Violence in health care: the contribution of the Australian Patient Safety Foundation to incident monitoring and analysis

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Because of growing concern about violence in health care in Australia, we reviewed the relevant data on incidents involving violence collected using the Australian Incident Monitoring System (AIMS). Among 42 338 incidents reported from 1 July 2000 to 30 June 2002, 3621 (9% of all incidents) involved patients and physical violence or violent verbal exchange; staff injury was reported in 5% of cases. The proportion was higher in emergency departments (16%, with frequent involvement of mental health problems or alcohol or drug intoxication) and mental health units (28%). Contributing factors include changes in our society and in mental health service provision. With the closure of public psychiatric hospitals in the past decade, more patients with mental illness are seeking care in public hospital emergency departments. AIMS analysis highlights the importance of understanding the contributing and precipitating factors in violent incidents, and supports a variety of preventive initiatives, including de-escalation training for staff; violence management plans; improved building design to protect staff and patients; and fast-tracking of patients with mental health problems as well as improved waiting times in public hospital emergency services. We recommend that a national system be developed to share and compare incident monitoring data, to monitor trends, and to facilitate learning and thinking at all levels - ward, department, hospital, state and national.Klee A Benveniste, Peter D Hibbert and William B Runcima

International recruitment of nurses : United Kingdom case study

The author acknowledges the assistance and support of staff at the Department of Health, England; Work Permits (UK); United Kingdom Central Council for Nursing Midwifery and Health Visiting (UKCC) [Note: the UKCC was reconfigured on 1 April 2002 as the Nursing and Midwifery Council- NMC]; Royal College of Nursing (RCN); NHS Professionals; the Independent Healthcare Association (IHA); An Bord Altranais; three private sector recruitment agencies; and management and nurses at three NHS trusts actively recruiting in international nursing labour markets. This paper is based on research funded by WHO, ICN, and RCN, and the support of staff at WHO and ICN is also acknowledged. The views expressed in the report are those of the author.This paper is based on research funded by the World Health Organisation, the International Council of Nurses and the Royal College of Nursing of the United Kingdom. Whilst the primary focus is on the UK, general lessons related to international recruitment and migration of nurses are also highlighted. There is general agreement amongst all stakeholders in the UK that nursing shortages have become a major factor constraining health care delivery in the National Health Service in the UK. In order to overcome these skills shortages, four areas of government initiative are underway: attracting more applicants to nurse education; encouraging returners to nursing employment; improving retention through improved career structures and flexible working practices; and recruiting nurses from abroad. NHS Plan targets for increased staffing have been one major factor in focusing attention on international recruitment. There has been a significant growth in the level on inflow of nurses from other countries to the UK. Registration data on annual admissions of nurses from non-UK sources shows a fivefold increase since the early 1990s. In 2000/01 a total of 9,694 initial entrants on the UK Register were from all overseas sources. This figure has risen to approximately 15,000 in 2001/02, which equates to almost half of all new nurses entering the UK Register in the year. Registration data highlights that a total of more than 30,000 new non-UK nurses have registered in the UK in the last three years. The Philippines, South Africa and Australia have been the main sources. The trend in significant growth of recruitment of nurses from non-EU countries has not been matched by any growth in inflow from the countries of the European Union. In recent years the EU has reduced in significance as a source of nurses entering the UK. The Department of Health in England issued guidance on ethical international recruitment practices in 1999 requiring NHS employers to avoid direct recruitment from designated countries such as South Africa and the West Indies. Registration data suggests that the 1999 guidelines may have had some short-term impact in reducing recruitment from South Africa and the Caribbean, but that this recruitment activity may have then been displaced to other developing countries. The Department has issued a strengthened Code for international recruitment in late 2001. The pull factor of meeting NHS Plan staffing targets is likely to mean that the UK, particularly England, will continue to be active in recruiting from international nursing labour markets, partly as a result of new targets having been set for 2008. UK government policy initiatives to increase the number of nursing students, and to improve retention and return rates, can have a positive effect. However, the growth in the number of UK nurses who can retire is likely to challenge the capacity of the NHS to retain the required numbers of nurses. When coupled with the likelihood of liberalisation of global labour markets, this points to a continuing high profile for the UK in international nursing labour markets.sch_nur1 For a detailed discussion on the UK nursing labour market see Buchan J, Seccombe I (2002) Behind the Headlines: A Review of the UK Nursing Labour Market. RCN/QMUC 2 See Buchan J, Seccombe I (2002) Behind the Headlines: A Review of the UK Nursing Labour Market. RCN/QMUC 3 Organisation for Economic Co-operation and Development (2001) Health Data, 2001. OECD, Paris 4 Buchan J (2001) Warning on misleading nursing ratios data. Employing Nurses and Midwives, Issue 60, p12-14. Dec 2001 5 Department of Health (2001) Review for 2002. Written Evidence from the Health Departments for Great Britain, Review Body for Nursing Staff, Midwives, Health Visitors and Professions Allied to Medicine. DH: London. 