Workforce Retention Research Articles

Health workforce retention in low-income settings: an application of the Root Stem Model.

The World Health Organization (WHO) recognizes a critical shortage of health workers as a growing global crisis. The shortage persists despite local and global efforts to recruit health workers ethically. Unequal migration of healthcare professionals, most often from low to high-resource countries, overwhelmingly defeats the objective of achieving Universal Health Coverage (UHC). If not addressed, especially given emerging global pandemics like COVID-19, the critical shortage of health workers could decimate vulnerable public health systems. This Viewpoint describes the Root-Stem Model, a six-stage process of strategic factors affecting work life that could help policymakers address the challenge of brain-drain among healthcare workers in low-income countries.

Prevalence of burnout and associated factors among health professionals working in public health facilities of Dire Dawa city administration, Eastern Ethiopia.

Background:Burnout is a common condition among health workers, characterized by emotional tiredness, depersonalization, and a sense of low personal accomplishment. Ethiopia has major health workforce management challenges, including shortages, poor motivation, retention, and performance, and research evidence is limited for health professionals' burnout status, particularly in Eastern Ethiopia. Therefore, this study is aimed at determining the prevalence of burnout and associated factors among health professionals working at governmental health facilities in Eastern Ethiopia.MethodAn institutional-based cross-sectional study was conducted among health professionals using structured self-administered validated questionnaires using the Maslach Burnout Inventory scale. Data were entered into Epi-Data version 3.1 and exported to SPSS version 22 for analysis. Multivariable logistic regression was used to determine the association between burnout and its predictors.ResultsA total of 508 health professionals were approached, out of which 501 participated (a response rate of 98.4%). The magnitude of burnout was 54.1 with a 95% confidence interval of 49.9–58.0%. Working in a hospital (AOR = 3.55, 95%CI: 2.00, 6.33), age >/= 40 (AOR = 3.98, 95%CI:1.60, 9.89) and 30–39 years (AOR = 1.90, 95%CI:1.08, 3.34), being female(AOR = 2.41, 95%CI: 1.37, 4.25), being widowed (AOR = 3.39, 95%CI: 1.13, 10.18), having intention of leaving work (AOR = 2.28, 95%CI: 1.35, 3.87), using at least one substance (AOR = 2.24, 95%CI: 1.36, 3.69), having a 6–11 years of experience (AOR = 2.17, 95%CI: 1.15, 4.06), having no job supervision (AOR = 4.65, 95%CI: 2.07, 10.43), monthly payment <10,000 Ethiopian Birr (AOR = 5.69, 95%CI: 2.30, 14.07) and between 10,000 to 15,000 Ethiopian Birr (AOR = 2.74, 95%CI: 1.22, 6.15), working in Pediatric Unit (AOR = 3.28, 95%CI: 1.24, 8.70), and profession type (Midwifery, Public health officer, Medical Laboratory professionals) were factors significantly associated with burnout.ConclusionBurnout affected more than half of the health professionals working in governmental health facilities in Dire Dawa. Health facility type, age, sex, marital status, intention to leave work, substance use, work experience, job supervision, monthly payment, profession type, and working unit were significantly associated predictors of burnout.

Incentivizing STEM participation: Evidence from the SMART Grant Program

AbstractThe U.S. National Science and Mathematics Access to Retain Talent (SMART) Grant program provided up to $8000 to high‐achieving, low‐income undergraduates majoring in STEM fields. We evaluate the effects of this financial incentive on college graduates' major fields and subsequent STEM workforce retention using nationally‐representative survey data and a difference‐in‐differences quasi‐experimental approach. The SMART Grant program significantly increased the probability that first‐generation college graduates majored in STEM, by about 7 percentage points. However, this increase is almost entirely offset by affected STEM graduates' significantly lower STEM workforce retention. These program effects also appear to be concentrated among students whose parents had some college experience rather than those who were first in their families to attend college.

