Nursing
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Item Gender and the profile of International Nurses in the UK.(Harvard University Press, 2007) Buchan, James; Reichenbach, LauraItem Evaluating the impact of a new pay agreement on New Zealand nursing(Wiley-Blackwell, 2009) Buchan, James; North, N.Aim: This paper examines the labour market impact of a new national pay award for nurses implemented in New Zealand in 2004/5 - the Multi-Employer Collective Agreement (MECA). Background: The health system in New Zealand is unusual in that, while retaining a public sector system, the focus of pay determination for nurses over the last 20 years has shifted first from national to local pay determination, and then more recently reversed this trend, moving back to a national level pay determination. The shift back to a national pay determination approach in 2004/5 is therefore worthy of examination, both in terms of its labour market impact, and as a case study in the use of national level pay determination. Methods: The research was conducted in 2007-8. A rapid appraisal method was used, based on key stakeholder interviews, a document and literature review and a review and analysis of available data on the New Zealand nurse labour market, and trends in application rates to schools of nursing were assessed. In addition, interviews with managers of two District Health Boards, and interviews with five non-government employers of nurses, were conducted. Results: Indicators pointing to improvements included: steady (though not rapid) growth in staff numbers; reduced difficulty in recruiting; reduced vacancy rates; and increased application rates to schools of nursing. Managers interviewed in the study supported these positive indications, but some health-care employers not covered by the pay award reported negative knock-on effects (e.g. needing to match DHB rates, increased retention and recruitment difficulties). Conclusions: Available nurse labour market data provide an incomplete but compelling picture of the positive impacts of the MECA in a period of a very tight labour market. While much of the content of the 2004/5 agreement could be characterized as a 'normal' pay bargaining contract, there were also issues that differentiated it from the norm. In particular, it included an agreement to establish a safe staffing commission to assess the impact and implications of low staffing levels, nursing workload, and to establish guidelines on safe staffing and healthy workplaces. 2009 International Council of Nurses.Item Sinking feeling.(RCN Publishing, 2009-06-24) Buchan, JamesAs the pound's value plunges, more nurses want to leave the UK, and fewer want to arrive.Item The impact of health facilities on healthcare workers' well-being and performance(2009-07) Rechel, Bernd; Buchan, James; McKee, MartinThe impact of health facilities on patients has been extensively researched. Yet, while there is a growing recognition of the need for healthy working environments, little is known about how health facilities affect the staff working in them. This paper explores how the design of health facilities impacts on the well-being and performance of healthcare workers. The article is based on a review of published literature, identified through PubMed and Google, as well as through searches of websites of relevant organizations. Many traditionally designed health facilities seem to impact negatively on the well-being of healthcare workers, as well as on staff recruitment, retention and performance. Better-designed health facilities can improve working conditions and staff safety, and enable staff to do their job more efficiently. The needs of healthcare workers should be taken into account at the initial design stage of health facilities, ideally though direct involvement or meaningful consultation. 2008 Elsevier Ltd. All rights reserved.Item Assessing the impact of a new health sector pay system upon NHS staff in England(BioMed Central, 2008-06-30) Buchan, James; Evans, DavidBackground: Pay and pay systems are a critical element in any health sector human resource strategy. Changing a pay system can be one strategy to achieve or sustain organizational change. This paper reports on the design and implementation of a completely new pay system in the National Health Service (NHS) in England. 'Agenda for Change' constituted the largest-ever attempt to introduce a new pay system in the UK public services, covering more than one million staff. Its objectives were to improve the delivery of patient care as well as enhance staff recruitment, retention and motivation, and to facilitate new ways of working. Methods: This study was the first independent assessment of the impact of Agenda for Change at a local and national level. The methods used in the research were a literature review; review of 'grey' unpublished documentation provided by key stakeholders in the process; analysis of available data; interviews with key national informants (representing government, employers and trade unions), and case studies conducted with senior human resource managers in ten NHS hospitals in England Results: Most of the NHS trust managers interviewed were in favour of Agenda for Change, believing it would assist in delivering improvements in patient care and staff experience. The main benefits highlighted were: 'fairness', moving different staff groups on to harmonized conditions; equal pay claim 'protection'; and scope to introduce new roles and working practices. Conclusion: Agenda for Change took several years to design, and has only recently been implemented. Its very scale and central importance to NHS costs and delivery of care argues for a full assessment at an early stage so that lessons can be learned and any necessary changes made. This paper highlights weaknesses in evaluation and limitations in progress. The absence of systematically derived and applied impact indicators makes it difficult to assess impact and impact variations. Similarly, the lack of any full and systematic evaluation constrained the overall potential for Agenda for Change to deliver improvements to the NHS.Item International recruitment of nurses : United Kingdom case study(Queen Margaret