James is the Adjunct Professor of the WHO Collaborating Centre at University of Technology Sydney (UTS), Australia, with thirty years experience of practice, consultancy, and applied/ policy research in health care human resources (HRH) in over +50 countries.
James is specialised in developing strategic intelligence and policy advice at national level and internationally on the HRH implications of health sector reorganisation and healthcare reform; health workforce pay, incentives and reward strategy; workforce planning; employment relations; regulation of health professionals; performance management, labour market analysis; and skill mix/ extended roles.
He has extensive experience working with Ministries of Health and equivalent at national level and is an experienced invited speaker at national and international conferences on HR issues in health sector. He acts as a consultant and adviser for many national and international bodies and organisations such as, World Bank, ICN, WHO, OECD and EU. Recent work has been in China, Malaysia, Kazakhstan, Moldova and Japan.
Dussault, G, Buchan, J, Sermeus, W & Padaiga, Z 2010, Assessing Future Health Workforce Needs.
Buchan, J, Policies, EOOHSA, Europe, WHOROF & Network, HE 2008, How Can the Migration of Health Service Professionals be Managed So as to Reduce Any Negative Effects on Supply?.
Humphries, N, Connell, J, Negin, J & Buchan, J 2019, 'Tracking the leavers: towards a better understanding of doctor migration from Ireland to Australia 2008-2018.', Human resources for health, vol. 17, no. 1.View/Download from: Publisher's site
BACKGROUND:The recession of 2008 triggered large-scale emigration from Ireland. Australia emerged as a popular destination for Irish emigrants and for Irish-trained doctors. This paper illustrates the impact that such an external shock can have on the medical workforce and demonstrates how cross-national data sharing can assist the source country to better understand doctor emigration trends. METHOD:This study draws on Australian immigration, registration and census data to highlight doctor migration flows from Ireland to Australia, 2008-2018. FINDINGS:General population migration from Ireland to Australia increased following the 2008 recession, peaked between 2011 and 2013 before returning to pre-2008 levels by 2014, in line with the general economic recovery in Ireland. Doctor emigration from Ireland to Australia did not follow the same pattern, but rather increased in 2008 and increased year on year since 2014. In 2018, 326 Irish doctors obtained working visas for Australia. That doctor migration is out of sync with general economic conditions in Ireland and with wider migration patterns indicates that it is influenced by factors other than evolving economic conditions in Ireland, perhaps factors relating to the health system. DISCUSSION:Doctor emigration from Ireland to Australia has not decreased in line with improved economic conditions in Ireland, indicating that other factors are driving and sustaining doctor emigration. This paper considers some of these factors. Largescale doctor emigration has significant implications for the Irish health system; representing a brain drain of talent, generating a need for replacement migration and a high dependence on internationally trained doctors. This paper illustrates how source countries, such as Ireland, can use destination country data to inform an evidence-based policy response to doctor emigration.
Maier, CB, Budde, H & Buchan, J 2018, 'Nurses in expanded roles to strengthen community-based health promotion and chronic care: Policy implications from an international perspective; A commentary', Israel Journal of Health Policy Research, vol. 7, no. 1.View/Download from: Publisher's site
© 2018 The Author(s). Chronic conditions and health inequalities are increasing worldwide. Against this backdrop, several countries, including Israel, have expanded the roles of nurses as one measure to strengthen the primary care workforce. In Israel, community nurses work in expanded roles with increased responsibilities for patients with chronic conditions. They also work increasingly in the field of health promotion and disease prevention. Common barriers to role change in Israel are mirrored by other countries. Barriers include legal and financial restrictions, resistance by professional associations, inflexible labor markets and lack of resources. Policies should be revisited and aligned across education, financing and labor markets, to enable nurses to practice in the expanded roles. Financial incentives can accelerate the uptake of new, expanded roles so that all patients including vulnerable population groups, benefit from equitable and patient-centered service delivery in the communities.
Russo, G, Fronteira, I, Jesus, TS & Buchan, J 2018, 'Understanding nurses' dual practice: a scoping review of what we know and what we still need to ask on nurses holding multiple jobs.', Human resources for health, vol. 16, no. 1, pp. 14-14.View/Download from: Publisher's site
BACKGROUND:Mounting evidence suggests that holding multiple concurrent jobs in public and private (dual practice) is common among health workers in low- as well as high-income countries. Nurses are world's largest health professional workforce and a critical resource for achieving Universal Health Coverage. Nonetheless, little is known about nurses' engagement with dual practice. METHODS:We conducted a scoping review of the literature on nurses' dual practice with the objective of generating hypotheses on its nature and consequences, and define a research agenda on the phenomenon. The Arksey and O'Malley's methodological steps were followed to develop the research questions, identify relevant studies, include/exclude studies, extract the data, and report the findings. PRISMA guidelines were additionally used to conduct the review and report on results. RESULTS:Of the initial 194 records identified, a total of 35 met the inclusion criteria for nurses' dual practice; the vast majority (65%) were peer-reviewed publications, followed by nursing magazine publications (19%), reports, and doctoral dissertations. Twenty publications focused on high-income countries, 16 on low- or middle-income ones, and two had a multi country perspective. Although holding multiple jobs not always amounted to dual practice, several ways were found for public-sector nurses to engage concomitantly in public and private employments, in regulated as well as in informal, casual fashions. Some of these forms were reported as particularly prevalent, from over 50% in Australia, Canada, and the UK, to 28% in South Africa. The opportunity to increase a meagre salary, but also a dissatisfaction with the main job and the flexibility offered by multiple job-holding arrangements, were among the reported reasons for engaging in these practices. DISCUSSION AND CONCLUSIONS:Limited and mostly circumstantial evidence exists on nurses' dual practice, with the few existing studies suggesting that the phenome...
Castro Lopes, S, Guerra-Arias, M, Buchan, J, Pozo-Martin, F & Nove, A 2017, 'A rapid review of the rate of attrition from the health workforce.', Human Resources for Health, vol. 15, no. 1, pp. 1-9.View/Download from: Publisher's site
Attrition or losses from the health workforce exacerbate critical shortages of health workers and can be a barrier to countries reaching their universal health coverage and equity goals. Despite the importance of accurate estimates of the attrition rate (and in particular the voluntary attrition rate) to conduct effective workforce planning, there is a dearth of an agreed definition, information and studies on this topic.We conducted a rapid review of studies published since 2005 on attrition rates of health workers from the workforce in different regions and settings; 1782 studies were identified, of which 51 were included in the study. In addition, we analysed data from the State of the World's Midwifery (SoWMy) 2014 survey and associated regional survey for the Arab states on the annual voluntary attrition rate for sexual, reproductive, maternal and newborn health workers (mainly midwives, doctors and nurses) in the 79 participating countries.There is a diversity of definitions of attrition and barely any studies distinguish between total and voluntary attrition (i.e. choosing to leave the workforce). Attrition rate estimates were provided for different periods of time, ranging from 3 months to 12 years, using different calculations and data collection systems. Overall, the total annual attrition rate varied between 3 and 44% while the voluntary annual attrition rate varied between 0.3 to 28%. In the SoWMy analysis, 49 countries provided some data on voluntary attrition rates of their SRMNH cadres. The average annual voluntary attrition rate was 6.8% across all cadres.Attrition, and particularly voluntary attrition, is under-recorded and understudied. The lack of internationally comparable definitions and guidelines for measuring attrition from the health workforce makes it very difficult for countries to identify the main causes of attrition and to develop and test strategies for reducing it. Standardized definitions and methods of measuring attrition are req...
Pozo-Martin, F, Nove, A, Lopes, SC, Campbell, J, Buchan, J, Dussault, G, Kunjumen, T, Cometto, G & Siyam, A 2017, 'Health workforce metrics pre- and post-2015: A stimulus to public policy and planning', Human Resources for Health, vol. 15, no. 1.View/Download from: Publisher's site
© 2017 The Author(s). Background: Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support the attainment of universal health coverage (UHC). This paper describes the main characteristics of available health workforce data for 74 of the 75 countries identified under the 'Countdown to 2015' initiative as accounting for more than 95% of the world's maternal, newborn and child deaths. It also discusses best practices in the development of health workforce metrics post-2015. Methods: Using available health workforce data from the Global Health Workforce Statistics database from the Global Health Observatory, we generated descriptive statistics to explore the current status, recent trends in the number of skilled health professionals (SHPs: physicians, nurses, midwives) per 10 000 population, and future requirements to achieve adequate levels of health care in the 74 countries. A rapid literature review was conducted to obtain an overview of the types of methods and the types of data sources used in human resources for health (HRH) studies. Results: There are large intercountry and interregional differences in the density of SHPs to progress towards UHC in Countdown countries: a median of 10.2 per 10 000 population with range 1.6 to 142 per 10 000. Substantial efforts have been made in some countries to increase the availability of SHPs as shown by a positive average exponential growth rate (AEGR) in SHPs in 51% of Countdown countries for which there are data. Many of these countries will require large investments to achieve levels of workforce availability commensurate with UHC and the health-related sustainable development goals (SDGs). The availability, quality and comparability of global health workforce metrics remain limited. Most published workforce studies are descriptive, but more sophisticated needs-based workforce planning methods are being developed. Conclusions: There is a need for high-...
A document that details government concerns about a 7-day NHS was released to a national newspaper in August, revealing the precarious state of NHS finances in England. The 'secret' internal document, known as the risk register, sets out civil servant assessments of the political danger in trying to implement the new working pattern throughout the health service.
Buchan, J 2016, 'Focus is on 'our' doctors', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 31, no. 15, p. 28.
With around one in three NHS doctors having been trained in another country, the headline-grabber at the Conservative party conference in October was the government's commitment to NHS England becoming 'self-sufficient' in doctors. Funding for the projected 15% increase in the number of medical students will come from the Department of Health's existing budget.
In the autumn, the NHS Pay Review Body (RB) will take evidence from government, employers and nurses' unions. It will then deliberate before making recommendations on what should be a pay rise in April 2017. But as NHS nurses know only too well, this supposedly independent system has been compromised by top down pay freezes initiated by the Westminster government as part of its 'austerity' measures.
The heated debate about the ending of bursaries for nursing students has given scant attention to one important issue: drop-out rates.
You do a brilliant job for your patients, you are a crucial part of our NHS, and as a country we value you.'
Some nurses will soon receive an invitation to participate in this year's NHS staff survey. This large scale test of the temperature of the NHS workforce helps give national policymakers a picture of staff motivation, and provides trusts with feedback on how their staff are feeling in comparison to those working for other NHS employers.
It was revealed recently that Health Education England (HEE) had sent letters to 54,000 former registrant nurses, urging them to enrol on return-to-practice courses. This move was part of HEE's 'Come Back' campaign, launched in 2014, which aims to encourage experienced staff to return to the nursing workforce.
We have a natural experiment emerging, with different UK countries looking at different approaches to NHS nurse staffing. For example, in June, Scotland first minister Nicola Sturgeon announced that Scotland will enshrine the use of existing local nurse workforce planning tools in law. This was misrepresented in some media coverage as being about legislated staffing levels, but it actually legislates what was already common local practice: flexibility framed by tested workforce tools, underpinned by professional judgement.
Lies, damned lies and Brexit statistics. It's not been a good month for anyone espousing evidence-based policy and politics after the chair of the Commons health committee switched from Leave to Remain, citing misuse of data by the Leave campaign.
Rumsey, M, Thiessen, J, Buchan, J & Daly, J 2016, 'The consequences of English language testing for international health professionals and students: An Australian case study', INTERNATIONAL JOURNAL OF NURSING STUDIES, vol. 54, pp. 95-103.View/Download from: Publisher's site
© 2015 Mosby, Inc. In 2010, all member states of the World Health Assembly, including the United States, adopted the World Health Organization (WHO) Global Code of Practice on the International Recruitment of Health Personnel (the WHO Code).1 The development and unanimous adoption of the Code by all WHO affiliate countries marked a watershed in policy focus on the issue of health worker migration.
Kroezen, M, Dussault, G, Craveiro, I, Dieleman, M, Jansen, C, Buchan, J, Barriball, L, Rafferty, AM, Bremner, J & Sermeus, W 2015, 'Recruitment and retention of health professionals across Europe: A literature review and multiple case study research', Health Policy, vol. 119, no. 12, pp. 1517-1528.View/Download from: Publisher's site
© 2015 Elsevier Ireland Ltd. Many European countries are faced with health workforce shortages and the need to develop effective recruitment and retention (R&R) strategies. Yet comparative studies on R&R in Europe are scarce. This paper provides an overview of the measures in place to improve the R&R of health professionals across Europe and offers further insight into the evidence base for R&R; the interaction between policy and organisational levels in driving R&R outcomes; the facilitators and barriers throughout these process; and good practices in the R&R of health professionals across Europe. The study adopted a multi-method approach combining an extensive literature review and multiple-case study research. 64 publications were included in the review and 34 R&R interventions from 20 European countries were included in the multiple-case study. We found a consistent lack of evidence about the effectiveness of R&R interventions. Most interventions are not explicitly part of a coherent package of measures but they tend to involve multiple actors from policy and organisational levels, sometimes in complex configurations. A list of good practices for R&R interventions was identified, including context-sensitivity when implementing and transferring interventions to different organisations and countries. While single R&R interventions on their own have little impact, bundles of interventions are more effective. Interventions backed by political and executive commitment benefit from a strong support base and involvement of relevant stakeholders.
Buchan, J, Twigg, D, Dussault, G, Duffield, C & Stone, PW 2015, 'Policies to sustain the nursing workforce: An international perspective', International Nursing Review, vol. 62, no. 2, pp. 162-170.View/Download from: Publisher's site
Aim: Examine metrics and policies regarding nurse workforce across four countries. Background: International comparisons informs health policy makers. Methods: Data from the OECD were used to compare expenditure, workforce and health in: Australia, Portugal, the United Kingdom (UK) and the United States (US). Workforce policy context was explored. Results: Public spending varied from less than 50% of gross domestic product in the US to over 80% in the UK. Australia had the highest life expectancy. Portugal has fewer nurses and more physicians. The Australian national health workforce planning agency has increased the scope for co-ordinated policy intervention. Portugal risks losing nurses through migration. In the UK, the economic crisis resulted in frozen pay, reduced employment, and reduced student nurses. In the US, there has been limited scope to develop a significant national nursing workforce policy approach, with a continuation of State based regulation adding to the complexity of the policy landscape. The US is the most developed in the use of nurses in advanced practice roles. Ageing of the workforce is likely to drive projected shortages in all countries. Limitations: There are differences as well as variation in the overall impact of the global financial crisis in these countries. Conclusion: Future supply of nurses in all four countries is vulnerable. Implications for nursing and health policy: Work force planning is absent or restricted in three of the countries. Scope for improved productivity through use of advanced nurse roles exists in all countries.
