Workforce Policy Research Articles

Integrating nurse practitioners into primary healthcare to advance health equity through a social justice lens: An integrative review.

To develop a framework to guide the successful integration of nurse practitioners (NPs) into practice settings and, working from a social justice lens, deliver comprehensive primary healthcare which advances health equity. Integrative review. The integrative review was informed by the Whittemore and Knafl's framework and followed the Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. Quality was assessed using the Johns Hopkins Research Evidence Appraisal Tool. Findings were extracted and thematically analysed using NVivo. A social justice lens informed all phases. Databases, including CINAHL, PubMed, Scopus and Web of Science, were searched for peer-reviewed literature published in English between 2005 and April 2022. Twenty-eight articles were included. Six themes were identified at the individual (micro), local health provider (meso), and national systems and structures (macro) levels of the health sector: (1) autonomy and agency; (2) awareness and visibility; (3) shared vision; (4) leadership; (5) funding and infrastructure; and (6) intentional support and self-care. The evidence-based framework is explicitly focused on the components required to successfully integrate NPs into primary healthcare to advance health equity. Integrating NPs into primary healthcare is complex and requires a multilevel approach at macro, meso and micro levels. NPs offer the potential to transform primary healthcare delivery to meet the health needs of local communities. Health workforce and integration policies and strategies are essential if the contribution of NPs is to be realized. The proposed framework offers an opportunity for further research to inform NP integration. Nurse practitioners (NPs) offer the potential to transform primary healthcare services to meet local community health needs and advance health equity. Globally, there is a lack of guidance and health policy to support the integration of the NP workforce. The developed framework provides guidance to successfully integrate NPs to deliver comprehensive primary healthcare grounded in social justice. Integrating NPs into PHC is complex and requires a multilevel approach at macro, meso and micro levels. The framework offers an opportunity for further research to inform NP integration, education and policy. What problem did the study address: The challenges of integrating nurse practitioners (NPs) into primary healthcare (PHC) are internationally recognized. Attempts to establish NP roles in New Zealand have been ad hoc with limited research, evidence-informed frameworks or policy to guide integration initiatives. Our review builds on existing international literature to understand how NPs are successfully integrated into PHC to advance health equity and provide a guiding framework. What were the main findings: Six themes were identified across individual (micro), local health provider (meso) and national systems and structures (macro) levels as fundamental to NP integration: autonomy and agency; awareness and visibility of the NP and their role; a shared vision for the direction of primary healthcare utilizing NP scope of practice; leadership in all spaces; necessary funding and infrastructure; and intentional support and self-care. Where and on whom will the research have an impact: Given extant health workforce challenges together with persisting health inequities, NPs provide a solution to delivering comprehensive primary healthcare from a social justice lens to promote healthcare access and health equity. The proposed evidence-informed framework provides guidance for successful integration across the health sector, training providers, as well as the NP profession, and is a platform for future research. This integrative review adhered to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method. No patient or public contribution.

Bolstering health systems to cope with the impacts of climate change events: A review of the evidence on workforce planning, upskilling, and capacity building.

As global CO2 emissions continue to rise and the 'era of global boiling' takes hold, the health workforce must cope with the challenge of providing care to increasing numbers of patients affected by climate change-related events (e.g., hurricanes, wildfires, floods). In this review, we describe the impacts of these events on the health workforce, and strategies responding to these challenges. This rapid systematic review was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses and a registered protocol (PROSPERO CRD42023433610). Eight databases were searched in May 2022 and again in June 2023. Empirical studies discussing climate change and workforce policy, planning, preparedness, and capacity were included. Inductive thematic analysis of extracted data was conducted. From the 60 included studies, two categories emerged: the impacts of climate events on the health workforce (n=39), and workforce responses to and preparations for climate events (n=58). Thirty-seven studies reported on both categories. Four impact themes were identified: absenteeism, psychological impacts, system breakdown, and unsafe working conditions; and six responses and preparations themes: training/skill development, workforce capacity planning, interdisciplinary collaboration, role flexibility, role incentivisation, and psychological support. This review provides an overview of some of the deleterious impacts of climate events on the health workforce, as well as potential strategies for the health workforce to prepare or respond to climate events. Future studies should assess the implementation and effectiveness of these strategies to ensure a continuously improving healthcare system, and a well-supported health workforce.

