Staff Vacancies Research Articles

Employee Compensation of Nonprofit Child Welfare Agencies in New York: Crises and Strategies

ABSTRACTWhile existing literature documents the low compensation of nonprofit human services workers, it is not well understood how managers of these organizations perceive and respond to the problem. Adopting resource dependency and competing institutional logics perspectives, we chose the New York nonprofit child welfare sector—a heavily government‐funded field—as a collective case to study these issues. Based on interviews with 17 leaders of the primary NY nonprofit child welfare agencies, we found that these agencies' employee compensation was primarily constrained by government contracts, and they were torn by conflicting institutional logics from the state, the labor market, private funders, and unions. Overall, government contracts and market competition determined worker pay, and nonprofit child welfare agencies faced labor competition not only from peer organizations, but also from the government and for‐profit sectors. With the “great resignation” atmosphere and increased cost of living intensified by the COVID‐19 pandemic, agencies were under tremendous pressure to raise worker pay. However, programs chronically underfunded by the government were incapable of providing competitive wages and were experiencing high staff turnover and vacancies. Agency leaders agreed on the need to push the government to pay programs adequately but disagreed about advocacy goals and messaging. Most leaders had reservations about aggressive collective bargaining measures such as “going on strike.” These common but attenuated labor dynamics, related managerial responses, and implications for the future of the sector are discussed, particularly in response to competing institutional pressures.

Direct Care Staff Vacancies and Adverse Youth Events in Illinois Child Welfare Residential Treatment During the COVID-19 Pandemic

ABSTRACT Direct care staff provide 24/7 care and supervision in residential treatment for youth; vacancy rates for these positions increased significantly during the COVID-19 pandemic. This study used multi-level, two-stage least squares regression to examine the relationship between staff vacancies and adverse events experienced by 1352 youth in Illinois child welfare residential care during October 2019-February 2022. Hierarchical cluster analysis was used to explore whether particular adverse event clusters were differentially related to vacancy rates. We hypothesized that direct care staff vacancies would be related to an increased number of adverse events overall and a specific increase in safety-related events. Although direct care staff vacancies were not significantly related to the overall number of adverse events, they were significantly associated with the magnitude of adverse events related to school suspensions, substance use, and law enforcement encounters. Several other novel, unanticipated findings emerged, with various youth- and facility-level factors (e.g. race, age, length of admission, facility level of clinical acuity) showing significant relationships with the magnitude of adverse events. This study fills a notable gap in the literature in its novel empirical approach to exploring administrative data capturing direct care staffing and adverse events in child welfare residential care.

Barriers and Facilitators to Implementing the National Patient Safety Implementation Framework in Public Health Facilities in Tamil Nadu: A Qualitative Study.

In 2017, the National Patient Safety Implementation Framework (NPSIF) was introduced in India to ensure patient safety at different levels of the health care delivery system by 2025. Evaluating the implementation status, feasibility, and challenges and obtaining suggestions for improvement are key to the successful and sustainable implementation of any national health framework. Hence, we explored the facilitators and challenges in implementing the NPSIF and sought suggestions to address the challenges. We adopted a descriptive qualitative approach to inquire about NPSIF implementation. Health care workers were selected using maximum variability sampling from 18 secondary- and tertiary-level public health care facilities in Tamil Nadu, India. From August to October 2021, we conducted a total of 80 key informant interviews and in-depth interviews with the relevant officers in-charge and HCWs of varied cadres. Facilitating factors reported were facilities obtaining/working toward quality certification; availability of standard protocols and checklists; and government rewards for the best-performing hospitals, doctors, and staff. Major implementation challenges reported were staff shortages; lack of infrastructure, facilities, and equipment; lack of awareness about patient safety, noncompliance to standard guidelines, and lack of patient cooperation. Recommendations suggested to overcome these challenges included providing educational materials to patients, offering regular continuing medical education and training, improving record maintenance, having a dedicated staff/team and surveillance system setup for patient safety and dedicated staff for data entry, filling existing staff vacancies, and using a carryover option for funding. Based on the current situation of patient safety practices in public health facilities in Tamil Nadu, it will be difficult to achieve full-scale implementation of the NPSIF by 2025. However, as a first step, a core patient safety committee can be formed at the state level to develop a Gantt chart for implementation based on the priorities over the next 2 years.

