Evaluation of the feasibility of an Education-Career pathway in Healthcare for Older People (ECHO) for early career nurses

BACKGROUND

Rapid population ageing is driving demand for qualified gerontological nurses. Yet, early career nurse attrition and limited focus on retention in the speciality limits supply.

OBJECTIVES

To test the feasibility and acceptability of an Education-Career pathway in Healthcare for Older People (ECHO) intervention for early career nurses to improve retention and capability in gerontological nursing. ECHO is a multicomponent intervention with integrated education, career planning and coaching components, tested over two 6-month cycles.

METHODS

A feasibility study with a pre-post design using a multi-methods evaluation. Twenty-nine early career nurse participants were recruited from eight NHS acute and community care Trusts in England. ECHO participants completed online questionnaires at baseline (Time 1), 6-month (T2, end of intervention) and follow-up at 18 months from baseline (T3). Outcome measures were career intention, self-reported knowledge, career planning confidence, and burnout using the Maslach Burnout Inventory. Qualitative interviews were undertaken with participants (n = 23) and organizational stakeholders (n = 16) who facilitated ECHO. Data analysis used descriptive statistics and non-parametric tests for paired data and thematic analysis for qualitative data.

RESULTS

Overall, 19 of 29 participants (65%) completed all aspects of the intervention. The evaluation was completed by 23 participants. ECHO was well received by participants and stakeholders. At T3, the 23 participants were working in the speciality, though two had changed organizations. There was a significant improvement in self-reported gerontological knowledge, pre 87 (IQR 81-102), post 107 (IQR 98-112) p = 0.006, but no significant changes in other outcomes. In qualitative data, participants and organizational stakeholders held similar views, presented under four main themes: intended outcomes (personal and professional development, raise gerontological profile, expand horizons); nurse retention-a double-edged sword, ECHO logistics, and sustainability.

CONCLUSION

Education-Career pathway in Healthcare for Older People was feasible and may positively impact early career nurse retention, capability and socialization into gerontological nursing. ECHO requires further refinement and piloting, but learning can contribute to retention strategies.

IMPLICATIONS FOR PRACTICE

Attracting and retaining early-career nurses to the gerontological speciality requires greater innovation, organizational and senior nurse leadership.

Nurses' intention to stay in the work environment in acute healthcare: a systematic review

Background

With staffing shortages affecting increasing numbers of health services globally, and predictions that shortages will worsen in the future, there is broad consensus that leaders at all levels must do more to support and develop current employees. However, the wide range of attributes of a healthy work environment identified in the literature and the financial implications of creating healthy work environments make it challenging to determine which elements of the nursing work environment are the most important in terms of workforce sustainability. This is a significant gap in our knowledge, and there is no consensus in the literature regarding definition and explanation of work environment factors in a way that facilitates prioritisation.

Objectives

The aim of this review was to synthesise and evaluate the evidence of the factors which may have an effect on intention to stay and role of the work environment in enhancing nurses' intention to stay in the work environment in acute healthcare.

Design and methods

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. A comprehensive search was performed for relevant articles published between 1990 and December 2017 using the following electronic databases: Allied and Complementary Medicine Database (AMED), Excerpta Medica dataBASE (EMBASE), ProQuest Nursing & Allied Health Source, ProQuest theses and dissertations, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, MEDLINE (Ovid) and PsycINFO. The reviewers independently screened the abstracts and full texts, extracted data, and assessed the methodological quality of the included papers using appropriate tools.

Results

A total of 4968 studies were screened by title, abstract, and full-text review, and 29 studies were included in this review. The identified determinants of nurses' intention to stay were grouped into four main categories: individual indicators (personal and professional), organisation/profile, work environment, and patient-related. Several working environment variables identified in this review were significantly associated with the nurses' intention to stay.

Conclusion

Despite the limitations of this review, the evidence indicates that attention to meso-level variables such as organisational characteristics and work environment is vital if the working environment is to improve and nurses' intention to stay is to increase. The multifaceted nature of the concept of intention to stay makes it difficult to present definitive conclusions based on the findings of this review. However, the identified theoretical models were instrumental in differentiating intention to stay from other concepts such as intention to leave, turnover and retention, theoretically, and operationally.

