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.

The potential of task-shifting in scaling up services for prevention of mother-to-child transmission of HIV: a time and motion study in Dar es Salaam, Tanzania.

BACKGROUND: In many African countries, prevention of mother-to-child transmission of HIV (PMTCT) services are predominantly delivered by nurses. Although task-shifting is not yet well established, community health workers (CHWs) are often informally used as part of PMTCT delivery. According to the 2008 World Health Organization (WHO) Task-shifting Guidelines, many PMTCT tasks can be shifted from nurses to CHWs. METHODS: The aim of this time and motion study in Dar es Salaam, Tanzania, was to estimate the potential of task-shifting in PMTCT service delivery to reduce nurses' workload and health system costs. The time used by nurses to accomplish PMTCT activities during antenatal care (ANC) and postnatal care (PNC) visits was measured. These data were then used to estimate the costs that could be saved by shifting tasks from nurses to CHWs in the Tanzanian public-sector health system. RESULTS: A total of 1121 PMTCT-related tasks carried out by nurses involving 179 patients at ANC and PNC visits were observed at 26 health facilities. The average time of the first ANC visit was the longest, 54 (95% confidence interval (CI) 42-65) min, followed by the first PNC visit which took 29 (95% CI 26-32) minutes on average. ANC and PNC follow-up visits were substantially shorter, 15 (95% CI 14-17) and 13 (95% CI 11-16) minutes, respectively. During both the first and the follow-up ANC visits, 94% of nurses' time could be shifted to CHWs, while 84% spent on the first PNC visit and 100% of the time spent on the follow-up PNC visit could be task-shifted. Depending on CHW salary estimates, the cost savings due to task-shifting in PMTCT ranged from US$ 1.3 to 2.0 (first ANC visit), US$ 0.4 to 0.6 (ANC follow-up visit), US$ 0.7 to 1.0 (first PNC visit), and US$ 0.4 to 0.5 (PNC follow-up visit). CONCLUSIONS: Nurses working in PMTCT spend large proportions of their time on tasks that could be shifted to CHWs. Such task-shifting could allow nurses to spend more time on specialized PMTCT tasks and can substantially reduce the average cost per PMTCT patient.

Source country perceptions, experiences, and recommendations regarding health workforce migration: a case study from the Philippines.

BACKGROUND: The Philippines continues to overproduce nurses for export. Little first-hand evidence exists from leading organisations in the Philippines concerning their experiences and perceptions in relation to Filipino nurse migration. What are their views about health workforce migration? This paper addresses this research gap by providing a source country perspective on Filipino nurse migration to Australia. METHODS: Focus-group interviews were conducted with key informants from nine Filipino organisations in the Philippines by an Australian-Filipino research team. The organisations were purposively selected and contacted in person, by phone, and/or email. Qualitative thematic analysis was performed using a coding framework. RESULTS: Health workforce migration is perceived to have both positive and negative consequences. On the one hand, emigration offers a welcome opportunity for individual Filipino nurses to migrate abroad in order to achieve economic, professional, lifestyle, and social benefits. On the other, as senior and experienced nurses are attracted overseas, this results in the maldistribution of health workers particularly affecting rural health outcomes for people in developing countries. Problems such as 'volunteerism' also emerged in our study. CONCLUSIONS: In the context of the WHO (2010) Code of Practice on the International Recruitment of Health Personnel it is to be hoped that, in the future, government recruiters, managers, and nursing leaders can utilise these insights in designing recruitment, orientation, and support programmes for migrant nurses that are more sensitive to the experience of the Philippines' education and health sectors and their needs.

Nurse Credentials: What Is the Economic Value?

A workshop sponsored by the Institute of Medicine brought together health care leaders to focus on the impact of credentials on nurse, patient, and organization outcomes. Demonstrating the value of credentials is very challenging. Does the credential cause improvement? Or does it simply indicate which organizations are the better performers (and thus does not cause improvement)? As our health care system moves toward rewarding the value of health care, proponents of credentials will need to demonstrate credentials reflect true differences in the capacity to deliver health care. Credentialing is expensive; thus, it is imperative to critically assess the overall value of credentials, whether some credentials are more important than others, and how to support attainment of the most important credentials.

