J Public Health Manag Pract. 2024 Sep-Oct 01;30(5):765-771. doi: 10.1097/PHH.0000000000002030. Epub 2024 Jul 22.
NO ABSTRACT
PMID:39041770 | DOI:10.1097/PHH.0000000000002030
PLoS One. 2024 Jul 12;19(7):e0303255. doi: 10.1371/journal.pone.0303255. eCollection 2024.
ABSTRACT
INTRODUCTION: There is a shortage of nurses and many are leaving the profession. Maintaining sufficient nursing staff is a major healthcare challenge for societies worldwide. Work conditions, job orientation, and career opportunities all factor into nurses' rates of attrition, exit, and turnover. Newly graduated nurses have requested structured introductory and/or mentoring programmes to ease their transition from education to work life and develop the skills and knowledge necessary in their particular work setting. Nurses also seek opportunities to continue learning and developing professionally.
AIMS: To map and describe the content of recruitment advertisements for nurses. Research questions were: 'What qualifications do healthcare employers request when recruiting nurses?' and 'What sorts of professional development do healthcare employers offer nurses?
MATERIALS AND METHODS: A comprehensive national mapping of recruitment advertisements for nurses in Sweden where all advertisements, N = 450, on 20 of the 21 regional hospital websites were collected. A qualitative and a quantitative content analysis was performed.
RESULTS: Personal characteristics dominated requested competence in recruitment advertisements. Employers offered general nursing opportunities with unspecific work content and focused more on recruiting newly registered, rather than experienced, nurses. In only a few advertisements, employers asked for a master's degree. No employer requested nurses with a PhD or research experience.
CONCLUSION: While the World Health Organization stresses the need for a sustainable recruitment and attainment of nurses to secure health care, employers' recruitment of mostly newly graduated nurses and offering little professional development and few career opportunities may be one explanation for the difficulties in securing safe nurse staffing.
PMID:38995934 | DOI:10.1371/journal.pone.0303255
Chest. 2024 May 22:S0012-3692(24)00631-7. doi: 10.1016/j.chest.2024.04.012. Online ahead of print.
ABSTRACT
BACKGROUND: The last national estimates of US intensive care unit (ICU) physician staffing are 25 years old and lack information about interprofessional teams.
RESEARCH QUESTION: How are US adult ICUs currently staffed?
STUDY DESIGN AND METHODS: We conducted a cross-sectional survey (05/04/2022-02/02/2023) of adult ICU clinicians (targeting nurse/physician leadership) contacted using 2020 American Hospital Association (AHA) database information and, secondarily, through professional organizations. The survey included questions about interprofessional ICU staffing availability and roles at steady-state (pre-COVID-19). We linked survey data to hospital data in the AHA database to create weighted national estimates by extrapolating ICU staffing data to non-respondent hospitals based on hospital characteristics.
RESULTS: The cohort consisted of 596 adult ICUs (response rates-AHA contacts: 2.1%; professional organizations: unknown) with geographic diversity and size variability (median [interquartile range]: 20 [12,25] beds); most cared for mixed populations (414 [69.5%]), yet medical (55 [9.2%]), surgical (70 [11.7%]), and specialty (57 [9.6%]) ICUs were well represented. 554 (93.0%) had intensivists available, with intensivists covering all patients in 75.6% of these and onsite 24 hours/day in half (53.3% weekdays; 51.8% weekends). Of all ICUs, 69.8% had physicians-in-training and 77.7% nurse practitioners/physician assistants. For mechanically ventilated patients, nurse:patient ratios were 1:2 in 89.6%. Clinical pharmacists were available in 92.6%, and respiratory therapists in 98.8%. We estimated 85.1% (95% confidence interval: 85.7%, 84.5%) of hospitals nationally had ICUs with intensivists, 51.6% (50.6%, 52.5%) with physicians-in-training, 72.1% (71.3%, 72.9%) with nurse practitioners/physician assistants, 98.5% (98.4%, 98.7%) with respiratory therapists, and 86.9% (86.4%, 87.4%) with clinical pharmacists. For mechanically ventilated patients, 86.4% (85.8%, 87.0%) used 1:2 nurses:patients.
INTERPRETATION: Intensivist presence in adult US ICUs has greatly increased over 25 years. Intensivists, respiratory therapists, and clinical pharmacists are commonly available, and each nurse usually provides care for two mechanically ventilated patients. However, team composition and workload vary.
PMID:38788896 | DOI:10.1016/j.chest.2024.04.012
Risk Manag Healthc Policy. 2024 May 23;17:1361-1372. doi: 10.2147/RMHP.S459840. eCollection 2024.
ABSTRACT
INTRODUCTION: Staffing is critical to hospital quality, but recent years have seen hospitals grappling with severe shortages, forcing them to rely on contract or agency staff for urgent patient care needs. This shift in staffing mix has raised questions about its impact on quality. Consequently, this study investigated whether the increased use of agency staff has affected healthcare quality in hospitals. Given the limited recent research on this topic, practitioners remain uncertain about the effectiveness of their staffing strategies and their potential impact on quality.
METHODS: Drawing from agency theory, data were obtained from Definitive Healthcare which consolidates information from numerous public access databases pertaining to hospitals such as the American Hospital Association Annual Survey (hospital profile) and the Hospital Value-Based Purchasing Program (quality data). We conducted a cross-sectional study using a multivariable linear regression model (2021-2022) with appropriate organizational and market- level control variables. Quality was measured across eight variables while the independent variable of interest was agency labor cost ratio operationalized as the percentage of net patient revenue consumed by agency labor expense.
