The NHS Plan: nurse satisfaction, commitment and retention strategies.

The NHS Plan envisages a paradigm shift from a centralized, producer-led National Health Service (NHS) to a devolved, patient-centred health care service, fuelled by a substantial investment in human resources, beds, hospitals and infrastructure. The planned net increase of 20,000 nurses by 2004 is examined in the light of findings from a qualitative study of nurse satisfaction, commitment or intention to leave their hospital, nursing or the NHS, involving 124 nurses in four London hospitals. This paper presents nurses' perceptions and rankings of retention strategies and we compare these with the Plan's proposals. Lastly we propose an integrated approach to examining and dealing with the complex issue of nurse recruitment, retention and quality of patient care, based on a conceptual framework, the Nurse Satisfaction, Service Quality and Nurse Retention Chain, which highlights the scope of the challenges confronting the Plan, in both design and implementation of proposals designed to improve working conditions as a foundation for nurse recruitment and retention. Our principal findings are that just 57% of our interviewees may be viewed as 'core loyals' to the profession, 12% are serious in their intention to leave and the remainder may be sensitive to further deterioration in working conditions or a failure to meet expectations on pay. Such findings if realized clearly threaten the Plan's success.     

Controlling the cost of nurse recruitment: an administrator's challenge

One of hospital administrators' many challenges is the recruitment of nursing staff. This article explores eight hospitals' recruitment strategies as well as these methods' direct and indirect costs. It also provides suggestions for administrators on how to improve their recruitment procedures.     

Overseas nurse recruitment: Ireland as an illustration of the dynamic nature of nurse migration

This paper presents an analysis of Ireland's recent experience of overseas nurse recruitment. Ireland began actively recruiting nurses from overseas in 2000 and has recruited almost 10,000 nurses, primarily from India and the Philippines since that time. This paper takes a timely look at the Irish experience to date. It reviews the literature on the supply and demand factors that determine the need for, and the international migration of, nurses and presents working visa and nurse registration statistics. This enables the authors to quantify and discuss the trends and scale of recent nurse migration to Ireland from outside the European Union (EU). The paper discusses the data essential for national workforce planning and highlights the deficiencies in the Irish data currently available for that purpose. The paper concludes with a discussion of the implications of Ireland's heavy reliance on overseas nurse recruitment.     

"The nurse satisfaction,service quality and nurse retention chain": implications for management of recruitment and retention

This paper presents the findings of a qualitative study, based on interviews with over 130 nurses and midwives in four London Trust hospitals on: the main factors influencing nurse satisfaction and retention; empirical support for the robustness of a conceptual framework or model "the nurse satisfaction, service quality and nurse retention chain"; and some managerial considerations for recruitment and retention. The three main factors influencing job satisfaction were patients, the inherent characteristics of nursing and the nursing team; the two main sources of job dissatisfaction were staff shortages and poor management and amongst nurse retention strategies improving working conditions was more important than increased pay. For recruitment, as well as retention, improving the image and reputation of nursing along with improvements in work-life balance were pre-requisites for meeting the challenging target of an additional 20,000 nurses on the wards by 2004.     

Clinical problem-solving by medical students: a cross-sectional and longitudinal analysis

The evolution of clinical reasoning in medical students was studied. A cross-sectional sample consisted of randomly-selected medical students from three classes. Additionally, twenty-two students were observed at yearly intervals from the preclerkship period to the first post-graduate year. Subjects were observed in a clinical examination of a simulated patient, and their thought processes were abstracted from a 'stimulated recall' of the videotaped encounter.
The data were transcribed and coded for computer analysis, yielding several variables characterizing the clinical reasoning process, and four measures of outcome of the encounter. Analysis of variance of differences between students at various educational levels and a doctor criterion group indicated that the majority of the process variables were unrelated to educational level. By contrast, diagnostic and management outcomes were positively related to education. The single process variable which was related to both educational level and outcome was an 'hypothesis aggregate score', a measure of the content of the student's diagnostic hypotheses.
The results of the study indicate that the problem-solving or clinical reasoning process remains relatively constant from medical school entry to practice. This observation has important implications for clinical teaching and evaluation.     

