Downward occupational mobility of baccalaureate-prepared, internationally educated nurses to licensed practical nurses.

AIM: This study explored the experience of baccalaureate-prepared, internationally educated nurses who work as licensed practical nurses in Canada. BACKGROUND/INTRODUCTION: Internationally educated nurses experience several barriers to workforce integration on arrival in destination countries. Given these barriers, evidence suggests that internationally educated nurses sometimes experience downward occupational mobility and deskilling in destination countries. Some baccalaureate-prepared, internationally educated nurses work as licensed practical nurses in destination countries, but there is minimal research on this population. METHODS: We used an exploratory transnational feminist qualitative research design. Following ethics approval, a total of 14 baccalaureate-prepared, internationally educated nurses who currently or recently worked as practical nurses in Canada were interviewed for the study. Data were thematically analysed with the aide of NVivo 11 data software. RESULTS: Our results revealed four key themes related to the experiences of this group of nurses: they migrate to Canada with hope for a better personal and professional life; they experience barriers to workforce integration as registered nurses and discover an easier path in the licensed practical nurse registration process; they experience deskilling and ambivalent skill recognition; and they feel dissatisfied as a licensed practical nurse in Canada. DISCUSSION/CONCLUSION: There is a need for policy to support the upward mobility of baccalaureate-prepared, internationally educated nurses who work as practical nurses. IMPLICATIONS FOR NURSING POLICY: Implications for policymakers include the need to address the barriers to becoming registered nurses, including application processing times and lack of adequate access to educational programmes.

A deskilling and challenging journey: the lived experience of Indonesian nurse returnees.

AIM: To illuminate the lived experiences of Indonesian nurses who previously worked as caregivers in Japanese residential care facilities, by exploring the journey of becoming returnees. BACKGROUND: The creation of bilateral agreements between Indonesia and Japan has facilitated the movement of Indonesian nurses to work as caregivers in Japan since 2008. While this decision raised concerns with regard to the degradation of nursing skills, little is known about this issue from the perspective of nurse returnees and how the experience affects their life. METHOD: A hermeneutic phenomenological method was employed for this study. A purposive sample of 15 Indonesian nurse returnees participated in this study. Semi-structured interviews were conducted in four of Indonesia's provinces between August and October 2015. Data were analysed thematically, supported by QSR NVIVO 10 software. FINDINGS: Four key themes emerged from the data analysis: (i) returning home; (ii) going back to zero; (iii) walking through a difficult journey; and (iv) overcoming barriers. These findings described the lived experiences of nurse returnees when they got back to the country of origin. CONCLUSION: Indonesian nurse returnees experienced deskilling and struggled to re-enter the nursing profession or to find other non-nursing jobs. The significant impact of this migration on individual nurses with regard to maximizing the benefits of return migration deserves further investigation. IMPLICATION FOR NURSING AND HEALTH POLICY: The Indonesian government, jointly with other stakeholders, should develop a brain gain strategy to align returnees' expertise with the needs of the national labour market. The public-private partnership should be strengthened to utilize returnees in healthcare services.

Pipette Show: An Open Source Web Application to Support Pipetting into Microplates.

Despite increasing automation, manual pipetting remains a daily important task in life science laboratories. However, the creation of an efficient work plan is often time-consuming, and its completion is error-prone. Here, we present Pipette Show, a free Vue.js based application that optimizes the generation of an efficient work plan for pipetting into microplates and supports its reliable execution by visual guidance. The basis forms a graphical web interface with a module for building workflows as well as a module displaying the information for each pipetting step by illuminating wells of microplates placed on a tablet.

Tools of war and virtue-Institutional structures as a source of ethical deskilling.

Shannon Vallor has raised the possibility of ethical deskilling as a potential pitfall as AI technology is increasingly being developed for and implemented in military institutions. Bringing the sociological concept of deskilling into the field of virtue ethics, she has questioned if military operators will be able to possess the ethical wherewithal to act as responsible moral agents as they find themselves increasingly removed from the battlefield, their actions ever more mediated by artificial intelligence. The risk, as Vallor sees it, is that if combatants were removed, they would be deprived of the opportunity to develop moral skills crucial for acting as virtuous individuals. This article constitutes a critique of this conception of ethical deskilling and an attempt at a reappraisal of the concept. I argue first that her treatment of moral skills and virtue, as it pertains to professional military ethics, treating military virtue as a sui generis form of ethical cognition, is both normatively problematic as well as implausible from a moral psychological view. I subsequently present an alternative account of ethical deskilling, based on an analysis of military virtues, as a species of moral virtues essentially mediated by institutional and technological structures. According to this view, then, professional virtue is a form of extended cognition, and professional roles and institutional structures are parts of what makes these virtues the virtues that they are, i.e., constitutive parts of the virtues in question. Based on this analysis, I argue that the most likely source of ethical deskilling caused by technological change is not how technology, AI, or otherwise, makes individuals unable to develop appropriate moral-psychological traits but rather how it changes the institution's capacities to act.

The safe resumption of elective orthopaedic services following the first wave of the COVID-19 pandemic : a review of 2,316 consecutive cases and implications for recovery following further waves.