Child Health Needs and the Adolescent Medicine Workforce Supply: 2020-2040.

Adolescent medicine (AM) subspecialists provide primary, subspecialty, and consultative care to adolescents and young adults (AYAs). Given insufficient numbers of AM subspecialists to care for all AYAs, the workforce supports AYAs health care capacity through education, research, advocacy, and the development of policies and programs sensitive to their unique needs. A modeling project funded by the American Board of Pediatrics Foundation was developed to forecast the pediatric subspecialty workforce in the United States from 2020 to 2040 on the basis of current trends in each subspecialty. The model predicts workforce supply at baseline and across alternative scenarios, and reports results in headcount and headcount adjusted for percentage of time spent in clinical care, termed "clinical workforce equivalent." For the AM subspecialty, several scenarios were considered that modified the number of fellows and/or clinical time. The baseline model predicted low growth nationally (27% and 13% increase in total AM subspecialists and AM subspecialists per 100 000 children, respectively) and declines in AM workforce relative to population growth in census divisions with existing geographic workforce disparities. In the alternative scenarios, fellow number and clinical time changes did not significantly change predictions relative to the baseline model, but a 12.5% decrease in fellows predicted a 40% reduction in the workforce from baseline with a widening of geographic workforce disparities. On the basis of the expansive clinical and nonclinical roles of AM subspecialists and these forecasted workforce challenges, significant educational, practice, and policy changes will be necessary to bolster the supply of well-trained clinicians addressing the dynamic health care needs of AYAs.

School psychology: Increasing awareness, enhancing policies, and reducing shortages

AbstractThis exploratory mixed methods study investigates the school psychology workforce shortage phenomenon and underlying contributing factors. The development of an Education Specialist school psychology program in the middle of the COVID‐19 pandemic prompted the authors to explore variables impacting awareness of the school psychology profession. State policies were reviewed to identify how many states have adopted the nationally recommended 1:500 ratio for school psychologists. Additionally, undergraduate and postbaccalaureate student knowledge of the work of school‐based mental health professionals, specifically school psychologists, was surveyed. Finally, the authors explore the need for new action frameworks to achieve this awareness and to promote workforce policy development. Based on findings, three key points for practitioners are the need to promote the adoption of policies that align with the 1:500 recommended ratio for school psychologists, increase awareness of the profession with preservice and in‐service educators, and create coordinated training pathways and career opportunities for individuals to become school psychologists.

Slack Is Needed to Solve the Shortage of Nurses.

Healthcare systems are facing a shortage of nurses. This article identifies some of the major causes of this and the issues that need to be solved. We take a perspective derived from queuing theory: the patient-nurse relationship is characterized by a scarcity of time and resources, requiring comprehensive coordination at all levels. For coordination, we take an information-theoretic perspective. Using both perspectives, we analyze the nature of healthcare services and show that ensuring slack, meaning a less than exhaustive use of human resources, is a sine qua non to having a good, functioning healthcare system. We analyze what coordination efforts are needed to manage relatively simple office hours, wards, and home care. Next, we address the level of care where providers cannot themselves prevent the complexity of organization that possibly damages care tasks and job quality. A lack of job quality may result in nurses leaving the profession. Job quality, in this context, depends on the ability of nurses to coordinate their activities. This requires slack resources. The availability of slack that is efficient depends on a stable inflow and retention rate of nurses. The healthcare system as a whole should ensure that the required nurse workforce will be able to coordinate and execute their tasks. Above that, workforce policies need more stability.

The mental health needs of healthcare workers: When evidence does not guide policy. A comparative assessment of selected European countries.