RESULTS: Our results suggested that the employment of agency staff was significantly and negatively associated with six of eight quality measures tested, including the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) star rating, Hospital Compare rating, the hospital Total Performance Score (TPS), and three of the four sub-domains that comprise the TPS: clinical domain score, person and community engagement domain score, and the efficiency and cost reduction score.
DISCUSSION: Our results indicated that the increased use of agency labor may have a significant negative influence on quality outcomes at the hospital level. Our findings support the premise that interventions that promote full-time staffing may be more supportive of the quality of care delivered as well as patients' perceptions of care.
PMID:38803621 | PMC:PMC11129761 | DOI:10.2147/RMHP.S459840
Nurs Manage. 2024 Jun 1;55(6):5. doi: 10.1097/nmg.0000000000000138. Epub 2024 May 29.
NO ABSTRACT
PMID:38811369 | DOI:10.1097/nmg.0000000000000138
Int J Nurs Stud. 2024 Feb 1;153:104706. doi: 10.1016/j.ijnurstu.2024.104706. Online ahead of print.
ABSTRACT
BACKGROUND: The relationship between nurse staffing, skill-mix and quality of care has been well-established in medical and surgical settings, however, there is relatively limited evidence of this relationship in emergency departments. Those that have been published identified that lower nurse staffing levels in emergency departments are generally associated with worse outcomes with the conclusion that the evidence in emergency settings was, at best, weak.
METHODS: We searched thirteen electronic databases for potentially eligible papers published in English up to December 2023. Studies were included if they reported on patient outcomes associated with nurse staffing within emergency departments. Observational, cross-sectional, prospective, retrospective, interrupted time-series designs, difference-in-difference, randomised control trials or quasi-experimental studies and controlled before and after studies study designs were considered for inclusion. Team members independently screened titles and abstracts. Data was synthesised using a narrative approach.
RESULTS: We identified 16 papers for inclusion; the majority of the studies (n = 10/16) were observational. The evidence reviewed identified that poorer staffing levels within emergency departments are associated with increased patient wait times, a higher proportion of patients who leave without being seen and an increased length of stay. Lower levels of nurse staffing are also associated with an increase in time to medications and therapeutic interventions, and increased risk of cardiac arrest within the emergency department.
CONCLUSION: Overall, there remains limited high-quality empirical evidence addressing the association between emergency department nurse staffing and patient outcomes. However, it is evident that lower levels of nurse staffing are associated with adverse events that can result in delays to the provision of care and serious outcomes for patients. There is a need for longitudinal studies coupled with research that considers the relationship with skill-mix, other staffing grades and patient outcomes as well as a wider range of geographical settings.
TWEETABLE ABSTRACT: Lower levels of nurse staffing in emergency departments are associated with delays in patients receiving treatments and poor quality care including an increase in leaving without being seen, delay in accessing treatments and medications and cardiac arrest.
PMID:38447488 | DOI:10.1016/j.ijnurstu.2024.104706
Tout a été écrit pour expliquer la difficulté d’attirer et de fidéliser les talents : manque de sens, dédain à l’égard de l’effort, instabilité structurelle... Pourtant, d’autres pistes peuvent être avancées : d’une part, les critères d’attractivité changent; d’autre part, les salariés s’inscrivent dans des tactiques de carrière spécifiques. Nous assistons à une véritable rupture : celle du basculement des demandeurs d’emploi en offreurs de travail à certaines conditions.
La situation sur le marché de l’emploi est de plus en plus tendue. Les raisons invoquées sont, entre autres, démographiques et conjoncturelles. Dans de nombreux secteurs d’activité, la pénurie fait rage. Pour les entreprises, le problème est d’abord quantitatif. Les bassins d’emplois ne proposent pas toujours un vivier de main-d’œuvre qualifiée. Le problème est classique pour les cols bleus dans les zones rurales et devient prégnant pour les cols blancs dans les grands centres urbains, ce qui est nouveau.
Ce problème d’ordre quantitatif se double maintenant d’un problème davantage qualitatif. Même là où les candidats ne manquent pas, ce sont les candidatures qui font défaut. La rareté des postulants surprend les entreprises, que les crises successives et le maintien d’un taux de chômage élevé ont habituées à trouver facilement les forces vives dont elles ont besoin. Dans cette chasse aux candidats, l’attractivité des emplois et des employeurs devient une clé concurrentielle fondamentale.
Qu’est-ce que l’attractivité?
Comme le font les instituts de sondage, les sociétés de conseil et de services RH tentent régulièrement de classer les différents leviers d’attractivité. Leurs enquêtes, qui mobilisent des critères voisins, étonnent cependant par leur variabilité : l’ordre des critères évoqués par les personnes interrogées – rémunération, ambiance de travail, perspectives d’avancement, équilibre entre vie privée et vie professionnelle, flexibilité – semble conjoncturel et assez instable.
Les critères retenus dans ces sondages peuvent être remis en question : majoritairement extrinsèques (rémunération, équilibre travail-famille), ils renvoient une image mercenaire des candidats et prennent peu en compte les aspects intrinsèques du travail. En suggérant des leviers efficaces communs à tous les candidats, ces études incitent les entreprises à se présenter selon les mêmes critères, sans toujours s’assurer que ces derniers soient représentatifs de leurs pratiques réelles. L’attractivité devient alors une question de communication d’une image employeur en harmonie avec les attentes du marché.
