Workforce Policy Research Articles

Adaptation and Validation of the Korean Version of the Scope of School Nursing Practice Tool.

The scope of the school nursing practice tool (SSNPT) is needed to apply and explore the gap between what school nurses perceive as important and actual practices. This study adapted and validated the Korean version of SSNPT (K-SSNPT) among 360 Korean school nurses in January 2022. The reliable and valid K-SSNPT can inform school nurses' workforce policies by capturing the current scope of school nursing practice and setting priorities for improving school health in South Korea.

U.S. Primary Care Provider Needs: An Analysis of Workforce Projections and Policy Implications.

The primary care (PC) physician workforce has consistently been projected as requiring additional numbers to meet the needs of the U.S. The Health Resources and Service Administration (HRSA) has reported the PC nurse practitioner (NP) workforce to be 90,000 NPs more than required to meet the PC needs of the U.S. With both clinician types contributing to the PC workforce in the country, it is difficult to understand such an oversupply of NPs with continued deficit in PC physicians. The purpose of this study was to investigate results and methods used for HRSAs current PC workforce projections and compare those with the same used for Bureau of Labor Statistics (BLS) and American Association of Medical Colleges (AAMC) projections. Methods included a review of technical documents, dashboards, and published reports. Interviews with subject matter experts were also completed. Projections were found to differ significantly, as did data and assumptions. Two of the three projections modeled physicians as the sole provider of PC. An integrated model gives the most comprehensive and accurate picture of PC workforce needs. The utilization of NPs as PC providers has been demonstrated to be safe and effective, with the potential to alleviate predicted shortages, improve patient care outcomes, reduce cost, and address PC inequities. Implications include improving workforce data, creating projections that mirror clinical integration in PC, adjusting workforce preparation funding, incentivizing interprofessional collaboration in research, addressing barriers to practice among non-physician providers, and leveraging growth in the NP workforce.

Midwifery workforce challenges in Victoria, Australia. A cross-sectional study of maternity managers

BackgroundIn Australia, there is a lack of accurate data on midwifery workforce staffing and skill mix, which in turn hinders workforce policy and planning. AimTo describe the current staffing levels of the midwifery workforce in Victoria, Australia, explore workforce challenges and assess the impact of COVID-19 pandemic on staffing. DesignCross-sectional. MethodsMidwifery managers in all public and private maternity services in Victoria, Australia were invited to complete a survey exploring midwifery staffing numbers and adequacy. Topics explored included midwifery turnover, recruitment, and skill mix. Descriptive statistics were used. FindingsThe survey was open March to October 2021, and 56 % (38/68) of managers responded. Of these, 76 % reported inadequate midwifery staff levels, with deficits ranging from one to 19 estimated Full-Time Equivalent (EFT) midwives, with a combined total deficit of 135 EFT. In the 12 months prior to the survey, 73 % of services had found it difficult to recruit midwives, with increased difficulty during the COVID-19 pandemic. Managers were concerned about retaining and recruiting ‘experienced’ midwives due to an ageing workforce and high turnover due to work/life imbalance and job dissatisfaction. These issues have led to a predominantly early career midwifery workforce and created concern about skill mix. ConclusionVictorian maternity services have a midwifery workforce shortage and are experiencing significant skill mix issues. The pandemic has exacerbated these considerable gaps in the workforce. Urgent implementation of retention and recruitment schemes are needed, along with strategies to improve the working conditions for the current workforce.

Current approaches and future directions for addressing ethics in infant and early childhood mental health.

In this paper, we consider whether the field of infant and early childhood mental health (IECMH) needs its own code of ethics. We begin by describing unique features of infant and early childhood mental health (IECMH) and the diverse strategies that the field has developed to address complex clinical dilemmas, among them workforce development, clinical supports, policy statements, and statements of ethical values. Because of the field's interdisciplinary nature, we also consider how various contributing professions and organizations address ethical issues. While these are important resources that can inform ethical decision-making, we identify some of the limitations of the current approaches. We argue that it is time for the field of IECMH to take an intentional, systematic approach to directly address the complex and unique ethical dilemmas faced by infant and early childhood mental health practitioners, and we grapple with some of the challenges developing such a code might entail. We suggest several avenues for better understanding the scope of ethical issues and ethical decision-making processes in IECMH that could be used to support developing an ethics code that is responsive to the unique and challenging world of infant and early childhood mental health.

Impact of Service-Based Student Loan Repayment Program on the Primary Care Workforce.