The healthcare workforce (HCWF) globally is facing high stress levels and deteriorating mental health due to workplace, labour market and policy deficiencies that further exacerbate the existing crisis. However, comprehensive and effective action is missing. We adopt a health system and governance perspective to address the mental health needs of healthcare workers (HCWs), considering the nature of interventions and the levels and actors involved in governance. The aim is to move the debate forward by identifying governance gaps hampering the implementation of health workforce policies and exploring strategies to effectively increase mental health support. A qualitative comparative methodology is applied based on a case study design utilising a multi-level intersectoral governance matrix. We conducted a rapid assessment of HCWF developments in the European context (Germany, Portugal, Romania, Switzerland and the United Kingdom), drawing on secondary sources and country experts. Awareness of mental health threats among HCWs increased, but policy discourse is driven by service delivery and labour market demands. The attention to HCWs' needs is stronger on the international level and weakest at national/regional levels. Although organisations and professions demonstrate varying degrees of activity, their efforts are scattered and lack sustainability. Similar challenges were identified across healthcare systems, including limited action, disconnected actors, missing coordination, and a lack of attention to governance gaps and system weaknesses. Adopting a health system approach is important but not sufficient. Successful mental health policy implementation needs multi-level governance and coherent coordination mechanisms.

Modelling the Wage Bill and Budget Space for Health Workforce in Ghana: Implications for Sustainable Health Professions Education Policy.

Global discussions on health systems strengthening have lately tilted towards increasing investments in human resources for health to address health workforce challenges, especially shortages and employment. Countries have, as a result, increased investments in the health workforce by expanding the production and recruitment of the needed health workforce, with the resultant effects of increasing health workforce budget space and the unending clamour by health policy actors for further increases. Despite these calls, there has been no wage bill affordability and budget space analysis to rationalise the sustainable production of and demand for health workers, which is the thrust of Ghana's current health workforce policy and strategy. Using an adapted approach (the Asamani approach), the study modelled the supply of some essential health workers and their associated cost of employment, compared it with the modelled budget space for health workforce employment and then drew conclusions on the wage bill sustainability for policy consideration. Of the seven cadres considered in the study (doctors, professional nurses, midwives, enrolled nurses, community health nurses, pharmacists and biomedical scientists), who constitute about 97% of the wage bill, the study found the baseline stock to be 129 378 in 2022, which was estimated to increase to 199 715 by 2027 and 254 466 by 2032 with corresponding wage bills of US$869.4 million and US$ 1.1 billion, respectively, holding routine salary increases constant. The budget space for health was, meanwhile, projected to be US$899.3 million and US$1.1 billion in 2022 and 2032 respectively, out of a projected overall government fiscal space of US$7 billion per year. This study concludes that, given current levels and mix of production, Ghana was estimated to expend an average of 88% of its health budget space as wage bill cost. This was 54.4% over the global median and 95.6% over the African Region's median, making the current regime unsustainable.

Beyond Borders: Socio-Economic Dynamics and Demographic Profiles Shaping Migration Patterns of Romanian Doctors Across EU

Healthcare professional migration has emerged as a global phenomenon, underscoring the need to comprehend migrant doctors' patterns and characteristics for effective policymaking and workforce planning. The paper analyses medical practitioners' migration across European countries. Through a quantitative survey, it unveils socio-demographic and professional attributes specific to Romanian doctors. The study explores correlations between the demographic and professional attributes of Romanian migrant doctors and the socio-economic traits of destination countries. Employing clustering analysis, the research identifies four distinct clusters, revealing variations in medical specialisations, income levels, marital statuses, and durations of stay across different European countries. These findings provide a comprehensive understanding of migration patterns among Romanian doctors. More research is needed to investigate factors influencing Romanian doctors' migration decisions and experiences and compare their profiles to those of migrant doctors from other countries. Understanding these patterns can help healthcare workforce planning, recruitment strategies, and policy development.