Improving the quality of long-term care services in workforce dimension: expert views from Australia and South Korea

Background

The long-term care workforce is an essential factor in the provision of qualified long-term care services. Identifying workforce issues can help developing countries in East Asia and the Pacific prepare for the increase in the older population. Their experiences can be used as lessons for other countries. This study aimed to identify the workforce issues that should be addressed in order to provide high-quality long-term care services for older adults.

Methods

In-depth interviews and content analysis were conducted with a purposive sample of long-term care experts. There were eight participants from Australia and 14 from South Korea. The participants were questioned on important workforce issues to improve the quality of long-term care services. These were open-ended questions that comprised ideas derived from the literature. Major themes were systematically and comprehensively classified and coded to examine recurring comments and themes.

Results

The issues in the two countries were very similar: labor shortages, inadequate working conditions, insufficient career and staff training, and the need of counselors or consultants for finding proper services. There were also differences in terms of competency of the service operators and their corresponding multicultural competency.

Conclusions

Providing high-quality long-term care service requires multipronged approaches to workforce capacity and work environment. An adequate and competent workforce should be established to match the service needs of the older population. To improve quality, better working conditions and improved motivation to work in care for older people should be considered. Concurrently, each country would need a workforce strategy tailored to different conditions and environments. This should include policies to induce an influx into the workforce.

Structural Model of Retention Intention of Nurses in Small- and Medium-Sized Hospitals: Based on Herzberg’s Motivation-Hygiene Theory

The purpose of this study is to identify factors affecting the retention intention of nurses in small- and medium-sized hospitals and to perform a structural equation model study. Survey data of 348 nurses from 6 small and medium hospitals were analyzed. The collected data were analyzed using the SPSS 25.0 and the AMOS 25.0 programs. As a result of the study, it was confirmed that the endogenous variables influencing job satisfaction were calling, resilience, workplace bullying and nursing work environment, while resilience was the strongest variable as a factor influencing the nursing work environment. It was confirmed that the endogenous variables influencing intention to stay were calling, resilience, workplace bullying and job satisfaction, while job satisfaction was the strongest variable influencing intention to stay. To increase the retention intention of nurses in small and medium hospitals, it is necessary to provide measures to increase the value and meaning of work, and to increase resilience to overcome adversity and adapt to the circumstances. In addition, it is necessary to secure and maintain the resources of nurses in small- and medium-sized hospitals with a strategy to reduce workplace bullying and enhance job satisfaction by improving the organizational culture.

Organizational Factors Associated With Retention of Direct Care Workers: A Comparison of Nursing Homes and Assisted Living Facilities

BACKGROUND AND OBJECTIVES

Low retention of direct care workers (DCWs), either certified nursing assistants in nursing homes (NHs) or personal care assistants in assisted living (AL), continues to be an unresolved problem. While numerous studies have examined predictors of DCW retention in NHs, little attention has been paid to differences between settings of long-term care. This study compares the predictors of DCW retention rates across both settings.

RESEARCH DESIGN AND METHODS

The 2017 Ohio Biennial Survey of Long-Term Care Facilities provides facility-level information from NHs and ALs (NHs = 739; ALs = 465). We compare the factors that predict retention rates of DCWs utilizing regression analysis. The factors are structural, financial, resident conditions, staffing, and management characteristics, as well as retention strategies.

RESULTS

Average DCW retention rates were 66% and 61% in ALs and NHs, respectively. Not-for-profit status was significantly associated with higher retention rates across settings. While the percent of residents with dementia and less administrator turnover were associated with significantly higher DCW retention in NHs, these were not significant for ALs. However, in the AL context, a higher county unemployment rate and DCWs' participation in resident care planning meetings were positively related to DCW retention after controlling for all other covariates, while DCW cross-training was negatively associated.

