Nurse Corps' impact on increasing registered nurse staffing in critical shortage areas and facilities, 2017 to 2022.

BACKGROUND: The registered nurse (RN) workforce experienced critical pre-pandemic and pandemic shortages of labor in some areas in the United States. People living in these health professional shortage areas (HPSAs) may have less access to health services. The Bureau of Health Workforce within the Health Resources and Services Administration administers Nurse Corps scholarship and loan repayment programs to increase healthcare access by increasing the supply and distribution of RNs, nurse practitioners, and nurse faculty to HPSAs. The American Rescue Plan Act of 2021 (ARPA) made available considerable new resources for the program. PURPOSE: This paper reports on Nurse Corps applications, awards, and distribution in 2 cohorts in the period 2017 to 2022 to assess the impact of receiving an additional $200 million appropriated in 2021. DISCUSSION: Additional funds through ARPA were associated with nearly threefold increases in the number of Nurse Corps awards. Program participants worked in a total of 1,316 counties (42% of all U.S. counties) in 2020 to 2022, a 76% increase from 749 counties in 2017 to 2019. CONCLUSION: Increased funding for scholarship and loan repayment can help to improve the distribution of nurse labor to a greater number of critical shortage areas in the United States.

The Impact of the COVID-19 Pandemic on Staffing Levels in Philadelphia Nursing Homes: Disparities Based on the Racial Composition of Geographical Areas.

Research to assess and inform health policy is an essential component of the policymaking process to advance equity in public health practice. This study investigated health disparities during the COVID-19 pandemic (2020-2022) in older adult institutional settings in Philadelphia, PA, to inform policy initiatives, interventions, and infrastructure development. We first explored the changing patterns of nursing staffing levels (total direct care staff and registered nurses [RNs]) measured by hours per resident per day (HPRD) before and after COVID-19. Our findings revealed that HPRD levels consistently fell below the Centers for Medicare and Medicaid Services recommended standards from 2018 to 2022, with notable declines observed starting from 2021. Results from multilevel modeling showed significant declines in HPRD for total direct care nursing staff in nursing homes located in zip codes with a high proportion of Black residents (≥40%). In contrast, HPRD for RNs significantly declined in nursing homes located in zip codes with a lower proportion of Black residents (<40%). Moreover, higher reported direct care HPRD and RN HPRD were associated with any reported COVID-19 cases only within zip codes with a low proportion of Black residents. These findings indicate the need for additional policies to address these observed patterns in staffing levels. Our study provides a foundation for future policy reviews utilizing a conceptual framework that is health equity-centric for local and state health departments program and units intended for institutional care settings for older adults.

Nursing's Staffing Mandate: Build a More Flexible Workforce.

The COVID-19 pandemic exhausted the nursing workforce, casting doubt that future supply will meet demand. To preserve their workforces, nursing leaders are offering emotional support to the frontline. Although these efforts are essential, leaders are overlooking an untapped opportunity to safeguard staffing levels: creating a more flexible nursing workforce. In this article, the authors discuss flexible nurse staffing and suggest 4 key opportunities for improvement.

Health Care Workers' Challenges in the Care of a COVID-19 Patient.

The COVID-19 pandemic has introduced us to new challenges with personal protective equipment, long shifts, and changes in regular routines. This has placed a tremendous stress on health care workers. This article defines the various health care worker challenges, both at the bedside and on a personal front. Therapeutic strategies are discussed.

Nurse Staffing and Coronavirus Infections in California Nursing Homes.

In the United States, 1.4 million nursing home residents have been severely impacted by the COVID-19 pandemic with at least 25,923 resident and 449 staff deaths reported from the virus by June 1, 2020. The majority of residents have chronic illnesses and conditions and are vulnerable to infections and many share rooms and have congregate meals. There was evidence of inadequate registered nurse (RN) staffing levels and infection control procedures in many nursing homes prior to the outbreak of the virus. The aim of this study was to examine the relationship of nurse staffing in California nursing homes and compare homes with and without COVID-19 residents. Study data were from both the California and Los Angeles Departments of Public Health and as well as news organizations on nursing homes reporting COVID-19 infections between March and May 4, 2020. Results indicate that nursing homes with total RN staffing levels under the recommended minimum standard (0.75 hours per resident day) had a two times greater probability of having COVID-19 resident infections. Nursing homes with lower Medicare five-star ratings on total nurse and RN staffing levels (adjusted for acuity), higher total health deficiencies, and more beds had a higher probability of having COVID-19 residents. Nursing homes with low RN and total staffing levels appear to leave residents vulnerable to COVID-19 infections. Establishing minimum staffing standards at the federal and state levels could prevent this in the future.

