Addressing the Needs of Clinical Trial Sites in a Post-COVID-19 World

[...]many sponsors have implemented alternative ways to conduct trials or components of them, incorporating remote and virtual activities, which aim to bring studies directly to patients via a range of technologies. Every clinical investigation begins with the development of a protocol that describes h.ow a clinical trial will be conducted-encompassing the objective(s), design, methodology, statistical considerations, and organization of the study-and ensures the safety of the trial subjects and integrity of the data collected. [...]of the pandemic, we will see more hybrid trials that combine site and remote patient visits. In forcing the research community to be more open to using different tools to ensure vital research continues, the pandemic is driving the beginning of a new era of patient and site engagement-one in which a more proactive and efficient approach ensures the lines of communication remain open and data is collected appropriately and with greater speed.

Empowering cultural change at North Manchester general hospital

ContextNorth Manchester General Hospital is a large District General Hospital in Greater Manchester, serving a relatively disadvantaged population. The overall culture change project involved practically all facets of a functioning medical organisation, including the Senior Medical Leadership Team (SMLT), Transformation team, Human Resources, Finance, and many more. However, one of the key aims of the change was to improve the experience of Junior Doctors working at NMGH. Therefore, postgraduate doctors in training have been key to all of the development, including the Medical Director's Leadership Fellow (MDLF), Junior Doctors' Leadership Group (JDLG), and every staff member that they represent.Issue/ChallengeHistorically, North Manchester General Hospital (NMGH) has had a reputation as a poor place to work;staff aimed to avoid the site. The hospital was unable to retain highly-skilled employees, and trainee experience was extremely low, impacting on patient safety metrics. The site was stuck in a continuous cycle of having this reputation, leading to an inability to attract permanent staff, causing a deficit in teaching and training opportunities, further diminishing the reputation.Rotational junior doctors are the most transient group of NHS healthcare workers (HCWs). Their experience is reflective of organisational culture and that of other, less vocal groups of HCWs. Prior to 2020, many junior doctors considered NMGH to be a ‘rite of passage' ‘ one to be avoided if possible, but if unavoidable, just get through it. On-call teams were chronically short-staffed, 3 services were in enhanced General Medical Council (GMC) monitoring, and GMC survey results were unsatisfactory. Teams were forced to be tenacious, lateral thinking, and resilient to cope with the stresses of work.2019 saw NMGH receive significant criticism from GMC and Health Education North West (HENW) monitoring visits. The General Surgery (GS) Department remained in ‘enhanced monitoring', and patient safety concerns were raised. These included inadequate ‘prescribing of admission medication', poor use of incident reporting systems, and challenges escalating sick patients. Trainees described ‘fire-fighting, not learning'. Improvement recommendations included addressing departmental culture, reinforcing the importance of incident reporting, and ensuring trainees had easy access to appropriate senior support at all times. Early in 2020, trainee experience further deteriorated in GS, due to a negative culture and deficiencies in support, education and training. This resulted in Foundation Year 1 doctors being removed from GS.The Senior Medical Leadership Team (SMLT) decided that enough was enough;the hospital culture needed a fundamental overhaul. There was a clear and urgent need to address staff experience.Assessment of issue and analysis of its causesThe Senior Medical Leadership Team (SMLT) set themselves an audacious goal: to support NMGH to transform into the best training and working experience for junior doctors in Greater Manchester. This goal was split into primary drivers, with each driver linked to specific future projects, and projects assigned to each leadership team member. These projects, identified through co-production with junior doctors, were aimed to improve employee experience, including facilitating access to breaks, improving supervision and support, and enhancing development opportunities â€' aiming to raise staff wellbeing and patient safety standards. Changes were made to General Surgery, resulting in huge investments in expanding the permanent junior doctor and consultant workforces.Several initiatives were implemented to help assess the scope of work required, including setting up a Junior Doctors' Leadership Group (JDLG), or ‘Shadow Board'. All hospital specialties are represented;some representatives sit on the SMLT, on Educational Board meetings, and the Clinical Leaders Forum. The SMLT join every JDLG meeting. Whilst acting as a conduit for rapid two-way communication between clinician and leadership teams (e.g. reliably informing doctors about last-minute changes to visiting policy during Covid surges, or effectively communicating crucial information to crash-call teams when building work closed part of the hospital), the group debates issues raised by junior doctor colleagues they represent, and feeds that back to the SMLT. Recent examples include raising patient safety concerns related to misinterpretation of the Emergency Department Referrals policy, and working collaboratively with junior doctors to address urgent staffing and patient safety risks related to the last wave of the pandemic.In addition to this, a Medical Director's Leadership Fellow (MDLF) role was established. This was fundamental in progressing projects related to the SMLT goal and ensuring appropriate input from junior doctors, Human Resources, the Communications and Transformation teams, and more. As a key member of the JDLG, the MDLF is a role designed in part to enhance junior doctor experience, foster better relationships between staff groups, and encourage feedback provision. The role has been vital in bridging the gap between doctors and hospital leaders, managers and executives – often a source of discontent amongst clinicians. Bridging this gap is important in developing the hospital's culture. Even though many projects are still ongoing, improvements are already being experienced.Impact2021 GMC Survey results showed improvement in 15/18 metrics compared to 2019. These included improvements in ‘Reporting Systems', ‘Workload', and ‘Clinical Supervision Out Of Hours'. 