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Advances and Challenges in the Labour Markets for Healthcare Professionals
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Advances and Challenges in the Labour Markets for Healthcare Professionals

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Health Policy".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 28535

Special Issue Editors

Prof. Dr. Wim Groot

E-Mail Website
Guest Editor
Department of Health Services Research, Maastricht University, 6211 LK Maastricht, The Netherlands
Interests: health economics; labour economics; economics of education
Prof. Dr. Frits Van Merode

E-Mail Website
Guest Editor
1. Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
2. Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands
Interests: layout of hospital buildings; intelligent workflow management systems and real-time scheduling systems; patient logistics

Special Issue Information

Dear Colleagues,

In many countries, there is a shortage of care professionals (e.g., physicians and nurses). In this Special Issue, we would like to assemble a complete overview of the problems, analyses and potential solutions for this shortage in different countries. We invite contributions that address any issue related to shortages of care professionals. In particular, we are interested in studies on the evaluation of (successful) interventions to reduce shortages. These could relate to wages, work conditions, competition with other economic sectors, job substitution, skilling and de-skilling jobs to solve labour shortages.

Contributions could also focus on problems and solutions in a cross-country comparison, but also in comparisons between specific areas within the healthcare sector within one country. There might also be differences between regions in one country, or between urban and non-urban regions.

Educating students to become nurses and, especially, physicians takes a long time. Studies on policies regarding the future of a country’s healthcare system and its workforce challenges, and how these are aligned with the medical and nursing curricula, are also of interest.

Some countries have high in- and outflows of care professionals. Do these migration flows provide solutions to shortages in the receiving countries, and how do they affect shortages in countries with an outflow of care professionals? Is there return migration where migrant care professionals return to their country of origin? What effects does that have on the country of origin?

Prof. Dr. Wim Groot
Prof. Dr. Frits Van Merode
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • labour markets for care professionals
  • nurse shortages
  • de-skilling
  • job substitution

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Further information on MDPI's Special Issue polices can be found here.

Published Papers (9 papers)

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Editorial

Jump to: Research

3 pages, 145 KiB  
Editorial
Advances and Challenges in the Labor Markets for Healthcare Professionals
by Wim Groot and Frits van Merode
Healthcare 2024, 12(12), 1233; https://doi.org/10.3390/healthcare12121233 - 20 Jun 2024
Viewed by 966
Abstract
A lack of nurses is a prevalent and persistent problem in many countries [...] Full article
(This article belongs to the Special Issue Advances and Challenges in the Labour Markets for Healthcare Professionals)

Research

Jump to: Editorial

22 pages, 2329 KiB  
Article
Slack Is Needed to Solve the Shortage of Nurses
by Frits Van Merode, Wim Groot and Melline Somers
Healthcare 2024, 12(2), 220; https://doi.org/10.3390/healthcare12020220 - 16 Jan 2024
Cited by 1 | Viewed by 3510
Abstract
Healthcare systems are facing a shortage of nurses. This article identifies some of the major causes of this and the issues that need to be solved. We take a perspective derived from queuing theory: the patient–nurse relationship is characterized by a scarcity of [...] Read more.
Healthcare systems are facing a shortage of nurses. This article identifies some of the major causes of this and the issues that need to be solved. We take a perspective derived from queuing theory: the patient–nurse relationship is characterized by a scarcity of time and resources, requiring comprehensive coordination at all levels. For coordination, we take an information-theoretic perspective. Using both perspectives, we analyze the nature of healthcare services and show that ensuring slack, meaning a less than exhaustive use of human resources, is a sine qua non to having a good, functioning healthcare system. We analyze what coordination efforts are needed to manage relatively simple office hours, wards, and home care. Next, we address the level of care where providers cannot themselves prevent the complexity of organization that possibly damages care tasks and job quality. A lack of job quality may result in nurses leaving the profession. Job quality, in this context, depends on the ability of nurses to coordinate their activities. This requires slack resources. The availability of slack that is efficient depends on a stable inflow and retention rate of nurses. The healthcare system as a whole should ensure that the required nurse workforce will be able to coordinate and execute their tasks. Above that, workforce policies need more stability. Full article
(This article belongs to the Special Issue Advances and Challenges in the Labour Markets for Healthcare Professionals)
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Figure 1

