Regulating in the public interest: Lessons learned during the COVID-19 pandemic.

This article has three aims. First, to reflect on how conceptualizations of the public interest may have shifted due to COVID-19. Second, to focus on the implications of regulatory responses for the health workforce and corresponding lessons as health leaders and systems transition from pandemic response to pandemic recovery. Third, to identify how these lessons lead to potential directions for future research, connecting regulation in a whole-of-systems approach to health system safety and health workforce capacity and sustainability. Pandemic regulatory responses highlighted both strengths and limitations of regulatory structures and frameworks. The COVID-19 pandemic may have introduced new considerations around regulating in the public interest, particularly as the impact of regulatory responses on the health workforce continues to be examined. Clearly articulating practitioner practice parameters, reducing barriers to practice, and working collaboratively with stakeholders were primary aspects of regulators' pandemic responses that impacted the health workforce.

Participation of women in the health workforce in the fragile and conflict-affected countries: a scoping review.

INTRODUCTION AND BACKGROUND: The full participation of women as healthcare providers is recognized globally as critical to favorable outcomes at all levels, including the healthcare system, to achieving universal health coverage and sustainable development goals (SDGs) by 2030. However, systemic challenges, gender biases, and inequities exist for women in the global healthcare workforce. Fragile and conflict-affected states/countries (FCASs) experience additional pressures that require specific attention to overcome challenges and disparities for sustainable development. FCASs account for 42% of global deaths due to communicable, maternal, perinatal, and nutritional conditions, requiring an appropriate health workforce. Consequently, there is a need to understand the impact of gender on workforce participation, particularly women in FCASs. METHODS: This scoping review examined the extent and nature of existing literature, as well as identified factors affecting women's participation in the health workforce in FCASs. Following Arksey and O'Malley's scoping review methodology framework, a systematic search was conducted of published literature in five health sciences databases and grey literature. Two reviewers independently screened the title and abstract, followed by a full-text review for shortlisted sources against set criteria. RESULTS: Of 4284, 34 sources were reviewed for full text, including 18 primary studies, five review papers, and 11 grey literature sources. In most FCASs, women predominate in the health workforce, concentrated in nursing and midwifery professions; medicine, and the decision-making and leadership positions, however, are occupied by men. The review identified several constraints for women, related to professional hierarchies, gendered socio-cultural norms, and security conditions. Several sources highlight the post-conflict period as a window of opportunity to break down gender biases and stereotypes, while others highlight drawbacks, including influences by consultants, donors, and non-governmental organizations. Consultants and donors focus narrowly on programs and interventions solely serving women's reproductive health rather than taking a comprehensive approach to gender mainstreaming in planning human resources during the healthcare system's restructuring. CONCLUSION: The review identified multiple challenges and constraints facing efforts to create gender equity in the health workforce of FCASs. However, without equal participation of women in the health workforce, it will be difficult for FCASs to make progress towards achieving the SDG on gender equality.

Commentary: Equity, Diversity and Inclusion: A Key Solution to the Crisis of Doctoral Nursing Education in Canada.

Canada desperately needs more doctoral graduates. We also need more diverse graduates to move into education and leadership roles across the country. This article examines the origins and development of doctoral education for nurses in Canada and the continuing dire shortfall of doctorally prepared nurses to meet the expanding needs of the profession. In the context of this desperate shortage, this article then moves to examine the critical issues of equity, diversity and inclusion and the failure of the nursing academy and the profession to address these long-standing matters. These two issues - the shortfall of doctoral graduates and the lack of diversity in education and leadership in nursing - need to be addressed through a combined and focused strategy if we are to ensure the future sustainability of the profession. Given the decade-long lead time required to effect significant changes in doctoral graduations, the article concludes with a call for a national strategy engaging multiple stakeholders to increase awareness of the issues and their implications for the sustainability of the profession. It concludes that only through the united efforts of the profession will Canadian nursing be able to ensure that nursing education will produce a sufficient number of graduates for the needs of education, practice and policy across the country and that these graduates will better reflect the diversity of the nursing profession and the Canadian population, overall.