2020 Care Quality Commission inspection reports showed improvement in 11 individual aspects, including improvement to ‘outstanding' in 3 elements.HENW/GMC monitoring visits in 2021 reported ‘they have more robust teams to support the ward and on call workload', resulting from investment in clinicians. It also notes, ‘prescribing audits have shown improvements in prescribing of time critical medication', and demonstrable improvements in ‘use of incident reporting systems and sharing of lessons learnt'. Further comments note that there have been ‘significant improvements in culture in the [General Surgery] department over the past year';one doctor described the department as ‘the most supportive place he had worked'. The report summary noted, ‘through strong clinical leadership and oversight, and a concerted effort to improve departmental culture there have been significant improvements in General Surgical trainee experience with good support, supervision and education reported'. The department was subsequently removed from enhanced GMC monitoring.Although this rapid and impressive turnaround occurred within one department, benefits were seen elsewhere in the organisation.The efforts of the SMLT and JDLG have resulted in positive cultural changes. Surveys reflected: ‘friendly colleagues, less work-related stress, helpful management', and ‘thank you for your work to improve NMGH. I was worried about working at NMGH having heard ‘horror stories' about working there. However, these have not been reflected in reality at all, and NMGH has offered excellent training opportunities.InterventionThe JDLG helps ensure that important information is shared with the wider junior doctor group. Colleagues now feel that their voices are heard. The positives from the previous culture are still evident – leadership teams across the Trust have repeatedly recognised the ‘can-do attitudes' of NMGH staff, with the negative culture firmly in the past. Staff testimonials include: ‘there has definitely been an improvement over the years I have worked here;‘my supervisor was supportive and encouraged reflection through discussions about experiences;and ‘the senior staff are INCREDIBLE. They offer support, they teach, and they encourage us to learn new skills. I cannot be more thankful'. This is in contrast to historical Freedom To Speak Up (FTSU) submissions, which pointed to a culture of disregarding the opinions of NMGH staff.The ‘can-do' approach has been evident during the waves of Covid-19;members of the JDLG fed into management and governance structures to highlight problems in real time, increasing the organisation's responsiveness to challenges faced, working as a two-way conduit of information.During the 2021 HENW/GMC visit, the team reported that junior doctors knew the Medical Director and Director of Medical Education by first name, and felt able to raise concerns directly to them, evidencing a more flattened hierarchy. The visiting team reported being impressed by this positive change and were not aware of other organisations where this had been achieved to this extent.Having Postgraduate Doctors in Training play such a significant role within the Senior Leadership Team setup is relatively unique. As explained, empowering staff to feel they can raise any issues directly to the Medical Director or SMLT, or via the JDLG, has played a huge role in facilitating palpable cultural change through leadership structure additions. As a point of contact, the MDLF has acted as an extension of the JDLG, but works directly alongside the Medical Director and Associate Director of Medical Education, essentially enabling the SMLT to keep their ear to the ground, their fingers on the pulse of staff atmosphere and wellbeing.Examples of achievements of the MDLF include projects to introduce personalised theatre caps (benefits include enhanced communication, especially in emergencies, improving patient outcomes), formation of a Wellbeing group (representatives from all cohorts of staff across the site discuss wellbeing initiatives and colleagues' wellbeing concerns), and an impressive and rapid response to staffing crises and patient safety risks during the most recent Covid-19 wave. As a result of these outcomes, other Trusts haveapproached the SMLT, requesting further information regarding the JDLG and MDLF model;another MDLF has since been appointed at a different trust site.Involvement of stakeholders, such as patients, carers or family members:The SMLT itself is made up of clinicians from a variety of backgrounds, across medicine and surgery. SMLT members sit in morning medical handovers to actively gather clinician experience feedback. They also work closely alongside colleagues from Nursing, Finance, HR, Transformation teams, and more, which enables the SMLT to work collaboratively with the multidisciplinary team to improve culture at NMGH.The MDLF is in the perfect position to take advantage of this MDT approach. As a result, the MDLF sits on Group-level Patient Safety Panels (acting to highlight patient safety incidents, initiatives, and achievements across the entire Trust). This panel consists of representatives from hospital, community, and medical education staffing groups. The lessons learnt are then communicated to