Nursing

This paper examines various aspects of the nursing and midwifery workforce in Africa, looking at education and supply systems; recruitment, retention and motivation and career systems. It further investigates attrition from migration and HIV/AIDS, as well as other factors and makes some recommendations on how to move forward using examples of experiences from countries. These experiences, albeit on a small scale, show promise of good results after being scaled up. [author’s description]

Human resources become increasingly relevant in this context. Health human resource (HHR) is currently experiencing a three-fold problem, which encompasses old issues, together with the effects of reform, and the consequences of globalisation. This includes the workforce crisis in nursing which, facing all kinds of difficulties, requires complex in-depth analysis, synergies and alliances in order to ensure quality nursing services.

Recruiting and keeping the right staff are key challenges for health policy-makers. The performance and quality of a health system ultimately depend on the quality and motivation of health human resources. Therefore, recruitment and retention problems should be appropriately addressed, as nursing staff shortages and low motivation are likely to have adverse effects on the delivery of health services and the outcome of care. The main objective of this paper is to examine how to develop and retain a motivated nursing workforce. [author’s description]

This document summarises underlying evidence and issues related to good human resource management (HRM)in the health sector with reference to: (a) indicators of performance and measurement of nursing outcomes; (b) performance issues related to individuals and teams; and (c) employee engagement, commitment and organisational citizenship behaviour (OCB). There are two key themes: What are the interventions and indicators associated with good HRM outcomes, and how can these be measured? [author’s description]

Planning for the efficient and effective delivery of health care services to meet the health needs of the populations is a significant challenge. Globally policy makers, educators, health service researchers, leaders of unions and professional associations, and other key stakeholders struggle with the best way to plan for a workforce to fulfill the health needs of populations.

This paper aims to provide an overview of the current evidence and opinion of the workforce implications of regulation, competency development and role definition. These three elements are inextricably linked to each other and are fundamental to the practice of nursing in today’s environment. [from introduction]

This report focuses primarily on the policy implications of the international migration of nurses, and highlights recent trends. International recruitment and migration of nurses has been a growing feature of the global health agenda since the late 1990s. Nurses have always taken the opportunity to move across national borders in pursuit of new opportunities and better career prospects, but in the last few years nurse migration appears to have grown significantly, with the potential to undermine attempts to achieve health system improvement in some developing countries.

Against the backdrop of growing concern about shortages of health personnel, the report focuses on one of the most critical components of the workforce

The nurse program for foreign countries in Indonesia has been carried out since 1996. In the beginning, this program attempted to solve the false ‘surplus’ problem of nurses in Indonesia. Recently, however, the MOH has developed serious concerns with this program. There have been several efforts to promote the nurse program for foreign countries starting with the improvement of education, recruitment and other mechanisms related to nurses for foreign countries. Some achievements, strengths, weaknesses, potentials and threats are discussed in this paper.

The lack of human resources for health (HRH) is increasingly being recognized as a major bottleneck to scaling up antiretroviral treatment (ART), particularly in sub-Saharan Africa, whose societies and health systems are hardest hit by HIV/AIDS. In this case study of Swaziland, we describe the current HRH situation in the public sector. We identify major factors that contribute to the crisis, describe policy initiatives to tackle it and base on these a number of projections for the future. Finally, we suggest some areas for further research that may contribute to tackling the HRH crisis in Swaziland.

The relationship between poor conditions of employment and work of nursing personnel and shortages is complex. Consequences may include: increased patient morbidity and mortality; greater levels of violence in the workplace; reduced occupational safety and health for remaining personnel; high levels of job dissatisfaction with intention to quit; and unsustainable patterns of health worker migration from developing countries.The Nursing Personnel Convention articulates the kinds of provisions needed to address many of the identified problems. It must be implemented in the greatest number of countries in order to set decent standards of work, boost the professional and political profile of nursing personnel, and provide incentive for nursing personnel to remain in their jobs.

The Royal College of Nursing (RCN) commissioned this report into the experiences of internationally recruited nurses (IRNs) working in the UK. The study explores the motivations and experiences of IRNs in order to understand why overseas nurses come to work in the UK, what experiences they undergo and whether they plan to stay in the UK, return to their countries of origin or go to another country to work after a short period. [from executive summary]

The purpose of these Guidelines is to assist Member Countries in strengthening the management of their nursing and midwifery workforce and, through this, to assist in strengthening health care delivery and strategies for improving health. In particular, they aim to assist Member Countries by assisting them to effectively manage nursing and midwifery issues, including the problems of continuing shortage and maldistribution of nursing and midwifery personnel along with an inappropriate skill mix. [from introduction]

In line with government initiatives, this series of studies was undertaken to establish the training and development needs of nurses and midwives working within a variety of contexts in Indonesia, with the ultimate aim of enhancing care provision within these domains. [from abstract]

This study aimed to establish the occupational profiles of each grade of nurse in Indonesia, identify their training and development needs and ascertain whether any differences existed between nurses working in different regions or within hospital or community settings. [from abstract]

This report is the result of a two-year project. The aim of the project was to examine the crucial issue of nursing shortages and identify priority areas for intervention. Five priority areas of intervention for ICN and nursing were identified: Macroeconomic and health sector funding policies; Workforce policy and planning, including regulation; Positive practice environments and organisational performance; Recruitment and retention, addressing in-country maldistribution, and out-migration; and Nursing leadership.

