Yes / Consultant posts were developed to strengthen strategic leadership whilst maintaining front line service responsibilities and clinical expertise. The nursing profession has attempted to develop tools to enable individuals to evaluate their own practice and consider relevant measurable outcomes. This study evaluated the feasibility of transferring such a nursing ‘toolkit’ to another health profession. Method: This evaluation was structured around a one-day workshop where a nurse consultant impact toolkit was appraised and tested within the context of consultant radiographic practice. The adapted toolkit was subsequently validated using a larger sample at a national meeting of consultant radiographers. Results: There was broad agreement that the tools could be adopted for use by radiographers although several themes emerged in relation to perceived gaps within the nursing template, confirming the initial exercise. This resulted in amendments to the original scope and a proposed new evaluation tool. Conclusion: The impact toolkit could help assess individual and collaborat ive role impact at a local and national level. The framework provides consultant radiographers with an opportunity to understand and highlight the contribution their roles have on patients, staff, their organisation and the wider profession.

The mental health workforce is continually evolving and competing for resources, influenced by local and national factors however effective, provision of mental health care depends on the most important resource—staff.

Yes / Introduction Over the last 2 decades the assistant radiographer practitioner (ARP) role has been introduced into NHS diagnostic imaging departments as a strategy to expand the workforce and create capacity. This skill mix initiative has not been implemented in a standardised way and there is limited knowledge of the current role scope within general radiography (X-Ray). Method An electronic survey of ARPs working within UK diagnostic imaging departments was conducted. Both open and closed questions sought information regarding basic demographic data (age category; gender; geographic region), scope of practice (patient groups; anatomical regions; imaging outside of the diagnostic imaging department), limitations placed on practice, supervision and additional roles. Results A total of 108 responses, including 13 trainees, were received. Most sites employ three or less ARPs in general radiography (n = 43/66; 65.2%), although 11 sites have five (range 1–15). The majority undertake imaging of both adults and children (n = 85/108; 78.7%), although limitations on age were described. Their scope of practice covers a broad anatomical range and included some non-ambulant patients. The level of supervision varied with some sites empowering ARPs to check the referral prior to examination (n = 25) or images post acquisition (n = 32) (both n = 20/66; χ2 = 16.003; 1df; p = 0.000). Conclusion ARPs are helping to maintain capacity in imaging departments but we suggest there is further scope for expansion. The practice described by the post holders suggests that many are working beyond the scope envisaged by the radiography professional body.

Yes / The aim of this study is to profile the contemporary advanced clinical practitioner (ACP) role through standardized document sets. Documentary analysis of job descriptions (JDs), person specification and advertisements. England based jobs advertised on NHS jobs website from 22 January to 21 April 2021. A toatal of 143 trainee and qualified ACP roles were identified. A wide range of sectors and specialities were represented from across all English regions. The most common roles were urgent care, emergency medicine and primary care. Most qualified roles were agenda for change band 8A, although this did vary across specialities. Many roles were restricted to a small number of professions, notably nursing, physiotherapy and paramedic. Inconsistent role titles were noted. A lack of understanding of regulation across different professions was noted. The ACP role has become an accepted across healthcare providers in England. Implementation remains varied across specialities and organizations. Eligibility criteria may relate to professional bias. ACP roles are expanding but this may be at the detriment to advanced nursing posts. Inconsistency in role eligibility suggests some professional bias exists. This was scoping of ACP roles across England using job advertisements. ACP roles are common across sectors and specialities but eligibility varies. The research will have impact on those looking to recruit to ACP roles as well as those refining JDs. No EQUATOR guideline exists for document analysis. No Patient or Public Contribution. The research relates to organizational human resource information only.