We still need international applicants.

Sam Foster, Chief Nurse, Oxford University Hospitals, reflects on her experience visiting Kerala to interview overseas candidates for nursing recruitment.

Funding is only the start of fixing CPD.

Sam Foster, Chief Nurse, Oxford University Hospitals, considers the Government's promise of funding for continuing professional development, and calls for transparecy and further guidance.

Nurse and health professional migration during COVID-19.

The COVID-19 pandemic has exposed the vulnerabilities of nursing supply flows, domestically and internationally. Its impact at the country-level has further highlighted preexisting nurse supply gaps and the effect of staffing shortages. Internationally, the pandemic has disrupted global supply chains. The world has witnessed the closing of borders, the interruption of travel, and, in some countries, the restriction of outflows. The State of the World's Nursing Report (SOWN) (WHO, 2020) noted a shortfall of almost six million nurses immediately pre-COVID-19, a shortage suffered particularly by low- and middle-income countries. This is of major concern given that increased international outflows of nurses in the new post-COVID era could undermine, even more than before, the readiness of those countries to meet healthcare demands (ICN, 2020). In this default scenario, some, but not all, highincome destination countries will continue to rely on international inflow of nurses to a significant extent, as they did pre-COVID- 19, further exacerbating the suffering of poor countries. Put simply, without country-level policy changes related to the nursing workforce and backed by international organisations, pre-COVID-19 trends of increased nurse flows from low- to high-income countries will likely continue. In this scenario, the iniquitous maldistribution of nurses may become more pronounced. This "do nothing" option risks undermining both country-level progress towards the attainment of Universal Health.

Global nurse shortages-the facts, the impact and action for change.

INTRODUCTION: Nurses comprise half the global health workforce. A nine million shortage estimated in 2014 is predicted to decrease by two million by 2030 but disproportionality effect regions such as Africa. This scoping review investigated: what is known about current nurse workforces and shortages and what can be done to forestall such shortages? SOURCES OF DATA: Published documents from international organisations with remits for nursing workforces, published reviews with forward citation and key author searches. AREAS OF AGREEMENT: Addressing nurse shortages requires a data informed, country specific model of the routes of supply and demand. It requires evidence informed policy and resource allocation at national, subnational and organisation levels. AREAS OF CONTROVERSY: The definition in law, type of education, levels and scope of practice of nurses varies between countries raising questions of factors and evidence underpinning such variation. Most policy solutions proposed by international bodies draws on data and research about the medical workforce and applies that to nurses, despite the different demographic profile, the work, the career options, the remuneration and the status. GROWING POINTS: Demand for nurses is increasing in all countries. Better workforce planning in nursing is crucial to reduce health inequalities and ensure sustainable health systems. AREAS TIMELY FOR DEVELOPING RESEARCH: Research is needed on: the nursing workforce in low income countries and in rural and remote areas; on the impact of scope of practice and task-shifting changes; on the impact over time of implementing system wide policies as well as raising the profile of nursing.

Determinants and supporting factors for rebuilding nursing workforce in a post-disaster setting.