DISCUSSION AND IMPLICATIONS

Retention strategies for DCWs may need to differ by setting, as a result of differing working environments, resources, and regulations.

Facility-Level Factors Associated With CNA Turnover and Retention: Lessons for the Long-Term Services Industry

BACKGROUND AND OBJECTIVES

Certified nursing assistant (CNA) turnover and retention are critical aspects of facilities' ability to provide cost-effective, high-quality person-centered care. Previous studies and industry practice often treat turnover and retention as similar concepts, assuming that low turnover and high retention are synonymous. The study addressed the question of whether turnover and retention rates differ and if so, what those differences mean for nursing home practice, policy, and research.

RESEARCH DESIGN AND METHODS

This study examines facility-level factors associated with CNA retention and turnover rates using 2015 data from the Ohio Biennial Survey of Long-Term Care Facilities, Ohio Medicaid Cost Reports, Certification and Survey Provider Enhanced Report, and the Area Health Resource File. Using bivariate tests and regression analysis, we compare rates and the factors associated with retention and turnover.

RESULTS

The mean facility annual retention rate was 64% and the mean annual turnover rate was 55%. As expected, there was a statistically significant and negative correlation between the rates (r = -0.26). However, some facilities had both high retention and high turnover and some had low rates for both measures. Not all the variables that are associated with turnover are also associated with retention.

DISCUSSION AND IMPLICATIONS

CNA retention is not simply the absence of CNA turnover. Given the differences, nursing homes may need to use strategies and policies designed to target a particular stability measure.

Pharmacist-led medication reviews in aged care residents with dementia: A systematic review

OBJECTIVES

To evaluate outcomes associated with pharmacist-led medication reviews in residential aged care facility (RACF) residents with dementia.

METHODS

Six scientific databases were searched. All study designs investigating pharmacist-led medication reviews in RACF residents with dementia were considered. The protocol was registered with PROSPERO (CRD42019121681).

RESULTS

One randomised controlled trial (RCT) and five observational studies were identified. Two studies reported reductions in medication usage per resident, and one study reported improved appropriateness of psychotropic use following reviews as part of multi-faceted, collaborative interventions. In three studies, reviews undertaken as an isolated intervention or by a visiting pharmacist with minimal collaboration with physicians were associated with low implementation rates of recommendations to alter therapy.

CONCLUSION

Pharmacist-led medication reviews, when conducted collaboratively, may improve the use of medicines in RACF residents with dementia. However, robust conclusions cannot be drawn, largely due to the low quality of evidence available, including only one RCT.

Empowerment of learning and knowledge: Appreciating professional development for registered nurses in aged residential care

Continued education and professional development ensures nursing competence and contributes positively to quality health outcomes, however it must also include a professional pathway that challenges the contextual confrontations faced by registered nurses within the workplace environment. This is especially relevant for the nursing workforce employed in the Aged Residential Care sector. This research was undertaken in New Zealand and uses Appreciative Inquiry to 'Appreciate the professional development needs of registered nurses working in the sector'. The findings highlighted the uniqueness of the sector, along with the diversity of the nursing workforce which signals the need for ongoing formal and informal professional development methods. Currently, professional development and learning is not assimilated well into the sector and there remains a void in terms of a professional clinical pathway. This has implications for the future development of professional learning for registered nurses in other sectors. Quality is integral to developing any professional learning, accordingly there must be input from both clinical and education providers. This partnership, between the sector and academia, will integrate learning into the practice area and improve outcomes for residents in aged residential care facilities.

Recommended Common Data Elements for International Research in Long-Term Care Homes: Exploring the Workforce and Staffing Concepts of Staff Retention and Turnover

The aim of this review is to develop a common data element for the concept of staff retention and turnover within the domain of workforce and staffing. This domain is one of four core domains identified by the WE-THRIVE (Worldwide Elements to Harmonize Research in Long-Term Care Living Environments) group in an effort to establish an international, person-centered long-term care research infrastructure. A rapid review identified different measurement methods to assess either turnover or retention at facility level or intention to leave or stay at the individual staff level. The selection of a recommended measurement was guided by the WE-THRIVE group’s focus on capacity rather than deficits, the expected availability of internationally comparable data, and the goal to provide a short, ecologically viable measurement. We therefore recommend to measure staff’s intention to stay with a single item, at the individual staff level. This element, we argue, is an indicator of staff stability, which is important for reduced organizational cost and improved productivity, positive work environment, and better resident–staff relationships and quality of care.