individual hospitals, no matter where the incident or initiative originated. A big part of the meeting is the FTSU aspect, and local FTSU Guardians are active within the panel.Given that the MDLF role is so closely linked to improving communication and feedback, a Freedom To Speak Up Champion role fitted well within the responsibilities of the post. Therefore, over the past year, the MDLF has worked alongside the FTSU team and has completed training as a FTSU Champion. As a consequence of working closely with shop-floor colleagues, the MDLF has received communications from a wide variety of staff roles and levels of seniority throughout the year, asking questions, or raising awareness about issues. The MDLF can then seek appropriate advice, signpost the colleague, and keep them updated on a potential resolution, further propagating the positive feedback loop and support of the wider MDT. As previously mentioned, the JDLG consists of representatives from all medical specialties, and each member is encouraged to raise concerns, suggest improvements, and lead on projects;these include an overhaul of the medical handover process, enabling a safer and more efficient handover, and escalating concerns of a coll ague speaking up about potential patient safety concerns within a department. Furthermore, speakers at JDLG meetings have included the Head of Nursing: Quality & Patient Experience, local FTSU Guardians, the Director of Human Resources, and the local Guardian of Safe Working Hours, enabling group members to share information from a wide range of disciplines with shop-floor colleagues. As a result of the efforts and MDT approach of the above groups, a placement feedback survey performed early in 2022 demonstrated that 93% of respondents felt their working environment supports a multidisciplinary approach.Key MessagesOne of the hallmarks of good medical leadership is putting all staff members, regardless of their role, seniority, or experience, in the best position for them to succeed. Giving Postgraduate doctors early opportunities to play a significant part in, and learn about, an organisation's leadership structure, is not only beneficial to the doctor, but helps the organisation capitalise on a previously relatively untapped market of ideas and solutions. Crucially, this is not limited to postgraduate doctors in training, but also locally-employed doctors, which make up a significant proportion of the workforce in any hospital yet typically remain underrepresented and under-utilised.NMGH has realised the potential that can be unlocked in Junior Doctors, through leadership placements and roles, and the positive benefit this can have on the individual, team and organisation.Lessons learntNorth Manchester General Hospital was fortunate in that the entire SMLT bought into everything: the overall project for culture change, the introduction of the MDLF into the SMLT, and empowering members of the JDLG to contribute to change at the highest level. Having spoken to other organisations looking to replicate our success, they have found that this buy-in is absolutely crucial. Recruiting effectively, to both the MDLF position and JDLG representative roles, is vital, as a huge amount of motivation to fight for change and the betterment of the system is required when overcoming barriers and challenges. Many of the barriers we faced are well-documented in literature, and to a point we expected them;these included resistance from non-medical stakeholders, which was somewhat abetted by further conversations, explanation of goals and objectives, and outlining the overall vision of the SMLT. Of course, resistance to change is important in any project, as it can highlight potential issues not yet visualised.Measurement of improvementFrom the start, we set out our intention to use openly-available, independent metrics of improvement, such as the GMC Nation Training Survey. To compliment this, the MDLF utilised a variety of temperature-check methods, including surveys (dissemination supported by the increasingly-established network of the Postgraduate doctors in training of the JDLG) and departmental visits. Importantly, having a fellow junior doctor asking for feedback, rather than a traditional member of the SMLT, enabled us to garner potentially more honest opinions, criticisms and ideas. As explained elsewhere, GMC survey results have shown improvement, and local surveys have displayed some very positive results. That said, it is recognised that the vision is a long-term project, and continuous improvement will be sought, rather than settling on the progress made thus far.Strategy for improvementThe SMLT sat down and brainstormed an overall vision alongside the individual large-scale projects that would contribute to achieving change. Within this, individual members of the SMLT were assigned roles leading one or more projects, and the MDLF role was created in part to support with the running of these projects where required. This enabled utilisation of the minds of the JDLG and other Postgraduate doctors in training. The MDLF role was instrumental in not only involving this cohort, but also reaching out to other organisations to share learned experiences when they had gone through implementation of similar projects. The team was kep accountable not by having a set timeline for implementation but by having regular away days, reporting back to their colleagues and the transformation team regarding progress.The JLDG, established in 2020, and reappointed every year, have been key to the success of the culture change, through engagement, sense-checking and feedback regarding strategy and relevant projects. Over time the organisation has increasingly engaged this Shadow Board in the development and role out of projects as well as problem solving of significant challenges. Through this team the SMLT has fedback key messages and challenges to the Junior Doctor workforce, which has resulted in increased engagement across the organisation.

