Retention Strategies for Nursing:

Human Health Resource Series Number 5 Andrea Baumann Jean Yan Jaclyn Degelder Kamil Malikov Retention Strategies for Nursing: A Profile of Four Count...
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Human Health Resource Series Number 5

Andrea Baumann Jean Yan Jaclyn Degelder Kamil Malikov

Retention Strategies for Nursing: A Profile of Four Countries

November 2006

Retention Strategies for Nursing: A Profile of Four Countries, November 2006 Number 5 Andrea Baumann, RN, PhD, Associate Vice President, International Health and Director, Nursing Health Services Research Unit (McMaster University site)

Authors

Jean Yan, Chief Scientist for Nursing & Midwifery, World Health Organization, Geneva, Switzerland Jaclyn Degelder, RN, BScN, Research Coordinator, Nursing Health Services Research Unit (McMaster University site) Kamil Malikov, MD (Russia), MSc (UK), MBA (Canada), Program Officer and Clinical Research Coordinator, International Health, Faculty of Health Sciences, McMaster University Advisory Howard Catton, Head of Policy Development and Implementation Royal College of Nursing, UK Margaret Chota, Commissioner, Nursing Services, Ministry of Health, Uganda Wipada Kunaviktikul, Dean, Faculty of Nursing, Chiang Mai University, Director of the World Health Organization Collaborating Centre for Nursing and Midwifery Development Anna Maslin, Professor, International Officer, Nursing & Midwifery, Department of Health, England, UK Debbie Mellor, Head of Workforce Capacity, Department of Health, England, UK Ashley Moore, Workforce Policy Manager, Department of Health, England, UK Rutja Phuphaibul, Professor, Director of WHO Collaborating Centre for Nursing and Midwifery Development, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Supanee Senadisai, Associate Professor, Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand Contact Andrea Baumann Phone (905) 525-9140 ext 22581 E-mail [email protected] Website www.nhsru.com

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Table of Contents

Executive Summary........................................................................................................................................3 Recommendations .........................................................................................................................................4 Introduction ..................................................................................................................................................5 What is Retention? .........................................................................................................................................5 Frameworks for Retention .............................................................................................................................6 Analysis of National Retention Strategies ......................................................................................................6 Uganda ..........................................................................................................................................................7 Investment in Health ......................................................................................................................................7 Migratory Patterns ..........................................................................................................................................7 Policy Framework ...........................................................................................................................................7 United Kingdom ............................................................................................................................................8 Investment in Health ......................................................................................................................................8 Migratory Patterns ..........................................................................................................................................8 Policy Framework ...........................................................................................................................................8 Canada...........................................................................................................................................................9 Investment in Health ......................................................................................................................................9 Migratory Patterns ..........................................................................................................................................9 Policy Framework ...........................................................................................................................................9 Thailand ......................................................................................................................................................10 Investment in Health ....................................................................................................................................10 Migratory Patterns ........................................................................................................................................10 Policy Framework .........................................................................................................................................10 Conclusion ..................................................................................................................................................11 Recommendations ......................................................................................................................................12 References ....................................................................................................................................................13 Annex 1. Selected Socio-Economic and Health Indicators in Canada, Thailand, Uganda, and the United Kingdom ..........................................................................................................................................16 Annex 2. Canadian Recruitment and Retention Policies at the Provincial/Territorial Level .........................17 Annex 3. Retention Policies in Uganda ........................................................................................................22 Annex 4. Retention Policies in England .......................................................................................................23 Annex 5. Retention Policies in Canada ........................................................................................................25 Annex 6. Retention Policies in Thailand ......................................................................................................26

Executive Summary A seven-point framework was used to analyze retention strategies in four countries: Uganda, the United Kingdom, Canada, and Thailand. This framework draws upon available country data and includes GDP and investment in health, mix of private/public investment, international migration, health policy frameworks, countrywide strategies, provincial/regional strategies, and professional associations/regulatory bodies. Comparison of the countries demonstrated that progress has been made in nurse retention. The analysis showed that each country has made a considerable investment in health. All had a system of basic preventive and primary health care services, a significant acute care hospital sector, and low external migration of the general population. In addition, each had a comprehensive health policy framework in place and professional/regulatory bodies that reinforced the national strategies. All the strategies addressed similar issues such as increasing nursing workforce numbers, role expansion of nursing aides, and a commitment to continuing education. Uganda and Thailand had strategies that included a salary plan for health personnel and professional development. In Canada and the UK, the national strategy filtered down to the regional level where other complementary policy frameworks exist. Both countries had specific human resources plans that focused on healthy workplace initiatives and strategies for improvement of nurse morale. The report emphasizes the relationship between health investment, policy frameworks, the existence of professional associations, and the retention of nurses. Although some might argue that this is a loose association, the countries have been successful in retaining nurses. The sevenpoint framework is helpful as a means for countries to look at ways to stem the rate of external migration and the continual loss of a valuable health resource.

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Recommendations 1.

Increase nursing workforce numbers through: • increasing admission to the professional education programs • signing bonuses for new graduates • retention bonuses

2.

Harmonize salary scales.

3.

Upgrade skills of nursing aides.

4.

Provide allowances for large and smaller supportive initiatives including: • housing subsidies • extended child care • flexible working times and retirement • healthy workplaces • provision of a hot lunch

5.

Allowances for continuing education and professional development.

6.

Elimination of barriers to exercise nursing skills to the full capacity.

7.

Invest in modernized and safe equipment for patient care.

8.

Create conditions to eliminate violence at workplace.

9.

Maintain ongoing dialogue with nurses regarding the continuous improvement of working conditions.

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Introduction There are an estimated 35 million people working in the health sector worldwide (Martineau, Decker, & Bundred, 2004). During the past decade, there has been considerable international migration. This trend has been driven by shortages of health care workers in Western countries and demand from areas of the Middle East such as Saudi Arabia and the United Arab Emirates. Consequently, existing shortages have been exacerbated and the supply of health human resources in certain areas of the world has been further depleted. In addition, developing countries are experiencing significant brain drain. This has had a serious impact on some countries as adequate health human resources affect health outcomes (Anand & Bärnighausen, 2004). In order to achieve millennium development goals, there must be an adequate balance of health human resources (Buchan & Calman, 2004). Various authors have described factors that lead to an inadequate supply of health care workers. For example, there are significant pull and push factors that encourage migration: better remuneration and working conditions (Muula, 2005), the toll of diseases such as HIV/AIDS, inadequate staffing levels, poor employee support, and challenging workloads (Baumann & Degelder, 2006). There is a critical need to examine all aspects of retention including staff movement within (internal) and outside the country (external). This report is a brief overview of retention strategies and is of interest to health care planners at both the national and international level. Using Uganda, the United Kingdom (UK), Canada, and Thailand as exemplars, it demonstrates that progress has been made in nurse retention. For example, according to data from the UK (one of the major recipients of overseas trained nurses), only 18 nurses or 0.41% of Uganda’s nursing stock were registered for practice in the UK in 2002 (Ross, Polsky, & Sochalski, 2005). A WHO commissioned study conducted in six African countries found that that only 18% of midwives and 24% of nurses from Uganda want to emigrate (Awases, Gbary, Nyoni, & Chatora, 2004). The current report outlines the effective retention practices used in the countries, as well as the background economics of each country, some of the overarching health policies, actual nursing retention policies, and relevant grey and published literature.

