An Analysis of Restructuring Orientation to Enhance Nurse Retention.

The nursing shortage has received much media attention; however, something that contributes to it-nurse turnover-has not received the same attention. Facilities spend time and money to train new employees only to have them leave within a few months. Staff morale, money, time, and quality of care are all affected by nurse turnover. The fact that it often occurs so soon after one takes a position makes it pertinent to look at the process of transition into the new position, namely, the orientation program. This article examines the turnover statistics, costs, rationale, and orientation programs that have proven positive results. It is hoped that the findings can assist health care facilities to replicate successful orientation programs and reduce nurse turnover.

Untangling approaches to management and leadership across systems of medical education.

AIMS: How future doctors might be educated and trained in order to meet the population and system needs of countries is currently being debated. Incorporation of a broad range of capabilities, encompassed within categories of management and, increasingly, leadership, form part of this discussion. The purpose of this paper is to outline a framework by which countries' progress in this area might be assessed and compared. METHODS: Key databases and journals related to this area were reviewed. From relevant articles potential factors impacting on the incorporation of aspects of management and leadership within medical education and training were identified. These factors were tested via an online survey during 2013 with six members of a European Association of doctors who promote medical involvement in hospital management, including members from countries less represented in the health management literature. RESULTS: A framework for analysing how management and leadership education is being approached within different systems of healthcare is developed and presented. CONCLUSIONS: More systematic work across a wider range of countries is needed if we are to have a better understanding of how countries within and beyond Europe are approaching and progressing the education of doctors in management and leadership.

Immediate care training in Ireland, 2002-2013: a potential link between high uptake rates and effect.

Recent data suggest GPs contribute to successful resuscitation of cardiac arrests in the community. This paper examines uptake of Immediate Care training by GPs over a 12 year period. Data was collated on all courses and attenders (2002-2013). 244 cardiac, trauma and paediatric courses were held with 4247 attendances by 2069 individuals, including 1790 (86.5%) doctors. Of these 1648 (92.1% of all doctors) were GPs or GP registrars who generated 3585 days of attendance (84.4% of the total); 1270 attended more than one course. Between 2006 and 2013, an average of 219 (range 186-261) GPs/GP registrars attended at least one course each year, representing around 8% of all GPs in Ireland. A subset of these GPs has been shown to have a significant success rate in cardiac arrest care; there may be links between uptake of training and the clinical effectiveness of care provided.

Baccalaureate nursing education: has it delivered? A retrospective critique.

Despite political support for the baccalaureate degree as entry to practice, historical concerns over nursing education - the value of education versus service, professional versus vocational identity and theoretical versus practical knowledge - persist. The authors challenge the notion of a "two-tiered" nursing system and call for a nationwide curriculum review to help the profession adapt to the changing needs of the Canadian healthcare system.

Virtual day of the midwife: a global 'pyjama party'.

The Virtual International Day of the Midwife (VIDM) (www.vidm.org) is an annual online conference designed to break down traditional barriers to continuing professional development (CPD); provide online opportunities for international midwifery networking; and model open access communication and collaboration practices. Whilst the VIDM is designed to reach midwives all around the world, issues of access to the Internet, language and cultural differences prevent some midwives from attending, especially those who live in resource-poor countries. Nevertheless, the VIDM has successfully demonstrated how CPD can be delivered to midwives in a flexible and cost-effective way, as well as bring them together in a truly global open and collaborative environment.

The big Cs - contemplating on the competency and credibility of master's-prepared early career nurses.

The landscape in master's-prepared nursing education has vastly changed. Programs are constantly expanding and evolving to respond to changing trends and needs in healthcare. Simultaneously, the demographic profile of nurses returning to graduate studies has immeasurably diversified. While it can be argued that developing advanced practice nurses (APNs) at an earlier time point may lengthen their leadership careers such that they build stronger portfolios to effect more substantive healthcare changes, it is also worth questioning whether limited clinical experience in our new generation of nurse leaders will ultimately widen our proverbial knowledge-practice gap.

Disparities in new graduate transition from multiple stakeholder perspectives.

The purpose of this qualitative study was to understand multiple stakeholder perspectives of new graduate (NG) transition programs. It was part of a larger mixed-methods study (2011) designed to provide a comprehensive assessment of new graduate nurse transition best practices, across six British Columbia health authorities. Data collection involved individual interviews with academic nurse educators (n=4) and separate focus groups with new graduate (n=48) and front-line nurse leaders (n=69). Disparity emerged as the overriding theme and described differences between stakeholder group perspectives, between expectations and reality, and within and across programs. Four disparities emerged: entry-level education and practice, perspectives on employment and career planning, transition program elements and support. Despite general satisfaction with undergraduate preparation, theory-practice gaps were identified. New Graduates experienced misalignments between their employment expectations and their realities. The employed student nurse program in which many new graduates had participated did not always yield employment, but when it did, differences in transitional expectations arose between new graduates and leaders. There was considerable variation across and within provincial new graduate programs with respect to orientation, supernumerary time and preceptorship characteristics, including lack of training. Disparities arose in the nature, amount of and access to support and the monitoring of new graduate progress. Findings reinforced organizational complexities and the importance of communication across education and practice sectors. This paper uncovers the tensions between the perspectives of new graduates and nurse leaders about transitional programs and opens the opportunity to collaborate in aligning the perspectives.

Challenges for medical educators: results of a survey among members of the German Association for Medical Education.