As the average level of medical education indebtedness rises, physicians look to programs such as Public Service Loan Forgiveness (PSLF) and National Health Service Corps (NHSC) to manage debt burden. Both represent service-dependent loan repayment programs, but the requirements and program outcomes diverge, and assessing the relative uptake of each program may help to inform health workforce policy decisions. We sought to describe variation in the composition of repayment program participant groups and measure relative impact on patient access to care. In this bivariate analysis, we analyzed data from 10,677 respondents to the American Board of Family Medicine's National Graduate Survey to study differences in loan repayment program uptake as well as the unique participant demographics, scope of practice, and likelihood of practicing with a medically underserved or rural population in each program cohort. The rate of PSLF uptake tripled between 2016 and 2020, from 7% to 22% of early career family physicians, while NHSC uptake remained static at 4% to 5%. Family physicians reporting NHSC assistance were more likely than those reporting PSLF assistance to come from underrepresented groups, demonstrated a broader scope of practice, and were more likely to practice in rural areas (23.3% vs 10.8%) or whole-county Health Professional Shortage Areas (12.5% vs 3.7%) and with medically underserved populations (82.2% vs 24.2%). Although PSLF supports family physicians intending to work in public service, their peers who choose NHSC are much more likely to work in underserved settings. Our findings may prompt a review of the goals of service loan forgiveness programs with potential to better serve health workforce needs.

Association between inequalities in human resources for health and all cause and cause specific mortality in 172 countries and territories, 1990-2019: observational study

ObjectiveTo explore inequalities in human resources for health (HRH) in relation to all cause and cause specific mortality globally in 1990-2019.DesignObservational study.Setting172 countries and territories.Data sourcesDatabases of the Global Burden...

Health workforce governance and professions: a re-analysis of New Zealand’s primary care workforce policy actors

BackgroundThis article contributes to the health workforce planning literature by exploring the dynamics of health professions in New Zealand’s Primary Care sector and deriving broad lessons for an international audience. Professions tend influence health policy and governance decisions and practices to retain their place, status and influence. Therefore, understanding their power dynamics and the positions that they have on workforce policies and issues assists workforce governance or health system reform plans.MethodsUsing the infrequently reported health workforce policy tool, actor analysis, a reanalysis of previously collected data is undertaken using an actor-based framework for the study of professionalism. Two models were developed, (1) the framework’s original four-actor model and (2) a five-actor model for the comparison of the Medical and Nurse professions. Existing workforce actor data were reclassified, formatted, and entered into actor analysis software to reveal the professions’ relative power, inter-relationships and strategic workforce issue positions.ResultsIn the four-actor model, the Organised user actor is found to be most influential, while the others are found to be dependent. In the five-actor model, the Medical and Nurse professions are individually more influential than their combined position in the four-actor model. Practicing professionals and Organised user actors have strong converging inter-relationships over workforce issues in both models, though in the five-actor model, the Nurse profession has weaker coherency than the Medical profession. The Medical and Nurse professions are found to be in opposition over the workforce issues labelled divisive.ConclusionsThese results reflect the professions’ potential to influence New Zealand’s Primary Care sector, indicating their power and influence over a range of policy and reform measures. As such, the four lessons that are derived from the case indicate to policy makers that they should be aware of situational contexts and actor power, take care when encountering divisive issues and try to achieve broad-based support for proposed policies.

Participatory action research

1. Introducing Participatory Action Research 2. Child Welfare Participatory Action Research Design Teams for Workforce Reconfiguration, Organizational Innovation, and Policy Change . 3. Participatory Action Research with Youth 4. A Complex, Community-Based Participatory Action Research Design to Address Obesity in Young Children and Their Families 5. The Critical-Emancipatory Tradition of Participatory Action Research in Postdisaster Recovery Settings in the Global South 6. Summary Reflections and Lessons Learning KEY WEBSITES FOR PARTIPATORY ACTION RESEARCH REFERENCES INDEX

We Had a Good Thing Going: The Rise, Fall, and Future of Vocational ESL in the United States

Vocational English as a Second Language (VESL) is a form of adult language education that teaches communicative skills in the context of preparing learners for a particular vocation. Despite their pedagogical and logistical benefits for adult language learners, such programs are uncommon today. This literature review traces the emergence and disappearance of VESL in the United States through a corpus study. It then explains these trends by analyzing second language acquisition research and policies related to adult education. It finds that VESL remains a promising approach that fell out of favor due to welfare and workforce policy reforms in the 1990s. It concludes by arguing for the continued relevance of VESL today and the need for adult educators to be vigilant of unintended policy impacts on their programs.

