Challenges and practices in promoting (ageing) employees working career in the health care sector - case studies from Germany, Finland and the UK.

BACKGROUND: The health and social care sector (HCS) is currently facing multiple challenges across Europe: against the background of ageing societies, more people are in need of care. Simultaneously, several countries report a lack of skilled personnel. Due to its structural characteristics, including a high share of part-time workers, an ageing workforce, and challenging working conditions, the HCS requires measures and strategies to deal with these challenges. METHODS: This qualitative study analyses if and how organisations in three countries (Germany, Finland, and the UK) report similar challenges and how they support longer working careers in the HCS. Therefore, we conducted multiple case studies in care organisations. Altogether 54 semi-structured interviews with employees and representatives of management were carried out and analysed thematically. RESULTS: Analysis of the interviews revealed that there are similar challenges reported across the countries. Multiple organisational measures and strategies to improve the work ability and working life participation of (ageing) workers were identified. We identified similar challenges across our cases but different strategies in responding to them. With respect to the organisational measures, our results showed that the studied organisations did not implement any age-specific management strategies but realised different reactive and proactive human relation measures aiming at maintaining and improving employees' work ability (i.e., health, competence and motivation) and longer working careers. CONCLUSIONS: Organisations within the HCS tend to focus on the recruitment of younger workers and/or migrant workers to address the current lack of skilled personnel. The idea of explicitly focusing on ageing workers and the concept of age management as a possible solution seems to lack awareness and/or popularity among organisations in the sector. The concept of age management offers a broad range of measures, which could be beneficial for both, employees and employers/organisations. Employees could benefit from a better occupational well-being and more meaningful careers, while employers could benefit from more committed employees with enhanced productivity, work ability and possibly a longer career.

Future Emergency Nursing Workforce: What the Evidence Is Telling Us.

INTRODUCTION: In Australia, on any given day, there are more than 300 advertised emergency nursing positions, and this situation can be replicated in nearly every country internationally. The nursing shortage globally is known. The importance of not only why nurses specialize in the field of emergency nursing but also why they remain in the field requires an understanding of the evidence and research into nursing recruitment and retention. Leadership within the emergency department has a strong correlation to staff retention. It is hoped that, by gaining a greater understanding of the elements that influence staff retention, we will be able to lay down a strong foundation for the future of emergency nursing. METHODS: This literature review used a bibliographic search as well as the author's own experience. RESULTS: This article presents the key factors that have impact on emergency nursing retention: workplace environment, demands on emergency nurses, resilience, and education and training. DISCUSSION: Emergency nursing recruitment and retention is a multifaceted issue that requires urgent attention to develop tools and strategies to support organizations to build a sustainable workforce. This literature review has highlighted the need for further studies to understand why emergency nurses lack the knowledge or capability for a long-term career in emergency nursing.

Health care reform in Iran: Implications for nurses' moral distress, patient rights, satisfaction and turnover intention.

AIM: The aim of the present study was to assess the implications of Iran's recent health care reforms on nurses' experience of moral distress, their perceptions of the respect for patient rights and the relationship of these variables to job and income dissatisfaction and turnover intention. BACKGROUND: Health systems around the world are reforming themselves to adapt to meeting the future needs of increasing patient care to an ever-growing population. METHODS: This was a cross-sectional correlational study. The participants were 276 nurses at six large private and public hospitals in Tehran, Iran. FINDINGS: Negative correlations were reported between turnover intention and respecting patient rights (r = -0.560, p < 0.001), satisfaction with job (r = -0.710, p < 0.001) and satisfaction with income (r = -0.226, p < 0.001). The correlation between moral distress intensity (r = 0.626, p < 0.001) and frequency (r = 0.701, p < 0.001) was positive with turnover intention. CONCLUSIONS: Moral distress was significantly correlated to poor respect for patient rights, poor job satisfaction and income satisfaction and was a major predictor of turnover intention. IMPLICATIONS FOR NURSING MANAGEMENT: Health system reform must take into account the concomitant increasing workload and its negative impact in order to ensure that reform does not lead to unintentional detrimental outcomes of increased moral distress, decreased satisfaction and increased turnover rates among nursing personnel.

