A scoping review of nursing workforce planning and forecasting research.

AIM: This study will critically evaluate forecasting models and their content in workforce planning policies for nursing professionals and to highlight the strengths and the weaknesses of existing approaches. BACKGROUND: Although macro-level nursing workforce issues may not be the first thing that many nurse managers consider in daily operations, the current and impending nursing shortage in many countries makes nursing specific models for workforce forecasting important. METHOD: A scoping review was conducted using a directed and summative content analysis approach to capture supply and demand analytic methods of nurse workforce planning and forecasting. The literature on nurse workforce forecasting studies published in peer-reviewed journals as well as in grey literature was included in the scoping review. RESULTS: Thirty six studies met the inclusion criteria, with the majority coming from the USA. Forecasting methods were biased towards service utilization analyses and were not consistent across studies. CONCLUSION: Current methods for nurse workforce forecasting are inconsistent and have not accounted sufficiently for socioeconomic and political factors that can influence workforce projections. Additional studies examining past trends are needed to improve future modelling. IMPLICATIONS FOR NURSING MANAGEMENT: Accurate nursing workforce forecasting can help nurse managers, administrators and policy makers to understand the supply and demand of the workforce to prepare and maintain an adequate and competent current and future workforce.

Organization of nursing care in three Nordic countries: relationships between nurses' workload, level of involvement in direct patient care, job satisfaction, and intention to leave.

BACKGROUND: Health care systems in Finland, Norway and Sweden share many similarities, e.g. full-coverage and tax-financed, with predominately public sector hospitals. Despite similarities, there are differences in the working situations for RNs within these Nordic countries. The aim of this study was to analyze associations between RNs' patient workload and level of involvement in direct patient care, their job satisfaction and intention to leave in these countries. METHODS: A workforce survey was conducted through RN4CAST, an EU 7th framework project. The survey included 118 items derived from validated instruments or tested in prior research. Responses from 1133 RNs at 32 Finnish hospitals, 3752 RNs at 35 Norwegian hospitals, and 11 015 RNs at 71 Swedish hospitals comprise the database, which was analyzed using logistic and odds ratio regressions analyses. RESULTS: We found statistically significant differences in RNs' level of involvement in direct patient care (p < 0.001, Sweden compared to Norway and Finland), in patient workload and in number of patients needing ADL assistance and surveillance. A U-formed relationship was found between level of involvement in direct patient care and intention to leave in Sweden, and more satisfaction among RNs in roles with more direct patient care (OR = 1.16, 1.02 ≤ CI95% ≤ 1.32). Nearly half the Finnish sample report intention to leave, with significantly lower levels in Norway and Sweden (p < 0.001). Patient workload is associated with job satisfaction and intention to leave to some degree in all countries, i.e. greater patient workload, less job satisfaction and greater intention to leave. CONCLUSIONS: This study suggests that more attention paid to patient mix, workload and role of RNs in patient care might potentially diminish intention to leave and increase job satisfaction in these Nordic countries.

Cross-cultural evaluation of the relevance of the HCAHPS survey in five European countries.

OBJECTIVE: To describe the systematic language translation and cross-cultural evaluation process that assessed the relevance of the Hospital Consumer Assessment of Healthcare Providers and Systems survey in five European countries prior to national data collection efforts. DESIGN: An approach involving a systematic translation process, expert review by experienced researchers and a review by 'patient' experts involving the use of content validity indexing techniques with chance correction. SETTING: Five European countries where Dutch, Finnish, French, German, Greek, Italian and Polish are spoken. PARTICIPANTS: 'Patient' experts who had recently experienced a hospitalization in the participating country. Main OutcomeMeasure(s) Content validity indexing with chance correction adjustment providing a quantifiable measure that evaluates the conceptual, contextual, content, semantic and technical equivalence of the instrument in relationship to the patient care experience. RESULTS: All translations except two received 'excellent' ratings and no significant differences existed between scores for languages spoken in more than one country. Patient raters across all countries expressed different concerns about some of the demographic questions and their relevance for evaluating patient satisfaction. Removing demographic questions from the evaluation produced a significant improvement in the scale-level scores (P= .018). The cross-cultural evaluation process suggested that translations and content of the patient satisfaction survey were relevant across countries and languages. CONCLUSIONS: The Hospital Consumer Assessment of Healthcare Providers and Systems survey is relevant to some European hospital systems and has the potential to produce internationally comparable patient satisfaction scores.

