The Internet offers potential for reducing professional isolation of Appalachian health care providers by enhancing access to medical information and facilitating contact with colleagues. However, there is a gap in the knowledge of current computer and Internet access in Appalachia, and in the technology-related behaviors and attitudes of health care professionals there. This study examined Internet-related access and behaviors of Appalachian family physicians and advanced practice nurses. A survey was mailed to 429 graduates of East Tennessee State University's family medicine residency and advanced practice nursing programs currently in practice in southern and central Appalachia. Demographic information was collected from ETSU graduate records. The Dillman survey method included a pre-notice letter, two survey mailings, and post card and telephone follow-ups. Two hundred sixty-four providers (61.5%) returned surveys. Data were analyzed using SPSS. Respondents were similar to the total population in gender, provider discipline, age, and percentage in rural practice. Workplace computer access was common; 59.6% had sole access and 40.2% shared access. Internet access was: 82.7% broadband, 13.5% dial-up, and 2.4% no access. Although rural providers were more likely than urban to have slower dial-up access, they regularly used the Internet. Over 75% of providers accessed the Internet at home for work; 34% reported dial-up and 66% broadband home connection. Although 50% used the Internet for continuing education in 2004, most preferred in-person workshops or print-based modes of continuing education; 58.9% e-mailed daily and 80% accessed medical information via the Internet regularly. Other Internet uses included accessing online journals and patient information, receiving professional association updates, filing insurance, and writing prescriptions. The Internet is ubiquitous in Appalachia; health care providers access it for a variety of professional activities daily. Telemedicine was not a popular technological innovation. Of those 20.8% reporting telemedicine availability in the practice, few used it. When presented with a list of possible benefits of telemedicine, 41.1% selected "none of the above". Although many technological innovations are used regularly by Appalachian health care providers, barriers to the use of new technologies lie more in attitudes than in technology access.

An associate degree of nursing program in the southeastern region of the United States has had significant increases in student attrition over the past few years. Admission requirements did not include an entrance exam, such as the Test of Essential Academic Skills (TEAS), which may be useful in decreasing the deficiencies associated with poor student progression. Guided by the Knowles' theory of adult learning and Bandura's social learning theory, the purpose of this correlation study was to explore the relationship between the TEAS scores and the cumulative grade point average (GPA) of first-year students to determine if success at the completion of students' first year in the nursing program can be predicted from the overall TEAS score and its subsections of reading, math, science, and English. Archival data for 130 nursing students enrolled from 2012 to 2013 were analyzed using stepwise multiple regression. According to the study results, there was a significant correlation of the total TEAS score and student GPA after the first year of nursing school. The first semester GPA was positively related to the TEAS English score and the TEAS science score; however, there was no significant correlation found for TEAS math and reading scores with students' GPA. A 3-day workshop and a student mentoring program were developed to address academic deficiencies of at-risk nursing students, particularly in English and science. Positive social change can occur through improved retention, which will lead to a higher number of nursing graduates eligible to take and pass the National Certification Licensure Exam for Registered Nurses, provide job security for graduates, and improve the present critical shortage of nurses in the United States.

