Building a Professional Mexican Nursing Workforce: A Case Study

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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

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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

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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

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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

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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

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Mexico
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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)

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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

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Significant Factors

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

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Significant Factors

• Globalization
• International Institutions
• International Exchanges
• English language requirement

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Significant Factors

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

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Significant Factors

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

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Significant Factors

• Positive
• Negative
• Repression

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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
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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

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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)

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Nursing Human Resources Development Its
Complicated
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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)

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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

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(No Transcript)
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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

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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

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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

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Results (Squires Beltrán Sánchez, 2009,
Accepted, under revision)

• Robust regression plt0.000 adjusted r2.7

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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.

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Thank You! Gracias! Mercí! Obrigada!

• Questions?
• Comments
• Contact Information
• (til August 2009)
• Allison Squires, PhD, RN
• asq_at_nursing.upenn.edu