AIMS: There is little published on the outcomes after restarting elective orthopaedic procedures following cessation of surgery due to the COVID-19 pandemic. During the pandemic, the reported perioperative mortality in patients who acquired SARS-CoV-2 infection while undergoing elective orthopaedic surgery was 18% to 20%. The aim of this study is to report the surgical outcomes, complications, and risk of developing COVID-19 in 2,316 consecutive patients who underwent elective orthopaedic surgery in the latter part of 2020 and comparing it to the same, pre-pandemic, period in 2019. METHODS: A retrospective service evaluation of patients who underwent elective surgical procedures between 16 June 2020 and 12 December 2020 was undertaken. The number and type of cases, demographic details, American society of Anesthesiologists (ASA) grade, BMI, 30-day readmission rates, mortality, and complications at one- and six-week intervals were obtained and compared with patients who underwent surgery during the same six-month period in 2019. RESULTS: A total of 2,316 patients underwent surgery in 2020 compared to 2,552 in the same period in 2019. There were no statistical differences in sex distribution, BMI, or ASA grade. The 30-day readmission rate and six-week validated complication rates were significantly lower for the 2020 patients compared to those in 2019 (p < 0.05). No deaths were reported at 30 days in the 2020 group as opposed to three in the 2019 group (p < 0.05). In 2020 one patient developed COVID-19 symptoms five days following foot and ankle surgery. This was possibly due to a family contact immediately following discharge from hospital, and the patient subsequently made a full recovery. CONCLUSION: Elective surgery was safely resumed following the cessation of operating during the COVID-19 pandemic in 2020. Strict adherence to protocols resulted in 2,316 elective surgical procedures being performed with lower complications, readmissions, and mortality compared to 2019. Furthermore, only one patient developed COVID-19 with no evidence that this was a direct result of undergoing surgery. Level of evidence: III Cite this article: Bone Jt Open 2022;3(1):42-53.

Surgical Skills Beyond Scientific Management.

During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel's attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel-Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice.

Security and skills: the two key issues in health worker migration.

BACKGROUND: Migration of health workers from Africa continues to undermine the universal provision of quality health care. South Africa is an epicentre for migration--it exports more health workers to high-income countries than any other African country and imports health workers from its lower-income neighbours to fill the gap. Although an inter-governmental agreement in 2003 reduced the very high numbers migrating from South Africa to the United Kingdom, migration continues to other high-income English-speaking countries and few workers seem to return although the financial incentive to work abroad has lessened. A deeper understanding of reasons for migration from South Africa and post-migration experiences is therefore needed to underpin policy which is developed in order to improve retention within source countries and encourage return. METHODS: Semi-structured interviews were conducted with 16 South African doctors and nurses who had migrated to the United Kingdom. Interviews explored factors influencing the decision to migrate and post-migration experiences. RESULTS: Salary, career progression, and poor working conditions were not major push factors for migration. Many health workers reported that they had previously overcome these issues within the South African healthcare system by migrating to the private sector. Overwhelmingly, the major push factors were insecurity, high levels of crime, and racial tension. Although the wish to work and train in what was perceived to be a first-class care system was a pull factor to migrate to the United Kingdom, many were disappointed by the experience. Instead of obtaining new skills, many (particularly nurses) felt they had become 'de-skilled'. Many also felt that working conditions and opportunities for them in the UK National Health Service (NHS) compared unfavourably with the private sector in South Africa. CONCLUSIONS: Migration from South Africa seems unlikely to diminish until the major concerns over security, crime, and racial tensions are resolved. However, good working conditions in the private sector in South Africa provide an occupational incentive to return if security did improve. Potential migrants should be made more aware of the risks of losing skills while working abroad that might prejudice return. In addition, re-skilling initiatives should be encouraged.

Processo de vulnerabilização e danos ao ofício: a Modernização do Trabalho em questão / Vulnerabilization process and damages to the profession: the Work Modernization in question

Este estudo teve como objetivo analisar a intensificação e a individualização no âmago da "modernização do trabalho". Esses são compreendidos como processos que, ao se desenvolverem, causam sofrimento e penosidade aos trabalhadores. Nas organizações "modernas", a avaliação do trabalho é realizada cada vez mais sob um único prisma, qual seja, o da performance e o da rentabilidade econômica - aplicada nas relações de serviço e até mesmo do serviço público. É o sentido do trabalho que é afetado. Apoiando-se em uma pesquisa empírica conduzida junto a vendedores de bilhetes e pacotes de viagem de uma grande empresa de transporte, investigou-se a "quebra" dos ofícios como estratégia de assédio organizacional que fragiliza as defesas individuais e coletivas dos assalariados. Identificou-se um sentimento crescente de perda do controle sobre o trabalho por parte dos profissionais e um importante custo relacionado à saúde mental.

The study analyzes intensification and individualization in the core of "work modernization". Both are seen as processes that cause workers suffering and pain. In "modern" organizations, work has constantly been assessed by a single aspect: performance and economic profitability. When it happens within service relations, even within public service - it is the meaning of work that is affected. Supported by an empiric research involving travel packages and tickets salespersons from a large transport company, "breaking" of professions was investigated as a bullying at work strategy, which deteriorates wage earners' individual and collective defenses. The investigation found these sales professionals have increasingly been feeling they are losing control of their work, at significant cost to their mental health.