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Objectives The purpose of this study was to scope the literature that exists about factors influencing oral health workforce planning and management in developing countries (DCs). Methods The Arksey and O'Malley method for conducting a scoping review was used. A replicable search strategy was applied, using three databases. Factors influencing oral health workforce planning and management in DCs identified in the eligible articles were charted. Findings Four thousand citations were identified; 41 papers were included for review. Most included papers were situational analyses. Factors identified were as follows: lack of data, focus on the restorative rather than preventive care in practitioner education, recent increase in number of dental schools (mostly private) and dentistry students, privatization of dental care services which has little impact on care maldistribution, and debates about skill mix and scope of practice. Oral health workforce management in the eligible studies has a bias towards dentist‐led systems. Due to a lack of country‐specific oral health related data in developing or least developed countries (LDCs), oral health workforce planning often relies on data and modelling from other countries. Discussion and conclusion Approaches to oral health workforce management and planning in developing or LDCs are often characterized by approaches to increase numbers of dentists, thus not ameliorating maldistribution of service accessibility. Governments appear to be reducing support for public and preventative oral healthcare, favouring growth in privatized dental services. Changes to professional education are necessary to trigger a paradigm shift to the preventive approach and to improve relationships between different oral healthcare provider roles. This needs to be premised on greater appreciation of preventive care in health systems and funding models.

Despite recent discussions and campaigns to widen nursing's appeal to people of diverse gender identities, it continues to be perceived as a largely female profession. In the context of an ageing workforce, and alongside recruitment and retention challenges, efforts should be directed at developing a more inclusive profession rather than focusing on why people other than women do not become nurses. To attract more men, transgender people and those who identify as nonbinary, as well as women, the approach to nursing recruitment needs to change. The profession must develop a more inclusive culture and examine and promote the advantages that gender diversity can bring to nursing. This article explores the lack of gender diversity in contemporary nursing, briefly examines the history of gender in nursing, and considers how the profession might evolve into a more gender-diverse and inclusive workforce.

Aim This study aimed to profile the community nurse in Australia. Background The need for nurses in the community health care sector is increasing in response to shorter hospital stays, an aging population and chronic disease. The increase in demand has not been followed by appropriate workforce planning, leading to structural issues and lack of qualified nursing workforce in the community sector. Evaluation MEDLINE and ProQuest Public Health and grey literature were searched for records published between 2010 and 2020 relative to the profile of the community nurse in Australia. Twenty-five records (21 publications, 2 databases and 2 reports) were included in the review. Abstracted data followed the principles of workforce planning and included demographics, qualifications and roles. Key issues Inconsistent definitions, self-reported data and a focus on practice nurses have contributed to data irregularities. Little is known about the specific aspects of community nursing work. Conclusion A lack of concrete data has overshadowed a community nursing workforce crisis with implications for patients' health and safety across the lifespan. Implications for nursing management There is urgent need for nurse managers globally to refocus nursing recruitment to the community sector to maintain quality and ensure sustainability of the nursing workforce.

Demographic changes in Australia have led to an increase in both religious diversity and the number of people who do not nominate a faith affiliation at hospital admission. Models of chaplaincy have shifted from clerical and largely male to an increasingly skilled and diverse spiritual care workforce appointed directly by health services. This study uses survey and in-depth interview methods at an inner-city Australian hospital to examine patient preferences for hospital chaplaincy provided by faith communities, and the importance of faith affiliation compared to other spiritual care provider characteristics. Survey results indicate that of 110 respondents, a high proportion (74%) prefer spiritual care to be provided by a person of the same faith. However, when considered relative to other characteristics, faith affiliation was not as important as kindness, listening skills and a non-judgmental attitude. Our findings have implications for workforce planning and educating. Further research in different settings and with different populations will make the findings more generalizable.

