Workforce Pressures Research Articles

Considerations across multiple stakeholder groups when implementing fall prevention programs in the acute hospital setting: a qualitative study.

Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies. Clinicians of different disciplines, patients and their families were recruited from wards at two acute public hospitals. Semi-structured interviews and focus groups were conducted to gain a broad understanding of participants' perspectives about implementing fall prevention programs. Data were analysed using an inductive thematic approach. Data from 50 participants revealed three key themes across the stakeholder groups shaping implementation of acute hospital fall prevention programs: (i) 'Fall prevention is a priority, but whose?' where participants agreed falls in hospital should be addressed but did not necessarily see themselves as responsible for this; (ii) 'Disempowered stakeholders' where participants expressed feeling frustrated and powerless with fall prevention in acute hospital settings; and (iii) 'Shared responsibility may be a solution' where participants were optimistic about the positive impact of collective action on effectively implementing fall prevention strategies. Key stakeholder groups agree that hospital fall prevention is a priority, however, challenges related to role perception, competing priorities, workforce pressure and disempowerment mean fall prevention may often be neglected in practice. Improving shared responsibility for fall prevention implementation across disciplines, organisational levels and patients, family and staff may help overcome this.

Professional identity and GP trainers as educational leaders

ABSTRACT GP training in the UK has a long history of success, however that is measured. That success is in part due to the formality and credentialling that underlies preparation to take on that role of a GP teacher, which is somewhat under current threat due to workforce pressures. We identify three important factors associated with the GP trainer function [leadership, professional identity and clinical care improvement] that are not often analysed but are at some risk if preparation for the GP trainer role is reduced or devalued. Of particular note are the differing ways that GPs conceptualise their professional roles as teachers and clinicians, despite the transferable skills between them, the demonstrably improved patient care that occurs in practices that teach, and the necessary connections between educational theory and practice. We suggest that these areas define a research agenda ripe for exploration.

Key children's services challenges to shape next ADCS presidency

The new president of the Association of Directors of Children's Services Andy Smith identifies tackling social care reforms, workforce pressures and demand for SEND support as priorities for his year in office

Exploring the professional nurse advocate role and restorative clinical supervision.

The professional nurse advocate (PNA) role is the key enabler of delivery of the NHS England Advocating and Educating for Quality Improvement (A-EQUIP) model of professional nursing leadership and clinical supervision. The aim of the PNA role is to provide clinical, educational and well-being support to nurses through restorative clinical supervision. This article describes the PNA role and the A-EQUIP model and discusses some of the challenges experienced by nurses in relation to delivering care to older people and current workforce pressures. The author suggests that restorative clinical supervision may support nurses to manage these challenges and enhance their practice in the care of older people, and describes part of a workforce improvement project to illustrate this in practice. Finally, the author considers some of the barriers to implementation of restorative clinical supervision.

2050 Scoping an Oncogeriatric Pathway in Acute Care

Abstract Introduction Oncogeriatrics is relatively new concept aligning geriatric services with oncology, whereby older cancer patients have a comprehensive geriatrics assessment (CGA) to support oncology decision-making and improve outcomes and quality of care. Despite the rationale, evidence for effective oncogeriatric services is largely based upon specialist centres. We initiated a feasibility study February 2021, to establish criteria and pathway implications for an Acute Trust without oncology beds. Method Following an iterative process, a pathway was established between the Lung MDT and the established frailty unit. Patients with lung cancer who met criteria would be seen within a week and underwent a CGA by a frailty practitioner, consultant geriatrician, physiotherapist, occupational therapist. Referrals were made as appropriate to allied services e.g. dietician, pharmacy, continence teams etc. Results We refined the referral criteria and process, identifying the presence of a geriatrician at Lung MDT as key to ensuring incorporation of CFS (Rockwood) for effective MDT case discussion. Defining the cohort and pathway was challenging given the complex interplay of cancer symptom burden and comorbidity set against COVID, workforce pressures and cancer targets. Final referral criteria were: age over 70, Rockwood 4 or more, a formal lung cancer diagnosis, and a plan to undergo active treatment. Referral numbers were low during the feasibility phase. Only 38 patients were referred and we saw 23 patients over a 2-year period. Referral rates increased in the final 3 months of the pilot although only 9 of 22 who met criteria were referred. Conclusion Establishment of an effective oncogeriatrics service is challenging. The feasibility study has established a baseline for potential activity and job planning. Analysis of individual patient benefit is ongoing. Longer term we aim to extend the service to support patients after treatment has started, provide prehab, and include patients with all types of cancer.