Bakgrund: Idag beräknas bristen på sjuksköterskor uppgå till 5,9 miljoner sjuksköterskor globalt, ensiffra som väntas stiga. Att sjuksköterskor lämnar sina arbetsplatser beror på flera faktorer. Hög arbetsbelastning, etisk stress och bristande ledarskap är några exempel. Detta leder till brist på god omvårdnad och bristande patientsäkerhet.  Syfte: Syftet med studien var att undersöka vad som påverkar sjuksköterskors intention att stanna på sin arbetsplats.  Metod: En kvalitativ litteraturstudie baserad på data från 10 originalartiklar genomfördes, och analyserades med en tematisk innehållsanalys.  Resultat: Tre teman och åtta subteman identifierades. Individuella faktorer innehöll subteman: Privatliv, Klinisk erfarenhet och Ekonomiska faktorer. Det andra temat, Tillfredställelse i arbetet med subteman Professionsstolthet, omvårdnadsfokus och utmanande utveckling. Slutligen Mellanmänskliga relationer, vilken beskrev vikten av Omsorgsfullt ledarskap och Kollegial sammanhållning.  Slutsats: Sjuksköterskor behöver en stabil organisation och en miljö där de tillåts arbeta efter deras professionella autonomi, möjlighet till utveckling, ett gott ledarskap och goda relationer med kollegor. Vidare finns det likheter mellan sjuksköterskors intention att stanna och intentionen att lämna, men även viktiga skillnader. Ytterligare forskning kring detta samband förelsås. Detta för att bidra till god omvårdnad och en säker vård för patienterna. / Background: The global nursing shortage is estimated to 5,9 million nurses. Nurses are leaving their workplaces and the profession. This relates to several factors, for example, high workload, moral distress, and lack of good leadership which contributes to lack of proper nursing care and poor patient safety.   Aim: The aim of this study was to examine what affect nurses’ intention to stay in their workplace.  Method: A literature review of qualitative data was conducted from ten original articles, and was analysed using a qualitative thematic analysis approach.  Results: Three themes and eight subthemes were identified. Individual factors containing subthemes: personal life, clinical experience and financial factors. The second theme was Work satisfaction including subthemes professional pride, nursing care and challenging growth. The last theme was Interpersonal relationships describing the importance of caring leadership and collegial support.  Conclusion: Nurses´ need stable organisations, good leadership, collegial support and being allowed to use their expertise and professional autonomy. There are many similarities between nurses’ intention to stay and intention to leave, but also important differences. Further research investigating these differences are recommended to improve nurses’ work environment.

In the realm of higher education, retention is a concept vital to the progression and security of all institutions. This remains true for all nursing programs as well because reports have shown an attrition rate as high as 50% in some nursing programs across the globe. Along with the nursing shortage projected in the next 20 years, retention in nursing programs poses a massive problem for not just higher education but healthcare as well. Therefore, it is important for nursing educators to understand the factors affecting student completion of a nursing program. This two-phase, mixed-methods study sought to answer the overarching research question: What factors contribute to completion of the Southcentral Community and Technical College (SKYCTC) Practical Nursing (PN) program within three semesters? Since the majority of nursing programs utilize a selective admission process for accepting students, the first phase of the study gathered admission criteria on six cohorts of students accepted into the SKYCTC PN program from August 2008 through May 2015. This quantitative data was analyzed to determine if any of the admission criteria were related to completion of the program. For the second phase, qualitative data was gathered through a focus group attended by 11 graduates of the SKYCTC PN program between August 2008 and May 2015. The purpose of the focus group was to gather environmental or academic influences that graduates attributed to their success in completing the program.

The purpose of this multiple case study was to explore strategies that healthcare facility leaders in Central Minnesota use to recruit and retain qualified nurses. Participants were 6 healthcare facility leaders including 2 nursing directors, 2 human resource personnel, 1 nurse supervisor/administrator, and 1 nurse recruiter who had the knowledge and experience in recruitment and retention of Registered Nurses (RNs) in healthcare facilities in Central Minnesota. The Herzberg 2-factor theory was the conceptual framework. Semistructured interviews were used to collect data. Data were analyzed using Morse's 4 steps data analysis process. The major themes were recruitment strategies and retention incentives. The recruitment strategies were the various hiring methods participants used to attract and gain RNs, and the retention incentives were the benefits that motivated and retained RNs. Participants relied on both recruitment strategies and retention incentives to manage the shortages of RNs. The results provide healthcare facility leaders with additional information about how to successfully recruit and retain qualified RNs, which may lead to a larger and potentially satisfied nursing population. Social implications include strengthening the nursing workforce, increasing productivity for healthcare facilities, providing better customer service and increased patient satisfaction, and contributing to more satisfied RNs and families, as well as helping the local communities and the economy.