The nurses in the Republic of Bulgaria addressed a number of official demands to the Ministry of Health, one of them was to work out a long-term strategy for the development of standards, including detailed minimal requirements for the number of staff for both hospital, and outpatient care. Objectives: The goal of the current report is a summary of the regulatory documents, concerning the number of nurses in the Republic of Bulgaria, in context of the global practices. Methods: Current medical standards in the Republic of Bulgaria are being taken into account, and methods for determining the number of nurses in other countries. Results: In the period between November and December 2020, within the public consultations for projects of different Regulations for approval of medical standards, the proposed and developed methods by the Bulgarian association of health professionals in nursing to be included in the standards, which concern calculating the necessary staff of nurses, was not admitted for inclusion in any of those standards. Conclusions: Until now, the number of active nurses in the Republic of Bulgaria in all active medical standards is calculated either on the basis of doctors (not patients), or it’s pointed out that the methods of calculating the sufficient number of nurses may be applied. It should be noted that the International Council of Nurses, actually does not recommend universal methods for all countries worldwide.

Aims and objectives This study aimed to understand how licenced practical nurses perceive their work environments across different work settings and to analyse the association between these nurses’ perceptions of their work environments and their intentions to stay employed at their current nursing unit. Design A cross‐sectional descriptive survey was conducted with Licensed Practical Nurses in Alberta, Canada. Methods The study population consisted of 598 licenced practical nurses. Survey measures included demographic information, the Perceived Work Environment‐Nursing Work Index, and an intention to stay scale. Descriptive statistics were calculated and mean scores for perceptions about the work environment were compared by work setting. The associations between perceived work environment and intention to stay were analysed using linear regression. Results Overall, licenced practical nurses rated their work environment as mixed, with statistically significantly lower scores in acute care settings. Nurse manager ability and adequate staffing and resources were the highest contributing variables.

Background Stronger healthcare models are increasingly sought to address new population needs, health workforce inefficiencies and nursing shortages. One strategy is to focus on employees' strengths to capitalize on their competencies and maximize their scope of practice. Introduction Globally, there is an exponential demand for advanced practice nursing services. This study aimed to identify the roles and positions of nurses who align with APN defining criteria at all levels of care in Catalonia, Spain. Methods The first step of the study included the translation and validation to Catalan of the Advanced Practice Nurse Role Delineation Tool (IDREPA) and step 2 comprised a multicentre cross-sectional study, in which 126 healthcare centres participated: 1209 nurses were included in the study. The STROBE checklist was used to report this study. Results Transcultural equivalence and validation of the instrument showed a content validity index of 0.958 and the reliability of the questionnaire. The instrument identified 269 nurses who align with international APN defined criteria. They worked in specialized care, mental healthcare and primary and community care, especially in chronic conditions, ageing and end-of-life care. Discussion Most areas of Catalonia have access to nurses practicing at APN defining criteria. These nurses were developed as an optimal resource to respond to patient needs in the context of study. Both recognition and strategic implementation are necessary to apply their full competencies to solve healthcare problems. Conclusion Understanding the supply of services delivered by nurses practicing at an advanced level and their scope of practice may lay the foundations for effective workforce planning in a dynamic context. Nurses who align with APN defining criteria are working mainly in large acute services without regulation and recognition. Implications for nursing Advanced practice nurses show the value of their role and activities in healthcare services. Implications for health policy Promoting the establishment of APN defining criteria that includes credentialing and a regulatory framework within international guidelines should be a priority to make an impact on healthcare policy.

PurposeWorkforce planning must answer how many workforces, in which positions, and talents, and when each organization is needed. To find the requirements workforce, organizations need to know the organizational position and talents pools. Clarifying the number of workforces required in each pool requires attention to workforce flows, including hiring, promotion, degradation, horizontal movement, and exiting the organization. It is a dynamic issue and must be addressed over several periods over a specific duration, which adds to the complexity. According to the talent management presented in this research, all the above complex questions are answered by applying the optimal control (OC) model according to talent management presented in this research.Design/methodology/approachThis research presents a dynamic model by using a linear-quadratic optimal control model, which was solved by Pontryagin's maximum principle, to achieve an optimal number of workforce requirements for each of the positions of nursing services manager, supervisor, head nurses and nurses in the health sector according to the required talents in each position.FindingsThe results have shown that the target value of workforce numbers has been achieved in the planning period, and the validation test and sensitivity analysis justified the model by reaching the workforce planning targets.Originality/valueThis study provides a dynamic model for achieving quantitative workforce planning targets; the model presented in this manuscript has included an important qualitative factor, namely workforce talents. According to the authors' review, there is no comprehensive research devoted to workforce planning through optimal control models by attention to workforces skills.

