[Primary care medicine in Germany at the crossroads]. / Primärmedizinische Versorgung in Deutschland am Scheideweg.

In addition to the existing social law options for primary care under medical responsibility for those with statutory health insurance, there are several projects to supplement the service structures: healthcare kiosks, primary care centers and community health nursing as well as general practitioner outpatient clinics in hospitals. These new projects amount to an institutionalization of services that were previously based at outpatient offices and partially to the transfer of medical services that were previously the responsibility of doctors to the responsibility of non-physician healthcare professionals, with additional financial outlay but without creating new care capacities. The constructs considered do not appear to be suitable for making a relevant contribution to compensating for the gap in doctors specialized in general or internal medicine and in other medical professionals in a demographically induced capacity phasing out process that is forecast to last until around 2036. The further development of German social law on primary care should instead focus on increasing the efficiency of resources which are becoming scarcer through guided and graduated access to doctors according to medical criteria.

Dialysis nurse demand in Europe: an estimated prediction based on modelling.

Background: To estimate the projections of supply and demand for dialysis nurses (DNs) over 5 years in four European countries (France, Italy, Spain and the UK). Methods: This study modelled the nursing labour workforce across each jurisdiction by estimating the current nursing labour force, number of nursing graduates and the attrition rate. Results: France currently has the greatest demand for DNs (51 325 patients on dialysis), followed by Italy, the UK and Spain with 40 661, 30 301 and 28 007 patients on dialysis, respectively. The number of in-centre haemodialysis (HD) patients is expected to increase in the four countries, while the number of patients on home HD (HHD) or on peritoneal dialysis (PD) is expected to increase in the UK. Currently Italy has the greatest proportion of DNs (2.6%), followed by France (2.1%), Spain (1.7%) and the UK (1.5%). Estimation of the dialysis nursing staff growth rate over 5 years showed that the UK has the greatest estimated growth rate (6%), followed by Italy (2%), France (2%) and Spain (1%). Conclusions: Dialysis demand will increase in the coming years, which may exacerbate the DN shortage. Additionally, competencies and training requirements of DNs should be precisely defined. Finally, implementing and facilitating PD and HHD strategies would be helpful for patients, healthcare professionals and healthcare systems and can even help ease the DN shortage.

Licensed Practical Nurses in Team Triage: A Safe Way to Address Nursing Shortages in the Emergency Department.

Background There is a Registered Nurse (RN) shortage across the United States that is predicted to intensify in the upcoming years. RNs are an integral part of Emergency Departments (EDs) and perform many vital tasks, including IV placement, blood draws, medication administration, acute assessments, and patient hand-offs. Thus, RN staffing is a crucial part of ED operations, and ED initiatives should account for RN workforce shortages. Given the increase in ED visits and crowding, throughput initiatives that can expedite patient care are integral to the functioning of an ED. Team Triage is a throughput initiative that has been shown to improve ED time to provider, length of stay, and left without being seen rates. In our institution, we created a Team Triage model where advanced practice providers (APPs) perform a patient's initial evaluation in triage and place orders for labs, intravenous (IV) catheters, and imaging. Given the RN staffing shortage, we incorporated Licensed Practical Nurses (LPNs) in Team Triage to place IV catheters and draw blood work for laboratory tests. The objective of this investigation was to describe a Team Triage model that incorporated LPNs and to report the patient safety and productivity of this model. Methods This was a single-site retrospective study at a large, academic, tertiary care center with over 100,000 annual visits. Adult patients who self-presented to the ED and went through Team Triage (11 am-11 pm) between Jan 1, 2020, and Jan 31, 2020, were included in this study. LPNs staffed the Team Triage, along with APPs. LPNs placed IV catheters and drew blood specimens for the Team Triage patients. The primary outcomes studied were the proportion of specimens mislabeled by LPNs, the proportion of patients receiving IV catheters, the proportion of patients receiving blood work, blood tubes drawn per hour, and IVs inserted per hour in Team Triage. Results During the study period, 1355 patients went through Team Triage. Of these patients, 1075 (79%) were ordered for blood work, and 1017 (75%) were ordered for an IV catheter. All Team Triage blood work and IV catheter placements were completed by LPNs, who staffed 372 hours of Team Triage. A total of 2558 blood tubes were collected by LPNs. The LPNs cared for 2.9 patients per hour, collected 6.9 blood tubes per hour, inserted 2.7 IV catheters per hour, and collected 2.4 blood tubes per patient. The LPNs had a 0% specimen mislabeling rate. Conclusion Due to the significant RN workforce shortage impacting Emergency Medicine coupled with increased ED crowding, there is a significant need to evaluate the integration of LPNs into Team Triage to place IV catheters and perform blood draws. This study shows that incorporating LPNs in Team Triage is a productive and safe way to address nursing shortages in Emergency Medicine.

