Staff Turnover Research Articles

A Review of the Lawrence Livermore Nuclear Accident Dosimeter 1980s-present

A Nuclear Accident Dosimetry program is a federal requirement for all facilities that have the potential to have a criticality accident. Personnel Nuclear Accident Dosimeter (PNAD) theory and analytical procedures are driven by various scientific needs and interacting regulations. A brief history of the status of USA Department of Energy (DOE) nuclear accident dosimetry regulations, recommendations, and performance testing criteria are given. Then, the history of the Lawrence Livermore National Laboratory (LLNL) PNAD is explored, including changes in the physical dosimeter and adjustments of the analysis method through the last four decades. Finally, the performance of LLNL’s PNAD at criticality accident intercomparison training exercises since 2009 is explored. In general, reported neutron doses have been within or close to DOE-STD-1098 performance criteria while reported gamma doses have been outside of DOE-STD-1098 performance criteria. Reported total absorbed doses have varied in meeting ANSI/HPS N13.3 and ANSI/HPS N13.3 (R2019) performance criteria. Dosimetry staff retirement and turnover have left historical knowledge gaps, yet provided opportunities within the NAD program at LLNL. This review paper serves as an overview of the history and status of the NAD program. Brief technical, procedural and programmatic recommendations to improve LLNL’s NAD program are given. Technical recommendations include investigating orientation factors through modeling or empirical experimentation, investigating gamma dosimetry methods for high-dose scenarios, and exploring other dosimetric methods for simpler, quicker NAD analysis. Procedural recommendations include better documentation of conversion factor (activity-to-fluence and fluence-to-dose) derivations and spectrum uses, and updated analysis spreadsheets or simple Graphic User Interfaces for dose calculations. Programmatic recommendations include formalized training for NAD analysts, and having multiple SMEs trained on the NAD program.

SIMULATION TRAINING: INTERNATIONAL EXPERIENCE AND DEVELOPMENT STRATEGY IN UKRAINE

The article presents information on the relevance of simulation training in modern medical education. Leading specialists emphasize the need to learn practical and communication skills, be able to work more intensively in a team; they also note that simulation training can significantly contribute to the achievement of these educational goals under present-day conditions. Simulation training, beginning at the undergraduate or graduate level, can help overcome a number of challenges, such as patient safety issues, ethical issues related to the acquisition and development of skills in interacting with real patients, the need to standardize learning experiences, competency assessments, and medical certification, the need for rapid staff adaptation (staff turnover), promotion of high standards of medical care, increasing the scope of the doctor's responsibility. In addition, simulation training makes it possible to practice more or less typical clinical situations with severe consequences, to promote the acquisition of relevant knowledge and skills, to improve technical skills, to practice the provision of medical care by an interdisciplinary team and individually. The experience of the simulation training development in some countries and a brief history of the foundation of the first simulation training centers in Ukraine are presented. The advantages of simulation training, which allow them to be widely used in educational activities are emphasized. The development of a training program is important in the work of the simulation center and is based on the capacity of simulation training and involves practicing technical and non-technical skills in managing certain situations in accordance with the guidelines. Debriefing (discussion) is necessary so that participants can evaluate their actions during training. Thus, simulation training is an effective method for practicing relevant skills and team interaction in doctor training. Team building experiences are offered using the simulation training, the individual characteristics of students that did not appear in traditional classes are revealed, the ability to conduct a discussion, dialogue and draw conclusions is acquired. A compulsory stage in stimulation training should be the assessment process, therefore it is necessary to notice the reaction of the participants, their satisfaction with the process, and the evaluation of the achievement of the tasks set. This will allow to improve the quality of the learning process and learning materials, to make changes in the training program. A questionnaire can be used for this purpose. The participants assess the relevance of the topic, individual levels of the simulation training and offer possible topics to advance the training program, express their wishes regarding the feasibility, frequency and points of further simulation training and the development of new frameworks. Communication skills are particularly important for doctors and can be actively developed in working conditions of our stimulation center. To conduct doctor training, it is optimal to establish simulation centers with experienced staff and a program developed to meet the needs of the rapidly changing medical landscape.

