Nurses working in primary and community care settings in England: problems and challenges in identifying numbers

BACKGROUND: One third of the primary care nursing workforce is aged 50 years and over. Workforce planning is essential if primary care is to ensure that there are appropriate numbers of nurses available to replace the loss of experienced nurses as they approach retirement. INTRODUCTION: As part of an ongoing study to explore the factors influencing retention of female nurses over the age of 50 years in the primary care nursing workforce, a questionnaire survey targeting all community nurses employed in five Primary Care Trusts was undertaken. Accurate statistics on the number and type of community nurse employed in the five Primary Care Trusts were sought to: (i) identify a denominator to accurately identify the response rates to questionnaires in the survey of Primary Care Trusts; and (ii) to compare the Primary Care Trust data with Department of Health statistics to investigate the accuracy of workforce data. A number of problems with locating accurate primary care nursing workforce statistics were identified. AIM: The purpose of this paper is to highlight the difficulties inherent in collating workforce data and the implications for future workforce planning, both locally and nationally. The impact on research is also highlighted. KEY ISSUES: An ageing nursing workforce indicates that primary care nursing will experience significant reductions in its workforce. Local and National workforce statistics for primary care are flawed. There are significant gaps in primary care data for school and practice nurses. There needs to be clarification and a consensus for the term 'community nurse'. The expansion of the public health role for school nurses is seriously challenged because of limited availability of appropriately qualified nurses and an urgent need for an investigation into school nursing statistics. Future workforce planning and development needs to be based on accurate and reliable statistics, to plan for an ageing nursing workforce. The quality of research in primary care is compromised because of the lack of availability of accurate nursing workforce data. CONCLUSIONS: Effective delivery of the NHS Plan requires a thorough understanding of the composition of the primary care nursing workforce and targets need to be based on accurate and reliable workforce statistics.     

Globalisation, localisation and implications of a transforming nursing workforce in New Zealand: opportunities and challenges

Severe staff and skill shortages within the health systems of developed countries have contributed to increased migration by health professionals. New Zealand stands out among countries in the Organisation for Economic Co-operation and Development in terms of the high level of movements in and out of the country of skilled professionals, including nurses. In New Zealand, much attention has been given to increasing the number of Māori and Pacific nurses as one mechanism for improving Māori and Pacific health. Against a backdrop of the changing characteristics of the New Zealand nursing workforce, this study demonstrates that the globalisation of the nursing workforce is increasing at a faster rate than its localisation (as measured by the growth of the Māori and New Zealand-born Pacific workforces in New Zealand). This challenges the implementation of culturally appropriate nursing programmes based on the matching of nurse and client ethnicities.     

The role of internationally educated nurses in a quality,safe workforce

Migration and globalization of the nursing workforce affect source countries and destination countries. Policies and regulations governing the movement of nurses from one country to another safeguard the public by ensuring educational comparability and competence. The global movement of nurses and other health care workers calls for quality and safety competencies that meet standards such as those defined by the Institute of Medicine. This article examines nurse migration and employment of internationally educated nurses (IENs) in the context of supporting and maintaining safe, quality patient care environments. Migration to the United States is featured as an exemplar to consider the following key factors: the impact of nurse migration on the nursing workforce; issues in determining educational comparability of nursing programs between countries; quality and safety concerns in transitioning IENs into the workforce; and strategies for helping IENs transition as safe, qualified members of the nursing workforce in the destination country.     

Workplace practices with mental health implications impacting on recruitment and retention of overseas nurses in the context of nursing shortages

In response to nursing workforce shortages, health agencies in Australia and elsewhere have sought to meet the demand for nursing services by recruiting nurses internationally. While there is a major focus on recruitment, little attention is given to factors that could enhance retention of overseas qualified nurses. There are a host of factors reported in the literature that impact upon retention of overseas nurses in the workforce, including: impact of re-settlement experiences in the new country; discriminatory practices in accessing employment and negative experiences in the work place. For the benefit of long term retention of overseas nurse graduates in the workforce in Australia and globally, these experiences are major issues needing urgent attention. This discussion paper reviews the literature to explore the impact of aggression and discriminatory practices in nursing as evidence for nurses leaving the profession, and discusses the mental health implications and consequences of such practices relating to overseas nurse graduates.     