Escalating competition in NHS: implications for healthcare quality and workforce sustainability.

The UK's National Health Service (NHS) faces escalating competition ratios for specialty training positions, with application rates dramatically outpacing the growth in available posts. This trend contributes to systemic bottlenecks and challenges traditional career progression pathways within medicine. In this evolving landscape, the once-certain career progression within medicine is now increasingly uncertain. This commentary explores the complex dynamics of increased medical school admissions against stagnant specialty training placements and the broader strategic implications for workforce planning within the NHS. It critically evaluates the implications of current funding policies, which seem to prioritise an expansion of nondoctor healthcare roles over the development of specialist training, raising concerns about the long-term patient care quality and safety. Key recommendations include a reassessment of medical education expansion, a review of funding allocation, increased support for specialty training, and government accountability for healthcare workforce planning. The urgent need for strategic policy reform is underscored to ensure that NHS can sustain a high-quality, specialist-led healthcare provision in the face of rising competition and workforce pressures.

Feasibility of an artificial intelligence phone call for postoperative care following cataract surgery in a diverse population: two phase prospective study protocol

IntroductionArtificial intelligence (AI) development has led to improvements in many areas of medicine. Canada has workforce pressures in delivering cataract care. A potential solution is using AI technology that can...

“I wasn’t interested until I actually had that consultation”: Exploring the acceptability of a community pharmacy-based hypertension visualisation intervention

Abstract Introduction Hypertension affects around 30% of the UK population and is the leading modifiable cause of cardiovascular disease1. Despite available evidence-based treatments, nonadherence to antihypertensive medication is prevalent. Health psychology theory suggests that beliefs about a condition and its treatment influence health-related behaviours such as medication adherence through the formation of ‘illness representations’, a lay perception of the health threat. Accurate illness representations and an increased belief in the necessity for medication are associated with greater medication adherence2. Visualisation of the internal process of an illness has been shown to support the accuracy of illness representations3. ViSTA-BP (Visualisation to Support Treatment Adherence for High Blood Pressure) is a digital intervention used within a healthcare consultation, enabling individuals to visualise and conceptualise hypertension and the resulting changes to the circulatory system using real-time animations. The purpose is to support medication adherence through the improved understanding of hypertension and increased perception of medication necessity. Aim To explore the acceptability of a community pharmacy-based hypertension visualisation intervention (ViSTA-BP) with community pharmacists and patients. Methods Acceptability of ViSTA-BP was investigated in a community pharmacy setting in South Wales by conducting semi-structured qualitative interviews with pharmacists and patients. Ethical approval was granted by NHS Research Ethics Committee Wales (REC) 5 (20/WA/0280) and Cardiff Metropolitan University Ethics Committee (PGR-3806). Template analysis, a form of qualitative thematic analysis, was used to guide data interpretation. The Theoretical Framework of Acceptability (TFA) provided a lens through which to investigate acceptability, considering affective attitude towards the intervention burden, intervention coherence, ethicality, opportunity costs, perceived effectiveness and self-efficacy. Patients were purposely selected, incorporating a range of locations, adherence and treatment beliefs, thus minimising bias. Results Interviews were conducted with fifteen patients and eight pharmacists who provided feedback. Both groups demonstrated a positive attitude towards ViSTA-BP. Patients were both interested in and reassured by the intervention. They showed good intervention coherence, articulating an increased understanding of hypertension and suggesting patient groups that could benefit from ViSTA-BP. Pharmacists felt ViSTA-BP illustrated the necessity for medication, demonstrating that hypertension could be managed effectively. Patients and pharmacists were positive about ViSTA-BP’s potential for effectiveness. Patients felt it provided context for their understanding of hypertension and could prompt action. Pharmacists liked the visual elements, with ViSTA-BP providing a useful addition to their consultation ‘toolkit’. Patients felt that ViSTA-BP fits well within a community pharmacy setting. Intervention accessibility and facilitator knowledge were key; patients found the intervention duration acceptable. Pharmacists felt that ViSTA-BP fits within their current practice. However, the evolving role of the community pharmacy workforce and time pressures from competing workloads created uncertainty regarding the future feasibility of ViSTA-BP within this setting. Discussion/Conclusion Both patients and pharmacists were positive about ViSTA-BP, acknowledging the potential effectiveness of the personalised interactive visual to engage the viewer and conceptualise hypertension through visual-based communication. However, pharmacists’ perceptions of future roles supported by the community pharmacy contractual framework in Wales and staff time constraints provide potential barriers to future implementation.

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.

Am I my students' nurse? Reflections on the nursing ethics of nursing education.