De son côté, la littérature scientifique aborde plutôt la question en analysant les déclencheurs de l’intention de postuler. L’adéquation entre les caractéristiques des emplois et celles des individus semble alors être la raison de postuler. Pourtant, les candidats manquent d’informations pour analyser si cette adéquation est possible ou non : l’âpreté de la concurrence, les critères de jugement des recruteurs, la culture organisationnelle ou les réalités du poste à pourvoir, entre autres, leur sont inconnus. Le choix de postuler est donc fait d’anticipations de ces jugements. Comment, alors, réinscrire la compréhension de ces comportements dans leur réalité, plutôt que dans une modélisation abstraite? Comment enrichir la perspective classique qui réduit l’attractivité à une adéquation entre préférences et comment prendre en compte les dimensions intrinsèques attachées au travail, mais aussi à la gestion de l’organisation?
Que recherche-t-on chez un nouvel employeur?
Pour mieux comprendre ce qui se cache derrière les changements d’emploi, nous avons questionné 1155 salariés qui ont choisi un nouveau poste en 2022 et 137 étudiants qui s’apprêtent à faire des choix professionnels. Outre l’échantillon très ciblé, l’originalité de cette recherche réside aussi dans les critères considérés (38 au total), issus tant de la littérature scientifique en psychologie, en gestion et en sociologie que des enquêtes traditionnelles. Mais nous avons également pris en compte les facteurs liés au management humain, comme la bienveillance (le respect de la dignité humaine), la reconnaissance et la qualité du management.
Le management humain est une proposition qui répond aux critiques formulées à l’égard de la gestion traditionnelle des ressources humaines, qui aurait tendance à instrumentaliser les personnes (vues comme des ressources, des équivalents temps plein, des heures de travail, des indices de productivité, etc.). Or, de nos jours, cette tendance à l’objectivation et à l’hyperindividualisation passe mal. En effet, les travailleurs, gestionnaires compris, cherchent davantage de sens dans leur travail. Celui-ci passe par le respect de leur dignité, mais aussi par l’écho de leur «voix» dans la prise de décision. Les personnes s’attendent à être considérées et entendues, pas seulement à être rétribuées pour leur performance. Le modèle du management humain repose sur une anthropologie réflexive. Il fait de la reconnaissance sa finalité première et du travail réel son objet principal1.
Les résultats de la recherche que nous avons menée montrent d’abord que les critères d’attractivité les plus efficaces sont la bienveillance, l’équilibre travail-vie privée, l’ambiance de travail, la nature du travail, la qualité du management et la reconnaissance. C’est, en soi, la manifestation d’une rupture par rapport aux enquêtes classiques. Au-delà de la rétribution, c’est la qualité du management qui est mise de l’avant. Dans un contexte où la recherche de sens semble particulièrement explicite, notre analyse démontre que cette quête existe non seulement dans le travail (sa nature, son intérêt), mais aussi – et surtout – au sein de l’organisation. La qualité du management, bienveillance et reconnaissance en tête, permet ici même de traduire cette quête de sens.
Notre analyse montre aussi que l’employabilité des candidats peut influer sur certains facteurs d’attractivité. Les facteurs relatifs au sens du travail (bienveillance, qualité du management, reconnaissance, éthique, nature du travail) attirent les candidats dont l’employabilité est forte et qui ont donc la possibilité de choisir un employeur capable de répondre à ces critères. Des critères liés aux perspectives en matière de progression attirent des candidats qui cherchent à développer davantage leur employabilité. Enfin, des critères d’attractivité comme le salaire, la flexibilité ou la sécurité d’emploi attirent des individus dont l’employabilité est plus faible et qui recherchent avant tout un emploi.
Les choix de postuler révèlent donc ce que nous appelons des «tactiques de carrière» : accéder à un emploi avant tout pour certains, se développer pour d’autres et rejoindre un idéal pour les mieux dotés en employabilité (voir le tableau ci-dessous). Tout comme de mêmes critères d’attractivité peuvent alimenter des tactiques de carrière différentes (c’est le cas, par exemple, de l’intérêt du travail et de pratiques de flexibilité spatio-temporelle), ces tactiques se relaient en cours de carrière, au gré de l’évolution du rapport au travail2. En d’autres termes, on peut osciller entre une tactique d’employabilité et une tactique d’emploi, ou encore une tactique de sens et d’employabilité, et ce, tout au long de son parcours professionnel.
| La plupart des critères d’attractivité plébiscités par les travailleurs se rattachent au sens du travail. Cet élément marque une rupture à plusieurs égards. D’abord, les chercheurs d’emploi placent dorénavant ce critère tout en haut de leur liste d’exigences. La brutale «guerre des talents», qui consiste à marchander les conditions de travail et de rémunération pour convaincre un candidat de choisir son entreprise, ne permet donc pas de répondre à ces attentes. C’est plutôt le management qui semble clairement en mesure d’attirer – ou de repousser – lesdits talents. Bienveillance, qualité du management, reconnaissance, éthique et qualité de la direction sont autant de dimensions liées à un certain style de management. On ne veut pas d’un management «froid» et désincarné, celui de la mesure et de l’objectivation, mais bien d’un management incarné, respectueux et bienveillant auquel se réfère le management humain, parmi d’autres aspects qui ont pour point commun de remettre la dimension collective du travail au centre de l’action organisationnelle. Petit bémol à ce résultat : les candidats ne sont pas tous égaux devant un emploi. Choisir une entreprise bienveillante et humaine n’est malheureusement pas à la portée de toutes les personnes et varie selon leur degré d’employabilité. 2 - Deuxième constatCes critères s’inscrivent dans des tactiques de carrière qui sont spécifiques, non seulement en fonction de l’employabilité des personnes, mais aussi selon leur parcours professionnel, qui est indissociable du rapport au travail et du parcours de vie. 3 - Troisième constatLoin de ne constituer qu’une question de communication, l’attractivité met en lumière l’importance de la qualité du management et de sa capacité perçue, aujourd’hui, à répondre à un besoin d’éthique et de reconnaissance qui ne correspond pas seulement à un besoin individuel à combler, mais aussi à un besoin collectif. Et c’est justement de cette perspective que tient compte le management humain. |
Article publié dans l’édition Printemps 2024 de Gestion
Notes
1 - Letarte, M., «Gérer des humains et non des ressources», Gestion HEC Montréal, vol. 48, n°1, 2023, p. 32-35.