Background Medical centers across the country have had to rapidly adapt clinician staffing strategies to accommodate large influxes of patients with the coronavirus disease 2019 (COVID-19). Objective We sought to understand the adaptations and staffing strategies that US academic medical centers employed in the inpatient setting early in the spread of COVID-19, and to assess whether those changes were sustained during the first phase of the pandemic. Design Cross-sectional survey assessing organization-level, team-level, and clinician-level inpatient workforce adaptations. Participants Hospital medicine leadership at 27 academic medical centers in the USA. Key Results Twenty-seven of 36 centers responded to the survey (75%). Widespread practices included frequent staffing reassessment, organization-level changes such as geographic cohorting and redeployment of non-hospitalists, and exempting high-risk healthcare workers from direct care of patients with COVID-19. Several practices were implemented but discontinued, such as reduction of non-essential services, indicating that they were less sustainable for large centers. Conclusion These findings provide guidance for inpatient leaders seeking to identify sustainable practices for COVID-19 inpatient workforce planning. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06697-6.

AIM: The study aimed to establish the views of a range of stakeholders about their experiences of the newly implemented nursing associate role in England and its potential to contribute to patient care.\ud \ud BACKGROUND: Second-level nursing roles are increasingly used internationally within the healthcare workforce. In response to registered nurse workforce deficits, a new nursing associate role has been introduced in England to augment care provided by registered nurses and enable career progression of support workers.\ud \ud DESIGN: Qualitative descriptive design.\ud \ud METHODS: Semi-structured interviews and a focus group were conducted with a range of healthcare professionals in a large inner city acute secondary care healthcare organisation in England. Interviews were guided by the Consolidated Framework for Implementation Research and analysed using Framework Analysis. The study was reported according to COREQ guidelines.\ud \ud RESULTS: 33 healthcare professionals were interviewed-directors of nursing, ward managers, nursing associates and multidisciplinary team members. Participants perceived the role was broadly adaptable to different healthcare settings and provided a positive professional development mechanism for healthcare support workers. Managers felt training commitments made implementing the role complex and costly. Participants argued the role had limitations, particularly with intravenous medicine management. Implementation was impeded by rapid pace and consequent lack of clear communication and planning.\ud \ud CONCLUSIONS: The nursing associate role was perceived as an inclusive pathway into nursing but with limitations when working with high-acuity patients. Further evaluation is needed to investigate how the role has embedded over time.\ud \ud RELEVANCE TO CLINICAL PRACTICE: The role should be seen as both a stepping stone into registered nursing positions and valued as part of the nursing workforce. Consideration must be given to how the role can be safely implemented in different settings. Findings have relevance to healthcare leaders internationally, who continue to work in a climate of economic pressure and staffing shortages.