Bakgrund Det blir allt vanligare att sjuksköterskor väljer att avsluta sina anställningar, byta arbetsplats eller byta bransch, vilket leder till att det på många håll råder brist på sjuksköterskor samt är underbemannat på arbetsplatser. Brist på sjuksköterskor innebär större arbetsbelastning och tidsbrist vilket riskerar att vårdkvalitet, personcentrerad vård samt patientsäkerhet äventyras. Syfte Syftet med denna litteraturstudie är att belysa hur omvårdnadsarbete påverkas vid underbemanning av sjuksköterskor avseende patientsäkerhet och vårdkvalitet. Metod Examensarbetet genomfördes som en strukturerad litteraturstudie med inslag av den metodologi som används vid systematiska översikter. En innehållsanalys genomfördes av13 vetenskapliga artiklar. Resultat En konsekvens av underbemanning av sjuksköterskor var brister i utförande av omvårdnadsmoment. Bristerna påverkade patientnära arbete, sjuksköterskors arbetsmiljö och förutsättningar för att vårda patienter utifrån ett personcentrerat förhållningssätt. Ett högt antal patienter per sjuksköterska kunde påverka vården negativt. Slutsats Underbemanning av sjuksköterskor bidrar till hög arbetsbelastning och tidsbrist, vilket resulterar i att utförande av omvårdnadsåtgärder blir bristande. Sjuksköterskor tvingas prioritera mellan arbetsuppgifter, vilket resulterar i att vården som bedrivs inte alltid uppfyller principerna för personcentrerad vård. Konsekvenser av underbemanning påverkar både patienter och sjuksköterskor negativt och riskerar att resultera i försämrad vårdkvalitet och minskad patientsäkerhet. / Background It is becoming more common that nurses choose to end their employment, change workplaces or change industries, resulting in nursing shortage and understaffed workplaces. A lack of nurses means a greater workload and time shortage, providing a risk that the quality of care, person-centred care and patient safety are compromised. Aim The aim of this literature review is to illustrate how nursing care is affected by nurse understaffing regarding patient safety and quality of care. Method This thesis was carried out as a structured literature study with elements of the methodology used in systematic reviews. A content analysis was conducted on 13 articles in this literature review. Results A consequence of nurse understaffing is insufficiency in conducting nursing care tasks. The shortcomings in nursing care tasks affect bedside care, nurses’ work environment and the circumstances that provide for person-centered care. High nurse-to-patient ratio affects the care that nurses can provide to patients. Conclusions Nurse understaffing contributed to high workload and time shortage which resulted in insufficiency in conducting nursing care tasks. Nurses were forced to prioritize between work tasks which resulted in care that not always met the principles of conducting personcentered care. The consequences of nurse understaffing affected both patients and nurses negatively and risked resulting in declining quality of care and patient safety.

The United States is in the middle of a gripping nursing shortage; a shortage that is putting patients' lives in danger. This study determined the impact community and tribal colleges in severely economically distressed counties of the United States have on the nursing shortage faced by health care facilities serving these areas. The initial sample of 24 institutions selected in the Ford Foundation's Rural Community College Initiative (RCCI) (1995-2000). Data were collected from the Fall 1998 National Study of Post Secondary Faculty to obtain characteristics of faculty and from the 2003 Integrated Postsecondary Education Data System (IPEDS) to obtain characteristics of students, both at all publicly-controlled community colleges, all tribal colleges, and the 24 RCCI colleges that included 18 community and six tribal colleges. A survey was sent to the directors/deans/chairs of the nursing programs to ascertain issues related to the nursing program, nursing faculty, and nursing students. Respondents were asked to identify the healthcare facilities used for students' clinical experiences. A survey was then sent to each of these facilities asking about rural health, and source of nursing staff. Findings: 1) 87% of these these rural healthcare facilities are experiencing a significant shortage of nurses, and they are challenged to recruit and retain nursing staff; 2) Nursing programs, including both Licensed Practical Nursing and Associate's Degree Nursing are important to these rural community and tribal colleges, have seen growth over the past 5 years and expect to continue growth (86%); 3) Financial aid for nursing students is critically important; 4) Students are predominantly white and female; minorities are significantly under-represented; 5) Lack of subsidized public transportation and child care for nursing students even at tribal colleges are barriers that impact program completion; and 6) A shortage of nursing faculty exists at rural community and tribal colleges that negatively impacts student enrollment in these programs, thus reducing the rural nursing workforce pipeline. It is the rural community and tribal college nursing programs help provide severely economically distressed counties of the United States with the nursing workforce needed to decrease the nurse to patient ratio.