2 - Le rapport au travail est le résultat d’une négociation permanente entre des normes familiales, professionnelles et organisationnelles dont l’importance respective varie au gré du temps et des événements. Voir, à ce sujet, Laurent, M.-E., Taskin, L., et Ughetto, P., «Une rupture dans le rapport au travail? La pandémie de COVID-19 et les temporalités de gestion de leur parcours par les salariés», Revue internationale de psychosociologie et de gestion des comportements organisationnels, n°73, 2022, p. 63-83.
image/jpg 74_attraction_1200.jpg
Hospital medicine (HM) services are ubiquitous in acute care hospitals. A wide variety of HM team structures, with differing combinations of residents, advanced practice providers (APPs), and attending physicians, sometimes within the same hospital, are employed in delivering care. It is not known which team structure or structures optimize quality of care. In “Comparison of Hospitalist Service Staffing Models at Baylor University Medical Center,” Raver et al performed a retrospective cohort study to determine the impact of different staffing models for HM teams at a 900-bed quaternary hospital.1 Their study sought to tease out how team structures that include differing combinations of residents, APPs, and physician hospitalists influence a wide variety of clinical and operational outcomes, including length of stay, total hospital charges, 30-day readmission rates, patient satisfaction, hospital-acquired infections, mortality, and early discharges.
Overall, during the 5-month period that was studied, mortality, patient satisfaction, and hospital-acquired infections were the same among all groups. Similar to previous research in this field, they found that resident teaching teams had the shortest length of stay2,3 and a younger patient population. In contrast, the independent APP teams discharged patients earlier but had higher readmission rates. From this, the authors concluded that the continuity of care and lower patient-to-clinician ratios positively impacted care. This interesting and comprehensive study is of interest to leaders and practice administrators of both hospitals and HM groups as they seek to balance improved outcomes and patient care with the ever-present constraints of staffing availability and financial uncertainty endemic to the US health care system.
While this study informs HM service design with respect to team structures, recent research has explored how various physician characteristics, including gender,4 age,5 medical school,6 language concordance,7 and even racial concordance8 may impact clinical outcomes. Combining the previous research on physician characteristics with Raver et al’s study of team composition leads us toward the holy grail of identifying which team structures and blend of personal characteristics result in optimal performance.
Outside of health care, businesses have long been interested in the characteristics of high-performing teams. Everything from relative similarity of educational backgrounds to gender mix, amount of socializing outside of work, balance of personality types, to similarity (or lack thereof) of hobbies has been explored. Prior research by the McKinsey group9 and others10 has demonstrated that both racial and ethnic diversity as well as gender diversity result in a higher likelihood of companies outperforming financial goals. More recently, Google’s Aristotle Project was formed to determine the characteristics of their highest-performing teams. Surprisingly, they found that none of the personal or group characteristics influenced team performance.10,11 However, they did find that psychological safety, or “a sense of confidence that the team will not embarrass, reject, or punish someone for speaking up,” was the team characteristic most highly correlated with exceeding goals.11
The limitations of this study highlight the challenges of this line of research in health care. First, it looked only at same-hospital, 30-day readmission rates. As this hospital is located in a large urban setting, this omits data on patients who might have presented to other area hospitals. In fact, patients who may have had the worst outcomes may have intentionally requested or chosen to be readmitted to another hospital. Second, outcomes are attributed to the discharging physician. Depending on schedule and time of admission, patients typically are treated by multiple physicians during a hospital stay. Accordingly, the discharging physician may have cared for the patient only on the day of discharge, and most of the costs or burdens for length of stay would have been accrued previously in the hospital stay. Attributing care outcomes, such as length of stay, costs, and experience, is challenging, whether for operational or research purposes. While the assumption may be that because hospitalists rotate through most or all of the services, this effect is negligible, examining the truth of this would be beneficial. Therefore, future iterations of this research might seek to describe how often each physician and APP is on or covers each type of service. This might elucidate data that identifies rounding styles that enhance efficiency and throughput or improve outcomes.
Additionally, with regard to outcomes on teaching teams, one avenue of thought may be that length of stay is shorter on teaching teams because the bolus pattern of admissions on call days incentivizes discharges, whereas the drip system on HM teams discourages it. This has been posited previously, but was refuted by Szecket et al in their crossover study of a change from a bolus system to a drip or “trickle” system.12 In future studies, it would be informative to examine the pattern of discharges on both types of services to understand the impact of differing admission patterns. Similarly, as continuity of care in this study was thought to shorten the length of stay, there is continued interest in best practices for scheduling in HM to balance patient care and outcomes with physician longevity and burnout.
In summary, this study provides interesting insight into outcomes with varying HM team structures and workflows in one hospital. While one size does not fit all, further research may help to identify optimal HM team staffing structures and scheduling patterns. Moreover, as the field evolves, social networks, cultural influences, personality mixes, and other social-dynamic aspects of teams may also be explored.
1. Raver C, Bunker J, Caldwell M, et al.. Comparison of hospitalist service staffing models at Baylor University Medical Center. Proc (Bayl Univ Med Cent). 2023;37(1):1–8. doi: 10.1080/08998280.2023.2260671. [CrossRef] [Google Scholar]
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12. Szecket N, Wong HJ, Wu RC, Berman HD, Morra D.. Implementation of a continuous admission model reduces the length of stay of patients on an internal medicine clinical teaching unit. J Hosp Med. 2012;7(1):55–59. doi: 10.1002/jhm.926. [PubMed] [CrossRef] [Google Scholar]
J Hosp Med. 2023 Dec 26. doi: 10.1002/jhm.13267. Online ahead of print.