BACKGROUND: Despite the increasing interest in medical education in the German-speaking countries, there is currently no information available on the challenges which medical educators face. To address this problem, we carried out a web-based survey among the members of the Association for Medical Education (Gesellschaft für medizinische Ausbildung, GMA). METHODS: A comprehensive survey was carried out on the need for further qualifications, expertise and the general conditions of medical educators in Germany. As part of this study, the educators were asked to list the three main challenges which they faced and which required urgent improvement. The results were analysed by means of qualitative content analysis. RESULTS: The questionnaire was completed by 147 of the 373 members on the GMA mailing list (response rate: 39%). The educators named a total of 346 challenges and emphasised the following areas: limited academic recognition for engagement in teaching (53.5% of educators), insufficient institutional (31.5%) and financial support (28.4%), a curriculum in need of reform (22.8%), insufficient time for teaching assignments (18,9%), inadequate teacher competence in teaching methods (18.1%), restricted faculty development programmes (18.1%), limited networking within the institution (11.0%), lack of teaching staff (10.2%), varying preconditions of students (8.7%), insufficient recognition and promotion of medical educational research (5.5%), extensive assessment requirements (4.7%), and the lack of role models within medical education (3.2%). CONCLUSION: The medical educators found the biggest challenges which they faced to be limited academic recognition and insufficient institutional and financial support. Consequently, improvements should be implemented to address these issues.

The future of monitoring in clinical research - a holistic approach: linking risk-based monitoring with quality management principles.

Since several years risk-based monitoring is the new "magic bullet" for improvement in clinical research. Lots of authors in clinical research ranging from industry and academia to authorities are keen on demonstrating better monitoring-efficiency by reducing monitoring visits, monitoring time on site, monitoring costs and so on, always arguing with the use of risk-based monitoring principles. Mostly forgotten is the fact, that the use of risk-based monitoring is only adequate if all mandatory prerequisites at site and for the monitor and the sponsor are fulfilled.Based on the relevant chapter in ICH GCP (International Conference on Harmonisation of technical requirements for registration of pharmaceuticals for human use - Good Clinical Practice) this publication takes a holistic approach by identifying and describing the requirements for future monitoring and the use of risk-based monitoring. As the authors are operational managers as well as QA (Quality Assurance) experts, both aspects are represented to come up with efficient and qualitative ways of future monitoring according to ICH GCP.

Effects of eliminating psychiatric rehabilitation from the secure levels of a mental-health service system.

Psychiatric rehabilitation (PR) is widely recognized as a treatment approach and an array of evidence-based practices effective for promoting the recovery of people with serious mental illness (SMI). However, its use in institutional settings is not widespread for unclear reasons. Policymakers may sometimes believe the superiority of PR in controlled research does not apply in the real world, for various reasons. This study exploits an unusual set of real-world circumstances surrounding the closure of a well-developed PR program in a state hospital. The program was closed after a period of mental-health services reform that significantly augmented the surrounding community-service system. The PR program was converted to conventional medical-institutional model-treatment units with no reduction in beds or funding within the state hospital. A database composed of public documents was used to analyze the consequences of the closing. Within the institution, the consequences included a persistent presence of long-term difficult-to-discharge patients, a slowed discharge rate, a net increase in the hospital's per capita treatment costs, and higher use of restraint/seclusion. Effects were also detectable in the surrounding mental-health service system, including degraded outcome of community-based step-down services and increased pressure on emergency/crisis services. The consequences of closing the program are consistent with expectations based on research, and demonstrate danger in assuming that real world exigencies obviate research findings.

The end of an era? Midwifery conferences.

It has long been accepted that conferences are a useful mode of continuous professional development (CPD) (Russell 2010). Midwives welcome the chance to learn about recent practice developments, and the opportunity to network with each other in a face to face environment. However, barriers such as geographical isolation, time and financial constraints restrict midwives' ability to attend conferences (McIntosh 2007; Patterson and Davis 2007). At the same time, the effectiveness of conferences for CPD has been questioned (Guskey 2000). In these days of financial retrenchment, CPD has to be innovative and creative, offering ongoing support and learning in communities of practice that meet individual learning needs. The Virtual International Day of the Midwife (VIDM) is one such innovation. It is an annual 24 hour international synchronous online conference that celebrates the International Day of the Midwife on 5th May, and is freely open to all. Using the VIDM as a case study, this article discusses how online conferences may support and provide CPD for midwives.

Interventions to reduce the use of seclusion and restraint in inpatient psychiatric settings: what we know so far a review of the literature.

INTRODUCTION: In recent times, much attention has been focused on the reduction of seclusion and restraint in psychiatric settings. This paper analyzes evidence available from evaluations of single seclusion and/or restraint reduction programmes. A total of 29 papers were included in the review. RESULTS: Seven key strategy types emerged from the analysis: (i) policy change/leadership; (ii) external review/debriefing; (iii) data use; (iv) training; (v) consumer/family involvement; (vi) increase in staff ratio/crisis response teams; and (vii) programme elements/changes. Outcomes indicate that a range of reduction programmes are successful in reducing the frequency and duration of seclusion and restraint use, while at the same time maintaining a safe environment. CONCLUSION: The development of new seclusion and restraint reduction programmes should include strong leadership from local management; external seclusion and restraint review committees or post-incident debriefing and analysis; broad-based staff training and programme changes at a local level. Behavioural and cognitive-behavioural programmes appear to be very useful in child and adolescent services. Further systematic research should be conducted to more fully understand which elements of successful programmes are the most powerful in reducing incidents of seclusion and restraint.