In Indonesia responsibility for immunizations is placed on local government health centres and on the nurses who provide the immunizations at each centre. An on-the-job peer training programme for these nurses, which was designed to improve the immunization performance of poorly performing health centres in terms of coverage and practice in Maluku province, was evaluated. [from abstract]

A number of ART projects are trying to tackle the HRH problematic by delegating certain tasks from medical doctors to other cadres. While this task-shifting is certainly an important step, we contend that it will not be enough for scaling up ART in the high HIV-prevalence countries with the most severe HRH shortages. In the present report we argue that an altogether different approach to HIV/AIDS care and treatment might be required for overcoming the HRH bottleneck. [from summary]

Zambian nurses have been greatly affected by the rise in the morbidity and mortality of nurses with TB. This article explains the impact of TB on the Zambian nursing workforce. Review of Zambian government programmes designed to address this health crisis and targeted interventions to reduce TB among nurses are offered. [abstract]

These briefs are primarily intended for directors and managers of community- based health care programmes—whether working within ministries of health, international donor agencies or non-government organizations. This brief takes up a number of likely questions about the management functions of the nurses in charge of small, local health facilities:

• How prepared are “nurses in charge” for carrying out administrative and management functions?
• How should they relate to the new management committees?
• What additional training do they need?
• What are the lessons from the Kwale project—lessons about the training of nurses—that can be applied elsewhere?
  

Using incentives and disincentives to direct individuals’ energies and behaviour is common practice in all work settings, of which the health care system is no exception. The range and influence of economic incentives/disincentives affecting community nurses are the subject of this discussion paper. The tendency by nurses to disregard, and in many cases, deny a direct impact of economic incentives/disincentives on their motivation and professional conduct is of particular interest. The goal of recent research was to determine if economic incentives/disincentives in community nursing exist, whether they have a perceivable impact and in what areas.

This study was carried out in order to determine factors that may facilitate the poor retention of registered nurses in the Malawian public health sector.

Migration and remittances are of considerable importance in the small Pacific island states. There has been a significant migration of skilled health workers in recent decades to metropolitan fringe states, including Australia and New Zealand. This paper reports the findings of a re-analysis of a survey of Samoan and Tongan migrants in Australia where the sample is split between nurse households and others.

Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels. [from abstract]

This paper analyzes shortages of nurses in OECD countries. It defines and describes evidence on current nurse shortages, and analyzes international variability in nurse employment.

Nurses, as the largest human resource element of health care systems, have a major role in providing ongoing, high-quality care to patients. Productivity is a significant indicator of professional development within any professional group, including nurses. The human resource element has been identified as the most important factor affecting productivity. This research aimed to explore nurses’ perceptions and experiences of productivity and human resource factors improving or impeding it. [from abstract]

This document outlines five key areas requiring intervention: human resources planning and capacity building, management of personnel, evidence-based practice, education, and stewardship. It provides a tangible response to resolution WHA54.12, which was adopted by the World Health Assembly in May 2001, and facilitates the achievement of WHO’s four strategic directions as well as the United Nations Millennium Development Goals. The document consists of two sections. Part I introduces the Strategic Directions, Key Result Areas and Objectives with the Expected Results to achieve them.

Nurses are expected to empower their clients, but they cannot do so if they themselves feel powerless. They must become empowered before they can empower others. This paper is an attempt to clarify the concept of power in nursing. It also presents a model describing the factors affecting nurse empowerment. [from abstract]

Over the last five years, international development organizations began to modify and adapt the conventional Performance Improvement Model for use in low-resource settings. This model outlines the five key factors believed to influence performance outcomes: job expectations, performance feedback, environment and tools, motivation and incentives, and knowledge and skills. This study presents a unique exploration of how the factors affect the performance of primary reproductive health providers (nurse-midwives) in two regions of Armenia. [from abstract]

This pilot study focused on self-identified factors of nursing students who expressed an interest in rural practice post-graduation. The sample included students from the USA and Canada, who were enrolled in graduate and undergraduate programs of nursing, and were attending an international rural nursing conference. [From abstract]