6 Wanless D (2001). Securing our Future Health: Taking a Long Term View. Interim Report. November. Public Enquiry Unit, HM Treasury, London; p183 7 Office of Manpower Economics annual survey. Published in Review Body for Nursing Staff, Midwives, Health Visitors and Professions Allied to Medicine (2001) Nineteenth Report. December 2001, London 8 see Buchan J, Seccombe I (2002) Behind the Headlines: A Review of the UK Nursing Labour Market. RCN/QMUC 9 NHS Executive (2000) The NHS Plan. DH: London 10 see e.g:Department of Health (2001) Investment and Reform for NHS Staff- Taking Forward the NHS Plan. DH: London 11 Department of Health (2002) HR Directors Bulletin, special issue. Budget 2002. 24 April 2002. DH: London 12 Department of Health (1999). Working lives DH: London 13 Home Office (2001) Control of Immigration: Statistics United Kingdom 2000. The Stationary Office, HMSO cmnd 5315 14 Mejia, A., Pizurki, H., Royston, E. (1979) Physician and Nurse Migration, World Health Organisation, Geneva 15 Buchan, J., Seccombe, I., Thomas, S. (1997) Overseas Mobility of UK Based Nurses. International Journal of Nursing Studies 34(1), 54-62 16 Department of Health (2001) Investment and Reform for NHS Staff- Taking Forward the NHS Plan. Para. 3.26. DH: London 17 Department of Health (2001) NHS Emergency Pressures: Making Progress. DH: London, p15 18 Department of Health (2002) HR Directors Bulletin, special issue. Budget 2002. 24 April 2002. DH: London 19 UKCC (2001)More countries providing more nurses and midwives. Press statement, 14 August 20 Lipley N (2002) UKCC introduces English test for non-EU applicants. Nursing Standard, 16 (26), p4. March 13th 21 Data provided by Nurses and Midwives Council, May 2002 22 Home Office (2001) Control of Immigration: Statistics United Kingdom 2000. The Stationary Office, HMSO cmnd 5315., Table 2.1, p 32 23 Lipley N (2002) UKCC introduces English test for non-EU applicants. Nursing Standard, 16 (26), p4. March 13th 24 UKCC. Overseas trained nurses apply to the UK in record numbers. UKCC News, website, dated 4 June 2001 ((http://www.ukcc.org.uk/cms/content/home/search.asp). This press statement quotes a figure for 2000-2001 of 7,705, and states that this financial year this figure is expected almost to double..- If doubled, this would suggest a figure of around 15,500 for 2001-2002. The UKCC subsequently increased their estimate for 2000-2001 to 8,403 from non EU sources only, (press statement on 14 August - (http://www.ukcc.org.uk/cms/content/home/search.asp)) 25 Permits waived for skilled staff-. Nursing Standard, January 9th, 2002, page 7 26 See e.g. UKCC. Spanish nurses face language barrier. UKCC News, Friday 1 March 2002 (www.ukcc.org.uk) 27 UKCC. Spanish nurses face language barrier. UKCC News, Friday March 1st, 2002 (www.ukcc.org.uk) 28 Lipley N (2002) UKCC introduces English test for non-EU applicants. Nursing Standard, 16 (26), p4. March 13th 29 Department of Health and Children (2000). The Nursing and Midwifery Resource. Interim Report of the Steering Group. Department of Health and Children, Dublin 28 International Recruitment of Nurses: UK case study July 2002 30 Letter from Executive Secretary, ICN to Chief Nursing Officer, Ministry of Health, England, 20 August, 1948. Source: Public Records Office 31 Department of Health (1999). Guidance on International Recruitment. DH: London 32 See e.g Parish C (2000) Broken Promises. Nursing Standard. 15 (3), p13 33 Department of Health (2001) Code of Practice for NHS Employers involved in international recruitment of healthcare professionals. DoH, London (http://www.doh.gov.uk/international-nurse/ ) 34 Commonwealth Secretariat (2001). Migration of Health Workers from Commonwealth Countries. Commonwealth Secretariat, London 35 Independent Healthcare Association/ Registered nursing home Association / Voices (2002). Supervised Practice Programme for Internationally Qualified Nurses: Independent Sector Rcommendations. IHA/ RNHA, London 36 International Council of Nurses (2002) available at www.icn.ch 37 Secretary for State for Health (2002).Speech to RCN Congress, 24 April 2002. Accessed at HYPERLINK http://wwwdoh.gov.uk/speeches/apr2002milburnrcnhtm http://www.doh.gov.uk/speeches/apr2002milburnrcn.htm [accessed on April 30] 38 See e.g: Sen, A. (1970) Problems of Overseas Students and Nurses. National Foundation for Educational Research (NFER), England; Mejia, A., Pizurki, H., Royston, E. 1979 Physician and Nurse Migration, World Health Organisation, Geneva; Buchan, J, Seccombe, I., Ball, J. 1994 The International Mobility of Nurses: A United Kingdom Perspective. International Journal of Nursing Studies 31(2), 143-154 Buchan, J., Seccombe, I., Thomas, S. 1997 Overseas Mobility of UK Based Nurses. International Journal of Nursing Studies 34(1), 54-62 Kingma M (2001) Nursing Migration:global treasure hunt or disaster in the making? Nursing Inquiry, 8 (4), 205-212 39 Unpublished data/ commercially sensitive. Source: recruitment agency, London 40 Pearce L (2002) World of a difference. Nursing Standard 16 (32) 14-16, April 24 41 Daniel P, Chamberlain A, Gordon F (2001) Expectations and experiences of newly recruited Filipino nurses. British Journal of Nursing, 10 (4) 254-265 42 Sawbridge Y (2001). Import Duties. Health Service Journal, 4th January, 20-21 43 See e.g War on foreign nurse abuse- Nursing Times 98 (18), p11 44 UKCC (2001) Nursing home loses right to train overseas nurses. News, Friday 10 August 2001. 45 Successful schemes helps foreign recruits adjust to life in the UK. Nursing Times, 98 92), p6. February 21, 2002 46 Successful schemes helps foreign recruits adjust to life in the UK. Nursing Times, 98 92), p6. February 21, 2002 47 UKCC unpublished analysis. See Buchan J, O'May F (1999). Globalisation and Healthcare Labour Markets: A Case study from the UK. Human Resources for Health Developments Journal. 3(3),199-209 48 Mulholland H (2002). Nurses flee UK despite efforts to raise numbers. Nursing Times. 98 (14), p4 49 In Australia there is an estimated shortfall of 5,000 out of a total workforce of 250,000. Nursing Times, 3 August 2000 50 Department of Health and Children (2000) The Nursing and Midwifery Resource- Report of the Steering Group. Dublin, September 51 Health Canada (2000) Nursing Strategy for Canada. Health Canada, Ottawa. 52 Buerhaus, P., Staiger D. and Auerbach D. (2000) 'Implications of an ageing registered nurse workforce'. Journal of the American Medical Association, 283(22), 2948-54 53 International Council of Nurses (2002) available at www.icn.ch 54 Buchan J (1999) The greying- of the UK nursing workforce: Implications for Employment Policy and Practice. Journal of Advanced Nursing, 30 (4) 818-826unpub18unpu