Portrait and Expectations of Kediri City MSMEs at the Time and Post of Pandemic COVID-19

The purpose of this study is to identify the impact of the Covid-19 pandemic on micro, small and medium enterprises (MSMEs) on 1) operations, 2) workforce policies, 3) income, 4) adaptation, 5) optimism, and 6) identification of needed empowerment facilities by MSMEs in post-pandemic. This study used primary data obtained by distributing research instruments to target respondents who represent the population. The population in this study were all MSMEs in Kediri City which were registered with the East Java Cooperative and SMEs Office, totalling 45,629 business units, with a sample of 500 respondents. Data were analyzed using descriptive statistical analysis which was used to determine the distribution of values from respondents' responses to the indicators used in the study. The results of this study are to present data on the portrait of MSMEs during the Covid 19 pandemic, MSME policies on implementing physical distancing, the factors faced by MSMEs during the pandemic. Adaptations made by MSMEs in the new normal period, facilitating the empowerment needed by MSMEs after the pandemic. Keywords: MSMEs, Portrait, Expectations, Optimism, Effort

Retention in nursing education and scholarship programs: Survival analysis of the Veterans Health Administration National Nursing Education Initiative Data.

To investigate factors affecting non-completion by registered nurses (RNs) participating in degree programs supported by the scholarship program of the National Nursing Education Initiative of the United States Veterans Health Administration. Secondarily, to assess overall retention in the scholarship program over time. Retrospective longitudinal design using administrative data. Defining retention time as the time elapsed from enrollment date to non-completion, we performed survival (retention) analysis (i.e.,Kaplan-Meier survival functions, log-rank tests and Cox regressions) to retrospectively analyzea national sample of RNs (N =15,908) enrolled in the scholarship program between the United States federal fiscal years 2000 and 2020. Nurses' mean age was 44 years (range: 19-71), and 86% were females. Six- and 12-month cumulative educational program retention rates were 92% and 84% respectively. The newest group of enrollees (2016-2020), younger nurses (<50 years), and nurses in traditional degree programtype were more likely to complete their academic programs than the earlier groups, older nurses and nurses in non-traditional type, respectively. Male nurses who aspired to advanced occupational levels upon completion were more likely to complete their academic programs compared to those who expected no change from their current level of practice. Multiple factors affected non-completion of academic degree programs by RNs enrolled in the scholarship program. More work is needed to examine these plus additional plausible factors and their correlates extensively. Our findings highlighted areas for quality improvement in employee scholarship programs for RNs. The findings are expected to inform tailoring of proactive helpful intervention towards individual needs and prioritization of limited resources to maximize graduation rate from academic programs for scholarship recipients. The study will have impact on nursing workforce policy makers interested in implementing employee scholarship programs, and on their scholarship recipients.

Osteopathy in rural and remote Australia: analysis of demographic, practice and clinical management characteristics from a nationally representative sample of 992 osteopaths.

There is significant interest in allied health and the role it plays in health care for rural and remote populations. In Australia, osteopaths are allied health professionals who manage predominantly musculoskeletal complaints using manual therapy, exercise and patient education. Workforce distribution is a significant issue for osteopathy in Australia with most practitioners centred in the metropolitan regions of Victoria and New South Wales. There is limited evidence about the role osteopathy plays in the musculoskeletal health of Australian rural and remote populations. This research sought to profile the characteristics of Australian osteopaths who practise in rural and remote settings. A secondary analysis of the Osteopathy Research and Innovation Network (ORION) data was undertaken to identify the demographic, practice and clinical management characteristics of Australian osteopaths in rural and remote settings. ORION is a practice-based research network for the Australian osteopathy profession. The ORION questionnaire comprised 27 items regarding osteopaths' characteristics. Inferential statistics were used to identify characteristics that were significantly different between Australian osteopaths practising in rural and remote settings compared to those practising in urban settings. Logistic regression was used to calculate adjusted odds ratios (AOR) relating to characteristics significantly associated with practising in a rural and remote setting. Of 992 osteopaths who responded to the ORION questionnaire, 18.3% (n=172) indicated practising in a rural and remote setting. Australian osteopaths in rural and remote settings were more likely to report receiving referrals from massage therapists (AOR 2.17), send referrals to other osteopaths (AOR 1.64), and often treat patients over the age of 65 years (AOR 2.25) compared to their urban counterparts. Osteopaths in rural and remote setting were less likely to report using private health insurance claim systems (AOR 0.36) and to treat non-English-speaking patients (AOR 0.09). This secondary analysis identified several practitioner and practice characteristics that differ between osteopaths practising in rural and remote settings and those practising in urban settings. These findings contribute to the emerging picture of the practice of rural and remote Australian osteopaths. Further research is required to understand the role osteopaths play in rural and remote health care, and how the current data can inform workforce and health policy development.