Duffield, CM, Roche, MA, Dimitrelis, S, Homer, C & Buchan, J 2015, 'Instability in patient and nurse characteristics, unit complexity and patient and system outcomes.', Journal of Advanced Nursing, vol. 71, no. 6, pp. 1288-1298.View/Download from: Publisher's site
AIMS: To explore key factors related to nursing unit instability, complexity and patient and system outcomes. BACKGROUND: The relationship between nurse staffing and quality of patient outcomes is well known. The nursing unit is an important but different aspect that links to complexity and to system and patient outcomes. The relationship between the instability, complexity and outcomes needs further exploration. DESIGN: Descriptive. METHODS: Data were collected via a nurse survey, unit profile and review of patient records on 62 nursing units (wards) across three states of Australia between 2008-2010. Two units with contrasting levels of patient and nurse instability and negative system and patient outcomes, were profiled in detail from the larger sample. RESULTS: Ward A presented with greater patient stability (low occupancy, high planned admissions, few ICU transfers, fewer changes to patient acuity/work re-sequencing) and greater nurse instability (nurses changing units, fewer full-time staff, more temporary/casual staff) impacting system outcomes negatively (high staff turnover). In contrast, Ward B had greater patient instability, however, more nurse stability (greater experienced and permanent staff, fewer casuals), resulting in high rates for falls, medication errors and other adverse patient outcomes with lower rates for system outcomes (lower intention to leave). CONCLUSION: Instability in patient and nurse factors can contribute to ward complexity with potentially negative patient outcomes. The findings highlight the variation of many aspects of the system where nurses work and the importance of nursing unit managers and senior nurse executives in managing ward complexity.
Nurse turnover is a critical issue facing workforce planners across the globe, partic- ularly in light of protracted and continuing workforce shortages. An ageing population coupled with the rise in complex and chronic diseases, have contributed to increased demands placed on the health system and importantly, nurses who themselves are ageing. Costs associated with nurse turnover are attracting more attention; however, existing measurements of turnover show inconsistent findings, which can be attributed to differences in study design, metrics used to calculate turnover and variations in definitions for turnover. This paper will report the rates and costs of nurse turnover across three States in Australia.
Gero, A, Fletcher, SM, Rumsey, M, Thiessen, J, Kuruppu, N, Buchan, J, Daly, J & Willetts, JR 2015, 'Disasters and climate change in the Pacific: Adaptive capacity of humanitarian response organisations', Climate and Development, vol. 7, no. 1, pp. 35-46.View/Download from: Publisher's site
Climate change is likely to affect the pattern of disasters in the Pacific and, by extension, the organizations and systems involved in disaster response. This research focused on how immediate humanitarian health-related needs following disasters are met using the concept of adaptive capacity to investigate the resilience of organizations and the robustness of the broader system of disaster response. Four case study countries (Cook Islands, Fiji, Samoa, and Vanuatu) were chosen for deeper investigation of the range of issues present in the Pacific. Key findings were that adaptive capacity was enhanced by strong informal communication and relationships as well as formal relationships, appropriate participation of traditional leaders and churches, and recognition and support for the critical role national disaster management offices play in disaster coordination. Adaptive capacity was found to be constrained by lack of clear policies for requesting international assistance, lack of coordinated disaster assessments, and limited human resources for health in disaster response. Limitations in psychosocial support and Australian medical services to meet specific needs were observed. Finally, the research revealed that both Pacific and Australian disaster-response agencies would benefit from a strengthened 'future' focus to better plan for uncertainty and changing risks.
Dawson, A, Buchan, J, Duffield, CM, Homer, CS & Wijewardena, K 2014, 'Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence', Health Policy and Planning, vol. 29, no. 3, pp. 396-408.View/Download from: Publisher's site
Reducing maternal mortality and providing universal access to reproductive health in resource poor settings has been severely constrained by a shortage of health workers required to deliver interventions. The aim of this article is to determine evidence to optimize health worker roles through task shifting/sharing to address Millennium Development Goal 5 and reduce maternal mortality and provide universal access to reproductive health. A narrative synthesis of peer-reviewed literature from 2000 to 2011 was undertaken with retrieved documents assessed using an inclusion/exclusion criterion and quality appraisal guided by critical assessment tools. Concepts were analysed thematically. The analysis identified a focus on clinical tasks (the delivery of obstetric surgery, anaesthesia and abortion) that were shifted to and/or shared with doctors, non-physician clinicians, nurses and midwives.
Duffield, CM, Roche, MA, Homer, CS, Buchan, J & Dimitrelis, S 2014, 'A comparative review of nurse turnover rates and costs across countries', Journal of Advanced Nursing, vol. 70, no. 12, pp. 2703-2712.View/Download from: Publisher's site
Measuring and comparing the costs and rates of turnover is difficult because of differences in definitions and methodologies. A comparative review of turnover data was conducted using four studies that employed the original Nursing Turnover Cost Calculation Methodology. A significant proportion of turnover costs are attributed to temporary replacement, highlighting the importance of nurse retention.
Rumsey, M, Fletcher, SM, Thiessen, J, Gero, A, Kuruppu, N, Daly, J, Buchan, J & Willetts, JR 2014, 'A qualitative examination of the health workforce needs during climate change disaster response in Pacific Island Countries', Human Resources for Health, vol. 12, no. 1, pp. 2-20.View/Download from: Publisher's site
There is a growing body of evidence that the impacts of climate change are affecting population health negatively. The Pacific region is particularly vulnerable to climate change; a strong health-care system is required to respond during times of disaster. This paper examines the capacity of the health sector in Pacific Island Countries to adapt to changing disaster response needs, in terms of: (i) health workforce governance, management, policy and involvement; (ii) health-care capacity and skills; and (iii) human resources for health training and workforce development.
Aim: To present an overview of UK National Health Service nurse staffing changes across the last 10 years. Background: National Health Service funding is now being constrained as part of the overall measures to reduce UK public expenditure. This has implications for future staffing levels and deployment. Government and professional associations are disagreeing about the current extent of actual and likely National Health Service nurse staffing decline. Design: The paper reviews 'official' data and evidence on National Health Service staffing to assess actual National Health Service nurse staffing trends in recent years, highlights the results of scenario modeling of future National Health Service nursing numbers and relates this to national policies on staffing. Discussion: The available evidence now points to nurse staffing growth having tailed off and a likely pattern of overall decline in National Health Service nurse staffing is emerging. This is a policy concern in the UK, but also in many other countries. Implications for nursing: Whilst there has been a 'recession benefit' to the UK nursing labour market, this supply side boost cannot continue indefinitely. Any continued trend towards reduced intakes to training and reduced staffing levels will intensify the debate about the appropriate staffing levels and skills mix. Conclusions: We have seen significant National Health Service nurse staffing growth in the last 10 years, which is likely now to reverse. The real measure of the effectiveness of local and national National Health Service nursing workforce policy is not how many nurses are employed, it is that sufficient are deployed to provide safe care. © 2012 Blackwell Publishing Ltd.
Buchan, J, Couper, ID, Tangcharoensathien, V, Thepannya, K, Jaskiewicz, W, Perfilievaf, G & Dolea, C 2013, 'Early implementation of WHO recommendations for the retention of health workers in remote and rural areas', Bulletin of the World Health Organization, vol. 91, no. 11, pp. 834-840.View/Download from: Publisher's site
The maldistribution of health workers between urban and rural areas is a policy concern in virtually all countries. It prevents equitable access to health services, can contribute to increased health-care costs and underutilization of health professional skills in urban areas, and is a barrier to universal health coverage. To address this long-standing concern, the World Health Organization (WHO) has issued global recommendations to improve the rural recruitment and retention of the health workforce. This paper presents experiences with local and regional adaptation and adoption of WHO recommendations. It highlights challenges and lessons learnt in implementation in two countries - the Lao People's Democratic Republic and South Africa - and provides a broader perspective in two regions - Asia and Europe. At country level, the use of the recommendations facilitated a more structured and focused policy dialogue, which resulted in the development and adoption of more relevant and evidence-based policies. At regional level, the recommendations sparked a more sustained effort for cross-country policy assessment and joint learning. There is a need for impact assessment and evaluation that focus on the links between the rural availability of health workers and universal health coverage. The effects of any health-financing reforms on incentive structures for health workers will also have to be assessed if the central role of more equitably distributed health workers in achieving universal health coverage is to be supported.
Buchan, J, O'May, F & Dussault, G 2013, 'Nursing workforce policy and the economic crisis: A global overview', Journal of Nursing Scholarship, vol. 45, no. 3, pp. 298-307.View/Download from: Publisher's site
Purpose: To assess the impact of the global financial crisis on the nursing workforce and identify appropriate policy responses. Organizing Construct and Methods: This article draws from international data sources (Organisation for Economic Co-operation and Development [OECD] and World Health Organization), from national data sources (nursing regulatory authorities), and the literature to provide a context in which to examine trends in labor market and health spending indicators, nurse employment, and nurse migration patterns. Findings: A variable impact of the crisis at the country level was shown by different changes in unemployment rates and funding of the health sector. Some evidence was obtained of reductions in nurse staffing in a small number of countries. A significant and variable change in the patterns of nurse migration also was observed. Conclusions: The crisis has had a variable impact; nursing shortages are likely to reappear in some OECD countries. Policy responses will have to take account of the changed economic reality in many countries. Clinical Relevance: This article highlights key trends and issues for the global nursing workforce; it then identifies policy interventions appropriate to the new economic realities in many OECD countries. © 2013 Sigma Theta Tau International.
Buchan, J, Temido, M, Fronteira, I, Lapão, L & Dussault, G 2013, 'Nurses in advanced roles: A review of acceptability in Portugal', Revista Latino-Americana de Enfermagem, vol. 21, no. SPL, pp. 38-46.View/Download from: Publisher's site
Objective: This paper focuses on the policy context for the deployment of nurses in advanced roles, with particular reference to Portugal. The health sector in Portugal, as in all countries, is labour intensive, and the scope to utilise nurses in more advanced roles is currently being debated. Methods: Mixed methods were used: an analysis of international data on the nursing workforce; an analysis of documents and media articles; interviews with key-informants; an online survey of managers, and a technical workshop with key-informants. Conclusions: The limited evidence base on nurses in advanced roles in Portugal is a constraint on progress, but it is not an excuse for inaction. Further research in Portugal on health professionals in innovative roles would assist in informing policy direction. There is the need to move forward with a fully informed policy dialogue, taking account of the current political, economic and health service realities of Portugal.
Cabral, J, Dussault, G, Buchan, J & Ferrinho, P 2013, 'Scaling-up the medical workforce in Timor-Leste: Challenges of a great leap forward', Social Science and Medicine, vol. 96, pp. 285-289.View/Download from: Publisher's site
The health services system of Timor-Leste (T-L) will, by 2015, add 800 physicians, most of them trained in Cuba, to the 233 employed by the national health system in 2010-2011. The need for more physicians is not in discussion: poor health indicators, low coverage and utilization of services, and poor quality of services are well documented in T-L. However, the choice of this scaling-up, with a relatively narrow focus on the medical workforce, needs to be assessed for its relevance to the health profile of the country, for its comprehensiveness in terms of other complementary measures needed to make it effective. This article discusses the potential effects of the rapid scaling-up of the medical workforce, and the organizational capacity needed to monitor the process and eventually mitigate any deleterious consequences. The analysis is based on a review of documentation collected on site (T-L) and on interviews with key-informants conducted in 2011. We stress that any workforce scaling-up is not simply a matter of increasing numbers of professionals, but should combine improved training, distribution, working conditions, management and motivation, as a means towards better performing health services' systems. This is a major challenge in a context of limited organizational and managerial capacity, underdeveloped information systems, limited training and research capacity, and dependency on foreign aid and technical assistance. Potential risks are associated with funding the additional costs of recruiting more personnel, associated expenditures on infrastructure, equipment and consumables, the impact on current staff mix, and the expected increased demand for services. We conclude that failing to manage effectively the forthcoming "great leap forward" will have long term effects: formal policies and plans for the balanced development of the health workforce, as well as strengthened institutions are urgently needed. © 2013 Elsevier Ltd.
Campbell, J, Buchan, J, Cometto, G, David, B, Dussault, G, Fogstad, H, Fronteira, I, Lozano, R, Nyonator, F, Pablos-Méndez, A, Quain, EE, Starrsj, A & Tangcharoensathien, V 2013, 'Human resources for health and universal health coverage: Fostering equity and effective coverage', Bulletin of the World Health Organization, vol. 91, no. 11, pp. 853-863.View/Download from: Publisher's site
Achieving universal health coverage (UHC) involves distributing resources, especially human resources for health (HRH), to match population needs. This paper explores the policy lessons on HRH from four countries that have achieved sustained improvements in UHC: Brazil, Ghana, Mexico and Thailand. Its purpose is to inform global policy and financial commitments on HRH in support of UHC. The paper reports on country experiences using an analytical framework that examines effective coverage in relation to the availability, accessibility, acceptability and quality (AAAQ) of HRH. The AAAQ dimensions make it possible to perform tracing analysis on HRH policy actions since 1990 in the four countries of interest in relation to national trends in workforce numbers and population mortality rates. The findings inform key principles for evidence-based decision-making on HRH in support of UHC. First, HRH are critical to the expansion of health service coverage and the package of benefits; second, HRH strategies in each of the AAAQ dimensions collectively support achievements in effective coverage; and third, success is achieved through partnerships involving health and non-health actors. Facing the unprecedented health and development challenges that affect all countries and transforming HRH evidence into policy and practice must be at the heart of UHC and the post-2015 development agenda. It is a political imperative requiring national commitment and leadership to maximize the impact of available financial and human resources, and improve healthy life expectancy, with the recognition that improvements in health care are enabled by a health workforce that is fit for purpose.
