Modelling a Consultant Workforce for the United Kingdom: needs-based planning for Dental Public Health.

OBJECTIVE: To develop a needs-based workforce planning model to explore specialist workforce capacity and capability for the effective, efficient, and safe provision of services in the United Kingdom (UK); and test the model using Dental Public Health (DPH). BASIC RESEARCH DESIGN: Data from a national workforce survey, national audit, and specialty workshops in 2020 and 2021 set the parameters for a safe effective DPH workforce. A working group drawing on external expertise, developed a conceptual workforce model which informed the mathematical modelling, taking a Markovian approach. The latter enabled the consideration of possible scenarios relating to workforce development. It involved exploration of capacity within each career stage in DPH across a time horizon of 15 years. Workforce capacity requirements were calculated, informed by past principles. RESULTS: Currently an estimated 100 whole time equivalent (WTE) specialists are required to provide a realistic basic capacity nationally for DPH across the UK given the range of organisations, population growth, complexity and diversity of specialty roles. In February 2022 the specialty had 53.55 WTE academic/service consultants, thus a significant gap. The modelling evidence suggests a reduction in DPH specialist capacity towards a steady state in line with the current rate of training, recruitment and retention. The scenario involving increasing training numbers and drawing on other sources of public health trained dentists whilst retaining expertise within DPH has the potential to build workforce capacity. CONCLUSIONS: Current capacity is below basic requirements and approaching 'steady state'. Retention and innovative capacity building are required to secure and safeguard the provision of specialist DPH services to meet the needs of the UK health and care systems.

Exploring the Inner Lens: Examining Oncology Consultants' Use of Competency and Assessment Frameworks in Clinical Teaching Settings.

Medical education in oncology has adopted a competency-based medical education (CBME) approach in Canada. Oncologist competencies are arranged within assessment frameworks, but it is unknown whether oncologists routinely use assessment frameworks when determining what to teach oncology trainees. Understanding oncologists' actual approaches to assessment and teaching as a form of enacted CBME could inform and focus faculty development efforts. Using a participatory action research approach, oncology faculty were interviewed regarding their teaching practices and use of assessment frameworks. Faculty suggestions regarding challenges in setting teaching goals and completing assessment within the CBME paradigm were solicited. Furthermore, teaching objectives developed by faculty in-house were assessed regarding the domains of competence targeted. Thirty-one of the 40 faculty members in the Department of Oncology, Western University, agreed to participate. Trainee factors (training level, areas of interest), faculty personal values and experience, the teaching setting, and some components of frameworks (medical expert, communicator, advocate, and professional) were articulated as determinants of teaching goals. Of the 1117 in-house objectives reviewed, 76% focused on the medical role. Faculty held widely disparate views on assessment framework features which would enable teaching and assessment. Oncology faculty members used a multifaceted approach to determine what to teach trainees. This approach contains elements both of the conventional apprenticeship models under which many faculty members themselves were trained and of the CBME paradigm. Future research should focus on exploring ways to resolve the tension between established individual teaching approaches and nationally standardized competency frameworks which are being implemented.

Nurse Child Care Health Consultants, Professional Development, and Accreditation Improve Medication Safety in Child Care Programs.

Medication administration is a critical safety issue in hospitals and the community. Children are especially at risk because of their dependence on adults to safely administer medications. The purpose of this study was to examine non-compliance with state child care medication administration regulations and factors associated with improved compliance. The data included routine, unannounced inspections of child care programs by state licensing specialists collected in two time periods over 10 years. Factors potentially associated with regulatory compliance were included in this secondary analysis. Most child care center medication administration regulations showed decreased non-compliance between the two time periods. However, regulations pertaining to prescriber orders and parent permission revealed a significant increase in non-compliance (58.4%). Factors positively associated with medication administration regulatory compliance included: compliance with annual professional development (p < 0.0001 in both periods), achievement of accreditation (p = 0.0115 in Time 1), and among centers with children under 3 years of age, compliance with a weekly mandatory visit by a nurse consultant (p = 0.0004 in Time 2). Though family child care homes had a lower frequency of medication administration non-compliance, only 19% were administering medications in Time 1. High quality, safe, and affordable child-care is essential for all children including those with special health care needs. This study highlights the importance of medication safety practices in child care programs, national child care health and safety standards, federal and state policies regarding medication administration regulations, and the critical role of nurse child care health consultants in promoting safe medication administration in child care programs.