Challenges of Conducting Point-Of-Care Testing Operations In The Municipal Public Health System Based Ambulatory Care Clinics In New York City

Abstract Introduction/Objective Our New York City Municipal Public Health System- based multisite ambulatory clinics that offer various waived POCT (point of care tests) and provider-performed microscopy (PPM) to our communities, ensure standardization and quality of POC testing across our health system. Our laboratory service conducts system-wide centralized implementation, monitoring and oversight of the POCT operations regarding regulatory compliance, test performance, quality control and training. With our day-to-day POCT operations, like all other clinical laboratories, our ambulatory care clinics encounter various hurdles and challenges. Here we elaborated on the issues we encounter and how we manage to overcome them. Methods/Case Report We identified and stratified the challenges that affect our managerial as well as field-level laboratory operations and devised ways to deal with those POCT operational issues. Results (if a Case Study enter NA) Among the staffing issues, rapid staff turnover causes significant delays or cessation of POCT operations in our ambulatory care clinics, due to orientation, re-education and ensuring competency to the staff, that conducts POCT in our clinics. Besides, supply shortages, staff shortages and absences due to illness and overwork are the issues, noted at the laboratory field operational level. Delays in the processing of paperwork and new staff recruitments and in the laboratory supply chains are notable management issues. Conclusion Even though the vastness and complexity of our multisite ambulatory care network sometimes affect our ambulatory care clinic POCT operation in various challenging way, our timely, planned and coordinated intervention, close monitoring and communication and rapid initiatives handle those issues very effectively to ensure the quality of POC testing for the patient safety and care across our health system, which is one of the largest municipal-based public health care, in the country.

The Role of Organizational Trust in Shaping Commitment and Reducing Turnover Intention in Aviation

In the contemporary business landscape, advancements in artificial intelligence and robotics are rapidly transforming industries, including air transportation. Although the demand for human resources may diminish with technological progress, the necessity for skilled personnel remains critical. The air transportation sector, in particular, relies heavily on qualified professionals, whose contribution to sustainable business practices is substantial. However, despite their importance, these trained professionals may occasionally exhibit a turnover intention their positions. Such turnover in an industry where technology plays a pivotal role represents a significant loss for organizations. Mitigating turnover intentions may depend on the application of effective organizational behavior models, one of which is fostering an environment of trust within the organization. Increased trust in the organization can enhance employees’ commitment and job satisfaction, thereby reducing their turnover intention. The primary aim of this study is to identify the factors influencing turnover intention, with a specific focus on whether organizational trust affects this intention. Furthermore, the study seeks to determine whether organizational commitment mediates the relationship between organizational trust and turnover intention. To explore these dynamics, a survey was conducted with 404 ground and flight personnel employed in both public and private aviation sectors in Türkiye. The research findings show that trust has important implications in an organizational setting. As a result of the analysis conducted within the scope of the research, it was determined that organizational trust has no effect on turnover intention. The reason for the different result from the literature may be the sensitivity of the aviation industry and the high staff turnover rate. Due to these characteristics of the sector, employees of the aviation industry may show turnover intention even if they trust their organizations.

A qualitative exploration of policy interventions to improve the health-related quality of life of people living with HIV AIDS and co-morbidities of hypertension and/or diabetes in Ghana.

