The effect of the physician J-1 visa waiver on rural Wisconsin.
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CONTEXT: One strategy to increase the number of physicians in rural and other underserved areas grants a waiver to foreign physicians in this country on a J-1 education visa allowing them to stay in the United States if they practice in designated underserved areas. PURPOSE: The goal of this study is to evaluate the retention and acceptance of the J-1 Visa Waiver physicians in rural Wisconsin. METHODS: Sites in Wisconsin at which physicians with a J-1 Visa Waiver practiced between 1996 and 2002 were identified. A 12-item survey that assessed the acceptance and retention of these physicians was sent to leaders of institutions that had participated in this program. Retention of J-1 Visa Waiver physicians was compared to other physicians recruited to rural Wisconsin practices by the Wisconsin Office of Rural Health during the same time period. FINDINGS: While there was a general perception that the communities were well satisfied with the care provided and the physicians worked well with the medical community, there was a lower satisfaction with physician integration into the community-at-large. This was found to correlate with the poor retention rate of physicians with a J-1 Visa Waiver. Physicians participating in a placement program without J-1 Visa Waivers entering practice in rural communities had a significantly higher retention rate. CONCLUSIONS: Physicians with J-1 Visa Waivers appear to provide good care and work well in health care environments while fulfilling the waiver requirements. To keep these physicians practicing in these communities, successful integration into the community is important. (+info)
Association between intention to stay on the job and job satisfaction among Japanese nurses in small and medium-sized private hospitals.
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In order to examine the relationship between the intention to stay on the job and job satisfaction among Japanese nurses, and to obtain clues for preventing turnover, we conducted a questionnaire survey. The subjects involved in the survey included 625 female nurses (registered nurses, licensed practical nurses and assistant nurses) working in 4 small and medium-sized private hospitals, excluding directors of nursing. Of the 625 questionnaires distributed, 556 (89.0%) were returned. After excluding the questionnaires with missing values, 480 questionnaires were analyzed (effective response rate, 76.8%). The average age of the respondents was 32.8 yr (range: 20-65). The content of the questionnaire was nurse attributes, job satisfaction (30 items) and intention to stay on the job. For job satisfaction, factor analysis (principal factor method and promax rotation) was performed, and factors with an eigenvalue of > or =1 were extracted. Six factors were extracted by factor analysis. These factors were interpreted as "Work as specialists" (1st factor), "Relationship with superiors" (2nd factor), "Comfortable life" (3rd factor), "Relationship among nurses" (4th factor), "Communication with physicians" (5th factor) and "Working conditions" (6th factor). The factor scores were calculated and used as a scale for the evaluation of job satisfaction. To investigate the factors associated with intention to stay on the job among nurses, the standard partial regression coefficient was computed by multiple linear regression analysis, with intention to stay on the job as the dependent variable, and nurse attributes and job satisfaction (factor scores) as independent variables. Various factors including the organizational culture of each hospital may affect the relationship between job satisfaction and the intention to stay on the job. In order to adjust for these factors, differences among hospitals were included in the statistical model as independent variables. The result of the multiple regression analysis suggests that the intention to stay on the job was higher among nurses who were older and more satisfied with work as specialists (1st factor) and working conditions (6th factor). (+info)
How many employees receive safety training during their first year of a new job?
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OBJECTIVE: To describe the provision of safety training to Canadian employees, specifically those in their first year of employment with a new employer. DESIGN: Three repeated national Canadian cross-sectional surveys. SUBJECTS: 59 159 respondents from Statistics Canada's Workplace and Employee Surveys (1999, 2001 and 2003), 5671 who were in their first year of employment. MAIN OUTCOME: Receiving occupational health and safety training, orientation training or office or non-office equipment training in either a classroom or on-the-job in the previous 12 months. RESULTS: Only 12% of women and 16% of men reported receiving safety training in the previous 12 months. Employees in their first 12 months of employment were more likely to receive safety training than employees with >5 years of job tenure. However, still only one in five new employees had received any safety training while with their current employer. In a fully adjusted regression model, employees who had access to family and support programs, women in medium-sized workplaces and in manufacturing, and men in large workplaces and in part-time employment all had an increased probability of receiving safety training. No increased likelihood of safety training was found in younger workers or those in jobs with higher physical demands, both of which are associated with increased injury risk. CONCLUSIONS: From our results, it would appear that only one in five Canadian employees in their first year of a new job received safety training. Further, the provision of safety training does not appear to be more prevalent among workers or in occupations with increased risk of injuries. (+info)
Drivers of professional mobility in the Northern Territory: dental professionals.