Evaluating change in a pressured healthcare system: a cross-sectional study of implementation outcomes using routine data indicators and proxies

BackgroundImplementation evaluation should focus on implementation success, guided by theories and frameworks. With high staff vacancies in the health services, it is important to consider pragmatic methods of data collection for implementation evaluation. This paper presents a cross-sectional rapid evaluation of a handheld medical device designed for remote examinations, piloted in Northern England. By using downloaded device data and administrative records mapped to domains from the implementation outcomes framework, this evaluation offers a pragmatic example of assessing implementation success.MethodsThe pilot design was pragmatic: sites volunteered, decided which services to use the device in, and launched when ready. The pilot and evaluation together lasted 1 year. Data was downloaded from the devices, and administrative records for the pilot accessed. Variables were mapped to five of the implementation outcomes, after reviewing with the device manufacturer and pilot team to assess robustness.ResultsN=352 care episodes were recorded using the device with 223 patients. Out of 19 sites ‘signed up’ to the pilot, 5 launched and delivered 10 of 35 proposed projects: a site and project adoption rate of 26 and 29%, respectively. Six sites signed up to an extension period; three had launched and three had not during the original timelines, indicating some sustainability. Feasibility was high, with only one in seven care episodes needing to be repeated due to poor device quality or error (sound/audio/internet). Fidelity of device usage was low for two of the eight available device examinations. Device and staffing costs were high but potential cost savings were attributable to fewer in-person appointments.ConclusionsThrough using device and administrative data, this evaluation minimised burden on busy healthcare staff yet was still guided by an evaluation framework. Five out of the eight implementation outcomes were measured, including sustainability and costs. The findings give insight into implementation challenges, particularly around adoption. For future research, it is recommended to engage with staff to prioritise outcome measurements and to focus on meaningful interpretation of indicators.

No choice? Hiring agency social workers in the Swedish personal social services

ABSTRACT The practice of hiring agency social workers, i.e. social workers who are employed by for-profit staffing agencies but rented out to the social services, has been questioned and depicted as legally complex, costly and unsustainable. Nevertheless, it continues to be an institutional way of handling vacancies and understaffing in the social services. In this article, professionals’ reasoning about the use of agency workers is investigated through qualitative interviews with 21 social workers/managers in the social services. According to the interviewees’ descriptions, agency social workers are hired in order to achieve numerical stability, i.e. to maintain services notwithstanding staff absence and vacancies. Similar to findings in previous literature, the interviewed professionals describe that workload, turnover and recruitment difficulties are reasons behind the use of agency workers. However, they also highlight other aspects that are associated with the use, such as chronic understaffing and a large proportion of newly qualified social workers. Throughout, the use of agency workers is described as reactive, i.e. as an acute (and often unwanted) solution, and not as deliberate and planned.

COVID-19 Mixed Impact on Hospital Antimicrobial Stewardship Activities: A Qualitative Study in UK-Based Hospitals.

Antimicrobial resistance (AMR) is a well-known global threat due to the subsequent increase in antimicrobial usage. Several antimicrobial stewardship (AMS) strategies have been implemented to curb irrational prescribing and reduce the AMR burden. However, since the beginning of the COVID-19 pandemic, it has enormously impacted the healthcare system and jeopardized public health, causing millions of deaths globally. Our semi-structured qualitative study aimed to explore the impact of COVID-19 on AMS activities in the UK hospitals. Seventeen interviews were conducted with health care professionals who were part of AMS teams (consultant medical microbiologists, infectious disease consultants, antimicrobial pharmacists). Interviews were audio-recorded and transcribed. An inductive thematic framework was adopted to analyse and create the themes. After agreement of the hierarchical framework definition, all transcripts were coded accordingly. Four main themes and 15 sub-themes were identified. These main themes were: (1) AMS activities or strategies before and during the pandemic; (2) challenges to implementing AMS activities before and during the pandemic; (3) information from public authorities on AMS during the pandemic; and (4) new AMS activities/strategies adopted during the pandemic. Staff vacancies, redeploying of AMS staff to other duties and meeting the burden related to the COVID-19 and lack of resources were the most frequently identified contributing factors to withheld AMS activities during the pandemic. However, modifications to the hybrid working environment, i.e., remote or flexible working, allowed for resumption of AMS activities including virtual ward rounds, virtual meetings and other activities. Further research needs to assess the impact of the hybrid delivery system on AMS activities.

