Healthcare workforce

A data-driven safety surveillance framework was developed in a study that incorporated supervised machine learning models and geospatial analytics to forecast and map occupational hazards in the United States healthcare sector. The incident records of 12,347 cases were de-identified in more than 500 facilities in the 30 states (2018-2022). There were four predictive models: logistic regression, support vector machines, random forest, and XGBoost, and the optimal one was XGBoost (AUC-ROC = 0.91, F1 = 0.85). The main predictive variables were the duration of a shift (importance score = 0.178), the type of department (0.154), and PPE compliance (0.139), as well as the ratios of staff to their patients and the time at which the incident occurred. The frequency of injuries was very high in some high-risk departments, i.e., the emergency and ICU, especially under morning and early shifts. Musculoskeletal injuries (31%), needlestick (22%), and infectious exposures (19%) were the most common hazards. Kernel density estimation and Getis-Ord Gi hotspot analysis on spatial mapping revealed the targeted areas of risk concentration within hospitals and long-term care facilities, but only in New York, California, Texas, and Ohio. These results validate the fact that occupational injuries within care are statistically predictable and spatially patterned, and that there should be a transition to real-time and predictive, geographically informed safety governance.

Objective. A component of health-care reform in 2010 identified physician assistants (PAs) as needed to help mitigate the expected doctor shortage. We modeled their number to predict rational estimates for workforce planners. Methods. The number of PAs in active clinical practice in 2010 formed the baseline. We used graduation rates and program expansion to project annual growth; attrition estimates offset these amounts. A simulation model incorporated historical trends, current supply, and graduation amounts. Sensitivity analyses were conducted to systematically adjust parameters in the model to determine the effects of such changes. results. As of 2010, there were 74,476 PAs in the active workforce. The mean age was 42 years and 65% were female. There were 154 accredited educational programs; 99% had a graduating class and produced an average of 44 graduates annually (total n56,776). With a 7% increase in graduate entry rate and a 5% annual attrition rate, the supply of clinically active PAs will grow to 93,099 in 2015, 111,004 in 2020, and 127,821 in 2025. This model holds clinically active PAs in primary care at 34%. conclusions. The number of clinically active PAs is projected to increase by almost 72% in 15 years. Attrition rates, especially retirement patterns, are not well understood for PAs, and variation could affect future supply. While the majority of PAs are in the medical specialties and subspecialties fields, new policy steps funding PA education and promoting primary care may add more PAs in primary care than the model predicts.

Half of all pregnancies at risk of malaria worldwide occur in the Asia–Pacific region, where Plasmodium falciparum and Plasmodium vivax co-exist. Despite substantial reductions in transmission, malaria remains an important cause of adverse health outcomes for mothers and offspring, including pre-eclampsia. Malaria transmission is heterogeneous, and infections are commonly subpatent and asymptomatic. High-grade antimalarial resistance poses a formidable challenge to malaria control in pregnancy in the region. Intermittent preventive treatment in pregnancy
reduces infection risk in meso-endemic New Guinea, whereas screen-and-treat strategies will require more sensitive point-of-care tests to control malaria in pregnancy. In the first trimester, artemether–lumefantrine is approved, and safety data are accumulating for other artemisinin-based combinations. Safety of novel antimalarials to treat artemisinin-resistant P. falciparum during pregnancy, and of 8-aminoquinolines during lactation, needs to be established. A more systematic approach to the prevention of malaria in pregnancy in the Asia-Pacific is required.

Since the onset of the COVID-19 pandemic, the departure of registered dental hygienists (RDHs) from clinical practice in Pennsylvania has become a pressing public health concern. This issue is further exacerbated by a broader healthcare workforce shortage. This study uses a mixed-methods approach, integrating quantitative survey data from the Job Satisfaction Survey (JSS) with qualitative insights from focus group discussions to explore the factors contributing to RDHs’ intent to leave the profession. Findings reveal three major systemic barriers driving RDH dissatisfaction: restrictive licensure policies, inequitable professional representation, and workforce mobility limitations. These factors significantly contribute to RDHs’ intent to leave the profession. Additionally, workplace challenges such as inadequate compensation, limited career advancement opportunities, and poor working conditions exacerbate dissatisfaction. The findings emphasize the critical need for tailored interventions, such as regulatory reform, enhanced compensation packages, and improved workplace support, to address workforce challenges in Pennsylvania. This study offers practical recommendations for policymakers, industry leaders, and employers to reduce job dissatisfaction and improve retention among RDHs. Strengthening the RDH workforce will enhance access to oral health care and support broader public health objectives.
Keywords: Registered dental hygienist, healthcare workforce shortage, Pennsylvania, intent to leave, job dissatisfaction, COVID-19.