Tracks to Postgraduate Rural Practice: Longitudinal Qualitative Follow-Up of Nursing Students Who Undertook a Rural Placement in Western Australia

The nursing workforce is the backbone of healthcare provision in rural and remote Australia. Introducing student nurses to rural clinical placements is one strategy used to address the shortfall of healthcare workers outside of major cities, with the goal of improving the training, recruitment and retention of nurses in rural areas. The aim of this qualitative, longitudinal study was to better understand personal and professional decision-making around rural nursing practice intentions and subsequent rural employment and retention. The study methodology consisted of repeated semi-structured interviews with student nurses who had completed at least one rural placement and following them on their journey to becoming graduate nurses over a 6-year period. Thematic longitudinal analysis was undertaken, with three main themes developing, each with further subthemes: (1) participants' satisfaction with rural placements; (2) their challenges with gaining employment; and (3) considerations regarding 'going rural' for work. The participants engaged in both prospective and retrospective reflection around several professional, personal, and wider systemic barriers and enablers to rural practice, which are discussed in detail in this paper. The insights from this longitudinal study have the potential to assist the development of a sustainable rural nursing workforce through informing rural workforce programs, strategies and policies.

Comparing Health Workforce Policy during a Major Global Health Crisis: A Critical Conceptual Debate and International Empirical Investigation.

The health workforce is central to healthcare systems and population health, but marginal in comparative health policy. This study aims to highlight the crucial relevance of the health workforce and contribute comparative evidence to help improve the protection of healthcare workers and prevention of inequalities during a major public health crisis. Our integrated governance framework considers system, sector, organizational and socio-cultural dimensions of health workforce policy. The COVID-19 pandemic serves as the policy field and Brazil, Canada, Italy, and Germany as illustrative cases. We draw on secondary sources (literature, document analysis, public statistics, reports) and country expert information with a focus on the first COVID-19 waves until the summer of 2021. Our comparative investigation illustrates the benefits of a multi-level governance approach beyond health system typologies. In the selected countries, we found similar problems and governance gaps concerning increased workplace stress, lack of mental health support, and gender and racial inequalities. Health policy across countries failed to adequately respond to the needs of HCWs, thus exacerbating inequalities during a major global health crisis. Comparative health workforce policy research may contribute new knowledge to improve health system resilience and population health during a crisis.

Self-revocation of nurse licences in Finland - nursing response to deteriorating workplace and patient safety: Implications for future nursing action.

To communicate trends in nurse licence revocation in Finland and examine policies and legislation that have implications for future nursing responses to workplace hazards. The causes of the shortage of nurses working in Finland are multifactorial and complex. Nurses are joining trade unions and taking industrial action in response to the devaluation of their profession and the underpayment of nurses during the pandemic. The Health Care Professions Act in Finland allows nurses to apply voluntarily to withdraw or revoke their licence using online digital tools - and many are doing so as a last resort. A declining nursing workforce is anticipated, with retiree trends increasing while nurse recruitment decreases over the next few decades. Nurses' remuneration and working conditions have suffered during the pandemic, and industrial actions organised by trade unions that include nurses have advocated for the policy and decision-making process to improve, but with mixed results. The process of how legislation enables licence revocation in Finland is essential to understanding this new phenomenon. Advocacy for nurses, who are disadvantaged within the current pandemic emergency response policy environment, is needed across every nursing context and every career stage. Without support, nurses confronted with precarious working conditions are more likely to draw attention to their plight by using recent legislation to revoke their nursing licences voluntarily. A revocation may be temporary or permanent. Nurses need advocates and mentors to address attrition issues around the voluntary withdrawal of licences. The situation in Finland offers trade unions and nursing associations an opportunity to validate their existence in society. Public displays of distress about the political undervaluing of the nursing profession discourage applications to study nursing and pursue a nursing career or remain in the nursing profession. International experience tells us that when proficient nurses exit the profession, the level of patient safety and health benefits and national productivity suffer. Finland's Nursing Act is an aspect of policy that needs exploring and the basis for amending policies to enable collective bargaining agreements to protect the rights and future of nurses. Reactive policies for recruiting foreign nurses to bolster a failed domestic nursing workforce policy have their own problems. These policy issues reflect the problems facing nurses worldwide.

Muslim American physicians' experiences with, and views on, religious discrimination and accommodation in academic medicine.