Should China Expand Its Medical Education Scale? Evidence From Comparative Research

Purpose This study compares doctor staffing level and the scale of medical education in China with those of other countries and proposes policy recommendations for future adjustments to the scale of China's medical education. Design/Approach/Methods This study employs a literature review and descriptive analysis. Findings China had 1.98 medical doctors per 1,000 people in 2018, ranking 85th out of the 193 member-states of the World Health Organization (WHO). In 2017, China had 1.99 practicing doctors per 1,000 people, only ranking above Turkey (1.88) in Organisation for Economic Co-operation and Development (OECD) countries. China had only 10.28 medical graduates per 100,000 people—placing in the bottom third of OECD countries. China's provision of 1.4 medical schools per 10 million people was also significantly lower than the global average (3.9). However, the average number of students enrolled in medical schools (509) in China was significantly higher than the global average (160). Originality/Value Although the scale of admission in undergraduate medical education must be expanded in China, this needs to be achieved while controlling the average number of medical students per school and reducing enrollment in low-quality medical schools. Furthermore, it is necessary to establish new medical schools while improving the operating level of existing ones.

Social distancing causing crises: learning from workforce adaptation by e-tailers

PurposeThis study explores workforce related adaptation by e-tailers during social distancing causing crises (SDCC) and provides a conceptual framework.Design/methodology/approachA grounded theory based approach has been used wherein about 120 news articles were analyzed to understand the real-world measures taken. 50 journal papers were also referred to. A typical qualitative methodology, including open, and axial was used.FindingsIn the early stages, panic buying emerged as the key disrupting factor which necessitated staff shortage management. In the long term, e-tailers can adapt to prevent reverse worker migration and modify their hiring and training processes.Research limitations/implicationsThis study synthesizes knowledge on workforce-related adaptation by e-tailers and offers considerable potential for future research as well as the development of case studies and consulting services for the industry. Two research propositions are offered that can guide hypothesis generation and further studies can be conducted in sectors other than retail also.Practical implicationsThis study puts forward propositions based on theoretical dimensions for managers adapting to workforce-related problems during SDCC. The pandemic has led to vast unemployment and the shutting down of a number of businesses across the globe due to economic downfall. Hence, this study has economic and social implications.Originality/valueThis study is unique as it is one of the few that delves into e-tailers' workforce- related adaptation as SDCC evolves and contributes to a body of literature which is scarce.