From staff nurse to nurse consultant: Team working part 8: the multidisciplinary team.

John Fowler, Educational Consultant, explores ways to enhance teamwork.

From staff nurse to nurse consultant.

John Fowler, Educational Consultant, explores ways to enhance teamwork.

From staff nurse to nurse consultant: Team working part 7: developing a positive ethos.

John Fowler, Educational Consultant, explores ways to enhance teamwork.

Team working part 5: Everyone is valuable.

John Fowler, Educational Consultant, explores how to survive your nursing career.

From expert to advanced clinical practitioner and beyond.

This article considers the potential development of advanced clinical practitioners (ACPs) and consultant practitioners, beyond the 'expert' status as defined by Pat Benner in 1984. The suggested Derby Model: 7 Levels of Practice Advancement, adapted from Benner's From Novice to Expert, recognises Health Education England's four pillars of advanced practice and how they can be implemented and enhanced within these senior roles, and what that means in a 21st century healthcare system.

Team working part 1: Nursing is a team profession.

John Fowler, Educational Consultant, explores how to survive your nursing career.

MINIMISE Moisture™: a local quality improvement initiative raising awareness of moisture-associated skin damage.

Julie Tyrer, Tissue Viability Nurse Consultant, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool (julie.tyrer@lhch.nhs.uk), runner-up in the BJN Awards 2020.

From staff nurse to nurse consultant: Survival Guide part 8: Surviving on a basic wage.

John Fowler, Educational Consultant, explores how to survive your nursing career.

Roles of the Clinical Ethics Consultant: A Response to Kornfeld and Prager.

We believe that clinical ethics consultants (CECs) should offer advice, options, and recommendations to attending physicians and their teams. In their article in this issue of The Journal of Clinical Ethics, however, Kornfeld and Prager give CECs a somewhat different role. The CEC they describe may at times be more aptly understood as a medical interventionist who appropriates the roles of the attending physician and the medical team than as a traditional CEC. In these remarks, we distinguish the role of the CEC from that of the physician, in contrast to some of these authors' recommendations, which confuse the two roles.

From staff nurse to nurse consultant: Continuing professional development part 12: keeping evidence.

John Fowler Educational Consultant, discusses the nature and importance of evidence.

From staff nurse to nurse consultant: Continuing professional development part 9: support and finance.

John Fowler, Educational Consultant, explores CPD for clinically based nurses.

From staff nurse to nurse consultant: Continuing professional development part 5: Learning from experience.

John Fowler, Educational Consultant, explores CPD for the clinically based nurse, looking at demonstrating and validating experiential learning.

From staff nurse to nurse consultant.

John Fowler, Educational Consultant, highlights the importance of considering your own CPD needs in the context of what you really want to do, and how you could get there.

From staff nurse to nurse consultant.

The reasons why nurses may want to study for a master's or PhD are many and varied, as is the choice of courses on offer. John Fowler, Educational Consultant, looks at the benefits of undertaking advanced study, but warns that it will require good organisational skills and the support of family, friends and employers.

From staff nurse to nurse consultant: Continuing professional development part 3: Assessing your needs.

John Fowler, Educational Consultant, explores continued professional development for the clinically based nurse, looking at making the most of opportunities.

From staff nurse to nurse consultant Continuing professional development part 6: Mentoring and being mentored.

John Fowler, Educational Consultant, explores CPD for the clinically based nurse, looking at the qualities that make a good mentor and the times in a nursing career when mentoring is particularly helpful.

From staff nurse to nurse consultant: Continuing professional development part 2: What opportunities do you have?

John Fowler, Educational Consultant, explores continued professional development for the clinically based nurse, looking at making the most of opportunities.