Regional differences among employed nurses: A Queensland study

Objective:  To ascertain differences in the working lives of geographically dispersed nurses.
Design:  Cross-sectional.
Setting:  Registered, enrolled and assistants-in-nursing members of the Queensland Nurses' Union employed in nursing in Queensland, Australia.
Participants:  A total of 3000 members of the Union, equally stratified by sector (public, private, aged care). Among them, 1192 responded and 1039 supplied postcodes matching the Australian Standard Geographical Classification.
Main outcome measures:  Statistically significant differences in working lives of nurses employed in different geographical locations.
Results:  Nurses in outer regional/remote/very remote localities are more likely to be employed as permanent full-time staff and self-report higher levels of work stress. These levels could be explained by: lack of replacement staff for leave, longer working and on call hours and lack of support for new staff. Distance remains a major barrier to accessing continuing professional education. However, outer regional/remote/very remote nurses were more likely to be provided employer support for professional education. Inner regional nurses were more likely to work part time, would work more hours if offered and were more likely to have taken a break from nursing as a result of family commitments.
Conclusion:  The data confirm that current policies are not addressing the differences in the working lives of geographically dispersed nurses. Policies addressing orientation, mentoring and workloads should be implemented to address these issues.     

Potential of China in Global Nurse Migration

Objective. The purpose of this paper is to examine what is known about the nurse workforce and nursing education in China in order to assess the likely potential for nurse migration from China in the future.
Principle Findings. There is a severe shortage of nurses in China (only one nurse per thousand in population), but at the same time there is a very high level of unemployment and underemployment of nurses. China's nursing education system is huge in size (about 500,000 nursing students in 2005), but weak in quality and career development.
Conclusions. As a result of lack of limited job opportunities, low salary, and low job satisfaction, many talented Chinese nurses intend to switch occupation or work outside China. Commercial recruiters have expressed a strong interest in recruitment of nurses in China, but to date there are few examples of successful ventures. Even if the Chinese government were to implement health care financing reforms that led to an increase in nursing jobs and improved work conditions, some level of surplus will remain. As such, it is likely that China will become an important source of nurses for developed nations in the coming years.     

Developing a Nursing Database System in Kenya

Objective. To describe the development, initial findings, and implications of a national nursing workforce database system in Kenya.
Principal Findings. Creating a national electronic nursing workforce database provides more reliable information on nurse demographics, migration patterns, and workforce capacity. Data analyses are most useful for human resources for health (HRH) planning when workforce capacity data can be linked to worksite staffing requirements. As a result of establishing this database, the Kenya Ministry of Health has improved capability to assess its nursing workforce and document important workforce trends, such as out-migration. Current data identify the United States as the leading recipient country of Kenyan nurses. The overwhelming majority of Kenyan nurses who elect to out-migrate are among Kenya's most qualified.
Conclusions. The Kenya nursing database is a first step toward facilitating evidence-based decision making in HRH. This database is unique to developing countries in sub-Saharan Africa. Establishing an electronic workforce database requires long-term investment and sustained support by national and global stakeholders.     

International Nurse Recruitment in India

Objective. This paper describes the practice of international recruitment of Indian nurses in the model of a "business process outsourcing" of comprehensive training-cum-recruitment-cum-placement for popular destinations like the United Kingdom and United States through an agency system that has acquired growing intensity in India.
Findings. Despite the extremely low nurse to population ratio in India, hospital managers in India are not concerned about the growing exodus of nurses to other countries. In fact, they are actively joining forces with profitable commercial ventures that operate as both training and recruiting agencies. Most of this activity is concentrated in Delhi, Bangalore, and Kochi.
Conclusions. Gaps in data on nursing education, employment, and migration, as well as nonstandardization of definitions of "registered nurse," impair the analysis of international migration of nurses from India, making it difficult to assess the impact of migration on vacancy rates. One thing is clear, however, the chain of commercial interests that facilitate nurse migration is increasingly well organized and profitable, making the future growth of this business a certainty.     