Crettenden, I, Poz, MD & Buchan, J 2013, 'Right time, right place: Improving access to health service through effective retention and distribution of health workers', Human Resources for Health, vol. 11, no. 1.View/Download from: Publisher's site
This editorial introduces the 'Right time, Right place: improving access to health service through effective retention and distribution of health workers' thematic series. This series draws from studies in a range of countries and provides new insights into what can be done to improve access to health through more effective human resources policies, planning and management. The primary focus is on health workforce distribution and retention. © 2013 Crettenden et al.; licensee BioMed Central Ltd.
This paper examines issues related to the future supply of registered nursing staff, midwives and health visitors in the National Health Service (NHS) in England at a time when there are major public sector funding constraints and as more of these staff are reaching retirement age. Based on available workforce data, the paper reviews different possible scenarios for the supply of NHS nurses over a ten year period, assessing the impact of different numbers of new staff being trained and of varying retirement patterns from the ageing profession.The government in England has more policy levers available than is the case in many other countries. It determines the number of pre-registration training places that are commissioned and funded, it is the major employer, and it also controls the inflow of nurses from other countries through migration policies. Scenario models provide a picture of what the future might look like under various assumptions. These outcomes can be quantified and the results used to assess the risks and opportunities of alternate policy decisions. The approach used in this paper is that of the aggregate deterministic supply model.As part of this exercise, eight scenarios were selected and modelled. These were:. A. " No change" - current inflows and outflows. B. " Redundancies" - current inflow with higher outflow. C. " Improved retention" - current inflow with lower outflow. D. " Reduced training intakes A" - lower inflows with lower outflow. E. " Reduced training intakes B" - lower inflow with higher outflows. F. " Pension time-bomb" - current inflow with a higher rate of retirement. G. " Pension delayed" - current inflow with a lower rate of retirement. H. " Worst case" - lower inflow and higher outflow including higher retirement. Most of the scenarios indicate that a reduction in the supply of nursing staff to NHS England is possible over the next ten years. Small changes in assumptions can make a substantial difference to outcomes and theref...
Hayes, LJ, O'Brien-Pallas, L, Duffield, CM, Shamian, J, Buchan, J, Hughes, FA, Laschinger, H & North, N 2012, 'Nurse turnover: A literature review - An update', International Journal of Nursing Studies, vol. 49, no. 7, pp. 887-905.View/Download from: Publisher's site
Background: Concerns related to the complex issue of nursing turnover continue to challenge healthcare leaders in every sector of health care. Voluntary nurse turnover is shown to be influenced by a myriad of inter-related factors, and there is increasing evidence of its negative effects on nurses, patients and health care organizations. Objectives: The objectives were to conduct a comprehensive review of the related literature to examine recent findings related to the issue of nursing turnover and its causes and consequences, and to identify on methodological challenges and the implications of new evidence for future studies. Design: A comprehensive search of the recent literature related to nursing turnover was undertaken to summarize findings published in the past six years. Data sources: Electronic databases: MEDLINE, CINAHL and PubMed, reference lists of journal publications. Review methods: Keyword searches were conducted for publications published 2006 or later that examined turnover or turnover intention in employee populations of registered or practical/enrolled or assistant nurses working in the hospital, long-term or community care areas. Literature findings are presented using an integrative approach and a table format to report individual studies. Results: From about 330 citations or abstracts that were initially scanned for content relevance, 68 studies were included in this summary review. The predominance of studies continues to focus on determinants of nurse turnover in acute care settings. Recent studies offer insight into generational factors that should be considered in strategies to promote stable staffing in healthcare organizations. Conclusions: Nursing turnover continues to present serious challenges at all levels of health care. Longitudinal research is needed to produce new evidence of the relationships between nurse turnover and related costs, and the impact on patients and the health care team.
Aims and objectives: This study examines the impact of implementing a new pay system (Agenda for Change) on nursing staff in the National Health Service (NHS) in the UK. This new pay system covered approximately 400,000 nursing staff. Its objectives were to improve the delivery of patient care as well as staff recruitment, retention and motivation. Background: The new system aimed to provide a simplified approach to pay determination, with a more systematic use of agreed job descriptions and job evaluation to 'price' individual jobs, linked to a new career development framework. Design: Secondary analysis of survey data. Methods: Analysis of results of large-scale surveys of members of the Royal College of Nursing of the United Kingdom (RCN) to assess the response of nurses to questions about the implementation process itself and their attitude to pay levels. Results: The results demonstrated that there was some positive change after implementation of Agenda for Change in 2006, mainly some time after implementation, and that the process of implementation itself raised expectations that were not fully met for all nurses. Conclusions: There were clear indications of differential impact and reported experiences, with some categories of nurse being less satisfied with the process of implementation. The overall message is that a national pay system has strengths and weaknesses compared to the local systems used in other countries and that these benefits can only be maximised by effective communication, adequate funding and consistent management of the system. Relevance to clinical practice: How nurses' pay is determined and delivered can be a major satisfier and incentive to nurses if the process is well managed and can be a factor in supporting clinical practice, performance and innovation. This study highlights that a large-scale national exercise to reform the pay system for nurses is a major undertaking, carries risk and will take significant time to implement eff...
Buchan, J, Fronteira, I & Dussault, G 2011, 'Continuity and change in human resources policies for health: Lessons from Brazil', Human Resources for Health, vol. 9.View/Download from: Publisher's site
Background: This paper reports on progress in implementing human resources for health (HRH) policies in Brazil, in the context of the implementation and expansion of the Unified Health System (Sistema Unico de Saúde - SUS).The three main objectives were: i) to reconstruct the chronology of long term HRH change in Brazil, and to identify and discuss the precursors, drivers, and enablers for these changes over a long time period; (ii) to examine how change was achieved by describing facilitators and constraints, and how policies were adapted to deal with the latter; and (iii) to report on the current situation and draw policy implications.Methods: A mixed methods approach was used. A literature review was conducted using pre-defined keywords; and stakeholders were contacted and asked to provide relevant information, data and policy reports.Results: There are two key features of HRH change which are related to the implementation of SUS which merit attention: the achievement of staffing growth, and the improvement in HRH policy making and management. Staff growth rates across the period have been high enough to exceed population growth rates. As a consequence, the ratio of staff to population has improved. In 1990 the physician ratio per 1000 inhabitants was 1.12. In 2007, it was 1.74. Another critical factor in achieving staffing growth has been HRH policy making capacity and influence within the political establishment.Conclusions: Policies have had to adapt to changing circumstances, whilst focusing on sequential improvements aimed at achieving long term goals. The end objectives, of improving care and access to care, have been kept in view. No one Ministry could secure all the resources and impetus for change that has been required, hence the need for inter-ministry, inter-governmental and inter-agency collaboration, and the development of alliances of shared interest. Across the period of thirty years or more, not all initiatives have been equally successful, bu...
Buchan, JM, Naccarella, L & Brooks, PM 2011, 'Is health workforce sustainability in Australia and New Zealand a realistic policy goal?', AUSTRALIAN HEALTH REVIEW, vol. 35, no. 2, pp. 152-155.View/Download from: Publisher's site
Campbell, J, Oulton, JA, McPake, B & Buchan, J 2011, 'Increasing access to 'free' health services: Are health workers not a missing link?', International Journal of Clinical Practice, vol. 65, no. 1, pp. 12-15.View/Download from: Publisher's site
Connell, J & Buchan, J 2011, 'The impossible dream? Codes of Practice and the international migration of skilled health workers', World Medical and Health Policy, vol. 3, no. 3.View/Download from: Publisher's site
The international migration of skilled health workers has increased significantly from the 1990s. Many source countries have expressed concern over losses of health workers, resulting in regional Codes of Practice and bilateral Memoranda of Understanding being established since 1999 to achieve more effective, equitable and ethical international migration. The finalisation of a Global Code in 2010 drew attention to continued migration concerns. Codes have three key objectives - protecting rights of migrant workers, adequate workplace support for migrant workers and ensuring that migration flows do not disrupt health services in source countries. There is no agreed definition of ethical international recruitment, and no consensus on the significance and location of harmful recruitment practices. Most codes have covered relatively few regions and exhibit a high degree of generality. Several source countries encourage rather than discourage migration. Migration is a right and occurs in contexts that do not necessarily involve health issues. There are no incentives for recipient countries and agencies to be involved in ethical international recruitment. All codes are voluntary which has restricted their impact. Substantial migration and recruitment have occurred outside their scope, and codes have diverted skilled health workers beyond regulation. The private sector is effectively excluded from codes. Bilateral agreements and memoranda have a greater chance of success, enabling managed migration and return migration, but are more geographically limiting. The most effective constraints to the unregulated flow of skilled health workers are the production of adequate numbers in present recipient countries and provision of improved employment conditions in source countries. © 2011 Policy Studies Organization.
Naccarella, L, Buchan, J, Newton, B & Brooks, P 2011, 'Role of Australian primary healthcare organisations (PHCOs) in primary healthcare (PHC) workforce planning: Lessons from abroad', Australian Health Review, vol. 35, no. 3, pp. 262-266.View/Download from: Publisher's site
Objective. To review international experience in order to inform Australian PHC workforce policy on the role of primary healthcare organisations (PHCOs/Medicare Locals) in PHC workforce planning. Method. A NZ and UK study tour was conducted by the lead author, involving 29 key informant interviews with regard to PHCOs roles and the effect on PHC workforce planning. Interviews were audio-taped with consent, transcribed and analysed thematically. Results. Emerging themes included: workforce planning is a complex, dynamic, iterative process and key criteria exist for doing workforce planning well; PHCOs lacked a PHC workforce policy framework to do workforce planning; PHCOs lacked authority, power and appropriate funding to do workforce planning; there is a need to align workforce planning with service planning; and a PHC Workforce Planning and Development Benchmarking Database is essential for local planning and evaluating workforce reforms. Conclusion. With the Australian government promoting the role of PHCOs in health system reform, reflections from abroad highlight the key action within PHC and PHCOs required to optimise PHC workforce planning. © 2011 AHHA.
Buchan, J 2010, 'Can the WHO code on international recruitment succeed?', BMJ (Online), vol. 340, no. 7750, pp. 791-793.
This paper examines the issue of workforce stability and turnover in the context of policy attempts to improve retention of health workers. The paper argues that there are significant benefits to supporting policy makers and managers to develop a broader perspective of workforce stability and methods of monitoring it. The objective of the paper is to contribute to developing a better understanding of workforce stability as a major aspect of the overall policy goal of improved retention of health workers. The paper examines some of the limited research on the complex interaction between staff turnover and organisational performance or quality of care in the health sector, provides details and examples of the measurement of staff turnover and stability, and illustrates an approach to costing staff turnover. The paper concludes by advocating that these types of assessment can be valuable to managers and policy makers as they examine which policies may be effective in improving stability and retention, by reducing turnover. They can also be used as part of advocacy for the use of new retention measures. The very action of setting up a local working group to assess the costs of turnover can in itself give managers and staff a greater insight into the negative impacts of turnover, and can encourage them to work together to identify and implement stability measures. © 2010 Buchan; licensee BioMed Central Ltd.
Buchan, J 2010, 'Working out the workforce.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 24, no. 32, pp. 70-71.
Naccarella, L, Buchan, J & Brooks, P 2010, 'Evidence-informed primary health care workforce policy: Are we asking the right questions?', Australian Journal of Primary Health, vol. 16, no. 1, pp. 25-28.View/Download from: Publisher's site
Australia is facing a primary health care workforce shortage. To inform primary health care (PHC) workforce policy reforms, reflection is required on ways to strengthen the evidence base and its uptake into policy making. In 2008 the Australian Primary Health Care Research Institute funded the Australian Health Workforce Institute to host Professor James Buchan, Queen Margaret University, UK, an expert in health services policy research and health workforce planning. Professor Buchan's visit enabled over forty Australian PHC workforce mid-career and senior researchers and policy stakeholders to be involved in roundtable policy dialogue on issues influencing PHC workforce policy making. Six key thematic questions emerged. (1) What makes PHC workforce planning different? (2) Why does the PHC workforce need to be viewed in a global context? (3) What is the capacity of PHC workforce research? (4) What policy levers exist for PHC workforce planning? (5) What principles can guide PHC workforce planning? (6) What incentives exist to optimise the use of evidence in policy making? The emerging themes need to be discussed within the context of current PHC workforce policy reforms, which are focussed on increasing workforce supply (via education/training programs), changing the skill mix and extending the roles of health workers to meet patient needs. With the Australian government seeking to reform and strengthen the PHC workforce, key questions remain about ways to strengthen the PHC workforce evidence base and its uptake into PHC workforce policy making. © 2010 La Trobe University.
Objective: This paper examines how the National Health Service (NHS) in the UK achieved significant nursing workforce growth during the period between 2000 and 2006 and discusses the policy implications of the methods used to achieve this staffing growth. Methodology: Data analysis, literature review and policy analysis. Results: NHS nurse staffing growth was approximately 25% over the period 1997-2007, with most growth occurring in the years between 1999 and 2005. Whilst increases in intakes to home-based pre-registration education was a factor in achieving growth, the pace and level of growth which occurred was only possible by using active international recruitment, which was adopted as a deliberate national policy. The numbers of nurses and midwives entering the UK from other countries increased rapidly from 1999 onwards, to a peak in 2002, and then reduced markedly in the period from 2005 onwards. The policy of supporting international recruitment shifted rapidly in late 2005/2006 when financial difficulties hit the NHS and staffing growth was curtailed. Discussion: Active international recruitment can contribute to health sector staffing growth, assuming the recruiting country has the resources to recruit and can tap into international markets, but it may not be effective in addressing all types of skills shortages. If it is not well linked to other components of workforce planning it may cause difficulties of over expansion, as well as raising broader issues of the ethics and impact. © 2009 Royal College of Nursing, Australia.