‘You’re only a care worker’. Exploring the status of adult social care work through the intersection of HRM innovation and job quality

This paper examines the intersection between job quality and innovation by exploring policy-led innovation aimed at delivering high-quality adult social care jobs that attract and retain much-needed skilled workers. Through qualitative enquiry, we examine workforce policy’s emphasis on training, development and career progression, key elements of job quality, to create higher-skilled, higher-status roles. Drawing on focus groups and interviews with care providers and care workers in Wales (UK), we question the likely success of policy-led innovation given first its ineffective delivery and second its failure to address broader aspects of job quality. Policy thus fails both to institutionalise skilled roles in care work and to raise the status of the care worker occupation. We contribute to emerging HRM and interdisciplinary theory and policy debates about the complex nature of innovation activities and their outcomes for job quality in care work within a sector typified by low-quality jobs. We illustrate the different ways in which job quality and innovation interact and how both can be constrained by one another as a function of environmental antecedents.

Physical Disabilities and Rehabilitation Services in Khartoum State, Sudan

Background: The study aimed to compile a profile of people with physical disabilities in Khartoum State, Sudan, while identifying disability types, challenges and satisfaction with services. 
 Methods: The study made use of a quantitative, cross-sectional design. Convenience sampling was employed to select 25% of the population of people with physical disabilities in Khartoum state, consisting of a sample of 467 participants. A self-developed, reliable questionnaire consisting of closed-ended questions was used to collect the data. Test-retest reliability has been determined through a pilot study of the questionnaires. Descriptive statistics was used to analyse the data. All the necessary ethical considerations were adhered to during the implementation of the study. Results: In our sample, 48.4% were children with disabilities who were less than 10 years old. Among the participants, amputations (30.8%) and cerebral palsy (30.3%) were the major types of physical disability. About 60% of the respondents were using assistive devices and out of these, 78.9% maintained their assistive devices themselves. Finances (70.5%) and transportation (42.7%) were the major barriers to accessing health services. Of the 84% who had access to physiotherapy services, 95.8% were satisfied with the services. Unemployment rates among people with physical disabilities were high in our sample.
 Conclusion: High prevalence of children with CP in our sample indicates the need for the prevention of disability and increased rehabilitation support. The high number of persons with amputation shows the need for prevention of injuries and prevention of and care in diabetes. Unemployment among physically disabled individuals is apparently high in our sample from Khartoum state. Although there were barriers to accessing services like finance and transportation, the majority of those recruited could access rehabilitation services. Many are using assistive devices and maintain them themselves. The participants were satisfied with the services they received. Recommendations: Prevention of disability, access to rehabilitation services and empowerment of people with disabilities need to be promoted, with inclusive education and appropriate workforce policy to reduce poverty. More investigation into disability services in rural Sudan is needed.

Leadership in Australia’s early childhood workforce policy: Silences and ambiguities as missed opportunities

This paper explores how leadership is addressed within Australia’s National Children’s Education and Care Workforce Strategy (ACECQA, 2021). The Workforce Strategy has been widely welcomed, arriving at a time of unprecedented workforce pressures in the early childhood education and care (ECEC) sector. Yet, on close examination there appears an absence of focus on leaders as a distinct group within the ECEC workforce. Considering leadership is unequivocally central to retaining and sustaining early childhood educators, this absence of focus is noteworthy. First, the paper unpacks what is currently known about ECEC leadership. Then, how leadership in the policies under consideration is constructed as a problem in relation to quality and capability. Next, silences and ambiguities in how the strategy addresses the retention of leaders and their wellbeing is discussed. Ultimately it is argued that we need more understanding of the experiences of leaders as a distinct subset of the ECEC workforce.

Home care nurses facilitating planned home deaths. A focused ethnography

BackgroundHome care nurses provide complex palliative care for patients who want to die in their own homes. This study aimed to explore home care nurses’ facilitation of planned home death to better understand nursing practices.MethodsData were collected between March 2019 and March 2020 using participant observations and semi-structured interviews. In addition, the number of planned home deaths was recorded. The analysis was guided by Roper and Shapira`s framework on focused ethnography.ResultsTwenty home care nurses (three men) in eight home care areas in two Norwegian municipalities met the inclusion criteria. Eight home deaths were registered, seven participatory observations were performed, and 20 semi-structured interviews were completed. Home care nurses find facilitating planned home deaths to be rewarding work, to the point of going above and beyond. At the same time, they describe facilitating planned home deaths as demanding work due to organizational stressors such as staff shortages, heavy workloads, and time restraints. While they tend to patients’ needs, they also express concern for the wellbeing of the next of kin. They find it challenging to juggle the needs of the patients with the needs of next of kin, as these are not always correlated.ConclusionHome care nurses are pushing the boundaries of their practice when facilitating planned home deaths while compensating for a fragile system by going above and beyond for patients and their next of kin. Providing insights into the work of home care nurses providing palliative care in patients’ homes can impact recruiting and retaining nurses in the workforce and influence local practices and policies.