The intersection of infectious diseases, such as HIV, with chronic conditions like hypertension and diabetes poses a significant challenge in global health. While advancements in antiretroviral therapy have transformed HIV into a manageable chronic condition, a growing number of individuals with HIV now grapple with coexisting non-communicable diseases, impacting their Health-Related Quality of Life (HRQoL). Despite strides in HIV care, there is a notable policy gap that undermines efforts to address HIV-associated co-morbidities, particularly hypertension and diabetes, especially efforts to improve access, early detection, and ultimately HRQoL for individuals with HIV and co-morbidities. This study seeks to explore policy interventions aimed at improving the quality of life of HIV patients with hypertension or diabetes. The study utilized a qualitative descriptive design to explore the experiences and perspectives of healthcare professionals and support staff regarding policy interventions for managing HIV patients with hypertension and/or diabetes co-morbidities in three regions of Ghana. The research was conducted in the Upper West, Ashanti, and Greater Accra regions among 11 participants, chosen purposively from professions involved in HIV patient care to understand their views on the implementation of policy interventions to HRQoL for individuals with HIV and co-morbidities. In-depth interviews were conducted face-to-face and tape-recorded. Thematic analysis approach was used to analyze the data. The study involved 11 participants from three regions with varied years of experience. Implemented policies that potentially improve the HRQoL for individuals with HIV and co-morbidities involve support groups, home visits, provision of free drugs, and counselling. Barriers to policy implementation included non-adherence to medication, stigma, cost of non-communicable diseases (NCDs) medications, accessibility issues to NCDs services, lack of interest or understanding among implementers, and high staff turnover. Facilitators encompassed in-service training, guidelines in common platforms, knowledge sharing, external resources, regular check-ups, and motivational packages for patients. Individuals with HIV and comorbidities face complex challenges impacting their HRQoL, including emotional and financial dimensions. The study identifies critical policies and barriers, underscoring the need for tailored, patient-centered approaches. Facilitators like in-service training and regular check-ups offer actionable insights for effective policy implementation, emphasizing improved health outcomes for those with comorbid conditions. The study recommends integrated care approach and adherence support programs that address the unique challenges faced by people living with HIV.

Barriers and Facilitators to Implementing Keep It Up!, A Digital Health Intervention, in Community-Based Organizations.

Despite ongoing investments in the development and testing of new digital interventions for HIV prevention, the widespread use of interventions with proven effectiveness remains limited. This study assessed real-world implementation of a digital HIV prevention intervention, Keep It Up!. The study aimed to identify barriers and facilitators to implementing Keep It Up! within community-based organizations (CBOs) serving racially diverse sexual and gender minoritized populations. The Keep It Up! trial is a type III effectiveness-implementation hybrid trial to compare two delivery approaches: direct-to-consumer and CBO-based implementation. This manuscript focuses on the CBO-based approach through interviews with CBO staff members before and during implementation (n = 37 and n = 25, respectively). Interviews were coded according to the Consolidated Framework for Implementation Research and thematically analyzed. Staff highlighted adaptability, leadership engagement, compatibility, and organizational culture as facilitators of Keep It Up! implementation. Identified barriers included self-efficacy, motivation, staff turnover, and partnerships and connections. CBO infrastructure, capacity, research experience, and processes influenced the relative importance of these barriers and facilitators. This study is one of the first to detail barriers and facilitators experienced by staff implementing a digital HIV prevention intervention in CBOs. Interviews illuminated the need for interventions like Keep It Up! for young men who have sex with men and detailed the need for additional strategies to assist CBOs unfamiliar with implementing digital health interventions. Trial Registration Number: NCT03896776.

Process evaluation of a breastfeeding support intervention to promote exclusive breastfeeding and reduce social inequity: a mixed-methods study in a cluster-randomised trial

