Retaining nurses in metropolitan areas: insights from senior nurse and human resource managers.

AIM: To investigate the views of senior nurse and human resource managers of strategies to retain hospital nurses in a metropolitan area. BACKGROUND: Against a global shortage, retaining nurses is a management imperative for the quality of hospital services. METHOD: Semi-structured interviews, thematically analysed. RESULTS: Metropolitan areas have many health organisations in geographical proximity, offering nurses choices in employer and employment. Senior nurse and human resource managers recognised the complexity of factors influencing nurse turnover, including those that 'pulled' nurses out of their jobs to other posts and factors that 'pushed' nurses to leave. Four themes emerged in retaining nurses: strategy and leadership, including analysis of workforce and leavers' data, remuneration, the type of nursing work and career development and the immediate work environment. CONCLUSIONS: In contexts where multiple organisations compete for nurses, addressing retention through strategic leadership is likely to be important in paying due attention and apportioning resources to effective strategies. IMPLICATIONS FOR NURSING MANAGEMENT: Aside from good human resource management practices for all, strategies tailored to different segments of the nursing workforce are likely to be important. This metropolitan study suggests attention should be paid to strategies that address remuneration, progressing nursing careers and the immediate work environment

What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study.

OBJECTIVES: To investigate the deployment of physician associates (PAs); the factors supporting and inhibiting their employment and their contribution and impact on patients' experience and outcomes and the organisation of services. DESIGN: Mixed methods within a case study design, using interviews, observations, work diaries and documentary analysis. SETTING: Six acute care hospitals in three regions of England in 2016-2017. PARTICIPANTS: 43 PAs, 77 other health professionals, 28 managers, 28 patients and relatives. RESULTS: A key influencing factor supporting the employment of PAs in all settings was a shortage of doctors. PAs were found to be acceptable, appropriate and safe members of the medical/surgical teams by the majority of doctors, managers and nurses. They were mainly deployed to undertake inpatient ward work in the medical/surgical team during core weekday hours. They were reported to positively contribute to: continuity within their medical/surgical team, patient experience and flow, inducting new junior doctors, supporting the medical/surgical teams' workload, which released doctors for more complex patients and their training. The lack of regulation and attendant lack of authority to prescribe was seen as a problem in many but not all specialties. The contribution of PAs to productivity and patient outcomes was not quantifiable separately from other members of the team and wider service organisation. Patients and relatives described PAs positively but most did not understand who and what a PA was, often mistaking them for doctors. CONCLUSIONS: This study offers new insights concerning the deployment and contribution of PAs in medical and surgical specialties in English hospitals. PAs provided a flexible addition to the secondary care workforce without drawing from existing professions. Their utility in the hospital setting is unlikely to be completely realised without the appropriate level of regulation and authority to prescribe medicines and order ionising radiation within their scope of practice

Contaminated concrete surface layer removal

Equipment is being developed to economically remove contaminated concrete surfaces in nuclear facilities. To be effective this equipment should minimize personnel radiation exposure, minimize the volume of material removed, and perform the operation quickly with the least amount of energy. Several methods for removing concrete surfaces are evaluated for use in decontaminating such facilities. Two unique methods especially suited for decontamination are described: one, the water cannon, is a device that fires a high-velocity jet of fluid causing spallation of the concrete surface; the other, a concrete spaller, is a tool that exerts radial pressure agains the sides of a pre-dilled shallow cylindrical hole causing spallation to occur. Each method includes a means for containing airborne contamination. Results of tests show that these techniques can rapidly and economically remove surfaces, and leave minimal rubble for controlled disposal

Physician associates in England's hospitals: a survey of medical directors exploring current usage and factors affecting recruitment.

In the UK secondary care setting, the case for physician associates is based on the cover and stability they might offer to medical teams. We assessed the extent of their adoption and deployment - that is, their current usage and the factors supporting or inhibiting their inclusion in medical teams - using an electronic, self-report survey of medical directors of acute and mental health NHS trusts in England. Physician associates - employed in small numbers, in a range of specialties, in 20 of the responding trusts - were reported to have been employed to fill gaps in medical staffing and support medical specialty trainees. Inhibiting factors were commonly a shortage of physician associates to recruit and lack of authority to prescribe, as well as a lack of evidence and colleague resistance. Our data suggest there is an appetite for employment of physician associates while practical and attitudinal barriers are yet to be fully overcome

Interventions to Reduce Adult Nursing Turnover: A Systematic Review of Systematic Reviews.