The Crisis in the Nursing Labour Market: Canadian Policy Perspectives.

The labour market for care professionals has experienced significant changes, resulting in critical shortages globally. Nurses represent the largest share of health workers worldwide; nonetheless, an estimated 13 million more nurses will be needed over the next 10 years. Prior to the pandemic, the domestic supply of nurses in Canada had not kept pace with the ever-increasing demand for services. Pre-pandemic age- and needs-based forecasting models have estimated shortages in an excess of 100,000 nurses nationwide by 2030. While COVID-19 has accelerated the demand for and complexity of service requirements, it has also resulted in losses of healthcare professionals due to an increased sick leave, unprecedented burnout and retirements. This paper examines key factors that have contributed to nursing supply issues in Canada over time and provides examples of policy responses to the present shortage facing the healthcare system. To provide adequate care, the nursing workforce must be stabilized and-more importantly-recognized as critical to the health of the population.

Inadequate number of staff and other reasons for implicit rationing of nursing care across hospital types and units.

AIM: The aim of the study was to find differences in perceived reasons for implicit rationing of nursing care across hospital types and units. DESIGN: A descriptive multicentre study. METHODS: The study in 14 Czech acute care hospitals was conducted from September 2019 to October 2020. The sample consisted of 8316 nurses working in medical and surgical units. Items for rating the reasons for implicit rationing of nursing care were selected from the MISSCARE Survey. Nurses were asked to rate each item on a scale from 0 (a not significant reason) to 10 (the most significant reason). RESULTS: The most significant reasons for implicit rationing of nursing care were 'Inadequate number of staff', 'Inadequate number of assistive personnel' and 'Unexpected patient admission and discharge'. Most reasons were rated as more significant by nurses from non-university hospitals. Nurses from medical units perceived all reasons for implicit rationing of nursing care as more significant.

Determining the Role of Employee Engagement in Nurse Retention along with the Mediation of Organizational Culture.

In today's unpredictable environment, the rapid emergence of the COVID-19 pandemic has shaken the world and its healthcare infrastructure immensely. As nurses are the building blocks of the healthcare personnel labor market, organizations should develop tactics that aid in their retention. With a solid theoretical foundation in self-determination theory, this study aims to understand the role of employee engagement in keeping nurses in 51 hospitals in the Northern Indian region, along with the mediation of organizational culture through smart PLS. In a complementary mediation relationship with organizational culture, nurse retention is positively correlated with employee engagement.

Cardiovascular Nursing Workforce Challenges: Transforming the Model of Care for the Future.

The complexities of acute and critical care cardiovascular management demand specialty trained and experienced nurses to ensure quality patient outcomes. An ongoing nurse labor shortage threatens to destabilize the healthcare system and presents a twofold challenge: a decreasing supply of registered nurses and increasing demand for nursing services. This article describes the numerous forces driving the current nursing shortage as well as the impact of the coronavirus-19 pandemic on nurse job satisfaction and turnover. We present a reinvented model of nursing care as a framework for healthcare organizations to address nurse staffing challenges.

Challenges perceived by nursing professionals in physician-centred organizations: An exploratory qualitative study.