Figure 1
<p>The relationship between the occupancy rate of nurses or doctors and waiting times for patients in a simple office hour system when arrivals and process times are uncertain. The x-axis indicates the occupancy rate, while the y-axis depicts the mean waiting time in minutes. The green area shows the acceptable mean waiting times for patients. The red area depicts unacceptable mean waiting times for patients.</p> Full article ">Figure 2
<p>The effect of pooling the queuing patients and staff of a one-server system to a two server system. Three states are distinguished: low-coordination need (<span class="html-fig-inline" id="healthcare-12-00220-i001"><img alt="Healthcare 12 00220 i001" src="/healthcare/healthcare-12-00220/article_deploy/html/images/healthcare-12-00220-i001.png"/></span>), high-coordination need (<span class="html-fig-inline" id="healthcare-12-00220-i002"><img alt="Healthcare 12 00220 i002" src="/healthcare/healthcare-12-00220/article_deploy/html/images/healthcare-12-00220-i002.png"/></span>), and chaos (<span class="html-fig-inline" id="healthcare-12-00220-i003"><img alt="Healthcare 12 00220 i003" src="/healthcare/healthcare-12-00220/article_deploy/html/images/healthcare-12-00220-i003.png"/></span>).</p> Full article ">Figure 3
<p>Multiphase healthcare system sequencing tasks leading to an open- loop system as uncontrollable queues develop. The green areas show the acceptable mean waiting times for patients. The red areas depicts unacceptable mean waiting times. The arrows represent patient flows. At the first workstation, both variable and uncertain inter-arrival and process times develop. When patients are finished at this first workstation, they enter the next queue, and this continues. The result is that the uncertainty and variety at the workstation are without control and are not communicated to the subsequent workstations. Without integrated control, the queues can even amplify. For the sequencing of tasks, care pathways need integrated control [<a href="#B21-healthcare-12-00220" class="html-bibr">21</a>].</p> Full article ">Figure 4
<p>An example of a highly standardized three-phase outpatient clinic office shift. The color red represents waiting times for patients. The other colors represent processing times. The task time when entering the pathway is exactly 20 min. At each stage, the process time is 13 min plus 5 mean extension (Poisson distributed). This example shows the times of 12 patients. Calculating with this task time, the office hour is expected to last 280 min. It will sometimes be somewhat shorter and sometimes (considerably) longer.</p> Full article ">Figure 5
<p>The spreading of blockages [<a href="#B17-healthcare-12-00220" class="html-bibr">17</a>] (p. 81). The green areas show the acceptable mean waiting times for patients. The red areas depict unacceptable mean waiting times. The grey arrows represent patient flows. The red arrows blocking signals.</p> Full article ">
12 pages, 618 KiB  
Article
Mediating Influences of the Exchange Relationship with a Preceptor on the Relationship between Burnout and Job Retention Intention among New Nurses in Korea
by Jihyun Kim and Yaki Yang
Healthcare 2023, 11(18), 2575; https://doi.org/10.3390/healthcare11182575 - 18 Sep 2023
Cited by 1 | Viewed by 1492
Abstract
The main factor in the turnover of new nurses in Korea is burnout, and a high turnover rate can lead to discontinuation in the nursing profession, due to failure to adapt to the organization. This study aimed to examine the mediating influences of [...] Read more.
The main factor in the turnover of new nurses in Korea is burnout, and a high turnover rate can lead to discontinuation in the nursing profession, due to failure to adapt to the organization. This study aimed to examine the mediating influences of an exchange relationship with the preceptor on the relationship between burnout and job retention intention among new nurses in Korea. Data were collected from 210 new nurses in three general hospitals from 2 May to 30 June 2023. The following statistical analysis were conducted: t-test, ANOVA, the Scheffé test, Pearson’s correlation coefficient analysis, and Hayes Process Macro Model 4 (to test the mediating effect). Burnout was negatively associated with job retention intention (r = −0.54, p < 0.001) and the exchange relationship with the preceptor (r = −0.29, p = 0.001). The exchange relationship with the preceptor was positively associated with job retention intention (r = 0.38, p < 0.001). Furthermore, the mediation analysis indicated that the exchange relationship with the preceptor mediated the relationship between burnout and job retention intention. According to the results, the impact of burnout on the job retention intention was mediated by the exchange relationship with the preceptor. Therefore, to increase the job retention intention of new nurses, developing programs to enhance the exchange relationship with the preceptor are recommended. Full article
(This article belongs to the Special Issue Advances and Challenges in the Labour Markets for Healthcare Professionals)
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<p>Mediating influences of exchange relationship with preceptor on relationship between burnout and job retention intention.</p> Full article ">
12 pages, 1575 KiB  
Article
Pediatric Neurology Workforce in Saudi Arabia: A 5-Year Update
by Ahmed K. Bamaga, Anas S. Alyazidi, Albatool Almubarak, Mohammad N. Almohammal, Ayidh S. Alharthi and Matar A. Alsehemi
Healthcare 2023, 11(16), 2288; https://doi.org/10.3390/healthcare11162288 - 14 Aug 2023
Viewed by 1537
Abstract
Background: The medical workforce plays a pivotal role in advancing human health, particularly within the healthcare system of Saudi Arabia. While government-employed healthcare providers form the central structure of the system and offer free healthcare services, the private healthcare sector is also witnessing [...] Read more.
Background: The medical workforce plays a pivotal role in advancing human health, particularly within the healthcare system of Saudi Arabia. While government-employed healthcare providers form the central structure of the system and offer free healthcare services, the private healthcare sector is also witnessing significant growth. In parallel, the field of child neurology has experienced notable transformations in recent years, with continued expansion. This expansion brings forth a range of challenges for both current and future pediatric neurologists, necessitating careful consideration and proactive measures to address them. Aim of the study: To investigate and analyze the current characteristics of the workforce, with a specific focus on their employment status and related data. Methods: This is a cross-sectional analysis, using a survey to assess the distribution of pediatric neurologists in Saudi Arabia (SA). The final analytical sample included 82 subjects, working in 13 regions in SA. A descriptive analysis was used to address the study question. Results: The survey received responses from a total of 82 pediatric neurologists in Saudi Arabia (response rate 55%), with 38 (46%) being men and 44 (54%) being women. The mean age was 33 ± 1.225 years. The majority of participants practiced in major cities such as Riyadh and Jeddah. Nearly 50% of pediatric neurologists experienced some form of delay in obtaining their first job, ranging from 1 to 36 months. Conclusion: The landscape of the pediatric neurology workforce is currently witnessing noteworthy demographic shifts. With the majority of practitioners concentrated in major cities, there is an ongoing demand for qualified professionals in peripheral areas. This study describes the real-life challenges faced by pediatric neurologists, particularly the delay in securing employment after graduation, and underscores the critical importance of addressing these persistent issues along the journey of pediatric neurology. Full article
(This article belongs to the Special Issue Advances and Challenges in the Labour Markets for Healthcare Professionals)
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Figure 1