Understanding the influence of medical education on physician geographic disposition: A qualitative study of family physician perspectives in Canada

AbstractRationalePrimary care access challenges are experienced by many communities. In several jurisdictions, including Canada, family physicians (FP) have the professional autonomy to organize their practice in alignment with professional and personal interests. Although system‐level interventions are tremendously important, investment in upstream interventions associated with the medical education of graduating FPs is a promising strategy for ameliorating primary healthcare access challenges.Aims and ObjectivesThis study investigates the medical education experiences that influence FP's decisions about practice locations in Canada.MethodsWe conducted semistructured interviews with FPs who completed undergraduate and postgraduate medical training in Canada and now have a practice in Ontario, Canada. Interview data were coded and analysed using an unconstrained descriptive approach.ResultsFPs preferred practice locations are intimately tied to their desired practice scope. Practice preferences were shaped through training experiences with patient populations, heightened clinical responsibilities, practice models and locations, professional mentorships and networks. Proximity to family, partner and lifestyle preferences, cultural connections and the available practice opportunities also shaped practice location decisions.ConclusionMedical education influences the identification and refinement of professional family practice preferences. Health workforce policies and interventions should leverage medical education to promote more equitable primary healthcare access.

Migrant healthcare workers: exploring resilience and capacity for circular migration

Abstract Background This study focuses on migrant healthcare workers’ experiences and explores mobility patterns in the middle of a global health crisis, aiming to explore the capacity for circular migration and support effective equitable healthcare workforce policy. Methods Romanian physicians working in Germany served as an empirical case study. We applied a qualitative explorative approach; interviews (n = 21) were collected from mid of September to early November 2022 and content analysis was performed. Results Migrant physicians showed strong resilience during the COVID-19 crisis and rarely complained. Commitment to high professional standards and career development were major pull factors towards Germany, while perceptions of limited career choices, nepotism and corruption in Romania caused strong push mechanisms. We identified two major mobility patterns that may support circular migration policies: well-integrated physicians with a wish to give something back to their home country, and mobile cosmopolitan physicians who flexibly balance career opportunities and personal/family interests. Conclusions Health policy must establish systematic monitoring of the migrant healthcare workforce including actor-centred approaches, support integration in destination countries as well as health system development in sending countries, and invest in evidence-based circular migration policy. Key messages • Effective retention policy must consider mobility patterns of healthcare workers and motivational factors, calling for systematic data and research evidence. • Major push and pull factors reveal strong interconnectedness of healthcare systems and policy in sending and receiving countries, calling for more equitable health workforce policy.

10.N. Round table: Healthcare workforce crisis: moving the Bucharest Declaration forward, bridging evidence and policy