Severe neighborhood deprivation and nursing home staffing in the United States.

Low nursing home staffing in the United States is a growing safety concern. Socioeconomic deprivation in the local areas surrounding a nursing home may be a barrier to improving staffing rates but has been poorly studied. Thus, the objective of this paper was to assess the relationship between neighborhood deprivation and nursing home staffing in the United States. This cross-sectional study used 2018 daily payroll-based staffing records and address data for 12,609 nursing homes in the United States linked with resident assessment data. Our primary exposure of interest was severe economic deprivation at the census block group (neighborhood) level, defined as an area deprivation index score ≥85/100. The primary outcome was hours worked per resident-day among nursing home employees providing direct resident care. Marginal linear regression models and generalized estimating equations with robust sandwich-type standard errors were used to estimate associations between severe neighborhood deprivation and staffing rates. Compared to less deprived neighborhoods, unadjusted staffing rates in facilities located within severely deprived neighborhoods were 38% lower for physical and occupational therapists, 30% lower for registered nurses (RNs), and 5% lower for certified nursing assistants. No disparities in licensed practical nurse (LPN) staffing were observed. In models with state-level and rurality fixed effects and clustered on the county, a similar pattern of disparities was observed. Specifically, RN staffing per 100 resident-days was significantly lower in facilities located within severely deprived neighborhoods as compared to those in less deprived areas (mean difference: 5.6 fewer hours, 95% confidence interval [CI] 4.2-6.9). Disparities of lower magnitude were observed for other clinical disciplines except for LPNs. Significant staffing disparities were observed within facilities located in severely deprived neighborhoods. Targeted interventions, including workforce recruitment and retention efforts, may be needed to improve staffing levels for nursing homes in deprived neighborhoods.

Older Nurses’ Perceptions of Workforce Retention Facilitators and Barriers During the COVID-19 Pandemic

Nursing workforce retention is critical to provide quality healthcare, raising concern as nurse turnover rates continue to increase. In this study, we examined older Registered Nurse (RN) perceptions of their work experiences during the COVID-19 pandemic to identify facilitators and barriers in workplace environments that relate to RN workforce retention. The methods section describes our study population that included RNs aged 50 years and older (n=195) who completed surveys containing open and closed-ended questions between August 2020 and January 2021. Our study results indicate that most respondents (86.2%) worked during the COVID-19 pandemic in moderate-to-high patient acuity settings and felt their employers provided employees adequate Personal Protective Equipment (73.3%). The discussion section notes implications for nursing and study limitations. In conclusion, workforce retention facilitators included offering resources and implementations that made experienced, older RNs feel included, valued, supported, and protected. Workforce retention barriers were short/rushed workplace orientation, unsafe patient assignments, micromanaging, perceived ageist policies, and implementing pay and benefit-related policy changes without RN input.

More I than we – the effect of organisational identification in the Australian aged care workforce