Health services research and the nursing workforce: access and utilization issues

Access to personal health services is only possible if there are an adequate number and distribution of qualified nurses. However, most work on access has been conceptualized as access to physician services or particular types of settings such as hospital care, not as access to nurses. In this paper I have used the Institute of Medicine Access framework to conceptualize the relationship of the nursing workforce to several aspects of access, and evaluated both the current state of research and existing gaps. Some of the gaps identified in the research that need to be included in a health services research agenda for nursing are: (1) the effect of regional market factors (such as physician ratios and poverty), or attitudes on the supply of nurses; (2) the lack of a critical analysis of staffing and outcome research, and measures of utilization and access specific to nurses in a variety of settings; (3) the need for more and better data to evaluate nurse career patterns, nursing workforce educational capacity, and effectiveness; and (4) relevant workforce policies.     

Retention of nurses in the primary and community care workforce after the age of 50 years: database analysis and literature review

Title.  Retention of nurses in the primary and community care workforce after theage of 50 years: database analysis and literature review.
Aim.  This paper is a report of a study conducted to explore strategies for retaining nurses and their implications for the primary and community care nursing workforce.
Background.  An ageing nursing workforce has forced the need for recruitment and retention of nurses to be an important feature of workforce planning in many countries. However, whilst there is a growing awareness of the factors that influence the retention of nurses within secondary care services, little is known about those that influence retention of nurses in primary and community care. Little is known about the age profile of such nurses or the impact of the ageing nursing workforce on individual nursing specialities in the England.
Methods.  Nursing databases were analysed to explore the impact of age on nursing specialities in primary and community care. The nurse retention literature was reviewed from 1995 to 2006.
Findings.  Workforce statistics reveal that primary and community care nurses have a higher age profile than the National Health Service nursing workforce as a whole. However, there are important gaps in the literature in relation to the factors influencing retention of older primary and community care nurses. Specific factors exist for older nurses within primary care that are unique. Implications for their retention are suggested.
Conclusion.  Particular attention needs to be paid to factors influencing retention of older nurses in primary and community care. These factors need to be incorporated into local and national policy planning and development.     

Perceptions and expectations of Baccalaureate-prepared nurses in Jordan: Community survey

The overall purpose of this paper is to describe the process of utilizing community participation for curriculum design to develop a new school of nursing. A brief Community Needs Assessment Survey was carried out in order to explore community perceptions and expectations of Baccalaureate-prepared nurses in Jordan. The sample consisted of 152 participants who were staff nurses, nurse administrators, nurse supervisors, nurse educators, physicians, pharmacists and consumers of services. Data were collected through a self-administered survey form using open-ended questions. Participants were asked to describe their perceptions of nursing and nurses, the desired professional skills and personal characteristics of the Baccalaureate-prepared nurse, important curriculum contents and to provide suggestions or comments for improving the preparation of Bachelor of Science in Nursing (BSN) nurses. The findings indicated that nursing was viewed as a caring profession where nurses care for the person both in sickness and health. Several professional skills and personal characteristics emerged as being important for the BSN nurse, including clinical competence, the desire to continue learning, communication skills, ethical and moral character, critical thinking, assessment skills, and computer and English-language skills. The participants provided the desired curriculum contents and suggestions related to the expected skills. Implications for nursing education were discussed.     

建立护理规范服务培训基地的实践与体会

目的树立护士形象，规范文明服务，营造和谐护患关系，为病人提供一流护理服务。方法建立护理规范服务培训示范基地，对240名新护士进行医院规范的“护士形象十条标准”、“护理规范服务用语”、“人性化护理服务标准”进行培训；制定服务培训计划和方案；采取分批实践。逐一考核的系列培训措施。结果培训前后规范服务考试成绩由60．83％提高到99．17％（P〈0．01）；出院病人满意度较培训基地建立前明显提高。结论在医院建立护理服务培训基地，是推行人性化服务理念，树立良好护士形象，融洽护患关系，提高病人的满意度，减少护患冲突行之有效的新型护理管理模式。     

Organizational support in the recruitment and transition of overseas‐qualified nurses: Lessons learnt from a study tour

The migration of nurses has been a global phenomenon, and the integration of overseas‐qualified nurses within host countries has led to debate worldwide. Evidence suggests that support provided by organizations can vary and that there is minimal information on the nature and extent of organizational support required to enhance a smooth transition of overseas‐qualified nurses into nursing practice. This explorative study tour examined the organizational support provided to enhance overseas‐qualified nurses' transition into the nursing workforce in two countries. The various support mechanisms provided to overseas‐qualified nurses in different organizations include transition, acculturation, mentoring programs, and initial settlement assistance. The successful transition of overseas‐qualified nurses into a host country is a complex issue. A robust support system for these nurses should be based on ethical considerations and a team approach that is linked to strong leadership. In addition, education and support for existing staff is essential for a successful transition of overseas‐qualified nurses into practice. Lessons learnt from this study tour might also be relevant to the transition of other overseas‐qualified health professionals, such as doctors and allied health professionals, in host countries.     

