RN4CAST: Human Resources Forecasting in Europe Luk Bruyneel

RN4CAST.EU | CONTENTS 1 1. INTERNATIONAL CONTEXT OF THE NURSING WORKFORCE 2. RN4CAST: FP7-FUNDED RESEARCH ON THE NURSING WORKFORCE 3. PRELIMINARY RESULTS 4. FURTHER PROGRESS

RN4CAST.EU | INTERNATIONAL CONTEXT | RATIO NURSES/PHYSICIANS 2 Source: OESO 2005 – for Belgium (exact): J.Pacolet, 2006 Ratio nurses/physicians

RN4CAST.EU | INTERNATIONAL CONTEXT | NURSING LITERATURE 3  Worldwide numeric, skill and geographic imbalances in the nursing workforce  Joint effects of staffing and various practice environment elements on patient outcomes (Aiken et al., 2002)  Poor nursing workforce planning and associated shortages in any country threaten the stability of the nurse workforce in neighbouring countries and beyond through distortions in patterns of international nurse migration

RN4CAST.EU | INTERNATIONAL CONTEXT | NURSING LITERATURE 4  Surgical patients in hospital with better nurse work environments have 13% lower odds on dying  Patients in hospitals with better staffing (two fewer patients per nurse) have 11% lower odds on dying  Patients in hospitals with better educated nurses (20% more BSNs) have 8% lower odds on dying  Surgical patients in hospitals that are better on all three have roughly 30% lower odds on dying

RN4CAST.EU | FP-7 FUNDED RESEARCH | CO-ORDINATION 5  RN4CAST: nurse forecasting in Europe  Timeframe:  Budget: 3 mio Euros  Co-ordination:  Co-ordinator: Walter Sermeus (K.U.Leuven, Belgium) Vice-coordination: Linda Aiken (Upenn, USA)  Partners: 15 (+1): 11(+1) in Europe, USA, 3 ICPC

RN4CAST.EU | FP-7 FUNDED RESEARCH | EUROPEAN PARTNERS 6 Belgium Katholieke Universiteit Leuven Finland Kuopio University Germany Technische Universität Berlin Greece University of Athens Ireland Dublin City University The Netherlands UMC St Radboud Poland Jagiellonian University Krakow Spain Institute of Health Carlos III Sweden Karolinska Institutet Switzerland Basel University United Kingdom King’s College London Norway is an official reference partner

University of Pennsylvania, USA: previous expertise International Cooperating Partner Countries of the European Union: China Botswana South-Africa 7 RN4CAST.EU | FP-7 FUNDED RESEARCH | PARTNERS WORLDWIDE

8 To refine current forecasting models for manpowerplanning of the nursing workforce with new elements: 1.Various aspects of the nursing work environment 2.Impact of nurse deployment on recruitment, retention and productivity of nurses and on patient outcomes And to present mid-term and long-term projections on a European and national level RN4CAST.EU | FP-7 FUNDED RESEARCH | OBJECTIVE

9 Hospitals: acute hospitals (at least 30 per country) Nursing units: general medicine and surgery (cf. Kane et al., 2007) Patient questionnaire Nurse questionnaire Hospital characteristics Hospital discharge data RN4CAST.EU | FP-7 FUNDED RESEARCH | METHODS

10 CountryNurse surveyPatient survey HospitalsNursesRR NursesHospitalsPatientsRR Patients Belgium % % China % % Finland % % Germany* % % Greece* %-81% %-60% Ireland* %10300? Netherlands* %No Norway %No * In progress RN4CAST.EU | PRELIMINARY RESULTS | DATA COLLECTION

11 * In progress § Estimated RN4CAST.EU | PRELIMINARY RESULTS | DATA COLLECTION CountryNurse surveyPatient survey HospitalsNursesRR NursesHospitalsPatientsRR Patients Poland % % South-Africa* %No Sweden* %No Switzerland* % % UK* %No Spain % % TOTAL EU § TOTAL NON EU §

How satisfied are you with your current job in this hospital? Very unsatisfied2.8% Unsatisfied18.7% Satisfied69.7% Very satisfied9.8% Job dissatisfaction 12 RN4CAST.EU | PRELIMINARY RESULTS | JOB DISSATISFACTION AND INTENTION TO LEAVE