AIM: To explore and analyse contextual challenges in nursing that have affected nurses' perceptions and role performance. BACKGROUND: Health system hierarchy and patient/family-centred care has led to a high demand for skilled nurses. However, patriarchal organizations create challenges for nursing clinicians in Pakistan and elsewhere. METHODS: A qualitative exploratory research (phenomenology) design was used. Twenty-five participants identified through purposive sampling contributed to the study. The data analysis was conducted using NVivo 12 Plus. We generated six major themes. Reporting was accomplished according to the consolidated criteria for reporting qualitative research checklist. RESULTS: Gendered division of labour places nurses in a submissive position in clinical practice. Decreases in nurse-to-patient ratio and increase in patient-focused care adversely affect evidence-based practice. The gap between theory and practice in delivering quality care is increasing due to existing communication barriers among health-related professionals and an inadequate work environment. Comparatively inactive nursing leadership and directorate roles are not improving the social image of nursing, and are promoting role conflict and poor nursing self-concepts among nurses. In fact, cultural shock experienced by young nurses has produced inherent disorientation in their professionalism and fostered displays of horizontal violence towards them by senior nurses. CONCLUSION: These challenges are influencing nurses' decisions to remain in or to join nursing as a profession that is confronted by severe recruitment and retention shortages due to the social and cultural stigmatization of this female dominated profession. IMPLICATIONS FOR NURSING, HEALTH AND SOCIAL POLICY: This study promotes the concept of evidence-based practice to deliver quality health services in public hospitals and to improve the social status of nursing in Pakistan. It provides influential evidence to policymakers who should urgently address nurses' workplace health and safety issues as a global right.

The future of nurse education? Studying at the Open University in Scotland.

This article describes nurse education with the Open University in Scotland (OUiS). Although there are problems with nurse recruitment and retention across the UK, in Scotland the landscape is somewhat different, with greater support for students required in remote and rural areas. Despite these challenges, the OUiS continues to recruit to the commissioned numbers of places. OUiS nursing students are primarily health care support workers who are a key group within the health and social care workforce but historically have faced many challenges in developing clear career pathways into nursing. At the heart of the OU is the fundamental recognition of distance online pedagogy, complemented by work-based learning support by employers. Partnership working between the OU, employers and education commissioners is crucial to its success.

I Want to Become a Registered Nurse as a Non-Traditional, Returning, Evening, and Adult Student in a Community College: A Study of Career-Changing Nursing Students.

The current significant human resource and workforce shortages of registered nurses (RNs) are impacting urban, suburban, and rural hospitals and healthcare facilities all over the globe, regardless of the entities' economic and financial backgrounds. The purpose of this research study is to understand why non-traditional, returning, evening, and adult (NTREA) students decided to enrol at the Associate Degree in Nursing programme during their mid-adulthood? 40 s-career nursing students who are pursuing their nursing programme were invited to individual interview sessions and focus group activities on sharing and expressing the motivations in the New England region in the United States. Based on the theoretical framework of Social Cognitive Career Theory, the researcher concluded that family consideration and higher social status were two of the major themes. The study provided a blueprint for human resource professionals, health and social caring leaders, government agencies, policymakers, and researchers to reform their current nursing curriculum and health workforce policy to attract potential second-career nursing joining the nursing profession.

Professional Identity of Male Nursing Students in 3-Year Colleges and Junior Male Nurses in China.

PURPOSE: To investigate the changing tendency and influencing factors of the professional identity of male nursing students in 3-year colleges and junior male nurses in China. BACKGROUND: In China, the majority of nurses are 3-year nursing college graduates, among which male nurses are underrepresented. Many male nurses leave the profession 3 or 4 years after graduation. Little is known about the professional identity of Chinese male nursing students in 3-year colleges and junior male nurses. METHODS: This study included 237 male nursing students from a 3-year college and 33 junior male nurses with less than 3 years of experience in China. By using the data collected with the Professional Identity Questionnaire of Nursing Students and through in-depth semistructured interviews from November 2019 to April 2020, t-test, and ANOVA analysis in SPSS22.0 were conducted and thematic analysis was applied to interviews. RESULTS: Compared with undergraduate nursing students, Chinese male nursing students in 3-year colleges had a better professional identity, displaying a declining tendency with grades. Junior male nurses reported the lowest professional identity. Demographic factors such as family residence and presence of relatives in medical service were positively related to professional identity. Low professional identity was related to heavy workload as well as gender stereotypes. Two unique contextual factors influenced the professional identity: (a) curriculum setting and (b) nurse exams. CONCLUSION: College education and initial working experience were critical to professional identity formation for male nurses. Appropriate measures need to be taken to improve professional identity and promote gender diversity.

The Shortage of Expert Nephrology Nurses in Hemodialysis: A Literature Review.