Nurses on the Move: A Global Overview

Objective. To look at nurse migration flows in the light of national nursing workforce imbalances, examine factors that encourage or inhibit nurse mobility, and explore the potential benefits of circular migration.
Principal Findings. The number of international migrants has doubled since 1970 and nurses are increasingly part of the migratory stream. Critical nursing shortages in industrialized countries are generating a demand that is fueling energetic international recruitment campaigns. Structural adjustments in the developing countries have created severe workforce imbalances and shortfalls often coexist with large numbers of unemployed health professionals. A nurse's motivation to migrate is multifactorial, not limited to financial incentives, and barriers exist that discourage or slow the migration process. The migration flows vary in direction and magnitude over time, responding to socioeconomic factors present in source and destination countries. The dearth of data on which to develop international health human resource policy remains. There is growing recognition, however, that migration will continue and that temporary migration will be a focus of attention in the years to come.
Conclusions. Today's search for labor is a highly organized global hunt for talent that includes nurses. International migration is a symptom of the larger systemic problems that make nurses leave their jobs. Nurse mobility becomes a major issue only in a context of migrant exploitation or nursing shortage. Injecting migrant nurses into dysfunctional health systems—ones that are not capable of attracting and retaining staff domestically—will not solve the nursing shortage.     

Marketing Nursing as a Profession: Integrated Marketing Strategies to Address the Nursing Shortage

The nursing shortage in the United States is at a crisis level characterized by critical shortages of highly trained nurses and of nursing faculty. Key issues in addressing these shortages include awareness and image-building, along with enhanced outreach programs. Although these issues are related to marketing theory, most studies in this area are based on a vocational choice model. This study was grounded in marketing theory and the results offer a new perspective for addressing the nursing shortage. In-depth interviews conducted with 31 first-year nursing students indicated that there were two distinct segments among nursing students: traditionals and instrumentals. Traditionals were attracted to nursing as a helping profession while instrumentals were interested in career-related rewards such as variety, mobility, and compensation. These findings were discussed in terms of building awareness and marketing programs for nursing students that are integrated across schools of nursing, private foundations and public agencies.     

Nurse Migration: A Canadian Case Study

Objective. To synthesize information about nurse migration in and out of Canada and analyze its role as a policy lever to address the Canadian nursing shortage.
Principal Findings. Canada is both a source and a destination country for international nurse migration with an estimated net loss of nurses. The United States is the major beneficiary of Canadian nurse emigration resulting from the reduction of full-time jobs for nurses in Canada due to health system reforms. Canada faces a significant projected shortage of nurses that is too large to be ameliorated by ethical international nurse recruitment and immigration.
Conclusions. The current and projected shortage of nurses in Canada is a product of health care cost containment policies that failed to take into account long-term consequences for nurse workforce adequacy. An aging nurse workforce, exacerbated by layoffs of younger nurses with less seniority, and increasing demand for nurses contribute to a projection of nurse shortage that is too great to be solved ethically through international nurse recruitment. National policies to increase domestic nurse production and retention are recommended in addition to international collaboration among developed countries to move toward greater national nurse workforce self sufficiency.     

Quality outcomes and program evaluation in nursing education: an overview of the journey

Program evaluation, accreditation, and ongoing quality improvement are complex, interrelated processes in nursing education. The purpose of this article is to provide a general overview of the process of evaluation and accreditation with continuous quality improvement that is required for formal nursing education programs in the United States. This article discusses core components of nursing program evaluation, regional and national accreditation, state boards of nursing and licensure, and the role of specialty certification in nursing. A case study of a private college of nursing illustrates the role of program evaluation and quality improvement in nursing education.     