Decentralised nursing education has emerged as a pivotal strategy for addressing workforce shortages and promoting equitable access to quality healthcare. This article analyses the impact of decentralised nursing and clinical and technical programmes offered through the Ministry of Health in Guyana and how they can help address shortages of healthcare workers and promote equitable access to quality healthcare. Attempts to increase diversity within the healthcare profession have resulted in more ethnically diverse students enrolling on nursing education programmes. One of the critical challenges faced by nursing and clinical education programmes in Guyana is the limited capacity of centralised institutions to accommodate many students. As a result, there is a need to explore alternative methods of delivering nursing and clinical education to meet the increasing health sector demand. Decentralised nursing and clinical education provide a solution to this challenge by bringing nursing and clinical education programmes closer to the communities in need. The paper uses empirical evidence collected from 2019-2024 on four (4) decentralised training programmes: the nursing assistant, community health worker, pharmacy assistant, and medical laboratory technician training programmes. It examines the reasons behind decentralised education, its implementation in Guyana, and its various impacts on nursing practice, education, and healthcare outcomes. The rapid expansion in healthcare facilities throughout Guyana would demand an increase in the number of healthcare workers trained. This research has significant findings that show the impact of decentralising nursing and clinical education, which could be deemed one of the main sources of increasing the number of healthcare workers, improving healthcare accessibility, empowering local communities, and strengthening its health workforce.

Background There is a global shortage of midwives, whose services are essential to meet the healthcare needs of pregnant women and newborns. Evidence suggests that if enough midwives, trained and regulated to global standards, were deployed worldwide, maternal, and perinatal mortality would decline significantly. Health workforce planning estimates the number of midwives needed to achieve population coverage of midwifery interventions. However, to provide a valid measure of midwifery care coverage, an indicator must consider not only the raw number of midwives, but also their scope and competency. The tasks midwives are authorized to deliver and their competency to perform essential skills and behaviors provide crucial information for understanding the availability of safe, high-quality midwifery services. Without reliable estimates for an adequate midwifery workforce, progress toward ending preventable maternal and perinatal mortality will continue to be uneven. The International L...

Midwives' authorization to deliver the seven basic emergency obstetric and newborn care (BEmONC) functions is a core policy indicator in global monitoring frameworks, yet little evidence supports whether such data are captured accurately, or whether authorization demonstrates convergence with midwives' skills and actual provision of services. In this study, we aimed to validate the data reported in global monitoring frameworks (criterion validity) and to determine whether a measure of authorization is a valid indicator for BEmONC availability (construct validity). We conducted a validation study in Argentina, Ghana, and India. To assess accuracy of the reported data on midwives' authorization to provide BEmONC services, we reviewed national regulatory documents and compared with reported country-specific data in Countdown to 2030 and the World Health Organization Maternal, Newborn, Child and Adolescent Health Policy Survey. To assess whether authorization demonstrates convergent validity with midwives' skills, training, and performance of BEmONC signal functions, we surveyed 1257 midwives/midwifery professionals and assessed variance.

The COVID-19 vaccine rollout programme in Uganda was launched in March 2021 for priority groups: Healthcare Workers (HCWs), older persons (�50 years), and persons with chronic conditions. Misinformation, distrust in healthcare systems, and cultural beliefs, pose significant challenges to vaccine uptake. We describe the social and structural factors affecting the uptake of COVID-19 vaccines among HCWs and older people in Uganda. Between September and October 2021, we conducted 33 in-depth interviews with 25 HCWs aged 21-63 years from three hospitals in central Uganda and eight older people from Wakiso district. Participant selection was purposive, based on sex, occupation, education, cadre of HCWs and vaccination status. We explored participants' knowledge, beliefs, personal experiences, barriers, and facilitators to vaccine uptake as well as suggestions for future COVID-19 vaccine rollout. Interviews were audio-recorded, transcribed and translated into English, coded, and analysed by theme. Twenty-two of the 25 (88%) HCWs and 3 of the 8 (38%) older people had received at least one dose of the COVID-19 vaccine at the time of interview. The structural facilitating factors to vaccine uptake included access to correct information, fear of a risky work environment, and mandatory vaccination requirements especially for frontline HCWs. Age, chronic health conditions, and the fear of death were facilitating factors for older people. Misconceptions about COVID-19 vaccines and fear of side effects were common social barriers for both groups. Long distances to vaccination centres, vaccine stock-outs, and long queues at the vaccination centres were specific barriers for older people. The prerequisite of signing a consent form was a specific structural barrier for HCWs. Future roll out of new vaccines should have a comprehensive information dissemination strategy about the vaccines. Improved access to vaccines through

