Creating a Statewide Nurse Residency: Using an Apprenticeship Model.

The Institute of Medicine recommends residency programs be implemented for new graduates across all settings, yet hospitals have not consistently hardwired this into their organizations. The value proposition is in recruitment, retention, and the conservation of resources. New Jersey's experiences using the US Department of Labor apprenticeship model for nurse residency programs provides a strategy that can be implemented on a statewide basis.

The utility of conceptualisations of place and belonging in workforce retention: A proposal for future rural health research.

This paper explores the utility of sense of place, place attachment and belonging-in-place for research into rural health workforce retention. One of the key contributors to health disparities between rural and metropolitan-based residents is inadequate staffing of rural health services, and many rural places around the world struggle to retain health professionals. Despite some recognition of the complex array of factors and circumstances impacting rural workforce retention, research focuses primarily on organisational and role-based causes. Health geography and concepts associated with place currently being used in some rural research may offer much to workforce retention research, especially when applied alongside person-centred approaches.

Preparing the child welfare workforce: Organizational commitment, identity, and desire to stay.

BACKGROUND: Since 1995, Colorado has had a Title IV-E child welfare Stipend Program, most recently involving four universities in partnership with the Colorado Department of Human Services. OBJECTIVE: A ten-year cohort study was conducted to understand program graduates' experiences with organizational commitment, the impact of stipends on child welfare professional identity and desire to remain in the child welfare field. PARTICIPANTS AND METHODS: The mixed methods evaluation involved 245 stipend graduates from 2006 to 2016 from Bachelor of Social Work (BSW) and Master of Social Work (MSW) programs and included an online survey and focus groups. RESULTS: Results indicate stipend graduates remained in the workforce beyond payback periods, felt prepared for the job, appreciated the skills and networks gained from their programs, and expressed gratitude for the financial assistance. Graduates identified workforce factors including peer support, supervisor support, and mobility in the agency as key retention sources for remaining in child welfare.

Development and retention of the dental workforce: findings from a regional workforce survey and symposium in England.

BACKGROUND: To help promote a flexible and sustainable workforce in dentistry, it is necessary to access accurate and timely data about the structure and nature of the evolving dental team. This paper considers the results and learning from a region-wide dental workforce survey conducted in one area of Health Education England and how the team has changed since the last survey a decade earlier. METHODS: A mixed-methods approach comprised two phases. In Phase 1 a customised workforce questionnaire was sent to all dental practices registered with the Care Quality Commission in the North East of England and North Cumbria in March 2016. Findings then informed Phase 2, a regional symposium held in October 2016, where interactive workshops generated qualitative data that elaborated on factors influencing workforce development. RESULTS: Of 431 primary dental care practices identified, 228 questionnaires were returned - a 53% response rate. The largest professional groups were dental nurses (n = 1269, 53% by headcount; 50% of fte) and dentists (34% by headcount; 42% by fte), though there had been increases in numbers of all staff groups over the decade, which was most marked for dental therapists (from 1 per 39 dentists to 1 per 8 dentists). The dental team predominantly fell into 'younger' age groups (< 46 years age), with evidence of a significant increase in the number of dentists reporting part-time working in a practice since the last survey. Around one third of dental practices reported employing dental nurses with additional skills (n = 74, 32.5%) or dental therapists (n = 73, 32%), and nearly half employed a dental hygienist (n = 104, 46%). However, there was considerable variability in whether these staff actually carried out the range of skills within their scope of practice. Factors shaping workforce development were identified as, the national context, loss of expertise, patients' health needs and expectations, surgery premises and financial constraints. CONCLUSIONS: The composition and work patterns of the primary care dental workforce have changed markedly over the last decade, though utilisation of skill-mix continues to be constrained. Consideration of factors determining career progression of dentists and dental care professionals is needed to optimise a sustainable future workforce.

Improving nurses' organizational commitment by participating in their performance appraisal process.

AIMS: To promote the nurses' organizational commitment by their participation in the improvement of the performance appraisal process. BACKGROUND: Organizational commitment is one of the factors that secures safe and high-quality care of patients. It also enhances motivation among nurses, which affected by various factors such as performance appraisal. METHOD: A participatory action research study was undertaken (March 2015 to February 2018) with 39 intensive critical care nurses and nurse managers in Social Security Hospital in Iran, using a complete enumeration sampling method. The data were collected using organizational commitment and job satisfaction questionnaires, focus groups, semi-structured interviews and Delphi technique. RESULTS: Three major themes emerged including inappropriate performance appraisal system, inefficient instruments and unskilled evaluators. There were significant differences between organizational commitment and job satisfaction with performance appraisal process before and after the change in appraisal process. CONCLUSIONS: Nurses' involvement in revising and improving the process of their performance appraisal leads to higher commitment. IMPLICATIONS FOR NURSING MANAGEMENT: Maintaining a committed nursing workforce is vital for high-quality health care. Nurse Managers can improve the process of nurses' appraisal to make more motivation among them and prevent some problems such as job dissatisfaction.