Developing the standardized wound care documentation model: a Delphi study to improve the quality of patient care documentation.

OBJECTIVE: The aim of this study was to validate a set of previously developed criteria for wound care documentation and to use the validated criteria as a framework for developing a wound care documentation model. The Skin Integrity component of the Finnish Care Classification, the Finnish Classification of Nursing Diagnosis, and the Finnish Classification of Nursing Interventions serve as the basis for the wound care documentation model. SUBJECTS AND SETTING: Finnish wound care specialists, mainly nurses, from different Finnish hospitals, and from the Finnish Wound Care Society having on average 18 years of experience in wound management. Data were collected using electronic survey technology. METHODS: A Delphi technique was used to develop and validate the documentation system. RESULTS: The final model consists of 7 main categories and 25 subcategories of the Skin Integrity component of the Finnish Classification of Nursing Diagnosis and 5 main categories and 25 subcategories of the Skin Integrity component of the Finnish Classification of Nursing Intervention. Based on the results of the Delphi survey, consensus was reached on all elements of the wound care documentation model. CONCLUSION: The Delphi process was used to develop a wound care documentation model for use in an electronic record to promote systematic documentation of both wound assessment and wound care. Future research should address the utility of this documentation model for nurses with expertise in wound care and generalist nurses.

Developing internet-based health services in health care organizations.

It is often said that we are living in an information society and information technology (IT) is a normal part of life in many fields. But IT is not used effectively in health care. The purpose of this study was to survey what kind of Internet-based health services and related electronic services are offered to clients by the web-pages of health care organizations in Finland.

The adoption of a controlled nursing vocabulary in Finnish scientific journals.

"Hoidokki" is a Finnish controlled nursing vocabulary for indexing and information retrieval purposes. Its second edition includes nearly 1000 terms. In this study, the congruence between the key words of three Finnish scientific nursing journals and the vocabulary was explored. Also, the content of the vocabulary was validated. The data included key words (N=208) used in 49 articles of three scientific journals in 2006. Two experts used content analysis to judge each key word and inter-rater reliability was calculated. Delphi-method was used to evaluate the potential new terms.

Nurse informaticians in Finland - who are they and what are they doing?

The role of a nurse informatician is not yet common in health care settings in Finland although electronic patient records have been in use since 1980's. A web-based survey instrument was compiled based on the surveys conducted by HIMSS in spring 2009. The aim was to find out what kind of positions nurses have in nursing informatics in the Finnish health care sector. Based on the results the role of nurse informaticians varied between hospitals and health centres based on organization size and affiliation weather on IT-department or clinical setting. In many organizations nurses are also working quite isolated due to scarce number of nurses in the field of informatics.

Validation of the Impact of Health Information Technology (I-HIT) Scale: an international collaborative.

In 2005, the Healthcare Information Management Systems Society (HIMSS) Nursing Informatics Community developed a survey to measure the impact of health information technology (HIT), the I-HIT Scale, on the role of nurses and interdisciplinary communication in hospital settings. In 2007, nursing informatics colleagues from Australia, England, Finland, Ireland, New Zealand, Scotland and the United States formed a research collaborative to validate the I-HIT across countries. All teams have completed construct and face validation in their countries. Five out of six teams have initiated reliability testing by practicing nurses. This paper reports the international collaborative's validation of the I-HIT Scale completed to date.

Technology developments applied to healthcare/nursing.

Future technology developments as applied to healthcare and particularly nursing were discussed. Emerging technologies such as genetics, small unobtrusive monitoring devices, use of information and communication technologies are as tools to not only facilitate but also promote communication among all parties of the healthcare process. These emerging technologies can be used for ubiquitous healthcare (u-health). The role of nursing in the u-health is fundamental and required for success and growth. Nursing's role will evolve as nurses become 'information-mediators' in a broader-sense than current role. All technologies will ultimately focus on the consumer through 'behind-the-scenes' data collection, which in turn will also allow nurses to analyze these data to improve care. We need to acknowledge an increased presence and or pervasiveness of information technologies as key components of quality healthcare. This sort of acknowledgment will help propel nursing, and healthcare, to increase use of these tools. To develop nurses with these types of skills the nursing education process will require a fundamental change to integrate these technology-sorts of tools as necessary elements for success.

Perceptions of health care professionals concerning development of clinical pathways.

