1. RN4CAST: Human Resources Forecasting in Europe Luk Bruyneel

2. 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

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

4. 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

5. 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

6. RN4CAST.EU | FP-7 FUNDED RESEARCH | CO-ORDINATION 5  RN4CAST: nurse forecasting in Europe  Timeframe: 2009-2011  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

7. 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

8. 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

9. 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

10. 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

11. 10 CountryNurse surveyPatient survey HospitalsNursesRR NursesHospitalsPatientsRR Patients Belgium56318672.07%51232368.00% China181977497.50%179654092.50% Finland32113045.39%32195252.03% Germany*49362840.19%1239064.87% Greece*2650038%-81%2680055%-60% Ireland*31249556.00%10300? Netherlands*23316369.00%No Norway35660056.85%No * In progress RN4CAST.EU | PRELIMINARY RESULTS | DATA COLLECTION

12. 11 * In progress § Estimated RN4CAST.EU | PRELIMINARY RESULTS | DATA COLLECTION CountryNurse surveyPatient survey HospitalsNursesRR NursesHospitalsPatientsRR Patients Poland30260597.31%30413693.66% South-Africa*54206343.80%No Sweden*60-701000069.00%No Switzerland*35222271.20%35145866.05% UK*32616932.00%No Spain61656084.00%2996094.00% TOTAL EU § 4704800022512000 TOTAL NON EU § 235118001796540

13. 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

14. 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

15. Min 10th Pctl 25th Pctl 50th Pctl 75th Pctl 90th PctlMax 3.27.413.317.330.444.168.2 Variation between hospitals Intention to leave Variation between hospitals Min 10th Pctl 25th Pctl 50th Pctl 75th Pctl 90th PctlMax 1316.021.228.637.545.755.9 14 Job dissatisfaction RN4CAST.EU | PRELIMINARY RESULTS | JOB DISSATISFACTION AND INTENTION TO LEAVE

16. 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 exhaustion0.790.841 Depersonalisation0.680.770.881 Personal accomplishment-0.49-0.65-0.74 1 15 RN4CAST.EU | PRELIMINARY RESULTS | JOB DISSATISFACTION AND INTENTION TO LEAVE

17. HospitalIntention-to- leave Job dissatisfaction HOS 213.11 %3.23 % HOS 713.51 %5.41 % HOS 1113.21 %7.41 % HOS 1813.51 %8.11 % HospitalIntention-to- leave Job dissatisfaction HOS 4545.57 %47.50 % HOS 4741.18 %52.94 % HOS 5355.88 %44.12 % HOS 3754.55 %68.18 % Top 4 Bottom 4 16 RN4CAST.EU | PRELIMINARY RESULTS | JOB DISSATISFACTION AND INTENTION TO LEAVE

18. 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

19. 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

20. 2009 EU PROPOSAL PROTOCOL FINALISATIONDATA COLLECTIONDATA ANALYSIS AND POLICY IMPLICATIONS 2007-2008 19 20102011 RN4CAST.EU | FURTHER PROGRESS | 3-YEAR TIMELINE

21. 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

22. 21 AWARENESS – INVOLVEMENT – POLICY IMPLICATIONS RN4CAST.EU | FURTHER PROGRESS | STAKEHOLDER INVOLVEMENT

23. 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 2010 126 participants 25 countries 14 international organisations POLICY DIALOGUES RN4CAST.EU | FURTHER PROGRESS | EU ACTION

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