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INTRODUCTION: Attracting and retaining an efficient allied health workforce is a challenge faced by communities in Australia and overseas. High rates of staff turnover in the professional workforce diverts resources away from core business and results in the loss of valuable skills and knowledge. Understanding what attracts professionals to a particular place, and why they leave, is important for developing effective strategies to manage turnover and maximise workforce productivity. The Northern Territory (NT) faces particular workforce challenges, in part because of its geographic location and unusual demography. Do these factors require the development of a tailored approach to recruitment and retention? This article reports on a study undertaken to examine the motivations for coming to, staying in and leaving the NT for dental professionals, and the implications of results on workforce management practices. METHODS: In 2006, dentists, dental specialists, dental therapists and dental hygienists who were working or had worked in the NT, Australia, in the recent past were surveyed to collect demographic and workforce data and to establish the relative importance of social and work-related factors influencing their migration decisions. Multivariate logistic regression models were generated to describe the demographic characteristics of dental professionals who stayed in the NT for more than 5 years and to analyse why dental professionals left. The analyses, based on a 42% response rate, explained 60-80% of the variation in responses. RESULTS: Generally dental professionals who had stayed for more than 5 years were older, had invested in the purchase of homes and were more involved in social and cultural activities. Those who moved to the NT as a result of financial incentives or who had strong expectations that working in the NT would be an exciting, novel experience tended to stay for no more than 5 years, often leaving because they found the work environment too stressful. In contrast, those who stayed longer came because they had existing social networks and were familiar with the NT environment, staying primarily because they have enjoyed the NT lifestyle, particularly the sense of community and the opportunities available through living in smaller centres. CONCLUSION: There are benefits in actively engaging newly recruited professionals and their families in social networks. Work related stress and departure was associated with administrative deficiencies within the management system. Despite the NT's unusual demographic profile, the factors influencing recruitment and retention are not markedly different from those reported elsewhere. (+info)
Studying nursing in a rural setting: are students adequately supported and prepared for rural practice? A pilot study.
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INTRODUCTION: A rural nursing program has a vital role in improving the recruitment and retention of nurses in rural and remote settings. A small pilot study was conducted to explore the views and experiences of the first cohort of undergraduate nursing students who completed a rurally based bachelor of nursing program which commenced in 2002 in Renmark, South Australia. The participants were eight current undergraduate nursing students who were part of the first cohort of nursing students nearing completion of the program. The pilot study set out to explore support provided to rural nursing students studying in a rural setting; to investigate whether rural nursing students feel adequately prepared for rural clinical practice near completion of the nursing program; to identify the challenges and highlights of studying rurally; and to explore the probability of retention and recruitment of future nursing graduates in a rural setting. METHODS: The method used was a descriptive, exploratory, web-based survey. Quantitative data were limited to descriptive statistics of demographic characteristics, career goals, graduate nurse program and future employment intentions, level of support, preparation for practice, challenges and highlights of rural study and clinical placements. Qualitative responses to open-ended questions were content analysed to identify common themes. FINDINGS: This study found between two and four participants indicated they received no support from academic, administrative staff and clinical facilitators from the city campus. Five participants (63%) indicated they received no financial support during their studies. Seven of the participants (88%) surveyed, indicated an intention to undertake a graduate nurse program and the same number indicated they would be living in a rural or remote area in 5 years time. Six participants (75%) indicated they were prepared with regard to their 'attitude' towards their future practice as a registered nurse. The study identified some of the challenging issues of a rurally based program, such as 'realising that if you miss a day you are actually missing a whole week's worth of lectures', as well as the positive and unique aspects of rural study, 'not having to leave the family to travel to the city'. CONCLUSION: This study indicates the rural placement of the bachelor of nursing program has been of benefit to this particular community and is a positive outcome for the South Australian rural nursing workforce. The study shows that students actively sought nursing employment in a rural setting, and identifies highlights experienced by students and the advantages associated with remaining at home (as opposed to relocating) while enjoying the benefits of smaller class sizes. The challenges of rural study were issues such as limited lecture times, compared with the city campus, which often caused a disproportionate workload for rural students on alternate weeks during the study term. The quality of the delivery of some lectures was also an issue for some students. This study determined that a lack of support was encountered by students, and that further investigation is warranted. Greater consideration will be required to address the delivery of the program together with the future availability and accessibility of further university rurally based nursing programs. (+info)
Nurse working conditions, organizational climate, and intent to leave in ICUs: an instrumental variable approach.