PurposeThis paper aims to determine the effects of leadership style (LS) on organisational identification (OID) in aged care provider organisations to inform talent management strategies for the sector, which has quite severe workforce shortages.Design/methodology/approachThis paper reports on a mixed-methods study. Study 1 was quantitative in approach that measured responses to an online questionnaire containing the Multifactor Leadership Questionnaire and the Identification with a Psychological Group scale. The analytical strategy provided results that demonstrated the socio-demographic characteristics of the sample, the reliability and distributions of data and calculated the correlations between the factors of the deployed tools. The relationship between the factors that comprise both tools was measured, and any differences between the two natural groups were labelled leaders and raters. Study 2 was qualitative in approach, using interpretive phenomenological analysis to provide an in-depth analysis of phenomena.FindingsThe results and findings of this study are that OID was not evident in the quantitative or qualitative samples. There are recommendations for future research relating to the social capital of organisations and the use of social media to determine how these could be harnessed in support of workforce recruitment and retention strategies.Research limitations/implicationsThis research was conducted in Australia with participants from the workforces of aged care providers in three eastern states of Australia. The results and findings may be limited to the Australian aged care context. The researcher evaluated the limitations of this research relating to: Methodology: There may be an overstatement of the strength of the relationships between variables among those motivated to participate in the survey in the quantitative study; Transferability: The qualitative study required the researcher to be thorough in describing the research context, and it may be that those who wish to transfer the results of this study to a different context are responsible for making the judgement on the suitability of the transfer; Credibility: The qualitative analysis was not designed to directly reflect a relationship between each leader and their direct report raters’ experiences; and Confirmability: The researcher maintained an awareness and openness to the dynamism of the results. Frequent reflection and self-criticism about preconceptions that may have affected the research were recorded in field notes after each interview.Practical implicationsAged care providers who must compete in the labour market for staff may use the results and findings of this research to inform recruitment and retention strategies relating to brand recognition and loyalty and social capital strategies.Social implicationsProviding an appropriate, skilled and well-led workforce will assist in providing the appropriate level of aged care service at a high standard of quality and safety that will benefit the community as a whole.Originality/valueTo the best of the authors’ knowledge, this paper reports on original research conducted following ethical clearance in part fulfilment of a successful conferral of a Doctor of Philosophy programme. After an extensive search of the literature, no research reports returned that examined LS and OID in the aged care service provision.

Investigating the links between diagnostic uncertainty, emotional exhaustion, and turnover intention in General Practitioners working in the United Kingdom.

BackgroundGeneral Practitioners (GPs) report high levels of burnout, job dissatisfaction, and turnover intention. The complexity of presenting problems to general practice makes diagnostic uncertainty a common occurrence that has been linked to burnout. The interrelationship between diagnostic uncertainty with other factors such as burnout, job satisfaction and turnover intention have not been previously examined.ObjectivesTo examine associations between diagnostic uncertainty, emotional exhaustion (EE), depersonalization (DP), job satisfaction, and turnover intention in GPs.MethodsSeventy general practices in England were randomly selected through the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP-RSC). A total of 348 GPs within 67 these practices completed a 10-item online questionnaire which included questions on GP characteristics, work-life balance, job satisfaction, sickness presenteeism, diagnostic uncertainty, turnover intention as well as EE and DP. Associations between diagnostic uncertainty and each of EE, DP, job satisfaction, and turnover intention were evaluated in multivariate mixed-effect ordinal logistic regressions whilst adjusting for covariates, to account for the correlation in the three outcomes of interest.ResultsAlmost one-third of GPs (n = 101; 29%) reported experiencing >10% of diagnostic uncertainty in their day-to-day practice over the past year. GPs reporting greater diagnostic uncertainty had higher levels of EE [OR = 3.90; 95% CI = (2.54, 5.99)], job dissatisfaction [OR = 2.01; 95% CI = (1.30, 3.13)] and turnover intention [OR = 4.51; 95% CI = (2.86, 7.11)]. GPs with no sickness presenteeism had lower levels of EE [OR = 0.53; 95% CI = (0.35, 0.82)], job dissatisfaction [OR = 0.56; 95% CI = (0.35, 0.88)], and turnover intention [OR = 0.61; 95% CI = (0.41, 0.91)].ConclusionDiagnostic uncertainty may not only negatively impact on the wellbeing of GPs, but could also have adverse implications on workforce retention in primary care.

Nurses' Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study.

BackgroundReports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses’ experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce; therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses’ work, and nurses themselves are not negatively impacted.ObjectiveThis study aims to explore Australian nurses’ postimplementation experiences of an organization-wide EMR system.MethodsThis qualitative descriptive study used focus group and individual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses’ use of the EMR using the Theoretical Domains Framework.ResultsA total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses’ work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional divide captured nurses’ feelings of division related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it’s personal detailed nurses’ beliefs about the EMR implementation leading to bigger changes to nurses as individuals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation.ConclusionsNurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses’ perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses’ adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.

