Transitioning from Hospital-based to Office-Based Practice.

The decision to change your career path from a hospital-based practice, whether it's from being a hospital employee or a member of a private practice, can be an emotionally draining choice that is complex and overwhelming to say the least. There are many factors to consider before making this switch, but most importantly, one must realize it may be the hardest but most rewarding work in your career. While the physical, emotional and financial stresses placed on you while developing a practice can be rather demanding, on the flip side, if done correctly and the practice thrives, it can be a change that will bring you great pride and satisfaction, as well as personal reward and freedom.

Pathways to leadership: what accounts for women's (in)equitable career paths in the health sectors in India and Kenya? A scoping review.

OBJECTIVES: We aimed to capture evidence on enablers and barriers to improving equal opportunity and effective organisational interventions that can advance women's leadership in India and Kenya's health sectors. METHODS: We systematically searched JSTOR, PubMed, SCOPUS and Web of Science databases, reference lists of selected articles and Google Scholar using string searches. We included studies that were published in English from 2000 to 2022 in peer-reviewed journals or grey literature, focused on paid, formal health professionals in India or Kenya, described factors relating to women's representation/leadership. RESULTS: We identified 26 studies, 15 from India and 11 from Kenya. From each country, seven studies focused on nursing. Participants included women and men health sector workers. Seven studies used mixed methods, 11 were qualitative, 5 were quantitative and 3 were commentaries. Factors influencing women's career progression at individual/interpersonal levels included family support, personal attributes (knowledge/skills) and material resources. Factors at the organisational level included capacity strengthening, networking, organisational policies, gender quotas, work culture and relationships, flexibility, and work burden. Nursing studies identified verbal/sexual harassment and professional hierarchies as barriers to career progression. Structural barriers included a lack of infrastructure (training institutes and acceptable working environments). Normative themes included occupational segregation by gender (particularly in nursing), unpaid care work burden for women and gender norms. Studies of interventions to improve women's career progression and sex-disaggregated workforce data in India or Kenya were limited, especially on leadership within career pathways. The evidence focuses on enablers and barriers at work, rather than on organisations/systems to support women's leadership or address gender norms. CONCLUSIONS: Women in India and Kenya's health sectors face multiple impediments in their careers, which impact their advancement to leadership. This calls for gender-transformative interventions to tackle discrimination/harassment, provide targeted training/mentorship, better parental leave/benefits, flexible/remote working, family/coworker support and equal-opportunity policies/legislation.

Gender Differences in the Path to Medical School Deanship.

Importance: Women account for only 28% of current US medical school deans. Studying the differences between women and men in their preparation to becoming deans might help to explain this discrepancy. Objective: To identify differences in the leadership development experiences between women and men in their ascent to the medical school deanship. Design, Setting, and Participants: In this qualitative study, volunteers from the roster of the Association of American Medical Colleges Council of Deans were solicited and interviewed from June 15 to November 9, 2023. Women deans were recruited first, then men who had been appointed to their deanships at a similar time to their women counterparts were recruited. Deans were interviewed on topics related to number of applications for deanships, prior leadership roles, leadership development, personal factors, and career trajectories. Interviews were coded, and themes were extracted through conventional content analysis. Main Outcome and Measures: Career and leadership development experiences were elicited using a semistructured interview guide. Results: We interviewed 17 women and 17 men deans, representing 25.8% (34 of 132) of the total population of US medical school deans. Most deans (23 [67.6%]) practiced a medicine-based specialty or subspecialty. No statistically significant differences were found between women and men with regard to years to attain deanship (mean [SD], 2.7 [3.4] vs 3.7 [3.7] years), years as a dean (mean [SD], 5.7 [5.2] vs 6.0 [5.0] years), highest salary during career (mean [SD], $525 769 [$199 936] vs $416 923 [$195 848]), or medical school rankings (mean [SD], 315.5 [394.5] vs 480.5 [448.9]). Their reports indicated substantive gender differences in their paths to becoming a dean. Compared with men, women deans reported having to work harder to advance, while receiving less support and opportunities for leadership positions by their own institutions. Subsequently, women sought leadership development from external programs. Women deans also experienced gender bias when working with search firms. Conclusions and Relevance: This qualitative study of US medical school deans found that compared with men, women needed to be more proactive, had to participate in external leadership development programs, and had to confront biases during the search process. For rising women leaders, this lack of support had consequences, such as burnout and attrition, potentially affecting the makeup of future generations of medical school deans. Institutional initiatives centering on leadership development of women is needed to mitigate the gender biases and barriers faced by aspiring women leaders.

