Local, national, global: the challenge of workforce planning for nurses.

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Local, national, global the challenge of
workforce planning for nurses.

• Dr Susan Hamer
• Director, Organisational and Workforce
  Development
• University of Leeds

Susan.Hamer_at_nihr.ac.uk
Delivering clinical research to make patients,
and the NHS, better
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International Nurses Day
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International perspective

• The World Health Assembly (WHA), the supreme
  decision making body of WHO, has repeatedly
  recognised the essential need for strengthening
  nursing and midwifery services in achieving
  better health for individuals, families and
  communities. The WHO progress report (2013b)
  describes achievements in response to the series
  of resolution adopted by the WHA to strengthen
  nursing and midwifery services. However this
  report concludes that in relation to the
  provision of health services many remain
  understaffed by nurses and midwives who in turn
  can be undertrained and poorly developed (WHO
  2013b).

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International perspective

• Kingma (2007) concludes in a detailed study of
  global nurse migration, Todays search for
  labour is a highly organized global hunt for
  talent that includes nurses. International
  migration is a symptom of the larger systemic
  problems that make nurses leave their jobs. Nurse
  mobility becomes a major issue only in a context
  of migrant exploitation or nursing shortage.
  Injecting migrant nurses into dysfunctional
  health systems, ones that are not capable of
  attracting and retaining staff domestically will
  not solve the nursing shortage. (p.1281)

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• Security of Supply
• Multiple imbalances (undersupply, unemployment
  and underemployment)
• Political interference
• Gap between supply and demand
• Migration
• EU Mobility
• Educational investment and systems

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Health professional education

• Insufficient to address need
• Mismatch of competencies to patient and
• population need
• Persistent gender stratification of professional
  status
• Quantitative and qualitative imbalances in the
  health care professions
• Insufficient emphasis and time allocation for
  clinical learning use of ineffective clinical
  teaching methodologies unsuitable, poor quality
  or crowded clinical learning places and a lack
  of good clinical role models.
• Nursing faculty staff share the same demographic
  challenges as the rest of the workforce

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Changing Length of Nurse careers

• Changing working life span of the nurse workforce
• Manpower planning models
• Female dominated professions
• Different statutory pension ages
• Health workers tend to retire earlier (global
  trend)
• Different working patterns
• Age distribution of the workforce
• Weak approaches to workforce planning and
• management

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The Solution
An educated nurse workforce a good work
environment High quality care This simple,
evidence based, equation, whether applied at a
global or a local level in the health system is
fundamental to understanding how to make the best
of the vital resource which is nursing.
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A skilled nurse workforce-
right number, right place?

• Have board level commitment (with a nursing
  director/chief nurse as a key requirement)
• Actively involve staff and are transparent in
  their processes
• Use established approaches and apply them
  consistently
• Triangulate (e.g. dependency scoring system to
  gauge workload, professional judgement and
  benchmark)
• Be evaluated regularly (against patient and
  staffing outcomes data)
• Actively engage with the education sector and
  increasingly social care
• Act on the results

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Support to change roles who does what?

• Role substitution (task shifting)
• Increased complexity of interventions
• Evaluating impact of new roles
• Who pays?
• Role of patients and communities

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When health professionals change fast

• Supportive environments
• Right skill mix
• Effective leadership
• Expectation of change and authority to act
• Flexible regulatory environment
• Clinically attractive (innovation)

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A positive work environment
Attribute 1 Shared core values.
Attribute 2 Shared vision and mission with
individual and collective responsibility.
Attribute 3 Adaptability, innovation and
creativity maintain workplace effectiveness.
Attribute 4 Appropriate change driven by the
needs of patients/ communities.
Attribute 5 Formal systems exist to
continuously enable and evaluate learning,
performance and shared governance
(Manley et al 2011)