The skills and brain drain what nurses say

Aims and objectives. To explore sub-Saharan African nurses' reasons for moving to the UK, their views on the skills and brain drain, and what can be done to stem the situation. Background. The UK and other developed nations such as the USA, Canada and Australia have been recruiting internationally qualified nurses including those from sub-Saharan African, which has raised concerns of skills and brain drain from these countries that are known to suffer from nurse shortages. Methods. A purposeful sample of 30 nurses from sub-Saharan African was drawn from four National Health Service trusts in the north-east of England. Using focus group discussions and personal interviews, the study explored and examined nurses' views on their motivation to move to the developed countries and what can be done to reduce nurse migration from sub-Saharan African and give those countries a chance to develop their health systems by retaining their health personnel. Results. Five main themes emerged from data analysis: poor remuneration, lack of professional development in the home countries, poor health care and systems, language and education similarities and easy availability of jobs and visas. Conclusion. Data indicate that migration motives for nurses are complex and inherent in historical links and in global values. Nurses stressed that they would like to stay in their own countries and help develop healthcare there, but reasons for moving were often strong and apparently not within their control. Relevance to clinical practice. Nurse migration from sub-Saharan African has often been cited as a limitation in providing effective healthcare in those countries. Delineating motivational factors for nurses could help to stem this migration. © 2013 Blackwell Publishing Ltd

Briefing paper 'On the European workforce for health'

A critique of the EC report 'On the European Workforce for Health', together with workshop conclusions

Human Resources for Health Migration: global policy responses, initiatives, and emerging issues

This report identifies and maps contemporary global policy responses to, and initiatives on, international HRH migration, with particular reference to low‐income source countries. It reports on a systematic review and analysis of the responses and initiatives of twelve multilateral organisations and global fora: European Union; Global Forum on Migration and Development; Global Health Workforce Alliance; International Labour Organization; International Organization for Migration; Organisation for Economic Cooperation and Development; Pan‐American Health Organization; UN Global Migration Group; UN High‐Level Dialogue on Migration and Development; World Bank; World Health Organization; and the World Trade Organization. The report documents how these global policy actors are presently engaging with the HRH migration field through their activities, initiatives and policy responses. It situates this engagement within global policy initiatives spanning health, migration and development. In addition to reviewing and mapping current initiatives and policy responses and their outcomes, the report identifies emerging issues, upcoming promising initiatives and global policy scenarios