Medical negligence and the NHS: an economic analysis

Medical negligence was estimated to cost the NHS in England £235m in 1996/1997, growing at rate of up to 25% per annum. Yet analysis of NHS accounts suggest that a change in accounting policy has led to growth rates and recurrent expenditure on medical negligence being over estimated. The main concern, however, is total societal cost, not the accounting cost to the NHS. The objective of policy should be to ensure that cost‐effective investment in injury prevention takes place. Measures that simply shift cost to other social budgets or onto patients are not helpful. NHS arrangements changed in the 1990s with Trusts taking responsibility for claims against hospital doctors and a new NHS Litigation Authority providing insurance for Trusts. It is unclear, however, whether Trusts have had either the incentives or the ability to implement effect risk management policies. Estimates based on two US studies and one UK study suggest that negligence in the NHS in England may cause around 90 000 adverse events per year involving 13 500 deaths, but only resulting in around 7000 claims and 2000 payments. A priority must be the establishment of a comprehensive national database of claims information. Other policy measures are proposed to reinforce the incentives on Trusts and doctors to implement cost‐effective risk management policies. Copyright © 1999 John Wiley & Sons, Ltd.     

Unemployment and retirement and ill-health: a cross-sectional analysis across European countries

OBJECTIVE: To determine the associations between different measures of health and labor market position across ten European countries. METHODS: We studied 11,462 participants of the Survey on Health and Ageing in Europe (SHARE) who were 50-64 years old. Logistic regression was used to calculate the associations between health and other determinants and being retired, unemployed, or a homemaker. RESULTS: A large variation across European countries was observed for the proportion of persons 50-65 years with paid employment, varying among men from 42% in Austria to 75% in Sweden and among women from 22% in Italy to 69% in Sweden. Among employed workers 18% reported a poor health, whereas this proportion was 37% in retirees, 39% in unemployed persons, and 35% in homemakers. A perceived poor health was strongly associated with non-participating in labor force in most European countries. A lower education, being single, physical inactivity and a high body mass index were associated with withdrawal from the labor force. Long-term illnesses such as depression, stroke, diabetes, chronic lung disease, and musculoskeletal disease were significantly more common among those persons not having paid employment. CONCLUSION: In many European countries a poor health, chronic diseases, and lifestyle factors were associated with being out of the labor market. The results of this study suggest that in social policies to encourage employment among older persons the role of ill-health and its influencing factors needs to be incorporated.     

Anthropometrically predicted visceral adipose tissue and blood-based biomarkers: a cross-sectional analysis

Purpose

We hypothesized that anthropometrically predicted visceral adipose tissue (apVAT) accounts for more variance in blood-based biomarkers of glucose homeostasis, inflammation, and lipid metabolism than body mass index (BMI), waist circumference (WC), and the combination of BMI and WC (BMI + WC).

Methods

This was a cross-sectional analysis of 10,624 males and females who participated in the Third National Health and Nutrition Examination Survey (NHANES III; 1988–1994). apVAT was predicted from a validated regression equation that included age, height, weight, waist, and thigh circumferences. Bootstrapped linear regression models were used to compare the proportion of variance (R ²) in biomarkers explained by apVAT, BMI, WC, and BMI + WC.

Results

apVAT accounted for more variance in biomarkers of glucose homeostasis than BMI (?R ² = 8.4–11.8 %; P < 0.001), WC (?R ² = 5.5–8.4 %; P < 0.001), and BMI + WC (?R ² = 5.1–7.7 %; P < 0.001). apVAT accounted for more variance in biomarkers of inflammation than BMI (ΔR ² = 3.8 %; P < 0.001), WC (ΔR ² = 3.1 %; P < 0.001), and BMI + WC (ΔR ² = 2.9 %; P < 0.001). apVAT accounted for more variance in biomarkers of lipid metabolism than BMI (ΔR ² = 2.9–9.2 %; P < 0.001), WC (ΔR ² = 2.9–5.2 %; P < 0.001), and BMI + WC (ΔR ² = 2.4–4.1 %; P ≤ 0.01).

Conclusions

apVAT, estimated with simple and widely used anthropometric measures, accounts for more variance in blood-based biomarkers than BMI, WC, and BMI + WC. Clinicians and researchers may consider utilizing apVAT to characterize cardio-metabolic health, particularly in settings with limited availability of imaging and laboratory data.

     

Birth cohort analysis using irregular cross-sectional data: a technical note

Cancer mortality and morbidity data are usually collected and published by calendar time period and by age class. Transformation of the age-specific incidence or mortality rates into those for birth cohorts is readily undertaken when one age class of each time period corresponds to a given cohort: a requirement that is often not satisfied. The authors propose a method for the computation of birth cohort age-specific incidence rates given irregular cross-sectional data. The procedure is based on a cross-sectional interpolation of cumulated population and case figures, from which cohort rates can be derived. Using the method several examples of trends in cancer incidence by birth cohort are discussed.     

