The health system consequences of agency nursing and moonlighting in South Africa

PKBackground: Worldwide, there is an increased reliance on casual staff in the health sector. Recent policy attention in South Africa has focused on the interrelated challenges of agency nursing and moonlighting in the health sector. Objective: This paper examines the potential health system consequences of agency nursing and moonlighting among South African nurses. Methods: During 2010, a cluster random sample of 80 hospitals was selected in four South African provinces. On the survey day, all nurses providing clinical care completed a self-administered questionnaire after giving informed consent. The questionnaire obtained information on socio-demographics, involvement in agency nursing and moonlighting, and self-reported indicators of potential health system consequences of agency nursing and moonlighting. A weighted analysis was done using STATA† 13. Results: In the survey, 40.7% of nurses reported moonlighting or working for an agency in the preceding year. Of all participants, 51.5% reported feeling too tired to work, 11.5% paid less attention to nursing work on duty, and 10.9% took sick leave when not actually sick in the preceding year. Among the moonlighters, 11.9% had taken vacation leave to do agency work or moonlighting, and 9.8% reported conflicting schedules between their primary and secondary jobs. In the bivariate analysis, moonlighting nurses were significantly more likely than non-moonlighters to take sick leave when not sick (p 0.011) and to pay less attention to nursing work on duty (p 0.035). However, in a multiple logistic regression analysis, the differences between moonlighters and non-moonlighters did not remain statistically significant after adjusting for other sociodemographic variables. Conclusion: Although moonlighting did not emerge as a statistically significant predictor, the reported health system consequences are serious. A combination of strong nursing leadership, effective management, and consultation with and buy-in from front-line nurses is needed to counteract the potential negative health system consequences of agency nursing and moonlighting

The impact of basic and social infrastructure investment on economic growth and social development in South Africa’s urban and rural municipalities

Abstract: South Africa is characterised by widespread inequality and divided societies, which impede economic growth and social development. Basic and social infrastructure investment can assist in addressing these challenges by promoting economic growth and social development. The aim of this study is to determine if basic and social infrastructure investment differently effect economic growth and social development indicators of urban and rural municipalities respectively. We use a balanced panel data set containing infrastructure, economic, demographic and social indicators for rural and urban municipalities for the period from 1996 to 2012. To address the research question we construct synthetic indices of basic and social infrastructure, using principal component analysis, to be used in panel regression estimations. To estimate our economic growth and social development functions we make use of restricted within LSDV estimation techniques. We use the results on the respective elasticities to evaluate whether the differences between urban and rural municipalities are statistically significant. Our results show that the elasticities of basic and social infrastructure investment generally are more pronounced for economic growth and social development indicators in rural municipalities than in urban municipalities. These findings could potentially influence policy decisions in terms of infrastructure investment in favour of rural municipalities to increase economic growth and social development in these regions, which could contribute to the reduction of spatial inequalities in South Africa

Triggered Star Formation by Massive Stars

We present our diagnosis of the role that massive stars play in the formation of low- and intermediate-mass stars in OB associations (the Lambda Ori region, Ori OB1, and Lac OB1 associations). We find that the classical T Tauri stars and Herbig Ae/Be stars tend to line up between luminous O stars and bright-rimmed or comet-shaped clouds; the closer to a cloud the progressively younger they are. Our positional and chronological study lends support to the validity of the radiation-driven implosion mechanism, where the Lyman continuum photons from a luminous O star create expanding ionization fronts to evaporate and compress nearby clouds into bright-rimmed or comet-shaped clouds. Implosive pressure then causes dense clumps to collapse, prompting the formation of low-mass stars on the cloud surface (i.e., the bright rim) and intermediate-mass stars somewhat deeper in the cloud. These stars are a signpost of current star formation; no young stars are seen leading the ionization fronts further into the cloud. Young stars in bright-rimmed or comet-shaped clouds are likely to have been formed by triggering, which would result in an age spread of several megayears between the member stars or star groups formed in the sequence.Comment: 2007, ApJ, 657, 88

Does moonlighting influence South African nurses' intention to leave their primary jobs?