The nursing shortage: part way down the slippery slope

The shortage of nurses has reached a crisis point for health care services. A number of issues including the effects of economic rationalism, generational differences, working conditions and nurse education are revisited in a discussion that aims to refuel the debate on workplace reform for nurses. Economic rationalism has altered the healthcare service landscape. Attempts to balance service delivery with workforce resources have led to possibly unforeseen changes. Highly skilled nurses are required in acute services, however resource allocation may prevent this. The nursing workforce is aging although the current nursing workforce consists of three generations: baby boomers, generation X and generation Y. There are significant ideological and work organisational differences between these generations leading to possible conflict between nurses. The pool of available nurses to fill employment vacancies is finite. Attracting overseas nurses to fill nurse vacancies will leave vacancies elsewhere and is not a long-term solution to the nursing shortage. Moreover, if the workplace has not addressed the reasons why nurses have left the health care workplace then there is a real danger of losing those recently attracted back into the workplace. Working conditions are a critical element within the retention puzzle. Job satisfaction dimensions such as autonomy and professional relationships are key components for improving working conditions. The final issue explored is the question of whether the tertiary education system is the most appropriate place in which to develop and educate nurses. It is suggested that workplace reforms should be the target of retention strategies rather than changes in the educational process of nursing.     

Overcoming barriers and improving public health nursing practice

Public health nurses (PHN) are critical to ensuring the health of communities. Absent the most basic information on the PHN workforce in our state, we conducted interviews with 21 PHN and school health nurse (SHN) leaders and an online survey of PHNs and SHNs practicing in Maryland (N = 491). Our study identified an older, very experienced, and well-educated workforce. Both the interviews and survey identified similar barriers: low salaries, recruitment and hiring challenges, limited funding for public health programs, and no opportunities for education or career advancement. Survey participants also identified barriers of inadequate leadership, recognition, and communication including PHNs not being represented at decision-making tables or at the state leadership level. Strategies to promote public health nursing from leaders and survey participants were similar: increasing awareness about what public health and PHNs do and their value; improving advocacy and stakeholder engagement; improving access and availability of services; improving PHN leadership representation at the state level; a improving PHN salaries and benefits including tuition reimbursement. Although results were similar to national studies, comprehensive, granular workforce data is critical to ensure the public health workforce can meet current and emerging public health needs and that public health infrastructure and services are appropriately funded.     

Graduate education for advanced practice public health nursing: at the crossroads

The complexity of public health problems and advancement of science framing public health demand an expansion of traditional educational approaches and curriculum to prepare a futuristic advanced practice public health nursing (APPHN) workforce. This position paper sponsored by the Association of Community Health Nursing Educators challenges nurse educators to apply innovative strategies in preparing public health nursing (PHN) professionals and to expand curriculum paradigms to promote PHN's ecological approach to solving problems. To meet the challenges of ensuring public health in the 21st century, advanced practice public health nurses must have greater foundational knowledge in critical content areas discussed in this document. Competence in these areas will enable advanced practice public health nurses to address future health care challenges such as rapidly changing social structures, escalating knowledge explosion, globalization, and growth of new technologies. This education will prepare nurses to forge new knowledge and establish health care teams to create effective solutions.     

Nursing practice environment: A strategy for mental health nurse retention?

Historically, mental health services have faced challenges in their ability to attract and retain a competent nursing workforce in the context of an overall nursing shortage. The current economic downturn has provided some respite; however, this is likely to be a temporary reprieve, with significant nursing shortages predicted for the future. Mental health services need to develop strategies to become more competitive if they are to attract and retain skilled nurses and avoid future shortages. Research demonstrates that creating and maintaining a positive nursing practice environment is one such strategy and an important area to consider when addressing nurse retention. This paper examines the impact the nursing practice environment has on nurse retention within the general and mental health settings. Findings indicate, that while there is a wealth of evidence to support the importance of a positive practice environment on nurse retention in the broader health system, there is little evidence specific to mental health. Further research of the mental health practice environment is required.     