Health Educators in State/Local Public Health Departments: Training Needs and Awareness of Emerging Areas of Public Health Practice.

Although great progress has been made to define the field of health education and provide a voluntary certification system for professionals, research about the governmental health educator and health education specialist workforce is limited. The 2017 PH WINS (Public Health Workforce Interests and Needs Survey) provides valuable data on understanding the workforce demographics, attitudes, and training needs of governmental public health workers, including health educators, and informs future investments in workforce development efforts nationally. The purpose of this article is to examine demographics, job engagement and satisfaction, training needs, certification, and other characteristics of health educators and certified health education specialists (CHES) from PH WINS. We analyzed the data to describe the health educator workforce and compared it with the national governmental workforce across a range of variables. Compared with the national 2017 PH WINS sample, health educators were relatively younger, more ethnically diverse, more likely to be educated with an advanced degree, and were predominately employed in local versus state public health agencies. Health educators sampled were significantly more knowledgeable of all public health concepts compared with the national 2017 PH WINS respondent workforce. Comparison of CHES versus non-CHES professionals is also provided, along with practice and policy implications based on the data. This is the first detailed analyses of health educators in state and local health departments, with important findings and implications related to workforce composition, satisfaction, retention, and training. Further cross-sectional workforce research is needed to understand the current strengths and gaps in the health education workforce.

Supporting each other: Pacific emergency care clinicians navigate COVID-19 pandemic challenges through collaboration

Supporting each other: Pacific emergency care clinicians navigate COVID-19 pandemic challenges through collaboration

Prioritizing Clinical Teaching Excellence: A Hidden Curriculum Problem.

Abstract:There have been many initiatives to improve the conditions of clinical teachers to enable them to achieve clinical teaching excellence in Academic Medical Centres (AMC). However, the success of such efforts has been limited due to unsupportive institutional cultures and the low value assigned to clinical teaching in comparison to clinical service and research. This forum article characterizes the low value and support for clinical teaching excellence as an expression of a hidden curriculum that is central to the cultural and structural etiology of the inequities clinical teachers experience in their pursuit of clinical teaching excellence. These elements include inequity in relation to time for participation in faculty development and recognition for clinical teaching excellence that exist within AMCs. To further compound these issues, AMCs often engage in the deployment of poor criteria and communication strategies concerning local standards of teaching excellence. Such inequities and poor governance can threaten the clinical teaching workforce's engagement, satisfaction and retention, and ultimately, can create negative downstream effects on the quality of patient care. While there are no clear normative solutions, we suggest that the examination of local policy documents, generation of stakeholder buy-in, and a culturally sensitive, localized needs assessment and integrated knowledge translation approach can develop a deeper understanding of the localized nature of this problem. The findings from local interrogations of structural, cultural and process problems can help to inform more tailored efforts to reform and improve the epistemic value of clinical teaching excellence. In conclusion, we outline a local needs assessment plan and research study that may serve as a conceptually generalizable foundation that could be applied to multiple institutional contexts.

Healthcare Workers From Diverse Ethnicities and Their Perceptions of Risk and Experiences of Risk Management During the COVID-19 Pandemic: Qualitative Insights From the United Kingdom-REACH Study.