The COVID-19 vaccine rollout programme in Uganda was launched in March 2021 for priority groups: Healthcare Workers (HCWs), older persons (�50 years), and persons with chronic conditions. Misinformation, distrust in healthcare systems, and cultural beliefs, pose significant challenges to vaccine uptake. We describe the social and structural factors affecting the uptake of COVID-19 vaccines among HCWs and older people in Uganda. Between September and October 2021, we conducted 33 in-depth interviews with 25 HCWs aged 21-63 years from three hospitals in central Uganda and eight older people from Wakiso district. Participant selection was purposive, based on sex, occupation, education, cadre of HCWs and vaccination status. We explored participants' knowledge, beliefs, personal experiences, barriers, and facilitators to vaccine uptake as well as suggestions for future COVID-19 vaccine rollout. Interviews were audio-recorded, transcribed and translated into English, coded, and analysed by theme. Twenty-two of the 25 (88%) HCWs and 3 of the 8 (38%) older people had received at least one dose of the COVID-19 vaccine at the time of interview. The structural facilitating factors to vaccine uptake included access to correct information, fear of a risky work environment, and mandatory vaccination requirements especially for frontline HCWs. Age, chronic health conditions, and the fear of death were facilitating factors for older people. Misconceptions about COVID-19 vaccines and fear of side effects were common social barriers for both groups. Long distances to vaccination centres, vaccine stock-outs, and long queues at the vaccination centres were specific barriers for older people. The prerequisite of signing a consent form was a specific structural barrier for HCWs. Future roll out of new vaccines should have a comprehensive information dissemination strategy about the vaccines. Improved access to vaccines through

Background Midwives' authorization to deliver the seven basic emergency obstetric and newborn care (BEmONC) functions is a core policy indicator in global monitoring frameworks, yet little evidence supports whether such data are captured accurately, or whether authorization demonstrates convergence with midwives' skills and actual provision of services. In this study, we aimed to validate the data reported in global monitoring frameworks (criterion validity) and to determine whether a measure of authorization is a valid indicator for BEmONC availability (construct validity). Methods We conducted a validation study in Argentina, Ghana, and India. To assess accuracy of the reported data on midwives' authorization to provide BEmONC services, we reviewed national regulatory documents and compared with reported country-specific data in Countdown to 2030 and the World Health Organization Maternal, Newborn, Child and Adolescent Health Policy Survey. To assess whether authorization demonstrates convergent validity with midwives' skills, training, and performance of BEmONC signal functions, we surveyed 1257 midwives/midwifery professionals and assessed variance.

Background There is a global shortage of midwives, whose services are essential to meet the healthcare needs of pregnant women and newborns. Evidence suggests that if enough midwives, trained and regulated to global standards, were deployed worldwide, maternal, and perinatal mortality would decline significantly. Health workforce planning estimates the number of midwives needed to achieve population coverage of midwifery interventions. However, to provide a valid measure of midwifery care coverage, an indicator must consider not only the raw number of midwives, but also their scope and competency. The tasks midwives are authorized to deliver and their competency to perform essential skills and behaviors provide crucial information for understanding the availability of safe, high-quality midwifery services. Without reliable estimates for an adequate midwifery workforce, progress toward ending preventable maternal and perinatal mortality will continue to be uneven. The International Labor Organization (ILO) and the International Confederation of Midwives (ICM) suggest standards for midwifery scope of practice and competencies. This paper compares national midwifery regulations, scope, and competencies in three countries to the ILO and ICM standards to validate measures of midwife density. We also assess midwives' self-reported skills/behaviors from the ICM competencies and their acquisition.

Objective This paper explores the impact and mechanisms for successful implementation of a speech language pathology assistant (SLPA) role into a rehabilitation setting using a traineeship approach. Methods Multiple data sources were used, including interviews with key stakeholders, documentary evidence and a workload audit. Results The SLPA role increased clinical service capacity by 28 h per week across the service and required a total of 3 h per week of supervision input (the equivalent of 38 min per speech and language pathologist (SLP)). The SLPA used non-clinical time for training and administration. Mechanisms that facilitated the implementation of the SLPA role were: support for existing staff; formal knowledge and skills in training; consultation and engagement; access to a competency framework; close working with the registered training organisation; clearly defined role and delegation boundaries; clear supervision structures; confidence in own role; supportive organisatio...