Growing the Next Generation of Nurses and Nurse Leaders.

It is imperative to support the next generation of nurses and nurse leaders facing the challenges of our complex health systems. A formal mentoring program provides a structure that allows nurses to have a relationship that promotes ongoing counsel, career development, and a myriad of other benefits with another nurse or other healthcare professionals. The 2023 Magnet® Application Manual requires organizations to implement and use mentoring and succession planning programs under the transformational leadership standard. Adopting and sustaining effective and meaningful mentoring and succession planning activities and programs promote an environment of inclusion and professional development. In addition to formal mentoring programs, the importance of informal mentoring relationships can have a lasting impact on nurses along their nursing journey.

Gendered hiring and attrition on the path to parity for academic faculty.

Despite long-running efforts to increase gender diversity among tenured and tenure-track faculty in the U.S., women remain underrepresented in most academic fields, sometimes dramatically so. Here, we quantify the relative importance of faculty hiring and faculty attrition for both past and future faculty gender diversity using comprehensive data on the training and employment of 268,769 tenured and tenure-track faculty rostered at 12,112U.S. PhD-granting departments, spanning 111 academic fields between 2011 and 2020. Over this time, we find that hiring had a far greater impact on women's representation among faculty than attrition in the majority (90.1%) of academic fields, even as academia loses a higher share of women faculty relative to men at every career stage. Finally, we model the impact of five specific policy interventions on women's representation, and project that eliminating attrition differences between women and men only leads to a marginal increase in women's overall representation-in most fields, successful interventions will need to make substantial and sustained changes to hiring in order to reach gender parity.

Put Yourself out There! A Strategy for Effective Self-Promotion in Academic Medicine.

Introduction: Trainees and faculty in academic medicine often struggle with self-promotion. Barriers may be more formidable for women and other groups underrepresented in medicine. Experience-based stories illustrating personal strengths are preferable when engaging in self-promotion activities. Methods: We developed a 90- to 120-minute workshop utilizing approaches such as iterative journaling and peer discussion to teach the development of problem-action-result (PAR) stories for self-promotion efforts in interviews and written applications to new positions. Participants provided Likert-scale (1 = strongly disagree, 5 = strongly agree) and free-response evaluations, which we analyzed for workshop strengths and areas for improvement. Results: We presented the workshop in person to 28 pediatric residents and subsequently to 22 residents, fellows, and faculty at an in-person national meeting. Sixty-one percent of the resident group and 100% of the national workshop group completed the evaluation. Both groups reported high satisfaction with the workshop's format (M = 4.7) and content (M = 4.7) and indicated intention to use the skills learned (M = 4.7). Strengths included the PAR format, interactivity, journaling, opportunity for reflection, and tips for interviewing and writing. Areas to improve included offering the workshop earlier in the academic year and providing more written examples of PAR stories. Discussion: This workshop used strategies of personal reflection, journaling, and peer feedback to help participants understand behavior-based recruiting practices and the PAR framework as a strategy for successful self-promotion. Learners can use these strategies to develop greater confidence and efficacy and to address barriers to effective self-promotion they encounter.

Human nursing was a natural career progression from veterinary nursing.