NO ABSTRACT
PMID:38146815 | DOI:10.1002/jhm.13267
Cureus. 2023 Oct 18;15(10):e47275. doi: 10.7759/cureus.47275. eCollection 2023 Oct.
ABSTRACT
Amid the global nursing shortage, artificial intelligence (AI) offers a solution to align patient needs with nursing expertise, ensuring equitable workload distribution. Highlighting the transformative potential of artificial intelligence in healthcare, this editorial underscores its revolutionary impact on nursing staffing. By leveraging AI, we can enhance patient outcomes and operational efficiency and reduce staff burnout. However, challenges like data security and job stability arise. It is pivotal to emphasize its optimal integration, engaging nurses in decision-making, rigorous training, and prioritizing data security. This holistic approach ensures that contemporary healthcare practices benefit from AI's capabilities while upholding core values.
PMID:38021626 | PMC:PMC10655932 | DOI:10.7759/cureus.47275
Front Pediatr. 2023 Nov 1;11:1271730. doi: 10.3389/fped.2023.1271730. eCollection 2023.
ABSTRACT
AIM: Infants and children who require specialized medical attention are admitted to neonatal and pediatric intensive care units (ICUs) for continuous and closely supervised care. Overnight in-house physician coverage is frequently considered the ideal staffing model. It remains unclear how often this is achieved in both pediatric and neonatal ICUs in Canada. The aim of this study is to describe overnight in-house physician staffing in Canadian pediatric and level-3 neonatal ICUs (NICUs) in the pre-COVID-19 era.
METHODS: A national cross-sectional survey was conducted in 34 NICUs and 19 pediatric ICUs (PICUs). ICU directors or their delegates completed a 29-question survey describing overnight staffing by resident physicians, fellow physicians, nurse practitioners, and attending physicians. A comparative analysis was conducted between ICUs with and without in-house physicians.
RESULTS: We obtained responses from all 34 NICUs and 19 PICUs included in this study. A total of 44 ICUs (83%) with in-house overnight physician coverage provided advanced technologies, such as extracorporeal life support, and included all ICUs that catered to patients with cardiac, transplant, or trauma conditions. Residents provided the majority of overnight coverage, followed by the Critical Care Medicine fellows. An attending physician was in-house overnight in eight (15%) out of the 53 ICUs, seven of which were NICUs. Residents participating in rotations in the ICU would often have rotation durations of less than 6 weeks and were often responsible for providing care during shifts lasting 20-24 h.
CONCLUSION: Most PICUs and level-3 NICUs in Canada have a dedicated in-house physician overnight. These physicians are mainly residents or fellows, but a notable variation exists in this arrangement. The potential effects on patient outcomes, resident learning, and physician satisfaction remain unclear and warrant further investigation.
PMID:38027260 | PMC:PMC10646373 | DOI:10.3389/fped.2023.1271730
AACN Adv Crit Care. 2023 Dec 15;34(4):334-342. doi: 10.4037/aacnacc2023719.
ABSTRACT
A pediatric tele-critical care nursing program provides an extra layer of surveillance for patients and alerts bedside nurses of abnormal trends to mitigate adverse events. Although workforce turnover combined with patient complexity and acuity in a pediatric cardiac intensive care unit strains the sustainability of a healthy work environment, these variables have also opened the door to an innovative approach to tele-critical care nursing care delivery. In addition to virtual surveillance, a clinical bedside intervention was developed to provide hands-on assistance to bedside nurses. This article describes the evolution of this novel technique for enhancing nursing care delivery.
PMID:38033215 | DOI:10.4037/aacnacc2023719
MCN Am J Matern Child Nurs. 2024 Jan-Feb 01;49(1):59. doi: 10.1097/NMC.0000000000000974.
NO ABSTRACT
PMID:38047608 | DOI:10.1097/NMC.0000000000000974
J Intensive Care. 2023 Dec 4;11(1):60. doi: 10.1186/s40560-023-00708-w.
ABSTRACT
BACKGROUND: Japan has four types of intensive care units (ICUs) that are divided into two categories according to the management fee charged per day: ICU management fees 1 and 2 (ICU1/2) (equivalent to high-intensity staffing) and 3 and 4 (ICU3/4) (equivalent to low-intensity staffing). Although ICU1/2 charges a higher rate than ICU3/4, no cost-effectiveness analysis has been performed for ICU1/2. This study evaluated the clinical outcomes and cost-effectiveness of ICU1/2 compared with those of ICU3/4.
METHODS: This retrospective observational study used a nationwide Japanese administrative database to identify patients admitted to ICUs between April 2020 and March 2021 and divided them into the ICU1/2 and ICU3/4 groups. The ICU mortality rates and in-hospital mortality rates were determined, and the incremental cost-effectiveness ratio (ICER) (Japanese Yen (JPY)/QALY), defined as the difference between quality-adjusted life year (QALY) and medical costs, was compared between ICU1/2 and ICU3/4. Data analysis was performed using the Chi-squared test; an ICER of < 5 million JPY/QALY was considered cost-effective.
RESULTS: The ICU1/2 group (n = 71,412; 60.7%) had lower ICU mortality rates (ICU 1/2: 2.6% vs. ICU 3/4: 4.3%, p < 0.001) and lower in-hospital mortality rates (ICU 1/2: 6.1% vs. ICU 3/4: 8.9%, p < 0.001) than the ICU3/4 group (n = 46,330; 39.3%). The average cost per patient of ICU1/2 and ICU3/4 was 2,249,270 ± 1,955,953 JPY and 1,682,546 ± 1,588,928 JPY, respectively, with a difference of 566,724. The ICER was 718,659 JPY/QALY, which was below the cost-effectiveness threshold.