There are an estimated 35 million people working in the health sector worldwide. Developing countries are experiencing significant brain drain. Poor working conditions and inadequate remuneration lead to migration. Uganda, the UK, Canada, and Thailand have shown progress in retaining nurses.

What is Retention? There are many definitions for retention. In the context of the nursing workforce, it has traditionally been used to indicate the maintenance of an appropriate supply of nursing personnel to meet the health needs of any given population. It is therefore valuable to look at the best practices from a variety of settings, which have proved to be effective in retaining an adequate supply of nurses.

Retention in nursing is the appropriate supply of personnel to meet population health needs.

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Frameworks for Retention Several authors have suggested frameworks that could be used to examine issues of retention. The International Council of Nurses (2006) has outlined five priority interventions relevant to retention, which also provide guidance in developing strategies for action. These include macro economic and health sector funding policies, as well as workforce policy and planning including regulation, positive practice environments and organization performance, recruitment and retention, and nursing leadership. Buchan and Calman (2004) suggested a proposed policy intervention framework that addressed nursing shortages. These authors emphasized components such as workforce planning, recruitment and retention, deployment and performance, and utilization and skill mix are important themes when discussing issues of retention. The suggested frameworks are extremely useful when there is a comprehensive data base readily available to analysts. However, our comparison has demonstrated that it is often difficult to find comparable data across countries. Consequently, we created a seven-point framework to analyze retention strategies in the exemplar countries.

Analysis of National Retention Strategies

The ICN outlines five priority interventions relevant to retention. Annual workforce planning is essential. A seven point framework was created to analyze specific retention strategies.

This analysis outlines what Uganda, the UK, Canada, and Thailand have in common that may have led to effective retention initiatives. The seven-point framework focuses on particular areas (see Table 1) and arose from the data available from each country. Table 1 Seven-Point Framework

Areas of Focus 1

GDP and investment in health

2

Mix of private/public investment

3

International migration

4

Health policy frameworks

5

Countrywide strategies

6

Province/regional strategies

7

Professional association/regulatory body

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Uganda Investment in Health Uganda is a low-income country landlocked in East Africa. In 2003, the GDP per capita in PPP (Purchasing Parity Power index) adjusted dollars was $1,457 and health expenditures per capita were PPP $77 (United Nations Development Programme, 2005). The PPP is based on price data from the latest International Comparison Program (ICP) surveys (see Annex 1 for selected socio-economic and health indicators). In 2002, government expenditures on health made up about 28% of total health expenditures (WHO, 2004a). Uganda has a fairly decentralized health care system (The Republic of Uganda Ministry of Health, 1999). Services are provided through a mix of public and private facilities. Government funds are channeled through the Ministry of Health, but the distribution principles are not defined in the policy document. The cornerstone of the health care services provided through the public network is the Minimum Health Care Package, which includes basic preventive and primary health care services and some referral services in tertiary hospitals.

Health expenditures as percentage of GDP 7.4%. Uganda’s major health policy framework is the Ministry of Health National Policy (1999).

Migratory Patterns No detailed data on overall country migration was available; however, net migration per 1,000 population was -1.49 in 2005 (Index Mundi, 2005a).

Policy Framework The major health policy framework in Uganda is the Ministry of Health National Health Policy. However, another important policy is the Health Policy Statement 2001/2002 (The Republic of Uganda Ministry of Health, 2001), which also contains countrywide retention strategies and guiding principles. For example, increase nursing workforce numbers, harmonize salary scales, upgrade skills of nursing aides, and provide allowances for large initiatives (e.g., subsidization of housing) and smaller supportive initiatives (e.g., the provision of a hot lunch). It also includes important professional development initiatives and specific recommendations to achieve them. For example, increase salaries and institute a consultative process with the Ministry of Health, the Uganda Nurses and Midwives Council, and the Uganda National Association of Nurses and Midwives (UNANM). In 2004/2005, there was an increase in nurses’ salaries across the country (M. Chota, personal communication, March 16, 2006). Ugandan nurses working in both the public and private sectors are regulated by the UNANM (The Republic of Uganda Ministry of Health, n.d.), which also acts a lobby group for issues such as employment and retention.

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United Kingdom Investment in Health The UK is a high income country and a member of the Organization for Economic Cooperation and Development (OECD). In 2003, the GDP per capita was $27,147 in PPP adjusted dollars and health expenditures per capita were PPP $2,160 (United Nations Development Programme, 2005). The UK consists of four countries (England, Northern Ireland, Scotland, and Wales); each with its own National Health System (NHS). The NHS provides health care services through a network comprised of its own facilities, partners, and the independent sector. According to OECD statistics for 2003, 83% of total health expenditures go towards the public sector (OECD, 2005). These funds are used by the NHS to purchase health care services on behalf of patients.

Health expenditures as percentage of GDP 7.7%. The major health policy framework in the UK is the Health Act (1999).

Migratory Patterns Index Mundi (2005b) indicates that net migration in the UK in 2004 was 2.8 per 1,000 population. Data on the migration of nurses and midwives was not available from official databases; however, in 2002, over 15,760 nurses registered with the Nursing and Midwifery Council (NMC) to practice in the UK (Ross et al., 2005).

Policy Framework The major health policy framework in the UK is the Health Act 1999 (Government of the United Kingdom, 1998). However, for the purpose of this paper, only policy documents from England were analyzed as it is the largest country in the UK. There are several policy documents in England that deal with the health delivery system including human resources. The policy framework comes from The NHS Plan: A plan for investment, a plan for reform (Department of Health, 2000a) and the follow-up policy, Delivering the NHS Plan: Next steps on investment, next steps on reform (Department of Health, 2002a). These plans provide an overarching structure for many of the retention initiatives, which include increasing the number of nursing staff, improving staff pay, education and continuing education, and housing subsidization for nurses living in London. The Department of Health is committed to enhancing the working lives of all NHS staff, as evidenced by the creation of an Improving Working Lives Standard (IWL). The IWL establishes benchmarks for all NHS employers to follow (Department of Health, 2000b), and includes employment practices such as childcare support, flexi-time, flexible retirement, and a healthy workplace. Funding to support its implementation has been made available. In addition to the IWL, the NHS has a human resources plan in place. This plan is intended to make the NHS an exemplary employer, ensure it provides a model career for its staff, improve employee morale, and build people management skills (Department of Health, 2002b). The NHS is dedicated to providing lifelong learning for its employees and has a zero tolerance policy on violence against staff (Department of Health, 2001; National Task Force on Violence Against Social Care Staff, 2001).