Figure 1
<p>Distribution of pediatric neurologists in Saudi Arabia according to their current city of practice/training.</p> Full article ">Figure 2
<p>Distribution of pediatric neurologists in Saudi Arabia according to the city of their medical school.</p> Full article ">Figure 3
<p>Average number of patients per half-day session.</p> Full article ">Figure 4
<p>The available supporting services in respondents’ current center of practice. Abbreviations: VEP, visual evoked potential; BAER, brainstem auditory evoked response; SSER, somatosensory evoked response.</p> Full article ">
33 pages, 905 KiB  
Article
Experience with the Implementation of Continuous Medical Education among Mother-and-Child Healthcare Providers in Ukraine: A Case Study Based on Two International Collaboration Initiatives
by Tetiana Chernysh, Lucas Opitz, Nataliia Riabtseva, Martin Raab and Milena Pavlova
Healthcare 2023, 11(13), 1964; https://doi.org/10.3390/healthcare11131964 - 7 Jul 2023
Cited by 3 | Viewed by 1502
Abstract
Background: Healthcare labor market shortages due to migration, inadequate investments, and lack of continuous training are essential concerns in the Eastern European region. This article aims to describe and reflect on the experience with the implementation of continuous medical education among mother-and-child healthcare [...] Read more.
Background: Healthcare labor market shortages due to migration, inadequate investments, and lack of continuous training are essential concerns in the Eastern European region. This article aims to describe and reflect on the experience with the implementation of continuous medical education among mother-and-child healthcare providers in Ukraine, including achievements, challenges, and barriers. We analyze this case based on two international collaboration initiatives: the Swiss–Ukrainian program in mother-and-child health that ran from 2000 to 2015, supplemented by the recent Ukrainian–Swiss project “Medical education development” in 2018–2023. Methods: We use a case study approach as the methodology for our study. We collected data from documents (project reports reviews) and in-depth interviews with stakeholders. We apply the method of directed qualitative content analysis. Results: As a result of the Swiss–Ukrainian collaborations, the knowledge and awareness of medical personnel were greatly improved. Modern clinical concepts not well understood at the outset became commonplace and were incorporated into clinical activities. Nevertheless, obstacles to the implementation and rapid uptake of changes were found in the lack of knowledge of the English language among medical doctors, the fear of changes, and the lack of openness and readiness for novel evidence-based clinical practices. However, primary healthcare practitioners in this new project seem to be more inclined to change. Conclusions: A modernized continuous medical education which is based on the values of openness, respect, dialogue, and professionalism can be implemented with the input of an international assistance program despite the resistance of the system towards change. Full article
(This article belongs to the Special Issue Advances and Challenges in the Labour Markets for Healthcare Professionals)
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Figure A1
<p>Geographical coverage of the Swiss–Ukrainian collaboration.</p> Full article ">
9 pages, 587 KiB  
Article
The Crisis in the Nursing Labour Market: Canadian Policy Perspectives
by Andrea Baumann and Mary Crea-Arsenio
Healthcare 2023, 11(13), 1954; https://doi.org/10.3390/healthcare11131954 - 6 Jul 2023
Cited by 14 | Viewed by 7890
Abstract
The labour market for care professionals has experienced significant changes, resulting in critical shortages globally. Nurses represent the largest share of health workers worldwide; nonetheless, an estimated 13 million more nurses will be needed over the next 10 years. Prior to the pandemic, [...] Read more.
The labour market for care professionals has experienced significant changes, resulting in critical shortages globally. Nurses represent the largest share of health workers worldwide; nonetheless, an estimated 13 million more nurses will be needed over the next 10 years. Prior to the pandemic, the domestic supply of nurses in Canada had not kept pace with the ever-increasing demand for services. Pre-pandemic age- and needs-based forecasting models have estimated shortages in an excess of 100,000 nurses nationwide by 2030. While COVID-19 has accelerated the demand for and complexity of service requirements, it has also resulted in losses of healthcare professionals due to an increased sick leave, unprecedented burnout and retirements. This paper examines key factors that have contributed to nursing supply issues in Canada over time and provides examples of policy responses to the present shortage facing the healthcare system. To provide adequate care, the nursing workforce must be stabilized and—more importantly—recognized as critical to the health of the population. Full article
(This article belongs to the Special Issue Advances and Challenges in the Labour Markets for Healthcare Professionals)
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Figure 1