Factors in the drop in the migration of Spanish-trained nurses: 1999-2007.

AIM: To reveal correlates of the decrease of Spanish nurse migration (1999-2007). BACKGROUND: Nursing outmigration is a concern for countries. Nurse migration from Spain began in the 1990s. INTRODUCTION: From 1999 to 2007, the yearly number of migrations dropped significantly. We ask what social, economic and policy factors could be related to this drop. METHODS: We used publicly available statistics to confirm hypothesis (1) The drop in nursing migration coincided with a drop in nursing unemployment. Then we hypothesized that this coincided with (1a) a decrease in the number of graduates, (1b) an increase in the number of hospitals and/or beds functioning, and/or (1c) an increase in the ratio of part-time contracts. RESULTS: Our analysis confirms hypotheses (1) and (1c) and disconfirms (1a) and (1b). CONCLUSION: The greater availability of part-time contracts seems to have encouraged nurses to remain in Spain. IMPLICATIONS FOR NURSING MANAGEMENT: The strategy to reduce nursing unemployment with more part-time contracts, while temporarily successful in Spain, brings with it major challenges for patient care and the working life of nurses. We suggest that nurse leaders and health policymakers consider proactive policies to adjust the balance between supply and demand without decreasing the quality of available positions.

Mandatory Reporting of Health Professional Incompetence and Incapacity: Is it Time to Adopt the Australian Regime?

Identifying poor or unsafe practice is an important aspect of professional regulation. One way that health profession regulators access this information is through legislated mandatory reporting of incompetence or incapacity. Australia's mandatory reporting provisions are far-reaching and have become a touchstone issue in Australia's regulatory framework. In Ontario, mandatory reporting of health professionals is more limited. In this article, we compare the mandatory reporting regimes in these two jurisdictions through a historical and legal analysis examining the development and reform of mandatory reporting. Regulators' access to and handling of information about professionals has been under a critical media spotlight recently. Canadian policymakers and nurse leaders should consider advocating for more comprehensive mandatory reporting regimes with clear reporting structures to improve public confidence in regulation and protect the public.

Academic continuity planning in higher education.

Crisis planning in institutions of higher learning has focused largely on emergency management, physical safety and technology recovery. While these are clearly important, many aspects of planning for continuity have largely been ignored, including planning for the post-secondary education sector's core business, that is, the delivery of graduate and undergraduate academic programmes. Use of the term 'academic continuity' as a component of institutional planning is relatively new in higher education. Discussions on academic continuity have often centred on the use of technology-enhanced education and online teaching in the event of crisis or disaster affecting campuses. However, online approaches are only one aspect of academic continuity planning. Using examples of two different crisis situations encountered at a large urban university spanning three campuses, this paper presents an approach to academic continuity planning that can potentially serve as a model for other institutions.

Migration of Spanish nurses 2009-2014. Underemployment and surplus production of Spanish nurses and mobility among Spanish registered nurses: A case study.