Background: War and armed conflicts severely disrupt all health system components, including the healthcare workforce. Although data is limited on the scale of health care worker (HCW) displacement in conflict zones, it is widely acknowledged that conflict conditions result in the displacement of a significant portion of qualified HCWs from their country of origin. While voluntary HCW return is integral to health system rebuilding in conflict-affected and post-conflict settings, there has been little exploration of the nature of national or international policies which encourage HCW return and reintegration to their home countries in the post-conflict period. Methods: We conducted a systematic review to identify policies and policy recommendations intended to facilitate the return of displaced HCWs to their home countries and acknowledge their contribution to rebuilding the postconflict health system. We searched three bibliographic databases and a range of organisational and national health agency websites to identify peer-reviewed articles and grey literature published in English or Arabic between 1 January 1990 to 24 January 2021, and extracted relevant information. We classified policies and policy recommendations using an adapted version of the UNHCR 4Rs Framework. Results: We identified nine peer-review articles and four grey literature reports that fit our inclusion criteria, all of which were published in English. These covered issues of repatriation (n = 3), reintegration (n = 2), health system rehabilitation and reconstruction (n = 2); six documents covered several of these themes. Information was available for nine conflict contexts: Afghanistan,

INTRODUCTION International maternity care experts have called for expanding midwiferyled continuity of care (MCoC) models. However, the number of models need augmentation as the number of women receiving this care is small. The majority of the midwifery workforce in Australian public health systems comprises women who work part-time. This aspect of the midwifery workforce demands careful consideration when attempting to change a maternity care system and sustain new models of care. Sparse research has been undertaken to explore whether part-time factors could play a role in the growth and sustainability of MCoC in Australia. This integrative review aims to analyze the role of parttime practice arrangements in the sustainability of MCoC models in Australia. METHODS Following a systematic search of research databases (CINAHL, ScienceDirect, Cochrane Database of Systematic Reviews, and Proquest) and screening the literature with eligibility criteria including keywords related to midwifery continuity of care, workforce arrangements and full-time equivalent (FTE), eight Australian research articles were identified for evaluation. The articles were appraised for bias using the Mixed Methods Appraisal Tool (MMAT) and data were analyzed using an integrated convergent narrative synthesis method. RESULTS The resulting themes from the synthesis suggest that part-time MCoC roles may support the sustainability of the MCoC workforce without reducing quality of care to women. In various studies, midwives reported that FTE (full-time equivalent) of 0.5 may not meet the job's demands. However, this is likely influenced by local context and caseload size rather than the quantum of each midwife's FTE. The quality of the studies is limited due to the small scale of the studies; however, the qualitative results give a depth of understanding to the strengths and challenges that part-time arrangements in MCoC add to the midwifery workforce. CONCLUSIONS This review recommends that part-time arrangements in MCoC models in Australia be evaluated in conjunction with other routinely analyzed workforce data. Further considerations should be made by midwifery managers, leaders, stakeholders, and decision makers responsible for developing and supporting part-time job arrangements in caseload models of care in Australia.

BackgroundUK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.Objectives(1) To identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) To consider the feasibility of potentially implementing those policies and strategies.DesignThis was a comprehensive, mixed-methods study.SettingThis study took place in primary care in England.ParticipantsGeneral practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national stakehold...

Aim: The Simulated Telemedicine Environment Project for Students (STEPS) was embedded within the Nutrition and Dietetics Professional Placements course at Griffith University with the aim of providing standardised tutorials for all students. The secondary aim was to increase skills in using telehealth to provide dietary advice to patients. This study reports preliminary results of students’ perceptions of the effectiveness of the remotely accessed simulated learning program. Methods: Twenty-seven students from the Fourth Year Bachelor of Nutrition and Dietetics and 36 students from the Second Year Masters of Nutrition and Dietetics attending Professional Placement participated in the compulsory STEPS program. Each student participated in up to five sessions, of approximately fours hours in length. Activities included history taking, medical condition research and the provision of dietary advice to a simulated patient via the videoconferencing platform, WebEx. Peer feedback was also ...

Introduction: Quality of Work Life (QWL) is defined as the extent to which an employee is satisfied with personal and working needs through participating in the workplace while achieving the goals of the organization.