University College, 2002-07) Buchan, James; World Health Organisation; International Council of NursesThis paper is based on research funded by the World Health Organisation, the International Council of Nurses and the Royal College of Nursing of the United Kingdom. Whilst the primary focus is on the UK, general lessons related to international recruitment and migration of nurses are also highlighted. There is general agreement amongst all stakeholders in the UK that nursing shortages have become a major factor constraining health care delivery in the National Health Service in the UK. In order to overcome these skills shortages, four areas of government initiative are underway: attracting more applicants to nurse education; encouraging returners to nursing employment; improving retention through improved career structures and flexible working practices; and recruiting nurses from abroad. NHS Plan targets for increased staffing have been one major factor in focusing attention on international recruitment. There has been a significant growth in the level on inflow of nurses from other countries to the UK. Registration data on annual admissions of nurses from non-UK sources shows a fivefold increase since the early 1990s. In 2000/01 a total of 9,694 initial entrants on the UK Register were from all overseas sources. This figure has risen to approximately 15,000 in 2001/02, which equates to almost half of all new nurses entering the UK Register in the year. Registration data highlights that a total of more than 30,000 new non-UK nurses have registered in the UK in the last three years. The Philippines, South Africa and Australia have been the main sources. The trend in significant growth of recruitment of nurses from non-EU countries has not been matched by any growth in inflow from the countries of the European Union. In recent years the EU has reduced in significance as a source of nurses entering the UK. The Department of Health in England issued guidance on ethical international recruitment practices in 1999 requiring NHS employers to avoid direct recruitment from designated countries such as South Africa and the West Indies. Registration data suggests that the 1999 guidelines may have had some short-term impact in reducing recruitment from South Africa and the Caribbean, but that this recruitment activity may have then been displaced to other developing countries. The Department has issued a strengthened Code for international recruitment in late 2001. The pull factor of meeting NHS Plan staffing targets is likely to mean that the UK, particularly England, will continue to be active in recruiting from international nursing labour markets, partly as a result of new targets having been set for 2008. UK government policy initiatives to increase the number of nursing students, and to improve retention and return rates, can have a positive effect. However, the growth in the number of UK nurses who can retire is likely to challenge the capacity of the NHS to retain the required numbers of nurses. When coupled with the likelihood of liberalisation of global labour markets, this points to a continuing high profile for the UK in international nursing labour markets.Item International recruitment of health professionals(BMJ Publishing Group Ltd, 2005-01-29) Buchan, JamesFor the United Kingdom, and some other developed countries, active international recruitment has become a solution to shortages of health professionals. issue of migration of health professionals has become an important feature of international health policy debate symbolised by the passing of a resolution at the World Health AssemblyItem Global nursing shortages(BMJ Publishing Group Ltd., 2002-03-30) Buchan, JamesNursing shortages in the United Kingdom and elsewhere have been a repetitive phenomenon, usually due to an increasing demand for nurses outstripping static or a more slowly growing supply. Demand continues to grow, while projections for supply point to actual reductions in the availability of nurses in some developed and developing countries.Item Nursing numbers in Britain : the argument for workforce planning(BMJ Publishing Group Ltd, 2000-04-15) Buchan, James; Edwards, NigelBritain has a serious shortage of nurses, as well as problems in recruiting and retaining them It is not simply that there are too few nurses; some key skills shortages also exist, with increasing demand for more qualified staff in some areas Much better planning of the workforce is required, and this needs to be more integrated with the planning for other groups in health care A change in the pay system may help, but the creation of better work environments may be part of the solution The rapid pace of change in the nursing profession has produced a challenge that the NHS needs to addressItem New Role, New Country: introducing US physician assistants to Scotland(BioMed Central, 2007-05-04) Buchan, James; O'May, Fiona; Ball, JaneThis paper draws from research commissioned by the Scottish Executive Health Department (SEHD). It provides a case study in the introduction of a new health care worker role into an already well established and mature workforce configuration It assesses the role of US style physician assistants (PAs), as a precursor to planned piloting of the PA role within the National Health Service (NHS) in Scotland. The evidence base for the use of PAs is examined, and ways in which an established role in one health system (the USA) could be introduced to another country, where the role is new and unfamiliar, are explored. The history of the development of the PA role in the US also highlights a sometimes somewhat problematic relationship between P nursing profession. The paper highlights that the concept of the PA role as a 'dependent practitioner' is not well understood or developed in the NHS, where autonomous practice within regulated professions is the norm. In the PA model, responsibility is shared, but accountability rests with the supervising physician. Clarity of role definition, and engendering mutual respect based on fair treatment and effective management of multi-disciplinary teams will be pre-requisites for effective deployment of this new role in the NHS in Scotland.