Retaining nurses in a changing health care environment: The role of job embeddedness and self-efficacy.

BACKGROUND: Because nurses are on the front lines of care delivery, they are subject to frequent changes to their work practices. This change-laden environment puts nurses at higher risk for turnover. Given the frequent disruption to the way nurses perform their jobs, change-related self-efficacy (CSE), or confidence that one can handle change, may be vital to their retention. PURPOSE: The purpose of this article is to examine the roles of CSE and job embeddedness in reducing turnover intentions among nurses. Specifically, this article tests a model in which CSE is the intervening mechanism through which job embeddedness influences turnover intentions. METHODS: Drawing on a sample of 207 nurses working in the medical/surgical unit of a major metropolitan hospital in the United States, this study employs OLS regression to test for direct effects of job embeddedness and CSE on turnover intentions and bias-corrected bootstrapping to test for the indirect effects of job embeddedness on turnover intentions through CSE. FINDINGS: Results show that CSE is directly linked to turnover intentions, and the effects of job embeddedness on turnover intentions become fully manifest through CSE. PRACTICE IMPLICATIONS: Improved nurse retention may lead to stable patient care and less disruption in service delivery. Improved retention also benefits health care organizations financially, as costs of replacing a nurse can exceed 100% of the salary for the position. Given the shortage of nurses in some geographic areas, retention remains an important goal.

Does Visual Aesthetics of the Workplace Matter? Analyzing the Assessment of Visual Aesthetics as Antecedent of Affective Commitment and Job Crafting.

In this work, two objectives were addressed. First, the visual aesthetics assessment of the workplace was explored for the first time as a potential antecedent of the proactive behaviors of job crafting. Second, the potential mediating role of the affective organizational commitment in this relationship was analyzed. To address these purposes, a field study was conducted with a sample of 428 workers. Following a set of hypotheses, the results of the measurement model, χ2 (df) = 494.288 (215); CFI = .920; TLI = .906; RMSEA = .066, showed that the visual aesthetics assessment of the workplace was significantly correlated with three of the four dimensions of job crafting (r = .19 with ISO-JR, r = .15 with IC-JD and; r = .17 with IST-JR; p < .001) and with affective organizational commitment (r = .27, p < .001). In addition, through a structural equation model, χ2(df) = 494.895 (219); CFI = .921; TLI = .909; RMSEA = .065, positive and significant indirect effects were found from the visual aesthetic assessment of the workplace to the same three dimensions of job crafting, all through the affective organizational commitment: .17 with ISO-JR, .25 with IC-JD and, .23 with IST-JR; 95% CI [.097, .276], [.161, .361] and [.161, .361], respectively. The results obtained provide useful evidence for researchers and managers about the value of providing an aesthetically satisfactory workplace, which would enhance the affective commitment of employees and, consequently, positively affect the proactive behaviors of job crafting.

Satisfaction and limitation of primary health care nurses' work in rural areas.

INTRODUCTION: The health workforce is crucial to reduce inequalities in health and health care in rural areas, and nurses, although there are few professionals and these are poorly distributed compared to other professionals. There are few studies addressing nurses' work in the rural context. This study aimed to investigate the satisfaction and difficulties of the work of primary health care (PHC) nurses in rural areas. METHOD: This is a case study with a qualitative approach, whose subject was the health units in the rural area of a large city in the state of Paraíba, Brazil, with Family Health Strategy teams. Eleven nurses working in rural areas participated in the study. Data were collected through interviews with semi-structured scripts and submitted to content analysis. RESULTS: The study revealed that nurses working in rural areas have experienced job satisfaction with the recognition and gratitude of families, one of the major motivations for professionals interviewed. The nurses are committed and have adequate training in their area of activity. The working conditions, infrastructure, forms of access to the workplace and distance from the decision center are factors that stand out as difficulties of work. CONCLUSIONS: The nurses appreciate each other in their work, establish good relations with the population and work as a team despite the difficulties. The study reveals that nurses and the population experience isolation in the rural area as well as difficulty in accessing the workplace, in the case of practitioners, and in consolidating policies maintained in the urban area. It evidences the nurse as an essential element for PHC in the rural setting, which can make the difference in the care of populations often in the sideline of health services.

