Dissertation submitted in fulfilment of the requirements for the Degree of Master in Technology: Emergency Medical Care, Durban University of Technology, 2010. / South Africa currently has 1631 registered Advanced Life Support (ALS) paramedics to tend to the pre-hospital advanced life support needs of just under 50 million people. Compared to the globally accepted ratio of 1:10 000, the number of ALS paramedics in South Africa is grossly inadequate. The current shortage of South African ALS paramedics may be ascribed to migration. However, although literature on health worker migration in general abounds, there is a marked lack of national or international statistics and information on migration of ALS paramedics and their migration. Current measures to manage migration appear to be ineffective. The success of future strategies is dependent on an understanding of the migration of South African ALS paramedics - an understanding that presently does not exist. Purpose The purpose of this study was to describe the migration of South African undergraduate Advanced Life Support paramedics who qualified between 2001 and 2006, and to then develop a framework of retention strategies. In particular, it determined the extent and nature of their migration, identified the factors that have contributed to their decision to work outside South Africa and identified strategies to retain or encourage the return of ALS paramedics to practice exclusively in South Africa. Methods The study consisted of a two-phase mixed method descriptive survey. Paramedics with ALS undergraduate diplomas who qualified in South Africa between 2001 and 2006 made up the study population. Quantitative data (Phase One) was obtained from a web-based survey distributed to the accessible population (N=97). Thereafter, qualitative data (Phase Two) was gathered through in-depth interviews with selected information rich participants (n=10) also from within the accessible population. Through methodological triangulation, data from Phase One and Phase Two were Page vi integrated to obtain an in-depth understanding of South African ALS paramedic migration. Results Significant differences existed in the distribution of age (p=0.035), and years of experience post-graduation (p=0.007) and the ALS paramedic deemed most likely to migrate were individuals between the ages of 21 – 30. 15 (55%) of the participants working outside the country were engaged in short term contracts while all 24 (100%) of participants working inside South Africa were permanently employed. 18 (75%) of respondents working inside South Africa intended migrating, 12 (67%) of which intended to do so within 0 to 2 years. Nine major factors or reasons for migration were identified by participants. Working conditions, physical security and economic considerations were ranked as the top three major factors most likely to contribute to the decision or intended decision to migrate. This study also found five primary decisions that likely emerge during the life of a South African ALS Paramedic. The outcome of each decision is a result of facilitators weighted against barriers. Facilitators are factors that supported each of the primary decisions while barriers weakened or rejected them. Findings indicated that many barriers existed which rejected or weakened the decision of ALS paramedics to work inside South Africa, return to South Africa or remain in South Africa. On the converse, a vast number of facilitators existed which spurred continued migration. Conclusions As the decision to migrate may be conceptualised as early on as when individuals decide to become ALS paramedics, the constructs of return and retention strategies have to extend as far as revising recruitment policies. Preference or places into training programmes should be given to individuals who are less inclined to migrate, these include: military personnel; those already employed in the EMS, older mature candidates; candidates with families that have already settled in SA; and recognition of prior learning (RPL) candidates who are predominately obligated by contract to remain in South African EMSs.

The purpose of this study was to explore what keeps nurses in nursing by examining the impact of the relational experiences between the nurse and her or his patient in the context of the nursing situation. Heideggerian hermeneutic phenomenology grounded the study and was the method used to interpret the registered nurse participants' meaning of their everydayness. The nurses' first hand perspectives elicited implications for nursing practice. This qualitative research study examined what keeps nurses in nursing. The eight registered nurse participants provided rich descriptive data from which four relational themes emerged: Practicing from Inner Core Beliefs, Understanding the Other from Within, Making a Difference, and Nursing as an Evolving Process. The hermeneutical interpretative process guided the researcher to synthesize the themes into a constitutive pattern of meaning which the researcher named Intentional Compassion Energy. In intentional caring consciousness, the nurse intentionally knows the nursed as whole. Compassion energy is the intersubjective gift of compassion that gives nurses the opportunity to be with the nursed. Compassion energy is composed of compassionate presence, patterned nurturance and intentionally knowing the nursed and self as whole. Thus, intentional compassion energy is defined as the regeneration of nurses' capacity to foster interconnectedness when the nurse activates the intent to nurse. Intentional compassion energy was discovered in the meaning of the nurse participants being in their everydayness of practice. The participants described the intention to care compassionately as the grounding of their practice, striving to understand the other, to make a difference while living their nursing as an evolving process. Hermeneutic phenomenology provided the opening to discover what keeps nurses in nursing. / by Dorothy J. Dunn. / Thesis (Ph.D.)--Florida Atlantic University, 2009. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2009. Mode of access: World Wide Web.

The supply of non-physician clinicians (NPCs), such as physician assistant (PAs), could significantly influence demand requirements in medical workforce projections. This study predicts supply of and demand for PAs from 2006 to 2020. The PA supply model utilized the number of certified PAs, the educational capacity (at 10% and 25% expansion) with assumed attrition rates, and retirement assumptions. Gross domestic product (GDP) chained in 2000 dollar and US population were utilized in a transfer function trend analyses with the number of PAs as the dependent variable for the PA demand model. Historical analyses revealed strong correlations between GDP and US population with the number of PAs. The number of currently certified PAs represents approximately 75% of the projected demand. At 10% growth, the supply and demand equilibrium for PAs will be reached in 2012. A 25% increase in new entrants causes equilibrium to be met one year earlier. Robust application trends in PA education enrollment (2.2 applicants per seat for PAs is the same as for allopathic medical school applicants) support predicted increases. However, other implications for the PA educational institutions include recruitment and retention of qualified faculty, clinical site maintenance and diversity of matriculates. Further research on factors affecting the supply and demand for PAs is needed in the areas of retirement age rates, gender, and lifestyle influences. Specialization trends and visit intensity levels are potential variables.

The shortage of skilled professionals in the health sector has been an ongoing problem. This has resulted in poor service delivery and ultimately increased patient deaths. The primary objective of this study was to develop a conceptual model to retain scarce skilled professional workers in the health sector. An exploratory study was conducted which included both professionals and non-professionals in the pathology sector. Recruitment was done from a population of 207 employees. In total 188 employees responded, of which 116 were professionals and a comparator group of 72 being the non-professionals. The study was conducted in three phases. In the first phase, quantitative data collection methods such as the job diagnostic survey, career orientation inventory, organisational commitment questionnaire and intention to quit questionnaire were used to assess the characteristics of the groups of interest. The relationship between the independent and dependent variables were calculated. The results revealed that only a few of the traditional predictors influenced retention in the professional group. The predictors worked much better for the non-professional group. It was concluded that traditional retention strategies are not suitable to retain professionals in the health sector. The second and third phases utilised qualitative methods. The second part of the study related to identifying factors which retain professional staff. Following interviews with 15 professionals, ten themes were identified which relate to the retention of professionals. The third phase of the study consisted of interviews with 3 managers, and this was to determine what the managers can do to influence retention. A retention model for the professionals was then developed. This model not only contributes to the body of knowledge, but is also a useful managerial tool to manage professionals in the health sector / Graduate School of Business Leadership (SBL) / D.B.L. (Business Leadership)