation in its current form. The authors concluded that patients need to be recognized, making them present with an active voice. They also stressed the importance of established and ongoing evaluation of medical regulation as a policy and process.

Poor health and social outcomes for ex‐prisoners with a history of mental disorder: a longitudinal study

ObjectiveTo examine the association between self‐reported lifetime diagnosis of mental disorder and health‐related outcomes in prisoners during the first six months after release. MethodsWe interviewed 1,324 adult prisoners in Queensland, Australia, within six weeks of expected release and one, three and six months post‐release. Outcomes of interest included health service access, housing, employment, substance use and criminal activity. We used multivariate logistic regression to investigate the association between self‐reported, lifetime diagnosis of mental disorder and these health‐related outcomes post‐release, adjusting for pre‐existing disadvantage. Results43.4% of participants reported a lifetime diagnosis of mental disorder. This group had increased crude odds of poor outcomes across all evaluated domains. After adjusting for pre‐existing disadvantage, significantly increased odds of poor outcomes persisted in the substance use, mental health, crime and health service access domains. ConclusionsPeople with a history of mental disorder experience particularly poor outcomes following release from prison that are not fully explained by pre‐existing disadvantage. ImplicationsEvidence‐based transitional programs for prisoners with a history of mental disorder should be provided at a level commensurate with need.

‘Lean’, new technologies and employment in public health services: employees' experiences in the National Health Service

This article considers employees' experiences of a major organisational redesign project, which sought to deploy robotics technologies to improve the performance of National Health Service pharmacy distribution in one part of the UK. The principles of Lean-type approaches partly informed the redesign project, with senior managers seeking to tap the benefits of new technologies to streamline processes, while also arguing that change would bring opportunities for upskilling and inter-professional collaboration. The project managed to avoid some of the negative consequences for job quality predicted by the critical literature on Lean-type approaches in public services. However, employees' experiences varied, with some reporting new engagement in learning and collaborative service delivery ‘nearer the patient’, while others complained of fewer opportunities to rotate across a variety of job roles. More fundamentally, employees questioned management's assumption that new technologies and Lean-type approaches are crucial to improved performance and better jobs. For many employees, both performance and job quality were compromised by the ‘leanness’ of staffing models, which limited opportunities for development and contributed to work intensification. This tension is likely to remain a key theme in employment relations in the UK and beyond for as long as the public sector faces financial austerity.

NHS trust is voted second best employer of lesbian, gay, and bisexual staff in Britain

Nottinghamshire Healthcare NHS Trust has been named the second most gay friendly employer in Britain by the charity Stonewall. A further eight health service employers appeared in the charity’s list of the top 100 employers for lesbian, gay, and bisexual staff in 2014. To gain a place on the list employers submitted written responses and supporting evidence that the charity then assessed and rated. In addition to the written evidence, Stonewall interviewed …