A Psychometric Assessment of a Human Resources Practice Measure for Temporary Agency Workers.

Studies have proposed and validated several measures that evaluate employee's perceptions of the human resources practices (HRP). However, given the changes occurring in the labor market, there is a need to develop a measure specially adapted to the contingent workers specific employment relationship. Thus, this study assesses an HRP system scale that was administered to temporary agency workers (TAW) to examine the scale's response process, internal structure and relation to other variables (i.e., affective commitment). The measure was administered to 4,551 Portuguese TAW. The Messick's validation framework (1995) was use and two sectors were compared. Descriptive analyses, scale reliabilities, item characteristics, exploratory, confirmatory, and multiple group analyses demonstrated that the measure had good psychometric properties. Moreover, there were positive correlations between the HRP scale and affective commitment. The results contribute to a better understanding of managing TAW's in agencies and client companies. HRP are a valuable method for "communicating" with these workers, who are then able to recognize and respond to the investment. This is the first study to develop and assess the psychometric properties of an HRP system measure for TAW and to cross-validate it with workers' affective commitment towards both companies that are involved in this employment relation.

Ethical lessons learned and to be learned from mass casualty events by terrorism.

PURPOSE OF REVIEW: The world has seen a major upturn in international terror awareness. Medicine has had to respond. In addition to the unique physical and mental injuries caused by terror which require special clinical attention, so too terror represents a challenge for medicine from an ethics perspective. RECENT FINDINGS: Several responses in the literature over the past few years have attempted to reflect where the battlefront of ethical dilemmas falls. These include issues of resource allocation, triage, bioterror, the therapeutic relationship with terrorists, dual loyalty, and challenges in the role in the promotion of virtuous behavior as a physician under difficult conditions. SUMMARY: Although many challenges exist, physicians need to be prepared for ethical response to terror. With their associated unique status, providing legitimacy and specialized ability in the management and approach to terror situations, physicians are held to a higher standard and need to rise to the occasion. This is required in order to promote ethical behavior under trying conditions and ethical sensitivity of the medical profession by means of being attuned to the reality around.

Psychometric Assessment of the Job Embeddedness Instrument: A Rasch Perspective.

The aim of this study was to examine the psychometric properties of the job embeddedness instrument (JEI) using a Rasch perspective in a sample of Registered Nurses (RNs). A secondary analysis of data was conducted from a previous study examining the job embeddedness of rural and urban RNs. A Rasch analysis supported the six underlying dimensions: organizational fit, community fit, organizational links, community links, organizational sacrifice, and community sacrifice. The results of this study also demonstrate additional evidence of the validity, reliability, and generalizability of the JEI inferences with a sample of RNs. In total, 38 of 39 items of the original JEI were retained in the model. The psychometric evaluation attained through this multidimensional Rasch analysis provided support for using the JEI to assess the level of job embeddedness for RNs.

The Social Determinants of Nursing Retention in a Pediatric Hematology/Oncology Unit.

Pediatric hematology/oncology units (PHOUs) are highly paced, stressful environments and can be difficult areas to work. Thus, these units can present issues when it comes to both recruiting and retaining health care professionals (HCPs). There is scant research addressing how the environment of a PHOU contribute to a HCP's desire to stay or leave this environment. To conduct this project, a critical ethnographic approach was used. The researcher conducted semistructured interviews ( n = 29), which included nurses ( n = 21), physicians ( n = 4), and allied health care staff ( n = 4). This sample represented approximately one third of staff in each category. Participants identified that their ability to develop long-term relationships with children and families as a significant source of satisfaction. Belonging to the oncology team was seen as extraordinarily important to all the participants. The majority of the participants also felt that working in this ever-evolving dynamic medical field afforded them with ongoing learning opportunities. The main frustration described by participants pertained to administrative involvement in the everyday workings of the PHOU, potentially leading to attrition. It is important to note that there was also diversity among and between the categories of HCPs when describing the work environment and the issues that most influence them. While similarities among participants were found between satisfaction and dissatisfaction, significant differences between them led us to believe it would be unreasonable to attempt to compare the three groups here. Thus, in this article the author focused primarily on nursing while noting related observations from physicians and allied health professions.

A Systematic Review of the Benefits of Hiring People with Disabilities.