Personalbristen av sjuksköterskor i Sverige har blivit uppmärksammad i media och är en kritisk fråga som har stor påverkan på sjukvården. Trots detta ses yrket som ett kall då omvårdnad av människor är betydelsefullt för sjuksköterskor och är den främsta drivkraften till varför människor väljer detta yrke. Uppfattningen av yrket som målas upp i samhället är ofta i negativa termer vilket inte underlättar hanteringen av personalbristen. Många gånger hänger den mörka bilden av yrket ihop med dålig vård för samhället som konsekvens av bristande psykosocial arbetsmiljö och hög arbetsbelastning. Mindre forskning finns om kombinationen av teorier om kall och arbetsmiljö. Denna uppsats kommer därför undersöka krav-kontroll-stöd-modellen som bakgrund till förståelsen av sjuksköterskors psykosociala arbetsmiljö i relation till kallyrket som teoretisk utgångspunkt. Uppsatsen är gjord med kvalitativ metod och semistrukturerade intervjuer. Resultatet visar att sjuksköterskor trivs med sina arbetsuppgifter då omvårdnad av människor är något de brinner för. Däremot uppstår stressiga situationer och missnöje när sjuksköterskorna är underbemannade och arbetsbelastningen ökar. HR arbetar med personalfrågor inklusive arbetsmiljöfrågor och därför kan det perspektivet som bakgrund bidra till att förstå organisationers förutsättningar till arbetsmiljöarbetet och problemet med personalbristen. Det framgår att organisationer måste arbeta förebyggande med arbetsmiljöarbetet och tillgå med tillräckliga resurser och socialt stöd som är avgörande för vårdpersonalens trivsel på arbetsplatsen. Att få medarbetare att vilja stanna kvar inom organisationer är mer värdefullt än att rekrytera nya. / The staff shortage of nurses in Sweden has received attention in the media and is a critical issue that has a major impact on healthcare. Despite this, the profession is seen as a vocation as caring for people is important to nurses and is the main driving force why people choose this profession. The image of the profession that is painted in society is often in negative terms,which does not facilitate the management of the staff shortage. Many times the dark image of the profession is connected to poor care for the society as a consequence of a lack of psychosocial work environment and high workload. Less research exists on the combination of theories of vocational professions and work environment. This essay will therefore examine the demand-control-support model as a background to the understanding of nurses’ psychosocial work environment in relation to the vocational profession. The essay is made with a qualitative approach and semi-structured interviews. The results show that nurses enjoy their duties as caring for others is something they are passionate about. On the other hand, stressful situations and dissatisfaction arise when the nurses are understaffed, and the workload increases. HR works with personnel issues including work environment issues, and therefore that perspective as a background can contribute to the understanding of organizations’ prerequisites for work environment and the problem of staff shortages. It is clear that organizations must work preventively with work environment and have access to sufficient resources and social support, which are crucial for well-being of healthcare personnel in the workplace. Getting employees to want to stay within organizations is more valuable than recruiting new ones.