BackgroundBreastfeeding is a powerful public health intervention that produces long-term health benefits. However, in high-income countries such as Denmark, breastfeeding rates are suboptimal and unequally distributed across socio-economic positions. The ‘Breastfeeding – a good start together’ intervention, to promote longer duration of exclusive breastfeeding and reduce social inequity, was implemented in a cluster-randomised trial during 2022–2023 across 21 municipalities in two Danish regions. A process evaluation was conducted to assess the implementation, mechanisms of impact, and possible contextual factors affecting the intervention.MethodsThe study was guided by the Medical Research Council’s guidance for conducting process evaluations and employed a mixed-methods approach in a convergence design. Quantitative data: contextual mapping survey (n = 20), health visitor survey (n = 284), health visitor records from 20 clusters and intervention website statistics. Qualitative data: dialogue meetings (n = 7), focus groups (n = 3) and interviews (n = 8).ResultsOverall, the intervention was delivered as planned to intended recipients, with few exceptions. Health visitors responded positively to the intervention, noting that it fitted well within their usual practice and enhanced families’ chances of breastfeeding. Mothers expressed having received the intervention with few exceptions, and reacted positively to the intervention. Although health visitors were concerned about the potential stigmatisation of mothers receiving the intensified intervention, none of the interviewed mothers felt stigmatised. Contextual factors impacting the intervention implementation and mechanisms included staff and management turnover, project infrastructure and mothers’ context, such as resources, social networks and previous experiences. The overall fidelity of the intervention delivery was high.ConclusionsHealth visitors and families responded well to the intervention. Interventions aimed at enabling health care providers to deliver simplified and structured breastfeeding support, in alignment with support provided in other sectors of the health care system, may increase breastfeeding rates and reduce social inequity in breastfeeding, even in international contexts.Trial registrationClinical Trials: NCT05311631. First posted April 5, 2022.

Staff turnover management based on HR analytics data

Staff turnover management based on HR analytics data

Results of a Process Evaluation of the Implementation of a Housing First Program in Waterloo, Canada

This study evaluated PATHS2Home (P2H), a Housing First program in Canada, through qualitative interviews and focus groups with 34 program staff, participants, and partners. Results showed successful implementation with participant satisfaction, strong program design and leadership, skilled staff, positive service system relationships, effective housing support, and fidelity to the Housing First (HF) model. Challenges included skepticism of the program model, communication with partners, staff turnover, and systemic factors such as affordable housing availability. Overall, the evaluation showed successful implementation of the P2H program in line with HF principles and identified several areas for improvement to better support participants and achieve program goals.

The Impact of Retention Strategies on the Performance of Teachers in Private Secondary Schools: A Case of Dodoma City, Tanzania

The presence of persistent needs for motivated teaching staff to uphold the standards of education at secondary schools poses a significant challenge concerning the retention of competent teachers in private secondary schools. Teacher turnover poses significant tests for educational establishments, affecting both the stability of the schools and the quality of education provided. Like other educational institutions, the prevailing competition to recruit and retain highly qualified teachers, private secondary schools face the problem of maintaining competent teachers within a context characterized by higher rates of staff turnover. This article is to provide a comprehensive theoretical evaluation of strategies to sustain teachers' retention in private secondary schools by assessing the potential advantages associated with the implementation of effective retention measures. Moreover, the study probed into the existing literature to explore many retention features including, professional growth opportunities, organizational culture, leadership, and compensation to provide insights into the formulation of effective retention strategies to be applied by schools. By gaining a comprehensive understanding of the strategies, challenges, and potential outcomes, school management and educational policymakers can advance the efficacy, prosperity, and stability of learning environments for teaching staff and students. A cross-sectional survey design and the research approach combined both qualitative and quantitative paradigms. Simple random sampling (SRS) and purposive technic were used to draw a sample of eighty (80) respondents. SRS was adopted to interrogate teachers and purposive for key informants. Data analysis was employed by use of multiple responses, multiple linear regression, and analysis of variance (ANOVA). Salary, adequate learning facilities, a welcoming environment, and leadership style were identified as retention methods by the study's findings. The survey, however, identified the following barriers to implementing teachers' retention strategies including heavy workloads, lack of chances to advance, low pay and benefits, poor working conditions, and higher workplace stresses. Despite the outlined retention strategies, implementation matters including the lack of professional development opportunities, attractive incentive packages, and work-related benefits, unfavourable working conditions, and stress brought on by heavy workloads should be adequately addressed by school management and other decision-makers if they need to retain their valuable talented teachers.