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The above policies are national, but they are also applied at the regional level. The Cheshire and Merseyside Strategic Health Authority (SHA), for example, has implemented several of the strategies outlined in the policies including becoming a model employer. It also has a range of initiatives for improving recruitment and retention, has leadership programs for NHS staff, is involved in getting nurses to return to work, and has implemented a new modernized pay system (Cheshire and Merseyside SHA, 2004). Nurses in the UK are represented by the Royal College of Nurses (RCN), which also acts as a lobby group on their behalf (RCN, 2006).

Canada Investment in Health Like the UK, Canada is a high income country and a member of the OECD. In 2003, the GDP per capita was $30,677 in PPP adjusted dollars and health expenditures per capita were PPP $2,931 (United Nations Development Programme, 2005). Canada is a confederation of 10 provinces and three territories. Health care is regulated by the Canada Health Act (Department of Justice Canada, 2003). According to the Act, the provinces and territories are responsible for the provision of health care services to the population. The federal government supports the provinces and territories through health and social services transfers. In 2002, public funding accounted for almost 70% of total health expenditures in Canada (WHO, 2004b).

Health expenditures as percentage of GDP 9.6%. Canada’s major health policy framework is the Canada Health Act (2003).

Migratory Patterns The net migration rate in 2004 was 5.9 per 1,000 population (Index Mundi, 2005c). Less than 4% of nurses move to the United States (US) on an annual basis. However, this number is somewhat higher for new graduates and varies in a given year. For example, a recent study of new graduates in Ontario, which is one of the largest provinces in Canada, found that less than 8% moved out of the province (Baumann, Blythe, Cleverly, Grinspun, & Tompkins, 2006).

Policy Framework In addition to the overarching Health Act, Canada has other health policy documents related to health human resources. There is a national nursing strategy that highlights policies for change in the nursing workforce. These changes are intended to ensure an adequate number of nurses; appropriate education of nurses; and effective utilization, distribution, and retention strategies (Advisory Committee, Health Delivery and Human Resources, 2003). A nationwide initiative has been implemented to promote and maintain healthy workplace practices (Health Canada, 2004a). In addition, there are several policy frameworks addressing recruitment and retention. The most recent is the Health human resource strategy: Recruitment and retention (Health Canada, 2004b). The goals of this strategy are to recruit and retain more health care workers by increasing interest in health careers (including in areas of shortage), increase the diversity and supply of health care providers, improve utilization and distribution of existing health care providers, and improve working environments. This strategy will be implemented together with the provinces and territories, health stakeholders, employers, professionals, international organizations, and federal departments. Retention Strategies for Nursing: A Profile of Four Countries

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Various policy frameworks also exist at the provincial/territorial level (see Annex 2). Large investments are made in the health care system both federally and regionally. Most provinces and territories have strategies for health care delivery that focus on health human resources. Nine provinces and all three territories have strategies focusing specifically on the recruitment and retention of nurses. In provinces where strategies do not exist, funds have been allocated towards signing bonuses and nursing education. The latter is in relation to more education seats, orientation, student support, and continuing education. Also prominent in the provincial/territorial nursing strategies is the policy to improve work environments for nurses including zero tolerance for violence, mentorship programs, and safer medical equipment. Several provinces and territories have policies focusing on professional development and the need to create more full-time positions. A few include money for research initiatives and workforce planning strategies for nurses. The Canadian Nurses Association (CNA) is the national professional voice of registered nurses and lobbies for healthy public policy (Canadian Nurses Association, 2006). Most provinces and territories have their own nursing regulatory bodies (http://www.cna-nurses.ca/ CNA/ nursing/regulation/regbodies/default_e.aspx) and professional associations, which lobby for the interests of nurses and health care (http://www. canadianrn.com/directory/assoc.htm).

Thailand Investment in Health Thailand is an upper-middle income country situated in the centre of continental South-east Asia. In 2003, the GDP per capita was $7,595 in PPP adjusted dollars and health expenditures per capita were PPP $321 (United Nations Development Programme, 2005). The country is divided into four geographical regions: the central (including the capital city of Bangkok), the northern, the northeastern, and the southern. The administrative system comprises three major categories: central, provincial, and local. Health care is organized and provided by the public and private sectors. The Ministry of Public Health is the major provider of public health services. In 2002, government expenditures accounted for about 70% of overall health expenditures (WHO, 2004c). This money is channeled through the Ministry of Public Health and allocated to the provinces based on historical budgets.

Health expenditures as percentage of GDP 4.4%. Thailand’s major health policy framework is the National Health Development Plan (2001).

Migratory Patterns According to the International Labour Organization (2001), migration from Thailand has been decreasing since 1999. In 2003, only 147,769 people (2.28 per 1,000 population) left the country and 1,100,628 (17 per 1,000 population) immigrated to Thailand. Data on the migration of nurses and midwives was not available.

Policy Framework The major health policy document in Thailand is the National Health Development Plan Under the 9th National Economic and Social Development Plan (Government of Thailand, 2001). Several health professional associations, including the Nursing Council of Thailand, proposed Retention Strategies for Nursing: A Profile of Four Countries

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an incentive strategy to the government to prevent the shortage of health personnel. It included a salary plan for health personnel that takes into consideration the inherent responsibility and risk of their jobs. Salary increases or top-up incentives were recommended for highly skilled specialists and those who work night shifts. Although the government did not accept everything proposed in the plan, nurses will still receive an increase in their salaries (R. Phuphaibul, personal communication, April 4, 2006). Nurses are monitored by the Nursing Council of Thailand, which is a regulatory body (Nursing Council of Thailand, 2006). The Nurses Association of Thailand is the professional voice of nurses nationwide and lobbies for their interests (http:// www.thainurses-asso.com/php/index.php).

Conclusion Comparison of Uganda, the UK, Canada, and Thailand demonstrated that progress has been made in nurse retention. Moreover, it highlighted commonalities that may have contributed to better nurse retention in these countries. Although various frameworks have been suggested for examining retention, it is not possible to obtain data that evaluates overall working conditions and includes such factors as staffing levels, workload, organizational performance, utilization, and skill mix. However, in using the seven-point framework, certain indices and practices were shown to have a positive impact on retention. Each country made a considerable investment in health and had a mixture of private and public investment. All had a system of basic preventive and primary health care services, significant acute care hospital sectors, and very low external migration of the general population. Furthermore, each had an overarching health policy framework (see Annexes 3-6) and a professional/regulatory body that reinforced the national strategies. All the strategies derived from the existing policy frameworks addressed similar issues such as increasing nursing workforce numbers, role expansion of nursing aides, and commitment to continuing education. Uganda and Thailand had strategies that included a salary plan for health personnel and professional development. In Canada and the UK, the national strategy filtered down to the regional level where other complementary policy frameworks exist. For example, both countries had specific human resources plans that focused on healthy workplace initiatives and improvement of nurse morale.