Helen Ballantyne is a rarity in that she first qualified as a veterinary nurse and then followed her calling to train as a human-centred nurse, combining skills from both fields and finding a more fulfilling career path.

Hybrid working from home improves retention without damaging performance.

Working from home has become standard for employees with a university degree. The most common scheme, which has been adopted by around 100 million employees in Europe and North America, is a hybrid schedule, in which individuals spend a mix of days at home and at work each week1,2. However, the effects of hybrid working on employees and firms have been debated, and some executives argue that it damages productivity, innovation and career development3-5. Here we ran a six-month randomized control trial investigating the effects of hybrid working from home on 1,612 employees in a Chinese technology company in 2021-2022. We found that hybrid working improved job satisfaction and reduced quit rates by one-third. The reduction in quit rates was significant for non-managers, female employees and those with long commutes. Null equivalence tests showed that hybrid working did not affect performance grades over the next two years of reviews. We found no evidence for a difference in promotions over the next two years overall, or for any major employee subgroup. Finally, null equivalence tests showed that hybrid working had no effect on the lines of code written by computer-engineer employees. We also found that the 395 managers in the experiment revised their surveyed views about the effect of hybrid working on productivity, from a perceived negative effect (-2.6% on average) before the experiment to a perceived positive one (+1.0%) after the experiment. These results indicate that a hybrid schedule with two days a week working from home does not damage performance.

Managing Career Transitions in Cardiothoracic Surgery.

Transitions during a career in cardiothoracic surgery include transition to practice following residency, multiple transitions over the course of the career, and transition to retirement. Each carries some degree of uncertainty and stress, and early preparation for each transition is key to success. A clear understanding of both professional and personal goals drives decisions and choices along the course of a career. It is crucial to seek legal counsel with expertise in physician employment contracts. Developing collegial and collaborative relationships should be a focus throughout one's career. This article outlines the key elements to successful career progression.

Bridge Employment or Encore Career? Examining Predictors That Distinguish Later-Life Career Transitions.

OBJECTIVES: Bridge employment and encore careers are 2 prevalent retirement pathways that have different goals and outcomes. Yet, "changing jobs in later life" is the shared prequel that blurs the distinction between them in empirical studies. This study proposes a set of criteria-voluntariness of career transition and the duration of work in the posttransition job-to distinguish various retirement pathways and investigates the predictors that distinguish the workers' choice of these pathways. METHODS: I conducted multinomial logistic regression to examine the predictors that distinguish between bridge employment, encore career, and direct workforce exit using the longitudinal sample of respondents with full-time career jobs in the Health and Retirement Study 1992-2020 (HRS, N = 2,038). To examine the predictors that distinguish between bridge employment and encore careers, I conducted logistic regression on the subsample of respondents who chose either bridge employment or encore careers (n = 927). RESULTS: The results show that the accumulated human capital from career jobs, physical and mental health conditions before leaving career jobs, and self-identified retirement status when transitioning to new jobs distinguish the workers' choices of taking on different retirement pathways. DISCUSSION: Maintaining the labor force participation of older workers is an important human resource agenda for policymakers. This study suggests that increasing the number of quality jobs for older workers would promote bridge employment and encore careers by raising the benefits of making career transitions as well as improving older workers' health.

Understanding attrition of early career midwives in Australia.