The expert nephrology nurse is an integral part of quality care and essential for continuity of care in the renal community. A review of literature focused on the expert nephrology nurse, the need for these experts in the hemodialysis setting, and how the shortage of expert nephrology nurses may impact patient outcomes. The purpose was to synthesize the current literature to provide an understanding of the shortage of expert nephrology nurses. The review of 140 articles dated from 1984 through 2016 resulted in 65 that met the inclusion and exclusion criteria. The results of this literature review of shortage of expert nephrology nurses prompts concern for the renal community and its patients.

An Assessment of Climate Change Impacts on Los Angeles (California USA) Hospitals, Wildfires Highest Priority.

Introduction Although many studies have delineated the variety and magnitude of impacts that climate change is likely to have on health, very little is known about how well hospitals are poised to respond to these impacts. Hypothesis/Problem The hypothesis is that most modern hospitals in urban areas in the United States need to augment their current disaster planning to include climate-related impacts. METHODS: Using Los Angeles County (California USA) as a case study, historical data for emergency department (ED) visits and projections for extreme-heat events were used to determine how much climate change is likely to increase ED visits by mid-century for each hospital. In addition, historical data about the location of wildfires in Los Angeles County and projections for increased frequency of both wildfires and flooding related to sea-level rise were used to identify which area hospitals will have an increased risk of climate-related wildfires or flooding at mid-century. RESULTS: Only a small fraction of the total number of predicted ED visits at mid-century would likely to be due to climate change. By contrast, a significant portion of hospitals in Los Angeles County are in close proximity to very high fire hazard severity zones (VHFHSZs) and would be at greater risk to wildfire impacts as a result of climate change by mid-century. One hospital in Los Angeles County was anticipated to be at greater risk due to flooding by mid-century as a result of climate-related sea-level rise. CONCLUSION: This analysis suggests that several Los Angeles County hospitals should focus their climate-change-related planning on building resiliency to wildfires. Adelaine SA , Sato M , Jin Y , Godwin H . An assessment of climate change impacts on Los Angeles (California USA) hospitals, wildfires highest priority. Prehosp Disaster Med. 2017;32(5):556-562.

The impact of undergraduate clinical teaching models on the perceptions of work-readiness among new graduate nurses: A cross sectional study.

BACKGROUND: Clinical Placements are an essential component of bridging the gap between academic theory and nursing practice. There are multiple clinical models designed to ease the transition from student to professional, yet there has been little exploration of such models and their impact on graduates' perceptions of work-readiness. OBJECTIVES: This cross sectional study examined perceptions of work-readiness of new graduate nurses who attended one of the following clinical teaching models: the University Fellowship Program (UFP), the Traditional Multi-facility Clinical Model (TMCPM), and the Mixed Program (MP). METHODS: Three groups of first year graduate nurses (UFP, TMCPM, and MP) were compared using the Work-readiness Scale, a validated and reliable tool, which assessed nurses' perceptions of work-readiness in four domains: organizational acumen, personal work characteristics, social intelligence, and work competence. A multivariable Generalized Estimating Equations regression investigated socio-demographic and teaching-modelrelated factors associated with work-readiness. RESULTS: Of 43 nurses approached, 28 completed the survey (65% response rate) of whom 6 were UFP attendants, 8 attended the TMCPM and 14 the MP. Those who had attended the UFP scored higher than the other two in all four domains; however, the crude between-group comparisons did not yield statistically significant results. Only after accounting for age, gender, teaching setting and prior work experience, the multivariable model showed that undertaking the UFP was likely to increase perceptions of work-readiness by 1.4 points (95% CI 0.11-2.69), P=0.03). The UFP was superior to the other two placement models. CONCLUSION: The study suggests that the UFP may enhance graduate nurses' perceptions of work readiness.

Prominent attractive qualities of nurses' work in operating room departments: A questionnaire study.

BACKGROUND: The shortage of nurses in operating room departments (ORs) in Sweden and other countries can lead to reduced capacity and quality in healthcare, as well as more intense work for those on the job. Little is known about what nurses in ORs perceive as crucial for their workplace to be attractive. OBJECTIVE: To capture attractive qualities of nurses' work in Swedish ORs and take a first step in the process of adapting the Attractive Work Questionnaire for use in a health care context. METHODS: The Attractive Work Questionnaire was completed by 147 (67% ) nurses in four Swedish ORs. Principal Component Analyses (PCA) were performed to determine the underlying structure of the data. RESULTS: Factors contributing to job attractiveness identified in the area "work conditions" were: relations, leadership, equipment, salary, organisation, physical work environment, location, and working hours; in the area "work content": mental work, autonomy and work rate; and in the area "job satisfaction": status and acknowledgement. The PCA showed consistency with the original Attractive Work Questionnaire, Cronbach's alpha varied between 0.57-0.90. CONCLUSIONS: Prominent attractive qualities for nurses' work in Swedish ORs were possible to identify through the Attractive Work Questionnaire and the results suggest that the questionnaire can be useful in a health care context.