Certain indices and practices were shown to have a positive impact on retention. Each country made a considerable investment in health and had a mixture of private and public investment. Retention could be addressed through the human capital approach.

In conclusion, there is a relationship between health investment, policy frameworks, the existence of professional associations, and the retention of nurses. Although some might argue that this is a loose association, the exemplar countries in this report have been successful in retaining nurses. The seven-point framework is helpful as a means for countries to examine ways to stem the rate of external migration and the continual loss of a valuable health resource. Baumann and Blythe (2003a, 2003b) propose that retention could be addressed through the human capital approach. This approach redefines human resources as a cost component of a production process rather than a capital factor capable of producing a surplus. Human capital includes employee education and skills. Consequently, all measures to retain qualified staff (e.g., ongoing education) comprise capital investment because they increase an employee’s capacity to produce the surplus. The human capital approach justifies the investment of financial resources in the development of retention policies.

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Recommendations The social and economic conditions of a country affect the migration of health care professionals. Consequently, countries need to invest more effort in the study of migration and ways to retain health care personnel; for example, improving social and economic conditions for workers. Data relevant to understanding the factors that influence migration is vital. The seven-point framework could be used for data collection and analysis. Effective retention strategies require significant political and financial commitment from all levels of government. It is therefore recommended that retention policies receive support from national health ministries and regional health care organizations. Strategies should be regularly evaluated to ensure their efficacy. The existence of complementary policy frameworks at the regional level is also recommended. Equally important is the presence of a strong and influential professional body that represents salaried health care personnel and advocates on their behalf. The establishment and recognition of such bodies is recommended because of their supportive function, as well as the role they play in facilitating research and the development of relevant retention policies. The following suggestions are based on commonalities in the exemplar countries and have been shown to improve nurse retention: • Increase nursing workforce numbers through: o boosting admission to the professional education programs o signing bonuses for new graduates o retention bonuses • Harmonize salary scales. • Upgrade skills of nursing aides. • Provide allowances for large and smaller supportive initiatives including: o housing subsidies o extended child care o flexible working times and retirement o healthy workplaces o provision of a hot lunch o continuing education and professional development • Eliminate barriers that prevent nurses from exercising their skills to the full capacity. • Invest in modernized and safe equipment for patient care. • Create conditions to eliminate violence at workplace. • Maintain ongoing dialogue with nurses regarding the continuous improvement of working conditions.

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Department of Health. (2002b). HR in the NHS plan: More staff working differently. Retrieved February 14, 2006, from http://www.dh.gov.uk/assetRoot/04/05/58/66/04055866.pdf Department of Justice Canada. (2003). Canada Health Act. Retrieved April 5, 2006, from http:// laws.justice.gc.ca/en/C-6/233402.html Government of Thailand. (2001). National Health Development Plan under the 9th National Economic and Social Development Plan (2002-2006). Retrieved April 5, 2006, from http://www. moph.go.th/ops/health_48/CHAP3.PDF Government of the United Kingdom. (1998). Health act 1999. Retrieved April 4, 2006, from http://www.opsi.gov.uk/acts/acts1999/19990008.htm Health Canada. (2002). Health Canada to develop healthy workplace guidelines for Canadian nurses. Retrieved March 1, 2006, from http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/2002/2002_ 50_e.html Health Canada. (2004a). Health Canada’s healthy workplace initiative. Retrieved March 1, 2006, from http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/recru/workplace-milieudetravail_e.html Health Canada. (2004b). Health human resource strategy: Recruitment and retention. Retrieved February 9, 2006, from http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/recru/index_e.html Health Canada. (2005). 2003 First Ministers’ Accord on Health Care Renewal. Retrieved March 1, 2006, from http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2003accord/index_ e.html Index Mundi. (2005a). Uganda net migration rate. Retrieved April 3, 2006, from http://www. indexmundi.com/uganda/net_migration_rate.html Index Mundi. (2005b). United Kingdom Net migration rate. Retrieved April 3, 2006, from http:// www.indexmundi.com/united_kingdom/net_migration_rate.html Index Mundi. (2005c). Canada net migration rate. Retrieved April 3, 2006, from http://www. indexmundi.com/canada/net_migration_rate.html International Council of Nurses. (2006). The global nursing shortage: Priority areas for intervention. Retrieved March 29, 2006, from www.icn.ch/global/report2006.pdf International Labour Organization. (2001). International labour migration data base (ILM): Table 12: Outflows of nationals by sex and by country of destination, absolute numbers, 1986-2001: Thailand. Retrieved April 3, 2006, from http://www.abetech.org/ilm/english/ilmstat/table12.asp Martineau, T., Decker, K., & Bundred, P. (2004). “Brain drain” of health professionals: From rhetoric to responsible action. Health Policy, 70, 1-10. Muula, A. S. (2005). Is there any solution to the “brain drain” of health professionals and knowledge from Africa? Croatian Medical Journal, 46(1), 21-29. National Task Force on Violence Against Social Care Staff. (2001). Report and national action plan. Retrieved February 14, 2006, from http://www.dh.gov.uk/assetRoot/04/06/28/20/040628 20.pdf Nursing Council of Thailand. (2006). All about us. Retrieved March 29, 2006, from http://www. moph.go.th/ngo/nursec/aboutus.htm Retention Strategies for Nursing: A Profile of Four Countries

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Organisation for Economic Co-operation and Development. (2005). Health: Spending and resources. Retrieved April 3, 2006, from http://ocde.p4.siteinternet.com/publications/doifiles/ 012005061T002.xls Ross, S. J., Polsky, D., & Sochalski, J. (2005). Nursing shortages and international nurse migration. International Nursing Review, 52, 253-262. Royal College of Nurses. (2006). Our mission. Retrieved April 4, 2006, from http://www.rcn.org. uk/aboutus/mission.php The Republic of Uganda Ministry of Health. (n.d.). Public-private partnerships in health (PPPH): Increasing private health sector participation in all aspects of the National Health Programme. Retrieved April 4, 2006, from http://www.health.go.ug/part_health.htm The Republic of Uganda Ministry of Health. (1999). Ministry of health national health policy. Retrieved April 3, 2006, from http://www.health.go.ug/ The Republic of Uganda Ministry of Health. (2001). Health policy statement 2001/2002. Retrieved March 2, 2006, from http://www.health.go.ug/policies.htm United Nations Development Programme. (2005). Human development report 2005. Retrieved April 3, 2006, from http://hdr.undp.org/reports/global/2005/pdf/HDR05_complete.pdf World Health Organization. (2004a). National expenditure on health: Uganda. Retrieved April 3, 2006, from http://www.who.int/nha/country/UGA.xls World Health Organization. (2004b). National expenditure on health: Canada. Retrieved April 3, 2006, from http://www.who.int/nha/country/CAN.xls World Health Organization. (2004c). National expenditure on health: Thailand. Retrieved April 3, 2006, from http://www.who.int/nha/country/THA.xls