The purpose of this survey was to investigate the perceptions of health care professionals concerning the development of clinical pathways before the implementation of the regional electronic health record. The data of this study were collected from health care professionals working with conservative heart patients and surgical hip joint patients by means of a questionnaire. The professionals were working at one central hospital and two primary care units. In this hospital region, the process of regional electronic health record implementation is ongoing. The data from this survey were analyzed using statistical methods. The participants in this study set great store by developing and describing the current clinical pathways, and believed it was important to plan the changes in clinical pathways before implementing the electronic health record. However, the clinical pathways development work has not yet fully commenced.

Patient medication--How is it documented?

The purpose of this study was to find out how nurses use the standardized terminology of the Finnish Classification of Nursing Interventions (FiCNI) in describing their patients' medication. The main focus was on the use of the FiCNI component Medication and its various categories in daily documentation. The data were collected during a ten-month period in 2003 from electronic nursing care plans drawn up for patients of different ages (N = 1,157). The anonymous data were gathered on five psychiatric, two surgical and two medical wards, one children's intensive care unit as well as one surgical and one medical outpatient clinic at one central hospital. Data analysis was by descriptive statistical methods, and "Drug Administration per os" interventions including narrative text were further classified by means of content analysis. The main categories of the Medication component were used to describe medication administration, side effects and medication counselling. However the subcategories were more commonly used in descriptions of daily care than the main categories. Subcategories were most typically complemented with narrative descriptions of prescribed drugs, time, cause and routes of delivery.

Using standardized terminology for nursing documentation.

The documentation of nursing data is one important part of compiling information about patient care. Information recorded by using standardized and coded terms is needed to facilitate the subsequent use of nursing data. Structured data can be used to describe, compare and support nursing practice, research, education and management. The possibility of narrative text must also be included in documentation. The Finnish Classification of Nursing Interventions (FiCNI)Ensio A. & Saranto K.: The Finnish Classification of Nursing Interventions (FiCNI) based firmly on the Home Health Care Classification has been tested and used since 2003 in one Central Hospital and two Health Care Centers.

Education and training of health information systems--a literature review.

This review concerned the content of education and training in health information systems targeted for healthcare professionals. The publications selected for the review were explored as to their educational content, theoretical approaches, available options, learning outcomes and the respective impact on organisational learning. A total of 1772 abstracts were screened and up to 423 abstracts studied in more detail. Two reviewers independently assessed the extracted data and decided to include 21 articles for the final review. The studies were analysed in relation to health informatics competence level, previous knowledge of information system usage, learning environment, teaching methods, pedagogical approaches, goals of training and assessment of learning. The review revealed that any level of competence in health informatics contributes to the learning process. The review suggested that more attention should be paid to setting up goals for training and measuring the preferable competence level of learning. It also clearly indicated the need for further research on teaching health informatics to healthcare professionals.

The national evaluation of standardized terminology.

The purpose of this study is to present the results of the national evaluation of Finnish Classification of Nursing Interventions (FiCNI). The data was collected using a questionnaire which included both Likert type questions (scale 1 = best - 4 = worst) and open questions. The questions covered the clarity, concreteness, importance and coherence of the components (N = 17) in FiCNI. The content and structure of FiCNI was introduced to health care professionals who responded to the questionnaire. The data was analysed using descriptive statistical methods and content analysis. According to the results, the components Medication, Respiration and Summary of care had the greatest clarity (mean = 1). The least clear component was Physical regulation (mean = 3). The components Elimination, Medication, Self care and Skin integrity had the greatest concreteness (mean = !). The importance of components was estimated for 13 of 17 components at mean 1. Only Health services, Physical regulation, Safety and Self care were given the mean value 2. The Coherence of all components was given the mean value 2. The answers to open questions provided detailed information on e.g. the content of FiCNI and the benefits and disadvantages of the hierarchical structure of the classification. The nursing process model in electronic documentation was considered useful, even essential. The findings established a basis for further development of the classification.

A controlled nursing vocabulary for indexing and information retrieval.

The lack of a nursing thesaurus in Finnish has emerged among nursing professionals searching nursing knowledge and librarians when indexing literature to databases. The Finnish Nursing Education Society launched a project focusing on the development of a nursing vocabulary and the compilation of a thesaurus. The content of a vocabulary was created by six experts using Delphi-technique. The validity of the vocabulary was twice tested for indexing nursing research and has afterwards been revised. The vocabulary can be used for indexing and information retrieval purposes. The main challenge is that nurses easily can find national as well as international nursing research from databases and enhance research utilization.