Objectives: To assess the quality of life of nurses working in a medical college hospital in Bangalore and the factors associated with it.

Methods: Ethical approval from the institution and informed consent from the study participants was obtained and quality of life questionnaire was administered to all the nurses working in the hospital.

Results: A total of 671 (88.5%) nurses participated in the study. Among the participants, 452 (67.7%) indicated that they have the autonomy to make patient care decisions, 500 (74.9%) were unable to balance their work and family lives, 656 (98.2%) were stressed in their work and 543 (81.3%) of nurses were unable to complete their work in the time available.

Conclusion: It is important to consider the quality of working life of the nurses to improve productivity and performance of the nurses.

Objective: This study examined the effect of depression and burnout on PA professional fulfi llment and medical errors. Methods: Eight hundred eighty PAs completed an online survey containing the Professional Fulfi llment Index, PHQ-2, GAD-7, and demographic questions. Two serial mediation models examined the relationship between depression, burnout, and professional outcomes. Results: Burnout fully mediated the relationship between depression and outcomes in both models and the present research indicates that burnout plays a stronger role in job satisfaction than symptoms of depression. Conclusions: Understanding the underpinnings of professional satisfaction may mitigate clinician turnover, which in turn may lead to cost savings for the organization, better resilience and mental health for clinicians, and potentially better patient outcomes.

The authors are trained nurses who have worked with, researched and taught vulnerable groups in mental health and learning disabilities in a variety of settings, and like many health and social care professionals, also experienced the effects of burnout. In this article, they explore solution focused (SF) conversations and their use in the issue of burnout in nursing. First, the authors consider the current literature on nursing burnout to set a scene for appreciating how SF offers a different conversational approach for nurses. Second, particularly, concepts of 'best hopes', 'preferred futures' and other useful techniques of 'difference' aim to help nurses re-evaluate burnout. Once practitioners begin to translate some of the SF theory into conversational practice, they can build a different relationship with what it means to be burnt out. And third, the authors offer a few figures and infographics on how to translate SF conversations to nurses who, given the chance, are more than capable of 'ferrying themselves' and others through the murky waters of burnout.

The South African Nursing Council promulgated the compulsory community service (CCS) policy, in regulation R765 of 2007, for nurses of the four-year diploma or degree in nursing. The implementation of the CCS policy takes place at public health institutions. There have been no studies to date on how nurse managers experience this process of the CCS policy implementation. The findings of the study will inform future changes to the policy, such as guidelines for nurse managers on how to handle community nurse practitioners (CNPs) that are placed in their

Purpose: Australian private practice nurse practitioner (PPNP) services have grown since legislative changes in 2010 enabled eligible nurse practitioners (NPs) to access reimbursement for care delivered through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). This article provides data from a national survey on the workforce characteristics of PPNPs in Australia. Method: PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. There were 73 completed surveys. Conclusions: One of the intentions of expanding access to MBS and PBS for patients treated by NPs was to increase patients' access to health care through greater flexibility in the healthcare workforce. The results of this survey confirm that the workforce characteristics of PPNPs provide a potentially untapped resource to meet current primary healthcare demand. Implications for practice: The findings of this study allow us to understand the characteristics of PPNP services, which are significant for workforce planning. The focus of PPNP practice is toward primary health care with PPNPs working predominantly in general practice settings. The largest age group of PPNPs is over 50 years and means a proportion will be retiring in the next 15 years.

Background: Midlevel providers (i.e. physician assistants [PAs] and nurse practitioners [NPs]) are being integrated into systems of care due to the exponentially increasing demand for orthopaedic care. There is a lack of studies which investigate orthopaedic patients' perspectives regarding midlevel providers. Methods: An anonymous questionnaire was administered to 538 first-time patients of four orthopaedic surgeons before their new patient visit. Content included patient perspectives regarding: optimal scope of practice, midlevel provider importance in physician selection, and reimbursement equity with physicians. Results: Of 538 consecutive patients, 415 (77%) responded. 57% were female with an average age of 63.9 ± 11.4 years. Most patients (68%) considered the training background of the surgeon's midlevel provider when initially choosing an orthopaedic surgeon. 34% of all patients perceived PAs to be more highly trained than NPs while 17% perceived the opposite. Patients had specific preferences regarding which services should be surgeon-provided: follow-up for abnormal tests (82%), initial postoperative appointment (81%), new patient visits (81%), and determining the need for advanced diagnostic studies (e.g. MRI) (76%). Patients had specific preferences regarding which services could be midlevel-provided: preoperative teaching (73%), minor in-office procedures (65%), long term postoperative appointments (61%), and prescriptions (61%). Patients lacked a consensus on reimbursement equity for midlevel providers and orthopaedic surgeons, despite most patients (78%) reporting the surgeon provides a higher-quality consultation. Conclusions: As health care becomes increasingly consumer-centric and value-driven, a databased utilization of midlevel staff will allow orthopaedic physicians to optimize efficiency and patient satisfaction. Surgeons may consider our results in division of clinical duties among midlevel staff since patients had specific preferences regarding which services should be physician-provided or midlevel-provided. Orthopaedic surgeons may also consider including the midlevel provider in marketing efforts, as most patients considered the midlevel provider's training background when initially choosing a surgeon and perceived PAs to be more highly trained than NPs. Patients lacked a consensus towards reimbursement equity for orthopaedic surgeons and midlevels, despite reporting that the surgeon provides a higher quality consultation. These findings are important as the midlevel workforce grows in response to the rising demand for orthopaedic care.Level of Evidence: IV.