Despite having worked in higher education for over twenty years, I am still, first and foremost, a practicing nurse. My employer requires me to be a nurse and my regulator regards what I do as nursing. My practice is regulated by the Code and informed by nursing ethics. If I am nurse, practicing nursing, does that mean that my students are my patients? This paper considers how the relationship that I have with my students can be informed by the ethics of the nurse/patient relationship. After some initial theoretical preparation concerning argument from analogy, the paper identifies some areas for comparison between the two relationships. Areas of similarity and difference identify two areas of concern: Nurse education and educators regularly engage in coercion and surveillance in an attempt to increase student success, both of which would be considered outside nursing ethics. It is concluded that these coercive practices are not conducive to an environment where character is cultivated. Despite current financial and workforce pressures, nurse lecturers and more especially their managers would do well to return to the professional ethics of nursing to question and guide their practice.

Mentoring for Black and Minoritized Allied Health Professionals in Health and Social Care: A Scoping Review.

Diversity, equality and belonging are important aspects within Allied Health Professional (AHP) groups. Mentoring is considered as a solution to improve career progression. To date, there is no consensus on what good mentoring looks like and whether current models are fit for purpose for Black and Minoritised Ethnicity AHPs. Scoping review to understand mentoring among Black and Minoritised Ethnicity (BME) AHPs through searches in four electronic databases using pre-defined criteria. From 1440 studies screened, 2 studies were included in this review that researched mentoring for BME AHPs in a health and/or social care setting. Themes that emerged from the literature were related to access and amount of mentoring for BME AHPs, psychosocial mentoring may influence cross-race mentorship outcomes and organisational issues related to workforce pressures and management support. There is uncertainty around the importance of same race relationships in mentoring but there is some evidence that within cross-race mentoring this could influence outcomes. It is unknown if mentoring enables career success in BME AHPs. There is emerging evidence on the importance of psychosocial mentoring within cross-race relationships. Careful reflection and further research is needed on how current mentoring models work and ensure fair access to mentorship and support for BME AHPs.

Models of care and the role of clinical pharmacists in UK primary care for older adults: A scoping review protocol.

There has been global investment of new ways of working to support workforce pressures, including investment in clinical pharmacists working in primary care by the NHS in the England. Clinical pharmacists are well suited to support older adults who have multiple long-term conditions and are on multiple medications. It is important to establish an evidence base for the role of clinical pharmacists in supporting older adults in primary care, to inform strategic and research priorities. The aim of this scoping review is to identify, map and describe existing research and policy/guidance on the role of clinical pharmacists in primary care supporting older adults, and the models of care they provide. A scoping review guided by the Joanne Briggs Institute methodology for scoping reviews, using a three-step strategy. We will search Medline, CINAHL, Scopus, EMBASE, Web of Science, PSYCHInfo, and Cochrane for English language articles, from 2015 -present day. Grey literature will be searched using Grey Matters guidelines, the Index of Grey Literature and Alternative Sources and Resources, and Google keyword searching. References of all included sources will be hand searched to identify further resources. Using the Population, Concept and Context framework for inclusion and exclusion criteria, articles will be independently screened by two reviewers. The inclusion and exclusion criteria will be refined after we become familiar with the search results, following the iterative nature of a scoping review. Data will be extracted using a data extraction tool using Microsoft Excel and presented using a narrative synthesis approach. Ethical approval is not required for this review. Review findings will be disseminated in academic conferences and used to inform subsequent qualitative research. Findings will be published and shared with relevant local and national organisations.

COVID-19: a catalyst for change in remote and rural advanced clinical practice – A qualitative study

Purpose The purpose of this study is to explore the sustainability of innovations introduced during the coronavirus disease 2019 (Covid-19) pandemic in remote and rural primary care advanced clinical practice.Design/methodology/approach The methodology includes an exploratory qualitative study of eight key stakeholders from Scottish remote and rural primary care advanced practice (three policymakers and five advanced practitioners). Data were collected using semi-structured interviews during 2022 and analysed thematically.Findings Advanced practice in remote and rural primary care is characterised by a shortage of doctors, close-knit communities and a broad scope of practice. Covid-19 catalysed changes in the delivery of healthcare. Innovations which participants wanted to sustain include hybrid working, triage, online training and development, and increased inter-professional support networks.Practical implications Findings provide valuable insights into how best to support remote and rural advanced practice which may have implications for retaining healthcare professionals. They also identified useful innovations which could benefit from further investment.Originality/value Given current healthcare workforce pressures, identifying and sustaining innovations which will support and retain staff are imperative. Hybrid consultations and online access to training, development and support should be sustained to support the remote and rural advanced practice workforce. Further research should explore the sustainability of innovations introduced during the Covid-19 pandemic in other care contexts.