Abstract Background The WHO has declared the healthcare workforce a five-year policy priority, and the Bucharest Declaration and ‘Time to Act’ Report provide helpful signposts for the European Region. However, the implementation of these policies and the evidence of their impact largely remain a black-box. Because of this fact, knowledge exchange and learning from country experiences about what works, how and why to improve retention, recruitment and equity within and between countries are particularly relevant. Objectives This panel workshop provides a platform for cross-country learning and networking, building bridges between health workforce research evidence and policy. We connect health labour market approaches and actor-centred experiences. With a focus on retention and working conditions, the panel provides an overview of available knowledge, considering scientific data as well as the experience of front-line actors. The panel takes a policy approach and engages representatives of academia, policy, and international organisations, discussing challenges as well as good practice experiences with a focus on problem-solving. The following major questions will be addressed: What evidence is available about the healthcare workforce crisis? How do countries respond to new healthcare workforce threats? What experience is available to improve retention, mental health support, equity and inclusiveness? Finally, how can cross-country learning be improved? The panel will stimulate critical debate and discuss major policy recommendations including: (1) scaling-up efforts to improve retention and respond to the health and social needs of all healthcare workers; (2) improving the skill-mix and developing novel team models; (3) establishing zero tolerance policies against all forms of violence; (4) improving gender equality and protecting women healthcare workers; (5) paying greater attention to migrant healthcare workers and equitable health workforce policies; (6) exploring the capacity building for healthcare workforce solutions through governance innovation. The workshop starts with an introduction by the organisers and a brief overview of health labour market trends and healthcare worker needs. Then four different country case examples will follow along with an international reflection on the policy solutions from the Bucharest Declaration. The moderated panel sets the scene for an interactive discussion with the audience in the second part, aiming to explore new solutions to respond to the healthcare workforce crisis in a more effective and equitable manner. Key messages • Health workforce policy must strengthen retention and support more equitable, inclusive and ‘humanised’ responses to the health workforce crisis. • Action must be taken to bridge research evidence and policy and systematically connect health labour market approaches and actor-centred experience. Speakers/Panelists Niamh Humphries RCSI Graduate School of Healthcare Management, Dublin, Ireland Sara Alidina Department of Human Resources Management for Health, Lisbon, Portugal Marius-Ionut Ungureanu Babeș-Bolyai University, Cluj-Napoca, Romania Viola Burau Aarhus University, Aarhus C, Denmark Tomas Zapata WHO/Europe, Copenhagen, Denmark

A roadmap out of medical deserts into supportive health workforce initiatives and policies, results from the ROUTE-HWF study

Abstract Background Medical deserts are coined as a specific term for areas dealing with low levels of health workers and health services. Health-underserved areas are a Europe wide problem, but still there is a lack of understanding on the different types and causes of medical ‘desertification’. In absence of a clear definition and categorization, countries acknowledge the severity of medical desert problems and take action. But they do so without taking opportunities to learn from each other, in terms of finding the rationale underlying the appropriate choice of policies and measures. Aims and Objectives The aim of the ROUTE-HWF project that will be presented is to develop an elaborated taxonomy on medical deserts that supports country comparison, and improves the matching of different policy initiatives with different types of medical deserts. This includes guidelines on how to monitor and measure medical deserts, and solutions like task shifting and retention of health workers. Methods The ROUTE-HWF project is based on a systematic literature review, a survey among European countries, and workshops with case studies among a selected number of countries. During each stage of the project the taxonomy and a roadmap ‘out of medical deserts’ is further developed. Results We present the ROUTE-HWF taxonomy and roadmap with guidelines for monitoring and measuring medical deserts. Three main distinctive types of medical deserts are defined: medical deserts mainly caused by problems with the accessibility of health workers and facilities, medical deserts mainly caused by problems with population needs in area, and medical deserts with (cumulation) of problems both at the demand and supply side of the local health system. We show that this categorization is useful to tailor health policy measures to the distinctive causes and solutions for medical deserts, enabling mutual or cluster country learning within Europe.

9.N. Workshop: How to solve shortages and uneven distribution of health workers in Europe?

Abstract Background Europe's health workforce is under extreme pressure. The increasing challenge of an uneven distribution of health workers within countries is amplified by a structural problem of shortages, inappropriate skill mix, inadequate working conditions and ageing of health workers. In this workshop the results from five research projects, ROUTE-HWF, OASES, AHEAD, TASHI and METEOR (joined in the EU Health Workforce project cluster) will be presented. The ROUTE-HWF, OASES and AHEAD projects focus on the uneven distribution of health workers resulting in ‘medical deserts’, while the TASHI project focusses on task shifting and METEOR on the retention of health workers. In this workshop it will become clear which lessons can be learned from the five projects and how they complement each other. How should retention and task shifting policies be implemented locally, and can they mitigate the uneven distributions of health workers? And vice versa, how should retention and task shifting policies by customized in different types of medical deserts? By combining the five projects into one workshop their links and added values will be made clear. While all projects are based on cross-national comparisons and aim to improve health workforce policy by in-depth research, they also differ and complement approaches to overcome the pressing struggles of the current health workforce. Aims and Objectives The aim of this workshop is to present the key findings of the different projects, focusing on the need for different solutions for countries to mitigate structural problems of health workers. Workshop format This will be a regular workshop. During the workshop, all five projects will shortly present their key results and after each there will be room for discussion. At the end of the workshop there will be room to discuss the complementarity of the five projects, and how they jointly provide an overview of policy options to mitigate structural problems related to medical deserts, task shifting and retention of health workers. Key messages • The workshop will give insight into the specific problems of medical deserts and the possible approaches with regard to retention and task shifting policies. • The workshop will give insight into the need for customizing policy solutions to attach the complex problem of health care worker shortages and regional disparities.