BACKGROUND: The workforce shortage is one of the major issues associated with the recovery of Minamisoma City in Fukushima Prefecture, after the Great East Japan Earthquake and the subsequent accidents at the Fukushima Daiichi Nuclear Power Plants in March 2011. While the radiation risks are often discussed as a major factor of evacuation, little is known about the actual reasons why the residents chose to evacuate, and what enables them to return. This study aims to find the essential factors for rebuilding the workforce in a post-disaster setting by analysing the residents' decisions about evacuation and the return to Minamisoma. In particular, we focus on the experiences of nurses as an example of healthcare workers, who play an important role in the disaster recovery. METHODS: The data were obtained through qualitative interviews in a semi-structured form with 25 nurses from four hospitals in Minamisoma City. The interview questions focused on the reasons of their decisions on evacuation and return. The data were analysed by a thematic approach to investigate the major factors which led them to evacuate and enabled them to return afterwards, as well as the support they needed to resettle. RESULTS: Nearly two-thirds of the interviewees chose to evacuate from Minamisoma with their family. Family conditions seem to be the predominant factor that influenced their decisions. In particular, having small children was a strong cause for evacuation. After a certain period of time, the nurses that evacuated were then faced with another decision about returning to the area; once again, having children, as well as other life factors, such as livelihoods, job opportunities and emotional attachment to the work, influenced this decision. On the other hand, radiation risk was a minor factor. Therefore, we analyse that improved support considering their life situations would contribute to the better retention of the nurses. CONCLUSIONS: We suggest measures such as parenting supports, ensuring job opportunities after return, and psychological support in the workplace as possible solutions for higher job retention.

Appropriate Nursing Home Nurse Hours per Resident Day in Korea: A Secondary Analysis of Longitudinal Data.

PURPOSE: To encourage the enactment of laws about mandatory nurse staffing in nursing homes, researchers should provide evidence of concrete nurse hours per resident day (HPRD). This article estimates optimal nurse staffing HPRD to achieve increased quality-of-care outcomes for nursing home residents. DESIGN: Secondary analysis of longitudinal data. METHODS: This study used secondary analysis of longitudinal nursing home survey data. Nurse staffing HPRD and quality-of-care survey data accrued from nursing homes operating under long-term-care insurance in Korea. The collected data include a total of six quarterly base measurements on nurse staffing HPRD and 15 quality indicators from 2014 to 2017. The proposed optimization model emerged to most appropriately combine nurse staffing HPRD to increase quality-of-care outcomes for nursing home residents by 3% to 8%. Optimal outcome measures were fixed as best outcomes and compiled from 15 nursing-sensitive quality indicators. FINDINGS: Constrained nonlinear optimization was used for analysis. A 12% increase in registered nurse (RN) HPRD (from 0.168 HPRD [10 min 5 s] to 0.177 [10 min 38 s]) aligned with a 3% improvement in quality-of-care outcomes. A 20% RN HPRD increase aligned with a commensurate 5% to 8% increase in compiled quality-of-care outcomes (from 0.168 HPRD [10 min 5 s] to 0.202 HPRD [12 min 6 s]) without increasing certified nurse aide HPRD. About a 30% RN HPRD increase aligned with a commensurate 5% to 8% increase in compiled quality-of-care outcomes (from 0.168 HPRD [10 min 5 s] to 0.218 HPRD [13 min 6 s]) without increasing certified nurse aide HPRD. CONCLUSIONS: It is urgent to institute mandatory nurse HPRD for nursing homes in Korea by law. This research provides evidence that increasing nursing HPRD improved residents' outcomes in nursing homes. CLINICAL RELEVANCE: Findings from the optimization model implied that stable care by RNs in nursing homes is a key factor in achieving acceptable quality of care for residents.

Development and cross-validation of a new instrument to measure nurse's positive energy of retention: A methodological study.

AIM: The aim of this study was to develop and psychometrically test a new instrument for measuring nurse's positive energy of retention (NPER). BACKGROUND: The shortage of professional nurses is an unresolved global issue. Few studies explored the issue of the retention of nurses in terms of a positive psychological viewpoint. DESIGN: Methodological study. METHODS: Data collection was from June 2016-August 2017. Nurses (N = 947) recruited from northern, central and southern Taiwan covering different levels of hospitals were divided into three samples, which were used for explaratory factor analysis (EFA), confirmatory factor analysis (CFA) and cross-validation respectively. RESULTS: EFA resulted in a three-factor solution: proactive and persevering characteristics, nursing professional identity and passion accounting for 61.8% of total variance. The proposed three-factor model was confirmed by CFA. Cross-validation provided further evidence for the construct validity of the NPER instrument with 24 items. Cronbach's alpha coefficient of three subscales of the instrument were 0.95, 0.89, and 0.92 separately and 0.96 for the total scale. CONCLUSION: Psychometric properties indicate that the newly formulated NPER instrument is a valid and reliable assessment tool to recruit nurses who are more likely to remain in nursing. IMPACT: The study addressed the personal intrinsic factors, which are very important for nurses' retention. The NPER instrument consisted of three subscales is a reliable and psychometrically valid new instrument. Managers could apply the NPER instrument to recruit nurses possessing the attributes of positive energy of retention. Furthermore, researchers could use the rigorous process provided in the study to establish a new instrument.

