Local, national, global: the challenge
of workforce planning for nurses.
Dr Susan Hamer
Director, Organisational and Workforce Development
University of Leeds
Susan.Hamer@nihr.ac.uk
Delivering clinical research to
make patients, and the NHS, better
International Nurses Day
International perspective
The World Health Assembly (WHA), the supreme decision
making body of WHO, has repeatedly recognised the
essential need for strengthening nursing and midwifery
services in achieving better health for individuals, families
and communities. The WHO progress report (2013b)
describes achievements in response to the series of
resolution adopted by the WHA to strengthen nursing and
midwifery services. However this report concludes that in
relation to the provision of health services many remain
understaffed by nurses and midwives who in turn can be
undertrained and poorly developed (WHO 2013b).
International perspective
Kingma (2007) concludes in a detailed study of global
nurse migration, “Today’s search for labour is a highly
organized global hunt for talent that includes nurses.
International migration is a symptom of the larger systemic
problems that make nurses leave their jobs. Nurse
mobility becomes a major issue only in a context of
migrant exploitation or nursing shortage. Injecting migrant
nurses into dysfunctional health systems, ones that are
not capable of attracting and retaining staff domestically
will not solve the nursing shortage.” (p.1281)
Health at a Glance 2009: OECD Indicators - OECD © 2009 - ISBN 9789264061538
3. Health workforce
3.8 Practising nurses
Version 1 - Last updated: 19-Oct-2009
3.8.1. Practising nurses per 1 000
population, 2007 (or latest year available)
3.8.2. Change in the number of practising
nurses per 1 000 population, 2000-07
Norw ay
Ireland
Sw itzerland
Belgium
Denmark
Iceland
Luxembourg
Sw eden
United States
Finland
United Kingdom
Germany
New Zealand
Australia
OECD
Japan (2004-06)
Canada (2003-07)
Netherlands (2004-07)
Czech Republic
France
Spain
Austria 1
Italy (2004-07)
Slovak Rep. (2000-04)
Hungary
Poland
Portugal
Korea
Greece
Mexico
Turkey
31.9
Associate
Practising nurses
40
30
15.5
14.9
14.8
14.3
14.0
11.0
10.8
10.6
10.3
10.0
9.9
9.9
9.7
9.6
9.4
9.0
8.7
8.0
7.7
7.5
7.4
7.0
6.3
6.1
5.2
5.1
4.2
3.2
2.4
2.0
20
10
0
n.a.
1.5
2.1
n.a.
2.4
0.8
n.a.
1.5
4.6
1.3
0.8
0.5
-0.7
1.4
2.0
1.5
-2.5
0.8
2.0
2.0
0.6
1.6
-3.9
2.1
0.6
4.8
4.9
• Multiple imbalances (undersupply,
unemployment and underemployment)
2.8
0.7
2.6
-6
Per 1 000 population
Security of Supply
0.6
-3
0
3
6
Average annual grow th rate (%)
1. Austria reports only nurses employed in hospitals.
• Political interference
3.8.3. Ratio of practising nurses to practising physicians, 2007 (or latest year available)
10
• Gap between supply and demand
8.3
8
6
4
5.1
4.5 4.5 4.4 4.3
4.1 4.0 4.0
3.9 3.8 3.7
3.5 3.5
3.1 3.0
2.8
2.4 2.4 2.3 2.2 2.2 2.2
2.1 2.1 2.0 1.9
2
1.5 1.3
1.2
0.6
• Migration
0
• EU Mobility
Source: OECD Health Data 2009.
• Educational investment and systems
Health professional education
•
Insufficient to address need
•
Mismatch of competencies to patient and
population need
•
Persistent gender stratification of professional status
•
Quantitative and qualitative imbalances in the health care professions
•
Insufficient emphasis and time allocation for clinical learning; use of
ineffective clinical teaching methodologies; unsuitable, poor quality or
crowded clinical learning places; and a lack of good clinical role models.
•
Nursing faculty staff share the same demographic challenges as the rest of
the workforce
Changing Length of Nurse careers
•
•
•
•
•
•
•
•
Changing working life span of the nurse workforce
“Manpower planning models”
Female dominated professions
Different statutory pension ages
Health workers tend to retire earlier (global trend)
Different working patterns
Age distribution of the workforce
Weak approaches to workforce planning and
management
The Solution
An educated nurse workforce + a good work environment
= High quality care
This simple, evidence based, equation, whether applied at a global
or a local level in the health system is fundamental to understanding
how to make the best of the vital resource which is nursing.
A skilled nurse workforceright number, right place?
• Have board level commitment (with a nursing director/chief
nurse as a key requirement)
• Actively involve staff and are transparent in their
processes
• Use established approaches and apply them consistently
• Triangulate (e.g. dependency scoring system to gauge
workload, professional judgement and benchmark)
• Be evaluated regularly (against patient and staffing
outcomes data)
• Actively engage with the education sector and increasingly
social care
• Act on the results
Support to change roles: who does what?
• Role substitution (task shifting)
• Increased complexity of interventions
• Evaluating impact of new roles
• Who pays?
• Role of patients and communities
When health professionals change fast:
•
•
•
•
•
•
Supportive environments
Right skill mix
Effective leadership
Expectation of change and authority to act
Flexible regulatory environment
Clinically attractive (innovation)
A positive work environment
Attribute 1: Shared core values.
Attribute 2: Shared vision and mission with individual and collective
responsibility.
Attribute 3: Adaptability, innovation and creativity maintain workplace
effectiveness.
Attribute 4: Appropriate change driven by the needs of patients/ communities.
Attribute 5 : Formal systems exist to continuously enable and evaluate
learning, performance and shared governance
(Manley et al 2011)