Buchan, J 2009, 'Be ready to fight.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 23, no. 30, pp. 24-25.
Buchan, J 2009, 'Funnel vision.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 23, no. 25, pp. 24-25.
Buchan, J 2009, 'Sinking feeling.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 23, no. 42, pp. 26-27.
Buchan, J 2009, 'The squeeze is on.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 23, no. 37, pp. 24-25.
Aim: This paper examines the labour market impact of a new national pay award for nurses implemented in New Zealand in 2004/5 - the Multi-Employer Collective Agreement (MECA). Background: The health system in New Zealand is unusual in that, while retaining a public sector system, the focus of pay determination for nurses over the last 20 years has shifted first from national to local pay determination, and then more recently reversed this trend, moving back to a national level pay determination. The shift back to a national pay determination approach in 2004/5 is therefore worthy of examination, both in terms of its labour market impact, and as a case study in the use of national level pay determination. Methods: The research was conducted in 2007-8. A rapid appraisal method was used, based on key stakeholder interviews, a document and literature review and a review and analysis of available data on the New Zealand nurse labour market, and trends in application rates to schools of nursing were assessed. In addition, interviews with managers of two District Health Boards, and interviews with five non-government employers of nurses, were conducted. Results: Indicators pointing to improvements included: steady (though not rapid) growth in staff numbers; reduced difficulty in recruiting; reduced vacancy rates; and increased application rates to schools of nursing. Managers interviewed in the study supported these positive indications, but some health-care employers not covered by the pay award reported negative knock-on effects (e.g. needing to match DHB rates, increased retention and recruitment difficulties). Conclusions: Available nurse labour market data provide an incomplete but compelling picture of the positive impacts of the MECA in a period of a very tight labour market. While much of the content of the 2004/5 agreement could be characterized as a 'normal' pay bargaining contract, there were also issues that differentiated it from the norm. In particular, it...
Buchan, J, McPake, B, Mensah, K & Rae, G 2009, 'Does a code make a difference - Assessing the English code of practice on international recruitment', Human Resources for Health, vol. 7.View/Download from: Publisher's site
Background: This paper draws from research completed in 2007 to assess the effect of the Department of Health, England, Code of Practice for the international recruitment of health professionals. The Department of Health in England introduced a Code of Practice for international recruitment for National Health Service employers in 2001. The Code required National Health Service employers not to actively recruit from low-income countries, unless there was government-to-government agreement. The Code was updated in 2004. Methods: The paper examines trends in inflow of health professionals to the United Kingdom from other countries, using professional registration data and data on applications for work permits. The paper also provides more detailed information from two country case studies in Ghana and Kenya. Results: Available data show a considerable reduction in inflow of health professionals, from the peak years up to 2002 (for nurses) and 2004 (for doctors). There are multiple causes for this decline, including declining demand in the United Kingdom. In Ghana and Kenya itwas found that active recruitment was perceived to have reduced significantly from the United Kingdom, but it is not clear the extent to which the Code was influential in this, or whether other factors such as a lack of vacancies in the United Kingdom explains it. Conclusion: Active international recruitment of health professionals was an explicit policy intervention by the Department of Health in England, as one key element in achieving rapid staffing growth, particularly in the period 2000 to 2005, but the level of international recruitment has dropped significantly since early 2006. Regulatory and education changes in the United Kingdom in recent years have also made international entry more difficult. The potential to assess the effect of the Code in England is constrained by the limitations in available databases. This is a crucial lesson for those considering a global code: without a clea...
North, N & Buchan, J 2009, 'Winners and losers: Organizational impacts of a nurses pay agreement', Policy, Politics, and Nursing Practice, vol. 10, no. 4, pp. 259-268.View/Download from: Publisher's site
This article considers the impacts on organizations of a new national employment agreement for nurses in New Zealand. In the 1980s, local employer bargaining replaced national awards. As nurses' employment conditions deteriorated, in 2004 that trend was reversed with a new national agreement between the nurses' union and the public sector health boards. Qualitative information was collected and analyzed from two employers covered by the agreement and from five nongovernment organizations not party to the agreement. In the organizations studied, there was evidence of winners and losers within and between organizations, flow-on effects on other groups of nurses not represented by the union and on other employee groups. Although impacts on public sector nursing workforces were generally positive, some imbalances and unintended consequences arose from the agreement. Differing experiences and perspectives of a national pay agreement largely reflected local nurse market conditions. © The Author(s) 2009.
Rechel, B, Buchan, J & McKee, M 2009, 'The impact of health facilities on healthcare workers' well-being and performance', International Journal of Nursing Studies, vol. 46, no. 7, pp. 1025-1034.View/Download from: Publisher's site
The impact of health facilities on patients has been extensively researched. Yet, while there is a growing recognition of the need for healthy working environments, little is known about how health facilities affect the staff working in them. This paper explores how the design of health facilities impacts on the well-being and performance of healthcare workers. The article is based on a review of published literature, identified through PubMed and Google, as well as through searches of websites of relevant organizations. Many traditionally designed health facilities seem to impact negatively on the well-being of healthcare workers, as well as on staff recruitment, retention and performance. Better-designed health facilities can improve working conditions and staff safety, and enable staff to do their job more efficiently. The needs of healthcare workers should be taken into account at the initial design stage of health facilities, ideally though direct involvement or meaningful consultation. © 2008 Elsevier Ltd. All rights reserved.
Aiken, LH, Buchan, J, Ball, J & Rafferty, AM 2008, 'Transformative impact of Magnet designation: England case study', Journal of Clinical Nursing, vol. 17, no. 24, pp. 3330-3337.View/Download from: Publisher's site
Aims. To test the impact of the implementation of Magnet principles of improving nurses' work environments. Background. Magnet hospital designation developed in the USA in the 1980s to recognise hospitals that had created excellent patient care environments and supported the professional practice of nursing. A pilot initiative in England was the first test of the applicability of Magnet standards outside the USA. Methods. Research methods included surveys of nurses in the demonstration hospital in a predesign and postdesign and comparisons to survey results of nurses practicing in a national sample of 30 National Health Service Trusts. Results. Prior to beginning the Magnet journey, the demonstration hospital had a nurse work environment that was somewhat less positive than the national sample NHS hospitals. Nurses practicing in the demonstration hospital were somewhat less satisfied with their jobs than nurses in other NHS hospitals. Following a two-year period during which the evidence-based Magnet standards were implemented and Magnet Designation was awarded, the quality of the nurse practice environment had improved significantly, as had job satisfaction of nurses and their appraisals of the quality of patient care. The quality of the nurse practice environment after Magnet designation was better than that of a national sample of NHS trusts. Improved nurse outcomes were because of the improved practice environment rather than staffing enhancements. Conclusions. Implementation of the Magnet hospital intervention was associated with a significantly improved nursing work environment as well as improved job-related outcomes for nurses and markers for quality of patient care. Relevance to clinical practice. Nurses can use Magnet principles to improve the quality of their work environments. © 2008 Blackwell Publishing Ltd.
Aims and objectives. This paper provides a context for this special edition. It highlights the scale of the challenge of nursing shortages, but also makes the point that there is a policy agenda that provides workable solutions. Results. An overview of nurse:population ratios in different countries and regions of the world, highlighting considerable variations, with Africa and South East Asia having the lowest average ratios. The paper argues that the 'shortage' of nurses is not necessarily a shortage of individuals with nursing qualifications, it is a shortage of nurses willing to work in the present conditions. The causes of shortages are multi-faceted, and there is no single global measure of their extent and nature, there is growing evidence of the impact of relatively low staffing levels on health care delivery and outcomes. The main causes of nursing shortages are highlighted: inadequate workforce planning and allocation mechanisms, resource constrained undersupply of new staff, poor recruitment, retention and 'return' policies, and ineffective use of available nursing resources through inappropriate skill mix and utilisation, poor incentive structures and inadequate career support. Conclusions. What now faces policy makers in Japan, Europe and other developed countries is a policy agenda with a core of common themes. First, themes related to addressing supply side issues: getting, keeping and keeping in touch with relatively scarce nurses. Second, themes related to dealing with demand side challenges. The paper concludes that the main challenge for policy makers is to develop a co-ordinated package of policies that provide a long term and sustainable solution. Relevance to clinical practice. This paper highlights the impact that nursing shortages has on clinical practice and in health service delivery. It outlines scope for addressing shortage problems and therefore for providing a more positive staffing environment in which clinical practice can be delive...
Background: Pay and pay systems are a critical element in any health sector human resource strategy. Changing a pay system can be one strategy to achieve or sustain organizational change. This paper reports on the design and implementation of a completely new pay system in the National Health Service (NHS) in England. 'Agenda for Change' constituted the largest-ever attempt to introduce a new pay system in the UK public services, covering more than one million staff. Its objectives were to improve the delivery of patient care as well as enhance staff recruitment, retention and motivation, and to facilitate new ways of working. Methods: This study was the first independent assessment of the impact of Agenda for Change at a local and national level. The methods used in the research were a literature review; review of 'grey' unpublished documentation provided by key stakeholders in the process; analysis of available data; interviews with key national informants (representing government, employers and trade unions), and case studies conducted with senior human resource managers in ten NHS hospitals in England Results: Most of the NHS trust managers interviewed were in favour of Agenda for Change, believing it would assist in delivering improvements in patient care and staff experience. The main benefits highlighted were: 'fairness', moving different staff groups on to harmonized conditions; equal pay claim 'protection'; and scope to introduce new roles and working practices. Conclusion: Agenda for Change took several years to design, and has only recently been implemented. Its very scale and central importance to NHS costs and delivery of care argues for a full assessment at an early stage so that lessons can be learned and any necessary changes made. This paper highlights weaknesses in evaluation and limitations in progress. The absence of systematically derived and applied impact indicators makes it difficult to assess impact and impact variations. Similarly, the l...
Nancarrow, S, Moran, A, Enderby, P, Parker, S, Dixon, S, Mitchell, C, Bradburn, M, Mc, AC, Gibson, C, John, A, Borthwick, A & Buchan, J 2008, 'The impact of workforce flexibility on older people's services', International Journal of Therapy and Rehabilitation, vol. 15, no. 9, pp. 374-375.View/Download from: Publisher's site
© 2008, MA Healthcare Ltd. All rights reserved. The health workforce has undergone unprecedented change over the past decade. Several countries have introduced substantial workforce changes to address staffing shortages in medicine, nursing and the allied health professions, and in some cases, to improve the productivity and efficiency of health services. This raft of changes, with various labels, including workforce redesign and re-engineering, has facilitated possibly the largest transformation in professional role boundaries in the history of the development of the professions. The result has been the introduction of new types of workers and new roles for several existing staff. The impact of these changes on service effectiveness and efficiency remains largely unknown.
Objective. To synthesize information about nurse migration into and out of the United Kingdom in the period to 2005, and to assess policy implications. Principal Findings. There has been rapid growth in inflow of nurses to the United Kingdom from other countries. In recent years, 40-50 percent of new nurse registrants in the United Kingdom have come from other countries, principally the Philippines, Australia, India, and South Africa. Outflow has been at a lower level, mainly to other English-speaking developed countries - Australia, the United States, New Zealand, Ireland, and Canada. The United Kingdom is a net importer of nurses. The principal policy instrument in the United Kingdom, the Code of Practice on International Recruitment, has not ended the inflow of nurses to the United Kingdom from sub-Saharan Africa. Conclusions. Given the increasing globalization of labor markets, it is likely that the historically high levels of inflow of internationally recruited nurses to the United Kingdom will continue over the next few years; however the "peak" number reached in 2002/2003 may not be repeated, particularly as large-scale active international recruitment has now been ended, for the short term at least. New English language tests and other revised requirements for international applicants being introduced by the Nurses and Midwives Council from September 2005 may restrict successful applications from some countries and will also probably add to the "bottleneck" of international nurse applicants. Demographic-driven demand for health care, combined with a potential reduction in supply of U.K. nurses as many more reach potential retirement age means that international recruitment is likely to remain on the policy agenda in the longer term, even with further growth in the number of home-based nurses being trained. © 2007 Health Research and Educational Trust.
This paper draws from research commissioned by the Scottish Executive Health Department (SEHD). It provides a case study in the introduction of a new health care worker role into an already well established and "mature" workforce configuration It assesses the role of US style physician assistants (PAs), as a precursor to planned "piloting" of the PA role within the National Health Service (NHS) in Scotland. The evidence base for the use of PAs is examined, and ways in which an established role in one health system (the USA) could be introduced to another country, where the role is "new" and unfamiliar, are explored. The history of the development of the PA role in the US also highlights a sometimes somewhat problematic relationship between P nursing profession. The paper highlights that the concept of the PA role as a 'dependent practitioner' is not well understood or developed in the NHS, where autonomous practice within regulated professions is the norm. In the PA model, responsibility is shared, but accountability rests with the supervising physician. Clarity of role definition, and engendering mutual respect based on fair treatment and effective management of multi-disciplinary teams will be pre-requisites for effective deployment of this new role in the NHS in Scotland. © 2007 Buchan et al; licensee BioMed Central Ltd.
Buchan, J, Jobanputra, R, Gough, P & Hutt, R 2006, 'Internationally recruited nurses in London: A survey of career paths and plans', Human Resources for Health, vol. 4.View/Download from: Publisher's site
Background: The paper reports on a survey of recently arrived international nurses working in London, to assess their demographic profile, motivations, experiences and career plans. Methods: A postal survey was conducted in October-December 2004 on a sample of 1000 nurses who were London-based international members of the Royal College of Nursing (RCN). The usable response rate was 40%. Registration data from the Nurses and Midwives Council (NMC) were also analysed. Results: The Philippines, Nigeria and South Africa were the three most commonly reported countries of training (in total, more than 30 countries of training were reported). Sixty per cent of the nurses from sub-Saharan Africa and more than 40% from South Africa and India/Pakistan/Mauritius were aged 40 or older; the youngest age profile was reported by the Australia/New Zealand/USA nurses. Two thirds of all the respondents indicated that a recruitment agency had been involved in their move to the United Kingdom (UK). Three quarters of the respondents (76%) reported that they were required to complete a supervised practice course/period of adaptation in the UK in order to be eligible to practice as a nurse in the UK. Two thirds (69%) of respondents were working in NHS hospitals in London, 13% were working in the private sector hospitals and 10% were working in private sector nursing homes. Most of the nurses reported they were the major or sole wage-earner contributing to household income. More than half of the respondents (57%) reported that they regularly sent remittances to their home country. The majority of respondents (60%) indicated that they planned to stay for at least five years, but just under half (43%) also reported that they were considering a move to another country. Conclusion: One critical issue for UK policy-makers is to determine if internationally recruited nurses will stay on in the UK, move back to their home country, or move on to another. That these nurses have made at least one...
