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Building a Professional Mexican Nursing Workforce: A Case Study

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Title: Building a Professional Mexican Nursing Workforce: A Case Study


1
Building a Professional Mexican Nursing
Workforce A Case Study
  • Allison Squires, PhD, RN
  • Research Fellow
  • Center for Health Outcomes Policy Research
  • University of Pennsylvania
  • Philadelphia, PA, USA
  • A presentation for the
  • 12th World Congress on Public Health
  • Istanbul, Turkey
  • April 28, 2009

2
The Nursing Role
  • A formally educated person who
  • Monitors patients for critical changes in their
    condition and ensures their safety during
    hospitalization
  • Implements medical treatments, based on available
    resources
  • Manages a complex system of care delivery and the
    complex nature of family dynamics during wellness
    and illness
  • Helps prevent hospitalization by facilitating the
    health of a community

3
Overview of the Problem
  • Global nursing shortage, especially of
    professionally educated personnel extent varies
    by country
  • Research demonstrates that nursing professionals
    educated at the post-high school level produce
    the best patient outcomes (See studies by L.H.
    Aiken, E. Lake, S. Clarke, P. Beurhaus, etc.)
  • Few to no studies that examine the process of
    producing professional nursing personnel or the
    development process

4
Overview of the Problem
  • Nurses organize under a professional model
  • Organization of nursing affects health system
    outcomes
  • Intersection of relationships between internal
    and external variables relevant to nursing not
    well understood
  • Creates problems for producing nurses at the
    country level

5
The Study
  • A qualitative case study of the
    professionalization of Mexican nursing between
    1980 and 2005
  • Purpose To identify the themes and variables
    involved in professional nursing workforce
    development.
  • General thematic analysis data synthesis of
  • 48 interviews with Mexican nurses from four
    regions of the country
  • 410 documents from government and non-government
    sources served as primary and secondary sources

6
Mexico
7
Nursing in Mexico
  • Formally organized around 1905
  • Centralized department and state level
    representation in the ministry of health
  • A pre-migration State even though a major free
    trade agreement exists and incentives for nurses
    to migrate abound
  • Nursing education from auxiliary to doctoral
    level
  • Primarily draws candidates from families of low
    socioeconomic status or the middle class
  • Nurse-to-population ratio
  • 2.3/1,000 (national average)
  • 1.3 to 3.1 (range between states)

8
The Results
  • Eight themes significantly affected the
    professionalization of Mexican nursing (a.k.a.
    nursing human resources development)
  • Historical
  • International Influences
  • Economic
  • Political
  • Unions
  • Sociocultural
  • Workplace
  • Intraprofessional dynamics

9
Significant Factors
  • Colonialism
  • 20th century health system design founding
  • Womens history
  • Nursings historical image

10
Significant Factors
  • Globalization
  • International Institutions
  • International Exchanges
  • English language requirement

11
Significant Factors
  • Instability
  • Trade Agreements
  • Migration
  • Economic security provided by becoming a nurse
  • Difficult to obtain full-time work with benefits

12
Significant Factors
  • Influence of the State
  • Political participation of nurses
  • Legislation/ Regulation
  • Corruption

13
Significant Factors
  • Positive
  • Negative
  • Repression

14
Significant Factors
Sociocultural
  • Being female
  • Female role models
  • Machismo
  • Male-female dynamics
  • Men in Nursing
  • Nature of nurses
  • Personal relationships
  • Self actualization
  • Single motherhood
  • Balancing work and family
  • Responding to social changes adaptive processes

EDUCATION SYSTEM
GENDER
HEALTHCARE SYSTEM
CLASS
INFLUENCE OF FAMILY
DISCRIMINATION
RELIGION
15
Significant Factors
  • Administration/ Management practices
  • Decentralization/ health system reforms
  • Institutional Variation
  • Working multiple jobs
  • Institutional nursing roles
  • Quality of Care
  • Relationships
  • Salaries
  • Supply Management
  • Work/Practice Environment

16
Significant Factors
  • Autonomy
  • Career path/advancement
  • Culture of nursing
  • Development processes
  • Professional education
  • Ethics
  • Visions of the future
  • Image (public/internal)
  • Knowledge development
  • Leadership
  • Licensure/credentialing
  • Professional organization
  • Reasons for becoming a nurse
  • Research
  • Rewards
  • Roles
  • Shortage
  • Specialization
  • Standards (education practice)

17
Nursing Human Resources Development Its
Complicated
18
Defining A System
  • A group of independent but interrelated elements
    comprising a unified whole a complex of method
    or rules governing behavior a procedure or
    process for obtaining an objective or an
    organized structure for arranging or classifying
  • (Definition downloaded from http//wordnet.princet
    on.edu/perl/webwn?ssystem, July 20, 2007)

19
The Nursing System (NS)
  • A country-level system that produces and develops
    professional nursing human resources
  • Exists separately from healthcare system, but is
    an integral part of it
  • The NS has several products that benefit the
    country on multiple levels, but most likely
    through social and healthcare system outcomes, as
    well as professional infrastructure development

20
(No Transcript)
21
Enhancing Infrastructure Through Better Outcomes
  • Profession-Based Outcomes
  • ? of educated females and females completing
    high school degrees
  • ? quality of professionals
  • ? recruitment into the profession
  • ? career mobility
  • ? economic security
  • Research/knowledge production

22
Enhancing Infrastructure Through Better Outcomes
  • Health System Outcomes
  • ? Quality of hospital and primary care
  • ? Patient satisfaction
  • ? Job satisfaction of nurses
  • ? Retention
  • In the long term, costs decrease because patient
    outcomes improve, complications rates decrease,
    and retention improves

23
Example Applying the Model
  • Can a combination of socioeconomic development,
    professional infrastructure, and health system
    indicators predict the nurse-to-population ratio?
  • State level analysis (31 Mexican states)
  • Variables
  • Median Income
  • Average years of education
  • Average of children per female
  • Total of nursing schools
  • Ratio of public to private healthcare facilties

24
Results (Squires Beltrán Sánchez, 2009,
Accepted, under revision)
  • Robust regression plt0.000 adjusted r2.7

25
Policy Implications for Professional
Infrastructure Development
  • Investments in education, from elementary to
    university level, indirectly help develop nursing
    human resources.
  • The types of workplaces available for nursing
    employment will affect recruitment, retention,
    and migration, but not always in the way we
    traditionally think.
  • Creating ways for nurses to become solid middle
    class members of society may help reduce
    migration.

26
Thank You! Gracias! Mercí! Obrigada!
  • Questions?
  • Comments
  • Contact Information
  • (til August 2009)
  • Allison Squires, PhD, RN
  • asq_at_nursing.upenn.edu
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