Purpose We reviewed literature on the benefits of hiring people with disabilities. Increasing attention is being paid to the role of people with disabilities in the workplace. Although most research focuses on employers' concerns, many companies are now beginning to share their successes. However, there is no synthesis of the peer-reviewed literature on the benefits of hiring people with disabilities. Methods Our team conducted a systematic review, completing comprehensive searches of seven databases from 1997 to May 2017. We selected articles for inclusion that were peer-reviewed publications, had a sample involving people with disabilities, conducted an empirical study with at least one outcome focusing on the benefits of hiring people with disabilities, and focused on competitive employment. Two reviewers independently applied the inclusion criteria, extracted the data, and rated the study quality. Results Of the 6176 studies identified in our search, 39 articles met our inclusion criteria. Findings show that benefits of hiring people with disabilities included improvements in profitability (e.g., profits and cost-effectiveness, turnover and retention, reliability and punctuality, employee loyalty, company image), competitive advantage (e.g., diverse customers, customer loyalty and satisfaction, innovation, productivity, work ethic, safety), inclusive work culture, and ability awareness. Secondary benefits for people with disabilities included improved quality of life and income, enhanced self-confidence, expanded social network, and a sense of community. Conclusions There are several benefits to hiring people with disabilities. Further research is needed to explore how benefits may vary by type of disability, industry, and job type.

Understanding the factors affecting the attraction and retention of health professionals in rural and remote areas: a mixed-method study in Niger.

BACKGROUND: The critical shortage of human resources in health is a critical public health problem affecting most low- and middle-income countries, particularly in sub-Saharan Africa. In addition to the shortage of health professionals, attracting and retaining them in rural areas is a challenge. The objective of the study was to understand the factors that influence the attraction and retention of health professionals working in rural areas in Niger. METHODS: A mixed-method study was conducted in Tillabery region, Niger. A conceptual framework was used that included five dimensions. Three data collection methods were employed: in-depth interviews, documentary analysis, and concept mapping. In-depth interviews were conducted with three main actor groups: policy-makers and Ministry of Health officials (n = 15), health professionals (n = 102), and local health managers (n = 46). Concept mapping was conducted with midwifery students (n = 29). Multidimensional scaling and cluster analysis were performed to analyse the data from the concept mapping method. A content analysis was conducted for the qualitative data. RESULTS: The results of the study showed that the local environment, which includes living conditions (no electricity, lack of availability of schools), social factors (isolation, national and local insecurity), working conditions (workload), the lack of financial compensation, and individual factors (marital status, gender), influences the attraction and retention of health professionals to work in rural areas. Human resources policies do not adequately take into account the factors influencing the retention of rural health professionals. CONCLUSION: Intersectoral policies are needed to improve living conditions and public services in rural areas. The government should also take into account the feminization of the medical profession and the social and cultural norms related to marital status and population mobility when formulating human resources management policies.

Rural recruitment and retention of health workers across cadres and types of contract in north-east India: A qualitative study.

Background Like many other low- and middle-income countries, India faces challenges of recruiting and retaining health workers in rural areas. Efforts have been made to address this through contractual appointment of health workers in rural areas. While this has helped to temporarily bridge the gaps in human resources, the overall impact on the experience of rural services across cadres has yet to be understood. This study sought to identify motivations for, and the challenges of, rural recruitment and retention of nurses, doctors and specialists across types of contract in rural and remote areas in India's largely rural north-eastern states of Meghalaya and Nagaland. Methods A qualitative study was undertaken, in which 71 semi-structured interviews were carried out with doctors (n = 32), nurses (n = 28) and specialists (n = 11). In addition, unstructured key informant interviews (n = 11) were undertaken, along with observations at health facilities and review of state policies. Data were analysed using Ritchie and Spencer's framework method and the World Health Organization's 2010 framework of factors affecting decisions to relocate to, stay in or leave rural areas. Results It was found that rural background and community attachment were strongly associated with health workers' decision to join rural service, regardless of cadre or contract. However, this aspiration was challenged by health-systems factors of poor working and living conditions; low salary and incentives; and lack of professional growth and recognition. Contractual health workers faced unique challenges (lack of pay parity, job insecurity), as did those with permanent positions (irrational postings and political interference). Conclusion This study establishes that the crisis in recruiting and retaining health workers in rural areas will persist until and unless health systems address the core basic requirements of health workers in rural areas, which are related to health-sector policies. Concerted attention and long-term political commitment to overcome system-level barriers and governance may yield sustainable gains in rural recruitment and retention across cadres and contract types.

Stakeholders' Perspectives on Strategies for the Recruitment and Retention of Primary Health Care Employees in Qatar: A Qualitative Approach.