Impact of Nursing Leadership Styles on the Staff Turnover Intention in Saudi Arabia: A Cross-Sectional Study.

Background and objectives The efficiency of healthcare systems and nursing care depends on appropriate leadership. The purpose of this study was todetermine the association between leadership styles of nurse managers and the staff turnover intention in Saudi Arabia. The nurses' intention to quit their jobs was considered as indicative of staff turnover intention. Methods A quantitative cross-sectional questionnaire-based study was conducted among 279 nurses, employed in three hospitals in Hafar Al-Batin City, Saudi Arabia. The questionnaire comprised three parts to determine the association between leadership styles of nurse managers and staff turnover intention, and how they related to participants' demographic variables (gender/age/education/income/marital status/experience). The first part collected demographic data, and the second part was an adapted and validated version of the multifactor leadership questionnaire (MLQ-6S) used to assess the perceived leadership styles of nurse managers, based on 21 items. The third part, comprising seven items, was used to assess nurses' turnover based on intention to quit. The second and third parts of the questionnairewere scored using a five-point Likert scale. Collected data were tabulated and analyzed using a statistical software package for descriptive and inferential statistics (t-test, one-way analysis of variance (ANOVA), and correlation), comparing dependent outcome variables against independent demographic variables. Statistical significance was assumed when p-value was less than 0.05. Results Based onleadership style scores, transactional (13.32 out of a maximum of 24; 55.48%) and transformational (26.58 out of a maximum of 48; 55.37%) leadership were the most frequently perceived leadership styles among nurse managers. Laissez-faireleadership (6.31 out of a maximum of 12; 52.57%) was the least frequently perceived style. Upon comparing perceived leadership styles of nurse managers againstdemographic variables, no significant differences were observed for transformational leadership. However, income and experience of nurses showed significant relationship with the perceived transactional and laissez-faire leadership style scores, respectively. Based onperceived "intention to quit" scores, majority of the nurses expressed uncertain intention to quit (n = 193; 69.2%) and there was a significant yet weak negative correlation between the perceived leadership styles and intention to quit. The correlation coefficient (Pearson's-r) was lowest for laissez-faire leadership (-0.258)followed by transactional (-0.295) and transformational styles of leadership (-0.348). Conclusions The present study indicated a greater degree of transactional and transformational leadership styles among nurse managers than laissez-faire leadership style. While most of the nurses mentioned an uncertain intention to quit, correlating it with the perceived leadership styles it was found that transformational leadership among nurse managers indicated greater retention of nurses within their present jobs. The present research findings underline the importance of prioritizing and fostering healthy workplace environment by the nurse managers, through inculcation of transformational leadership practices. Furthermore, focused, multi-centric studies from around the world can help understandthe leadership practices of nursing leaders and its relationship with the intention of nurses to quittheir respective roles.

Effect Of Strategic Innovation On Sustainability Of Mission Hospitals In Kiambu County, Kenya

Kenya's healthcare sector plays a crucial role in economic growth and the realization of Vision 2030. Mission hospitals in Kiambu County, however, face sustainability challenges, including inadequate financial resources, staff turnover, weak health systems, and patient non-payment. This study investigated how strategic innovation affects the sustainability of these hospitals, focusing on business models, services, processes, and technological innovations. The research involved 100 managers from seven mission hospitals, using a census approach and a cross-sectional descriptive design. Data were analysed using SPSS, with multiple linear regression to determine relationships between variables. The study found that adopting innovative business models, aligning with market trends, improving service quality, and implementing technological solutions like telemedicine and electronic health systems significantly enhanced operational efficiency, patient satisfaction, and financial stability. The study recommended that mission hospitals regularly review and adapt their value propositions, while the government should support innovation through policies to ensure healthcare sustainability.