A bridge between: Te Ao Māori and Te Ara Paerangi

Purpose Aotearoa New Zealand’s Research, Science and Innovation (RSI) system is undergoing a ‘once in a generation’ reform known as Te Ara Paerangi Future Pathways (TAP). One of TAP’s four high-level goals is to embed Te Tiriti o Waitangi across the RSI system. Using the analogy of bridge-making, we draw on insights from Māori submissions to TAP to identify collective Māori expectations for what a Tiriti-embedded system entails. Method Submissions were accessed through the document library on the Ministry of Business, Innovation and Employment website. 34 submissions from individuals and collectives were identified as Māori. Qualitative Document Analysis was used to identify major themes. Results Results are described with reference to basic bridge-building principles of design, foundations, materials and maintenance. Key thematic findings include: Māori, as Tiriti partners, must be meaningfully involved in the reform design; the RSI system’s foundations are deeply colonial - decolonisation is needed to value, respect and protect Māori knowledges and knowledge-holders; workforce development, infrastructure and policies are required to empower partnered and autonomous RSI approaches; and, ongoing system maintenance in the form of monitoring is required to ensure transparency, accountability and equitable benefits. Reflection Having committed to embedding Te Tiriti across the RSI system, MBIE now has a duty of care to deliver on its commitment vis-à-vis the National Research Priorities. This paper is a timely opportunity to set a baseline of collective expectations against which to assess the future efficacy of TAP. Ka mahi mātou, me te takune hei puananī We will work with the intent to travel freely in any direction

'Nurses are seen as general cargo, not the smart TVs you ship carefully': the politics of nurse staffing in England, Spain, Sweden, and the Netherlands.

Nurse workforce shortages put healthcare systems under pressure, moving the nursing profession into the core of healthcare policymaking. In this paper, we shift the focus from workforce policy to workforce politics and highlight the political role of nurses in healthcare systems in England, Spain, Sweden, and the Netherlands. Using a comparative discursive institutionalist approach, we study how nurses are organised and represented in these four countries. We show how nurse politics plays out at the levels of representation, working conditions, career building, and by breaking with the public healthcare system. Although there are differences between the countries - with nurses in England and Spain under more pressure than in the Netherlands and Sweden - nurses are often not represented in policy discourses; not just because of institutional ignorance but also because of fragmentation of the profession itself. This institutional ignorance and lack of collective representation, we argue, requires attention to foster the role and position of nurses in contemporary healthcare systems.

The changing profile of the internationally educated nurse workforce: Post-pandemic implications for health human resource planning.

As part of its post COVID-19 recovery plan, the Canadian government is increasing the number of skilled immigrants, including Internationally Educated Nurses (IENs). However, pre-pandemic data show that IENs are underutilized and underemployed despite their education and experience. Focusing on the province of Ontario, this article explores trends in the IEN workforce and policies to address the nursing shortage. Barriers to IEN integration are reviewed and changes in the demographic and employment characteristics of IENs are analyzed. The disproportionate number of IENs employed in the Ontario long-term care sector, which has low wages and poor working conditions, emphasizes the need for policies that support the integration of IENs into the broader Canadian health system and increase their earning potential. To engage in strategic workforce planning and policy development, health leaders require access to nurse demographic and employment data that is timely and reflects the international and domestic labour supply.