CONCLUSIONS: ICU1/2 is associated with lower ICU patient mortality than ICU3/4. Treatments under ICU1/2 are more cost-effective than those under ICU3/4, with an ICER of < 5 million JPY/QALY.
PMID:38049894 | DOI:10.1186/s40560-023-00708-w
PLoS One. 2023 Dec 14;18(12):e0295213. doi: 10.1371/journal.pone.0295213. eCollection 2023.
ABSTRACT
BACKGROUND: Health system performance depends on the availability, accessibility, acceptability, and quality of health workforces. Policymakers seek whether the number of nurses is optimally matched based on patients' needs. This study aimed to assess the workforce stock, workload activities, activity standards, and workload pressure to determine the number of required nurses in different types of hospitals in Iran.
METHODS: This study applied the workload indicators of staffing needs (WISNs) method and was conducted in 22 surgical and internal medicine wards at five hospitals in the southwest of Iran during six months. A time-motion study, and several group discussions, interviews were used to extract the required data. Descriptive statistics were used for data analysis.
RESULTS: All selected hospitals faced nursing shortages. The highest shortage (-47) and workload pressure (WISN ratio 0.45) were observed in the general-educational hospitals. In the specialized hospitals, the workload pressure was high (WISN ratio 0.49). The lowest shortage belonged to the private hospital. Based on our assessment, in all of the hospitals, nurses typically worked overtime due to high workload. The studied hospitals covered an average of 25% of their shortage with nursing overtime working. We noted that nurses were predominantly occupied with health service and supportive activities (≈90% of their time).
CONCLUSIONS: Based on the WISN method, all of the hospitals faced nursing shortages from moderate to high. However, it would be essential to consider current labor market analysis based on accurate data to adopt appropriate policies in HRH planning.
PMID:38096308 | DOI:10.1371/journal.pone.0295213
Montréal, 25 octobre 2023 – Au Québec, le taux d'activité des 60 à 69 ans sur le marché de l’emploi atteignait 39 % en 2021 alors qu’il était de 46 % en Ontario et de 44 % dans l’ensemble du Canada. Avec de bons outils en main, les organisations pourront faire évoluer leurs façons de faire à l’égard de ces travailleurs et travailleuses et ainsi espérer réduire cet écart. C’est le pari que fait l’Ordre des conseillers en ressources humaines agréés (CRHA), qui dévoile aujourd’hui une trousse d'outils inédits pour aider les employeurs à retenir ou attirer et intégrer du personnel expérimenté. La trousse a été conçue avec la participation financière du gouvernement du Québec.
« Il s’agit d’une excellente initiative de l’Ordre des CRHA à laquelle nous sommes fiers de participer. Il est important de créer des conditions gagnantes pour attirer et retenir les travailleurs et travailleuses expérimentés sur le marché du travail. Ce sont des personnes-ressources précieuses qui contribuent notamment à former la relève en jouant un rôle de mentor. Cette trousse, destinée aux entreprises, leur sera très certainement bénéfique! », soutient Kateri Champagne Jourdain, ministre de l‘Emploi et ministre responsable de la région de la Côte-Nord.
« Dans un marché du travail où la main-d’œuvre demeure rare malgré le ralentissement actuel, c’est avec toutes les contributions que les entreprises pourront réussir et prospérer. Le personnel expérimenté apporte des compétences clés telles que l'autonomie, la loyauté, le bon jugement et la fiabilité. Retenir ces travailleurs et travailleuses au sein d’une organisation s’avère non seulement stratégique, mais également financièrement avantageux, avec des économies potentiellement substantielles sur les coûts de recrutement ou de formation de nouveaux employés », commente la directrice générale de l’Ordre, Manon Poirier, CRHA.
Une trousse bien garnie
La trousse développée par l’Ordre regroupe trois vidéos informationnelles ainsi qu’une dizaine d’outils qui aideront les entreprises à s’orienter dans la rétention, le recrutement, l’accueil et l’intégration des travailleuses et travailleurs d’expérience. Parmi les titres des outils, mentionnons :
- Recruter du personnel d’expérience : par où commencer?
- Comment inciter votre personnel d’expérience à revenir sur le marché du travail?
- Retour à l’emploi d’une personne d’expérience : comment bien l’accompagner?
- Comment mobiliser votre personnel d’expérience?
- Vos politiques de gestion protègent-elles votre personnel d’expérience contre l'âgisme?
- Rédiger un contrat de travail pour un travailleur expérimenté
« Les organisations ont tout avantage à valoriser l’apport du personnel d’expérience. Riches de leurs compétences et de leur diversité, ces travailleurs et travailleuses favorisent le maintien de précieux réseaux de contacts, jouent souvent un rôle clé dans le transfert des connaissances à la relève et confortent la crédibilité d’une entreprise, contribuant ainsi à renforcer la culture organisationnelle », conclut Manon Poirier.
Pour accéder gratuitement à la trousse complète d'outils sur le recrutement, l'intégration et le soutien du personnel expérimenté, cliquez ici.
À propos de l’Ordre
Regroupant 12 000 professionnelles et professionnels agréés, l’Ordre des conseillers en ressources humaines agréés est la référence en matière de pratiques de gestion des RH. Il assure la protection du public et contribue à l’avancement des CRHA | CRIA. Par ses interventions publiques, il exerce un rôle majeur d’influence dans le monde du travail au Québec. L’Ordre participe ainsi activement au maintien de l’équilibre entre la réussite des organisations et le bien-être de la main-d'œuvre. Pour en savoir plus, visitez ordrecrha.org.