Hayes, LJ, O'Brien-Pallas, L, Duffield, CM, Shamian, J, Buchan, J, Hughes, FA, Spence Laschinger, H, North, N & Stone, P 2006, 'Nurse turnover: A literature review', International Journal of Nursing Studies, vol. 43, no. 2, pp. 237-263.View/Download from: Publisher's site
Ongoing instability in the nursing workforce is raising questions globally about the issue of nurse turnover. A comprehensive literature review was undertaken to examine the current state of knowledge about the scope of the nurse turnover problem, defini
O'Brien-Pallas, L, Griffin, P, Shamian, J, Buchan, J, Duffield, CM, Hughes, FA, Spence Laschinger, H, North, N & Stone, P 2006, 'The impact of nurse turnover on patient, nurse, and system outcomes: A pilot study and focus for a multicenter international study', Policy, Politics and Nursing, vol. 7, no. 3, pp. 169-179.
Buchan, J 2005, 'A Certain Ratio? The policy implications of minimum staffing ratios in nursing', Journal of Health Services Research and Policy, vol. 10, no. 4, pp. 239-244.
The debate about how best to determine nurse staffing levels continues. The conventional wisdom is that determining staffing levels is something best left to local management, taking account of local workload and resources. This 'bottom up' philosophy has now been challenged by the use of a different approach the use of 'top down'standardized, and mandatory, nurse:patient or nurse:bed ratios. This paper examines the characteristics and early results of the use of staffing ratios in the two health systems where nurse staffing ratios are now mandatory the states of Victoria (Australia) and California (USA). It then discusses the policy implications of using ratios. The paper identifies the main weaknesses of the use of nurse:patient ratios as being their relative inflexibility and their potential inefficiency, if they are wrongly calibrated. Their strength is their simplicity and their transparency. Their impact will be most pronounced when ratios are mandatory and where they offer a mechanism to improve and then to maintain staffing levels at some pre-determined level. The biggest challenges in their use are calibration (what is 'safe'? or 'minimum'?) and achieving the support of all stake-holders. The paper concludes that nurse:patient ratios are a blunt instrument for achieving employer compliance, where reliance on alternative, voluntary (and often more sophisticated) methods of determining nurse staffing have not been effective.
Buchan, J 2005, 'International recruitment of health professionals', British Medical Journal, vol. 330, no. 7485, p. 210.
Buchan, J, Jobanputra, R & Gough, P 2005, 'Should I stay or should I go?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 19, no. 36, pp. 14-16.
Aiken, LH, Buchan, J, Sochalski, J, Nichols, B & Powell, M 2004, 'Trends in international nurse migration: The world's wealthy countries must be aware of how the "pull" of nurses from developing countries affects global health', Health Affairs, vol. 23, no. 3, pp. 69-77.View/Download from: Publisher's site
Predicted shortages and recruitment targets for nurses in developed countries threaten to deplete nurse supply and undermine global health initiatives in developing countries. A twofold approach is required, involving greater diligence by developing countries in creating a largely sustainable domestic nurse workforce and their greater investment through international aid in building nursing education capacity in the less developed countries that supply them with nurses.
In terms of recent developments in national level nurse workforce planning there are some commonalities across all, or most of the four UK countries. There has been a greater emphasis on integration of workforce planning (but as yet not much actual evidence of this happening), an emphasis on developing or strengthening the regional level in workforce planning and an emphasis on improving workforce planning and development capacity. There are also some specific issues which differentiate the four countries. Only Scotland has a well-established long running approach to determining the number of nurses to educate at pre-reg level ('SNIP') (there is a review of SNIP in 2004); England has decentralised (to the Workforce Development Confederations) the budgets for preregistration nurse education; and Wales is committed to moving to all graduate nurse education; England has indicated it will not move in this direction. Each of the four UK country has a different nurse : population ratio, and there are also other factors which differentiate the workforces - such as different skill mixes, and different growth rates in nurse employment in the NHS. It is also clear that there is policy divergence on broader issues of health service priorities and resource allocation. However, there remains a single unifying regulatory framework, and (probably) a single pay and career structure (if Agenda for Change is fully implemented and foundation trusts do not have significant flexibility to vary local pay rates). As such, there will continue to be the potential for cross-border effects of changes in workforce policy and planning. The workforce planning arrangements in place to ensure that there are sufficient nurses, with the right skills, employed in the NHS are in a process of transition, reflecting broader changes in NHS health workforce development strategies. There may be no single 'right' way to effectively workforce plan at national or regional level, but the current systems bei...
Buchan, J 2004, 'International rescue? The dynamics and policy implications of the international recruitment of nurses to the UK', Journal of Health Services Research and Policy, vol. 9, no. SUPPL. 1, pp. 10-16.
This paper focuses on one global aspect of the current health sector workforce policy agenda - the international recruitment and migration of health workers. It does so primarily by using a case study of the recruitment of nurses to the UK, as a means of exploring the policy challenges and associated research questions. The paper highlights the limitations in comparing national data on the nursing workforce, illustrating the extent to which currently collated national data can present a misleading picture of staff:population ratios in different countries. It then reports on the significant growth in the numbers of nurses entering the UK from other countries, using registration data. In 2001/02, more than 16 000 nurses entered the UK nursing register from non-UK sources. In this year, for the first time, the number exceeded the number of home-trained nurses. An analysis of postcode data highlights that these non-UK nurses have a younger age profile than home-based registered nurses and are more likely to report a postcode in London and south-east England. The paper also examines the push and pull factors that contribute to the international mobility of health workers. The paper concludes by examining the policy implications of this growing reliance on international recruitment, including the effect of the ethical guidelines on international recruitment introduced by the Department of Health in England. © The Royal Society of Medicine Press Ltd 2004.
Buchan, J 2004, 'What Difference does ("Good") HRM Make?', Human Resources for Health, vol. 2, no. 6, pp. 1-7.
The importance of human resources management (HRM) to the success or failure of health system performance has, until recently, been generally overlooked. In recent years it has been increasingly recognised that getting HR policy and management "right" has to be at the core of any sustainable solution to health system performance. In comparison to the evidence base on health care reform-related issues of health system finance and appropriate purchaser/provider incentive structures, there is very limited information on the HRM dimension or its impact.
Buchan, J & Sochalski, J 2004, 'The migration of nurses: Trends and policies', Bulletin of the World Health Organization, vol. 82, no. 8, pp. 587-594.
This paper examines the policy context of the rise in the international mobility and migration of nurses. It describes the profile of the migration of nurses and the policy context governing the international recruitment of nurses to five countries: Australia, Ireland, Norway, the United Kingdom, and the United States. We also examine the policy challenges for Workforce planning and the design of health systems infrastructure. Data are derived from registries of professional nurses, censuses, interviews with key informants, case studies in source and destination countries, focus groups, and empirical modelling to examine the patterns and implications of the movement of nurses across borders. The flow of nurses to these destination countries has risen, in some cases quite substantially. Recruitment from lower-middle income countries and low-income countries, as defined by The World Bank, dominate trends in nurse migration to the United Kingdom, Ireland, and the United States, while Norway and Australia, primarily register nurses from other high-income countries. Inadequate data systems in many countries prevent effective monitoring of these workforce flows. Policy options to manage nurse migration include: improving working conditions in both source and destination countries, instituting multilateral agreements to manage the flow more effectively, and developing compensation arrangements between source and destination countries. Recommendations for enhancements to workforce data systems are provided.
Buchan, J & Sochalski, J 2004, 'Trends in the migration of nurses', Bulletin of the World Health Organisation, vol. 82, no. 8, pp. 587-594.
This paper examines the policy context of the rise in the international mobility and migration of nurses. It describes the profile of the migration of nurses and the policy context governing the international recruitment of nurses to five countries: Australia, Ireland, Norway, the United Kingdom, and the United States. We also examine the policy challenges for workforce planning and the design of health systems infrastructure. Data are derived from registries of professional nurses, censuses, interviews with key informants, case studies in source and destination countries, focus groups, and empirical modelling to examine the patterns and implications of the movement of nurses across borders.
Buchan, J, Ball, J & Rafferty, AM 2004, 'HSJ people. On the pull.', The Health service journal, vol. 114, no. 5893, pp. 40-41.
When Rochdale Infirmary prepared to become the first UK 'magnet' hospital, the boost to staff morale was just one of many attractions. James Buchan and colleagues explain the process.
Buchan, J, Jobanputrar, R & Gough, P 2004, 'Experts don't make exports. Is London overly reliant on overseas health.', The Health service journal, vol. 114, no. 5914, pp. 30-31.
Finlayson, B & Buchan, J 2003, 'HSJ people. Town planning.', The Health service journal, vol. 113, no. 5869, pp. 32-33.
Jobanputra, R & Buchan, J 2003, 'Foundation trusts. Power sharing.', The Health service journal, vol. 113, no. 5853, pp. 26-27.
Foundation trusts will in theory have greater freedoms over pay, non-pay rewards and recruitment, although details are still unclear. Foundations are likely to differ in their use of these powers, partly because of desire and partly because of practical limits. Taking advantage of new powers for short-term gain, at the expense of other trusts, will have negative effects if not part of a wider development of HR practice.
Stilwell, B, Diallo, K, Zurn, P, Dal Poz, MR, Adams, O & Buchan, J 2003, 'Developing evidence-based ethical policies on the migration of health workers: Conceptual and practical challenges', Human Resources for Health, vol. 1.View/Download from: Publisher's site
It is estimated that in 2000 almost 175 million people, or 2.9% of the world's population, were living outside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995. As the global labour market strengthens, it is increasingly highly skilled professionals who are migrating. Medical practitioners and nurses represent a small proportion of highly skilled workers who migrate, but the loss of health human resources for developing countries can mean that the capacity of the health system to deliver health care equitably is compromised. However, data to support claims on both the extent and the impact of migration in developing countries is patchy and often anecdotal, based on limited databases with highly inconsistent categories of education and skills. The aim of this paper is to examine some key issues related to the international migration of health workers in order to better understand its impact and to find entry points to developing policy options with which migration can be managed. The paper is divided into six sections. In the first, the different types of migration are reviewed. Some global trends are depicted in the second section. Scarcity of data on health worker migration is one major challenge and this is addressed in section three, which reviews and discusses different data sources. The consequences of health worker migration and the financial flows associated with it are presented in section four and five, respectively. To illustrate the main issues addressed in the previous sections, a case study based mainly on the United Kingdom is presented in section six. This section includes a discussion on policies and ends by addressing the policy options from a broader perspective. © 2003 Stilwell et al; licensee BioMed Central Ltd.
Buchan, J 2002, 'Agenda for change. Bitter pill.', The Health service journal, vol. 112, no. 5817, pp. 24-26.
The government's proposal to produce a holistic pay system for the NHS has been limited by the separate settlement for consultants. The new system must balance management needs for local flexibility and unions' desire to sustain national pay. The introduction of foundation hospitals and overseas clinical teams will have implications for the implementation of the new pay system.
Buchan, J 2002, 'Human resources. Rallying the troops.', The Health service journal, vol. 112, no. 5807, pp. 24-26.
The government's plans for the NHS will not be achieved simply through meeting its targets for staffing. More attention should be given to retention and a fairer pay system. The introduction of new roles and skill mix will be the biggest test of the human resources agenda. Success is more likely to come from developing the roles of current health professionals than from introducing new types of workers.
Buchan, J 2002, 'Magnet hospitals. Attraction of opposites.', The Health service journal, vol. 112, no. 5812, pp. 22-24.
US research suggests that magnet hospitals have better outcomes than other Institutions Key to magnet organisations are participative management style, strong professional development and flexible working practices. The magnet concept appears to be an effective way of tackling nurse shortages.
Buchan, J 2002, 'More winners than losers?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 17, no. 4, pp. 20-21.
Buchan, J 2002, 'Nurse recruitment. Going places.', The Health service journal, vol. 112, no. 5816, pp. 22-24.
Overseas nurses account for 40 per cent of all new registrations in the UK and this may be rising to 50 per cent. This upward trend is likely to continue. International recruitment is to be part of the NHS's long-term strategy and is becoming the focus of increasing policy attention. The international labour market will become tighter: the US needs to recruit an extra million nurses of its own.
In this report, key aspects of change in the labour market for nurses in Scotland are examined, and an integrated policy framework intended to improve nurse recruitment, retention and utilization is outlined. The purpose of this article is to provide an overview of the dynamics of the nursing labour market in Scotland and to draw some more general messages from the evidence base on the effectiveness of interventions to improve recruitment and retention of nursing staff. The paper has three main elements: it provides a backdrop of key trends in the Scottish nursing labour market; it summarizes issues related to planning and nursing shortages, including an assessment of the utility of current indicators of recruitment and retention difficulties; and it reviews the main potential interventions to address nurse recruitment and retention difficulties, drawing from key research/evidence from UK and other English language sources. Five main interventions are examined: integrating the planning of the healthcare workforce; improving recruitment; incentives to improve retention; improving staff deployment; and improving utilization/skill mix.
Buchan, J 2002, 'The capacity to change? Workforce growth in the health sector; a U.K. perspective.', HealthcarePapers, vol. 3, no. 2.
Canada is not alone in having to face up to significant human resource (HR) challenges as it debates how healthcare should be managed and delivered in the 21st century. The United Kingdom is having to deal with many similar issues related to demographic change, skills shortages and the drive to "modernize" public services. This commentary highlights some of the main dimensions of HR-related change in the U.K. National Health Service (NHS) to counterpoint the main messages in the lead paper. The primary focus is on examining the key HR aspects of achieving sustained improvement in staffing levels, mix and motivation.