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Annex 1. Selected Socio-Economic and Health Indicators in Canada, Thailand, Uganda, and the United Kingdom Category

Indicators

Socio-economic factors:

GDP per capita (PPP US$; 2003)

Uganda

United Canada Thailand Kingdom

1,457

27,147

30,677

7,595

77

2160

2,931

321

Physicians per 100,000 population

4.7

166.5

209

30

Life expectancy at birth (years; 2003)

47.3

78.4

80

70

12.4%

89.2%

81.5%

32.5%

55%

12.50%

12.80%

13.10%

HIV/AIDS prevalence (% ages 15 - 49; 2003)

4.10%

0.10%

0.30%

1.50%

Net migration rate (per 1,000 population)

-1.49

2.18

5.9

0

Health expenditures per capita (PPP US$; 2003)

Urban population Poverty prevalence (relative; population below 50% of median income %)

Workload indices:

Average nurse per 100,000 population

8.8

540

1011

161.7

Health outcomes:

U5MR (per 1,000 live births; 2003)

140

6

6

26

IMR (per 1,000 live births; 2003)

81

5

5

23

MMR (per 100,000 live births; 2000)

880

13

6

36

Standardized morbidity ratio or DALY

53,430

12,790

11,808

20,508

1,553.3

1,014.7

711.1

673.8

in the country (per 100,000; 2002) Standardized mortality ratio (death per 100,000; 2002)

Source: United Nations Development Programme (2005).

Retention Strategies for Nursing: A Profile of Four Countries

16

Annex 2. Canadian Recruitment and Retention Policies at the Provincial/Territorial Level Policy/Guidance

Year

Description

Source Documents

Increasing supply of health personnel in Alberta

2000

$10 million in annual post-secondary funding will go towards creating new student spaces at Alberta postsecondary institutions.

Government of Alberta. (2000). Alberta to train more than 500 new doctors, nurses and other health care professionals. Retrieved March 14, 2006, from http://www.advancededucation.gov.ab.ca/ news/2000/june/nr-newDoctors.asp

Improving health care in Alberta

2005

Thirteen initiatives to improve health of Albertans. Includes Action 11: Increase the supply of health care providers.

Government of Alberta. (2005). Getting on with better health care. Retrieved March 2, 2006, from http://www.health.gov.ab.ca/key/reform/getting. html#Related

British Columbia nursing strategy

2005

Since August 2001, the Ministry of Health and the Ministry of Advanced Education have announced $62.9 million in nursing strategies to support the recruitment, retention, and education of registered nurses, registered psychiatric nurse, and licensed practical nurses. For the 2005/06 nursing strategy, the Ministry of Health is providing $4.2 million to build on the successes of the previous four years.

Government of British Columbia. (2005). BC’s nursing strategy for 2005/2006. Retrieved March 2, 2006, from http://www.healthplanning.gov.bc.ca/ ndirect/ NursingStrategies/current/ns_summary_ 0506.html

Manitoba nursing strategy

2005

Five-year progress report analyzing the progress of the provincial nursing strategy, which consists of five target areas: 1. Increase the supply of nurses 2. Improve access to staff development 3. Improve utilization of nurses 4. Improve working conditions 5. Increase nurses’ opportunities to provide input into decision making

Government of Manitoba. (2005). Manitoba’s nursing strategy: Five-year progress report. Retrieved March 2, 2006, from http://www.gov.mb.ca/ health/nurses/strategy5.pdf

Manitoba Nurses Recruitment 2005 and Retention Fund (NRRF) update

The NRRF was established in 1999 to assist with the recruitment and retention of registered nurses, registered psychiatric nurses, and licensed practical nurses. The main objective is to enhance delivery of health services in the province by addressing issues of nursing supply. Since its inception, the NRRF has spent more than $15 million on strategies to increase the numbers of nurses in the Manitoba workforce. In addition to educational monies provided in the collective agreement, the NRRF has allocated more than $6.7 million to the Regional Health Authorities to support ongoing education for nurses.

Government of Manitoba. (2005). Nurses retention and recruitment fund update. Retrieved March 2, 2006, from http://www.gov.mb.ca/health/nurses/ update.html

New Brunswick nurses recourse strategy

To retain nurses in the province, this strategy suggests improving continuing education funding for nurses and getting rid of legislative barriers that stop nurses from fully using their nursing skills.

Government of New Brunswick. (2001). A nursing resource strategy for New Brunswick: Action plan. Retrieved March 2, 2006, from http://www.gnb. ca/0053/nursing/ActionPlan-e.asp

$3,000 cash incentive to fourth-year student nurses who were graduating in 2000, and who committed to work in the province for at least one year. This was in addition to bursary/incentive programs already in place for health professionals, which total over $1.5 million annually.

Government of Newfoundland and Labrador. (2000). Signing bonus for graduating nurses. Retrieved March 2, 2006, from http://www. releases.gov.nl.ca/releases/2000/ health/0202n03. htm

2001

Signing bonuses for 2000 graduating nurses in Newfoundland And Labrador

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Annex 2. Canadian Recruitment and Retention Policies at the Provincial/Territorial Level (continued) Policy/Guidance

Year

Description

Source Documents

Nursing program enrollment in Newfoundland And Labrador

2002

The provincial government provided $300,000 to the Bachelor of Nursing Collaborative Program to increase the number of students accepted into the program.

Government of Newfoundland and Labrador. (2002). Government to increase enrolment in nursing program. Retrieved March 2, 2006, from http:// www.releases.gov.nl.ca/releases/2002/ health/ 0321n30.htm

Northwest Territories retention and recruitment plan

2002

Defines strategies for recruitment and retention of nurses and allied medical professionals. Strategies include: • professional development • staff mix review • licensed practical nurse program • nursing family job evaluation review • bursaries • daycare services for shift workers

Government of the Northwest Territories. (2002). Retention and recruitment plan for the Northwest Territories’ allied health care professionals, nurses and social workers. Retrieved March 2, 2006, from http://www.hlthss.gov.nt.ca/content/Publications/ Reports/healthcare/retentionnov2002.pdf

Nova Scotia nursing strategy

2001

Strategy is based on four key areas: 1. Support to practicing nurses including funded orientation (total $2,000,000), continuing education (total $1,500,000), and specialty education programs (total $600,000). 2. Support to student nurses including co-operative learning experience (total $300,000). 3. Enhanced recruitment resources including relocation allowances and communications and marketing strategy (total $300,000). 4. Workforce development and utilization including full utilization of scope of practice and workforce deployment (total $300,000).