This study explores the recruitment and retention conditions influencing primary health care (PHC) human resources for health (HRH) in Qatar and suggests strategies for their improvement. A qualitative design employing semistructured key informant interviews with PHC stakeholders in Qatar was utilized. Key interviewees were originally recognized, and snowball sampling was used to identify additional interviewees until reaching saturation point. Interview scripts were transcribed and then analyzed thematically using the Nvivo software package. Thematic analysis precipitated a number of themes. Under recruitment, the centrality of enhancing collaboration with academic institutions, enhancing extrinsic benefits, and strengthening human resources recruitment and management practices. Dedicated support needs to be provided to expatriate HRH especially in regard to housing services, children schooling, and streamlining administrative processes for relocation. Findings revealed that job security, continuous professional development, objective performance appraisal systems, enhanced job transparency, and remuneration are key retention concerns. The study provides a number of recommendations for the proper recruitment and retention of HRH. Health planners and decision makers must take these recommendations into consideration to ensure the presence of a competent and sustainable HRH in the PHC sector in the future.

State Health Agency and Local Health Department Workforce: Identifying Top Development Needs.

OBJECTIVES: To identify occupations with high-priority workforce development needs at public health departments in the United States. METHODS: We surveyed 46 state health agencies (SHAs) and 112 local health departments (LHDs). We asked respondents to prioritize workforce needs for 29 occupations and identify whether more positions, more qualified candidates, more competitive salaries for recruitment or retention, or new or different staff skills were needed. RESULTS: Forty-one SHAs (89%) and 36 LHDs (32%) participated. The SHAs reported having high-priority workforce needs for epidemiologists and laboratory workers; LHDs for disease intervention specialists, nurses, and administrative support, management, and leadership positions. Overall, the most frequently reported SHA workforce needs were more qualified candidates and more competitive salaries. The LHDs most frequently reported a need for more positions across occupations and more competitive salaries. Workforce priorities for respondents included strengthening epidemiology workforce capacity, adding administrative positions, and improving compensation to recruit and retain qualified employees. CONCLUSIONS: Strategies for addressing workforce development concerns of health agencies include providing additional training and workforce development resources, and identifying best practices for recruitment and retention of qualified candidates.

Supporting and retaining Village Health Teams: an assessment of a community health worker program in two Ugandan districts.

BACKGROUND: Uganda's national community health worker program involves volunteer Village Health Teams (VHTs) delivering basic health services and education. Evidence demonstrates their positive impact on health outcomes, particularly for Ugandans who would otherwise lack access to health services. Despite their impact, VHTs are not optimally supported and attrition is a growing problem. In this study, we examined the support needs and existing challenges of VHTs in two Ugandan districts and evaluated specific factors associated with long-term retention. We report on findings from a standardized survey of VHTs and exploratory interviews with key stakeholders and draw conclusions that inform efforts to strengthen and sustain community health care delivery in Uganda. METHODS: A mixed-methods approach was employed through a survey of 134 individual VHT members and semi-structured interviews with six key stakeholders. Descriptive and bivariate regression analysis of quantitative survey data was performed along with thematic analysis of qualitative data from surveys and interviews. In the regression analysis, the dependent variable is 10-year anticipated longevity among VHTs, which asked respondents if they anticipate continuing to volunteer as VHTs for at least 10 more years if their current situation remains unchanged. RESULTS: VHTs desire additional support primarily in the forms of money (e.g. transportation allowance) and material supplies (e.g. rubber boots). VHTs commonly report difficult working conditions and describe a lack of respect from their communities and other health workers. If their current situation remains unchanged, 57% of VHTs anticipate remaining in their posts for at least 10 years. Anticipated 10-year longevity was positively associated with stronger partnerships with local health center staff and greater ease in home visiting. CONCLUSIONS: Supporting and retaining Uganda's VHTs would be enhanced by building stronger partnerships between VHTs and other health workers and regularly providing supplies and transportation allowances. Pursuing such measures would likely improve equity in access to healthcare for all Ugandans.

Intrinsic motivation and organizational identification among on-demand workers.

On-demand firms provide services for clients through a network of on-demand workers ready to complete specific tasks for a set contractual price. Given such on-demand work is defined by payment on short-term contracts with no obligation for continued employment, there is little reason to believe on-demand workers experience more than extrinsic motivation and a transactional relationship with the on-demand firm. However, using self-determination theory, we argue that to the degree that on-demand work fulfills innate psychological needs individual on-demand workers will develop intrinsic motivation, which further leads to organizational identification with the on-demand firm. Across 2 survey-based studies we find support for this path to organizational identification. This adds to the literature on motivation and identification by strengthening the link between individual needs and the individual-organizational relationship. Implications for theory and for the management of on-demand workers are discussed. (PsycINFO Database Record