BACKGROUND: After the financial crisis of 2008, increasing numbers of nurses from Spain are going abroad to work. OBJECTIVES: To examine the health and workforce policy trends in Spain between 2009 and 2014 and to analyze their correlation with the migration of nurses. DESIGN: Single embedded case study. DATA SOURCES: We examined data published by: Health Statistics, Organization for Economic Cooperation and Development (1996 to 2013); Ministry of Education, Culture and Sports (2006 to 2013); Ministry of Employment and Social Security (2009 to 2014); Ministry of Health, Social Services and Equality (1997 to 2014); and National Institute of Statistics (1976 to 2014). In addition to reviewing the scholarly literature on the topic in Spanish and English, we also examined Spanish mobility laws and European directives. POPULATION: We used the Organization for Economic Cooperation and Development definition of "professionally active nurses" which defines practising nurses and other nurses as those for whom their education is a prerequisite for employment as a nurse. Moreover, we used the term "nursing graduate" as defined by Spanish Ministry of Education to describe those who have obtained a recognized qualification in nursing in a given year, the term "registered nurses" is defined by Spanish law as nurses registered in the Nurses Associations and "unemployed nurses" are those without work and registered as seeking employment. RESULTS: A transformation of the Spanish health system has reduced the number of employed nurses per capita since 2010. Moreover, reductions in public spending, labour market reforms and widespread unemployment have affected nurses in two ways: first by increasing the number of applicants per vacancy between 2009 and 2013, and second, by an increase in casual positions. However, despite the poor job market and decreasing job security, the number of registered nurses and nursing graduates in Spain per year has continued to grow, increasing the pressure on the labour market. CONCLUSIONS: Spain is transforming from a stable nursing labour market, to one that is increasingly producing nurses for foreign markets, principally in Europe. With its low birth rate, increased life expectancy and increasing rates of chronic disease, it is critical for Spain to have sufficient nurses now and into the future. It is important that there be continued study of this phenomenon by Spanish policy makers, health service providers and educators in order for Spain to develop health human resources policies that address the health care needs of the Spanish population.

The downward occupational mobility of internationally educated nurses to domestic workers.

Despite the fact that there is unmet demand for nurses in health services around the world, some nurses migrate to destination countries to work as domestic workers. According to the literature, these nurses experience contradictions in class mobility and are at increased risk of exploitation and abuse. This article presents a critical discussion of the migration of nurses as domestic workers using the concept of 'global care chain'. Although several scholars have used the concept of global care chains to illustrate south to north migration of domestic workers and nurses, there is a paucity of literature on the migration of nurses to destination countries as domestic workers. The migration of nurses to destination countries as domestic workers involves the extraction of reproductive and skilled care labor without adequate compensatory mechanisms to such skilled nurses. Using the case of the Canadian Live-in Caregiver Program, the study illustrates how the global movement of internationally educated nurses as migrant domestic workers reinforces inequities that are structured along the power gradient of gender, class, race, nationality, and ethnicity, especially within an era of global nursing shortage.

The Postoperative Pain Assessment Skills pilot trial.

UNLABELLED: BACKGROUND/ OBJECTIVES: Pain-related misbeliefs among health care professionals (HCPs) are common and contribute to ineffective postoperative pain assessment. While standardized patients (SPs) have been effectively used to improve HCPs' assessment skills, not all centres have SP programs. The present equivalence randomized controlled pilot trial examined the efficacy of an alternative simulation method - deteriorating patient-based simulation (DPS) - versus SPs for improving HCPs' pain knowledge and assessment skills. METHODS: Seventy-two HCPs were randomly assigned to a 3 h SP or DPS simulation intervention. Measures were recorded at baseline, immediate postintervention and two months postintervention. The primary outcome was HCPs' pain assessment performance as measured by the postoperative Pain Assessment Skills Tool (PAST). Secondary outcomes included HCPs knowledge of pain-related misbeliefs, and perceived satisfaction and quality of the simulation. These outcomes were measured by the Pain Beliefs Scale (PBS), the Satisfaction with Simulated Learning Scale (SSLS) and the Simulation Design Scale (SDS), respectively. Student's t tests were used to test for overall group differences in postintervention PAST, SSLS and SDS scores. One-way analysis of covariance tested for overall group differences in PBS scores. RESULTS: DPS and SP groups did not differ on post-test PAST, SSLS or SDS scores. Knowledge of pain-related misbeliefs was also similar between groups. CONCLUSIONS: These pilot data suggest that DPS is an effective simulation alternative for HCPs' education on postoperative pain assessment, with improvements in performance and knowledge comparable with SP-based simulation. An equivalence trial to examine the effectiveness of deteriorating patient-based simulation versus standardized patients is warranted.

Science: nursing's big secret.

Nursing knowledge and skill are vitally important to the healthcare system, and nurses must dare to say so.