Background: For health care services to address the health care needs of populations and respond to changes in needs over time, workforces must be planned. This requires quantitative models to estimate future workforce requirements that take account of population size, oral health needs, evidence-based approaches to addressing needs, and methods of service provision that maximize productivity. The aim of this scoping review was to assess whether and how these 4 elements contribute to existing models of oral health workforce planning. Methods: A scoping review was conducted. MEDLINE, Embase, HMIC, and EconLit were searched, all via OVID. Additionally, gray literature databases were searched and key bodies and policy makers contacted. Workforce planning models were included if they projected workforce numbers and were specific to oral health. No limits were placed on country. A single reviewer completed initial screening of abstracts; 2 independent reviewers completed secondary screening and data extraction. A narrative synthesis was conducted. Results: A total of 4,009 records were screened, resulting in 42 included articles detailing 47 models. The workforce planning models varied significantly in their use of data on oral health needs, evidence-based services, and provider productivity, with most models relying on observed levels of service utilization and demand. Conclusions: This review has identified quantitative workforce planning models that aim to estimate future workforce requirements. Approaches to planning the oral health workforce are not always based on deriving workforce requirements from population oral health needs. In many cases, requirements are not linked to population needs, while in models where needs are included, they are constrained by the existence and availability of the required data. It is critical that information systems be developed to effectively capture data necessary to plan future oral health care workforces in ways that relate directly to the needs of the populations being served. Knowledge Transfer Statement: Policy makers can use the results of this study when making decisions about the planning of oral health care workforces and about the data to routinely collect within health services. Collection of suitable data will allow for the continual improvement of workforce planning, leading to a responsive health service and likely future cost savings.

At Sandwell and West Birmingham Hospitals Trust, an emergency rota was put into place in anticipation of the COVID-19 pandemic. Key changes included re-deploying non-general medical (GIM) consultants on to the GIM on-call rota and re-deploying junior doctors on to medical rotas, and introducing a COVID-19 induction training programme to support these redeployments. Results from a survey showed 100% of consultants felt the rotas were resilient, with 96% of consultants stating they felt the rotas were well-staffed and 77% stating that they observed no drop in quality of care. Here we outline how these changes were made and present quantitative and qualitative feedback, with the aim of informing other trusts carrying out similar urgent reconfigurations in the future, or seeking to apply the lessons learnt to their non-emergency rotas.

Background Advanced practice registered nurses (APRNs) play a pivotal role in meeting the increasing needs of elder care given the aging population. A good understanding of the characteristics of gerontological APRNs is important for future workforce planning. Purpose To understand the demographic, employment, and practice characteristics of APRNs who provide elder care. Methods A 34-item survey was distributed to 2,500 current members of the Gerontological Advanced Practice Nurses Association. Three hundred and sixty-four members provided demographic information and employment and practice patterns. To examine the sample representativeness, the survey sample was compared with a sample drawn from the National Sample Survey of Nurse Practitioners 2012. Descriptive statistics were used for analysis. Results Most respondents were older than 55 years, held a master's degree, were certified as a Gerontology APRN, worked in a long-term/elder care setting as an APRN, earned a salary ranging from $105,001 to $125,000, and practiced in urban or suburban areas. Most respondents worked full time, provided care for people who were 55 to 75 years old, and prescribed under a collaborative agreement. Implications for practice The study results suggested that gerontological APRNs have the experience and competence to meet the increasing needs of elder care, practice in a variety of settings, including in rural areas, and spend much time with patients. Future efforts are needed to support APRN practice, such as improving their autonomy and independence.

peer-reviewed The full text of this article will not be available in ULIR until the embargo expires on the 02/09/2021 Aims To examine the factors influencing final‐year nursing/midwifery students’ intentions to migrate following graduation. Background With expanding global staff shortages, effective recruitment and retention strategies targeted at new nursing/midwifery graduates are necessary. Understanding factors that influence graduates’ decisions to migrate or remain in the health care organisation that supported their education is essential but under‐researched. Methods A cross‐sectional electronic survey was distributed to graduating nursing/midwifery students across nine higher education institutions in Ireland with a 36% (N = 407) response rate. Results 85% of Irish (n = 376) nursing/midwifery graduating students reported an intention to migrate overseas and 70% intend to return within 5 years. Pay, working conditions and career were ranked as influencing intentions to migrate. Multivariable analysis illustrated that educational opportunities and friends predict migration, while family and obligation were protective factors. Conclusion Nursing and midwifery leaders and policymakers must reconsider recruitment and retention strategies and embrace innovative and responsive approaches to address migration intentions and trends. Implications for nursing/midwifery management Strategic leadership is required to develop effective structures that support personal, professional and career opportunities for new graduates. Targeted recruitment innovations to entice graduates back into the health service are recommended. ACCEPTED peer-reviewed