Background: The number of patients per nursing staff and skill mix (the percentage of registered nurse) among nursing staff have an impact on the working environment, effects quality of care and patient safety. Aim: The aim of this study was to map the number of patients per nursing staff during a 24-hour period and to describe skill mix among nursing staff at emergency departments in medium-sized hospitals in Sweden. Method: This study is a descriptive cross-sectional study with a quantitative approach. Thirty medium-sized Swedish emergency departments participated in this study. Result: The number of patients per registered nurse varied between 0,0-11,0 patients (mean=3,3) during a 24-hour period. The number of patients per licensed practical nurse varied between 0,0-17,2 (mean=4,7). The average skill mix was 58,1% registered nurses and 41,9% licensed practical nurses for 24 hours. Conclusion: The staffing of nurses does not follow the patient flow, which results in a higher number of patients per nursing staff between 11:00 am and 11:59 pm. Further studies are needed to optimize the staffing of nurses, which can lead to an improved working environment for nurses, an improved quality of care and an increased patient safety. / Bakgrund: Antal patienter per omvårdnadspersonal och skill mix (andel sjuksköterskor i procent) bland omvårdnadspersonal har en inverkan på arbetsmiljö, vårdkvalitet samt patientsäkerhet. Syfte: Syftet med studien var att kartlägga antalet patienter per omvårdnadspersonal under en 24-timmarsperiod samt att beskriva skill mix bland omvårdnadspersonalen vid akutmottagningar på mellanstora sjukhus i Sverige. Metod: Studien är en deskriptiv tvärsnittsstudie med kvantitativ ansats. Trettio mellanstora svenska akutmottagningar deltog i studien. Resultat: Antalet patienter per sjuksköterska varierade mellan 0,0–11,0 patienter (medel= 3,3) under en 24-timmarsperiod. Antalet patienter per undersköterska varierade mellan 0,0–17,2 patienter (medel= 4,7). Skill mix var i genomsnitt 58,1% sjuksköterskor och 41,9% undersköterskor under 24 timmar. Slutsats: Bemanning av omvårdnadspersonal följer inte söktrycket/patientflödet, vilket resulterar i ett högre antal patienter per omvårdnadspersonal mellan klockan 11:00–23:59. Vidare studier behövs för att optimera bemanning av omvårdnadspersonal, vilket kan leda till förbättrad arbetsmiljö för omvårdnadspersonalen, en förbättrad vårdkvalité samt en ökad patientsäkerhet.

The design team of System development projects is facing cognition of these users to requirement function in several departments of a large organization. The mix of both domains¡¦ knowledge involves these users of various groups and technology knowledge by the capabilities of existing technology and consequently creates the artifact to support organizational process and job. Because of the risks and uncertainties associated with Skill Mix in large, complex system development, the purpose of this research argues that a Skill Mix problem and solution acquired in the building and application of an artifact in a timely and cost-effective manner. On the one hand, the artifact can effectively support organizational process and job. On the other hand, the artifact is facing a difficulty that meets user needs. Nevertheless, the amount of organizational departments and users participated in the IS project are much too difficult to reach a participative, consensus cognition. Software development risks become too high. Therefore, organizational users participate design in the IS project is a crucial factor in affecting performance outcome. For such software development environment, this research suggested that both the design team and users of IS project apply a TQM organizational system perspective to Management Infrastructure as a base for communication. In addition, this study proposed an organizational process to improve software productivity and quality in system development. This research argues the process has two parts. One is the TQM Perspective as the base for management infrastructure and stakeholder participation. The other is a skill mix process concerning the management to coordinate and manage the interaction between stakeholders. This research stressed a systemic approach of developing infrastructure capabilities to enable implementation of Skill Mix to conduct the stable and meaningful requirement. The artifact is able to perform regular function in order to improve Skill Mix process of both Organizational domain knowledge and technology knowledge in system development. For example, this research argues this process to develop ERP system meets the business needs. ERP system is able to support that sales department sells service with producing condition of an order for goods.

According to the Institute of Medicine (IOM), the U.S. health care delivery system does not provide consistent, high-quality medical care to all people all the time. As a significant component of the health care delivery system, the state of Graduate Medical Education in the United States has prompted much analysis in recent years due to the general view that desired and actual outcomes are increasingly at variance with each other. One area of focus has been the implications of change for provider credentialing and funding of graduate medical education. With this research we test the hypothesis that residents perform valuable work in the teaching hospitals where they undergo training, to inform the issue regarding provider credentialing for residents. We developed a framework to compare second-year residents (PGY2), physician assistants with one year of experience, and nurse practitioners with one year of experience to measurably address the interchangeability of providers. Data was collected by obtaining expert opinions on the proficiency of the three provider options (resident, physician assistant, nurse practitioner) in performing a set of tasks/procedures by surveying the program directors of Internal Medicine residency programs in the United States. The other residency programs at the University of South Floridas College of Medicine were also surveyed to obtain measurable performance on the service providers.Statistical tools were used to analyze the survey responses, aggregate patient data and salary data for each provider. The data analysis and summary indicated that residents displayed higher levels of proficiency than physician assistants and nurse practitioners for the tasks investigated.

