RN4CAST: Human Resources Forecasting in Europe

Luk Bruyneel

RN4CAST.EU | CONTENTS1

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 LITERATURE3

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 LITERATURE4

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-ORDINATION5

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

RN4CAST.EU | FP-7 FUNDED RESEARCH | EUROPEAN PARTNERS6

BelgiumKatholieke Universiteit Leuven

FinlandKuopio University

GermanyTechnische Universität Berlin

GreeceUniversity of Athens

IrelandDublin City University

The NetherlandsUMC St Radboud

PolandJagiellonian University Krakow

SpainInstitute of Health Carlos III

SwedenKarolinska Institutet

SwitzerlandBasel University

United KingdomKing’s College London

Norway is an official reference partner

University of Pennsylvania, USA: previousexpertiseInternational Cooperating Partner Countriesof 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 environment2.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

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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

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Country Nurse survey Patient survey

Hospitals Nurses RR Nurses Hospitals Patients RR Patients

Belgium 56 3186 72.07% 51 2323 68.00%

China 181 9774 97.50% 179 6540 92.50%

Finland 32 1130 45.39% 32 1952 52.03%

Germany * 49 3628 40.19% 12 390 64.87%

Greece * 26 500 38%-81% 26 800 55%-60%

Ireland * 31 2495 56.00% 10 300 ?

Netherlands * 23 3163 69.00% No No No

Norway 35 6600 56.85% No No No

* In progress

RN4CAST.EU | PRELIMINARY RESULTS | DATA COLLECTION

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* In progress § Estimated

RN4CAST.EU | PRELIMINARY RESULTS | DATA COLLECTION

Country Nurse survey Patient survey

Hospitals Nurses RR Nurses Hospitals Patients RR Patients

Poland 30 2605 97.31% 30 4136 93.66%

South-Africa * 54 2063 43.80% No No No

Sweden * 60-70 10000 69.00% No No No

Switzerland * 35 2222 71.20% 35 1458 66.05%

UK * 32 6169 32.00% No No No

Spain 61 6560 84.00% 29 960 94.00%

TOTAL EU § 470 48000 225 12000

TOTAL NON EU § 235 11800 179 6540

How satisfied are you with your current job in this hospital?

Very unsatisfied 2.8%

Unsatisfied 18.7%

Satisfied 69.7%

Very satisfied 9.8%

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 Pctl Max

3.2 7.4 13.3 17.3 30.4 44.1 68.2

Variation between hospitals

Intention to leave

Variation between hospitals

Min

10th Pctl

25th Pctl

50th Pctl

75th Pctl

90th Pctl Max

13 16.0 21.2 28.6 37.5 45.7 55.9

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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

Depersonalisatoins

Personal accomplishment

Intention-to-leave the hospital 1Job dissatisfactie 0.81 1Emotional exhaustion 0.79 0.84 1Depersonalisation 0.68 0.77 0.88 1Personal accomplishment -0.49 -0.65 -0.74 -0.74 1

15 RN4CAST.EU | PRELIMINARY RESULTS | JOB DISSATISFACTION AND INTENTION TO LEAVE

Hospital Intention-to-leave

Job dissatisfaction

HOS 2 13.11 % 3.23 %

HOS 7 13.51 % 5.41 %

HOS 11 13.21 % 7.41 %

HOS 18 13.51 % 8.11 %

Hospital Intention-to-leave

Job dissatisfaction

HOS 45 45.57 % 47.50 %

HOS 47 41.18 % 52.94 %

HOS 53 55.88 % 44.12 %

HOS 37 54.55 % 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 FINALISATION DATA COLLECTION DATA ANALYSIS AND POLICY IMPLICATIONS

2007-2008

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2010 2011

RN4CAST.EU | FURTHER PROGRESS | 3-YEAR TIMELINE

RN4CAST.EU | FURTHER PROGRESS | POLICY MAKING20

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

Other European projects: MohProf,

PROMeTHEUS

Policy Making

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AWARENESS – INVOLVEMENT – POLICY IMPLICATIONS

RN4CAST.EU | FURTHER PROGRESS | STAKEHOLDER INVOLVEMENT

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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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