Preferred choice of work setting among nurses in Thailand: A discrete choice experiment.

The shortage of health personnel and nurses is an important issue in many developed and developing countries. Understanding preferred choice of work setting is an important strategy for retaining nurses in their work. The purpose of this study was to determine choices made by nurses in Thailand relative to their preferences for a work setting. A discrete choice experiment was conducted to elicit attributes and levels of job characteristics expected to contribute to work-place preferences. The sample included 921 nurses and was selected using stratified random sampling. A random effects probit model was used to identify factors contributing to work-setting preferences. The results showed that nurses' first work-place preference was a high level of work setting. The second preference was to work in a hospital in the same province as their families. The results provide information for hospital and nurse administrators and policymakers seeking to address the nursing shortage.

Management of nurse shortage and its impact on pathogen dissemination in the intensive care unit.

INTRODUCTION: Studies provide evidence that reduced nurse staffing resources are associated to an increase in health care-associated infections in intensive care units, but tools to assess the contribution of the mechanisms driving these relations are still lacking. We present an agent-based model of pathogen spread that can be used to evaluate the impact on nosocomial risk of alternative management decisions adopted to deal with transitory nurse shortage. MATERIALS AND METHODS: We constructed a model simulating contact-mediated dissemination of pathogens in an intensive-care unit with explicit staffing where nurse availability could be temporarily reduced while maintaining requisites of patient care. We used the model to explore the impact of alternative management decisions adopted to deal with transitory nurse shortage under different pathogen- and institution-specific scenarios. Three alternative strategies could be adopted: increasing the workload of working nurses, hiring substitute nurses, or transferring patients to other intensive-care units. The impact of these decisions on pathogen spread was examined while varying pathogen transmissibility and severity of nurse shortage. RESULTS: The model-predicted changes in pathogen prevalence among patients were impacted by management decisions. Simulations showed that increasing nurse workload led to an increase in pathogen spread and that patient transfer could reduce prevalence of pathogens among patients in the intensive-care unit. The outcome of nurse substitution depended on the assumed skills of substitute nurses. Differences between predicted outcomes of each strategy became more evident with increasing transmissibility of the pathogen and with higher rates of nurse shortage. CONCLUSIONS: Agent-based models with explicit staff management such as the model presented may prove useful to design staff management policies that mitigate the risk of healthcare-associated infections under episodes of increased nurse shortage.

Job satisfaction in mainland China: comparing critical care nurses and general ward nurses.

AIM: To explore the level of nurses' job satisfaction and compare the differences between critical care nurses and general ward nurses in Mainland China. BACKGROUND: Hospitals continue to experience high nurse turnover. Job satisfaction is a key factor to retain skilled nurses. The differences in job satisfaction among critical care nurses and general ward nurses are unknown. DESIGN: A cross-sectional design was selected for this descriptive correlation study. METHODS: Cross-sectional study of critical care nurses (n = 446) and general ward nurses (n = 1118) in 9 general hospitals by means of questionnaires that included the Chinese Nurses Job Satisfaction Scale and demographic scale. The data were collected from June 2010-November 2010. RESULTS: Chinese nurses had moderate levels of job satisfaction, were satisfied with co-workers and family/work balance; and dissatisfied with pay and professional promotion. Critical care nurses were younger; less educated and had less job tenure when compared with nurses working on general wards. Critical care nurses were significantly less satisfied than general ward nurses with many aspects of their job. CONCLUSION: Levels of nurses' job satisfaction can be improved. The lower job satisfaction of critical care nurses compared with general ward nurses should warn the healthcare administrators and managers of potentially increasing the critical care nurses turn over. Innovative and adaptable managerial interventions need to be taken to improve critical care nurse' job satisfaction and retain skilled nurse.