The novel coronavirus (COVID‐19) has rapidly impacted all of our lives following its escalation to pandemic status on 11 March 2020. Government guidelines and restrictions implemented to mitigate the risk of COVID‐19 community transmission have forced radiation therapy departments to promptly adjust to the significant impact on our ability to deliver best clinical care. The inherent nature of our tri‐partied professions relies heavily on multidisciplinary teamwork and patient–clinician interactions. Teamwork and patient interaction are critical to the role of a radiation therapist. The aim of this paper is to describe the experience of the Peter MacCallum Cancer Centre’s (Peter Mac) radiation therapy services during the preliminary stages of the COVID‐19 pandemic in minimising risk to patients, staff and our clinical service. Four critical areas were identified in developing risk mitigation strategies across our service: (a) Workforce planning, (b) Workforce communication, (c) Patient safety and wellbeing, and (d) Staff safety and wellbeing. Each of these initiatives had a focus on continuum of clinical care, whilst minimising risk of cross infection for our radiation therapy workforce and patients alike. Initiatives included, but were not limited to, establishing COVID‐Eclipse clinical protocols, remote access to local applications, implementation of Microsoft Teams, personal protective equipment (PPE) guidelines and virtual ‘Division of Radiation Oncology’ briefing/updates. The COVID‐19 pandemic has dictated change in conventional radiation therapy practice. It is hoped that by sharing our experiences, the radiation therapy profession will continue to learn, adapt and navigate this period together, to ensure optimal outcomes for ourselves and our patients., This commentary describes the operational changes made by the Peter MacCallum Cancer Centre's Radiation Therapy Services during the initial stages of the COVID‐19 pandemic. Changes to clinical operations, to ensure optimal patient and staff safety and wellbeing, whilst maintaining a high‐ quality clinical service, are detailed.

Problem There is a dearth of evidence on applied methodologies to workforce planning in nursing. Research and commentary to date reflects ad hoc, operational planning rather than strategic approaches. Strategic planning is particularly important in primary health care settings because investment in the early years lays the foundation for lifelong health representing a long-term return on investment. Aim The aim of this project was to ascertain the applicability of a comprehensive four-step workforce planning methodology to develop a three-to-five-year nursing workforce plan in a child and youth community health service. A secondary aim was to identify what elements of the methodology were important to engage nurses in the process. Methods Over a six-month period, a comprehensive methodology was applied. A survey was conducted with participants to elicit perspectives of the planning process. Free text responses were subject to thematic analysis. Findings Gaps in current processes and available data posed obstacles during workforce analysis. Three key themes generated from the survey data were: Engaging with the planning process, Creating change and Making a difference. This reflected an optimism toward the plan and an urgency to move ahead. Discussion A systematic approach that uses a variety of information sources is important to develop a comprehensive nursing workforce plan. Key processes that engaged nurses were scenario building and future forecasting. Conclusion This work demonstrates that a systematic workforce planning methodology is acceptable and effective. Engagement of nursing staff is a key factor in planning and important to create readiness for change.

Several high-profile inquiries and reports, including the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, by Sir Robert Francis QC, have identified that nurse staffing is an essential factor in patient safety and patient mortality rates. Since the Francis report, several policies and initiatives aimed at ensuring safe staffing in the NHS have been developed alongside guidance and evidence-based safe staffing tools, while the Care Quality Commission has been tasked with ensuring compliance with these policies. In 2015, the National Institute for Health Research (NIHR) Policy Research Programme commissioned research to examine the extent to which safe staffing policies have translated into practice locally in the NHS. This article summarises and examines the main findings of this research and suggests that, although policies have raised the profile of nurse staffing, nursing shortages have impeded their implementation.