IntroductionHealthcare workers (HCWs) are at higher risk of being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Previous studies have examined factors relating to infection amongst HCWs, including those from ethnic minority groups, but there is limited data regarding the lived experiences of HCWs in relation to self-protection and how they deal with SARS-CoV-2 infection prevention. In this study, we presented data from an ethnically diverse sample of HCWs in the United Kingdom (UK) to understand their perceptions of risks and experiences with risk management whilst working throughout the COVID-19 pandemic.MethodsWe undertook a qualitative study as part of the United Kingdom Research study into Ethnicity and COVID-19 outcomes among Healthcare workers (United Kingdom-REACH) conducting semi-structured interviews and focus groups which were recorded with participants’ permission. Recordings were transcribed and thematically analyzed.FindingsA total of 84 participants were included in the analysis. Five broad themes emerged. First, ethnic minority HCWs spoke about specific risks and vulnerabilities they faced in relation to their ethnicity. Second, participants’ experience of risk assessments at work varied; some expressed satisfaction while many critiqued it as a “tick-box” exercise. Third, most participants shared about risks related to shortages, ambiguity in guidance, and inequitable distribution of Personal Protective Equipment (PPE), particularly during the start of the pandemic. Fourth, participants reported risks resulting from understaffing and inappropriate redeployment. Finally, HCWs shared the risk mitigation strategies which they had personally employed to protect themselves, their families, and the public.ConclusionHealthcare workers identified several areas where they felt at risk and/or had negative experiences of risk management during the pandemic. Our findings indicate that organizational shortcomings may have exposed some HCWs to greater risks of infection compared with others, thereby increasing their emotional and mental burden. Ethnic minority HCWs in particular experienced risks stemming from what they perceived to be institutional and structural racism, thus leading to a loss of trust in employers. These findings have significance in understanding staff safety, wellbeing, and workforce retention in multiethnic staff groups and also highlight the need for more robust, inclusive, and equitable approaches to protect HCWs going forward.

Innovative Strategies for Developing Biomarker-Informed Cancer Clinical Trials to Accelerate Progress in Precision Oncology in Sub-Saharan Africa.

Well-designed, pragmatic, patient-centered clinical trials in low- and middle-income countries are essential to drive approval of more effective and less toxic cancer medicines to address the rising burden of cancer among populations in low- and middle-income countries. Moreover, through reverse innovation, clinical trials informed by genomic research enable development of precision medicine strategies for underserved populations within all populations. The African continent is home to many low- and middle-income countries; yet, it has seen very few cancer clinical trials. Considering that Africa is the cradle of humanity, with its diverse populations and geography, this represents a missed opportunity to understand the heterogeneity of cancer genomes and their implications for developmental therapeutics. Since 1998, the Nigerian Breast Cancer Study Group has striven to gain a better understanding of the root causes of breast cancer and accelerate progress in clinical research that will benefit the African ancestry diaspora globally through deployment of innovative "leapfrog" technologies. The University of Chicago supports interdisciplinary and interprofessional teams of researchers through the African Cancer Leaders Institute and in partnership with the African Organization for Research and Training in Cancer. By fostering public-private partnerships, the African Organization for Research and Training in Cancer can identify and integrate significant resources needed to build regional networks and establish clinical trial coordinating centers across African countries, enabling resources to be developed and shared equitably. Such resources include a standardized curriculum for specialist training in oncology, including medical oncology and oncology nursing, to increase the numbers of qualified team leaders and principal investigators. Adequate support for study participants-financial and psychosocial-and patient navigation services will be important in growing a clinical trials network. Finally, full participation of African clinical researchers in global oncology trials will ensure workforce retention in Africa and improve financial security and job satisfaction of health professionals on the African continent.

Mobile-Social Learning for Continuing Professional Development in Low- and Middle-Income Countries: Integrative Review.

