Competitive employer positioning through career path analysis: the case of the Swiss nursing sector.

BACKGROUND: The global shortage of nurses has caused strategic employer positioning and strengthened employer branding to become progressively relevant addressing the increased competition in the recruitment of nurses. This study provides competition-oriented strengths-and-weaknesses profiles for nurse attraction and attrition for the major types of healthcare institutions to advise on competitive employer positioning. METHODS: We applied bivariate weighted logistic regressions with cluster-adjusted standard errors to evaluate 4844 employer changes of 3011 nurses participating in the nurses at work study, whereby the reasons to quit (RQs) acted as both predictors of the former and the follow-up type of employer. For each employer type, we introduce a coordination system allocating each workplace criterion along its push and implicit pull characteristics, given through the specific odds ratios, to derive different strategic implications for an organisation's competitive nurse recruitment. RESULTS: Depending on the employer type, workplace criteria were variously acting as push or pull factors in nurses' career decisions. CONCLUSIONS: Nurses' career choices are affected by experienced and presumed workplace characteristics associated with specific employer types. Becoming aware of these associations and experiences, employers should leverage workplace criteria with relatively strong pull or/and weak push characteristics by intensified communication measurements and criteria with relatively weak pull or/and strong push characteristics should be enhanced to a competitive level.

Institutional effects on nurses' working conditions: a multi-group comparison of public and private non-profit and for-profit healthcare employers in Switzerland.

BACKGROUND: In response to the need for competitive recruitment of nurses resulting from the worldwide nursing shortage, employers need to attract and retain nurses by promoting their competitive strengths in their working conditions (WCS) and by addressing their competitive weaknesses. This study investigated workplace differences between public hospitals (PuHs), private for-profit hospitals (PrHs), socio-medical institutions (SOMEDs), home care services (HCs), private medical offices (PrOs) and non-profit organisations (NPOs), helping to provide a foundation for competition-oriented institutional employer branding and to increase transparency in the labour market for nurses. METHODS: Data from the Swiss Nurses at Work study of the career paths of 11 232 nurses who worked in Switzerland between 1970 and 2014 were subjected to secondary analysis, assessing the effect of institutional characteristics on self-reported determinants of job satisfaction (such as WCS) using multivariate linear regression and post hoc tests with Bonferroni-adjusted significance levels. Principal component analysis was used to reduce the number of WCS in the original study. RESULTS: Nurses at PuHs and PrHs were less likely to experience autonomy, flexibility of work hours and participation in decision-making than those at other workplaces. Although PuHs were rated higher than PrHs in terms of satisfaction with salary and advancement opportunities, they were associated with more alienating work factors, such as stress and aggression. SOMED workplaces were significantly more often associated with alienating conditions and low job satisfaction, but were rated higher than the other institutions in terms of participation in decision-making. The nurses' ratings implied that PrO workplaces were more likely to offer a mild work environment, social support and recognition than other institutions, but that advancement opportunities were limited. NPO workplaces were associated with the highest degree of autonomy, flexibility, participation, recognition, organisational commitment and job satisfaction. In these respects, HC and NPO workplaces received similar ratings, although the HC workplaces were associated with a significantly lower organisational commitment and significantly lower job satisfaction. CONCLUSIONS: Due to their structural characteristics, NPOs, SOMEDs and HCs can attract nurses seeking greater self-determination, PuHs can attract career-oriented nurses, and PrOs and PrHs are likely to attract nurses through offering less-stressful working conditions.

How to identify and recruit nurses to a survey 14 and 24 years after graduation in a context of scarce data: lessons learnt from the 2012 nurses at work pilot study on nurses' career paths.