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OBJECTIVE: To investigate causes of nurse intention to leave (ITL) while simultaneously considering organizational climate (OC) in intensive care units (ICUs) and identify policy implications. DATA SOURCES/STUDY SETTING: Data were obtained from multiple sources including nurse surveys, hospital administrative data, public use, and Medicare files. Survey responses were analyzed from 837 nurses employed in 39 adult ICUs from 23 hospitals located in 20 separate metropolitan statistical areas. STUDY DESIGN: We used an instrumental variable technique to assess simultaneously the relationship between OC and ITL. We estimated ordinary least squares and reduced form regressions to determine the extent of simultaneity bias as well as the sensitivity of our results to the instrumental variable model specification. PRINCIPAL FINDINGS: Fifteen percent of the nurses indicated their ITL in the coming year. Based on the structural model, we found that nurses' ITL contributed little if anything directly to OC, but that OC and the tightness of the labor market had significant roles in determining ITL (p values <.05). Furthermore, OC was affected by the average regionally adjusted ICU wages, hospital profitability, teaching, and Magnet status (p values <.05). CONCLUSIONS: OC is an important determinant of ITL among ICU nurses. Because higher wages do not reduce ITL, increased pay alone without attention to OC is likely insufficient to reduce nurse turnover. Implementing interventions aimed at creating a positive OC, as found in Magnet hospitals, may be a more effective strategy. (+info)
Organizational culture and physician satisfaction with dimensions of group practice.
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RESEARCH OBJECTIVE: To assess the extent to which the organizational culture of physician group practices is associated with individual physician satisfaction with the managerial and organizational capabilities of the groups. STUDY DESIGN AND METHODS: Physician surveys from 1997 to 1998 assessing the culture of their medical groups and their satisfaction with six aspects of group practice. Organizational culture was conceptualized using the Competing Values framework, yielding four distinct cultural types. Physician-level data were aggregated to the group level to attain measures of organizational culture. Using hierarchical linear modeling, individual physician satisfaction with six dimensions of group practice was predicted using physician-level variables and group-level variables. Separate models for each of the four cultural types were estimated for each of the six satisfaction measures, yielding a total of 24 models. SAMPLE STUDIED: Fifty-two medical groups affiliated with 12 integrated health systems from across the U.S., involving 1,593 physician respondents (38.3 percent response rate). Larger medical groups and multispecialty groups were over-represented compared with the U.S. as a whole. PRINCIPAL FINDINGS: Our models explain up to 31 percent of the variance in individual physician satisfaction with group practice, with individual organizational culture scales explaining up to 5 percent of the variance. Group-level predictors: group (i.e., participatory) culture was positively associated with satisfaction with staff and human resources, technological sophistication, and price competition. Hierarchical (i.e., bureaucratic) culture was negatively associated with satisfaction with managerial decision making, practice level competitiveness, price competition, and financial capabilities. Rational (i.e., task-oriented) culture was negatively associated with satisfaction with staff and human resources, and price competition. Developmental (i.e., risk-taking) culture was not significantly associated with any of the satisfaction measures. In some of the models, being a single-specialty group (compared with a primary care group) and a group having a higher percent of male physicians were positively associated with satisfaction with financial capabilities. Physician-level predictors: individual physicians' ratings of organizational culture were significantly related to many of the satisfaction measures. In general, older physicians were more satisfied than younger physicians with many of the satisfaction measures. Male physicians were less satisfied with data capabilities. Primary care physicians (versus specialists) were less satisfied with price competition. CONCLUSION: Some dimensions of physician organizational culture are significantly associated with various aspects of individual physician satisfaction with group practice. (+info)
Nurse migration: a Canadian case study.
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OBJECTIVE: To synthesize information about nurse migration in and out of Canada and analyze its role as a policy lever to address the Canadian nursing shortage. PRINCIPAL FINDINGS: Canada is both a source and a destination country for international nurse migration with an estimated net loss of nurses. The United States is the major beneficiary of Canadian nurse emigration resulting from the reduction of full-time jobs for nurses in Canada due to health system reforms. Canada faces a significant projected shortage of nurses that is too large to be ameliorated by ethical international nurse recruitment and immigration. CONCLUSIONS: The current and projected shortage of nurses in Canada is a product of health care cost containment policies that failed to take into account long-term consequences for nurse workforce adequacy. An aging nurse workforce, exacerbated by layoffs of younger nurses with less seniority, and increasing demand for nurses contribute to a projection of nurse shortage that is too great to be solved ethically through international nurse recruitment. National policies to increase domestic nurse production and retention are recommended in addition to international collaboration among developed countries to move toward greater national nurse workforce self sufficiency. (+info)