Determinants Strengthening Japanese Nurses' Intention to Stay at Their Current Hospital

In order to retain nursing staff, it is crucial to have a comprehensive understanding of the factors that motivate nurses to stay at an institution. Toward this aim, we identified a variety of factors that strengthen nurses' intention to stay at their current hospital. A cross-sectional questionnaire survey was conducted at 12 hospitals in the Tohoku and Kanto regions of Japan. Of the 1,034 nurses working in those hospitals, 713 returned the questionnaire (response rate: 69.0%). Of these, we analysed the data of 485 nurses (17.42 ± 9.83 years of clinical experience, 95.3% female) (valid response rate: 46.9%) who met the inclusion criteria of planning to stay at their current hospital and completing all questionnaire items. An exploratory factor analysis indicated that variables strengthening intention to stay at the current hospital could be grouped into five factors: "comfortable workplace environment," "passive motivational factors," "convenience of hospital location," "favorable work-life balance," and "fulfilment in nursing." Nurses who were married or had children placed a higher priority on a "favorable work-life balance" in remaining at their current workplace. Regular employees or nurses working in the smaller cities tended to display higher "passive motivational factors," which comprised various extrinsic factors. Though extrinsic factors are considered to make only short-term contributions to employee retention, they could generate positive synergistic effects when combined with intrinsic motivations such as "fulfilment in nursing." Effective nurse-retention strategies should be developed by capitalizing on the interaction among the five factors that strengthen nurses to stay at their current hospital.

Who Knows, who Cares? Dementia Knowledge among Nurses, Care Workers, and Family members of People Living with Dementia

The number of people with dementia is increasing rapidly worldwide. Commensurate with population ageing, the use of nursing homes in Australia (known as residential aged care facilities) for individuals with dementia is growing. As a terminal condition, dementia is best managed by instituting a palliative approach to care. A good knowledge of dementia, including its progression and management, among staff and families of people living with dementia is essential for clear decision making and the provision of appropriate care. Yet there is limited information regarding relative levels of dementia knowledge. This paper reports the results of a study that assessed dementia knowledge among these two cohorts using the Dementia Knowledge Assessment Tool; the study surveyed 279 staff members and 164 family members of residents with dementia. Dementia knowledge deficits were evident in both cohorts across a range of areas. It is critical that dementia knowledge deficits are identified and addressed in order to support evidence-based dementia care.

Le nombre de personnes atteintes de démence augmente rapidement à travers le monde. Ainsi on remarque en Australie une augmentation du nombre de ces malades admis dans les institutions de soins de longue durée. La démence étant une maladie terminale il appert que l'approche palliative est la meilleure forme de soins. Cependant, il est essentiel que le personnel soignant autant que les familles aient une bonne connaissance de la maladie, de ses symptomes, de la façon de traiter les maladies, et des décisions à prendre. Or, on en sait très peu quant au niveau de connaissances de ces deux groupes de personnes sur le sujet. Cet article porte sur les résultats d'une étude qui tentait d'évaluer le niveau de connaissances de 279 membres du personnel et de 164 membres des familles à l'aide de l'Έchelle d'évaluation des connaissances sur la démence. Le peu de connaissances était évident chez les deux cohortes et ce, sur un bon nombre de points. Il est donc de la plus haute importance que l'on identifie spécifiquement ces points et qu'on améliore la qualité des soins chez les personnes démentes en se basant sur des données probantes.