If possible, would you leave your current hospital within the next year as a result of job dissatisfaction? Intention to leave 29.5% of the Belgian nurses say they would leave their current hospital within the next year as a result of job dissatisfaction  Nursing  …in another hospital 40%  …not in a hospital 27.9%  Unclear 2.4%  Non-nursing 29.7% 13 RN4CAST.EU | PRELIMINARY RESULTS | JOB DISSATISFACTION AND INTENTION TO LEAVE

Min 10th Pctl 25th Pctl 50th Pctl 75th Pctl 90th PctlMax Variation between hospitals Intention to leave Variation between hospitals Min 10th Pctl 25th Pctl 50th Pctl 75th Pctl 90th PctlMax Job dissatisfaction RN4CAST.EU | PRELIMINARY RESULTS | JOB DISSATISFACTION AND INTENTION TO LEAVE

Correlation between job dissatisifaction and intention to leave at the hospital level r=0.81 Intention-to- leave Job dissatisfaction Emotional Exhaustion Deperson alisatoins Personal accomplishment Intention-to-leave the hospital1 Job dissatisfactie0.811 Emotional exhaustion Depersonalisation Personal accomplishment RN4CAST.EU | PRELIMINARY RESULTS | JOB DISSATISFACTION AND INTENTION TO LEAVE

HospitalIntention-to- leave Job dissatisfaction HOS %3.23 % HOS %5.41 % HOS %7.41 % HOS %8.11 % HospitalIntention-to- leave Job dissatisfaction HOS %47.50 % HOS %52.94 % HOS %44.12 % HOS %68.18 % Top 4 Bottom 4 16 RN4CAST.EU | PRELIMINARY RESULTS | JOB DISSATISFACTION AND INTENTION TO LEAVE

Top 4 Bottom 4 Educational opportunities Wages Professional status Independence at work Opportunities for advancement Work schedule flexibility Educational opportunities Wages Professional status Independence at work Opportunities for advancement Work schedule flexibility 17 RN4CAST.EU | PRELIMINARY RESULTS | JOB DISSATISFACTION AND INTENTION TO LEAVE

A nurse manager who backs up the nursing staff in decision making, even if the conflict is with a physician Praise and recognition for a job well done. A nurse manager who is a good manager and leader. A supervisory staff that is supportive of nurses. Top 4 Bottom 4 A nurse manager who backs up the nursing staff in decision making, even if the conflict is with a physician Praise and recognition for a job well done. A nurse manager who is a good manager and leader. A supervisory staff that is supportive of nurses. 18 RN4CAST.EU | PRELIMINARY RESULTS | JOB DISSATISFACTION AND INTENTION TO LEAVE

2009 EU PROPOSAL PROTOCOL FINALISATIONDATA COLLECTIONDATA ANALYSIS AND POLICY IMPLICATIONS RN4CAST.EU | FURTHER PROGRESS | 3-YEAR TIMELINE

RN4CAST.EU | FURTHER PROGRESS | POLICY MAKING 20 Traditional forecasting models RN4CAST data Patient safety Nursing work environment Nurse deployment & More accurate idea of the required personnel deployment in terms of number of qualification for safe patient care and a healthy work environment for nurses Macro-economic data Data on migration Other European projects: MohProf, PROMeTHEUS Policy Making

21 AWARENESS – INVOLVEMENT – POLICY IMPLICATIONS RN4CAST.EU | FURTHER PROGRESS | STAKEHOLDER INVOLVEMENT

22 GREEN PAPER ON THE EUROPEAN WORKFORCE ON HEALTH MINISTERIAL CONFERENCE IN LA HULPE BELGIUM CONSULTATION REPORT COUNCIL CONCLUSIONS POLICY BRIEFS Assessing future health workforce needs 1.Life-long learning 2.Work environments 3.Audit and feedback Leuven, April participants 25 countries 14 international organisations POLICY DIALOGUES RN4CAST.EU | FURTHER PROGRESS | EU ACTION

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