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Policy development in palliative and end-of-life care has changed significantly since its origins as a 'boutique' specialist area of hospice care in the 1960s and 1970s. International agencies have shifted the emphasis away from solely caring for cancer patients to a much broader definition of palliative care, which encompasses people with life-limiting illnesses who are not going to die immediately but still need to plan for death while undergoing life-prolonging treatment. This article explores the development of and demand for palliative and end-of life care in developed countries and the implications of this development for available workforce and future workforce planning. It argues that human resource planners in healthcare need to turn their attention to the growing demands of caring for the dying and the elderly and work closely with service planners to ensure that sufficient and qualified staff are available. [ABSTRACT FROM AUTHOR]

AIMS: To determine the impact on nursing work-force supply of delaying retirement. BACKGROUND DATA: The nursing workforce is aging, and the Baby Boomer generation is nearing retirement age. This potential loss of experienced nurses is likely to exacerbate current nursing shortages. METHODS: An analysis of loss rates of nurses in New South Wales (Australia) is provided using 2 different retirement ages--58 and 65 years. Supply numbers were used and then 'aged' to determine the impact of retirement on workforce numbers. The impact of potential retention strategies on the numbers who could be retained were determined if 100% of 50- to 55-year-old nurses was retained, 75% of those 56 to 60 years, and 50% of those 61 to 65 years. RESULTS: By the year 2004, approximately 4139 nurses (registered and enrolled) will be lost through retirement at age 65 years. However, retirement at age 58 years sees 7328 lost by 2004. Potentially 2139 nurses in this age spectrum could be retained if strategies are focused on delaying retirement. CONCLUSIONS: Delaying the retirement of nurses could provide a significant human resource, not only in terms of absolute numbers but more importantly, in terms of experience and expertise. However, retention of this portion of the workforce may require different strategies than for younger members of the workforce. The needs of this segment of the nursing workforce may require nurse administrators to consider different approaches to nursing work and work allocation. [ABSTRACT FROM AUTHOR]

Background and Objectives: Defining quality in the health care context has proven difficult, with many organizations not able to clearly articulate their use of this term in a manner that is easily understood by their clinical staff. This review seeks to investigate the literature to explore clinician engagement in quality including where engagement has been problematic, and if the reasons for this have been identified., Methods: An integrative review of the literature was undertaken to determine whether evidence within the literature supports a hypothesis that there is a lack of understanding of and engagement in quality at an organizational level by health professionals. A search of the literature was conducted using EBSCO Academic Complete, CINAHL, and MEDLINE databases., Results: This article identified 18 studies where the understanding of quality by clinicians and their level of engagement with the process are investigated. We found that there has been no comprehensive study that explores the development of an agreed-upon definition and measurement of quality or clinician understanding and engagement in quality. The studies conducted have been small and discipline-specific., Conclusion: There is a growing body of evidence indicating that clinical and nonclinical staff interpret the meaning of quality and quality improvement differently. Quality and quality improvement are interpreted in relation to the clinician's individual work, professional, and learning and development experience. The literature suggests that clinician interpretation is influenced in part by their own personal beliefs and values, in addition to their interpretation of their individual work/professional responsibilities., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To identify the reasons older RNs (≥45 years) remain in the healthcare workforce., Background: Despite predictions of early retirements of older nurses, many continue to work past the age when they can gain access to their retirement funds., Methods: The authors surveyed nurses older than 45 years in New South Wales, Australia., Results: The need for income was the most common reason for staying in nursing (61.9%; n = 210), with nearly 43% (n = 130) identifying this as the main reason for staying., Conclusions: Retaining older nurses in the workforce is an important strategy for managing workforce shortages. Nurse executives will need to consider strategies that will enhance retention of older nurses and focus on the reasons older nurses want to keep working.