Chatbot with Dialogflow for FAQ Services in Matana University Library

Industry 4.0 and situation of Corona pandemic encourage the development of chatbots. The Matana university library in Indonesia is facing protocol implementation due to the pandemic, library staff vacancies and the need to improve 24x7 online services. Therefore, a solution is needed to resolve these kinds of problems. The success of chatbots in the business world and public services is the reason for the adoption of chatbots to overcome these problems. The first phase of chatbot development focuses on Frequently Asked Questions (FAQ). The development model for chatbot applications development uses a prototyping model by utilizing Dialogflow, namely the natural language understanding (NLU) platform. Agents, intents, entities, contexts, events, fulfilment, and integration need to be considered before designing a chatbot conversation. The test results are the chatbot is feasible to be accepted and operated. The variety of phrases entered into the Intent will improve accuracy. However, the accuracy of this chatbot will become lower if the language conveyed uses a lot of abbreviations or local / foreign languages. In further development, it is necessary to apply the system implementation and system maintenance phases, make chatbot responses not rigid like robots, add other library services such as new member registration, information on book availability, user satisfaction and so on.

Specificity Matters: Unpacking Impact Pathways of Individual Interventions within Bundled Packages Helps Interpret the Limited Impacts of a Maternal Nutrition Intervention in India

BackgroundTo address gaps in coverage and quality of nutrition services, Alive & Thrive (A&T) strengthened the delivery of maternal nutrition interventions through government antenatal care (ANC) services in Uttar Pradesh, India. The impact evaluation of the A&T interventions compared intensive ANC (I-ANC) with standard ANC (S-ANC) areas and found modest impacts on micronutrient supplementation, dietary diversity, and weight-gain monitoring. ObjectivesThis study examined intervention-specific program impact pathways (PIPs) and identified reasons for limited impacts of the A&T maternal nutrition intervention package. MethodsWe used mixed methods: frontline worker (FLW) surveys (n = ∼500), counseling observations (n = 407), and qualitative in-depth interviews with FLWs, supervisors, and block-level staff (n = 59). We assessed 7 PIP domains: training and materials, knowledge, supportive supervision, supply chains, data use, service delivery, and counseling. ResultsExposure to training improved in both I-ANC and S-ANC areas with more job aids used in I-ANC compared with S-ANC (90% compared with 70%), but gaps remained for training content and refresher trainings. FLWs’ knowledge improvement was higher in I-ANC than S-ANC (22–36 percentage points), but knowledge of micronutrient supplement benefits and recommended foods was insufficient (<50%). Most FLWs received supervision (>90%), but supportive supervision was limited by staff vacancies and competing work priorities. Supplies of iron–folic acid and calcium supplements were low in both areas (30–50% stock-outs). Use of monitoring data during review meetings was higher in I-ANC than S-ANC (52% compared with 36%) but was constrained by time, understanding, and data quality. Service provision improved in both I-ANC and S-ANC areas, but counseling on supplement benefits and weight-gain monitoring was low (30–40%). ConclusionsSystems-strengthening efforts improved maternal nutrition interventions in ANC, but gaps remained. Taking an intervention-specific perspective to the PIP analysis in this package of services was critical to understand how common and specific barriers influenced overall program impact.