Buchan, J & Dal Poz, M 2002, 'Skill Mix in the Health Care workforce: reviewing the evidence.', Bulletin of the World Health Organisation, vol. 80, no. 7, pp. 575-580.
This paper discusses the reasons for skill mix among health workers being important for health systems. It examines the evidence base (identifying its limitations), summarizes the main findings from a literature review, and highlights the evidence on skill mix that is available to inform health system managers, health professionals, health policy-makers and other stakeholders. Many published studies are merely descriptive accounts or have methodological weaknesses. With few exceptions, the published analytical studies were undertaken in the USA, and the findings may not be relevant to other health systems. The results from even the most rigorous of studies cannot necessarily be applied to a different setting. This reflects the basis on which skill mix should be examined identifying the care needs of a specific patient population and using these to determine the required skills of staff. It is therefore not possible to prescribe in detail a "universal" ideal mix of health personnel. With these limitations in mind, the paper examines two main areas in which investigating current evidence can make a significant contribution to a better understanding of skill mix.
Buchan, J 2001, 'Nurses moving across borders: 'brain drain' or freedom of movement?', International nursing review, vol. 48, no. 2, pp. 65-67.
Buchan, J, Ball, J & O'may, F 2001, 'If changing skill mix is the answer, what is the question?', Journal of Health Services Research and Policy, vol. 6, no. 4, pp. 233-238.View/Download from: Publisher's site
Changing skill mix is often identified as a potential solution to health services staffing and resourcing problems, or is related to health sector reform. This paper discusses what is meant by skill mix, provides a typology of the different approaches to assessing skill mix and examines, by means of case studies, the contextual, political, social and economic factors that play a part in determining skill mix. These factors are examined in relation to three factors: the reasons (or drivers) for examining skill mix; the impact of contextual constraints; and the effect of varying spans of managerial control. Case studies conducted in Costa Rica, Finland, Mexico, the UK and the USA are used to explore the reality of assessing skill in different contexts and health care settings. We argue that, although skill mix may be a universal challenge, it is not a challenge that all managers or health professionals can meet in the same way, or with the same resources. Context can have a significant effect on the ability of health service managers to assess and change skill mix. The key determinant is the extent to which these factors are in the locus of control of management nationally, regionally, or locally, within different countries. We emphasise the need to evaluate the problem and examine the context, before deciding if a change in skill mix is the answer. The local managerial span of control and degree of organisational flexibility will be major factors in determining the likely impact of any attempts to change skill mix. Before embarking on a skill mix review, any organisation should ask itself the question: 'If changing skill mix is the answer, what is the question?'. © 2001, Royal Society of Medicine Press Limited. All rights reserved.
Buchan, J 2000, 'A change for the better.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 14, no. 31, p. 24.
Buchan, J 2000, 'Asset management is key to plan's success.', Nursing times, vol. 96, no. 32, p. 15.
© MA Healthcare Limited 2014. The new NHS plan projects ambitious growth targets for health services in England (Secretary of State for Health, 2000). It acknowledges that meeting these targets will depend on 'growing' the NHS workforce, including numbers of therapy professionals. Can the plan deliver the required increase in staffing?
The objective of the paper is to assess the human resource (HR) dimension of the National Health Service (NHS) reforms in the United Kingdom, and to highlight lessons for the health systems of countries undergoing reform or restructuring. Health sector reform in many countries in the 1980s and 1990s has focused on structural change, cost containment, the introduction of market mechanisms and consumer choice. This focus has inevitably challenged the ways that health professionals and other staff are employed and deployed. The methods used to manage human resources in health care may also in themselves be a major constraint or facilitator in achieving the objectives of health sector reform. The impact on the HR function of the NHS reforms is assessed in the paper by examining three central requirements of the HR function: to maintain effective staffing levels and skill mix; to establish appropriate employee relations policy and procedures; and to be involved in pay determination. The paper concludes that the most significant changes which have occurred as result of the NHS reforms have been in staffing change and organizational culture, and the individual attitudes of NHS management and staff. Attempts to alter methods of conducting employee relations and determining pay and conditions of employment have been less successful. However, an overall approach to HR management, which would have been unthinkable in the pre-reform NHS, is now accepted, albeit grudgingly by some, as the way forward. In general, the changes in the NHS HR function can be characterized as a partially successful attempt to adopt private sector HR management techniques to meet the challenges of public sector reform.
Buchan, J 2000, 'Nurse recruitment. Abroad minded.', The Health service journal, vol. 110, no. 5686, pp. 20-21.
Overseas nurses make up 3 per cent of the UK nursing workforce. But in inner London they make up more than 30 per cent. Overseas nurses account for a quarter of new registrations with the UKCC. Overseas recruitment is likely to remain a feature of the NHS for the foreseeable future. Trusts should pay attention to recruitment costs and ensure that overseas recruits are given induction training which includes practical aspects of living in the UK, such as finding accommodation.
This article examines key aspects of change in European nursing labour markets, and highlights an integrated policy framework intended to improve nurse recruitment, retention and utilization in European health care. Health care is labour intensive. Staffing costs are often a major focus of the health sector. There is a tendency for staffing to be regarded as part of the 'problem' of cost containment, and staffing costs are often a major focus of health sector reform. This report argues that it is more appropriate to regard staffing in general, and nurses in particular, as part of the solution to improving quality, access and cost of care. The major elements in nurse workforce planning are discussed, and the need for planning to be integrated with service delivery is emphasized. With projected increases in the demand for healthcare, and concern about staff shortages, policy attention across Europe and in other countries must focus on improving the methods of recruiting, retaining and utilizing nursing resources. A policy-based framework for sustained improvement is presented, based on five areas of action: improve 'conventional' recruitment; improve recruitment from 'non-conventional' sources; identify and apply incentives to improve staff retention and motivation; improve staff deployment; and improve utilization/skill mix.
Buchan, J 2000, 'Recruitment. Happy landings?', The Health service journal, vol. 110, no. 5719, pp. 24-27.
The number of overseas nurses coming to the UK has risen 48 per cent in 12 months. The bulk of the increase has come from non-EU countries such as South Africa, Australia, the Philippines, New Zealand and the West Indies. This trend flies in the face of Department of Health guidance that urged trusts not to recruit from developing countries which were experiencing shortages of their own. Overseas nurses now account for almost one third of those working in inner London and 3.5 per cent of the nursing workforce in England.
Buchan, J 2000, 'Workforce planning. Pressure is on.', The Health service journal, vol. 110, no. 5734, pp. 26-27.
The UK is very reliant on physiotherapists who trained overseas, who now represent almost a third of new entrants. Australia is the main source of overseas-trained physiotherapists. It the UK is to increase recruitment of physiotherapists from overseas, ethical considerations mean it should focus on the EU, the US and Australasia and not developing countries.
Buchan, J & Edwards, N 2000, 'Nursing by numbers.', Nursing times, vol. 96, no. 15, pp. 30-31.
Buchan, J & Edwards, N 2000, 'Nursing numbers in Britain: The argument for workforce planning', British Medical Journal, vol. 320, no. 7241, pp. 1067-1070.
Britain has a serious shortage of nurses, as well as problems in recruiting and retaining them. It is not simply that there are too few nurses; some key skills shortages also exist, with increasing demand for more qualified staff in some areas. Much better planning of the workforce is required, and this needs to he more integrated with the planning for other groups in health care. A change in the pay system may help, but the creation of better work environments may be part of the solution. The rapid pace of change in the nursing profession has produced a challenge that the NHS needs to address.
Buchan, J 1999, 'Evaluating the benefits of a clinical ladder for nursing staff: An international review', International Journal of Nursing Studies, vol. 36, no. 2, pp. 137-144.View/Download from: Publisher's site
This paper reviews the use of clinical ladders for nursing staff and examines the extent to which their claimed benefits have been realised, on the basis of available published research-based evaluation. A 'clinical ladder' is a grading structure which facilitates career progression and associated differentation of pay by defining different levels of clinical practice. The review examines publications from the United States, New Zealand, Australia and the United Kingdom. It notes that the vast majority of publications are descriptive 'this is how we did it' articles which do not provide any evaluation. The relatively few published evaluations are assessed, and it is concluded that the evidence base for supporting the claimed benefits of the use of clinical ladders is fragmented. Methods of evaluation have varied between studies, and in some cases fall short of that required for objective analysis. © 1999 Elsevier Science Ltd. All rights reserved.
Buchan, J 1999, 'International solutions.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 14, no. 11, pp. 19-20.
Buchan, J 1999, 'Review: Changing aspects of nurses' work environment: A comparison of perceptions in two hospitals in Sweden and the UK and implications for recruitment and retention of staff', Journal of Research in Nursing, vol. 4, no. 3, p. 234.View/Download from: Publisher's site
Buchan, J 1999, 'Still attractive after all these years? Magnet hospitals in a changing health care environment', Journal of Advanced Nursing, vol. 30, no. 1, pp. 100-108.View/Download from: Publisher's site
This paper examines the research base for 'magnet hospitals' - hospitals that have a good reputation for recruitment and retention of registered nurses. It also assesses the extent to which the concept of the magnet hospital continues to have relevance to nursing in the United Kingdom (UK). The study reviews previous research, examines recent trends in nursing employment, and reports on case studies conducted as fieldwork research. The early research on magnet hospitals, conducted in the 1980s in the United States of America (USA), is reassessed in the light of subsequent cost containment driven changes in the USA nursing labour market and in the organization of USA hospitals. Many of these changes have impacted on nursing staff, with increases in workload, and with changes in skill mix, particularly as a result of increased use of care assistants. Similar developments have been happening in the UK. The paper examines the extent to which the concept of the magnet hospital can retain validity in this changing health care environment. Case studies in 14 USA magnet hospitals were conducted in 1997. The results highlight that, as a result of hospital reorganization and merger, some of these hospitals no longer exhibit core characteristics of 'magnetism', whilst others have retained these characteristics despite organizational change. The paper concludes by cautioning that the concept of the magnet hospital continues to have a relevance to the management of nursing resources, but that the research base, with some notable exceptions, continues to be weak and that there is a need for monitoring and a process of re-accreditation to maintain a 'live' register of magnet hospitals.
Buchan, J 1999, 'The 'greying' of the United Kingdom nursing workforce: Implications for employment policy and practice', Journal of Advanced Nursing, vol. 30, no. 4, pp. 818-826.View/Download from: Publisher's site
One in five nurses on the United Kingdom (UK) professional register is aged 50 years or older. Over the next few years, the profession will lose, through retirement, many of its most experienced practitioners. The significance for policy makers and for employers of this age-shift is two-fold. Firstly it is clear that greater numbers of nurses and midwives are reaching, or soon will reach, potential retirement age. Secondly many more nurses are now reaching their middle years and they are likely to have different requirements and attitudes to nursing work. This paper examines the employment policy and practice of the ageing of the UK nursing population. The paper examines data from official sources, and information from attitudinal surveys and case studies with employing organizations to assess the major effects of the ageing of the nursing workforce. Key findings are that the age profile of those nurses working in the National Health Service appears to be 'younger' than that of the total population, with the age profile of nurses working in nursing homes and as practice nurses being older than that of the NHS nursing workforce. However, the overall age profile of NHS nurses masks considerable variation between specialties and trusts, and the 'pool' of potential nurse returners from which the NHS and other employers attempts to recruit, is declining in numbers, as it too ages. Other major issues requiring policy attention are the provision of appropriate flexible hours to older nurses who have caring responsibilities, improving access to continuing professional development, and reducing pension provision inflexibility.
Buchan, J 1999, 'There's no place like home.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 14, no. 2, pp. 22-23.
This paper sets out to establish what is meant by shared governance, analyses the literature on shared governance implementation, and discusses emergent issues. The paper is based on research funded by the Department of Health (England) and by North Staffordshire NHS Trust. A literature search was undertaken using the terms 'shared governance' and 'empowerment', restricted to English language. The databases used were CINAHL, British Nursing Index, Medline, Social Sciences Citation Index and FirstSearch, and the search period was January 1988-May 1998. Initially, nearly 500 articles were identified. This search also highlighted articles describing participative management, professional practice models, and self-managed work teams. For the purposes of this review, only published articles which either described and/or evaluated the implementation of shared governance were analysed. According to these criteria, 48 studies, which were obtained by the cut-off date, were included for detailed assessment. © 1999 Elsevier Science Ltd. All rights reserved.
Buchan, J 1998, 'Further flexing? Issues of employment contract flexibility in the UK nursing workforce', Health Services Management Research, vol. 11, no. 3, pp. 148-162.View/Download from: Publisher's site
This paper, based on research commissioned by the Royal College of Nursing, reports on the changing working patterns and flexibility in the employment of nursing staff in the National Health Service (NHS) in the UK. It reviews relevant literature, examines official data and draws information from 12 case study NHS trusts. Flexibility is invariably portrayed as a good thing, and as a means to a positive end, yet is rarely defined in detail, if at all. The aim of this paper is to consider flexibility not as a slogan or panacea, but in terms of the rationales for, and likely effects of, changing patterns of nursing work. It examines the reasons why NHS employers have been attempting to increase the flexibility of their nursing workforce.
Buchan, J 1998, 'Workforce planning. Your country needs you.', The Health service journal, vol. 108, no. 5613, pp. 22-25.
Shortage of nurses is a long-standing problem which was the subject of official inquiries long before the launch of the NHS. There has been persistent inertia about acting on the recommendations of these reports. Despite a continuing increase in activity rates, the number of nurses in the NHS has remained largely static for a decade. Another 5,000 will be needed by 2015. The UK should use its capacity for centralised planning to tackle the issue.
This paper reviews research on the supply of, and demand for, nurses. It examines the utility of various data indicators of nursing 'shortages' and highlights potential shortcomings in their application. The paper also assesses the linkages between nurses' pay and nurses' labour market behaviour, reviewing the comparatively few papers which have taken a UK perspective on this issue. The current situation of a mismatch between nurses' supply and demand in the UK is also examined, with the clear indication that there is the potential for an increase in mismatch as demand increases, while future supply appears problematic. Finally, the paper reviews the main recommendations from previous national studies on nursing shortages in the UK, and concludes that many lessons from these studies have been ignored, as a cycle of nursing shortages has continued to be apparent in the UK.