Figure 1
<p>Age distribution of employed nurses in Ontario, 2014 and 2021. Source: College of Nurses of Ontario (2022). Registration statistics report [<a href="#B18-healthcare-11-01954" class="html-bibr">18</a>].</p> Full article ">Figure 2
<p>Work status of new nurses in Ontario, 2015–2022. Source: College of Nurses of Ontario (2022). Registration statistics report [<a href="#B18-healthcare-11-01954" class="html-bibr">18</a>].</p> Full article ">
20 pages, 411 KiB  
Article
How Advanced Practice Nurses Can Be Better Managed in Hospitals: A Multi-Case Study
by Jia Wan and Haiou Xia
Healthcare 2023, 11(6), 780; https://doi.org/10.3390/healthcare11060780 - 7 Mar 2023
Cited by 5 | Viewed by 3309
Abstract
The labor markets for care professionals are a perennial topic of discussion. Advanced practice nurses (APN), as an advanced role in nursing, arose to solve the shortage of primary health care professionals. Prior research has advanced several areas of exploration for APNs’ training [...] Read more.
The labor markets for care professionals are a perennial topic of discussion. Advanced practice nurses (APN), as an advanced role in nursing, arose to solve the shortage of primary health care professionals. Prior research has advanced several areas of exploration for APNs’ training or employing methods in Chinese hospitals. However, this leaves a key imperative unexplored: the management strategy of APNs in hospitals. The present study seeks to explore the management strategy of APNs in Chinese hospitals. The resource orchestration theory served as the guide as the multi-case study method investigated 18 case hospitals, gathered information from a variety of case data sources, and summarized the management strategies for hospitals’ advanced practice nurses. Four types of APN management strategies—expert customized type, hierarchical linkage type, multidisciplinary benefit type, and professional penetration type—have been identified through resource orchestration. Hospitals can utilize the APN management strategy model as a guide to manage APNs in accordance with the unique characteristics of APN resources. Full article
(This article belongs to the Special Issue Advances and Challenges in the Labour Markets for Healthcare Professionals)
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Figure 1