Shifting Perspectives on Site Networks to Create Positive Change

In the short-term, however, there have been more immediate and acute concerns about the ability of clinical development to continue in the face of widespread infection;how will patients continue participation when leaving home poses a significant risk?;what happens to patients who are relying on speedy development of life-changing, even life-saving, treatments? [...]it is essential to develop therapeutic network strategies in specialist areas, such as rare disease and cell and gene therapy. Because of the access to large numbers of potentially qualified patients onsite, staffing levels may be a limited concern in quickly contacting and qualifying patients within its systems.

Online multidisciplinary integrated rural healthcare education programs during the COVID-19 pandemic for students from different universities: Experiences and guidelines

Purpose: The COVID-19 pandemic has led to "forced innovation" in the health education industry. High-quality training of the future rural health workforce is crucial to ensure a pipeline of rural health practitioners to meet the needs of rural communities. This paper describes the implementation of an online multidisciplinary teaching program focusing on integrated care and the needs of rural communities. Design/methodology/approach: A multidisciplinary teaching program was adapted to allow students from various disciplines and universities to learn together during the COVID-19 pandemic. Contemporary issues such as the National Aged Care Advocacy Program for Residential Aged Care COVID-19 Project were explored during the program. Findings: This case study describes how the program was adopted, how learning needs were met, practical examples (e.g. the Hand Hygiene Advocacy within a Rural School Setting Project), the challenges faced and solutions developed to address these challenges. Guidelines are proposed for remote multidisciplinary learning among health professional students, including those in medical, nursing, pharmacy, dentistry, and allied health disciplines. Originality/value: The originality of this program centers around students from multiple universities and disciplines and various year levels learning together in a rural area over an extended period of time. Collaboration among universities assists educators in rural areas to achieve critical mass to teach students. In addition it provides experiences and guidance for the work integrated learning sector, rural health workforce practitioners, rural clinical schools, universities, policy makers, and educators who wish to expand rural online multidisciplinary learning. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

A Hospital System's Journey Toward Zero Harm: Reducing Postoperative Respiratory Failure

Postoperative respiratory failure is a significant cause of morbidity and mortality. Early identification of patients at moderate to high risk of postoperative respiratory failure is critical to effective prevention strategies. A multi-disciplinary team developed a robust process for the early identification of at-risk patients and the prevention of respiratory failure in the perioperative setting.

Long-Term Care Staffing Policies Pre-COVID-19 and Pandemic Responses: A Case Comparison of Ontario and British Columbia

À la fin de mai 2020, les cas de COVID-19 chez les résident·es des établissements de soins de longue durée (SLD) en Ontario représentaient 5 157 des 28 499 cas de la province. En Colombie-Britannique (C.-B.), il y avait 339 cas chez les résident·es de ces établissements, comparativement à un total provincial de 2 562 cas. Bien que le secteur des SLD de ces deux provinces présente certaines différences, cet article passe en revue les politiques de dotation en personnel des SLD dans chacune des deux provinces avant la pandémie et compare leurs mesures de prévention de la COVID-19 ayant trait à la dotation pour 2020. Aux politiques de l'Ontario avant 2020 correspondent des ratios personnel-patients inférieurs à ceux de la Colombie-Britannique, ce qui peut avoir eu un effet limitant sur les réactions de l'Ontario à la pandémie. L'établissement de normes ou de lignes directrices ainsi qu'une modification du financement pourraient améliorer la résilience du secteur des SLD en matière de dotation en personnel.Alternate :By late May 2020, COVID-19 cases among long-term care (LTC) residents in Ontario constituted 5,157 of the province's 28,499 cases. In British Columbia (B.C.), there were 339 cases among LTC residents compared with a provincial total of 2,562 cases. While the LTC sectors in these two provinces have some differences, this article reviews their pre-pandemic LTC staffing policies and compares their staffing-related COVID-19 prevention measures in 2020. Ontario's policies before 2020 corresponded with lower staff-to-patient ratios than B.C., which may have constrained Ontario's pandemic responses. Implementation of standards or guidelines and changes to funding could help achieve LTC sector staffing resiliency.