Buchan, J & O'May, F 1998, 'Nursing supply and demand: reviewing the evidence.', Nursing times, vol. 94, no. 26, pp. 60-63.
This paper reviews research on the supply of, and demand for nurse. It examines the utility of various data indicators of nursing shortages and highlights potential shortcomings in their application. The paper also assesses the links between nurses' pay and nurses' labour market behaviour, reviewing the comparatively few papers that have taken a UK perspective on this issue. The current mismatch between nurses' supply and demand in the UK is also examined, with the clear indication that there is potential for an increase in mismatch as demand increases, while future supply appears problematic.
Gray, A & Buchan, J 1998, 'Pay in the British NHS: A local solution for a national service?', Journal of Health Services Research and Policy, vol. 3, no. 2, pp. 113-120.View/Download from: Publisher's site
An important component of the reforms of the British National Health Service (NHS) has been devolution of a previously highly centralised pay bargaining system to the local provider level. As the wage bill is by far the single largest item of health care expenditure, the implications of this change may be far-reaching. This article surveys the available theory and evidence from an economic perspective. It reviews the development of pay determination mechanisms in the NHS and the extent to which local pay has been adopted since the reforms were introduced. It then considers the theory of local pay and general evidence on local pay variations in the UK, before turning to the available evidence on local labour markets in the health care sectors of the UK and USA. It concludes with a discussion of the policy and research implications of current developments on local pay bargaining in the NHS. In particular, it suggests that judgements over the success or failure of local pay bargaining will concern: first, whether the weakened monopsony position of the NHS at national level results in higher pay for the more powerful employee groups; second, whether fragmentation of bargaining weakens the negotiating and lobbying power of national trade unions and professional organisations; third, whether competition between providers leads to higher or lower costs; and fourth, whether any efficiency gains from local bargaining outweigh the higher transaction costs involved.
Buchan, J 1997, 'Clinical Ladders: The Ups and Downs', International Nursing Review, vol. 44, no. 2, pp. 41-46.
Clinical (or career) ladders for qualified nurses can change how nurses' associations and trade unions negotiate their salaries and career structure. Below, a review of clinical ladders, their implications and how nurses are responding.
Buchan, J 1997, 'International focus: it doesn't add up.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 11, no. 40, p. 24.
Buchan, J 1997, 'Magnet hospitals: what's the attraction?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 12, no. 7, pp. 22-25.
Buchan, J 1997, 'Pay determination. The States we're in.', The Health service journal, vol. 107, no. 5550, pp. 28-29.
Buchan, J, Hancock, C & Rafferty, AM 1997, 'Health Sector Reform and Trends in the United Kingdom Hospital Workforce', Medical Care, vol. 35, no. SUPPL..
The authors examine changing trends in the profile and patterns of employment of the workforce in hospitals in the National Health Service (NHS) in the United Kingdom. The effect of the implementation of the NHS reforms is considered, with particular reference to the changing composition of the nursing workforce. The authors note that there are problems with establishing trend data because of altered information requirements as a result of the NHS reforms. METHODS. Analysis and review of data from secondary sources and research publications. RESULTS. Although hospital activity rates have grown, patient length of hospital stays decreased, and patient activity levels increased, there has not been a linked growth in the size of the nursing workforce. The main changes in the profile of the nursing workforce highlighted are a marked reduction in the numbers of nursing students and alterations in the skill mix between first- and second-level qualified nurses. The authors also note a large increase in the number of managerial and administrative staff employed and growth in medical staff numbers. Changes in working patterns and increases in contracting for support services and in the use of temporary staff also are discussed. CONCLUSIONS. There have been pronounced changes in the profile of the hospital workforce but little evaluation of the impact of these changes on outcomes of care.
This paper examines trends in international mobility of U.K. nurses. Inflow and outflow of qualified nurses from the U.K. are assessed, and source and destination countries identified. The reasons for mobility are also examined. The paper reveals that mobility of nurses to and from the U.K. has declined in the 1990s, after having increased markedly in the late 1980s. Mobility to and from North America and Australasia has reduced significantly, as a result of organisational change and reduced career opportunities, whilst inflow and outflow to and from other European countries has remained more static, but at a lower level. © 1997 Elsevier Science Ltd. All rights reserved.
Alderman, C, Seccombe, I & Buchan, J 1996, 'Nursing shortages: a virtual reality?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 10, no. 19, pp. 22-25.View/Download from: Publisher's site
There appears to have been a decline in mobility since the start of the decade partly because of a lack of recognition of overseas experience, and partly due to a lack of willingness to support temporary work abroad. The NHS Executive, however, is now encouraging NHS trusts to consider work abroad more favourably.
Buchan, J 1995, 'Are patient focused hospitals working?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 10, no. 8, p. 30.
The concept of patient focused hospitals has been with us since the 1980s. James Buchan looks at whether claims for the benefits of this type of care have been realised in practice.
Buchan, J 1995, 'Employment: going casual.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 9, no. 21, pp. 22-23.
This year's focus on a '3 per cent for all' pay rise may be a reflection of the fact that more and more nurses are reaching the top increments of their grade and are therefore unable to obtain a pay increase through the annual increment system. James Buchan looks at the implications of relying on the Review Body awards as the only way of securing a pay rise.
Buchan, J 1995, 'Is the population of nurses decreasing?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 9, no. 29, p. 39.
Buchan, J 1995, 'Male nurses: losing their job advantage?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 9, no. 33, p. 30.
Though the overall population of nurses remains at the same level, the number of male nurses is on the rise. With male nurses traditionally being an advantaged minority, this may increase competition for jobs.
Buchan, J 1995, 'Nurses bear the brunt of insecurity.', Nursing management (Harrow, London, England : 1994), vol. 1, no. 10, pp. 23-25.
Buchan, J 1995, 'Nursing overseas: a change in trends.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 9, no. 37, p. 29.
A nursing qualification has often been a licence to travel to other parts of the world. But trends indicate that fewer nurses from abroad are looking to work in the UK, while UK registered nurses who want to work overseas are choosing different destinations from a few years ago.
The costs of nurse absence to trusts can be high. As part of some trusts' pay offers, bonuses for good attendance at work are being suggested as a way of reducing the costs of absence. This article reviews the possible implications of such a move.
Buchan, J 1995, 'Shifting the patterns of nurses' work.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 9, no. 45, p. 29.
Although most nurses tend to work a three shift pattern of 'earlies', 'lates' and 'nights', increasing interest is being shown in the use of 12-hour shift patterns. James Buchan outlines the advantages and disadvantages of this type of work for both patients and nurses.
Examines in detail the issue of absence among nurses in the National Health Service (NHS) in the UK. Three main objectives are to: investigate levels and reasons for absence among nurses; assess the abilities of NHS management to monitor and control nurse absence effectively; and examine the impact of nurse absence on organizational costs and care delivery. Draws on data generated from four linked studies: a survey of back-injured nurses, conducted in 1992; a survey of 4,000 qualified nurse members of the Royal College of Nursing, conducted in March/April 1993; a postal survey of 119 NHS employing units, conducted in May/June 1993; and detailed case studies, conducted with management in ten NHS hospital sites in May/June 1993.
Nurse banks are locally organized in-house sources of temporary nursing staff. Reports on a study of policy and practice in the management of nurse banks in the National Health Service in Scotland. The study was based on a census survey of all 55 NHS units in Scotland (100 per cent response rate). Examines management rationales in establishing a nurse bank, explores costs and benefits of managing a bank, and provides recommendations on good practice in maintaining continuity of care.
Nurse banks are locally organised "in house" sources of temporary nursing staff. This paper reports on a survey of nurses working on three nurse banks in the National Health Service in Scotland. A total of 203 nurses responded to the survey, which revealed marked differences in the profile of the nurses working on each of the banks, in terms of age, biographical details, career plans and work commitments. Main issues for management revealed by the survey were the need for good communication with temporary staff and high levels of reported dissatisfaction with access to training opportunities. The paper concludes that there is no "standard" model of a nurse bank in the NHS in Scotland and no standard profile of bank nurses. © 1995.
Buchan, J 1994, 'A maturing profession.', Senior nurse, vol. 14, no. 1, p. 29.
Buchan, J 1994, 'Attendance management.', Nursing management (Harrow, London, England : 1994), vol. 1, no. 1, pp. 18-19.
Buchan, J 1994, 'Employment of newly registered nurses.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 9, no. 4, p. 31.
Buchan, J 1994, 'Job-sharing: the key to flexible working?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 8, no. 47, p. 29.
Job-sharing appears to be on the increase in nursing and may represent an important step in meeting equal opportunity goals for women. This article discusses the potential for this form of employment in the NHS.
This paper examines possible implications of the US 'magnet hospital' concept for the UK nursing labour market. Magnet hospitals have been researched in the US and have been demonstrated to exhibit lower nurse turnover and higher levels of reported job satisfaction than other hospitals. Key characteristics include a decentralized organizational structure, a commitment to flexible working hours, an emphasis on professional autonomy and development, and systematic communication between management and staff. The paper examines the labour market characteristics of UK nurses and US nurses and finds many sirmlarities. Detailed case studies of employment practice in 10 US hospitals and 10 Scottish hospitals are reported, with specific attention to remuneration practice, methods of organizing nursing care, establishment‐setting and flexible hours. The paper concludes that there are features of the magnet hospital concept which are of relevance and applicable to the UK nursing labour market, but that piecemeal importation of ideas is unlikely to be beneficial. Copyright © 1994, Wiley Blackwell. All rights reserved
Buchan, J 1994, 'Local pay: is it set to become a reality?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 8, no. 52, p. 31.
Buchan, J 1994, 'Nurse management. Pulling power.', The Health service journal, vol. 104, no. 5415, pp. 26-27.
This paper takes a broad based international perspective in examining the issue of nursing shortages. The role of human resource planning is discussed, and policy interventions to prevent shortages or ameliorate their effects are assessed and recommendations for action are made. The paper draws on published research from a number of countries and identifies key issues common to all countries. © 1994.
Buchan, J 1994, 'Pension provision for staff in the NHS.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 9, no. 9, p. 37.
Changes in the health service and employment patterns are likely to affect pension provision in the future. As the principle of 'a job for life' for National Health Service staff becomes less tenable and the large numbers of nurses recruited in the Seventies and Eighties reach retirement age, the ease of transferring pensions will become increasingly important.
Buchan, J 1994, 'Sharing the advantages.', Nursing management (Harrow, London, England : 1994), vol. 1, no. 3, pp. 22-23.
Buchan, J 1994, 'The introduction of 'annualised hours'.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 8, no. 34, p. 29.
Buchan, J 1994, 'Where do your staff go?', Nursing management (Harrow, London, England : 1994), vol. 1, no. 4, pp. 16-17.
Buchan, J, Seccombe, I & Jane, B 1994, 'The international mobility of nurses: a United Kingdom perspective', International Journal of Nursing Studies, vol. 31, no. 2, pp. 143-154.View/Download from: Publisher's site
This paper examines available information on the flows of qualified nurses to and from the United Kingdom, and reports on the results of a questionnaire survey of U.K.-based nurses who had worked abroad. The data examined reveals an upward trend in both "inflow" and "outflow" of nurses in the period 1984-1991, with indications of a net outflow. The survey results indicated that Australia was the most common destination; most nurses working abroad had moved to the English-speaking countries of North America and Australasia. Barriers and incentives to international mobility of nurses are discussed, and likely future trends in mobility are examined. © 1994.
Buchan, J 1993, 'Absent nurses.', Senior nurse, vol. 13, no. 5, pp. 28-29.
Buchan, J 1993, 'Empowering nurses in a practical way.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 8, no. 6, p. 36.
Practical approaches to increasing autonomy and participation will be required to underpin the rhetoric of 'empowerment', says James Buchan in his monthly column.
Buchan, J 1993, 'Empowering nurses in the health service.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 7, no. 15-16, p. 29.
Buchan, J 1993, 'International difficulties.', Senior nurse, vol. 13, no. 2, p. 29.
Buchan, J 1993, 'Job opportunities: growth or decline?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 7, no. 43, p. 29.
If and when those much promised green shoots of economic recovery start sprouting, the effect on nursing remains open to question. The growth in general unemployment has tailed off, but nurses are increasingly concerned about their own future employment prospects. This article discusses whether career opportunities look set to improve or diminish beyond mid-decade.
Buchan, J 1993, 'Magnet hospitals, attractive hospitals?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 7, no. 52, pp. 18-19.
Buchan, J 1993, 'Magnet hospitals. Attractive hospitals? Part 3.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 8, no. 2, pp. 22-23.
Buchan, J 1993, 'Matching supply with demand for nurses.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 7, no. 46, p. 39.
The difficulty of matching supply with demand for nursing staff is likely to become more complicated with the private sector making increasing demands for nurses, and Trusts exercising their freedom to determine their own staff mix. The author argues that the system in the United States of preparing an annual overview of employment indicators in each state should be considered in this country.
Buchan, J 1993, 'Nursing in Canada: evolution and opportunity.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 7, no. 36, p. 22.
Buchan, J 1993, 'Performance related pay and NHS nursing.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 7, no. 25, p. 30.
Buchan, J 1993, 'Posting notice about skill mix exercises.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 7, no. 21, p. 37.
Buchan, J 1993, 'Rewarding nurses for their performance.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 7, no. 30, p. 36.
Buchan, J 1993, 'Shifting patterns of nurses' work.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 7, no. 39, p. 29.
Buchan, J 1993, 'Under evaluation.', Senior nurse, vol. 13, no. 6, p. 29.
Buchan, J 1993, 'Working abroad: no longer an option?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 7, no. 35, p. 37.
Reductions in vacancies and career opportunities in the UK have led many nurses to consider working abroad. With many of the traditional choices such as Australia, the US, Canada and New Zealand also facing recessions, however, job opportunities are becoming increasingly limited, suggests James Buchan.
Buchan, J & Thomas, S 1993, 'Further flexing?', Senior nurse, vol. 13, no. 3, pp. 28-29.