Comparisons of raw span (i.e., number of staff who report directly to a manager) within and across organizations can misrepresent managerial capacity to support staff because managers may not allocate the same amount of time to staff contact. The purpose was to examine the influence of alternative measures of managerial span on nurse satisfaction with manager's supervision and on multidisciplinary teamwork. The alternative measures were (a) raw span as a measure of reporting structure and (b) time in staff contact as a measure of closeness of contact regard.

Background Currently, the growing shortage of primary care doctors and nurses is causing di culties in replacement, and this shortage is expected to increase. This situation is more pronounced in rural environments than in urban ones. Family and community care specialty training is a key component of both the transition to clinical practice and the retention of new professionals. The aim of the study is to explore the attitudes and perceptions of internal medicine residents and internal nurse residents trained in a rural teaching unit on factors associated with recruitment and retention, including the role of the specialty training programme. Methods A qualitative study was conducted. Purposive sampling was used and thirteen residents from the central Catalonia teaching unit who were in their nal year of training participated in semi-structured interviews. The data were collected during the year 2022. The data were subsequently analysed with thematic analysis. The study is reported using the COREQ checklist. Results Six themes emerged from the data related to perceptions and attitudes about the factors associated with recruitment and retention: training programme, characteristics of the family and community specialty, concept of rural life, family and relational factors, economic and resource factors, and recruitment and job opportunities. Conclusions Family and community medicine and nursing residents trained in rural settings expressed satisfaction with the specialty programme and most features of primary care, but they experience a wide range of uncertainties in deciding on their professional future. The study identi es individual and structural factors to consider and that could be of great use in order to retain doctors and nurses in rural areas.

Purpose: The main purpose of this study is to determine the toxic leadership perceptions of health care workers and to reveal whether the evaluations of the workers about toxic leadership subdimension differ according to individual and demographic characteristics or not. Another purpose of the study is to evaluate whether a scale that measures toxic leadership, validity and reliability revealed in other sectors can be used in the health care sector or not. Design/methodology/approach: The population of the study covers doctors, nurses and other health care workers who work in a state hospital operating in the province of Ankara, Turkey. The study was performed by convenience sampling. The data collection period covers between January-March 2016 and 292 usable surveys are attained. In order to reveal whether the evaluations of health care workers about toxic leadership and sub-dimensions differentiate or not in terms of individual and demographic characteristics, significance test of...

Concern abounds about whether the health care workforce is sufficient to meet changing demands spurred by the Affordable Care Act (ACA). We project that by 2022 the health care industry needs three to four million additional workers, forty percent of which is related to demand growth under the ACA. We project faster job growth in the ambulatory care sector, especially in home health care. Given the current profile, we expect that the future health care workforce will be increasingly female, young, racially/ethnically diverse, not US-born, at or below the poverty level and at a low level of educational attainment.