Integrating machine vision in the development of automatic mounting system for massive electroplating components

Abstract The traditional industrial electroplating parts manufacturing process typically relies on manual labour to suspend them in the electroplating tank, requiring a significant amount of manual work. However, due to a shortage of manpower and frequent staff turnover, this has posed challenges to production efficiency. Therefore, this research proposes an automated mounting system by integrating machine vision technology and the development of robotic arms to replace the conventional manual suspension method. The automated mounting system initially separates individual ring-shaped electroplating components using a disk vibratory feeder. Subsequently, it utilizes a unidirectional reciprocating mechanism and infrared detection to position these electroplating components onto a backlit panel. Then, the IDS uEye XS2 autofocus camera captures images, and in conjunction with machine vision technology, rapidly determines the position, characteristics, and orientation of these ring components. Finally, through TCP communication protocol, commands for gripping points are transmitted to the robotic arm, which uses electromagnetic valves on the arm to pick up the components and suspend them onto the hanger using an optimized path. The final test results demonstrate that the automated installation system can complete 14 installation operations per minute, effectively reducing the time and cost associated with manual labour, significantly enhancing the production output of the assembly line. Therefore, this study combines machine vision technology to propose a solution for the automated installation system of large-scale electroplating components.

THE ROLE OF MENTORING PRACTICES IN THE FORMATION OF SUSTAINABLE STAFF IN HEALTHCARE IN MOSCOW

Many countries around the world are faced with the problem of a shortage of medical workers due to insufficient investment in medical education, inconsistencies between training and employment strategies for medical personnel and the needs of the healthcare system, complicated by the lack of human resources for healthcare in remote areas and the migration of medical workers. One of the tools for developing medical personnel and forming a stable workforce is mentoring, which should be used throughout the working life of employees, and not only during the adaptation process of young employees. The purpose of the study is to identify the role of mentoring in reducing staff turnover and forming a sustainable workforce.

Impact of Job Satisfaction on the Labour Productivity of Healthcare Personnel

Introduction. The healthcare sector, a cornerstone of society and the economy, brings together specialists from various fields and departments. As healthcare organisations grapple with similar human resource management and policy development challenges as other types of organisations, research on increasing job satisfaction, a key indicator of effective management and employee attitudes, becomes increasingly relevant. Aim and tasks. This study aims to determine the level of satisfaction among those employed in the healthcare sector, particularly in Georgia, and to underscore its profound impact on performance. Results. Findings revealed that various factors affect job satisfaction and, consequently, the quality of service provided. Using the F test, it was found that there is a significant statistical relationship between education (0.01 level (p < 0.001, F = 9.992)), work experience (0.01 level (p < 0.001, F = 9.299)), age (0.01 level (P<0.001, F= 9.164)) and job satisfaction and quality of service. Also, the research results showed that 70% of the respondents believe job satisfaction enhances their performance. Specialized expertise, knowledge, and an appropriate strategy are required to manage these professionals. It is highly significant and essential for employees to have constant development opportunities, access to professional training, and work in a high-satisfaction environment. Conclusions. That is critically important for improving performance in healthcare and any organization. However, it is worth mentioning this sector faces stress, high mental load, and burnout. In order to address these issues, organizations should have their own clear policy, properly distribute roles and resources, involve employees in processes from the start, and provide relevant information. Hinged on the previously conducted research, opportunities for personnel development and training are limited in Georgia, which in turn is leading to a shortage of qualified personnel and high staff turnover. The presented recommendations will help managers of organizations analyse the importance of job satisfaction in the growth of productivity and success of the organization and its constituent indicators and develop an appropriate strategy for their improvement in the future.