Occupational health and safety management practices and musculoskeletal disorders in aged care

Purpose The purpose of this paper is to examine whether occupational health and safety (OHS) management used to manage musculoskeletal disorders (MSDs) in the aged care sector reflects contemporary research evidence of best practice to reduce the incidence of these disorders. Design/methodology/approach In total, 58 interviews were conducted with managers and supervisors in the aged care sector across four organisations in Australia. Policies and procedures relating to MSDs were reviewed for each organisation. Findings Policies and procedures for managing MSDs do not reflect contemporary evidence, which supports a complex aetiology, related to a range of physical and psychosocial workplace factors. Despite strong evidence that psychosocial factors contribute to MSD development, these were not included in the policies and procedures reviewed. Findings from the interviews management practices including leadership and various components of HRM were functioning well but fragmentation was evident due to the challenging nature of the aged care sector. Practical implications To address the significant burden of MSDs in the aged care sector, policies and procedures need to include coverage of psychosocial and physical workplace factors. The development of systematic and integrated OHS management at the workplace level may play an important role in the effective management of MSDs. Originality/value This study offers insights into the previously unexplored area of MSD risk management and the role of management practices such as HRM in the aged care sector.

Workplace design for the Australian residential aged care workforce

OBJECTIVES

This research explored residential aged care (RAC) workplace design features that influence how RAC staff feel valued, productive, safe, like they belong and connected. A secondary aim was to validate emerging themes about RAC design features with stakeholders.

METHODS

A multistage qualitative study was conducted in one RAC facility with 100 residents in outer metropolitan Melbourne: (i) photo-elicitation - photographs were used to prompt discussions with RAC staff; (ii) individual interviews with RAC directors; and (iii) validity testing with the advisory committee occurred.

RESULTS

Key workplace design features that influenced how RAC staff feel valued, productive, safe, like they belong and connected included the following: (i) home-like environment; (ii) access to outdoor spaces; (iii) quality indoor environment; and (iv) access to safe, open and comfortable workplaces.

CONCLUSIONS

Key workplace design features that matter to RAC staff in a 'shared workspace' exist. Increasing demands upon RAC requires evidence-based workplace design policy and evaluation approaches that support RAC staff to work in RAC shared workspaces.

"Bringing the outside world in": Enriching social connection through health student placements in a teaching aged care facility

BACKGROUND

Older adults living in residential aged care facilities (RACFs) often experience limited opportunities for social connection despite close proximity to peers, which has implications for mental health and quality of life (QoL). The introduction of large-scale undergraduate health student placements in RACFs may enhance opportunities for meaningful engagement through social connection, although this remains unexplored.

OBJECTIVE

This research explores whether interpersonal encounters between health students and RACF residents influence residents' opportunities for social connection and QoL.

METHODS

A mixed methods design was employed which included questionnaire data from residents, and qualitative interview data from residents, family members and RACF staff. Data were collected during and after student placements to allow for an in-depth exploration of residents, family members and staff perspectives.

RESULTS

Forty-three participants (28 residents, 10 staff and five family members) were recruited during 2014. Overall, many residents had clinical levels of depression, mild cognitive impairment and multiple morbidities, however reported moderate-to-good QoL. Thematic analysis was undertaken on interview transcripts, and three themes emerged: (i) social isolation and loneliness fostered by residents' age-related conditions, (ii) students expand socially supportive connections beyond the RACF and (iii) meaning making by sharing health experiences, which was found to help renegotiate older adults' pervasive narrative of vulnerability.

CONCLUSION

Supported and structured health student placements in RACFs enable older adults to participate in meaningful encounters with younger people. These encounters focus on sharing health experiences and address long-standing issues of isolation and loneliness by providing opportunities for social connection.