The influence of welfare state factors on nursing professionalization and nursing human resources: A time-series cross-sectional analysis, 2000-2015.

AIM: The aim of this study was to examine the relationship between welfare states and nursing professionalization indicators. DESIGN: We used a time-series, cross-sectional design. The analysis covered 16 years and 22 countries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Norway, Portugal, South Korea, Spain, Sweden, Switzerland, United Kingdom, and the United States, allocated to five welfare state regimes: Social Democratic, Christian Democratic, Liberal, Authoritarian Conservative, and Confucian. METHODS: We used fixed-effects linear regression models and conducted Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction. We applied the Amelia II multiple imputation strategy to replace missing observations. Data were collected from March-December 2017 and subsequently updated from August-September 2018. RESULTS: Our findings highlight positive connections between the regulated nurse and nurse graduate ratios and welfare state measures of education, health, and family policy. In addition, both outcome variables had averages that differed among welfare state regimes, the lowest being in Authoritarian Conservative regimes. CONCLUSION: Additional country-level and international comparative research is needed to further study the impact of a wide range of structural political and economic determinants of nursing professionalization. IMPACT: We examined the effects of welfare state characteristics on nursing professionalization indicators and found support for the claim that such features affect both the regulated nurse and nurse graduate ratios. These findings could be used to strengthen nursing and the nursing workforce through healthy public policies and increase the accuracy of health human resources forecasting tools.

Exploring preceptorship programmes: Implications for future design.

AIMS AND OBJECTIVES: To review and analyse current preceptorship programmes within NHS trusts in the North West of England. To evaluate the pedagogic rigour of the programme and suggest recommendations to inform the future design of preceptorship programmes. BACKGROUND: Enhancing the retention of newly qualified staff is of particular importance given that the journey from a new registrant to a competent healthcare professional poses a number of challenges, for both the individual staff member and organisations. DESIGN: A mixed methods evaluative approach was employed, using online questionnaires and content analysis of preceptorship documentation. METHODS: Forty-one NHS trusts across the North West region employing newly qualified nurses were invited to participate in the completion of an online questionnaire. In addition, preceptorship programme documentation was requested for inclusion in the content analysis. This study used the SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines. RESULTS: The response rate for the questionnaire was 56.1% (n = 23). Eighteen trusts (43.9%) forwarded their programme documentation. Findings highlighted the wide variation in preceptorship programmes across the geographical footprint. CONCLUSIONS: There were instances of outstanding preceptorship and preceptorship programmes where there was a clear link between the strategic vision, that is, trust policy, and its delivery, that is, preceptorship offering. There was no one framework that would universally meet the needs of all trusts; yet, there are key components which should be included in all preceptorship programmes. Therefore, we would encourage innovation and creativity in preceptorship programmes, cognisant of local context. RELEVANCE TO CLINICAL PRACTICE: The significant shortage of nursing staff in England is an ongoing issue. Recruitment and retention are key to ameliorating the shortfall, and formal support mechanisms like preceptorship, can improve the retention of newly qualified staff. Understanding current preceptorship programmes is an important first step in establishing the fundamental building blocks of successful preceptorship programmes and enabling the sharing of exemplary good practice across organisations.

More than just numbers! Perceptions of remote area nurse staffing in Northern Territory Government health clinics.