Utilising a Co-Design Approach to Strategically Plan Dementia Education for Diverse Populations in Ireland

Abstract Background In Ireland, the number of people living with dementia is projected to treble by 2050. National dementia education programmes span all care groups and areas of work, and include a 4-hour, a 2-day programme and HSEland modules. However, there is concern that these programmes often adopt a pedagogical approach that does not meet the needs of modern learners. Adopting a coproduction approach in designing dementia education initiatives is essential to ensuring that these programmes effectively impact healthcare professional’s attitudes, beliefs and care practices, meeting the needs of people from diverse populations and cultural backgrounds. Methods Methods included three key components: Firstly, a dementia education online survey for facilitators of national programmes to ascertain the benefits, challenges and impact on care practices. Secondly, a national event using World Café methodology to share insights and ideas and co-produce a vision for advancing dementia education in Ireland. Primary stakeholders included individuals living with dementia, their advocates, and delegates from various demographics and cultural backgrounds. Thirdly, a review of literature relating to dementia education in other jurisdictions. Results Key themes that emerged include the significance of understanding the lived experience and recognising diversity and cultural differences. Additionally, there is a need to explore various teaching and delivery methods, such as incorporating technology, simulation, and a tiered approach. There was general agreement that co designing a more adaptable, interactive national programme, including the lived experience of people with dementia would be more impactful. Challenges identified include staff turnover, difficulties releasing staff from clinical areas and organisational culture. Conclusion Through establishing an inclusive and collaborative platform, we can collectively shape a future where dementia education and care practices are compassionate, rights based and supportive. Crucially, people living with dementia and their supporters are at the heart of planning and decision-making processes in co-designing dementia education initiatives.

Integrating an incident dataset with a question and answering language model to assist hazard identification: Comparison of an extractive and generative model

Robust hazard identification (HAZID) relies upon extensive knowledge of the system being analysed, the technical aspects, and how it will be used operationally. Typically, this knowledge is held by human participants who can draw out answers in natural language to hazard related questions based upon their own experience. However, several threats exist to this, such as high staff turnover, a poor learning from incidents capability or even insufficient Information Technology resources. Alternatively, incident databases hold vast amounts of hazard information that can be transformed into a source of knowledge. As mitigation to the aforementioned issues, this paper presents a Question and Answering (Q&A) Bidirectional Encoder Representations from Transformers (BERT) language model trained upon aviation incidents and a unique Q&A dataset. The model can extract answers to typical HAZID questions, based upon factual incident reports. Alongside this extractive approach, the paper also explores the use of a generative Large Language Model combined with an incident dataset. Both models proved a useful addition to HAZID activities based upon the Structured What If Technique (SWIFT), answering safety-themed questions based upon a retrieved context of incident reports that semantically matched the query. For the purposes of HAZID, it was suggested that the generative option is preferable based upon its ease of implementation, lower resource requirements and quality of responses. Additionally, it is shown that it is possible for organisations to train and create their own custom models for HAZID purposes. Future work may wish to consider the application of models that can hypothesize scenarios based upon incident reports, building further understanding to the relationships between causes, hazards and consequences.

Optimising remote health workforce retention: protocol for a program of research

BackgroundNowhere is optimising healthcare staff retention more important than in primary health care (PHC) settings in remote Australia, where there are unacceptably high rates of staff burnout and turnover. Ensuing consequences for the remote health services and the community are acute – staffing shortfalls in clinics; organisational instability; excessive costs associated with frequent staff recruitment and orientation; diminished access to PHC for patients in need; and lack of continuity of patient care; all of which further entrench poor health outcomes for the community. Optimising remote healthcare staff retention is critical in order to provide high quality and continued PHC. Currently, however, there is paucity of knowledge to inform targeted and effective retention strategies in remote health services.This research program seeks to develop a stronger evidence base to understand (i) what retention strategies are effective in improving morale, job satisfaction, intention to remain in the job, and consequent length of service for remote healthcare staff; (ii) how best to ‘bundle’ these strategies for different health workforce groups; and (iii) how these ‘bundles’ work in different service contexts.MethodsThis paper describes a five-year implementation research program in partnership with twelve remote Aboriginal and Torres Strait Islander Community Controlled Health Services (ATSICCHS) in the Northern Territory and Queensland, Australia. Overall methodology follows a participatory action research approach which incorporates co-design and realist elements. The program comprises two broad phases involving evidence consolidation and synthesis (Phase 1), and co-design, implementation, and prospective evaluation of ‘bundles’ of retention strategies (Phase 2) to improve retention of healthcare staff in participating ATSICCHSs.DiscussionThis innovative research program has the potential to develop a comprehensive evidence base required to optimise health workforce retention in remote health services. This new evidence will strengthen understanding of what ‘bundles’ of retention strategies are effective, for which groups of employees, and how they work to improve staff retention.