Incentive payments and wellbeing snub ignites fury for Te Whatu Ora nurses

National director hospital and specialist services Fionnagh Dougan said no decision has been made "on whether winter payments will be made as part of Te whatu Ora's winter staffing arrangements", in response to enquiries by Kaitiaki. Data provided to Kaitiaki, after a complaint to the Ombudsman, showed the demand for additional shifts did not evaporate, as predicted. Mccallan said winter, and related illnesses, had always increased pressure on health services - but it had just got a lot worse as a result of the crisis of short-staffing.

AN ANALYSIS OF THE ONGOING CLINICAL LABORATORY SCIENCE WORKFORCE SHORTAGES IN THE U.S

Laboratory medicine and the services provided throughout the healthcare system remain critical components in the ability to deliver quality patient care. Over the years and as of recently, due to COVID-19, delivery of proper care has been challenged with continual staffing constraints within the clinical laboratory. While this is not a new issue, its exacerbation poses an ongoing threat to clinical laboratories nationwide and has many healthcare administrators and executives searching for viable solutions. This paper focuses on exploring the depth and breadth of the issue to get to the root of the cause(s) of the critical shortage. Once these keys issues are identified, then realistic and effective solutions can be proposed and implemented throughout the laboratory field.

Build resilient enterprises with resilient people: the case of ASK Consulting

PurposeWhile strong risk management and contingency planning are important for building capabilities useful for quick adaptation to foreseeable disruptions, they may not be useful for preparing for black swan-type events or situations that lack sufficient precedent to understand how they impact businesses. The key to creating a resilient organization relies most on resilient human capital, who are capable of withering whatever changes Chance may throw at them and the organization.Design/methodology/approachUsing company data and semi-structured interviews, this paper presents the case study of ASK Consulting, a medium-size entrepreneurial enterprise that learned that human resources are the cornerstone of a resilient organization.FindingsResilient people exhibit three common traits: discipline, open-mindedness to change, and a sense of service to the team rather than themselves. Insights about these traits can be elicited by asking prospective employees three questions during their interview.Practical implicationsThis case provides an illustrative case study and straightforward guidance for identifying whether a job candidate has the traits of a resilient person.Originality/valueMuch of the research into organizational resilience focuses on scenario planning, contingencies, and building organizational capabilities. This provides a much more straightforward and actionable approach that focuses on only one type of resource and is not contingent on the availability of slack time and money to implement.

Virtual Services in the Health Sciences Library: A Handbook

Pope reviews Virtual Services in the Health Sciences Library: A Handbook edited by Amanda R. Scull.

Two Years Later: How COVID-19 Has Shaped the Teacher Workforce

The unprecedented challenges of teaching during COVID-19 prompted fears of a mass exodus from the profession. We examine the extent to which these fears were realized using administrative records of Massachusetts teachers between 2015–2016 and 2021–2022. Relative to prepandemic levels, average turnover rates were similar going into the fall of 2020 but increased by 17% (from 15.0% to 17.5%) going into the fall of 2021. The fall 2021 increases were particularly high among newly hired teachers (31% increase) but were lower among Black and Hispanic/Latinx teachers (5% increases among both groups). Gaps in turnover rates between schools serving higher and lower concentrations of economically disadvantaged students narrowed during the first 18 months of the pandemic. The same holds true for gaps in turnover between schools serving higher and lower shares of Black and Hispanic/Latinx students. Together, these findings highlight important differences in teachers' responses to the pandemic across subgroups and the need to improve early-career retention to ensure long-term stability within the teacher workforce.