Reconciling Supply and Demand for State and Local Public Health Staff in an Era of Retiring Baby Boomers.

INTRODUCTION: The purpose of this study is to reconcile public health workforce supply and demand data to understand whether the expected influx of public health graduates can meet turnover events. METHODS: Four large public health workforce data sources were analyzed to establish measures of workforce demand, voluntary separations, and workforce employees likely to retire at state and local health departments. Data were collected in 2014-2016 and analyzed in 2016 and 2017. Potential workforce supply (i.e., candidates with formal public health training) was assessed by analyzing data on public health graduates. Supply and demand data were reconciled to identify potential gaps in the public health workforce. RESULTS: At the state and local level, ≅197,000 staff are employed in health departments. This is down more than 50,000 from 2008. In total, ≥65,000 staff will leave their organizations during fiscal years 2016-2020, with ≤100,000 staff leaving if all planned retirements occur by 2020. During 2000-2015, more than 223,000 people received a formal public health degree at some level. More than 25,000 students will receive a public health degree at some level in each year through 2020. CONCLUSIONS: Demands for public health staff could possibly be met by the influx of graduates from schools and programs of public health. However, substantial implications exist for transferal of institutional knowledge and ability to recruit and retain the best staff to sufficiently meet demand.

Nurse manager succession planning: A cost-benefit analysis.

AIM: This commentary presents a cost-benefit analysis to advocate for the use of succession planning to mitigate the problems ensuing from nurse manager turnover. BACKGROUND: An estimated 75% of nurse managers will leave the workforce by 2020. Many benefits are associated with proactively identifying and developing internal candidates. Fewer than 7% of health care organisations have implemented formal leadership succession planning programmes. EVALUATION: A cost-benefit analysis of a formal succession-planning programme from one hospital illustrates the benefits of the programme in their organisation and can be replicated easily. KEY ISSUES: Assumptions of nursing manager succession planning cost-benefit analysis are identified and discussed. The succession planning exemplar demonstrates the integration of cost-benefit analysis principles. CONCLUSION: Comparing the costs of a formal nurse manager succession planning strategy with the status quo results in a positive cost-benefit ratio. IMPLICATIONS FOR NURSING MANAGEMENT: The implementation of a formal nurse manager succession planning programme effectively reduces replacement costs and time to transition into the new role. This programme provides an internal pipeline of future leaders who will be more successful than external candidates. Using an actual cost-benefit analysis equips nurse managers with valuable evidence depicting succession planning as a viable business strategy.

Changes to nurses' practice environment over time.

AIMS: To examine changes in the nursing practice environment, retention-related factors, unit stability and patient care tasks delayed or left undone, over two periods between 2004 and 2013. BACKGROUND: Positive nurse practice environments have been linked to nurse retention and care quality outcomes. METHODS: The collection of the Practice Environment Scale of the Nursing Work Index, job satisfaction, intent to leave, unit instability and tasks delayed or not done at six acute-care hospitals across three Australian states, in two waves between 2004 and 2013; results from the two waves are compared. RESULTS: On average, practice environment scores declined slightly; nurses reported a greater difficulty in finding another nursing position, lower intent to leave their current job and greater instability in their current position. Rates of delayed tasks increased over the period, whereas rates of tasks left undone have decreased over the period. CONCLUSIONS: The decline in nurses' perceptions of the quality of the practice environment is disappointing, particularly given the protracted workforce shortages that have persisted. Significant organisational restructuring and turnover of nurse executives may have contributed to this decline. IMPLICATION FOR NURSING MANAGEMENT: Managers need to apply existing evidence to improve nurse practice environments and manage instability.

Health promotion funding, workforce recruitment and turnover in New Zealand.