Government of Nova Scotia. (2001). Nova Scotia’s nursing strategy. Retrieved March 2, 2006, from http://www.gov.ns.ca/health/downloads/Strategy. pdf

Nova Scotia nursing strategy

2006

Bursaries are provided to nurses who agree to work in Nova Scotia for at least one year upon graduation. In 2001-02, $3,000 bursaries were provided to 25 students. In 2002-03, bursaries were increased to $4,000 and offered to twice as many students. In 2002, 80% of nurse graduates stayed in Nova Scotia.

Government of Nova Scotia. (2003). Nova Scotia’s nursing strategy: Quick facts. Retrieved March 2, 2006, from http://www.gov.ns.ca/health/nursing/ facts.htm

The Practice Environment Collaboration Program provided by the College of Registered Nurses of Nova Scotia (CRNNS) is helping to create a more positive working environment for nurses, as well as helping them identify their professional development needs. Nunavut labour-market supplement

1999

This initiative was put in place by the Department of Health and Social services. The labour-market supplement, which was made effective December 1, 1999, means almost one million dollars in extra salary incentives for Nunavut nurses. The supplement has two components: a recruitment bonus and a retention bonus. The recruitment bonus applies to newly -hired indeterminate nurses and the retention bonus applies to existing indeterminate nurses. Depending on the length of service, nurses will each receive between $3,000 and $5,000.

Government of Nunavut. (1999). Nunavut nurses to receive labour-market supplement. Retrieved March 2, 2006, from http://www.gov.nu.ca/ dec799.htm

Retention Strategies for Nursing: A Profile of Four Countries

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Annex 2. Canadian Recruitment and Retention Policies at the Provincial/Territorial Level (continued) Policy/Guidance

Year

Description

Source Documents

Nurses who sign on for a minimum three-year stay in Nunavut were offered a taxable labour-market supplement of $24,000. The supplement consists of a $6,000 sign-on bonus and $2,000 paid quarterly over two years, plus a $2,000 bonus at the end of the second year.

Government of Nunavut. (2001). Government of Nunavut intensifies efforts to recruit nurses. Retrieved March 2, 2006, from http://www.gov.nu.ca/ june292001.htm

2002

Addresses core reasons for instability in the nursing workforce. Part of a broader Health Human Resource Strategy intended to improve access to care, reduce wait times, and improve patient outcomes by increasing the recruitment and retention of health care professionals.

Government of Ontario. (2002). Guidelines for application to the Ontario nursing strategy. Retrieved March 2, 2006, from http://www.health.gov. on.ca/english/providers/ program/nursing_sec/ strategy_app_mn.html

Ontario long-term care facility 2004 worker retention manual

Keeping and developing quality employees is crucial to the continued existence of long-term care facilities. This document focuses on best practices and employee retention strategies to assist facility administration in retaining and empowering current and future staff.

Government of Ontario. (2004). Long-term care facility worker retention. Retrieved March 2, 2006, from http://www.health.gov.on.ca/english/ providers/program/ltc_redev/dev_tools/learn_ser/ booklet_4.pdf

Investment in nursing education in Ontario

2005

$10 million investment in clinical simulation equipment and the development of Clinical Centres of Excellence for key nursing priorities (e.g., critical care).

Government of Ontario. (2005). Investing in clinical simulation equipment. Retrieved March 2, 2006, from http://www.health.gov.on.ca/english/ media/news_releases/ archives/nr_05/bg_111605. pdf

Report on Ontario Health Human Resources

2005

Progress report organized around six key themes: 1. Coordinating the education system with the health system 2. Gathering better data about current and future needs 3. Improving access to doctors, nurses, and other health care providers 4. Supporting providers to work collaboratively 5. Using innovative technologies 6. Supporting providers in the workplace

Government of Ontario. (2005). Laying the foundation for change: A progress report on Ontario’s health human resource initiatives. Retrieved March 2, 2006, from http://www.health.gov.on.ca/english/ public/pub/ ministry_reports/hhr_05/hhr_05.pdf

Improving quality of nursing care in Ontario

2006

$40 million will be held in a trust fund and administered by a management committee representing the Registered Nurses Association of Ontario, the Ontario Nurses Association, and the Registered Practical Nurses Association of Ontario. The management committee will establish an application process for hospitals interested in receiving funding from this initiative. The funding will be used in the following ways: • Nurses will be provided with opportunities to expand their knowledge and training so they can work in other clinical areas or in nursing roles in hospitals where there are vacancies. • Funding will be made available for registered nurses and registered practical nurses. Hospitals will be reimbursed for costs incurred for up to six months of orientation, training, and education that increase the clinical skills and expertise of nurses.

Government of Ontario. (2006). McGuinty government investing in quality nursing care. Retrieved March 2, 2006, from http://www.health. gov.on.ca/english/media/news_releases/ archives/ nr_06/jan/nr_012606.html

Nurse recruitment in Nunavut 2001

Ontario nursing strategy

Retention Strategies for Nursing: A Profile of Four Countries

19

Annex 2. Canadian Recruitment and Retention Policies at the Provincial/Territorial Level (continued) Policy/Guidance

Year

Description

Source Documents

Prince Edward Island nursing retention and recruitment strategy

2005

The provincial government announced the re-instatement of the following programs: • Bachelor of Nursing Student Summer Employment Program • Bachelor of Nursing Student Sponsorship Program • Health Care Futures Program

Government of Prince Edward Island. (2005). Nursing recruitment and retention strategy. Retrieved March 2, 2006, from http://www.gov.pe.ca/ infopei/index.php3? number=1006315&lang=E

The Action Plan for Saskatchewan Health Care

2001

Included $3 million in new funding to train more health providers and to offer return of service bursaries to students studying in selected health programs. It also expanded continuing education and professional development opportunities for health providers, staff, and managers to upgrade their skills; supported initiatives intended to develop quality health workplaces; and retain, recruit, and train Aboriginal people working in the health sector. The plan also provided additional support for initiatives to develop quality health workplaces.

Government of Saskatchewan. (2001). Healthy people. A healthy province: The action plan for Saskatchewan health care. Retrieved March 2, 2006, from http://www.health.gov.sk.ca/hplan_health_ care_plan.pdf

Saskatchewan retention and recruitment strategy update

2002

The provincial government devoted $3.8 million in 2002 to support return of service bursary programs in the health field. As part of the retention strategy outlined in the provincial Action Plan, an additional $800,000 was committed to the bursary program in 2002.