Oncology practices struggle 'to run at all levels' amid workforce shortage

"More than 300,000 health care providers dropped out of the workforce in 2021, including physicians, nurse practitioners, physician assistants and other clinicians who left the workforce that year," Shikha Jain, MD, FACP, associate professor of medicine with tenure in the division of hematology and oncology at University of Illinois Cancer Center in Chicago, consulting editor for Healio Women in Oncology and host of Healio's Oncology Overdrive podcast, told Healio ;HemOnc Today. In a nationwide survey of 1,000 U.S. health care professionals, more than half (57%) of respondents reported concerns about burnout from repetitive tasks and required documentation, 28% reported quitting a job in health care due to burnout and 48% reported concerns about the health care systems ability to retain and hire staff if automation is not prioritized. According to SITC, 95% of cancer centers reported personnel issues resulting from the "great resignation" and a poll of 44 NCI-designated cancer centers showed clinical trial accrual rates down 20% from January 2020 levels. Ongoing staffing issues have affected not only clinical trials at academic medical centers but also all stakeholders in the development of cancer therapies, including contract research organizations and trial sponsors, summit co-chair Leisha A. Emens, MD, PhD, SITC vice president, professor of medicine in hematology and oncology at University of Pittsburgh School of Medicine, and co-leader of UPMC Hillman Cancer Centers cancer immunology and immunotherapy program, told Healio ;HemOnc Today at the time of the summit.

The Great Resignation: survival strategies for pediatric practice

The Great Resignation According to surveys from The Physicians Foundation in 2020 and 2021, 8% of medical practices closed, 32% of practices had to reduce staff, and 49% of physician experienced a reduction in income during the pandemic.1,2 Additionally, the US Bureau of Labor Statistics reported that health care workers were leaving the industry at a rate of 500,000 per month during 20223;Elsevier Health reports that 47% of US health care workers plan to leave their positions by 2025.4 Many physicians took government loans or pay cuts to keep practices afloat during the pandemic;when they reopened, patient volume took months to return to prepandemic levels. Over 230,000 physicians, nurse practitioners, and physician assistants quit their jobs by the end of 2021;the health care industry lost 20% of its workforce.6'7 Thus, the "Great Resignation" is considered one of the most significant sequalae of the COVID-19 pandemic. The Great Resignation today As I write this in February 2023, we continue to wear masks in our offices, work with significant clerical and clinical staff reductions, see more patients daily than we did prepandemic, and regularly see patients with mental health issues who need therapy. Many visits, such as for rashes, mental health and atten-tion-deficit/hyperactivity disorder medication checks, weight checks, conjunctivitis, and follow-up illness visits, are appropriate for virtual care.

Nurses share hopes, achievements and challenges atf irst post-pandemic college & section day

Neonatal nurse exodus High turnover and recruitment were also the biggest challenges for neonatal nursing, said neonatal nurses college Aotearoa (<https://www.nzno.org.nz/groups /colleges_sections/colleges /neonatal_nurses_college>) chair Merophy Brown and committee member Michelle Willows. COASTN was also battling to maintain flight nurses on inter-hospital air ambulance transfers, amid a national ambulance service review. 'Work to do' to keep nurse-led services The women's health college (<https://www.nzno.org.nz/groups/colleges_sections/colleges /womens_health_college>) (WHC) was partnering with the NZ College of Sexual and Reproductive Health to provide long-acting reversible contraceptive (LARC) training (https://nzcsrh.org.nz /LARC-TTT-Training/10934/) for the first time this year, members Callie Reweti and Jackie Gartell said. Gastroenterology nurses also collaborated closely with their medical counterparts, running an annual scientific conference (https://www.gastroconference.co.nz/) with awards for nurses who made scientific posters, gave presentations or contributed scholarly articles for its Tube publication. (<https://www.nzno.org.nz/groups/colleges_sections/colleges /nzno_gastroenterology_nurses_college/the_tube) It also encouraged nurses to seek scholarships through its education fund. (https://www.nzno.org.nz/groups/colleges_sections/colleges/nzno_gastroenterology_nurses_college /education_fund) Its inflammatory bowel diseases nurses had partnered with Crohn's NZ and the Society of Gastroenterology