INTRODUCTION: Almost a decade on from the New Zealand Primary Health Care Strategy and amidst concerns about funding of health promotion, we undertook a nationwide survey of health promotion providers. AIM: To identify trends in recruitment and turnover in New Zealand's health promotion workforce. METHODS: Surveys were sent to 160 organisations identified as having a health focus and employing one or more health promoter. Respondents, primarily health promotion managers, were asked to report budget, retention and hiring data for 1 July 2009 through 1 July 2010. RESULTS: Responses were received from 53% of organisations. Among respondents, government funding for health promotion declined by 6.3% in the year ended July 2010 and health promoter positions decreased by 7.5% (equalling 36.6 full-time equivalent positions). Among staff who left their roles, 79% also left the field of health promotion. Forty-two organisations (52%) reported employing health promoters on time-limited contracts of three years or less; this employment arrangement was particularly common in public health units (80%) and primary health organisations (57%). Among new hires, 46% (n=55) were identified as Maori. DISCUSSION: Low retention of health promoters may reflect the common use of limited-term employment contracts, which allow employers to alter staffing levels as funding changes. More than half the surveyed primary health organisations reported using fixed-term employment contracts. This may compromise health promotion understanding, culture and institutional memory in these organisations. New Zealand's commitment to addressing ethnic inequalities in health outcomes was evident in the high proportion of Maori who made up new hires.

Inter-Provincial Migration Intentions of Family Physicians in Canada: The Roles of Income and Community Characteristics.

The inter-provincial migration patterns of family physicians in canada show that some provinces like newfoundland and saskatchewan experience persistent net out-migration, while others, including ontario and british columbia, are destinations more often than origins of migrants. Governments in provinces exhibiting net out-migration have responded with a number of incentive and recruitment programs. In this study, we investigate the determinants of the stated interprovincial migration intentions of 3,995 rural and urban family physicians in the 2010 wave of the national physician survey. We consider a range of physician characteristics, community attributes and working conditions. We find that in the intention to move, higher compensation has a modest effect, while the community characteristics have a consistently important influence. Our results suggest that policy and program designers should acknowledge the critical role of community-level living and working conditions in their family physician recruitment and retention efforts.

Promoting retention of nurses: A meta-analytic examination of causes of nurse turnover.

BACKGROUND: Because the health care field is expected to be the fastest growing job field until 2020, an urgent need to focus on nurse retention exists. PURPOSE: The aim of this study was to examine the relationships between predictors of turnover (i.e., personal characteristics, role states, job characteristics, group/leader relations, organizational/environmental perceptions, attitudinal reactions) and turnover cognitions and intentions, as well as actual turnover among nurses, in an effort to determine the strongest predictors of voluntary turnover. METHODOLOGY: Meta-analysis was used to determine best estimates of the effect of predictors on turnover based on 106 primary studies of employed nurses. Meta-analyzed correlations were subjected to path analysis to establish the structural relationships among the study variables. FINDINGS: Supportive and communicative leadership, network centrality, and organizational commitment are the strongest predictors of voluntary turnover based on meta-analytic correlations. Additional variables that relate to nurse turnover intentions include job strain, role tension, work-family conflict, job control, job complexity, rewards/recognition, and team cohesion. PRACTICE IMPLICATIONS: The findings suggest that some factors, such as salary, are relatively less important in prediction of turnover. Administrators concerned about nurse turnover may more effectively direct resources toward altering certain job characteristics and work conditions in the effort to reduce voluntary turnover among nurses.

Why do older RNs keep working?

OBJECTIVE: To identify the reasons older RNs (≥45 years) remain in the healthcare workforce. BACKGROUND: Despite predictions of early retirements of older nurses, many continue to work past the age when they can gain access to their retirement funds. METHODS: The authors surveyed nurses older than 45 years in New South Wales, Australia. RESULTS: The need for income was the most common reason for staying in nursing (61.9%; n = 210), with nearly 43% (n = 130) identifying this as the main reason for staying. CONCLUSIONS: Retaining older nurses in the workforce is an important strategy for managing workforce shortages. Nurse executives will need to consider strategies that will enhance retention of older nurses and focus on the reasons older nurses want to keep working.

In need of each other: the moderator of task interdependence between LMX variability and justice.