BackgroundAccess to continuing professional development (CPD) for health care workers in low- and middle-income countries (LMICs) is severely limited. Digital technology serves as a promising platform for supporting CPD for health care workers by providing educational content virtually and enabling virtual peer-to-peer and mentor interaction for enhanced learning. Digital strategies for CPD that foster virtual interaction can increase workforce retention and bolster the health workforce in LMICs.ObjectiveThe objective of this integrative review was to evaluate the evidence on which digital platforms were used to provide CPD to health care workers and clinical students in LMICs, which was complemented with virtual peer-to-peer or mentor interaction. We phrased this intersection of virtual learning and virtual interaction as mobile-social learning.MethodsA comprehensive database and gray literature search was conducted to identify qualitative, quantitative, and mixed methods studies, along with empirical evidence, that used digital technology to provide CPD and virtual interaction with peers or mentors. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible articles were written in English, conducted in an LMIC, and used a mobile device to provide CPD and facilitate virtual peer-to-peer or mentor interaction. Titles, abstracts, and full texts were screened, followed by an assessment of the quality of evidence and an appraisal of the articles. A content analysis was then used to deductively code the data into emerging themes.ResultsA total of 750 articles were identified, and 31 (4.1%) were included in the review. SMS text messaging and mobile instant messaging were the most common methods used to provide continuing education and virtual interaction between peers and mentors (25/31, 81%). Across the included articles, participants had high acceptability for using digital platforms for learning and interaction. Virtual peer interaction and mentorship were found to contribute to positive learning outcomes in most studies (27/31, 87%) through increased knowledge sharing, knowledge gains, improved clinical skills, and improved service delivery. Peer-to-peer and mentor interaction were found to improve social support and reduce feelings of isolation (9/31, 29%). There were several challenges in the implementation and use of digital technology for mobile-social learning, including limited access to resources (eg, internet coverage and stable electricity), flexibility in scheduling to participate in CPD, and sociobehavioral challenges among students.ConclusionsThe summary suggests that mobile-social learning is a useful modality for curriculum dissemination and skill training and that the interface of mobile and social learning serves as a catalyst for improved learning outcomes coupled with increased social capital.

Assessment of the prevalence of burnout and well-being in solid organ transplant pharmacists.

Solid organ transplant (SOT) pharmacist burnout and well-being has not been described. A survey of SOT pharmacists was distributed to transplant pharmacy organization listservs. Burnout was assessed with the full 22 item Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS-MP) and well-being was assessed with the Mayo Well-Being Index (WBI). Logistic multivariate regression was constructed to identify risk factors for a composite burnout assessment. In total, 230 responses were included (estimated response rate 36.2%). Survey participants were predominantly Caucasian (80.4%), female (79.1%), married/partnered (67.4%), and were within the first 5 years of practice (32.2%) as clinical pharmacist/specialists (87%). According to the MBI-HSS-MP, 63% met criteria for burnout. Comparing the groups with or without burnout, low quality of life (40.4% vs. 9.5%; P<.001), extreme fatigue (52.1% vs. 19%; P<.001), and likelihood of leaving the job for reasons other than retirement (38.5% vs. 10.7%; P<.001) were more common. The incidence of SOT pharmacists with WBI scores ≥ 5 (decreased well-being) was 26.5%. Among clinical pharmacists, risk factors for burnout included > 10h per week of clinical duties outside of transplant (OR 2.669, P = .021) and extreme fatigue (OR 3.473, P<.001). Pharmacist burnout in SOT practice was similar to that reported in various pharmacy specialties (53-61%), which impacts clinical workforce retention and personal well-being.

Building Inclusion and Belonging in Training Environments.

The Accreditation Council for Graduate Medical Education (ACGME) requires that programs engage in practices that prioritize recruitment and retention of a diverse workforce.1 To do so, graduate medical education (GME) programs must deliberately foster inclusive training environments with a genuine sense of belonging for all trainees, particularly those holding identities historically excluded from medicine. Yet creating these inclusive environments is fraught with challenges at the individual, interpersonal, and structural levels that interact in complex and often imperceptible ways.The dominant GME climate is the clinical learning environment (CLE), a microcosm where learning and patient care occur in tandem. These professional settings are variably welcoming to learners due to institutional culture, structures, spaces, and social interactions.2 When learners are excluded, harassed, or subjected to bias and discrimination in the CLE, overall well-being suffers, which can produce depression, burnout, and attrition.2Many institutions and programs aim to cultivate inclusive environments, yet the paradigm of inclusion typically assumes the subjugation of identities to adapt to a static medical culture designed by individuals with historical privilege and power. Underrepresented in medicine (UIM) residents describe being perceived as “other” in CLEs and must downplay core elements of their authentic selves to survive.3,4 Daily instances of micro- and macroaggressions, discrimination, bias, and racism3 negatively affect trainees' learning, ability to provide high-quality patient care, and well-being. Deliberately cultivating an environment of belonging in which everyone's authentic selves are valued, respected, and celebrated is imperative to ensure trainee success.5

Toward Constructive Change After Making a Medical Error: Recovery From Situations of Error Theory as a Psychosocial Model for Clinician Recovery.

