Nursing
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/24
Browse
56 results
Search Results
Item Tracking the leavers: Towards a better understanding of doctor migration from Ireland to Australia 2008–2018(BioMed Central, 2019-05-28) Humphries, Niamh; Connell, John; Negin, Joel; Buchan, JamesBackground: The recession of 2008 triggered large-scale emigration from Ireland. Australia emerged as a popular destination for Irish emigrants and for Irish-trained doctors. This paper illustrates the impact that such an external shock can have on the medical workforce and demonstrates how cross-national data sharing can assist the source country to better understand doctor emigration trends. Method: This study draws on Australian immigration, registration and census data to highlight doctor migration flows from Ireland to Australia, 2008–2018. Findings: General population migration from Ireland to Australia increased following the 2008 recession, peaked between 2011 and 2013 before returning to pre-2008 levels by 2014, in line with the general economic recovery in Ireland. Doctor emigration from Ireland to Australia did not follow the same pattern, but rather increased in 2008 and increased year on year since 2014. In 2018, 326 Irish doctors obtained working visas for Australia. That doctor migration is out of sync with general economic conditions in Ireland and with wider migration patterns indicates that it is influenced by factors other than evolving economic conditions in Ireland, perhaps factors relating to the health system. Discussion: Doctor emigration from Ireland to Australia has not decreased in line with improved economic conditions in Ireland, indicating that other factors are driving and sustaining doctor emigration. This paper considers some of these factors. Large scale doctor emigration has significant implications for the Irish health system; representing a brain drain of talent, generating a need for replacement migration and a high dependence on internationally trained doctors. This paper illustrates how source countries, such as Ireland, can use destination country data to inform an evidence-based policy response to doctor emigration.Item Challenges for WHO code on international recruitment(2010-04-10) Buchan, JamesItem 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 Evaluating the impact of a new pay system on nurses in the UK(2011-01) Buchan, James; Ball, JaneAims and objectives: This study examines the impact of implementing a new pay system (Agenda for Change) on nursing staff in the National Health Service (NHS) in the UK. This new pay system covered approximately 400,000 nursing staff. Its objectives were to improve the delivery of patient care as well as staff recruitment, retention and motivation. Background: The new system aimed to provide a simplified approach to pay determination, with a more systematic use of agreed job descriptions and job evaluation to 'price' individual jobs, linked to a new career development framework. Design: Secondary analysis of survey data. Methods: Analysis of results of large-scale surveys of members of the Royal College of Nursing of the United Kingdom (RCN) to assess the response of nurses to questions about the implementation process itself and their attitude to pay levels. Results: The results demonstrated that there was some positive change after implementation of Agenda for Change in 2006, mainly some time after implementation, and that the process of implementation itself raised expectations that were not fully met for all nurses. Conclusions: There were clear indications of differential impact and reported experiences, with some categories of nurse being less satisfied with the process of implementation. The overall message is that a national pay system has strengths and weaknesses compared to the local systems used in other countries and that these benefits can only be maximised by effective communication, adequate funding and consistent management of the system. Relevance to clinical practice: How nurses' pay is determined and delivered can be a major satisfier and incentive to nurses if the process is well managed and can be a factor in supporting clinical practice, performance and innovation. This study highlights that a large-scale national exercise to reform the pay system for nurses is a major undertaking, carries risk and will take significant time to implement effectively. 2010 Blackwell Publishing Ltd.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 Editorial: Paying nurses: a cross-country comparison(2011-01) Nakata, Yoshifumi; Buchan, JamesItem Instability in patient and nurse characteristics, unit complexity and patient and system outcomes(John Wiley & Sons Ltd., 2015-06) Duffield, Christine M.; Roche, Michael A.; Dimitrelis, Sofia; Homer, Caroline; Buchan, JamesAims: To explore key factors related to nursing unit instability, complexity and patient and system outcomes. Background: The relationship between nurse staffing and quality of patient outcomes is well known. The nursing unit is an important but different aspect that links to complexity and to system and patient outcomes. The relationship between the instability, complexity and outcomes needs further exploration. Design: Descriptive. Methods: Data were collected via a nurse survey, unit profile and review of patient records on 62 nursing units (wards) across three states of Australia between 2008-2010. Two units with contrasting levels of patient and nurse instability and negative system and patient outcomes, were profiled in detail from the larger sample. Results: Ward A presented with greater patient stability (low occupancy, high planned admissions, few ICU transfers, fewer changes to patient acuity/work re-sequencing) and greater nurse instability (nurses changing units, fewer full-time staff, more temporary/casual staff) impacting system outcomes negatively (high staff turnover). In contrast, Ward B had greater patient instability, however, more nurse stability (greater experienced and permanent staff, fewer casuals), resulting in high rates for falls, medication errors and other adverse patient outcomes with lower rates for system outcomes (lower intention to leave). Conclusion: Instability in patient and nurse factors can contribute to ward complexity with potentially negative patient outcomes. The findings highlight the variation of many aspects of the system where nurses work and the importance of nursing unit managers and senior nurse executives in managing ward complexity. 2014 John Wiley & Sons Ltd.Item The financial cost of physician emigration from sub-Saharan Africa(BMJ Publishing Group Ltd., 2011-11-24) Buchan, James