FinCC and the National Documentation Model in EHR--user feedback and development suggestions.

The structure of the Finnish nursing documentation model is based on the decision-making process and a standardized nursing terminology: Finnish Care Classification (FinCC). Nearly 20,000 nurses use the FinCC although not all healthcare organizations utilize it. Development projects for the common national nursing documentation framework have been carried out, for example, in 2010-2011 the aim of a project by the Ministry of Social Affairs and Health and the National Institute of Health and Welfare was to suggest recommendations for the Finnish nursing documentation model. The final report of the project was sent to different organizations all over the country for further feedback statements. The aim of this paper is to summarize the message of the statements (n=37) from primary and specialized care, universities including universities of applied science, professional nursing associations, trade unions and national authorities. Development suggestions for the FinCC and electronic health records will be introduced.

Nurses' intention to leave their profession: a cross sectional observational study in 10 European countries.

BACKGROUND: As the European population ages, the demand for nursing care increases. Yet, a shortage of nurses at the labour market exists or is predicted for most European countries. There are no adequate solutions for this shortage yet, and recruitment of future nurses is difficult. Therefore, retaining nurses for the profession is urgent. OBJECTIVE: To determine factors associated with nurses' intention to leave the profession across European countries. DESIGN: A multi-country, multi-centre, cross-sectional analysis of survey data. SETTING: 2025 surgical and medical units from 385 hospitals in ten European countries that participated in the RN4Cast study. Hospital selection was based on a stratified randomised selection procedure. PARTICIPANTS: All nurses from the participating medical and surgical hospital wards received a survey. 23,159 nurses (64%) returned the survey. METHODS: The nurse survey included questions about intention to leave the profession, nurse characteristics, factors related to work environment, patient-to-nurse staffing ratio, burnout and perceived quality and safety of care. Multilevel regression analyses with 'intention to leave the profession' as dependent variable were conducted for all 10 countries combined as well as per country. RESULTS: Overall, 9% of the nurses intended to leave their profession. This varied from 5 to 17% between countries. Seven factors were associated with intention to leave the profession at European level: nurse-physician relationship (OR 0.86; 95%CI 0.79-0.93), leadership (OR 0.78; 95% CI 0.70-0.86), participation in hospital affairs (0.68; 95%CI 0.61-0.76), older age (OR 1.13; 95%CI 1.07-1.20), female gender (OR 0.67; 95%CI 0.55-0.80), working fulltime (OR 0.76; 95%CI 0.66-0.86) and burnout (OR 2.02; 95%CI 1.91-2.14). The relevance of these factors differed for the individual countries. Nurse perceived staffing adequacy, patient-to-nurse staffing ratio, perceived quality and safety of care and hospital size were not associated with intention to leave at a European level. CONCLUSION: Burnout is consistently associated with nurses' intention to leave their profession across the 10 European countries. Elements of work environment are associated with intention to leave the nursing profession but differ between countries, indicating the importance of national contexts in explaining and preventing nurses' intention to leave their profession.

A systematic survey instrument translation process for multi-country, comparative health workforce studies.

BACKGROUND: As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems. OBJECTIVES: To describe the pre-data collection systematic translation process used in a twelve country, eleven language nursing workforce survey. DESIGN AND SETTINGS: We illustrate the potential advantages of Content Validity Indexing (CVI) techniques to validate a nursing workforce survey developed for RN4CAST, a twelve country (Belgium, England, Finland, Germany, Greece, Ireland, Netherlands, Norway, Poland, Spain, Sweden, and Switzerland), eleven language (with modifications for regional dialects, including Dutch, English, Finnish, French, German, Greek, Italian, Norwegian, Polish, Spanish, and Swedish), comparative nursing workforce study in Europe. PARTICIPANTS: Expert review panels comprised of practicing nurses from twelve European countries who evaluated cross-cultural relevance, including translation, of a nursing workforce survey instrument developed by experts in the field. METHODS: The method described in this paper used Content Validity Indexing (CVI) techniques with chance correction and provides researchers with a systematic approach for standardizing language translation processes while simultaneously evaluating the cross-cultural applicability of a survey instrument in the new context. RESULTS: The cross-cultural evaluation process produced CVI scores for the instrument ranging from .61 to .95. The process successfully identified potentially problematic survey items and errors with translation. CONCLUSIONS: The translation approach described here may help researchers reduce threats to data validity and improve instrument reliability in multinational health services research studies involving comparisons across health systems and language translation.