Perspectives on midwifery power: an exploration of the findings of the inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda, Ireland

Doctors don't Do-little: a national cross-sectional study of workplace well-being of hospital doctors in Ireland

OBJECTIVES

To measure levels of occupational stress, burn-out, work-life balance, presenteeism, work ability (balance between work and personal resources) and desire to practise in trainee and consultant hospital doctors in Ireland.

DESIGN

National cross-sectional study of randomised sample of hospital doctors. Participants provided sociodemographic data (age, sex), work grade (consultant, higher/basic specialist trainee), specialty, work hours and completed workplace well-being questionnaires (Effort-Reward Imbalance (ERI) Scale, overcommitment, Maslach Burnout Inventory) and single item measures of work ability, presenteeism, work-life balance and desire to practise.

SETTING

Irish publicly funded hospitals and residential institutions.

PARTICIPANTS

1749 doctors (response rate of 55%). All hospital specialties were represented except radiology.

RESULTS

29% of respondents had insufficient work ability and there was no sex, age or grade difference. 70.6% reported strong or very strong desire to practise medicine, 22% reported good work-life balance, 82% experienced workplace stress, with effort greatly exceeding reward, exacerbated by overcommitment. Burn-out was evident in 29.7% and was significantly associated with male sex, younger age, lower years of practice, lower desire to practise, lower work ability, higher ERI ratio and greater overcommitment. Apart from the measures of work ability and overcommitment, there was no sex or age difference across any variable. However, ERI and burn-out were significantly lower in consultants than trainees.

CONCLUSIONS

Hospital doctors across all grades in Ireland had insufficient work ability, low levels of work-life balance, high levels of work stress and almost one-third experienced burn-out indicating suboptimal work conditions and environment. Yet, most had high desire to practise medicine. Measurement of these indices should become a quality indicator for hospitals and research should focus on the efficacy of a range of individual and organisational interventions for burn-out and occupational stress.

Contestations and complexities of nurses' participation in policy-making in South Africa

Background

There has been increased emphasis globally on nurses’ involvement in health policy and systems development. However, there has been limited scholarly attention on nurses’ participation in policy-making in South Africa.

Objective

This paper analyses the dynamics, strengths, and weaknesses of nurses’ participation in four national health workforce policies: the 2008 Nursing Strategy, revision of the Scope of Practice for nurses, the new Framework for Nursing Qualifications, and the Occupation-Specific Dispensation (OSD) remuneration policy.

Design

Using a policy analysis framework, we conducted in-depth interviews with 28 key informants and 73 frontline nurses in four South African provinces. Thematic content analysis was done using the Atlas.ti software.

Results

The study found that nurses’ participation in policy-making is both contested and complex. The contestation relates to the extent and nature of nurses’ participation in nursing policies. There was a disjuncture between nursing leadership and frontline nurses in their levels of awareness of the four policies. The latter group was generally unaware of these policies with the exception of the OSD remuneration policy as it affected them directly. There was also limited consensus on which nursing group legitimately represented nursing issues in the policy arena. Shifting power relationships influenced who participated, how the participation happened, and the degree to which nurses’ views and inputs were considered and incorporated.

Conclusions

The South African health system presents major opportunities for nurses to influence and direct policies that affect them. This will require a combination of proactive leadership, health policy capacity and skills development among nurses, and strong support from the national nursing association.

"Knights" or "knaves"? Public policy, professional power, and reforming maternity services

Recent quality and safety discourse stresses locating "human errors and mistakes" within an institutional framework. I go further to contend that, in spite of well-meaning individual practitioners, aspects of a powerful, self-interested obstetric professional culture pose a major barrier to quality childbirth care. Using my analysis, I contrast the profession's "knightly" self-image with critical scholarship, and it examine evidence given to public inquiries into obstetric misdemeanors and mistakes in Australia, England, and Ireland. Policy incentives to reform maternity care need to go beyond technical auditing measures to foster collaboration, social as well as institutional accountability, and critical self-reflection within the obstetric profession.