Cross-Border Cooperation Health in Ireland//A RESPONSE

Providing healthcare services commands the largest allocation of public funding on both sides of the Irish border and concerns over the efficiency and effectiveness of these systems are perennial. Over the past two decades health has been identified as a key area for cross-border collaboration. However, in the absence of an overarching framework or strategy, there is little clarity about objectives. Using the responses to the COVID-19 pandemic as a case study it demonstrates that even in the face of an existential crisis, political leaders default to debates over culture and identity. The paper sets out how the healthcare systems in the two jurisdictions share similar core principles and values and face similar social, economic and political pressures. They have adopted broadly comparable approaches to tackling systemic issues, such as an ageing and growing population, evolving healthcare needs, workforce planning and financial pressures. It argues that there is potential for greater cross-border cooperation but this requires high-level political agreement and must be based on robust evidence. As this paper shows, there are significant barriers to developing all-island approaches, but these are not insurmountable.

Championing Nursing Workforce Through Innovative Dialogues and Collaborations

Cumulatively, it has had a hand in the great resignation, pushed hospitals profit margins into the nether regions, and reached into the ranks of nursing students, as well as their faculty, the academic workforce (Leaver et al., 2022). [...]the public, while grateful at least in the most difficult days of the pandemic, not only failed to translate these actions into strong policies that would result in much tangible change on a national level (Aiken et al., 2022), they have seemingly turned their own frustrations with health care delivery upon their former heroes, nurses themselves, resulting in episodes of nurse-directed assaults and violence, with an average of two nurses assaulted each hour in the United States (Press Ganey, 2022). According to Becker's Hospital Review (2022), an industry news source, "hospital margins are collapsing, and some organizations wonder if it's even possible to make money in the acute care space." Left unabated, shortages will result in patients receiving less face time with health care workers, lengthening current delays in diagnosis, reducing quality of care, burdening the health system (and patients) with our medical errors, and regretfully, increasing disparities and failure to adequately address social determinants of health.

GROWTH AND DEVELOPMENT OF AN INFUSION NURSE FLOAT POOL IN AN AMBULATORY COMPREHENSIVE CANCER CENTER

Professional Development The COVID-19 pandemic significantly impacted nurse staffing worldwide, forcing many hospitals to fulfill gaps in staffing by using per diem nurses and those from outside agencies. Historically, our NCI-designated ambulatory cancer care center has utilized float pool nurses who specialize in the care of patients with solid tumors or hematological cancers to fulfill these nurse staff shortages. However, in order to meet the pandemic staffing demands, nurse leadership recognized the need for greater clinical versatility from the float pool nurses and aimed to develop a float team equipped to provide care for populations across the institute's 13 disease-specific centers. With a focus on empowering float pool nurses to directly influence this work from its inception, foster proficiency, professional growth and development, and camaraderie among members, nurse leaders set out to develop an innovative approach to address staffing needs. The purpose was to create an innovative float pool infrastructure and processes to address pandemic staffing consequences while limiting utilization of per diem nurses and those from outside agencies. First, disease-centric education was created utilizing a multimodal approach. Didactic education was widely accessible to all staff via online modules and case studies. Experiential learning was enabled through a strategic placement program where float pool nurses were assigned to a disease center to gain exposure alongside chosen expert nurse mentors for 4 months. Secondly, an intentional check-in process was created consisting of meetings between the float pool nurse, clinical specialist, and nurse director every two weeks during the nurse's first four months on the team, and then every two months thereafter. Within 6 months, 100% of float pool nurses completed both their assigned didactic and strategic placement requirements. Within 10 months, they began caring for patients across multiple disease centers. As an outcome of the connections created throughout the check-in process, float pool nurses contributed valuable insight which shaped the content, timing, and delivery of each educational opportunity. Enhancing the clinical diversity of the float pool nurses provides a global support to all units requiring staffing support within the institute. It has the potential to provide improved patient outcomes by mitigating the safety risks of overusing per diem nurses and those from outside agencies who are not familiar with the environments, workflows, and safety checks for specialized care.