Aims and objectives To explore patients' understanding of the role of an advanced practice nurse (APN). Background The increasing prevalence of multimorbidities among people living with cardiovascular disease (CVD) has increased the complexity of their clinical care. Implementing the role of APNs in new models of care has been shown to improve outcomes in the CVD population. However, the CVD population's understanding of and experiences with the APN role have not been examined in Singapore. Methods An exploratory descriptive qualitative design using semi-structured face-to-face individual interviews was undertaken (November 2017-March 2018). Fourteen participants were purposively sampled from an outpatient clinic in one of Singapore's national heart centres. Thematic analysis was undertaken. The COREQ guidelines were adhered to. Findings The multi-ethnic sample included ten males and four females. Two main themes were identified: (1) APNs play a complementary role to doctors and (2) the acceptance of the APN role takes time. Each theme was supported by three subthemes to further elucidate the role and acceptance of APNs. Conclusion A lack of understanding of the role of APNs is present, thereby causing the less than optimal patient acceptance of APNs. As patients with CVD experience improvements to their health through APN-led services, they may gain confidence in APNs' skills and knowledge. Relevance to clinical practice When introducing new roles, fully explaining these roles to the target population is pertinent as it will be facilitative to patient engagement and optimisations of care. The findings support the call for APNs to explain the value and essence of advanced practice nursing more effectively. There should be a greater emphasis on teaching APNs to introduce and explain the role of APNs through APN preparatory education and incorporating this practice in APN practice standards, especially in contexts where APN development is premature.

Nurse leaders in today’s health care settings bear the onerous responsibility of driving care outcomes despite evolving consumer demands, economic influences, scarce resources, and workforce challenges. Understanding registered nurses’ perspectives serves to inform nurse leaders’ decision-making and actions in rapidly evolving health care environments. Results from the AMN 2019 Survey of registered nurses provide insights from almost 20,000 nurses that provide care to patients every day. Knowledge from this survey can frame leaders’ strategic thinking and decision-making around workforce planning, recruitment, and retention, and sustaining healthy work environments. The report provides evidence that growing pressures on registered nurses will increase in the next decade and could impact quality of patient care, quality of life, retention, and the health and well-being of nurses. The survey also suggests sustainable solutions in the form of greater support for nurses in professional development, diverse workplace environments, and flexibility in work-life balance.

Background Double degrees in nursing and midwifery have evolved in Australia as a proposed solution to possible impending shortages of qualified midwives in the healthcare workforce. The double degree is seen as a more acceptable option in non-metropolitan areas in particular. Concern has been expressed however, about dilution of midwifery philosophy and graduates’ opportunities in respect of future clinical practice. Aim This study aimed to provide a better understanding of motivations and intentions of students who undertake the Bachelor of Nursing Science/Bachelor of Midwifery double degree. Methods A cross-sectional survey design was employed at four universities that offered double degrees in nursing and midwifery in three states of Australia. Students enrolled in first and fourth year of a double degree and graduates of a double degree were invited to complete an online survey comprised of Likert scales and items requiring free text responses. Quantitative data was analysed using SPSS and thematic analysis was used to analyse the qualitative data. Findings Participants indicated a clear preference for midwifery as a career with this preference increasing for each cohort at each stage of study. Discussion Primary reasons for selecting a double degree were perceived increased opportunity for employment and use of nursing skills to enhance midwifery practice in a population with growing co-morbidities. A strong identification with midwifery philosophy and identity was also demonstrated. Conclusion An understanding of motivations and career intentions of students undertaking double degree studies can inform future program development and workforce planning.

The phrase 'cut the Gordian knot' describes a bold and direct solution to a complicated problem. Nursing presence has been defined as nurses' ability to pay attention to patients and make them feel that their needs have been considered. In the emergency department (ED), nursing presence can be adversely affected by factors such as fatigue, workplace bullying, moral distress and inadequate staffing levels, which could lead to suboptimal patient outcomes and compromise the goals of nursing. Nursing presence is also important for nurses' job satisfaction and therefore for staff retention. This article explores the combined effects of fatigue, workplace bullying, moral distress and inadequate staffing levels on emergency nurses. To cut the Gordian knot it also provides recommendations for mitigating these issues in EDs through safe staffing decisions that consider patient acuity and skill mix.