Strategic Workforce Planning for Health Human Resources: A Nursing Case Analysis

Background Health-care organizations provide services in a challenging environment, making the introduction of health human resources initiatives especially critical for safe patient care. Purpose To demonstrate how one specialty hospital in Ontario, Canada, leveraged an employment policy to stabilize its nursing workforce over a six-year period (2007 to 2012). Methods An observational cross-sectional study was conducted in which administrative data were analyzed to compare full-time status and retention of new nurses prepolicy and during the policy. The Professionalism and Environmental Factors in the Workplace Questionnaire® was used to compare new nurses hired into the study hospital with new nurses hired in other health-care settings. Results There was a significant increase in full-time employment and a decrease in part-time employment in the study hospital nursing workforce. On average, 26% of prepolicy new hires left the study hospital within one year of employment compared to 5% of new hires during policy implementation. The hospital nurses scored significantly higher than nurses employed in other health-care settings on 5 out of 13 subscales of professionalism. Conclusions Decision makers can use these findings to develop comprehensive health human resources guidelines and mechanisms that support strategic workforce planning to sustain and strengthen the health-care system.

Resident and family member perceptions of cultural diversity in aged care homes

Similar to many developed nations, older people living in residential aged care homes in Australia and the staff who care for them have become increasingly multicultural. This cultural diversity adds challenges for residents in adapting to the care home. This study explores: (i) residents' and family members' perceptions about staff and cultural diversity, and (ii) culturally and linguistically diverse residents' and family members' experiences. An interpretive study design employing a thematic analysis was applied. Twenty-three residents and seven family members participated in interviews. Four themes were identified from interpreting residents and family members' perceptions of the impact of cultural diversity on their adaptation to aged care homes: (i) perceiving diversity as an attraction; (ii) adapting to cross-cultural communication; (iii) adjusting to diet in the residential care home; and (iv) anticipating individualized psychosocial interactions. The findings have implications for identifying strategies to support staff from all cultural backgrounds in order to create a caring environment that facilitates positive relationships with residents and supports residents to adjust to the care home.

We are not all coping: a cross-sectional investigation of resilience in the dementia care workforce

Background

Research on workforce development for high‐quality dementia care more often focuses on enhancing employee knowledge and skill and less on managing employee stress and coping at work.

Objective

To review employee stress and coping in response to high job demands in community‐based dementia care organizations in Tasmania, Australia.

Methods

Stress and coping in response to job roles of 25 community‐based dementia care workers were reviewed using self‐report questionnaire data. Data were analysed for descriptive results and at an individual case level. Individual participant scores were reviewed for clinically significant stress and coping factors to create worker profiles of adjustment.

Results

Two adjustment profiles were found. The ‘global resilience’ profile, where workers showed positive adjustment and resilience indicating they found their jobs highly rewarding, were very confident in their abilities at work and had a strong match between their personal and organizational values. The second ‘isolated distress’ profile was only found in a minority and included poor opportunities for job advancement, a missmatch in personal and work values or clinically high levels of psychological distress.

Conclusion

Aged care workplaces that advocate employee well‐being and support employees to cope with their work roles may be more likely to retain motivated and committed staff. Future research should consider employee stress and coping at the workforce level, and how this can influence high‐quality care delivery by applying the measures identified for this study. Comparative research across different care settings using meta‐analytic studies may then be possible.

Enjoying the front-line of dementia care: an integrative analysis of what care home staff report makes them happy at work

Purpose

– High turnover of staff in the long-term dementia care sector contributes to poor quality care and lack of continuity of care in the UK and many other countries. The purpose of this paper is to explore the research evidence on what care assistants report they enjoy when working in front-line dementia care jobs in long-term care facilities.

Design/methodology/approach

– An integrative analysis was used to study research findings focusing on the front-line workforce in care homes. The literature review sought to capture key findings, including overviews of research, from studies from 1990 to mid-2014 that have considered the positive experiences of front-line care home staff working with people with dementia.

Findings

– There is a great deal of research investigating care home staff's job satisfaction. Much of this highlights the importance of personal, social and managerial relationships. Common themes continue to be reported. There is potential for work on improving care assistant experiences in care homes but also a need to address long-standing inequities affecting the care home sector.

Research limitations/implications

– Some studies are not precise about which staff groups they are investigating in studies about care homes and many concentrate on the problems staff report. Measures of job satisfaction vary. When exploring dementia-related care not all studies are clear if care home residents have dementia or not.