Restorative clinical supervision: a chance for change but are we ready?

In the wake of the COVID-19 pandemic, nurses are experiencing increasing stress, burnout and mental health problems. The Advocating and Educating for Quality ImProvement (A-EQUIP) model of clinical supervision aims to support staff wellbeing, promote positive work cultures and improve patient care. Although a growing body of empirical evidence supports the positive impact of clinical supervision, several individual and organisational barriers may impede the implementation of A-EQUIP in practice. Organisational culture, staffing and workforce pressures all affect employees' ability to engage with supervision, and organisations and clinical leaders must consciously work to sustain lasting change.

The assessment of undergraduate bachelor of nursing students in the collaborative clusters education model: A qualitative descriptive design

BackgroundWorldwide, undergraduate Bachelor of Nursing students are required to complete experiential learning placements in health care settings as part of the curriculum. There are a variety of facilitation models that support student learning and assessment on clinical placement. As workforce pressures increase globally, innovative approaches to clinical facilitation are required. In the Collaborative Clusters Education Model of clinical facilitation, hospital-employed clinical facilitators work collaboratively within peer groups (clusters) to collectively participate in a process of facilitating student learning and conducting assessment and moderation of student performance. The assessment process in this collaborative clinical facilitation model is not well described. AimTo describe how the assessment of undergraduate nursing students is achieved in the Collaborative Clusters Education Model. DesignA qualitative descriptive approach was employed. MethodsIn March 2021 individual and group interviews were conducted with seven clinical facilitators working in the Collaborative Clusters Education Model in one health service in southeast Queensland, Australia. Content analysis of transcribed interviews was performed. ResultsAssessment was achieved through two processes, situational scoring and moderation. In the process of situational scoring, clinical facilitators balanced the students’ perception of their role in assessment, accounted for the type of experiences available, considered multiple sources of evidence and used the Australian Nursing Standards Assessment Tool. In the process of moderation, clinical facilitators communicated with their cluster colleagues to determine a shared understanding of student history, considered data from multiple evidence sources and collaboratively evaluated the trustworthiness of student performance evaluation decisions. ConclusionsIn the Collaborative Clusters Education Model, the input of multiple assessors, working in a small team, ensured transparency in assessment processes. Furthermore, this transparency in assessment practices normalised on-going moderation, an in-built quality-check and, as such, an innovative component of assessment in the Collaborative Clusters Education Model. As nursing directors and managers seek to ameliorate the impact of nursing workforce pressures, this innovative model of collaborative assessment may serve as a valuable addition to nursing clinical assessment toolkits. Tweetable abstractThe Collaborative Clusters Education Model of Clinical Facilitation enables transparency in assessment processes and normalises moderation.

Design and implementation of a training programme on ultrasound-guided lower limb peripheral nerve blockade: An Advanced Clinical Practitioner's personal journey.

Increased demand in services, workforce pressures and continued financial constraints has resulted in a significant expansion in advanced clinical practice roles in the United Kingdom. This article will describe the personal experience of a perioperative Advanced Clinical Practitioner in the design and implementation of a training programme to achieve competence in ultrasound-guided lower limb peripheral nerve blockade. Three specific lower limb peripheral nerve blockade were included in the training programme, namely sciatic nerve block at the popliteal fossa, saphenous nerve block, and femoral nerve block. Key service drivers underpinning development, rationale for Advanced Clinical Practitioner involvement in lower limb peripheral nerve blockade and governance will also be discussed.

Challenges in implementing GP clusters in Scotland: a qualitative study comparing the views of senior primary care stakeholders in 2016 with those in 2021.

Formation of GP clusters began in Scotland in April 2016 as part of a new Scottish GP contract. They aim to improve the care quality for local populations (intrinsic role) and the integration of health and social care (extrinsic role). To compare predicted challenges of cluster implementation in 2016 with reported challenges in 2021. Qualitative study of senior national stakeholders in primary care in Scotland. Qualitative analysis of semi-structured interviews with 12 senior primary care national stakeholders in 2016 (n = 6) and 2021 (n = 6). Predicted challenges in 2016 included balancing intrinsic and extrinsic roles, providing sufficient support, maintaining motivation and direction, and avoiding variation between clusters. Progress of clusters in 2021 was perceived as suboptimal and was reported to vary significantly across the country, reflecting differences in local infrastructure. Practical facilitation (data, administrative support, training, project improvement support, and funded time) and strategic guidance from the Scottish Government was felt to be lacking. GP engagement with clusters was felt to be hindered by the significant time and workforce pressures facing primary care. These barriers were considered as collectively contributing to cluster lead 'burnout' and loss of momentum, exacerbated by inadequate opportunities for shared learning between clusters across Scotland. Such barriers preceded, but were perpetuated by, the impact of the COVID-19 pandemic. Apart from the COVID-19 pandemic, many of the challenges reported by stakeholders in 2021 were predicted in 2016. Accelerating progress in cluster working will require renewed investment and support applied consistently across the country.

