Clinical academic career pathway for nursing and allied health professionals: clinical academic role descriptors

The clinical academic pathway outlined highlights the range of typical practice and research-focused activities that a practitioner on a clinical academic career pathway might normally engage in at different levels and points along this career path. The activities are intended as a guide for practitioners interested in learning more about the practice and research components of a clinical academic career, as well as those already employed in clinical academic roles. They may also be useful for health care organisations and Higher Education Institutions as a tool for developing clinical academic roles

Productive Ward ten years on – lessons from a quality improvement programme

Productive Ward: Releasing Time to Care™ was a large-scale nursing quality-improvement programme introduced to English acute trusts a decade ago to improve productivity and reduce wastage on the ward. A multi-methods study looked at what remains of the programme today, how it was implemented and whether it has had any lasting impact. It concludes that it has useful lessons for the design, implementation and sustainability of other large-scale quality improvement programmes

Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the ten-year impact of the ‘Productive Ward: Releasing Time to Care’^TM programme in English acute hospitals

Background: The ‘Productive Ward: Releasing Time to Care’TM programme is a Quality Improvement (QI) intervention introduced in English acute hospitals a decade ago to: (1) increase time nurses spend in direct patient care, (2) improve experience for staff and patients, and (3) make changes to physical environments to improve efficiency. Objective: to explore how timing of adoption, local implementation strategies and processes of assimilation into day-to-day practice relate to one another and shape any sustained impact and wider legacies of a large-scale QI intervention. Design: multiple methods within six hospitals including 88 interviews (with Productive Ward leads, ward staff, Patient & Public Involvement representatives and senior managers), 10 ward manager questionnaires and structured observations on 12 randomly selected wards. Results: resource constraints and a managerial desire for standardisation meant that, over time, there was a shift away from the original vision of empowering ward staff to take ownership of Productive Ward and towards a range of implementation ‘short cuts’. Nonetheless, material legacies (e.g. displaying metrics data; storage systems) have remained in place on wards for up to a decade after initial implementation as have some specific practices (e.g. protected mealtimes). Variations in timing of adoption, local implementation strategies and contextual changes had consequences for assimilation into routine practice and subsequent legacies. Productive Ward has informed wider organisational QI strategies that remain in place today and developed lasting QI capabilities amongst those meaningfully involved in its implementation. Conclusions: as an ongoing QI approach Productive Ward has not been sustained but has informed contemporary organizational QI practices and strategies. Judgements about the long-term sustainability of QI interventions should consider the evolutionary and adaptive nature of change processes

Professional Judgement Framework: A guide to applying professional judgement in nurse staffing reviews

•This framework is designed to guide your application of ‘professional judgement’ when considering the results of staffing reviews and the establishment recommendations using the acuity dependency measure of the Safer Nursing Care Tool. •It is intended to provide a number of ‘prompts’ that might help sense check the results of staffing reviews and help to provide confidence in the results, or else flag circumstances where judgement might be used to recommend a variation from the calculated figures.•It is aimed both at those with less experience looking for guidance, and those with more experience looking for help on how to articulate intuitive judgements using available evidence.•Similar issues are likely to arise when considering the results of any tool.•The framework is based on the results of research funded by the National Institute for Health Research in England, and has been developed working alongside a number of professional experts.<br/

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Career development of international medical graduates in Canada: status of the unmatched

Abstract With limited residency positions, the majority of international medical graduates living in Canada and other developed countries cannot work as physicians. The educational experience and career development of unmatched international medical graduates (those who are not matched to a residency position) residing in Canada have never been studied. Through an innovative collaboration of provincial international medical graduate organizations, we launched an online survey targeting the career development of unmatched international medical graduates, with 356 survey responses entering data analysis. Respondents reported that at the early career planning stage, close to a third had not had adequate knowledge of their career prospects in Canada. Although official resources are available, most respondents found that the information did not match well with reality. After arriving in Canada, educational resources for unmatched international medical graduates are scarce. The majority of them work in healthcare-related fields but reported significant difficulties finding these positions, and there were limited career training opportunities. Among respondents who were no longer pursuing residency positions and had moved on to alternate career paths, we found, unexpectedly, that 69% of them reported previous residency application experience did not contribute to their current occupation, and most were not satisfied with their current career status and continuing education opportunities. In conclusion, the unmatched international medical graduates could serve as a vital reservoir of skilled medical professionals to serve the community, especially during public health crises. Continuing education and career support of unmatched international medical graduates are crucial for their career development and should be an area of priority for policymakers. Career support, especially for alternative career paths, can be built on the current services that exist in most provinces in Canada. In addition, novel online and social media tools can be utilized to increase the outreach of these programs

The Safer Nursing Care Tool as a guide to nurse staffing requirements on hospital wards: observational and modelling study

Background: The Safer Nursing Care Tool (SNCT) is a system designed to guide decisions about nurse staffing requirements on hospital wards, in particular the number of nurses to employ (establishment). The SNCT is widely used in English hospitals but there is a lack of evidence about how effective and cost-effective nurse staffing tools are at providing levels needed for safe and quality patient care.Objectives: To determine whether the SNCT corresponds to professional judgement, assess a range of options for using the SNCT and model the costs and consequences of various ward-staffing policies based on SNCT acuity/dependency measures. Design and Setting: Observational study on medical/surgical wards in four NHS hospital Trusts using regression, computer simulations and economic modelling. We compared effects and costs of a ‘high’ establishment (set to meet demand on 90% of days), the ‘standard’ (mean-based) establishment and a ‘flexible (low)’ establishment (80% of the mean) providing a core staff group that would be sufficient on days of low demand, with flexible staff redeployed/hired to meet fluctuations in demand.Main Outcomes: Professional judgement of staffing adequacy and reports of omissions in care, shifts staffed more than 15% below the measured requirement, cost per patient day and cost per life saved. Data Sources: Hospital administrative systems, staff reports and national reference costs.Results: 81 wards participated (85% response) with data linking SNCT ratings and staffing levels for 26,362 wards*days (96% response). According to SNCT measures, 26% of all ward days were understaffed by 15% or more. Nurses reported that they had enough staff to provide quality care on 78% of shifts. When using the SNCT to set establishments, on average 60 observations would be needed for a 95% confidence interval 1 whole time equivalent either side of the mean.Staffing levels below the daily requirement estimated using the SNCT were associated with lower odds of nurses reporting ‘enough staff for quality’ and increased reports of missed nursing care. However, the relationship was effectively linear with staffing above the recommended level associated with further improvements.<br/

Datasets: Identifying nurse-staffing requirements using the Safer Nursing Care Tool. Modelling the costs and consequences of real world application to address variation in patient need on hospital wards

These datasets underpin analyses relating to the project &quot;Identifying nurse-staffing requirements using the Safer Nursing Care Tool. Modelling the costs and consequences of real world application to address variation in patient need on hospital wards&quot;, accessible at https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/1419421/#/. The SAQX_Days tabs contain the data that were used to fit multilevel regression models linking staffing shortfalls with reported staffing adequacy. The Bootstrap_X tabs contain the data that were used for bootstrapping for calculating the precision of staffing estimates from different sample sizes. Disclaimer: This dataset was collected and processed as part of independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the PHR programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the PHR programme or the Department of Health and Social Care.</span