Government of Saskatchewan. (2002). Bursaries promise more health professionals. Retrieved March 2, 2006, from http://www.gov.sk.ca/newsrel/ releases/2002/12/13-950.html

Saskatchewan nursing strategies

2003

Four key strategies identified in the Action Plan: 1. Educating more nurses in Saskatchewan by adding new education seats 2. Expanding bursary programs to nursing professionals 3. Improving health workplaces 4. Supporting retention and recruitment

Government of Saskatchewan. (2003). A progress report on Saskatchewan’s nursing strategies. Retrieved March 2, 2006, from http://www.health.gov.sk.ca/ mc_dp_pr_sk_nursing _strategy.pdf

Saskatchewan nursing strategies update

2003

As part of its commitment to attract health professionals, the provincial government is expanding the registered nurse/registered psychiatric nursing education program by 100 positions and the practical nursing program by 16 positions.

Government of Saskatchewan. (2003). More nurses for Saskatchewan. Retrieved March 2, 2006, from http://www.gov.sk.ca/newsrel/releases/2003/07/31550.html

Working Together: Saskatchewan’s Health Workforce Action Plan

2005

This plan stems from the First Ministers’ Meeting 2004 and builds upon the Action Plan released in 2001.

Government of Saskatchewan. (2005). Saskatchewan’s health workforce action plan. Retrieved March 2, 2006, from http://www.health. gov.sk.ca/hplan_health_workforce _action_plan. pdf

The plan has five goals with specific objectives related to retention and recruitment, as well as the work environment: 1. Ensure the health care system has a sufficient number and effective mix of health care professionals who are used fully to provide safe, high-quality care. 2. Ensure the health system has safe, supportive, and quality workplaces that help to retain and recruit health care professionals. 3. Ensure Aboriginal people fully participate in the health sector in all health occupations. 4. Ensure the education, training, and supply of health care professionals in the province s aligned with projected workforce requirements and health service needs.

Retention Strategies for Nursing: A Profile of Four Countries

20

Annex 2. Canadian Recruitment and Retention Policies at the Provincial/Territorial Level (continued) Policy/Guidance

Year

Description

Source Documents

5. Ensure the health workforce is innovative, flexible, and responsive to changes in the health system. Yukon retention and recruitment plan

2001

A Continuing Nursing Education Fund of $50,000 has been established to help nurses obtain and maintain current knowledge and skills. The fund, which is administered by the Yukon Registered Nurses Association, augments existing education support.

Yukon Government. (2001a). Liberal government enhancing recruitment and retention plan for health professionals. Retrieved March 2, 2006, from http:// www.gov.yk.ca/news/2001/Feb-01/01-024.pdf

$10,000 will go towards establishing a Yukon Nursing Advisory Council to advise the government on nursing issues. Retention bonuses for Yukon 2001 Nurses

Commencing July 2001, registered nurses employed by the Yukon government are eligible for a $3000 bonus each year for three years. Community nurse practitioners also receive an additional $3000 per year for three years.

Yukon Government. (2001b). Yukon nurses to get retention bonuses. Retrieved March 2, 2006, from http://www.gov.yk.ca/news/2001/Jun-01/01-156. pdf

Retention Strategies for Nursing: A Profile of Four Countries

21

Annex 3. Retention Policies in Uganda Policy/Guidance

Year

Description

Source Documents

Increase nursing workforce numbers

2001

Additional recruitment of nursing aides will be carried out – new recruits will undergo training for a period of 6-9 months.

The Republic of Uganda Ministry of Health (2001) Health Policy Statement 2001/2002

Upgrade skills of nursing aids

2001

Existing cadre of nursing aides will undergo further training for at least 3 months.

The Republic of Uganda Ministry of Health (2001) Health Policy Statement 2001/2002

Harmonize positions and 2001 salary scales of nursing staff in public service

Will be done through a consultative process involving the Ministries of Health and Public Service, the Health Service Commission, the Nurses and Midwives Council, and the Association of Ugandan Nurses and Midwives.

The Republic of Uganda Ministry of Health (2001) Health Policy Statement 2001/2002

Professional development

2004

A strategy to counter the problem of migration of health professionals.

Awases et al. (2004) Migration of health professionals in six countries: A synthesis report

Increase in salaries for health care workers

2006

The government has increased salaries for all health care workers including nurses and midwives in 2004/2005.

M. Chota, personal communication, March 16, 2006

Housing allowances for hospital staff

2006

Houses were available for staff near the hospitals. However, when the number of staff increased, this option was no longer available and housing allowance packages were included in the salary of health care workers. There is a plan to reverse this decision so that more staff houses will be constructed near health care facilities.

M. Chota, personal communication, March 16, 2006

Lunch allowance for health care workers

2006

Given as a part of staff salary package.

M. Chota, personal communication, March 16, 2006

Special allowances/incentives for health care workers in remote areas

2006

Some districts are providing some form of incentive to their health care workers; other districts are discussing the possibility of using this strategy.

M. Chota, personal communication, March 16, 2006

Retention Strategies for Nursing: A Profile of Four Countries

22

Annex 4. Retention Policies in England Policy/Guidance

Year

Description

Source Documents

Adoption of staffing targets

2000

A target of 20,000 more nurses and midwives has been set for 2004.

Department of Health (2000a) The NHS plan: A plan for investment, a plan for reform

More training places

2000

Aim for 5,500 more nurses to be trained each year.

Department of Health (2000a) The NHS plan: A plan for investment, a plan for reform

Improved pay for NHS staff

2000

Between 1997 and 2000, nurses have received a 15% increase. The government recognizes the need for a new pay system as the current one inhibits the modernization of the service. The government will increase the pay of midwives immediately and will increase the pay of staff in local labour markets where staff shortages exist. Nurses and other staff will receive more help with accommodation costs (housing, possibly staff hotels), and the government will set up 2,000 more units of nurse accommodation in London. In addition, it will analyze nurse accommodation needs outside London, particularly in the South East.

Department of Health (2000a) The NHS plan: A plan for investment, a plan for reform

International recruitment

2000

The Department of Health will work actively to recruit health care staff from abroad (but not from developing countries), and will carefully plan international recruitment for nursing and midwifery.

Department of Health (2000a) The NHS plan: A plan for investment, a plan for reform

Improving Working Lives Standard

2000

The government is implementing an Improving Working Lives (IWL) Standard. It is expected that all NHS employers will put the IWL standard into practice. The standard addresses training and development, discrimination and harassment, improving diversity, zero tolerance on violence against staff, reducing workplace accidents, reducing sick absences, providing better occupational health and counseling services, and conducting annual attitude surveys. The government plans to invest: £140 million by 2003/04 in professional development for staff and £9 million to improve the workplace environment. The government also plans to invest £8 million by 2003/04 to extend occupational health services. The IWL also includes more flexible working conditions (e.g., childcare support and employee led rostering). The government will invest £30 million by 2004 for childcare services for NHS staff.