Background GRACE stands for Goalsetting, Reablement, Assessment, Complementary Therapy and Emotional Support. Person-centred goal setting focuses on patients’ priorities for normality and functional independence (Wosahlo, 2013). Among patients’ end-of-life concerns, fear of functional decline frequently eclipses fear of impending death (Cheville, 2001). Rehabilitation has been shown to reduce the impact of symptoms such as pain and anxiety and to improve functional status and quality of life (Javier & Montagnini, 2011). The model also allows for early identification of people approaching the end-of-life and initiating discussions about preferences for end-of-life care; care planning: assessing needs and preferences, agreeing a patient and carer care plan; and coordination of care. Aim To optimise function and wellbeing to enable people to live as well and independently as possible within the limitations of advancing illness. Methods 2019-2020: wellbeing days piloted. May-August 2020: literature review and remodelling. Sept-December 2020: workforce planning, training in Support Needs Approach for Patients (SNAP) intervention. Jan-May 2021: recruitment, process planning. Results The outcome measures utilised are IPOS and AKPS plus goals achieved and advance care planning. It is too early to truly evaluate the impact of our new approach. Conclusion GRACE is a person-centred approach with a focus on reablement and wellbeing. It allows for earlier identification and support of those in their last year of life.

BACKGROUND Abortion care has always been controversial, with health professionals worldwide continually working to offer well-rounded safe services. Key improvements in New Zealand since abortion law reform include the ability to self-refer, no formal certification under 20 weeks gestation, and change to the indications for abortion after 20 weeks. Nationally, we know that the second trimester abortion incidence is stable, and will therefore require an ongoing workforce to sustain the service. AIMS To document the current second trimester workforce for medical and surgical abortion in New Zealand, and examine their training and practice. MATERIALS AND METHODS Anonymous non-discriminatory snowball survey covering the domains of demographics, barriers to abortion care, abortion training, abortion provision and procedure specifics using Qualtrics software. RESULTS Eleven practitioners currently perform dilation and evacuation, and 33 wish to. Current providers have between zero and three other colleagues to assist them in service provision. Most learned by an informal apprenticeship model and operate relatively infrequently. There is variance in the cervical preparation and evacuation procedure as well as skillset and/or willingness for later gestations. Fifty-nine practitioners' units currently provide medical abortion, and 62 wish to. There is more coherence in the regime of medical abortion, although the availability of this is affected by gestation and location. CONCLUSION For most women requesting second trimester abortions, additional time, cost and stress is still very much the status quo. District Health Boards need to prioritise training and workforce planning to ensure the availability of this essential service.