BackgroundMaking a medical error is a uniquely challenging psychosocial experience for clinicians. Feelings of personal responsibility, coupled with distress regarding potential or actual patient harm resulting from a mistake, create a dual burden. Over the past 20 years, experiential accounts of making an error have provided evidence of the associated distress and impacts. However, theory-based psychosocial support interventions to improve both individual outcomes for the involved clinicians and system-level outcomes, such as patient safety and workforce retention, are lacking. There is a need for evidence-based ways to both structure and evaluate interventions to decrease the distress of making a medical error and its impacts. Such interventions play a role within wider programs of health professional support. We sought to address this by developing a testable, psychosocial model of clinician recovery after error based on recent evidence.MethodsSystematic review methodology was used to identify studies published between January 2010 and June 2021 reporting experiences of direct involvement in medical errors and/or subsequent recovery. A narrative synthesis was produced from the resulting articles and used as the basis for a team-based qualitative approach to model building.ResultsWe identified 25 studies eligible for inclusion, reporting evidence primarily from experiences of doctors and nurses. The identified evidence indicates that coping approach, conversations (whether they occur and whether they are perceived to be helpful or unhelpful), and learning or development activities (helpful, unhelpful or absent) may influence the relationship between making an error and both individual clinician outcomes of emotional impact and resultant practice change. Our findings led to the development of the Recovery from Situations of Error Theory model, which provides a preliminary theoretical basis for intervention development and testing.ConclusionsThe Recovery from Situations of Error Theory model is the first testable psychosocial model of clinician recovery after making a medical error. Applying this model provides a basis to both structure and evaluate interventions to decrease the distress of making a medical error and its impacts and to support the replication of interventions that work across services and health systems toward constructive change. Such interventions may be embedded into the growing body of peer support and employee support programs internationally that address a diverse range of stressful workplace experiences.

Challenges faced by new nurses during the COVID-19 pandemic.

IntroductionCOVID‐19 can be considered a unique and complex form of trauma with potentially devastating consequences for nurses in general and new nurses specifically. Few studies have been published that explain how relatively new nurses were prepared for COVID‐19 in terms of knowledge and skill and how these nurses fared physically and emotionally.DesignA qualitative descriptive design utilizing purposive sampling to recruit a diverse group of nurses who were within 2 years post‐graduation from nursing school.MethodsIn‐depth interviews of 29 nurses were conducted using a semi‐structured interview guide to elicit data, which was coded and analyzed using thematic analysis.ResultsSix main themes and multiple subthemes were identified in the data. The main themes were: “We were not prepared,” “I was just thrown in,” “Avoiding infection,” “It was so sad,” “We did the best we could,” and “I learned so much.”ConclusionThe nurses who participated in this study expressed fear, weariness, exhaustion, isolation, and distress, observations echoed by studies from other countries. Retention of new nurses in acute care settings has always been a concern. In the recent Current Population Survey, a 4% reduction in nurses under 35 years of age has been reported, imperiling the retention of an effective workforce for decades to come.Clinical RelevanceA recent report suggests that a larger than expected number of young nurses have left the profession in the wake of the pandemic. Staff shortages threaten the ability of the remaining nurses to do their jobs. This is the time to listen to the needs of new nurses to retain them in the profession and to avoid an even greater shortage in the near future.