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Patrick Leblanc Conseiller, affaires publiques Ordre des conseillers en ressources humaines agréés Cell. : 514 571-6400 [email protected]
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Today’s leaders are pushing to increase employee engagement and decrease turnover but face a harsh reality: widespread employee burnout. To fight it, managers need to offer employees more healthy and meaningful work. In surveys conducted in the United States by Gallup in 2022, 40% of employees reported that their job had a negative impact on their mental health, and around 30% said they frequently experience burnout. Moreover, U.S. employee engagement hit a seven-year low, with only 32% of workers polled by Gallup saying they were engaged and 17% saying they were actively disengaged in 2022.1 Globally, employees’ lack of engagement has been estimated to cost employers $7.8 trillion — equivalent to 11% of the global gross domestic product.2
The root causes of disengagement and work stress often lie in how an organization has designed people’s jobs. Decades of extensive research consistently link poor work design with negative employee outcomes, including mental strain, high turnover, job dissatisfaction, decreased productivity, and impaired learning.3 Many companies are now striving to do better.
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Unfortunately, our research indicates that many managers lack the necessary understanding to design high-quality jobs. This is where artificial intelligence technologies such as ChatGPT could play a key role, by bridging the manager knowledge gap and helping design high-quality work that benefits both employees and organizations. However, it is important for managers to first understand the pros and cons of using ChatGPT for work design. Let’s explore some takeaways for managers that our research has revealed.
Managerial Challenges: Mundane and Unfulfilling Jobs
What factors determine whether a job is high quality? The SMART work design model, a framework created by Sharon K. Parker, defines high-quality work as work that is stimulating (jobs with task variety and a chance to develop new skills), incorporates mastery (such as role clarity and job feedback), is agentic (such as job autonomy and change participation), is relational (where social support and positive teamwork are available), and is tolerable (with manageable work hours and reasonable levels of time pressure).4
Despite the benefits of well-designed jobs, poorly designed ones are still prevalent. According to the Gallup 2019 Great Jobs Survey, only 40% of employed Americans are engaged in jobs that possess SMART characteristics.
Fangfang Zhang, Ph.D., is a research fellow at the Centre for Transformative Work Design at Curtin University. She is also a CEPAR (Centre of Excellence in Population Ageing Research) research fellow. Her research interests include work design, job crafting, future of work, overqualification, and aging. Sharon K. Parker is a John Curtin Distinguished Professor at Curtin University, an Australian Research Council laureate fellow, and director of the Centre for Transformative Work Design. She is a fellow of the Australian Academy of Social Science and the Society for Industrial and Organisational Psychology. She is the creator of the SMART model and cofounder of the Thrive at Work initiative.
1. B. Wigert and R. Pendell, “6 Trends Leaders Need to Navigate This Year,” Jan. 31, 2023, Gallup, www.gallup.com.
2. Ibid.
3. S.K. Parker, “Beyond Motivation: Job and Work Design for Development, Health, Ambidexterity, and More,” Annual Review of Psychology 65 (January 2014): 661-691.
4. S.K. Parker, “Smart Work Design,” Safeguard, May/June 2022, 50-53.
5. J. Rothwell and S. Crabtree, “Not Just a Job: New Evidence on the Quality of Work in the United States,” PDF file (Washington, D.C.: Gallup, 2019), www.gallup.com.
6. Ibid.
7. S.K. Parker, D.M. Andrei, and A. Van den Broeck, “Poor Work Design Begets Poor Work Design: Capacity and Willingness Antecedents of Individual Work Design Behavior,” Journal of Applied Psychology 104, no. 7 (July 2019): 907-928.
Tags:
Artificial Intelligence Employee Engagement Generative AI image/jpg Parker-2400x1260-1-1200x630.jpgBMC Health Serv Res. 2023 Oct 25;23(1):1147. doi: 10.1186/s12913-023-10143-0.
ABSTRACT
INTRODUCTION: Strategies to achieve efficiency in non-operating room locations have been described, but emergencies and competing priorities in a birth unit can make setting optimal staffing and operation benchmarks challenging. This study used Queuing Theory Analysis (QTA) to identify optimal birth center operating room (OR) and staffing resources using real-world data.
METHODS: Data from a Level 4 Maternity Center (9,626 births/year, cesarean delivery (CD) rate 32%) were abstracted for all labor and delivery operating room activity from July 2019-June 2020. QTA has two variables: Mean Arrival Rate, λ and Mean Service Rate µ. QTA formulas computed probabilities: P0 = 1-(λ/ µ) and Pn = P0 (λ/µ)n where n = number of patients. P0…n is the probability there are zero patients in the queue at a given time. Multiphase multichannel analysis was used to gain insights on optimal staff and space utilization assuming a priori safety parameters (i.e., 30 min decision to incision in unscheduled CD; ≤ 5 min for emergent CD; no greater than 8 h for nil per os time). To achieve these safety targets, a < 0.5% probability that a patient would need to wait was assumed.
RESULTS: There were 4,017 total activities in the operating room and 3,092 CD in the study period. Arrival rate λ was 0.45 (patients per hour) at peak hours 07:00-19:00 while λ was 0.34 over all 24 h. The service rate per OR team (µ) was 0.87 (patients per hour) regardless of peak or overall hours. The number of server teams (s) dedicated to OR activity was varied between two and five. Over 24 h, the probability of no patients in the system was P0 = 0.61, while the probability of 1 patient in the system was P1 = 0.23, and the probability of 2 or more patients in the system was P≥2 = 0.05 (P3 = 0.006). However, between peak hours 07:00-19:00, λ was 0.45, µ was 0.87, s was 3, P0 was 0.48; P1 was 0.25; and P≥2 was 0.07 (P3 = 0.01, P4 = 0.002, P5 = 0.0003).