Do Degrees Matter? Rethinking Workforce Development for Youth with Intellectual Disabilities and Mental Health Challenges

The global workforce crisis significantly impacts how evidence-based treatment is provided to youth with developmental disabilities and co-occurring mental health conditions. Addressing the workforce crisis requires re-examining the long-standing methods of selecting individuals for employment based on academic degrees. This project offers an innovative workforce development option that provides specialized training to staff with advanced education degrees and staff with less education. The participants in this study were employed in a rural area of the USA within the mental health, child welfare, and correctional industries. All participants worked with youth experiencing intellectual disabilities and mental illness. Results indicated that participants improved their knowledge of the population, demonstrated a better understanding of EBPs, and were willing to employ evidence-based approaches regardless of their education or age. Although overall attitudes toward EBPs decreased, diverging attitudes increased, suggesting a need to accommodate treatment strategies when EBP models are unavailable for special populations. Initial knowledge gaps demonstrated by those with a master's degree and those with less education disappeared after the training. This finding supports the application of innovative task-shifting options in mental health, such as diverting more sophisticated care tasks to nonprofessionally trained persons, which can reduce workforce pressure and unmet demand for care. This study demonstrates cost-effective and time-efficient methods of training staff regardless of education by relying less on specific EBP models and more on adaptation.

From pressure in the pipeline to accelerating ascension: a survey to understand professional experiences of and opportunities for Canadian women in the healthcare sector

BackgroundMuch has been written about the state and persistent lack of progress regarding gender equity and the commonly referenced phenomenon of a ‘leaking pipeline’. This framing focuses attention on the symptom of women leaving the workforce, rather than the well-documented contributing factors of hindered recognition, advancement, and financial opportunities. While attention shifts to identifying strategies and practices to address gender inequities, there is limited insight into the professional experiences of Canadian women, specifically in the female-dominated healthcare sector.MethodsWe conducted a survey of 420 women working across a range of roles within healthcare. Frequencies and descriptive statistics were calculated for each measure as appropriate. For each respondent, two composite Unconscious Bias (UCB) scores were created using a meaningful grouping approach.ResultsOur survey results highlight three key areas of focus to move from knowledge to action, including (1) identifying the resources, structural factors, and professional network elements that will enable a collective shift towards gender equity; (2) providing women with access to formal and informal opportunities to develop the strategic relational skills required for advancement; and (3) restructuring social environments to be more inclusive. Specifically, women identified that self-advocacy, confidence building, and negotiation skills were most important to support development and leadership advancement.ConclusionsThese insights provide systems and organizations with practical actions they can take to support women in the health workforce amid a time of considerable workforce pressure.

General practice Electronic Medical Record (EMR) data: exploring patient and healthcare practitioner activity from 2019 to 2021.

General practice (GP) in Ireland is almost entirely computerised. Computerised records hold great potential for large-scale data analyses but existing software packages do not readily provide such analyses. For a profession facing considerable workforce and workload challenges, harnessing GP electronic medical record (EMR) data can facilitate critical analysis of general practice activity and can highlight important trends for service planning. Medical students in the ULEARN network of general practices using the GP EMR 'Socrates' in the Midwest region of Ireland supplied our research team with three reports on consulting and prescribing activity from 1 January 2019 to 31 December 2021. The three reports, anonymised on site using custom software, detailed chart activity (i.e. types of notes recorded in patient charts), consultation types and headline prescribing figures. Preliminary analyses of data from these sites reveal that while consultation activity faltered in the early stages of the pandemic, telephone consultations and prescribing continued apace. Interestingly, childhood vaccination appointments did not falter, whereas cervical smears, which were not allowed due to processing laboratory constraints, stopped for many months of the pandemic. There are differences between how different doctors in different practices record consultation types, which weakens some analyses, particularly when estimating face-to-face consultation rates. GP EMR data have great potential for highlighting workforce and workload pressures being experienced by Irish general practitioners and GP nurses. Small modifications to how information is recorded by clinical staff would further strengthen analyses.