Purpose To raise awareness of the frequency of bias that can affect the quality of radiographer plain film reading performance studies. Methods Studies that assessed radiographer(s) plain film reading performance were located by searching electronic databases and grey literature, hand-searching journals, personal communication and scanning reference lists. Thirty studies were judged eligible from all data sources. Results A one-way analysis of variance (ANOVA) demonstrates no statistically significant difference (P=0.25) in the mean proportion of biases present from diagnostic accuracy (0.37), performance (0.42) and outcome (0.44) study designs. Pearson¿s correlation coefficient showed no statistically significant linear association between the proportion of biases present for the three different study designs and the year that the study was performed. The frequency of biases in film and observer selection and application of the reference standard was quite low. In contrast, many biases were present concerning independence of film reporting and comparison of reports for concordance. Conclusions The findings indicate variation in the presence of bias in radiographer plain film reading performance studies. The careful consideration of bias is an essential component of study quality and hence the validity of the evidence-base used to underpin radiographic reporting policy.

NHS maternity services in England must increase productivity if the NHS is to make efficiency savings by 2014. At the same time, it is expected to maintain or improve patient outcomes such as safety and quality. Given staff costs are 60% of the budget; it is likely that either the number or composition of the workforce will need to be changed to meet these targets. In this article, the authors argue that very little is known about the impact of altering the skill mix on either productivity or patient outcomes. Furthermore, it is unclear whether output and outcomes are themselves trade-offs between increased workload, increased number of deliveries and the increased complexity of demand.

Bakgrund: Etiken inom vården går mot en personcentrering där varje patient ska ses som en unik person med resurser och behov. Samtidigt saknas det vårdpersonal. För att möta rekryteringsbehovet som finns har förändringar varit nödvändiga. Förändringar av kompetensmixen kan medföra att vården blir fragmenterad och helhetsbilden över patienten går förlorad. Det finns en kunskapslucka angående personcentrerad vård på vårdavdelningar som genomfört kompetens-mix.Syfte: Syftet var att belysa sjuksköterskors erfarenheter av personcentrerad vård på medicinska vårdavdelningar som genomfört kompetensmix.Metod: En kvalitativ metod med datainsamling genom tolv enskilda semistrukturerade intervjuer användes. Materialet analyserades med en induktiv ansats. En innehållsanalys av det manifesta innehållet genomfördes.Resultat: Analysen resulterade i tre huvudkategorier “Att etablera relationer”, “Att utforma vården i partnerskap” och “Att vårdkontexten påverkar” och tio underkategorier. Relationen mellan patient och sjuksköterska sågs som viktig för att kunna anpassa vården efter person. Flera utmaningar för personcentrerad vård lyftes där det framkom att såväl organisationen som vårdpersonal behöver skapa förutsättningar för att möjliggöra personcentrerad vård.Slutsats: Det upplevs positivt att bli avlastad av farmaceut och servicepersonal men sjuksköterskorna har helhetsansvaret över patienterna och har erfarenheter av att det främst är antalet patienter per sjuksköterska som behöver minska för att möjliggöra personcentrerad vård. / Background: Ethics in healthcare is moving towards a person-centred approach where each patient is to be seen as a unique person with resources and needs. At the same time, there is a lack of nursing staff. In order to meet the recruitment needs, changes have been necessary. Changes to the skill mix can mean that care becomes fragmented, and the overall picture of the patient is lost. There is a knowledge gap regarding person-centred care in medical wards that have imple-mented skill mix.Aim: The aim was to illustrate nurses' experiences of person-centred care in medical wards that have implemented skill mix.Methods: A qualitative method with data collection through twelve individual semistructured interviews was used. The material was analyzed with an inductive approach. A content analysis of the manifest content was carried out.Results: The analysis resulted in three main categories "To establish a relationship", "To design care in partnership" and "That the care context has influence" and ten subcategories. The relationship between patient and nurse was seen as important in being able to adapt care to the individual. Several challenges for person-centred care were raised, where it emerged that both the organization and health care professionals  need to create conditions to enable person-centred care.Conclusion: It is perceived positively to be relieved by the pharmacist and service staff, but the nurses have overall responsibility for the patients and have experience that it is mainly the number of patients per nurse that needs to be reduced to enable person-centred care.