Psychological and perceived situational predictors of physical activity: a cross-sectional analysis.

The purpose of this study was to identify psychological and self-reported situational factors that are associated with degree of involvement in moderate-intensity physical activity at various stages of adult life. The study is grounded in Personal Investment Theory which proposes that personal incentives, sense of self and perceived options determine behavior. Participants aged 18 and above, selected by random-digit dialling, were invited to participate in a study on physical activity habits. Of 251 who agreed to participate, 41.4% were male (N = 104) and 58.6% were female (N = 147). These participants were asked the number of days per week that they engaged in physical activity which accumulated a total of 30 min or more. The 140 participants who indicated one or more days of activity answered questions concerning personal incentives for physical activity, sense of self and perceived barriers. Stepwise multiple regression analyses and discriminant function analysis indicated that Personal Investment Theory is able to predict up to 29% of the variance associated with voluntary participation in moderate-intensity physical activity. Discussion focuses on implications for physical activity programs for citizens at different stages of their adult life.     

Management and leadership: analysis of nurse manager's knowledge

Nurses have assumed management positions in many health institutions. To properly accomplish the demands of this role, it is important that they be competent in both management and leadership. For appropriate performance, knowledge of management and supervision styles is a priority. Therefore, the goal of this investigation is to identify the nurse manager's knowledge regarding management and leadership. A structured questionnaire containing twenty-seven questions was applied to twelve Brazilian nurse managers of primary care center called "Family Basic Health Units". Data analysis suggested that the nurse manager lower knowledge in management and leadership is related to visionary leadership, management and leadership conceptual differences, leader's behavior, and situational leadership. And, nurse manager greater knowledge is related to power; team work, and coherence between values and attitudes.     

The effects of workplace flexibility on health behaviors: a cross-sectional and longitudinal analysis

OBJECTIVE: To examine the cross-sectional and longitudinal associations between workplace flexibility and health behaviors, and estimate the potential importance of flexibility for effective worksite health promotion programs. METHOD: Cross-sectional and longitudinal health risk appraisal data were obtained from US based employees of a multinational pharmaceutical company (n = 3193). Examined health behaviors were hours of sleep, physical activity frequency, health education seminar attendance, frequency of practicing personal resilience techniques, and self-appraised lifestyle. Self-reported flexibility in the workplace was the primary independent variable. RESULTS: Each health behavior, except regular attendance in health education seminars, was positively related to perceived flexibility in cross-sectional analyses. Sleep and self-appraised lifestyle were significantly related to changes in perceived flexibility over time. CONCLUSIONS: Workplace flexibility may contribute to positive lifestyle behaviors, and may play an important role in effective worksite health promotion programs.     

Beer and obesity: a cross-sectional study

OBJECTIVE: There is a common notion that beer drinkers are, on average, more 'obese' than either nondrinkers or drinkers of wine or spirits. This is reflected, for example, by the expression 'beer belly'. However, the few studies on the association between consumption of beer and abdominal obesity produced inconsistent results. We examined the relation between beer intake and waist-hip ratio (WHR) and body mass index (BMI) in a beer-drinking population. DESIGN: A cross-sectional study. SETTINGS: General population of six districts of the Czech Republic. SUBJECTS: A random sample of 1141 men and 1212 women aged 25-64 y (response rate 76%) completed a questionnaire and underwent a short examination in a clinic. Intake of beer, wine and spirits during a typical week, frequency of drinking, and a number of other factors were measured by a questionnaire. The present analyses are based on 891 men and 1098 women who where either nondrinkers or 'exclusive' beer drinkers (ie they did not drink any wine or spirits in a typical week). RESULTS: The mean weekly beer intake was 3.1 l in men and 0.3 l in women. In men, beer intake was positively related to WHR in age-adjusted analyses, but the association was attenuated and became nonsignificant after controlling for other risk factors. There appeared to be an interaction with smoking: the relation between beer intake and WHR was seen only among nonsmokers. Beer intake was not related to BMI in men. In women, beer intake was not related to WHR, but there was a weak inverse association with BMI. CONCLUSION: It is unlikely that beer intake is associated with a largely increased WHR or BMI.