OBJECTIVE: The need for more Remote Area Nurses in the Northern Territory is clear. This paper investigates the perspectives of Remote Area Nurse workforce issues among multiple stakeholders. The aim is to identify how Remote Area Nurse staffing issues are perceived by clinic managers, Remote Area Nurses themselves, Aboriginal colleagues and community members in seven remote communities in the Northern Territory. DESIGN: This is a qualitative study that uses interviews and focus groups to identify key messages of local stakeholders about Remote Area Nurse workforce issues. A content analysis was used for data analysis. SETTING: Seven diverse remote Aboriginal communities in the Northern Territory with government-run health clinics were visited. PARTICIPANTS: Non-random sampling techniques were used to target staff at the clinics at the time of field work. Staff and community members, who agreed to participate, were interviewed either individually or in groups. Interviews were conducted with 5 Managers, 29 Remote Area Nurses, 12 Aboriginal staff (some clinics did not have Aboriginal staff) and 56 community residents. Twelve focus groups were conducted with community members. RESULTS: Content analysis revealed that participants thought having the "right" nurse was more important than having more nurses. Participants highlighted the need for Remote Area Nurses to have advanced clinical and cultural skills. While managers and, to a lesser extent, Remote Area Nurses prioritised clinical skills, Aboriginal staff and community residents prioritised cultural skills. CONCLUSIONS: Participants identified the importance of clinical and cultural skills and reiterated that getting the "right" Remote Area Nurse was more important than simply recruiting more nurses. Thus, retention strategies need to be more targeted and cultural skills prioritised in recruitment.

A nursing shortage - a prospect of global and local policies.

AIM: The article addresses selected determinants of the nursing shortage in Poland and other countries in the face of employee ageing. BACKGROUND: Global demographic changes have led to a systematic increase in the elderly population and a decreasing number of births, which have impacted health policy and healthcare systems in various countries. Both processes necessitate transitions in global health care. Nursing care, which has faced a human resources crisis, is a strategic area within this context. SOURCES OF EVIDENCE: This study is based on national listings and strategic documents for nursing policy in Poland, including Increasing average age of nurses and midwives prepared by the Polish Main Council of Nurses and Midwives, the incorporation of big data, international reports and a literature review on nursing and healthcare challenges. DISCUSSION/CONCLUSIONS: This paper argues that the causes of the nursing shortage are multifaceted with no single global or local measure of its nature. An overview of the problem indicates ineffective planning and use of available nursing resources, poor recruitment or an undersupply of a new staff, and global demographic conditions. The overview highlights the fact that nursing shortages have reached a critical point for healthcare services on both the local and global levels. CONCLUSIONS FOR NURSING AND HEALTH POLICY: The general recommendations for nursing policy include the need to prepare and implement national social security agendas into services provided by nurses. Such a programme would include general issues: improving working and employment conditions, implementing mechanisms regulating salary and providing the possibility of lifelong learning with the incorporation of mobile and technological innovations as a sustainable solution.

Will the NHS Improvement interim plan help solve the nursing staff crisis?

Emeritus Professor Alan Glasper, University of Southampton, discusses the recently published people plan, which aspires to tackle workforce shortages that affect the ability of the NHS to deliver optimum care.

Attracting and retaining nurses through a clinical fellowship programme.

Shortages in nursing are the single biggest and most urgent workforce issue that the NHS needs to address. This article sets out the early success of the Nurse Clinical Fellowship Programme established by The Royal Wolverhampton NHS Trust. The unique programme aims to attract and retain nurses by offering a staff nurse post with supported access to academia, fully funded by the NHS Trust. To date, the Trust has attracted 90 nurses (both UK and international registered nurses) to the programme. The programme is also offered internally and the Trust has a cohort of 10 internal nursing staff enrolled onto the programme completing either their BSc (top-up) or Masters, with a second cohort of 60 internal nurses due to start in September 2019. To support international registered nurses with demonstrating their competence to meet Nursing and Midwifery Council requirements the Trust has also established an objective structured clinical examination preparation course designed to embrace and enhance the existing knowledge and skills, while guiding staff in transferring these in line with UK and Trust policies and practices.

Assessing the Quality of Nursing Homes in Managed Care Organizations: Integrating LTSS for Dually Eligible Beneficiaries.

Little is known about the quality of nursing homes in managed care organizations (MCOs) networks. This study (1) described decision-making criteria for selecting nursing home networks and (2) compared selected quality indicators of network and nonnetwork nursing homes. The sample was 17 MCOs participating in a California demonstration that provided integrated long-term services and supports to dually eligible enrollees in 2017. The findings showed that the MCOs established a broad network of nursing homes, with only limited attention to using quality criteria. Network nursing homes (602) scored significantly lower on 6 selected quality measures than nonnetwork (117) nursing homes. Low registered nurse and total nurse staffing were strong predictors of network nursing homes controlling for facility characteristics. Managed care organizations should consider greater transparency about the quality of their nursing homes and use specific quality criteria to improve the quality of their networks.