Background: Nurse turnover is an issue of concern in health care systems internationally. Understanding which interventions are effective to reduce turnover rates is important to managers and health care organisations. Despite a plethora of reviews of such interventions, strength of evidence is hard to determine. Objective: We aimed to review literature on interventions to reduce turnover in nurses working in the adult health care services in developed economies. Method: We conducted an overview (systematic review of systematic reviews) using the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, Applied Social Sciences Index and Abstracts, CINAHL plus and SCOPUS and forward searching. We included reviews published between 1990 and January 2015 in English. We carried out parallel blinded selection, extraction of data and assessment of bias, using the Assessment of Multiple Systematic Reviews. We carried out a narrative synthesis. Results: Despite the large body of published reviews, only seven reviews met the inclusion criteria. These provide moderate quality review evidence, albeit from poorly controlled primary studies. They provide evidence of effect of a small number of interventions which decrease turnover or increase retention of nurses, these being preceptorship of new graduates and leadership for group cohesion. Conclusion: We highlight that a large body of reviews does not equate with a large body of high quality evidence. Agreement as to the measures and terminology to be used together with well-designed, funded primary research to provide robust evidence for nurse and human resource managers to base their nurse retention strategies on is urgently required

A Quartz-bearing Orthopyroxene-rich Websterite Xenolith from the Pannonian Basin, Western Hungary: Evidence for Release of Quartz-saturated Melts from a Subducted Slab

An unusual quartz-bearing orthopyroxene-rich websterite xenolith has been found in an alkali basaltic tuff at Szigliget, Bakony-Balaton Highland Volcanic Field (BBHVF), western Hungary. Ortho- and clinopyroxenes are enriched in light rare earth elements (LREE), middle REE and Ni, and depleted in Nb, Ta, Sr and Ti compared with ortho- and clinopyroxenes occurring in either peridotite or lower crustal granulite xenoliths from the BBHVF. Both ortho- and clinopyroxenes in the xenolith contain primary and secondary silicate melt inclusions, and needle-shaped or rounded quartz inclusions. The melt inclusions are rich in SiO2 and alkalis and poor in MgO, FeO and CaO. They are strongly enriched in LREE and large ion lithophile elements, and display negative Nb, Ta and Sr anomalies, and slightly positive Pb anomalies. The xenolith is interpreted to represent a fragment of an orthopyroxene-rich body that crystallized in the upper mantle from a hybrid melt that formed by interaction of mantle peridotite with a quartz-saturated silicate melt that was released from a subducted oceanic slab. Although the exact composition of the slab melt cannot be determined, model calculations on major and trace elements suggest involvement of a metasedimentary componen

A Quartz-bearing Orthopyroxene-rich Websterite Xenolith from the Pannonian Basin, Western Hungary: Evidence for Release of Quartz-saturated Melts from a Subducted Slab

An unusual quartz-bearing orthopyroxene-rich websterite xenolith has been found in an alkali basaltic tuff at Szigliget, Bakony-Balaton Highland Volcanic Field (BBHVF), western Hungary. Ortho- and clinopyroxenes are enriched in light rare earth elements (LREE), middle REE and Ni, and depleted in Nb, Ta, Sr and Ti compared with ortho- and clinopyroxenes occurring in either peridotite or lower crustal granulite xenoliths from the BBHVF. Both ortho- and clinopyroxenes in the xenolith contain primary and secondary silicate melt inclusions, and needle-shaped or rounded quartz inclusions. The melt inclusions are rich in SiO2 and alkalis and poor in MgO, FeO and CaO. They are strongly enriched in LREE and large ion lithophile elements, and display negative Nb, Ta and Sr anomalies, and slightly positive Pb anomalies. The xenolith is interpreted to represent a fragment of an orthopyroxene-rich body that crystallized in the upper mantle from a hybrid melt that formed by interaction of mantle peridotite with a quartz-saturated silicate melt that was released from a subducted oceanic slab. Although the exact composition of the slab melt cannot be determined, model calculations on major and trace elements suggest involvement of a metasedimentary componen

The Physicist's Guide to the Orchestra

An experimental study of strings, woodwinds (organ pipe, flute, clarinet, saxophone and recorder), and the voice was undertaken to illustrate the basic principles of sound production in music instruments. The setup used is simple and consists of common laboratory equipment. Although the canonical examples (standing wave on a string, in an open and closed pipe) are easily reproduced, they fail to explain the majority of the measurements. The reasons for these deviations are outlined and discussed.Comment: 11 pages, 10 figures (jpg files). Submitted to European Journal of Physic