CONCLUSION: QTA is a useful tool to inform birth center OR efficiency while upholding assumed safety standards and factoring peaks and troughs of daily activity. Our findings suggest QTA is feasible to guide staffing for maternity centers of all volumes through varying model parameters. QTA can inform individual hospital-level decisions in setting staffing and space requirements to achieve safe and efficient maternity perioperative care.
PMID:37875897 | DOI:10.1186/s12913-023-10143-0
Vous vous intéressez à l’équité, la diversité et l’inclusion (EDI) pour votre organisation. Vous avez pensé à créer un sondage d’auto-identification, vous avez organisé des discussions de groupes pour mieux comprendre vos employés et vous avez identifié les points à travailler et les groupes sous-représentés. Bravo! Mais vous êtes-vous également questionné sur les différentes générations présentes dans votre organisation et sur ce que vous pourriez faire pour favoriser la collaboration? Si ce n’est pas le cas, vous allez probablement devoir vous y pencher et peut-être plus tôt que prévu!
La population canadienne vieillit de plus en plus. Les millénariaux deviendront la génération prédominante au Canada d’ici 2026. Fait intéressant : nous avons actuellement quatre générations de personnes dans nos entreprises en même temps. La main-d’œuvre multigénérationnelle va donc devenir très rapidement essentielle à la croissance des entreprises, mais celles-ci semblent encore rarement inclure la diversité intergénérationnelle dans leurs récentes initiatives d’équité, diversité et inclusion.
Afin de vous aiguiller sur la voie du changement, voici quelques pistes de réflexion pour améliorer la diversité et l’inclusion intergénérationnelles au sein de votre organisation.
Promouvoir la flexibilité
Les entreprises peuvent soutenir les employés qui ont dépassé l’âge traditionnel de la retraite en réorientant leurs stratégies de recrutement vers le maintien à l’emploi. Certaines entreprises mettent notamment en place de nouvelles mesures de soutien pour la ménopause ou des «congés des grands-parents», comme dans l’entreprise CISCO, pour retenir les talents plus âgés.
Le travail flexible est également un moyen de soutenir les employés de tous les âges. En effet, il peut être décidé d’implanter le travail exclusivement à distance ou hybride, ou d’offrir des semaines de travail raccourcies ou des horaires variables pour répondre à des besoins personnels ou familiaux. Les employés seront également incités à rester dans l’entreprise par l’instauration de programmes de retraite progressive, par exemple. L’objectif est de comprendre et reconnaître l’importance des intérêts hors du travail des individus et de leur donner les moyens pour qu’ils soient en mesure de coordonner harmonieusement leurs emplois du temps personnels et professionnels.
Comprendre les différentes générations
Chaque génération a ses propres valeurs, croyances et styles de travail. Déchiffrer ces différences et leurs caractéristiques uniques rendra la communication et la collaboration plus efficaces. Cela vous permet également d’adapter votre approche managériale à chaque employé. Pour en apprendre davantage sur les différences entre les baby-boomers, la génération X, les millénariaux et la Gen Z, nous vous conseillons la lecture de cet article.
Encourager du mentorat bilatéral
Créer un cadre de mentorat bilatéral permet d’optimiser le potentiel d’une relation dans laquelle les deux personnes reconnaissent ce qu’elles peuvent apporter, mais aussi ce qu’elles peuvent apprendre. Plutôt que d’avoir une personne plus expérimentée qui transmet de façon unidirectionnelle ses savoirs à une autre, ce qui correspond souvent au jumelage traditionnel, ce format admet que la personne mentorée a des expériences à partager avec le mentor et que ce dernier se trouverait aussi en situation d’apprentissage. Dans une perspective inclusive, cette pratique contribue à enrichir la réflexion, à déconstruire des biais et à susciter de l’empathie.
Être à l’aise de gérer des employés plus âgés que soi
Identifiez et récompensez les gestionnaires à l’aise d’embaucher et de gérer des employés plus âgés qu’eux. La conscience de soi nécessaire à l’engagement de salariés dont les compétences ou l’expertise font défaut est indispensable à la réalisation des objectifs de l’équipe, et elle l’est encore plus dans un contexte de pénurie de main-d’œuvre. Les gestionnaires suffisamment courageux pour intégrer des employés de l’âge de leurs propres parents à leurs équipes devraient être félicités. Les employés prêts à accepter cette configuration et à participer à son bon fonctionnement devraient l’être tout autant.
Offrir des formations
Chaque membre des différentes générations a un niveau d’expertise particulier en matière de technologie ou dans la façon d’aborder des tâches. La mise à disposition de formations et de ressources peut combler ces lacunes et éviter quelques incompréhensions mutuelles. Évidemment, il faut faire preuve de vigilance et ne pas tomber dans des clichés comme «jeunes = innovation» et autres «OK, boomers» de ce monde!
Faire évoluer les mentalités est une ambition considérable, particulièrement dans une organisation. Les employés plus âgés pourraient croire que la jeune génération est paresseuse et privilégiée. Cette jeune génération pourrait quant à elle penser que les membres «vétérans» de l’équipe sont ignorants et dépassés. C’est à vous, en tant que gestionnaire, de lutter contre ces stéréotypes générationnels et d’agir en leader positif en donnant l’exemple. Soyez prêts à faire preuve d’humilité en prenant conscience des préjugés que vous pourriez avoir afin d’inspirer les autres à surmonter les leurs.