A European survey of general nurses' self assessment of competence

Policy initiatives have prompted examination of the deployment and mobility of the nursing workforce within the European Union (EU). The European Health Care Training and Accreditation Network [EHTAN, 2005. Available from: ] project aims to improve the transparency of nursing qualifications, working practices, skills and experience, thus facilitating nurse workforce mobility, through compilation of a competency matrix [Cowan, D.T., Norman I.J., Coopamah, V.P., 2005a. European healthcare training and accreditation network. British Journal of Nursing 14, 613-617; EHTAN, 2005. Available from: ]. This paper reports on a survey across five EU countries in which the EHTAN nurse competence self-assessment tool was utilised. The purpose is to describe migrant nurses perception of their competence in: (a) the country where they trained and qualified and (b) the new country in which they are working and (c) to compare non-migrant nurses perception of their competence across different EU countries.     

Watching the Glass: Policy Hurdles for 21st Century Nurses

Our nursing clinical identity is being neglected as it dwindles into a support role for other clinicians. Underlying this process is a web of policies involving health practitioner licensure and credentialling, standardizing of nursing undergraduate preparation, hospital staffing models and nursing work design, nurse authorization limitations, government funding of nursing services and client access to insurance items and other subsidies in the private nursing market. Constraints placed on clinical nurses working in institutional services result in systematic deskilling and dismissal of the comprehensive knowledge and contribution of nurses. Nurses of the 21st century need to be savvy and earnest in reforming policy if they are to rescue the profession from the relentless contraction of clinical nursing status and profile that is happening worldwide. If a revival of clinical nursing as a professional role by 2030 is the goal, the process of reform needs to start now.     

A South African perspective: current position and challenges in health care service management and education in nursing

jooste k. & jasper m. (2012) Journal of Nursing Management 20, 56–64
A South African perspective: current position and challenges in health care service management and education in nursing Aim The present study discusses the current context of South African nurse managers’ working environment, exploring the challenges of disease demographics, service change and development, and educating a nursing workforce to meet healthcare delivery demands. Background Post-apartheid South Africa has a legacy of inequalities in access to healthcare; increasingly poor morbidity and mortality demographics; and inadequate numbers of qualified nurses to provide a service to meet the Millennium Development Goals outlined by the Government in 2010. Evaluation The present study discusses the current position and developments pertaining to nursing management relating to both healthcare challenges and educating a nursing workforce. Key issues Collaborative action by various stakeholders in the development of nursing management will ensure a nursing workforce and service environment fit-for-purpose in delivering the healthcare outcomes envisaged in the transformed South Africa in the future. Conclusion Different role players are involved in critical issues regarding the management and education of nursing in South Africa. Nurse managers are central to the success of service redesign, delivery and education. Implications for nursing management Nurse managers need to influence policy decisions regarding nursing service design and delivery, and the education required to prepare the next generation of practitioners for these new services.     

The nurse apprentice and fundamental bedside care: An historical perspective

This historical study aims to explain how the transition from student nurse service to fully qualified “graduate nurse” service in the United States in the 20th century affected assumptions about fundamental patient care in hospital wards and provide historical context for current apprenticeship programs. Through analysis of documents from 1920 when student nurse service, a nurse apprentice model, was the norm to 1960 when the nurse apprentice model was waning in favor of registered nurse service, this study found that the replacement of student nurses with registered nurses led to weakened standardization of fundamental bedside care and the introduction of large numbers of unlicensed nursing assistants. While student nurses could perform all the functions of fully qualified graduate nurses, nursing assistants could not, resulting in a separation of fundamental nursing care from the professional nurse role and changes in assumptions and attitudes toward fundamental care. These changes had a negative effect on fundamental nursing care. New apprenticeship programs provide opportunities for improvement.     

The future of baccalaureate degrees for nurses

PROBLEM. Unlike other professional healthcare disciplines, the profession of nursing has multiple levels of entry. Recently, several states have proposed legislation to mandate completion of baccalaureate education after 10 years of nursing licensure. METHODS. This article examines the proposals, statistics, strategies, and other relevant literature on baccalaureate education for nurses and the positive outcomes associated with a more highly educated nursing workforce. FINDINGS. The proposal recognizes the entry level preparation provided by associate degree nurses and is an innovative solution that offers a balance between multiple entry levels into practice and continued educational preparation. CONCLUSIONS. Through a combination of the entry level preparation of associate degree nurses and baccalaureate education, a stronger nursing workforce can be created and patient outcomes and quality of care improved.     

Transition to Nursing Faculty: Exploring the Barriers

The future nursing workforce is dependent upon qualified nursing faculty to teach nursing students. The purpose of this qualitative research study was to explore the perceived barriers to becoming an academic nurse educator by nurses who have graduate degrees. Themes identified include the perception of academic nurse educator role and barriers to becoming an academic nurse educator. Findings have the potential to help stakeholders begin to develop strategies to mitigate the shortage of nursing faculty.