Background and Aims: The COVID-19 pandemic accelerated the adoption of telemedicine in general. Its use has been widely adopted in the healthcare sector, but relatively little research has been conducted on the use of telemedicine for podiatry. This review aimed to explore and compare existing guidelines on telemedicine related to foot and ankle pathologies within a primary care setting. Methods: The preferred reporting guidelines for the extension of scoping reviews were used in this review, and a set of inclusion and exclusion criteria were developed and implemented. This study made use of both databases and gray literature searches. Between 2012 and 2022, these databases were searched using various subject headings and free-text terms for the keywords "telemedicine" "foot health" and "guidelines" with appropriate Boolean operators. Results: The search yielded 356 articles, which were reduced to 283 after removing duplicates. Six more records were discovered through a Google and Google Scholar search and one through an article reference search. Six articles and three institutional practice guidelines were selected for synthesis after screening. The findings were classified according to the level of evidence and research quality, the function of telemedicine and the communication used, the research outcomes sought, and the type of recommendations and guidelines made available. Conclusion: This review highlights the lack of podiatric telemedicine guidelines for foot and ankle pathologies. Although foot and ankle guidelines for orthopedic and musculoskeletal virtual consultations have been mentioned, they do not cover the full range of potential case scenarios that fall within the remit of podiatric consultations in a primary care setting. This review suggests the development of foot and ankle telemedicine guidelines with recommendations on how they can better provide accessible care to their patients, making foot and ankle care management not only a hand-on-one but also reachable virtually, where applicable.

Background Australian podiatrists and podiatric surgeons who have successfully completed the requirements for endorsement for scheduled medicines, as directed by the Podiatry Board of Australia, are eligible to prescribe a limited amount of schedule 2, 3, 4 or 8 medications. Registration to become endorsed for scheduled medicines has been available to podiatrists for over 10 years, yet the uptake of training has remained low (approximately 2% of registered podiatrists/podiatry surgeons). This study aimed to explore barriers to and facilitators for engagement with endorsement for scheduled medicines by podiatrists. Methods Qualitative descriptive methodology informed this research. A purposive maximum variation sampling strategy was used to recruit 13 registered podiatrists and a podiatric surgeon who were either endorsed for scheduled medicines, in training or not endorsed. Semi-structured interviews were employed to collate the data which were analysed using thematic analysis. Resu...

Background Concern has been voiced not only by patients and professionals but also by the Department of Health about the provision and quality of care for people with neurological conditions. A number of government reports in the UK have highlighted the problems of sub-optimal care (Clinical Standards Advisory Group, 2000; Department of Health, 1998; 2001). An alliance of patients' groups suggests that because of the complexity of these conditions the particular skills and expertise of neurologists are required (Neurological Alliance, 1996a; 1996b; 2000). This is echoed in studies involving patients (

SummaryLearning disability nursing has had an interesting history over recent decades. Despite many predictions of it being replaced it has survived to engage in a variety of roles in contemporary learning disability services. This paper acknowledges the anomalous position of the profession and discusses its current position within nursing, and within learning disability services.

Background Australian podiatrists and podiatric surgeons who have successfully completed the requirements for endorsement for scheduled medicines, as directed by the Podiatry Board of Australia, are eligible to prescribe a limited amount of schedule 2, 3, 4 or 8 medications. Registration to become endorsed for scheduled medicines has been available to podiatrists for over 10 years, yet the uptake of training has remained low (approximately 2% of registered podiatrists/podiatry surgeons). This study aimed to explore barriers to and facilitators for engagement with endorsement for scheduled medicines by podiatrists. Methods Qualitative descriptive methodology informed this research. A purposive maximum variation sampling strategy was used to recruit 13 registered podiatrists and a podiatric surgeon who were either endorsed for scheduled medicines, in training or not endorsed. Semi-structured interviews were employed to collate the data which were analysed using thematic analysis. Resu...

Physician shortages in the US are expected to intensify with the implementation of the Patient Protection and Affordable Care Act. These shortages may negatively impact access to care, quality of care, and confidence in the system's ability to adequately provide for health needs in the US. Concerns regarding physician demand underscore how critical Graduate Medical Education funding is to preparing the physician workforce. In 2014 5.6 % of US medical school seniors did not match into residency. Psychology has faced longstanding training imbalance issues with a misalignment between the number of internship positions and the number of applicants. The authors summon attention to the damaging effects a training imbalance poses to a health care profession, its trainees, and ultimately the public it serves.

Objectives: To describe the recruitment and retention of general practitioners and changes in their time commitment from 1 October 1990 to 1 October 1994. Design: Retrospective analysis of yearly data. Setting: England and Wales. Subjects: General practitioners in unrestricted practice. Main outcome measures: Numbers of general practitioners moving into and out of general practice; proportion of general practitioners practising less than full time; proportion of general practitioners having unchanged time commitment over the study period; and proportion of general practitioners leaving general practice in 1991 who were subsequently practising in 1994.