PROBLEM: There is a lack of understanding of the experiences of early career midwives which lead to workforce attrition. BACKGROUND: In the Australian midwifery setting, workforce attrition in conjunction with the ageing profile of the workforce is of increasing concern. Midwives in the earliest stages of their career are most vulnerable to career attrition, however limited research specifically engages with this cohort. AIM: To understand the professional and social circumstances that led early career midwives to leave clinical practice, how their midwifery background influenced career trajectories, and what would compel them to return to clinical practice. METHODS: Semi-structured interviews were conducted with 11 early career midwives who had left the profession within 5 years of qualification. Transcripts underwent thematic analysis. FINDINGS: Three themes described early career midwives' experiences: transition to professional practice, an untenable workplace culture, mental health impacts of early clinical midwifery practice. Two further themes emerged about experiences post-midwifery careers: influence of midwifery on subsequent career, and conditions for re-entry. DISCUSSION: Challenges with transitioning to professional midwifery practice in conjunction with untenable workplace culture led to such deterioration in wellbeing that remaining within the profession became unfeasible for early career midwives. Desire to remain within health care was apparent, however re-entry to the profession was deemed by most to be out of the question. CONCLUSION: Early workforce retention strategies should be the focus of future workforce planning and policy. Larger scale inquiry foregrounding early career midwives is necessary to inform strategies for midwifery workforce retention in Australia.

Cognitive changes in professional value and career development amid the COVID-19 pandemic: A qualitative study of nurses' experiences.

AIM: To explore cognitions in nurses' professional value and career development amid the COVID-19 pandemic and to analyse influencing factors. DESIGN: A qualitative descriptive study design was employed. METHODS: Thirty practising nurses from three general hospitals in Chengdu, China, were purposively recruited. Face-to-face semi-structured interviews were conducted. The content analysis was used for data analysis. RESULTS: After the outbreak of the COVID-19 pandemic, there were obvious cognitive changes in nurses' professional value, including improvement in the cognition of professional value, awareness of the broadening of the field of acting professional value, and realization of increasingly high requirements in careers. Approval and gratitude of patients, social recognition and attention, self-awareness of nurses were main influencing factors. For cognitive changes in career development, nurses became more motivated to develop their careers, had a clearer understanding of career development environment, and acquired a clearer understanding of what was needed to advance careers. Hospital support, social respect, family support, and team atmosphere were key influencing factors. CONCLUSIONS: The contributions made by nurses in the prevention and control of the COVID-19 pandemic have prompted positive changes in their cognition of professional value and career development. To promote nurses' positive understanding and approach to career development, measures should be taken by hospitals. Further, social respect, family support and team cooperation can enhance nurses' enthusiasm for career development.

Trends in the mobility of primary healthcare human resources in underdeveloped regions of western China from 2000 to 2021: Evidence from Nanning.

OBJECTIVE: This research aimed to identify the fundamental and geographic characteristics of the primary healthcare personnel mobility in Nanning from 2000 to 2021 and clarify the determinants that affect their transition to non-primary healthcare institutions. METHODS: Through utilizing the Primary Healthcare Personnel Database (PHPD) for 2000-2021, the study conducts descriptive statistical analysis on demographic, economic, and professional aspects of healthcare personnel mobility across healthcare reform phases. Geographic Information Systems (QGIS) were used to map mobility patterns, and R software was employed to calculate spatial autocorrelation (Moran's I). Logistic regression identified factors that influenced the transition to non-primary institutions. RESULTS: Primary healthcare personnel mobility is divided into four phases: initial (2000-2008), turning point (2009-2011), rapid development (2012-2020), and decline (2021). The rapid development stage saw increased mobility with no spatial clustering in inflow and outflow. From 2016 to 2020, primary healthcare worker mobility reached its peak, in which the most significant movement occurred between township health centers and other institutions. Aside from their transition to primary medical institutions, the primary movement of grassroots health personnel predominantly directs towards secondary general hospitals, tertiary general hospitals, and secondary specialized hospitals. Since 2012, the number and mobility distance of primary healthcare workers have become noticeably larger and remained at a higher level from 2016 to 2020. The main migration of primary healthcare personnel occurred in their districts (counties). Key transition factors include gender, education, ethnicity, professional category, general practice registration, and administrative division. CONCLUSIONS: This study provides evidence of the features of primary healthcare personnel mobility in the less developed western regions of China, in which Nanning was taken as a case study. It uncovers the factors that impact the flow of primary healthcare personnel to non-primary healthcare institutions. These findings are helpful to policy refinement and support the retention of primary healthcare workers.