Introduction: Inequitable distribution of health workforce limits access to healthcare services and contributes to adverse health outcomes. WHO recommends tracking health professionals from their points of entry into university and over their careers for the purpose of workforce development and planning. Previous research has focused on medical students and graduates' choice of practice location. Few studies have targeted nursing and allied health graduates' practice intentions and destinations. The Nursing and Allied Health Graduate Outcomes Tracking (NAHGOT) study is investigating factors affecting Australian nursing and allied health students and graduates' choice of graduate practice location over the course of their studies and up to 10 years after graduation by linking multiple data sources, including routinely collected university administrative and professional placement data, surveys of students and graduates, and professional registration data. Methods: By using a prospective cohort study design, each year a new cohort of about 2000 students at each participating university (Deakin University, Monash University and the University of Newcastle) is tracked throughout their courses and for 10 years after graduation. Disciplines include medical radiation practice, nursing and midwifery, occupational therapy, optometry, paramedicine, pharmacy, physiotherapy, podiatry and psychology. University enrolment data are collected at admission and professional placement data are collected annually. Students' practice destination intentions are collected via questions added into the national Student Experience Survey (SES). Data pertaining to graduates' practice destination, intentions and factors influencing choice of practice location are collected in the first and third years after graduation via questions added to the Australian Graduate Outcomes Survey (GOS). Additionally, participants may volunteer to receive a NAHGOT survey in the second and fourth-to-tenth years after graduation. Principal place of practice data are accessed via the Australian Health Practitioner Regulation Agency (Ahpra) annually. Linked data are aggregated and analysed to test hypotheses comparing associations between multiple variables and graduate practice location. Results: This study seeks to add to the limited empirical evidence about factors that lead to rural practice in the nursing and allied health professions. This prospective large-scale, comprehensive study tracks participants from eight different health professions across three universities through their pre-registration education and into their postgraduate careers, an approach not previously reported in Australia. To achieve this, the NAHGOT study links data drawn from university enrolment and professional placement data, the SES, the GOS, online NAHGOT graduate surveys, and Ahpra data. The prospective cohort study design enables the use of both comparative analysis and hypothesis testing. The flexible and inclusive study design is intended to enable other universities, as well as those allied health professions not regulated by Ahpra, to join the study over time. Conclusion: The study demonstrates how the systematic, institutional tracking and research approach advocated by the WHO can be applied to the nursing and allied health workforce in Australia. It is expected that this large-scale, longitudinal, multifactorial, multicentre study will help inform future nursing and allied health university admission, graduate pathways and health workforce planning. Furthermore, the project could be expanded to explore health workforce attrition and thereby influence health workforce planning overall.

Background: Paramedics working in advanced practice roles in the UK can now train to prescribe medicine. This is anticipated to benefit patient access to medicines and quality of care where there is a national shortage of doctors, particularly in primary care.Aim: To explore the experience of paramedics who are early adopters of independent prescribing in a range of healthcare settings in the UK.Design and setting: A qualitative study involving interviews between May and August 2019, with paramedics in the UK who had completed a prescribing programme.Methods: Individual interviews with a purposive sample of paramedics recruited via social media and regional paramedic networks. Interviews covered experiences, benefits and challenges of the prescribing role. A framework analysis approach was used to identify key themes.Results: Participants were 18 advanced paramedics working in primary care, emergency departments, urgent care centres and rapid response units. All participants reported being adequately prepared to prescribe. Key benefits of prescribing included improving service capacity, efficiency and safety, and facilitating advanced clinical roles. Challenges included technological problems, inability to prescribe controlled drugs and managing expectations about the prescribing role. Concerns were raised about support and role expectations, particularly in general practice.Conclusion: Paramedic prescribing is most successful in settings with a high volume of same-day presentations and urgent and emergency care. It facilitated advanced roles within multidisciplinary teams. Concerns indicate that greater consideration for support infrastructure and workforce planning is required within primary care to ensure paramedics meet the entry criteria for a prescribing role.

Aim To examine experienced registered nurses' motivations for choosing agency work, their experiences and perceptions of agency nursing and how they meet their regulatory professional development obligations. Background Agency registered nurses are employed by healthcare organizations to meet staffing shortfalls and contain costs. Methods Using an integrative review framework, four databases (CINAHL, Medline, Embase and Scopus) were systematically searched between 2000 and 2017: study selection followed the Preferred Reporting Items for Systematic reviews and Meta-analyses. Results Our search identified 491 sources. From these, two primary qualitative sources were included in this review. Four themes were identified: orientation, allocation of the agency nurse, isolation in clinical practice and lack of education opportunities. Conclusion Given the limited literature on agency nurses and how to support them, further research is required on this subject. Implications for nursing management Support for agency nurses is necessary, so they can seamlessly integrate with the healthcare team to provide safe patient care. This review may assist managers to identify strategies to effectively engage and support agency registered nurses in the acute care nursing team. The gaps identified highlight the need for further research to explore agency nurses' motivations, and support needs to inform future strategic workforce planning.