Tackling brain drain at Chinese CDCs: understanding job preferences of public health doctoral students using a discrete choice experiment survey

BackgroundGiven the demands for public health and infectious disease management skills during COVID-19, a shortage of the public health workforce, particularly with skills and competencies in epidemiology and biostatistics, has emerged at the Centers for Disease Controls (CDCs) in China. This study aims to investigate the employment preferences of doctoral students majoring in epidemiology and biostatistics, to inform policy-makers and future employers to address recruitment and retention requirements at CDCs across China.MethodsA convenience sampling approach for recruitment, and an online discrete choice experiment (DCE) survey instrument to elicit future employee profiles, and self-report of their employment and aspirational preferences during October 20 and November 12, 2020. Attributes included monthly income, employment location, housing benefits, children’s education opportunities, working environment, career promotion speed and bianzhi (formally established post).ResultsA total of 106 doctoral epidemiology and biostatistics students from 28 universities completed the online survey. Monthly income, employment location and bianzhi was of highest concern in the seven attributes measured, though all attributes were statistically significant and presented in the expected direction, demonstrating preference heterogeneity. Work environment was of least concern. For the subgroup analysis, employment located in a first-tier city was more likely to lead to a higher utility value for PhD students who were women, married, from an urban area and had a high annual family income. Unsurprisingly, when compared to single students, married students were willing to forgo more for good educational opportunities for their children. The simulation results suggest that, given our base case, increasing only monthly income from 10,000 ($ 1449.1) to 25,000 CNY ($ 3622.7) the probability of choosing the job in the third-tier city would increase from 18.1 to 53.8% (i.e., the location choice is changed).ConclusionMonthly income and employment location were the preferred attributes across the cohort, with other attributes then clearly ranked and delineated. A wider use of DCEs could inform both recruitment and retention of a public health workforce, especially for CDCs in third-tier cities where resource constraints preclude all the strategies discussed here.

Evaluation of postgraduate rural medical training programs and implications for rural workforce development: a systematic review.

Providing postgraduate rural training programs has been recognised as central for successful recruitment and retention of medical workforce. While there have been many documented cases of rural training program development, documented program outcome evaluations are few. This review investigated how postgraduate training and educational programs for rural and remote medicine are evaluated worldwide. Through the use of a systematic review, the study explored three questions: 'What are the outcomes of postgraduate rural and remote training programs worldwide?', 'How are the program evaluations conducted?' and 'What evaluation models and approaches are used in evaluating the effectiveness of these training programs?' A qualitative synthesis was undertaken of evaluations of postgraduate rural training programs published in the English language in medical education journals. The study involved pooling quantitative and mixed-methods research data and findings from qualitative studies, which were aggregated, integrated and interpreted. PubMed, PsycINFO, ERIC and Web of Science databases were searched to identify studies that satisfy the search criteria. Of the 1297 articles identified through the database search, 26 studies were included in the analysis. Most of the evidence from the studies consists of descriptive studies with some longitudinal tracking programs and cohort studies. Nine themes were identified: practice location after training completion; training location and decentralised model; educational aspects; incentives, political contexts and regulations; personal, social and cultural issues; professional development; rural orientation and community engagement; support system; and gender and racial issues. Key outcomes were analysed and cross-validated against the 2020 WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas. These studies' most frequent evaluation methods were surveys, followed by interviews, questionnaires and secondary data from existing databases. Methodological characteristics, the relationship between rural background and program outcomes, and implications for decentralised training, telehealth and tele-assessment during the COVID-19 pandemic are discussed. Analysis from the key outcomes suggests evaluation as a strategy to uncover outcomes in postgraduate rural and remote training and medical education. Regardless of the similar outcomes, the program evaluations implemented and the robustness of evidence vary across programs and medical schools. The absence of solid evaluation designs and their alignment to the program objectives will lessen the strengths of evidence. Better quality research and evaluation design, objective settings, qualitative inquiry to uncover the contexts, and developing appropriate indicators and benchmarks for monitoring and evaluating strategies must be considered during program development and implementation.