Purpose/objectives: The purpose was to describe the number, demographic characteristics, work patterns, exit rates, and work perceptions of nurses in Ontario, Canada, in 4 specialty classifications: advanced practice nurse (APN)-clinical nurse specialist (CNS), APN-other, primary healthcare nurse practitioner [RN(extended class [EC])], and registered nurse (RN) with specialty certification. The objectives were to (1) describe how many qualified nurses are available by specialty class; (2) create a demographic profile of specialist nurses; (3) determine the proportions of specialist and nonspecialist nurses who leave (a) direct patient care and (b) nursing practice annually; (4) determine whether specialist and nonspecialist nurses differ in their self-ratings of work environment, job satisfaction, and intention to remain in nursing. Employment patterns refer to nurses' employment status (eg, full-time, part-time, casual), work duration (ie, length of employment in nurses and in current role), and work transitions (ie, movement in and out of the nursing workforce, and movement out of current role)., Design: A longitudinal analysis of the Ontario nurses' registration database from 2005 to 2010 and a survey of specialist nurses in Canada was conducted., Setting: The setting was Canada., Sample: The database sample consisted of 3 specialist groups, consisting of RN(EC), CNS, and APN-other, as well as 1 nonspecialist RN staff nurse group. The survey sample involved 359 nurses who were classified into groups based on self-reported job title and RN specialty-certification status., Methods: Data sources included College of Nurses of Ontario registration database and survey data. The study measures were the Nursing Work Index, a 4-item measure of job satisfaction, and 1-item measure of intent to leave current job. Nurses registered with the College of Nurses of Ontario were tracked over the study period to identify changes in their employment status with comparisons made between nurses employed in specialist roles and those registered as general staff nurses. Analysis involved descriptive summaries, mean comparisons with independent-samples t test, and χ(2) tests for categorical data., Results: Exit rates from direct practice were highest for APN-other (7.6%) and CNS (6.2%) and lowest for RN(EC) (1.0%) and staff nurses (1.2%). χ(2) Tests indicated yearly exit rates of both APN-other and CNS nurse groups were significantly higher than those of staff nurses in all years evaluated (α = .025). Every specialist employment group scored significantly higher than staff nurses on measures of work environment and satisfaction outcomes., Conclusions: We provided a description of specialist nurses in Ontario and examined the relationship between specialization and employment patterns of nurses to inform nurse retention strategies in the future. Employment in specialist nursing positions is significantly associated with differences in transitions or exits from nursing among the specialist and nonspecialist groups. Registered nurses (EC) displayed improved retention characteristics compared with staff nurses. Advanced practice nurse-other and APN-CNS exit rates from nursing practice in Ontario were comparable to staff nurses, but exit rates from direct clinical practice roles were higher than those of staff nurses., Implications: Targeted strategies are required to retain CNS and APN-other in direct clinical practice roles.

Objective: To identify the range of positions to which registered nurses moved when they left the profession and to explore the perceptions of respondents about the skills and experiences gained from performing nursing work., Background Data: Many nurses do not remain employed in nursing positions for the duration of their working life. This pattern of career change has been seen in many countries, including Australia, the United Kingdom, the United States, and Canada., Methods: A mailed questionnaire was completed by respondents who had left nursing. This questionnaire covered demographic information, the industry and role in which respondents were currently working, ease of adjustment to the current industry and role, perceptions of the skills they had gained from nursing, reasons for becoming a nurse, and reasons they left nursing., Results: Many respondents moved to management positions outside the health industry, and most undertook additional study after leaving nursing. In addition, few identified difficulties in adapting to non-nursing employment, and most agreed that their nursing skills and experiences had assisted them in attaining these positions., Conclusions: The findings are reassuring that employment as a nurse provides invaluable skills for a range of employment prospects should an individual wish to change careers.

The goal of International Perspectives is to share the views of nurse leaders, from countries other than the United States, on global healthcare issues. The focus is on identifying healthcare management problems and their implications, research priorities, policy development, and ethicalmoral dilemmas faced by nurse administrators. You are encouraged to send the names and addresses of international nurse leaders who might be interested in participating, as well as your ideas, for format and content of the department.

The nursing profession in Australia implemented progressively in each state new clinical career structures commencing in 1986. While the structures differ, all states introduced the position of CNS. The role and responsibilities associated with this position also differ. The role of CNS in Australia is different from that described in the North American literature. Findings of a study that established a profile of CNSs in the heavily populated state of New South Wales are described. Data on education, experience, and career plans were obtained from 373 CNSs in 19 hospitals. The results enable some comparison with first-line nurse managers whose role is very similar to the American position of head nurse. As with their managerial counterparts, the Australian CNSs' lack formal educational preparation and were demonstrating a low rate of participation in educational programs at the time of the study. However, 82% of respondents intended to remain in clinical practice. This is significant since this was a major goal in development of a clinical career structure.