The impact of moral resilience on nurse turnover intentions: the mediating role of job burnout in a cross-sectional study

BackgroundHigh nursing staff turnover is a critical issue that negatively impacts the quality of care and patient safety. Turnover intentions, a key predictor of actual turnover, reflect an individual’s likelihood of leaving their current position. Understanding the underlying mechanisms driving nurse turnover intentions is crucial for developing targeted interventions to stabilize the nursing workforce globally.ObjectivesThis study aims to explore the relationship between moral resilience, job burnout, and turnover intentions among nurses, focusing on the mediating role of job burnout in this relationship.DesignThis study employed a quantitative, cross-sectional design.MethodsA convenience sample of 322 registered nurses was recruited from two tertiary hospitals in China between August and October 2023. Data were collected using the Chinese version of the Rushton Moral Resilience Scale (Chi-RMRS), the Maslach Burnout Inventory (MBI), and the Turnover Intention Scale. Data analyses were conducted using SPSS 26.0 and Amos 21.0. The study followed the STROBE guidelines for observational research.Ethical considerationBefore the commencement of data collection, the Institutional Review Board of Hunan Traditional Chinese Medical College (YXLL202401004) granted ethical approval.ResultsThe proposed model exhibited an excellent fit to the data, with fit indices as follows: χ2/df = 1.819, CFI = 0.977, TLI = 0.961, RMSEA = 0.072 (90% confidence interval [CI]: 0.033 to 0.107). The structural equation model revealed that moral resilience was inversely associated with job burnout and turnover intentions. Furthermore, job burnout fully mediated the relationship between moral resilience and turnover intentions (β = −0.473, p = 0.007). Further analysis indicated that the depersonalization component of job burnout was the sole mediator in the relationship between moral resilience and turnover intention (β = -3.934, 95% CI [-5.837, -1.932]).ConclusionThe findings indicate that moral resilience among nurses is negatively associated with turnover intentions, with this effect fully mediated by the depersonalization dimension of job burnout. Enhancing moral resilience in nurses may be valuable strategy for healthcare administrators to mitigate job burnout and subsequently reduce turnover intentions.

"I'm His Voice": Parent Perspectives on Obtaining an Autism Diagnosis and Services and the Influence of Personal and Cultural Factors.

To assess caregiver-reported barriers and facilitators to receiving a diagnosis of Autism Spectrum Disorder (ASD) and accessing services as well as the influence of personal and cultural factors.Participants included 29 parents whose children had been diagnosed with ASD between January 2019 and November 2021 while receiving primary care at one of two urban, hospital-affiliated clinics. Semi-structured interviews and surveys were conducted between May 2022 and June 2023 in both English and Spanish. Transcripts were coded and themes developed using thematic content analysis. In the survey portion of the study, 80% of parents said the experience of getting the diagnosis was "very easy/somewhat easy," while 28% of parents said the process of accessing autism services was "very difficult." Four general categories emerged from the qualitative analysis: (1) experience getting the diagnosis, (2) service navigation after diagnosis, (3) need for parent advocacy, and (4) perception of condition by others. Parents generally reported positive experiences with their pediatricians, but some felt their concerns were discounted due to personal factors. The most common frustration expressed was difficulty accessing Applied Behavior Analysis therapy after a diagnosis due to long waiting lists, staff turnover and poor quality. Many parents felt that it would be helpful to have a family navigator to assist with paperwork, insurance complexities, and service access. Parents reported many challenges obtaining an autism diagnosis as well as accessing services. Widespread system change will be required to meet the needs of families equitably and effectively.