Discusses the merits and demerits of performance-related pay (PRP) with respect to nursing in the NHS but concludes that justification for it remains unproven through the absence of hard evidence in support of its efficiency. Sees previous experience of the practicalities of implementing PRP and the fear that it will be neither cheap nor effective in solving "productivity" problems as hostile to its introduction in the NHS.
Seccombe, I & Buchan, J 1993, 'High anxiety.', The Health service journal, vol. 103, no. 5374, pp. 22-24.
Buchan, J 1992, 'Cost-effective caring.', International nursing review, vol. 39, no. 4, pp. 117-120.
Cost containment is the key issue in healthcare systems and a key concept that nurses must grasp in this time of shrinking budgets and growing demand for health care. As healthcare budgets come under increasing scrutiny, nurses must prove their cost-effectiveness. To ensure the maintenance of quality care, national nurses' associations have a strong role to play in supporting research efforts into nursing's real worth (not only in cost terms) and gathering and disseminating this information to demonstrate the value of quality nursing. To get nurses worldwide to campaign for cost-effectiveness, ICN will focus on "Quality, Costs and Nursing" in its celebration of International Nurses' Day in 1993.
Buchan, J 1992, 'Costing turnover.', Senior nurse, vol. 12, no. 1, p. 27.
Buchan, J 1992, 'Labour market dynamics.', Senior nurse, vol. 12, no. 4, p. 27.
Buchan, J 1992, 'Managing the right profile for health care.', Senior nurse, vol. 12, no. 3, pp. 26-27.
Buchan, J 1992, 'Nurse mobility and employment patterns.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 6, no. 36, p. 36.
There are a number of answers to the question 'what happened to nursing shortages?', says James Buchan in his regular monthly column.
Buchan, J 1992, 'Nursing and Europe.', Senior nurse, vol. 12, no. 6, pp. 28-29.
Buchan, J 1992, 'Personnel: pre-registration intake changes.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 6, no. 31, p. 28.
Buchan, J 1992, 'Recognising the value of women.', Senior nurse, vol. 12, no. 2, p. 27.
Buchan, J 1992, 'Running to stand still.', Nursing times, vol. 88, no. 4, pp. 28-29.
Buchan, J 1992, 'State of the unions in the Health Service.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 6, no. 47, p. 32.
Buchan, J 1992, 'The current profile of the profession.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 6, no. 39, p. 28.
Buchan, J 1992, 'The impact of pay.', Senior nurse, vol. 12, no. 5, p. 27.
Buchan, J 1992, 'The numbers game.', Nursing times, vol. 88, no. 39, p. 19.
Buchan, J 1992, 'UK and non-UK registered nurses.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 7, no. 6, p. 37.
Buchan, J, Secombe, I & Ball, J 1992, 'Travail sans frontieres.', The Health service journal, vol. 102, no. 5332, p. 30.
Seccombe, I & Buchan, J 1992, 'Pass the hat.', Nursing times, vol. 88, no. 2, p. 17.
Seccombe, I & Buchan, J 1992, 'Staffing: London's nursing workforce.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 6, no. 26, pp. 20-21.View/Download from: Publisher's site
Buchan, J 1991, 'Assessing the cost of nursing.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 6, no. 4, p. 40.
Buchan, J 1991, 'Characteristics of student cohorts.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 5, no. 52, p. 25.
Buchan, J 1991, 'Job share. A share in the future.', Nursing times, vol. 87, no. 23, pp. 32-33.
Buchan, J 1991, 'Meagre fare for nurses' pay.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 5, no. 25, p. 47.
Buchan, J 1991, 'Nurse recruitment from overseas.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 5, no. 48, p. 24.
Buchan, J 1991, 'Personnel: NHS Trusts and equal opportunities.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 6, no. 12, p. 29.
Buchan, J & Seccombe, I 1991, 'Nurse turnover costs.', Health manpower management, vol. 17, no. 4, pp. 23-25.
Buchan, J & Seccombe, I 1991, 'The high cost of turnover.', The Health service journal, vol. 101, no. 5256, pp. 27-28.
Buchan, J & Secombe, I 1991, 'Pay and conditions: nurses' work and worth.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 6, no. 4, pp. 22-24.View/Download from: Publisher's site
Buchan, J 1990, 'Caring for the consumer.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 4, no. 18, p. 46.
Buchan, J 1990, 'Eight years and counting.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 4, no. 49, p. 43.
Buchan, J 1990, 'Keeping nurses mobile.', The Health service journal, vol. 100, no. 5192, pp. 396-397.
Buchan, J 1990, 'Learning from history?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 5, no. 4, p. 47.
Buchan, J 1990, 'Pay Body Review. Breaking away.', Nursing times, vol. 86, no. 42, p. 21.
Buchan, J 1990, 'The shape of the future.', Nursing times, vol. 86, no. 25, p. 19.
Meager, N & Buchan, J 1990, 'Tapping the market.', The Health service journal, vol. 100, no. 5211, pp. 1108-1110.
Buchan, J 1989, 'Finding another answer.', The Health service journal, vol. 99, no. 5134, p. 79.
Buchan, J 1989, 'Grade expectations.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 3, no. 15, pp. 16-17.
Buchan, J 1989, 'Looking to the long-term.', Nursing times, vol. 85, no. 9, p. 21.
Buchan, J 1989, 'Moving for more money?', The Health service journal, vol. 99, no. 5133, pp. 48-49.
Buchan, J 1989, 'Regional anomalies.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 45, no. 3, p. 20.
Buchan, J 1989, 'Summer of discontent.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 3, no. 43, p. 22.
Buchan, J 1989, 'The hidden agenda.', Nursing times, vol. 85, no. 8, p. 20.
Buchan, J 1989, 'The role of part time workers in nursing.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 4, no. 5, pp. 45-46.
Buchan, J 1989, 'Worth your aggregate weight?', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 45, no. 3, p. 23.
Casey, N & Buchan, J 1989, 'Recruitment and retention: a review of data relating to the nursing workforce.', Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 3, no. 47, pp. 13-16.
Buchan, J 1988, 'Putting pay in its place.', Nursing times, vol. 84, no. 45, p. 20.
Buchan, J 1988, 'The hidden costs of the pay rise.', Nursing times, vol. 84, no. 18, p. 19.
Buchan, J 1987, 'Nurse recruitment. A shared future.', Nursing times, vol. 83, no. 4, pp. 44-45.
Buchan, J 1987, 'Reporting on Griffiths.', Nursing times, vol. 83, no. 29, pp. 34-35.
Buchan, J 1987, 'The budget: not a lot to drink to.', Nursing times, vol. 83, no. 12, pp. 18-19.
Buchan, J 1986, 'Occupational health. Worth their weight.', Nursing times, vol. 82, no. 9, pp. 54-55.
Buchan, J 1985, 'The new chief nurses: what happened to the chiefs?', Nursing times, vol. 81, no. 45, pp. 24-26.
Buchan, J 2015, 'Health Worker Migration in Context' in Kuhlmann, E, Blank, RH, Bourgeault, IL & Wendt, C (eds), The Palgrave International Handbook of Healthcare Policy and Governance, Springer, Germany, pp. 341-355.View/Download from: Publisher's site
Starting with more general issues of healthcare policy and governance in a global perspective and using the lens of national case studies of healthcare reform, this handbook addresses key themes in the debates over changing healthcare ...
Buchan, J 2006, 'Migration of health workers in Europe: policy problem or policy solution' in C.-A. Dubois, M. McKee & E. Nolte (eds), Human resources for health in Europe, World Health Organization on behalf of the European Observatory on Health Systems and Policies, Geneva, Switzerland, pp. 41-62.
Gero, A, Fletcher, SM, Rumsey, M, Thiessen, J, Kuruppu, N, Daly, J, Buchan, J & Willetts, JR 2013, 'Disaster response and adaptive capacity in the Pacific', Climate Adaptation 2013: Knowledge + Partnerships, National Climate Change Adaptation Research Facility (NCCARF) National Conference, Sydney, Australia.
Fletcher, S, Gero, A, Rumsey, M, Willetts, JR, Daly, J, Buchan, J, Thiessen, J & Kuruppu, N 2012, 'Understanding adaptive capacity to emergencies in the Pacific in the context of climate change', National Climate Change Adaptation Research Facility's (NCCARF's) Climate Adaptation in Action 2012: Sharing knowledge to adapt, Melbourne, Australia.
Buchan, J 2008, 'Migration of health workers.', Cahiers de sociologie et de démographie médicales, pp. 246-252.
The discussion and debate stimulated by these papers focused across a range of issues but there were four main areas of questioning: "measuring" and monitoring migration (issues related to comparability, completeness and accuracy of data sets on human resources); the impact of migration of health workers on health systems; the motivations of individual health workers to migrate (the "push" and "pull" factors) and the effect of policies designed either to reduce migration (e.g "self ufficiency") or to stimulate it (e.g active international recruitment). It was recognised that there was a critical need to examine migratory flows within the broader context of all health care labour market dynamics within a country, that increasing migration of health workers was an inevitable consequence of globalisation, and that there was a critical need to improve monitoring so as to better inform policy formulation and policy testing in this area.
A number of common issues and challenges face every country; however, their impact varies greatly across different countries. A particular concern in relation to nurse migration is its effect on adding to the imbalance in nursing resources that already exists in different regions and different countries. The number of nurses recruited into developed countries has increased significantly during the past decade, particularly from developing countries. Understanding and addressing the impact of migration requires not only examining what pulls nurses into destination countries but also what pushes them from source countries. We must also address the ethical issues involved in international recruitment. We must also not lose sight of nurses currently in the workforce. Effective national policies for recruiting and retaining nurses would reduce the need for recruiting from other countries. © 2006 Sage Publications.
Buchan, J & Weller, B. Western Pacific Regional Office of the World Health Organization 2014, Understanding the health labour in the Western Pacific region and countries., pp. 1-36, Manila, Philippines.
Gero, A, Fletcher, SM, Thiessen, J, Willetts, JR, Rumsey, M, Daly, J, Buchan, J & Kuruppu, N National Climate Change Adaptation Research Facility (NCCARF) 2013, Understanding the Pacific's adaptive capacity to emergencies in the context of climate change: Country Report- Cook Islands, pp. 1-33, Australia.
Gero, A, Fletcher, SM, Rumsey, M, Thiessen, J, Kuruppu, N, Buchan, J, Daly, J & Willetts, JR National Climate Change Adaptation Research Facility 2013, Disaster response and climate change in the Pacific, pp. 1-216, Sydney.
Disasters, and therefore disaster response, in the Pacific are expected to be affected by climate change. This research addressed this issue, and focused on the immediate humanitarian needs following a disaster, drawing upon adaptive capacity as a concept to assess the resilience of individual organisations and the robustness of the broader system of disaster response. Four case study countries (Fiji, Cook Islands, Vanuatu and Samoa) were chosen for deeper investigation of the range of issues present in the Pacific. The research process was guided by a Project Reference Group, which included key stakeholders from relevant organisations involved in Pacific disaster response to guide major decisions of the research process and to influence its progression
Gero, A, Fletcher, SM, Thiessen, J, Willetts, JR, Rumsey, M, Daly, J, Buchan, J & Kuruppu, N Institute for Sustainable Futures, and WHO Collaborating Centre, UTS 2013, Understanding the Pacific's adaptive capacity to emergencies in the context of climate change: Country Report - Vanuatu, pp. 1-36, Sydney.
Fletcher, SM, Gero, A, Thiessen, J, Willetts, JR, Rumsey, M, Daly, J, Buchan, J & Kuruppu, N Institute for Sustainable Futures, and WHO Collaborating Centre, UTS 2013, Understanding the Pacific's adaptive capacity to emergencies in the context of climate change: Country Report - Fiji, pp. 1-35, Sydney.
Fletcher, SM, Gero, A, Thiessen, J, Willetts, JR, Rumsey, M, Daly, J, Buchan, J & Kuruppu, N Institute for Sustainable Futures, and WHO Collaborating Centre, UTS 2013, Understanding the Pacific's adaptive capacity to emergencies in the context of climate change: Country Report - Samoa, pp. 1-30, Sydney.
Gero, A, Fletcher, SM, Rumsey, M, Thiessen, J, Kuruppu, N, Buchan, J, Daly, J & Willetts, JR Institute for Sustainable Furtures and WHO Collaborating Centre, UTS 2013, Disaster response systems in the Pacific: Policy Brief for Pacific Island Countries, pp. 1-4, Sydney.
Fletcher, SM, Rumsey, M, Thiessen, J, Gero, A, Kuruppu, N, Buchan, J, Daly, J & Willetts, JR Institute for Sustainable Futures, and WHO Collaborating Centre, UTS 2013, Disaster response systems in the Pacific: Policy Brief for Regional Organisations, pp. 1-4, Sydney.
Fletcher, SM, Rumsey, M, Thiessen, J, Gero, A, Kuruppu, N, Buchan, J, Daly, J & Willetts, JR Institute for Sustainable Futures, and WHO Collaborating Centre, UTS 2013, Disaster response systems in the Pacific: Policy Brief, pp. 1-4, Sydney.
Fletcher, SM, Gero, A, Rumsey, M, Willetts, JR, Daly, J, Buchan, J, Kuruppu, N & Thiessen, J WHO Collaborating Centre and the Institute for Sustainable Futures, UTS 2012, Review of Australia's Overseas Disaster and Emergency Response, pp. 1-30, Sydney.
Gero, A, Willetts, JR, Daly, J, Buchan, J, Rumsey, M, Fletcher, SM & Kuruppu, N Institute for Sustainable Futures and WHO Collaborating Centre, UTS 2012, Background Review: Disaster Response System of Four Pacific Island Countries, pp. 1-66, Sydney, Australia.
Gero, A, Willetts, JR, Daly, J, Buchan, J, Rumsey, M, Fletcher, SM & Kuruppu, N Institute for Sustainable Futures and WHO Collaborating Centre, UTS 2012, Projected climate change impacts in the Pacific: A summary, pp. 1-22, Sydney, Australia.
Buchan, J NZ Health Department 2008, Impact of the 2004/2005 New Zealand Nurses Employment Agreement, Wellington, New Zealand.