KIMBACKGROUND: Staff retention and turnover have risen in prominence in the global discourse on the health workforce. Moonlighting, having a second job in addition to a primary job, has not featured in debates on turnover. OBJECTIVE: This paper examines whether moonlighting is a determinant of South African nurses' intention to leave their primary jobs. DESIGN: During 2010, a one-stage cluster random sample of 80 hospitals was selected in four South African provinces. On the survey day, all nurses working in critical care, theatre, emergency, maternity, and general medical and surgical wards completed a self-administered questionnaire after giving informed consent. In addition to demographic information and information on moonlighting, the questionnaire obtained information on the participants' intention to leave their primary jobs in the 12 months following the survey. A weighted analysis of the survey data was done using STATA(®) 13. RESULTS: Survey participants (n=3,784) were predominantly middle-aged with a mean age of 41.5 (SD±10.4) years. Almost one-third of survey participants (30.9%) indicated that they planned to leave their jobs within 12 months. Intention to leave was higher among the moonlighters (39.5%) compared to non-moonlighters (27.9%; p<0.001). Predictors of intention to leave in a multiple logistic regression were moonlighting in the preceding year, nursing category, sector of primary employment, period working at the primary job, and number of children. The odds of intention to leave was 1.40 (95% CI: 1.16-1.69) times higher for moonlighters than for non-moonlighters. The odds ratio of intention to leave was 0.53 (95% CI: 0.42-0.66) for nursing assistants compared to professional nurses and 2.09 (95% CI: 1.49-2.94) for nurses working for a commercial nursing agency compared to those working in the public sector

Contestations and complexities of nurses' participation in policy-making in South Africa

PKBackground: There has been increased emphasis globally on nurses’ involvement in health policy and systems development. However, there has been limited scholarly attention on nurses’ participation in policy-making in South Africa. Objective: This paper analyses the dynamics, strengths, and weaknesses of nurses’ participation in four national health workforce policies: the 2008 Nursing Strategy, revision of the Scope of Practice for nurses, the new Framework for Nursing Qualifications, and the Occupation-Specific Dispensation (OSD) remuneration policy. Design: Using a policy analysis framework, we conducted in-depth interviews with 28 key informants and 73 frontline nurses in four South African provinces. Thematic content analysis was done using the Atlas.ti software. Results: The study found that nurses’ participation in policy-making is both contested and complex. The contestation relates to the extent and nature of nurses’ participation in nursing policies. There was a disjuncture between nursing leadership and frontline nurses in their levels of awareness of the four policies. The latter group was generally unaware of these policies with the exception of the OSD remuneration policy as it affected them directly. There was also limited consensus on which nursing group legitimately represented nursing issues in the policy arena. Shifting power relationships influenced who participated, how the participation happened, and the degree to which nurses’ views and inputs were considered and incorporated. Conclusions: The South African health system presents major opportunities for nurses to influence and direct policies that affect them. This will require a combination of proactive leadership, health policy capacity and skills development among nurses, and strong support from the national nursing associatio

High‐efficiency photovoltaic modules on a chip for millimeter‐scale energy harvesting

Photovoltaic modules at the millimeter scale are demonstrated in this work to power wirelessly interconnected millimeter‐scale sensor systems operating under low‐flux conditions, enabling applications in the Internet of things and biological sensors. Module efficiency is found to be limited by perimeter recombination for individual cells and shunt leakage for the series‐connected module configuration. We utilize GaAs and AlGaAs junction barrier isolation between interconnected cells to dramatically reduce shunt leakage current. A photovoltaic module with eight series‐connected cells and total area of 1.27 mm2 demonstrates a power conversion efficiency of greater than 26% under low‐flux near‐infrared illumination (850 nm at 1 μW/mm2). The output voltage of the module is greater than 5 V, providing a voltage up‐conversion efficiency of more than 90%. We demonstrate direct photovoltaic charging of a 16‐μAh pair of thin‐film lithium‐ion batteries under dim light conditions, enabling the perpetual operation of practical millimeter‐scale wirelessly interconnected systems.We demonstrate monolithic GaAs photovoltaic modules at the millimeter scale to efficiently power wirelessly interconnected millimeter‐scale sensor systems operating under low‐flux conditions. Eight series‐connected cells are used to provide an operating voltage of 5 V for direct battery charging. Module power conversion efficiency greater than 26% is achieved under weak 850‐nm near‐infrared illumination and 90% voltage up‐conversion efficiency utilizing AIGaAs junction barrier isolation as a critical technique in reducing shunt leakage current.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149283/1/pip3132_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149283/2/pip3132.pd

Self-esteem and outcome fairness: differential importance of procedural and outcome considerations.

Results of a survey of 222 detainees in Dutch jails and police stations showed that outcome-fairness judgments of individuals with high self-esteem were more strongly related to outcome considerations than to procedural considerations, whereas outcome-fairness judgments of individuals with low self-esteem were more strongly related to procedural considerations than to outcome considerations. It was proposed that these differences were due to the fact that (a) procedures more strongly express a social evaluation than outcomes and (b) individuals with low self-esteem are more concerned with social evaluations than individuals with high self-esteem. The implications of the results for other individual-differences factors and other populations than detainees are discussed