Understanding Implementation and Improving Nutrition Interventions: Barriers and Facilitators of Using Data Strategically to Inform the Implementation of Maternal Nutrition in Uttar Pradesh, India.

ABSTRACTBackgroundIn response to the high levels of maternal nutrition in Uttar Pradesh, Alive & Thrive (A&T) aimed to strengthen the delivery of nutrition interventions through the government antenatal care platform, including leveraging ongoing data collection to improve program delivery and reach (registered at clinicaltrials.gov as NCT03378141). However, we have a limited understanding of providers’ experiences and challenges in collecting and using data for decision making.ObjectiveThe aim was to identify barriers and facilitators to the 1) collection of data and 2) use of data for decision making.MethodsIn-depth interviews (n = 35) were conducted among block-level government staff, frontline worker (FLW) supervisors, and A&T staff in 2 districts in Uttar Pradesh. Systematic coding of verbatim transcripts and detailed summaries were undertaken to elucidate themes related to data collection and use. FLW supervisors (n = 103) were surveyed to assess data use experiences.ResultsData were used to understand the reach of maternal nutrition services, estimate the demand for supplements, and guide identification of areas of low FLW performance. About half of supervisors reported using data to identify areas of improvement; however, only 23% reported using data to inform decision making. Facilitators of data collection and use included collaboration between health department officials, perceived importance of block ranking, and monthly review meetings with staff and supervisors to review and discuss data. Barriers to data collection and use included human resource gaps, inadequate technology infrastructure, FLW educational level, political structure, and lack of cooperation between FLWs and supervisors.ConclusionsThe use of data for decision making is critical for supporting intervention planning and providing targeted supervision and support for FLWs. Despite intensive data-collection efforts, the use of data to inform decision making remains limited. Collaboration facilitated data collection and use, but structural barriers such as staff vacancies need to be addressed to improve the implementation of maternal nutrition interventions.

Migrants’ strategies within the Arctic Council member-states: bottleneck vacancies analysis (by the example of Finland, Sweden, Denmark and Norway)

The article deals with the Arctic Council labor market characteristics analysis, particularly, we have looked at some macro indicators and reviewed about 800 bottle-neck vacancies to identify differences across 4 Arctic Council member-states (Finland, Sweden, Denmark, and Norway), sectors and level of education referring to skill levels in demand. Differences in levels of economic development also seem to have an effect on labour demand in different countries.Our bottle-neck vacancies analysis has shown that vacancies demanding higher vocational education are highly necessary especially in Denmark and Sweden. Finland and Norway are demonstrating acute shortage both in vacancies with higher and secondary vocational education. Under bottleneck vacancies analysis a great emphasis was made upon high-tech/non hi-tech economic sectors. Vacancies demanded in high-tech economic sectors are mostly represented with mountain metallurgy technicians, software developers, chemical engineers, mechanics, biotechnologists, heavy industry technicians, IT engineers, and electrical engineers. These vacancies are particularly demanded in Sweden, Denmark, Norway. Non-high-tech bottleneck vacancies are represented in such economic sectors as construction, light industry, forestry, transportation and trade. Medical staff vacancies are also in high demand. Health care specialists are primarily demanded in Finland. One possible reason for that could be rapidly ageing population in the Arctic Council member-states resulting in higher demand for healthcare professionals.

Sustainability of United Nations Recruitment: An Empirical Analysis of Recent Vacancy Advertisements of United Nations Specialized Agencies

This paper examines the sustainability of recruitment in the United Nations (UN), the largest global inter-governmental organization working on sustainable development. It investigates the sustainability of UN recruitment on three main dimensions: remuneration and job stability; meritocracy and fairness; cost and efficiency, with the data from recent vacancy advertisements of two UN specialized agencies. The analytical results suggest that being different from the existing knowledge of UN recruitment, the job stability in UN as shown by the data is higher due to the large proportion of staff vacancies and long-term job contracts. The remunerations to UN job incumbents are high, not only because of the widely-known attractive packages which are provided referring to the highest remuneration levels of national civil service, but also due to the subsidies of working in hardship places. Also, it is found that UN specialized agencies have developed detailed competency frameworks for recruitment to ensure the meritocracy. However, due to the essential monitoring procedures, UN recruitment is often lengthy and costly. Therefore, in the dilemma of meritocracy, fairness, and efficiency in recruitment, efficiency is not highly emphasized in UN recruitment practice, in comparison with meritocracy and fairness. Practical recommendations for improving sustainability of UN recruitment are provided, but more evidence and implications are to be provided by future research.&#x0D; Key Words: United Nations; Recruitment; Sustainability; Meritocracy; Efficiency