Background Unfavorable leadership practices are a growing concern in the field of healthcare and nursing that have adverse consequences on nurses’ career outcomes. One of the undesirable leadership styles is the toxic leadership style. Considering the importance of nursing managers’ leadership style and its impact on nurses’ performance and the scarcity of studies in this field, the present study was conducted to determine toxic leadership behaviors in nursing managers and their relationship with the turnover intention among nurses. Methods A multicenter cross-sectional correlational study. This study involved 551 nurses from 5 educational-medical centers in Ardabil province, north-western Iran. Three self-report scales, including The demographic and occupational information form, the Toxic Leadership Behaviors of Nurse Managers Scale (ToxBH-NM), and the turnover intention questionnaire were adopted for assessment purposes in this study. Data were analyzed using SPSS (Version 22) so...

BBER would like to thank the Region 3 Office of the USDA Forest Service for permitting us to take on this important project. We hope that the information and analysis provided in this report will contribute to the development of a forest plan that continues to benefit all residents of New Mexico. Specifically, we would like to thank Dr. Richard Periman for his patience, support and willingness to answer an immeasurable number of questions from our staff. He also pointed us to key forest staff that generously shared their expertise. The author of this report is indebted to the collaboration and cooperation of many people, who made this study possible. This work was supported by many people with the National Forest Service. Particular thanks go to Jack Carpenter, the Carson NF Supervisor, for providing information and interpretation regarding forest operations and for putting us in contact with other forest experts. Jack also reviewed earlier drafts of this document and provided detailed comments that were extremely helpful. His attention to detail and accuracy are very much appreciated. Thanks are also due to Tom Dwyer for his insight on access and right-of-way issues and Lucy Aragon for information on the current invasive weeds conditions.

Recruiting and retaining rural primary care providers is challenging. The Graduate Nursing Education Primary Care Scholars (GNEPCS) is a partnership between a philanthropic organization and a school of nursing to recruit, educate, train, and retain primary care advanced practice registered nurses (APRNs) for practice in rural Alabama with a focus on improving the state's health outcomes. In its initial four years, the GNEPCS partnership has been successful in identifying 60 registered nurses interested in becoming rural primary care APRNs. These students have received mentoring, individualized content on rural health, preceptorships with rural providers, and opportunities for professional and leadership development. Pilot philanthropic funding has allowed us to develop sustainable curricula, attract additional complementary federal funds, and create a critical mass of practice-ready APRNs who are improving primary care access for some of the state's most rural and underserved populations.

Background Physician assistant was created in response to a shortage of physicians. However, this profession is not officially recognized in Korea. Many nurses are working as physician assistants. Their job satisfaction was low due to role conflict. Job satisfaction plays a major role in providing high quality nursing. This study aimed to investigate effects of work environment and professional identity on job satisfaction and identify the mediating role of moral distress in such effects. Methods Participants were 112 nurses working as physician assistants. They were recruited from three General Hospitals. A questionnaire scale was used to collect data. Data were analyzed using frequency, descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation, and Macro Model 4 with SPSS Statistics. Results Job satisfaction of nurses working as physician assistants had a score of 3.08 out of 5. It showed significant associations with work environment and professional identity...

Background: Client satisfaction surveys integral part of quality improvement at a health facility, help in preparing action plan to identify the causes of low satisfaction and steps to maximize patient satisfaction. Aims of this study were to (1) explore level of client satisfaction,(2) find out the reasons of low satisfaction and (3) suggest feasible means for improvement. Methodology: A mixed type of study with both quantitative and qualitative components was undertaken after permission from the head of institute. A total421 (124 OPD & 297 IPD) patient's satisfaction survey forms filled during 2015-2016 were analyzed. In order to get more insight and as part of qualitative research, 2 focus group discussions (FGDs) of treated/ discharged patients from IPD and1 for OPD cases were conducted in early 2017. Results: Most respondents during client survey, expressed satisfaction over, cleanliness, security, parking facilities andbehavior of hospital staff. Half of the participants were aware of their rights. More than 25% waited for less than 10 minutes for their registration. However, none of the participants could see concerned care provider within 30 minutes of registration. In FGDs too, most participants mentioned free of cost services, good behavior of doctor, satisfactory treatment and cleanliness of hospital as reasons for choosing this hospital. Conclusion: While survey findings are largely flattering to the system, those from FGDs pointed out certain areas of improvement. Hence, it is recommended to include FGDs, as a part of current client satisfaction survey. Grievance redressal system must be in place in the form of mail boxes installed at hospital. The observations of the survey were shared with all the stakeholders to find out realistic solutions.

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