Migration of Nurses from Sub-Saharan Africa: A Review of Issues and Challenges

Objective. To assess the impact of out-migration of nurses on the health systems in sub-Saharan Africa (SSA).
Setting. The countries of SSA.
Design and Methods. Review of secondary sources: existing publications and country documents on the health workforce; documents prepared for the Joint Learning Initiative Global Human Resources for Health report, the World Health Organization (AFRO) synthesis on migration, and the International Council of Nurses series on the global nursing situation. Analysis of associated data.
Principal Findings. The state of nursing practice in SSA appears to have been impacted negatively by migration. Available (though inadequate) quantitative data on stocks and flows, qualitative information on migration issues and trends, and on the main strategies being employed in both source and recipient countries indicate that the problem is likely to grow over the next 5–10 years.
Conclusions. Multiple actions are needed at various policy levels in both source and receiving countries to moderate negative effects of nurse emigration in developing countries in Africa; however, critically, source countries must establish more effective policies and strategies.     

Promoting mental health care in a rural paediatric unit through participatory action research

Objective:  To explore, advance and evaluate mental health practices in a rural general paediatric unit through participatory action research.
Design:  A participatory action research approach guided this study, providing an opportunity for nursing staff to become actively involved in the design, direction and outcomes of the research.
Setting:  A 16-bed paediatric unit of a rural general hospital.
Participants:  A purposive convenience sample of all paediatric nursing staff ( n =  20; of 24 nurses).
Outcome measures:  In the first phase of this study, focus groups were conducted to explore the experiences of nurses.
Results:  Participants considered mental health to be a specialist discipline area and the role of the mental health nurse to be complex. They felt that their lack of training and experience with mental health issues was detrimental to the delivery of optimal patient care. There was concern about differing approaches to treatment, relationships with other mental health services and the suitability of the ward environment for young people with a mental health problem. Participants called for training by qualified mental health staff and the development of policies and clinical guidelines to facilitate their delivery of care to patients with a mental health problem in an acute medical environment.
Conclusions:  There is a clear need for nursing specialities to work together to ensure that optimal care is given to patients admitted to general hospital with a mental health issue. Given the absence of accessible specialist child mental health inpatient units in regional and remote areas, upskilling paediatric nurses must be a priority.     

Nursing opinions on collaborating with residents in new and legacy OB/GYN programs

Collaboration among physicians and nurses is vital and has shown to lead to better patient care and improve outcomes. Our study surveyed two groups of Labor and Delivery nurses in two regionally similar community hospitals in midwestern United States: one group from a new Obstetrics and Gynecology (OB/GYN) residency program (n = 49) and another from an established (legacy) OB/GYN residency program (n = 49). The survey asked nurses from the hospital with new and legacy residency program about preparedness for working with residents, perceptions of nurse-resident-patient relationships, collaboration and opinions about how resident physicians impact patient safety. Most nurses from the legacy residency program showed positive perceptions of collaboration with the residency and institutional support. In the new OB/GYN residency program, nurses were generally neutral and showed skepticism about collaboration with OB/GYN resident physicians and institutional support. Nurses from both hospitals felt similarly in their comfort escalating issues to administration and in their satisfaction with interprofessional collaboration within Labor and Delivery units. Providing nurses with opportunities to learn about the role of new medical residents in their patient care setting as well as intentional collaboration between nursing and residency program administration might result in more effective collaboration between physician residents and nursing staff.     

Care drain: the political making of health worker migration

Migration of formal and informal health-care workers is a global phenomenon - and, as this article demonstrates, one that is produced by government policies and practices. Nurses and lesser-trained caregivers migrate from many lower-income countries to richer ones (including from the Philippines to the United States, from South Africa to England, from Central Asia to Turkey). Using the Austrian experience to illustrate how policies and lack of enforcement of labor laws lead to migration and mistreatment of health-care professionals and informal caregivers, this article recommends how to alleviate health-care staff shortages in Africa and elsewhere through policymaking in Europe and North America. Recognition of the political dimensions of health-care migration is the first step toward addressing ethical questions and damaging shortages of caregivers.     