Understanding How the Strategic Use of Data Can Improve the Implementation of Maternal Nutrition Interventions in Uttar Pradesh (UP), India

Abstract Objectives Maternal undernutrition remains high in India and is associated with maternal mortality and adverse birth outcomes. To address this challenge, Alive &amp; Thrive (A&amp;T) aimed to strengthen interpersonal counseling, micronutrient supplement provision, and community mobilization through the government antenatal care (ANC) platform in UP. The nutrition-intensified ANC (I-ANC) intervention facilitated regular use of data to enable corrective actions. We aimed to understand how maternal health data was used for improving the delivery of maternal nutrition services and to identify factors associated with data use. Methods In-depth interviews (N = 35) were conducted among sub-district government staff, frontline worker (FLW) supervisors and A&amp;T staff in two districts in UP. Systematic coding of verbatim transcripts and detailed summaries was undertaken to elucidate themes and patterns related to data use and facilitators and barriers. Results Sub-district government staff reported using government data (i.e., HMIS) to estimate demand for prenatal supplements. Sub-district government staff, FLW supervisors and A&amp;T staff used government and intervention monitoring data to understand the impact and reach of services delivered to women. Key indicators on the attendance of pregnant women at community health events and number of women receiving adequate supplements was discussed with FLWs in monthly review meetings. Data review guided identification of areas of low FLW performance (i.e., monitoring weight gain) and prompted refresher trainings. Facilitators of data use included collaboration between sub-district health department officials on data analysis and monthly review meetings to provide feedback on improving performance (including counseling topics and stock of supplements). Barriers to data use included staff vacancies, education level of FLWs and conflicts between FLWs and supervisors. Conclusions Use of data for decision making is critical for supporting intervention planning and providing targeted supervision and support for FLWs. Collaboration facilitated the use of data, but structural barriers such as staff vacancies need to be addressed to improve the implementation of maternal nutrition interventions. Funding Sources Bill &amp; Melinda Gates Foundation (through Alive &amp; Thrive, managed by FHI 360) and Emory University.

P74 Group counselling: a holistic care model

Abstract Background Disease modifying anti rheumatic drugs (DMARDs) play a vital role in controlling autoimmune disease. They are complex medications requiring nurse counselling to initiate. Staff vacancies and increasing referrals led to 12-week waiting times from decision to treat in our Trust. We wanted to improve the efficiency of the medication counselling process, but at the same time use it as an opportunity to educate our patients on their disease, management and self-care. Methods We designed and delivered a successful group clinic to improve patient experience, reduce waiting times and improve efficiency. As well as covering the necessary DMARD information, the clinic includes patient education on general, physical and mental well-being, dietary advice as well as physiotherapy and occupational therapy input. The clinic format consists of a presentation/discussion, peer support and individual consultation, providing truly holistic care. Results Waiting times: reduction from 84 days to 7-14 days from decision to treat for our two main DMARDS and 56 days to 14 days for our anti TNF therapies. Clinical outcome/patient safety: Earlier initiation of DMARDs has been shown to reduce morbidity. Financial: Additional £444 income per clinic (compared with previous clinic process) at a tariff of £111 per patient. Group clinics currently run weekly. Patient feedback: 50 patient feedback forms have been collected and reviewed. Of these 50 patients 97.8% of questions asked were marked as agree or strongly agree to a positive experience. Shared learning: The clinic format was presented at a regional meeting and at our Trusts Quality Improvement Day. There is interest in adopting a similar approach in other departments in the Trust and in other rheumatology departments in the region. Conclusion Our group consultation model provides a holistic model to care that has been very popular with our patients. We have subjectively had an increase uptake in physiotherapy services and patients seem to be persevering and tolerating their medications better. Our group consultations have been running successfully for a year, and we have expanded the sessions to cover more drugs including our anti TNF therapies. It is yet early days to comment on the long-term impact our clinic has on patients, but with our clinic providing patient education and empowering patients through self management we are hopeful that we will be improving the long-term outcome of our patients. Disclosures K. Nadesalingam None. C. Short None.