Figure 1
<p>Management strategies of APNs. In the diagram, solid circles indicate APNs, while hollow circles represent general nurses. The size of the circle denotes the amount of training, and the color of the circle symbolizes the various specializations. The hollow hexagon depicts a distinct group of patients who are the attention of APNs.</p> Full article ">
11 pages, 584 KiB  
Article
Determining the Role of Employee Engagement in Nurse Retention along with the Mediation of Organizational Culture
by Ridhya Goyal and Gurvinder Kaur
Healthcare 2023, 11(5), 760; https://doi.org/10.3390/healthcare11050760 - 5 Mar 2023
Cited by 3 | Viewed by 4286
Abstract
In today’s unpredictable environment, the rapid emergence of the COVID-19 pandemic has shaken the world and its healthcare infrastructure immensely. As nurses are the building blocks of the healthcare personnel labor market, organizations should develop tactics that aid in their retention. With a [...] Read more.
In today’s unpredictable environment, the rapid emergence of the COVID-19 pandemic has shaken the world and its healthcare infrastructure immensely. As nurses are the building blocks of the healthcare personnel labor market, organizations should develop tactics that aid in their retention. With a solid theoretical foundation in self-determination theory, this study aims to understand the role of employee engagement in keeping nurses in 51 hospitals in the Northern Indian region, along with the mediation of organizational culture through smart PLS. In a complementary mediation relationship with organizational culture, nurse retention is positively correlated with employee engagement. Full article
(This article belongs to the Special Issue Advances and Challenges in the Labour Markets for Healthcare Professionals)
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Figure 1

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<p>PLS model.</p> Full article ">
18 pages, 1479 KiB  
Article
Foreign Healthcare Professionals in Germany: A Questionnaire Survey Evaluating Discrimination Experiences and Equal Treatment at Two Large University Hospitals
by Elif Can, Clara Milena Konrad, Sidra Khan-Gökkaya, Isabel Molwitz, Jawed Nawabi, Jin Yamamura, Bernd Hamm and Sarah Keller
Healthcare 2022, 10(12), 2339; https://doi.org/10.3390/healthcare10122339 - 22 Nov 2022
Cited by 2 | Viewed by 2999
Abstract
Objective: To identify facilitators and barriers and derive concrete measures towards better workplace integration of migrants working in the German healthcare sector. Design: Two-centre cross-sectional quantitative online survey of experiences of discrimination among healthcare professionals with a migration history in two large German [...] Read more.
Objective: To identify facilitators and barriers and derive concrete measures towards better workplace integration of migrants working in the German healthcare sector. Design: Two-centre cross-sectional quantitative online survey of experiences of discrimination among healthcare professionals with a migration history in two large German university hospitals. Participants: 251 participants fully completed the questionnaires. Main outcome measures: Experiences of discrimination and perception of inequality. Results: Fifty-five percent of migrant health workers had had at least some command of German before arriving in Germany. Members of all professional groups surveyed expressed experiences of discrimination related to language, nationality, race/ethnicity, and sex/gender. The proportions of staff with experiences of discrimination by peers differed significantly among occupational roles, with nurses and technologists having the most experiences of discrimination. The perception of inequality was reported more frequently than experiences of discrimination and had a negative impact on workplace satisfaction. Specifically, the compulsion to compete was a frequent feeling stated by participants. Conclusion: The mechanisms of discrimination and structural inequality revealed by our survey could inform specific measures, for example at the management level, to increase workplace satisfaction and attract migrant health workers in the long term. Full article
(This article belongs to the Special Issue Advances and Challenges in the Labour Markets for Healthcare Professionals)
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<p>Flowchart of questionnaires included in the final analysis based on migrant status and exclusion at the two German university centres at which our survey was conducted. Information on the country of birth of all employees was available at Charité (<bold>A</bold>) but not at UKE (<bold>B</bold>). Abbreviations: Charité = Charité–Universitätsmedizin Berlin, UKE = Universitätsklinikum Eppendorf, Hamburg.</p> Full article ">Figure 2
<p>Distribution by EU and Non-EU countries of survey participants at Charité (<bold>A</bold>) and UKE (<bold>B</bold>). The pie chart shows how many different countries and language areas the participants originated from. EU nationals do not need visas/residence permits and have the equivalence of their qualifications automatically recognized.</p> Full article ">Figure 3
<p>Current positions in relation to qualifications at Charité (<bold>A</bold>) and UKE (<bold>B</bold>). In order to assess access to the labour market, the recognition procedures for professional degrees and qualifications as well as administrative difficulties were evaluated. The majority of respondents felt that their current position was appropriate to their qualifications.</p> Full article ">Figure 4
<p>German language skills at Charité (<bold>A</bold>) and UKE (<bold>B</bold>) were assigned to one of three proficiency levels: C1/2—Advanced/Fluent; B1/2—intermediate; and A1/2—Beginner. The occupational groups with the most patient contact had the best command of German. Overall, the reported language skills differed significantly between the three occupational groups (<italic>p</italic> = 0.001), with clinical and scientific staff reporting the most proficient language skills.</p> Full article ">
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