Department of Health (2000b) Improving working lives standard: NHS employers committed to improving the working lives of people who work in the NHS

Lifelong learning framework

2001

This framework is directed at NHS organizations, managers, supervisors, and staff. The goal is to help staff develop their skills to support changes and improvements in patient care, take advantage of wider career opportunities, and realize their potential. This framework will be implemented by the establishment of a new NHS University and making the NHS an effective learning organization.

Department of Health (2001) ‘Working together – learning together:’ A framework for lifelong learning for the NHS

Retention Strategies for Nursing: A Profile of Four Countries

23

Annex 4. Retention Policies in England (continued) Policy/Guidance

Year

Description

Source Documents

Reduce violence in the workplace

2001

Recommendations are proposed to substantially reduce the incidence of violence against social care workers in the NHS. The plan includes sending employers printed resource material on violence against staff, implementing training programs, and ensuring employer monitoring of violence in the workplace. Employers are given targets to meet to ensure a reduction in workplace violence.

National Task Force on Violence Against Social Care Staff (2001) Report and national action plan

Making the NHS a model employer

2002

To improve human resources in the NHS, the NHS Plan has four strategies including making the NHS a model “three star” employer by having the best policies, practices, and facilities.

Department of Health (2002b) HR in the NHS Plan: More staff working differently

Ensuring the NHS provides a model career

2002

In ensuring this policy, the NHS will implement the skills escalator in which lifelong learning is encouraged for staff. Efficiencies and skill mix benefits are generated by delegating roles and workload down the escalator. The five modernizations (modernization of pay, modernization of learning & personal development, modernization of professional regulation, increasing staff numbers and modernizing workforce planning, and modernization of jobs) will support the skills escalator.

Department of Health (2002b) HR in the NHS Plan: More staff working differently

Improving staff morale

2002

This policy will also improve HR in the NHS and will begin with discussing the issue with staff and improving staff morale.

Department of Health (2002b) HR in the NHS Plan: More staff working differently

Building people management skills

2002

A large part of this policy includes leadership training at the management level.

Department of Health (2002b) HR in the NHS Plan: More staff working differently

Adoption of staffing targets

2002

A second target of 35,000 additional nurses and midwives has been set for 2008.

Department of Health (2002a) Delivering the NHS plan: Next steps on investment, next steps on reform

New pay system for nurses

2002

This system will ensure staff that take on new responsibilities and make the greatest contribution will get extra rewards. It will also help to recruit and retain more staff, raise productivity, and promote flexibility as pay modernization allows local employers to pay staff according to the new roles they take on.

Department of Health (2002a) Delivering the NHS plan: Next steps on investment, next steps on reform

Professional development

2002

All NHS staff will have access to professional development programs through the new NHS University.

Department of Health (2002a) Delivering the NHS plan: Next steps on investment, next steps on reform

NHS as a model employer

2002

New “star rating” performance assessments of NHS organizations will include measures of how well staff are involved and supported. By 2004, organizations will invest more in flexible working, childcare support, and personal development to support their recruitment and retention programmes.

Department of Health (2002a) Delivering the NHS plan: Next steps on investment, next steps on reform

Retention Strategies for Nursing: A Profile of Four Countries

24

Annex 5. Retention Policies in Canada Policy/Guidance

Year

Description

Source Documents

Develop healthy workplace guidelines

2002

$250,000 has been provided by Health Canada to develop Healthy Workplace Guidelines, which will synthesize information and recommendations from recent health human resource reports/publications to provide clear and practical strategies for employers to improve nursing working conditions.

Health Canada (2002) Health Canada to develop Healthy Workplace Guidelines for Canadian Nurses

Four themes were identified in this report with strategies for change: 1. Unified action 2. Improved data, research, and human resource planning 3. Appropriate education 4. Improved deployment and retention

Advisory Committee, Health Delivery and Human Resources (2003) A report on the nursing strategy for Canada

Purpose is to identify and support current initiatives/ actions that promote and maintain healthy workplace practices. The initiative will also address indicators of unhealthy work environments. It is hoped that this initiative will lead to improved outcomes in one or more of the following: recruitment and retention; quality of patient care and patient safety; operational excellence; and other service quality outcomes. Health Canada has provided $3.5 million to support the HWIs of individual organizations.

Health Canada (2004a) Health Canada’s Healthy Workplace Initiative

Recruit and retain more health care workers 2004

Objectives are to: increase interest in health careers; (including in areas of shortage); increase diversity of health care providers; increase supply of health care providers; improve utilization and distribution of existing health care providers; and improve working environments for health care providers. The strategy will be implemented together with the provinces, territories, health stakeholders, employers, professionals, international organizations, and various federal departments.

Health Canada (2004b) Health human resource strategy: Recruitment and retention

Improve national health human resources planning and coordination

2005

Ninety million dollars ($90M) will be provided over five years to support better planning and management, improved recruitment and retention, and educational initiatives.

Health Canada (2005) 2003 First Ministers’ Accord on Health Care Renewal

Improve medical and diagnostic equipment

2005

One and a half billion dollars ($1.5B) will be provided over three years to provide equipment to enhance patient care and improve the working conditions of health providers (e.g. hospital beds and patient lifting devices).

Health Canada (2005) 2003 First Ministers’ Accord on Health Care Renewal

Money will be used from the $1.3 billion dedicated to First Nations and Inuit Health Services to improve nursing services in these areas.

Health Canada (2005) 2003 First Ministers’ Accord on Health Care Renewal

Ensure an adequate number of 2003 nurses, appropriate education of nurses, and effective utilization and distribution of nurses in Canada

Health Canada’s Healthy Workplace Initiative (HWI)

Enhance nursing services in First Nations and Inuit communities

2004

2005

Department of Finance Canada (2003) Budget 2003: Investing in Canada’s healthcare system

Department of Finance Canada (2003) Budget 2003: Investing in Canada’s healthcare system

Department of Finance Canada (2003) Budget 2003: Investing in Canada’s healthcare system

Retention Strategies for Nursing: A Profile of Four Countries

25

Annex 6. Retention Policies in Thailand Policy/Guidance

Year

An incentive strategy was 2006 proposed to the government. It included a salary plan for health personnel that takes into consideration the inherent responsibility and risk of their jobs. Salary increases or top-up incentives were recommended for highly skilled specialists and those who work night shifts.

Description

Source Documents

Although the government did not accept all of the proposed recommendations, they have committed the following payments for nursing groups for the fiscal year of 2005:

R. Phuphaibul, personal communication, April 4, 2006

Group 1: Nurses who work in outpatient departments – 900 Baht per month (39 Baht = 1 US dollar). Group 2: Nurses who work in inpatient departments and other units – 1,100 Baht per month. Group 3: Nurses who work in critical care units, advance practice nurses, anesthetists, nurse practitioners, and other nurse specialists – 1,450 Baht per month. The Council of Nurses has proposed increases for all three groups for the 2006 fiscal year.

Retention Strategies for Nursing: A Profile of Four Countries

26

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