Analysis of the operational risk factors in public hospitals in an Indian state

PurposeRisk management in the healthcare sector is a highly relevant sub-domain and a crucial research area from the humanitarian perspective. The purpose of this paper is to focus on the managerial/supply chain risk factors experienced by the government hospitals in an Indian state. The present paper analyzes the inter-relationships among the significant risk factors and ranks those risk factors based on their criticality.Design/methodology/approachThe current research focuses on 125 public hospitals in an Indian state. Questionnaire-based survey and personal interviews were conducted in the healthcare sector among the inpatients and hospital staff to identify the significant risk factors. An integrated DEMATEL–ISM–PROMETHEE method is adopted to analyze the impact potential and dependence behavior of the risk factors.FindingsThe analysis asserts the absence of critical risk factors that have a direct impact on patient safety in the present healthcare system under investigation. However, the results illustrate the remarkable impact potential attributed to the risk factor, namely, staff shortage in inducing other risk factors such as employee attitudinal issues, employee health issues and absenteeism altogether resulting in community mistrust/misbeliefs. Maintenance mismanagement, monsoon time epidemics, physical infrastructure limitations are also found to be significant risk factors that compromise patient satisfaction levels.Practical implicationsMultiple options are illustrated to mitigate significant risk factors and operational constraints experienced by public hospitals in the state. The study warrants urgent attention from government officials to fill staff vacancies and to improve the infrastructural facilities to match with the increasing demand from the society. Furthermore, this research recommends the hospital authorities to start conducting induction and training programs for the hospital employees to instill the fundamental code of conduct while working in hectic, challenging and even in conditions with limited resources.Originality/valueOnly limited papers are visible that address the identification and mitigation of risk factors associated with hospitals. The present paper proposes a novel DEMATEL–ISM–PROMETHEE integrated approach to map the inter-relationships among the significant risk factors and to rank those risk factors based on their criticality. Furthermore, the present study discloses the unique setting of the public healthcare system in a developing nation.

Neonatal nursing workforce survey – What does the landscape look like in England?

The aim of this survey was to identify an in-depth analysis of the staffing in all the neonatal units in the Operational Delivery Networks in England. A survey tool was constructed by the lead nurses from the ODN's in conjunction with a data analyst. This was then sent to all of the managers in every unit in England to complete. Questions were asked around nursing staff vacancies, how these were being managed, how registered and unregistered staff were being educated, if link nurses were employed, if community outreach teams were utilised and how this was all being funded. Managers were asked to provide free text comments so that some qualitative data would help illuminate the current difficulties that they were dealing with together with some insights into what had helped.The survey showed that almost all units had vacancies and that these were more prevalent in the south of England, with the biggest reason for these being retirement. Managers reported that in some areas it was relatively easy to recruit and conversely in others it was extremely challenging. It was especially difficult to recruit staff with experience. There were challenges in managing staff education and in particular enabling staff to achieve the QIS qualification, or in the case of nonregistered staff, NVQ or foundation degree qualifications.There are variations among units in availability of link roles and also the provision of community outreach teams and funding for these roles is unclear and disparate.Whilst this has provided a snapshot across England it has also pointed to further, more detailed work that needs to be done to ensure that units are staffed appropriately and in line with current standards.

An Exploration of Nursing Assistants' Perceptions About Job Satisfaction.