Practical implications

– Many studies have investigated the views of care assistants working with people with dementia in care homes that address happiness in their work, often reported as job or work satisfaction, and these should be consulted when developing dementia services or managing care homes. As with other parts of the social care workforce, employers and managers need to be aware of effective and acceptable workforce reforms and ways to reduce turnover.

Originality/value

– This review suggests the value of investigating positive aspects of care work with people with dementia living in care homes. Greater attention could be paid to job satisfaction in social care more widely.

Intention to stay and intention to leave: are they two sides of the same coin? A cross-sectional structural equation modelling study among health and social care workers

OBJECTIVES

"Intention to leave" (ITL) has been used interchangeably with the more positive construct "intention to stay" (ITS). The implicit assumption appears to be that both constructs represent different sides of the same coin. This study challenges this assumption. The objectives were (i) to test whether these constructs were similar measures of the same construct, and (ii) to assess the strength of the relationships between ITL and ITS with work-related outcomes.

METHODS

The Workforce Dynamics Questionnaire (WDQ) was administered to 298 staff. The WDQ included two items on ITL and was supplemented with three items on ITS. Structural equation modelling (SEM) was used.

RESULTS

The response rate was 43%. The correlation between the two constructs was negative and quite high (r=-0.84), indicating potential issues with discriminant validity. However, the constructs behaved differently in relation to job satisfaction and job integration. ITS was a strong predictor (0.95, p<0.001), whereas ITL was not significantly related (0.34, p=0.195) to JS. The direct effects of JI on ITS was 0.30 and on ITL was -0.42. The indirect effects of JI were more contrasting, being 0.56 for ITS and -0.30 for ITL, via job satisfaction.

CONCLUSIONS

This is the first study amongst British health and social care workers that has demonstrated that ITS and ITL are not measuring the same construct. While there is overlap, care should be taken when using these constructs interchangeably, particularly when measuring these concepts in organizations and when developing retention programs, policies, or activities to modify ITS and ITL.

Importance and performance of managerial skills in the Australian aged care sector - a middle managers' perspective

AIM

This study examined the importance and performance of middle managers' skills to provide a starting point for a sector-wide leadership and management framework.

BACKGROUND

There is an increasing consensus that the quality of management, leadership and performance of any organisation is directly linked to the capabilities of its middle managers and the preparation and on-going training they receive.

METHOD

A total of 199 middle managers from three aged care organisations in Australia participated in a questionnaire conducted during 2010-2011.

RESULT

This study found that middle managers perceived the need to develop their communication skills, self-awareness, change management, conflict resolution and leadership skills.

CONCLUSION

Middle managers perceive a discrepancy between performance and importance of various managerial skills. This study demonstrated that provision of training needs to go beyond clinical skills development and further investigation into managers' needs is necessary, particularly considering the diversity of this critical group in organisations.

IMPLICATIONS FOR NURSING MANAGEMENT

Future training opportunities provided to middle managers need to address the 'softer' skills (e.g. communication) rather than 'technical' skills (e.g. clinical skills). The provision of training in these skills may improve their performance, which may also lead to increased job satisfaction, continuity in leadership and management and ultimately improvements in the quality of care provided.

Applying workability in the Australian residential aged care context

The study is based on an innovative demonstration project which trialled the implementation of the Finnish 'workability' framework and research measures. It aimed, firstly, to test the applicability of the Workability Index (WAI) to the Australian residential aged care workforce, focusing on personal care assistants (PCAs), and secondly, to assess the effectiveness of actions aimed at improving workability. The facility manager implemented multidimensional 'actions' according to the workability framework. The Workability Survey (WAS) and WAI and intervention instruments were administered (n = 64). Completed responses to 'pre' and 'post' instruments formed matched pairs (n = 15). WAI scores increased significantly, by 3 points on average, after all 'actions' were implemented. The only significant 'action' was increasing the number of PCAs in high care. Workability provides a useful research workforce development instrument measuring interactions between aged care workers and organisational demands and the outcomes of 'actions'.