Program responses to acute and chronic malnutrition: divergences and convergences

Program approaches for addressing acute malnutrition and those for addressing chronic malnutrition have grown in different directions. Their specialization has led to productive advances in the efficacy of specific interventions but has also created divergences in implementation. Greater convergence and integration between the 2 sets of approaches would help programs respond to the diversity of conditions faced in the field and enable a more comprehensive continuum of care from prevention to treatment. After reviewing the causes of the differences in approach, this paper examines programmatic and scientific challenges to greater convergence and suggests steps to promote effective integration of acute and chronic malnutrition services. Steps include strengthening community linkages between program platforms, assessing the degree and type of integration needed in various situations, identifying cost efficiencies, and developing joint tools where possible.     

Developing capacity in health informatics in a resource poor setting: lessons from Peru

The public sectors of developing countries require strengthened capacity in health informatics. In Peru, where formal university graduate degrees in biomedical and health informatics were lacking until recently, the AMAUTA Global Informatics Research and Training Program has provided research and training for health professionals in the region since 1999. The Fogarty International Center supports the program as a collaborative partnership between Universidad Peruana Cayetano Heredia in Peru and the University of Washington in the United States of America. The program aims to train core professionals in health informatics and to strengthen the health information resource capabilities and accessibility in Peru. The program has achieved considerable success in the development and institutionalization of informatics research and training programs in Peru. Projects supported by this program are leading to the development of sustainable training opportunities for informatics and eight of ten Peruvian fellows trained at the University of Washington are now developing informatics programs and an information infrastructure in Peru. In 2007, Universidad Peruana Cayetano Heredia started offering the first graduate diploma program in biomedical informatics in Peru.     

Nursing Supply and Characteristics in the Nonmetropolitan Areas of the United States: Findings from the 1988 National Sample Survey of Registered Nurses

This study examines the supply and selected characteristics of nurses working in nonmetropolitan areas of the United States using the most recent data reported in the third national sample survey of registered nurses in 1988. Nursing supply is analyzed in terms of the ratio of registered nurses per 100,000 people for three standard nonmetropolitan census county size classifications and nine regional groupings of states. Seven dimensions relating to the educational background and current professional characteristics of registered nurses are studied. Findings indicate a notable difference in the ratio of nurses per population across county size and regions of the country. In terms of characteristics selected for this study, the educational background, salary gap, and time spent in various activities differentiate nurses in rural areas from those working in urban counties. Results of this study should be particularly relevant because a variety of educational, financial, and other incentives are being considered to address what is perceived to be a crisis in rural nursing availability.     

Development priorities of the North-East

Northeast India is in deep crisis. It therefore attracts considerable attention from policymakers. Some of the region's problems date from before independence, while others were generated later. The following factors are the root causes of the crisis: massive migration and sharing of the limited resources with poor indigenous people, overexploitation of the environment through extensive deforestation, policymakers' failure to take effective measures to change the economic scenario, and the application of developmental criteria without taking into consideration regional particularities. Migration, health care, environment, human rights, development policy, and nongovernmental organizations in the northeast are discussed. A sustainable development program based upon rural, small-scale industry with markets throughout the country may save the people and environment of the area.     

The impact of out-migration on the nursing workforce in Kenya

Objective. To examine the impact of out‐migration on Kenya's nursing workforce. Study Setting. This study analyzed deidentified nursing data from the Kenya Health Workforce Informatics System, collected by the Nursing Council of Kenya and the Department of Nursing in the Ministry of Medical Services. Study Design. We analyzed trends in Kenya's nursing workforce from 1999 to 2007, including supply, deployment, and intent to out‐migrate, measured by requests for verification of credentials from destination countries. Principle Findings. From 1999 to 2007, 6 percent of Kenya's nursing workforce of 41,367 nurses applied to out‐migrate. Eighty‐five percent of applicants were registered or B.Sc.N. prepared nurses, 49 percent applied within 10 years of their initial registration as a nurse, and 82 percent of first‐time applications were for the United States or United Kingdom. For every 4.5 nurses that Kenya adds to its nursing workforce through training, 1 nurse from the workforce applies to out‐migrate, potentially reducing by 22 percent Kenya's ability to increase its nursing workforce through training. Conclusions. Nurse out‐migration depletes Kenya's nursing workforce of its most highly educated nurses, reduces the percentage of younger nurses in an aging nursing stock, decreases Kenya's ability to increase its nursing workforce through training, and represents a substantial economic loss to the country.     