High levels of staff turnover of certified nursing assistants (CNAs) are costly and disruptive to patient care. A variety of factors contribute to a 36% turnover rate of CNAs nationwide (2015 Staffing Report, 2015). According to Stone and Wiener, high rates of turnover and staff vacancies have multilayered consequences; patient care suffers, cost of constantly replacing workers soars, and worker job dissatisfaction increases. This study examined the CNAs' beliefs about job satisfaction as an approach to prevent job turnover and retain high achieving staff in one acute care hospital in a south eastern region. The goal was to determine how CNAs define job satisfaction, evaluate their understanding of and gauge interest in the career options presented at information sessions as well as listen to their ideas on how they believe are the best approaches to achieve job satisfaction for the CNAs at this facility. A qualitative key informant design was used to interview a purposive sample of 9 nursing assistants who were currently employed at the hospital for at least 6 months and who attended a brief information session. Individual 20-minute face-to-face interviews of consented participants were recorded, transcribed, and coded for themes using constant comparative analysis. Four major categories emerged from the interviews: CNA views of job satisfaction, clinical ladder option, support services option, and what CNAs want.

Introduction of a team-based care model in a general medical unit.

BackgroundAlberta Health Services is a provincial health authority responsible for healthcare for more than four million people. The organization recognized a need to change its care delivery model to make care more patient- and family-centred and use its health human resources more effectively by enhancing collaborative practice. A new care model including changes to how providers deliver care and skill mix changes to support the new processes was piloted on a medical unit in a large urban acute care hospital Evidence-based care processes were introduced, including an initial patient assessment and orientation, comfort rounds, bedside shift reports, patient whiteboards, Name Occupation Duty, rapid rounds, and team huddles. Small teams of nurses cared for a portion of patients on the unit. The model was intended to enhance safety and quality of care by allowing providers to work to full scope in a collaborative practice environment.MethodsWe evaluated the new model approximately one year after implementation using interviews with staff (n = 15), surveys of staff (n = 25 at baseline and at the final evaluation) and patients (n = 26 at baseline and 37 at the final evaluation), and administrative data pulled from organizational databases.ResultsStaff interviews revealed that overall, the new care processes and care teams worked quite well. Unit culture and collaboration were improved, as were role clarity, scope of practice, and patient care. Responses from staff surveys were also very positive, showing significant positive changes in most areas. Patient satisfaction surveys showed a few positive changes; scores overall were very high. Administrative data showed slight decreases in overall length of stay, 30-day readmissions, staff absenteeism, staff vacancies, and the overtime rate. We found no changes in unit length of stay, 30-day returns to emergency department, or nursing sensitive adverse events.ConclusionsConclusions from the evaluation were positive, providing initial support for the idea of the collaborative practice model vision for adult medical units across Alberta. There were also a few positive effects on patient care suggesting that models such as this one could improve the organization’s ability to deliver sustainable, high-quality, patient- and family-centred care without compromising quality.

Changes in turnover and vacancy rates of care workers in England from 2008 to 2010: panel analysis of national workforce data.

The combination of growing demand for long-term care and higher expectations of care staff needs to be set in the context of long-standing concerns about the sustainability of recruitment and retention of front-line staff in the United Kingdom. Organisational and work environment factors are associated with vacancy levels and turnover rates. The aim of the current analysis was to investigate changes in turnover and vacancy rates over time experienced by a sample of social care employers in England. Taking a follow-up approach offers potentially more accurate estimates of changes in turnover and vacancy rates, and enables the identification of any different organisational characteristics which may be linked to reductions in these elements over time. The study constructed a panel of 2964 care providers (employers) using 18 separate data sets from the National Minimum Data Set for Social Care during 2008-2010. The findings indicate slight reductions in vacancy rates but the presence of enduring, high turnover rates among direct care workers over the study period. However, the experience of individual employers varied, with home-care providers experiencing significantly higher turnover rates than other parts of the sector. These findings raise questions around the quality and motivations of new recruits and methods of reducing specific vacancy levels. At a time of increased emphasis on care at home, it is worthwhile examining why care homes appear to have greater stability of staff and fewer vacancies than home-care agencies.