The ‘Skills Drain’ of Health Professionals from the developing World:a Framework for Policy Formulation

This paper examines policy towards health professionals’ migration from economic and governance perspectives

Cruel Britannia: a personal critique of nursing in the United Kingdom

The United Kingdom (UK) once led the world in nursing but because of the exigencies of the funding mechanisms of the National Health Service (NHS), it has fallen a long way behind other countries. We aim to raise awareness inside and outside the UK about the decline in nursing as a profession there. We are purposely contentious, in an attempt to raise questions, both for the UK and for countries which are recruiting British nurses who are leaving because of job losses caused by the funding crisis in the NHS. This paper discusses where the problems that have led to the decline have come from, where nursing is going and poses questions for the future. We hope that the UK government and those who influence the development of nursing will bring it back to the standard it once bad

Mental Health in the Workplace: Situation Analyses, Poland

[From Introduction] The workplace is an appropriate environment in which to educate and raise individuals’ awareness about mental health problems. For example, encouragement to promote good mental health practices, provide tools for recognition and early identification of the symptoms of problems, and establish links with local mental health services for referral and treatment can be offered. The need to demystify the topic and lift the taboos about the presence of mental health problems in the workplace while educating the working population regarding early recognition and treatment will benefit employers in terms of higher productivity and reduction in direct and in-direct costs. However, it must be recognised that some mental health problems need specific clinical care and monitoring, as well as special considerations for the integration or re-integration of the individual into the workforce

Asian women medical migrants in the UK

Introduction: The volume and geographical spread of Asian female migration as well as its impact on the sending countries has led to a rapid growth in research on such migration (Limand Oishi 1996; Yamanaka and Piper 2003). Broadly speaking, there are two strands to this literature, that which focuses on intra-Asian migration (Huang and Yeoh 2003; Wickramasekara 2002; Chin 2003) and that which follows the broad contours of brain drain migration, from countries of the Third World to the First (Parreñas 2001; McGovern 2003). The extent of intra-regional migration in Asia, the conditions under which much of this labour is performed and the new forms of political and civil engagements that have emerged as a result have all evoked feminist attention (Yamanaka and Piper 2003; Piper 2003; Barber 2000). Research on the movement of women from Asia to work in OECD countries, particularly the US (Espiritu 2002; Parreñas 2001) and the U.K. (Anderson, 2000) echoes many of the same concerns. In much of this literature female labour seems to primarily involve body work, work where the female body or 'femininity' are implicated in the nature of work provided (see for instance, Gulati 1994). For instance, most Asian women labour migrants move to take up jobs as domestic workers, sex workers and nurses, professions that are defined by notions of femininity. As Bowlby, Gregory and McKie (1997) argue such notions can act in oppressive ways to structure women's entry into occupations but also shape the form of international female migration. However, women who move from the Third World to the First as well as within Asia also take part in the less feminised sectors of the labour market such as IT where gender exclusivity and male dominance are the norm, although such participation has received much less attention (but see for instance, Yeoh and Willis 2004; Raghuram, 2004a; Raghuram 2004b). Shortages in these sectors in many First World countries have reawakened debates about brain drain and more recently of 'brain circulation' (Saxenian 2001). These forms of migration are also encompassed in the burgeoning literature on highly skilled migration (see for instance, Iredale 2001) yet much of the literature on these topics does not acknowledge the presence of Asian women in skilled migration streams (but see Kofman and Raghuram 2004; Raghuram and Kofman 2004). As more and more countries use labour market needs and the ability of migrants to fill skills shortages as important principles for selecting migrants, it is important to examine the ways in which Asian women too are significant players in skilled migration streams. Recognising the presence of Asian women in skilled migration expands the way in which we think of migrant Asian women and highlights the variations between women who migrate in different ways and through different routes. In this paper I take some tentative steps towards this by highlighting the presence of women doctors who migrate from the Asian subcontinent to the UK, working in a sector where the discourse around migration is relatively ungendered, but often implicitly masculinised. I suggest that migrant women too play an important part in UK's professional labour markets and explore how recognising the presence of Asian women in medical migration can alter the ways in which we think of the presence of Asian women in the UK.1 The rest of the paper is divided into three sections. The first section looks at some debates around migrant women's participation in the labour market and contrasts that with contemporary debates on the broader literature on women's participation in the professions. The following section outlines the extent of migrant women's participation in one sector, i.e. the medical sector of the labour market and the final section outlines some of the implications of these patterns for the way we think about Asian female migration