To assess Muslim physician experiences with religious discrimination and identify strategies for better accommodating Muslim identity in health care. Interviews were conducted with Muslim physicians from three US-based Muslim clinician organizations between June and August 2021. In-depth, semi-structured qualitative interviews used a phenomenological approach to describe experiences of religious discrimination and accommodation. A team-based framework approach to coding was used to inductively generate themes from interview data. Physicians from the Islamic Medical Association of North America, American Muslim Health Professionals, and the US Muslim Physicians group were invited to participate using closed organizational listservs. Inclusion criteria sought English-speaking, self-identifying Muslims with current or past affiliation with a university hospital in the United States. Potential participants were segmented into groups based on responses to questions about perceived religious discrimination and accommodation. Purposive sampling was used to iteratively approach participants within these groups in order to capture a diverse respondent pool. Interviews stopped after thematic saturation was reached. Eighteen physicians (11 women and 7 men; mean age: 41.5 [standard deviation=12.91] years) were interviewed. Nearly all (n= 16) held Islam to be important in their lives. Three overarching themes, with several subthemes, emerged. Participants (1) struggled to maintain religious practices and observances due to unaccommodating organizational structures; (2) experienced religious discrimination, which, in turn, impacted their professional trajectories and, at times, their personal well-being; and (3) believed that institutions could implement specific educational and policy interventions to advance the religious accommodation of Muslims in health care. Muslim physicians frequently encounter religious discrimination, yet there are concrete ways in which health care workplaces can better accommodate their religious needs and combat discrimination. To improve workforce diversity, equity, and inclusion, educational forums and policies that support the religious practices of physicians need to be established.

Community-Based Outbreak Investigation And Response: Enhancing Preparedness, Public Health Capacity, And Equity

Throughout the COVID-19 pandemic, the US has struggled with many aspects of the public health response, from determining where transmission is occurring to building trust with communities and implementing interventions. Three factors have contributed to these challenges: insufficient local public health capacity, siloed interventions, and underuse of a cluster-based approach to outbreak response. In this article we introduce Community-based Outbreak Investigation and Response (COIR), a local public health strategy developed during the COVID-19 pandemic that addresses these shortcomings. COIR can help local public health entities conduct disease surveillance more effectively, take a more proactive and efficient approach to mitigating transmission, coordinate response efforts, build community trust, and advance equity. We offer a practitioner's lens, informed through on-the-ground experience and engagement with policy makers, to highlight the financing, workforce, data system, and information-sharing policy changes needed to scale up COIR throughout the country. COIR can enable the US public health system to develop effective solutions to many of today's public health challenges and improve the nation's preparedness for public health crises in the years to come.

Growing Our Own Rural, Remote and Aboriginal Health Workforce: Contributions made, approaches taken and lessons learnt by three rural Australian academic health departments.

This paper describes the investments made, approaches taken and lessons learnt by three rural Australian academic health departments engaged in the delivery of the Health Career Academy Program (HCAP). The program seeks to address the under-representation of rural, remote and Aboriginal populations within Australia's health workforce. Significant resources are directed towards rural practice exposure for metropolitan health students to address workforce shortages. Fewer resources are directed towards health career strategies that focus on the earlier engagement of rural, remote and Aboriginal secondary school students, those in Years 7-10. Best practice career development principles highlight the importance of earlier engagement in the promotion of health career aspirations and in influencing secondary school student career intentions and uptake of health professions. This paper describes: delivery contexts; the theory and evidence that has informed the HCAP; program design, adaptability and scalability; program focus on priming the rural health career pipeline; program alignment to best practice career development principles; enablers and barriers confronted in program delivery, and lessons learnt to inform rural health workforce policy and resourcing. There is a need to invest in programs that seek to attract rural, remote and Aboriginal secondary school students to health professions if Australia is to develop a sustainable rural health workforce. A failure to invest earlier undermines opportunities to engage diverse and aspiring youth in Australia's health workforce. Program contributions, approaches and lessons learnt can inform the work of other agencies seeking to include these populations in health career initiatives.

Are Sustainable Health Workforces Possible? Issues and a Possible Remedy

The 2020–2022 period of the global COVID-19 pandemic exposed the fact that many countries health systems had inadequate health workforce availability. This is despite sustainable health workforces being critical to health service and healthcare delivery, an acknowledgement that drove the significant investment and focus on health workforce development over the previous two decades. As such, this review article discusses health workforce governance and planning, notes its weaknesses, and identifies some of the barriers to the implementation of health workforce policy making and planning and the achievement of sustainable health workforces. Important is the recognition that health workforce planning is long-term in nature, while health workforce decision-making processes are dominated by political processes that have much shorter time frames. The article concludes by offering the approach of backcasting to overcome this dichotomy.

Industrial Workforce Policy for an Economy in Transition

Industrial Workforce Policy for an Economy in Transition