AIM: This study examined how leader-member exchange differentiation could affect nurses' perception of organisational justice as well as the moderating effect of task interdependence on this link. BACKGROUND: Teams are essential to the health-care industry. However, the perception of injustice may lead to a high level of nurse turnover. METHOD: Data was collected from 187 nurses distributed in eight units in a mid-western hospital in the USA. Hierarchical linear modeling was used to analyze the cross-level interaction of leader-member exchange variability and task interdependence on individual-level perceptions of justice. RESULTS: Leader-member exchange variability was significantly related to distributive justice and interactional justice but not significantly related to procedural justice. The interaction term was significantly related to interpersonal justice, but not to procedural justice or distributive justice. CONCLUSION: This study showed that if leaders demonstrated a variation in treatment of different subordinates, nurses could perceive this as unfair regarding distribution and interaction; when the group was highly task interdependent, this kind of perception of 'unfairness,' particularly regarding interpersonal treatment, became even more salient. IMPLICATIONS FOR NURSING MANAGEMENT: Preferential and inconsistent treatment by them within the work group could introduce nurses' perceptions of unfair treatment. It is of crucial importance to provide training for supervisors on how to display relatively consistent behaviour towards nurses, particularly when the teams are highly task interdependent.

Characteristics of home care workers who leave their jobs: a cross-sectional study of job satisfaction and turnover in Washington State.

Attracting and retaining a stable and motivated home care workforce has become a top policy priority. We surveyed 402 former home care workers in Washington State. We compared these "leavers" to current home care workers recently surveyed. Those who left the profession were more highly educated, had higher household income, and were more likely to be White. Those newly employed have better benefits, wages, hours, and career mobility than in their home care jobs. The low status and poor pay of home care workers may result in the inability of the profession to retain those who face better prospects.

[Demography and labor shortage. Future challenges of labor market policy]. / Demografie und Fachkräftemangel. Die künftigen arbeitsmarktpolitischen Herausforderungen.

For demographic reasons, the German labor force will decrease dramatically and it will be much older on average. However, labor demand, especially for qualified workers, is expected to remain high. This paper focuses on the possibilities of expanding the labor force by increasing the participation rates of women and older persons. Herein, the change in the labor force is decomposed with respect to population and labor participation and, moreover, the effects of higher participation rates are simulated. The decomposition and simulation scenarios are based on data published by the Institute for Employment Research. The analysis clearly reveals that the effect of a considerably higher labor participation of women and older workers will disappear over time when the working-age population shrinks more and more. In addition, individuals who are currently unemployed or out of the labor force are not skilled enough. Since it seems difficult to get more qualified workers in the short and even in the medium term, improving the conditions for women and older people to take up jobs should be tackled soon. This includes investments in education and health care.

A review of trends in attrition rates for surgical faculty: a case for a sustainable retention strategy to cope with demographic and economic realities.

BACKGROUND: Our aim was to compare trends in retention of academic surgeons by reviewing surgical faculty attrition rates (leaving academic surgery for any reason) of 3 cohorts at 5-year intervals between 1996 and 2011. STUDY DESIGN: The Association of American Medical Colleges' Faculty Administrative Management On-Line User System database was queried for a retention report of all tenure/clinical track full-time MD faculty within our academic medical center on July 1, 1996 (group 1), July 1, 2001 (group 2), and July 1, 2006 (group 3). Retention was tracked for 5 years post snapshot. The individual 5-year cohort attrition rates (observed frequencies) were compared with combined attrition rates for all 3 groups (expected frequencies). RESULTS: Overall, attrition trends for groups 2 (lower) and 3 (higher) were significantly different than the trends for all groups combined. Minorities and professors at the full or associate rank in group 3 contributed to this difference. Faculty in group 3 leaving our academic medical center were significantly more likely to transition into nonacademic practice compared with the other 2 groups. CONCLUSIONS: Greater attrition in the last 5-year cohort, despite the increase in faculty positions, is worrisome. A continuous retention life cycle is critical if academic medical centers hope to compete for talent. Retention planning should include on-boarding programs for enculturation, monitoring of professional satisfaction, formalized mentoring of younger surgeons, retaining academic couples and a part-time workforce, leadership and talent management, exit interviews, and competitive financial packages.