The shortage of nurses in any health care setting increases workloads and complicates workflow. In South Africa the shortage is exacerbated by multiple factors, one of which is the emigration of nurses to countries that offer better benefits and working conditions. The purpose of the study was to explore and determine the views of nurse managers regarding staff turnover and retention, and to recommend effective measures to improve the retention of nurses. The inquiry was conducted in a KwaZulu-Natal hospital, a natural setting for the participants. The study utilized a qualitative, explorative, descriptive design. The population of this study comprised of 36 nurse managers. Purposive and convenience sampling techniques were applied to select a sample of 18 nurse managers. Data were collected through focus groups. Data were transcribed and analysed thematically, emerging patterns were noted. The researchers examined these categories closely and compared them for similarities and differences. identifying the most frequent or significant codes in order to develop the prominent categories. These were summarised in a narrative form. Four themes emerged from the findings: the staff turnover challenge; current retention strategies; measures to improve retention and strengthening management. The shortage of nursing staff was critical at this selected hospital, and this situation could be considered to be a microcosm of what is happening in public health care sectors in South Africa. Various measures were put in place to curb the high turnover. However, these measures had a fair to low level of success. Therefore, improved retention strategies are required to reduce the staff turnover. It is evident from the findings that needs to be done to investigate, plan and implement effective measures that are likely to retain nursing staff and recruit more nurses into the profession. / Health Studies / M. A. (Nursing Science)

Sveriges Kommuner och Regioner samt Statistikmyndigheten (SCB) prognostiserar att det kommer råda brist på sjuksköterskor i framtiden. Behovet av att förbättra kompetensförsörjningsarbetet finns och ett sätt är att sträva mot att bli en attraktivare arbetsgivare med ett starkare arbetsgivarvarumärke. Syftet med uppsatsen är att ta reda på vilka faktorer som är viktiga för sjuksköterskor för att de ska anse att en arbetsgivare är attraktiv och vilja arbeta där. Sju yrkesverksamma sjuksköterskor med varierande erfarenhet i yrket intervjuades och svarade på öppna frågor gällande bland annat relationer på arbetsplatsen, utvecklingsmöjligheter, upplevelsen av vad som är viktigt på arbetsplatsen, synen på arbetsgivaren och rekrytering. Intervjuerna transkriberades och analyserades med hjälp av en innehållsanalys. Resultatet visar att arbetsgivare behöver värdesätta sin personal. Därtill krävs ett bra ledarskap som bland annat innebär en chef som ser alla anställda, är rättvis, gör medarbetarna delaktiga genom att tillvarata deras kompetens och idéer. Utöver det krävs fungerande arbetsgrupper som bidrar till trivsel på arbetsplatsen. För att behålla sjuksköterskor behöver de få arbeta med patienter, göra nytta, ha adekvat lön, att arbete med utveckling möjliggörs, samt att tid och resurser finns till att bedriva en god vård. Arbetsgivare behöver förstå den stolthet som finns i sjuksköterskeyrket och att sjuksköterskor inte bara är händer i vården utan att deras största motivator i yrket är patienterna. Sjuksköterskor vill bli sedda som kompetenta medarbetare som kan bidra med kunskap och erfarenhet och arbetsgivaren behöver se, värdesätta och framförallt ta tillvara på det. Detta är faktorer en arbetsgivare behöver känna till för att kunna utveckla ett starkt arbetsgivarvarumärke inom vård och omsorg. / Sweden's Municipalities and Regions and the Statistics Authority (SCB) predict that there will be a shortage of nurses in the future. The need to improve skills supply work exists and one way is to strive towards becoming a more attractive employer with a stronger employer brand. The purpose of the essay is to find out which factors are important for nurses in order for them to consider an employer attractive and want to work there. Seven professional nurses with varying experience in the profession were interviewed and answered open questions regarding, among other things, relationships in the workplace, development opportunities, the experience of what is important in the workplace, the view of the employer and recruitment. The interviews were transcribed and analyzed using a content analysis. The result shows that employers need to value their staff. In addition, good leadership is required, which means, among other things, a manager who sees all employees, is fair, makes the employees involved by making use of their skills and ideas. In addition to that, functioning work groups are required that contribute to well-being in the workplace. In order to retain nurses, they need to be able to work with patients, to benefit, to have an adequate salary, to be able to work with development, and to have time and resources to provide good care. Employers need to understand the pride that exists in the nursing profession and that nurses are not only hands in care, but that their biggest motivator in the profession is the patients. Nurses want to be seen as competent employees who can contribute with knowledge and experience, and the employer needs to see, value and above all take advantage of that. These are factors an employer needs to know in order to be able to develop a strong employer brand within healthcare.