Unequal staffing: A snapshot of nurse staffing in critical care units in New South Wales, Australia

A growing body of research provides evidence of the link between nurse-to-patient ratios (NTPRs) and skill mix with adverse patient outcomes. This paper reports an investigation into nurse staffing patterns, skill mix and patient movement in critical care units in NSW, Australia. A ‘snapshot’ of staffing patterns and patient movement over 1 week in October 2012 was obtained by use of a cross-sectional design using retrospective survey and administrative data. A wide variation was found in NTPRs, skill mix and the number of nursing staff vacancies in coronary care and high dependency units. These variations suggest that the quality of patient care may vary between facilities in New South Wales.

Bill Seeks to Boost Number of Psychiatrists in VA

Back to table of contents Previous article Next article Government NewsFull AccessBill Seeks to Boost Number of Psychiatrists in VAMark MoranMark MoranSearch for more papers by this authorPublished Online:31 Mar 2014https://doi.org/10.1176/appi.pn.2014.4a20AbstractThe bill identifies a critical strategy for the VHA to implement to remedy a serious shortage of psychiatrists available to treat veterans.Legislation was introduced in Congress last month to address a severe shortage of psychiatrists in the Veterans Administration (VA) to serve members of the military returning from Afghanistan and Iraq. The Ensuring Veterans Resiliency Act, introduced by Rep. Larry Bucshon (R-Ind.) and Rep. David Scott (D-Ga.), would establish a three-year demonstration program under the VA modeled on the Department of Defense Health Professions Loan Repayment Program, which offers physicians up to $60,000 in medical school loan repayment for each year of service. The bill also authorizes the VA to recruit at least 10 psychiatrists into the loan-repayment program each year; the VA would hire these physicians permanently to fill full-time positions, and participants would be required to demonstrate a long-term commitment to the VA.Additionally, the legislation requires a report to Congress on the program’s impact on psychiatric vacancies and recruitment and authorizes a government study on pay disparities between psychiatric physicians at the VA.In a letter of support for the bill sent to Bucshon and Scott, APA CEO and Medical Director Saul Levin, M.D., M.P.A., noted that veterans face significant mental health challenges and pointed out that several studies place the rate of posttraumatic stress disorder (PTSD) in veterans of wars in Iraq and Afghanistan at approximately 40 percent. And each year, approximately 6,000 veterans complete suicide.“Staff vacancies likely contribute to the Veterans Health Administration’s (VHA) inability to deliver mental health services in a timely fashion,” Levin wrote. “Current policy makes it extremely difficult for the VHA to compete with other public and private entities in offering employment incentives, such as medical school loan repayment. According to USAjobs.gov, on September 17, 2013, there were 142 federal job vacancies for psychiatrists. Of those, 138 were for the VA, and 128 were for permanent hires. Of those permanent positions, only 33 were eligible for medical school loan repayment.“The demonstrated shortage of psychiatrists is a contributing factor to the inability of the VHA to deliver mental health services in a timely fashion,” Levin wrote. “Given that the acute mental health needs of our veterans will persist for years to come, APA strongly supports the demonstration project established by the Ensuring Veterans Resiliency Act. This project . . . promises to identify a critical strategy for the VHA to maintain a robust and stable psychiatric workforce.” Levin noted as well that APA supports the bill’s requirement for a government report to examine pay disparities among psychiatrists at the VHA. “This report is critical for determining how pay disparities negatively affect the stability of VHA’s psychiatric workforce,” Levin wrote.In a “Dear Colleague” letter written by Bucshon and Scott to fellow representatives, they urged support for the legislation, saying that a new way of encouraging more psychiatrists to choose a career with the VHA is needed. “We believe this modest legislation promises to identify a critical strategy for the VHA to maintain a robust and stable psychiatric workforce that can serve the acute mental health needs of our nation’s veterans,” they wrote. ■ ISSUES NewArchived