New York's Health Care Workforce Recruitment and Retention Act: an investigation of the effects of nonrecurring increases in health worker wage on health worker supply.

This article analyzes New York's Health Care Workforce Recruitment and Retention Act of 2002. The analysis comes in 4 parts: part 1 provides a brief overview of New York's economy as it relates to health care, a feel for the political climate at the time, and a detailed presentation of the chain of events that connect this climate to the birth of the Health Care Workforce Recruitment and Retention Act of 2002; part 2 consists of a breakdown of the provisions contained within bill, including major and minor goals, intended effects, and the mechanics behind raising supporting funds; part 3 explores what actually happened by evaluating available data to determine whether the bill's 2 major goals of workforce recruitment and retention were fulfilled; and finally, part 4 will take all the aforementioned information to determine the overall success of the bill, the implications, and specific suggestions for future policy changes that time has revealed since its inception.

The DH is talking utter nonsense about pay.

'Union leaders talk tough on pay' is a headline that could have been written thousands of times over the past 100 years, but rarely have nurses' representatives been so furious as they are now. Two weeks on from the decision to withhold a 1 per cent pay award from most NHS nursing staff in England and Wales, and tempers are continuing to flare.

Further freezes would make pay 'unfair and uncompetitive' say MPs.

A group of influential MPs has warned the government against continuing to freeze nurses' pay to address the financial challenges facing the NHS.

Five dilemmas associated with e-rostering.

Increased use of e-rostering is likely to benefit nurses and patients, but will also create dilemmas for staff. Rosters may not be flexible enough to accommodate day-to-day changes, and may also foster unfair treatment and disempower staff.

Historical data indicates a wage premium for black registered nurses.

The average observed wage of Black registered nurses (RNs) is higher than that of White RNs in the National Sample Survey of Registered Nurses over 2 decades from 1984 to 2004. In this study, wages of Black and White RNs were analyzed controlling for factors likely to affect wages in addition to race. Results indicate racial inequality in wages of RNs: Black RN wages exceeded White RNs wages over 2 decades from 1984-2004. This significant difference remained after controlling for factors likely to affect wages in addition to race such as experience, education, employer type, and specialty among other factors.

Teaching the business of health care.

This column identifies teaching modalities for assessing economic value, creating strategic plans, supporting implementation of cost-saving initiatives, and constantly evaluating.

A systems perspective on nursing productivity.

PURPOSE: Recent New Zealand reports have identified the nursing workforce for its potential to make a significant contribution to increased productivity in health services. The purpose of this paper is to review critically the recent and current labour approaches to improve nursing productivity in New Zealand, in a context of international research and experience. DESIGN/METHODOLOGY/APPROACH: An examination of government documents regarding productivity, and a review of New Zealand and international literature and research on nursing productivity and its measurement form the basis of the paper. FINDINGS: It is found that productivity improvement strategies are influenced by theories of labour economics and scientific management that conceptualise a nurse as a labour unit and a cost to the organisation. Nursing productivity rose significantly with the health reforms of the 1990s that reduced nursing input costs but impacts on patient safety and nurses were negative. Current approaches to increasing nursing productivity, including the "productive ward" and reconfiguration of nursing teams, also draw on manufacturing innovations. Emerging thinking considers productivity in the context of the work environment and changing professional roles, and proposes reconceptualising the nurse as an intellectual asset to knowledge-intensive health organisations. PRACTICAL IMPLICATIONS: Strategies that take a systems approach to nursing productivity, that view nursing as a capital asset, that focus on the interface between nurse and working environment and measure patient and nurse outcomes are advocated. ORIGINALITY/VALUE: The paper shows that reframing nursing productivity brings into focus management strategies to raise productivity while protecting nursing and patient outcomes.

The Health and Social Care Bill: value for money or service improvement?

Over the past couple of weeks, I have found myself yet again examining the proposed new Health and Social Care Bill. Although the Bill has cleared the House of Commons for now, it is being scrutinized in the House of Lords, who have had plenty of critical and uncomplimentary things to say. My concern regarding the progress of the Bill and the negative response surrounding it prompted me to revisit the legislation.