Redesigning the nursing care delivery system at Fairfax Hospital

The redesign of the nursing delivery process at Fairfax Hospital is occurring from the top down and the bottom up. Nursing leaders have identified improvement opportunities that all units are addressing, such as reevaluating skill mix. At the same time, each inpatient nursing unit is redesigning its own processes to meet customer requirements. For example, the postpartum unit shifted to a "wellness" approach. Nurses reduced the amount of time spent in reassessing patients and are focusing instead on those things their patients are concerned about, such as teaching new mothers how to care for their babies. Results: Customer research revealed that patients, physicians, and nurses wanted family-centered care from competent, caring clinicians. Flow charts identified many improvement opportunities that were common across all nursing units, such as reducing the time nurses spend reporting between shifts. Nurses are more empowered to make local decisions. Additional quantitative results are being tracked for this relatively recent effort.     

Meeting the challenges for gerontological nursing in Europe: The European Nursing Academy for Care of Older persons (ENACO)

In order to support the urgent need for proactive and targeted investments in care for older persons a group of geriatric nurse specialists from different European countries convened in Leuven (Belgium) in November 2002 to launch the European Nursing Academy for Care of Older persons (ENACO). The mission of ENACO is to enhance outcomes of older persons and their caregivers through strengthening gerontological clinical nursing care, education, research and health policy within an interdisciplinary context. Specific objectives of ENACO are: 1) providing up-to-date education and training by "teaching the teachers". More specifically, the target groups are master's prepared nurses specialized in gerontology who can contribute and guide the development of gerontological/geriatric nursing care in their own country; 2) developing a core curriculum for basic gerontological nursing education in Europe and; 3) developing an European network of gerontological nursing expertise. More specifically, a web page providing opportunities for interactive communication as well as a mentoring program will be developed for nurses interested in the deepening and fine-tuning of their professional experience in care for older persons. The fact that care for older persons is high on the European agenda, the collaboration with the European Academy for Medicine of Ageing (EAMA), and other professional organizations in Europe and other parts of the world, are promising elements in the development of ENACO.     

International Recruitment of Nurses: Policy and Practice in the United Kingdom

Objective. To synthesize information about nurse migration into and out of the United Kingdom in the period to 2005, and to assess policy implications.
Principal Findings. There has been rapid growth in inflow of nurses to the United Kingdom from other countries. In recent years, 40–50 percent of new nurse registrants in the United Kingdom have come from other countries, principally the Philippines, Australia, India, and South Africa. Outflow has been at a lower level, mainly to other English-speaking developed countries—Australia, the United States, New Zealand, Ireland, and Canada. The United Kingdom is a net importer of nurses. The principal policy instrument in the United Kingdom, the Code of Practice on International Recruitment, has not ended the inflow of nurses to the United Kingdom from sub-Saharan Africa.
Conclusions. Given the increasing globalization of labor markets, it is likely that the historically high levels of inflow of internationally recruited nurses to the United Kingdom will continue over the next few years; however the "peak" number reached in 2002/2003 may not be repeated, particularly as large-scale active international recruitment has now been ended, for the short term at least. New English language tests and other revised requirements for international applicants being introduced by the Nurses and Midwives Council from September 2005 may restrict successful applications from some countries and will also probably add to the "bottleneck" of international nurse applicants. Demographic-driven demand for health care, combined with a potential reduction in supply of U.K. nurses as many more reach potential retirement age means that international recruitment is likely to remain on the policy agenda in the longer term, even with further growth in the number of home-based nurses being trained.