BACKGROUND: Nursing workforce data are scarce in Switzerland, with no active national registry of nurses. The worldwide nursing shortage is also affecting Switzerland, so that evidence-based results of the nurses at work project on career paths and retention are needed as part of the health care system stewardship; nurses at work is a retrospective cohort study of nurses who graduated in Swiss nursing schools in the last 30 years. Results of the pilot study are presented here (process and feasibility). The objectives are (1) to determine the size and structure of the potential target population by approaching two test-cohorts of nursing graduates (1988 and 1998); (2) to test methods of identifying and reaching them 14 and 24 years after graduation; (3) to compute participation rates, and identify recruitment and participation biases. METHODS: Graduates' names were retrieved from 26 Swiss nursing schools: 488 nurses from the 1988 cohort and 597 from 1998 were invited to complete a web-based questionnaire. Initial updated addresses (n = 278, seed sample) were found using the Swiss Nursing Association member file. In addition, a snowball method was applied for recruitment, where directly-contacted respondents provided additional names of graduate mates or sent them the invitation. The study was further advertized through the main employers, study partners, and a press release. RESULTS: Participation rate was 26.5% (n = 287), higher for the older cohort of 1988 (29.7%, n = 145) than for 1998 (15.6%, n = 93). Additional nurses (n = 363) not belonging to the test cohorts also answered. All schools were represented among respondents. Only 18 respondents (6%) worked outside nursing or not at all. Among respondents, 94% would 'probably' or 'maybe' agree to participate in the main study. CONCLUSION: The pilot study demonstrated that targeted nurses could be identified and approached. There is an overwhelming interest in the project from them and from policymakers. Recommendations to increase nurses' participation rate for nurses at work include: (1) to open nurses at work recruitment to all nurses in Switzerland, while recreating cohorts post-hoc for relevant analysis; (2) to define a comprehensive communication strategy with special attention to graduate nurses who are harder to reach.

Self-reported health needs and use of primary health care services by adolescents enrolled in post-mandatory schools or vocational training programmes in Switzerland.

BACKGROUND: The second Swiss Multicenter Adolescent Survey on Health (SMASH02) was conducted among a representative sample (n = 7428) of students and apprentices aged 16 to 20 from the three language areas of Switzerland during the year 2002. This paper reports on health needs expressed by adolescents and their use of health care services over the 12 months preceding the survey. METHODS: Nineteen cantons representing 80% of the resident population agreed to participate. A complex iterative random cluster sample of 600 classes was drawn with classes as primary sampling unit. The participation rate was 97.7% for the classes and 99.8% for the youths in attendance. The self-administered questionnaire included 565 items. The median rate of item non-response was 1.8%. Ethical and legal requirements applying to surveys of adolescent populations were respected. RESULTS: Overall more than 90% of adolescents felt in good to excellent health. Suffering often or very often from different physical complaints or pain was also reported such as headache (boys: 15.9%, girls: 37.4%), stomach-ache (boys: 9.7%, girls: 30.0%), joint pain (boys: 24.7%, girls: 29.5%) or back pain (boys: 24.3%, girls: 34.7%). Many adolescents reported a need for help on psychosocial and lifestyle issues, such as stress (boys: 28.5%, girls: 47.7%) or depression (boys: 18.9%, girls: 34.4%). Although about 75% of adolescents reported having consulted a general practitioner and about one-third having seen another specialist, reported reasons for visits do not correspond to the expressed needs. Less than 10% of adolescents had visited a psychiatrist, a family planning centre or a social worker. CONCLUSIONS: The reported rates of health services utilisation by adolescents does not match the substantial reported needs for help in various areas. This may indicate that the corresponding problems are not adequately detected and/or addressed by professionals from the health and social sectors.

[Voluntary pregnancy termination in the canton of Vaud in 2002]. / Les interruptions volontaires de grossesse dans le canton de Vaud en 2002.

No rates of pregnancy termination are available for Switzerland as a whole. In the canton of Vaud, however, pregnancy termination has been monitored for over ten years. The annual incidence (10.9 per 1000 residents in 2002) is one of the lowest recorded worldwide, but considerable variations are observed depending on age and on nationality; the incidence for non-Swiss nationals being three times higher than for Swiss nationals. As in the past, and in line with legislative changes that came into effect in October 2002, the vast majority of pregnancy terminations take place before the twelfth week of pregnancy. Repeat termination is relatively frequent: a quarter of those requesting termination in 2002 reported previous experience of pregnancy termination. In parous women, one in five requests for termination occurs less than one year after the birth of the last child. These data indicate that contraceptive counselling should be reinforced at the time of childbirth and following pregnancy termination.

Cardiovascular risk factor profiles and their social gradient from adolescence to age 74 in a Swiss region.

BACKGROUND: Few European studies have investigated how cardiovascular risk factors (CRF) in adults relate to those observed in younger generations. OBJECTIVE: To explore this issue in a Swiss region using two population health surveys of 3636 adolescents ages 9-19 years and 3299 adults ages 25-74 years. METHODS: Age patterns of continuous CRF were estimated by robust locally weighted regression and those of high-risk groups were calculated using adult criteria with appropriate adjustment for children. RESULTS: Gender differences in height, weight, blood pressure, and HDL cholesterol observed in adults were found to emerge in adolescents. Overweight, affecting 10-12% of adolescents, was increasing steeply in young adults (three times among males and twice among females) in parallel with inactivity. Median age at smoking initiation was decreasing rapidly from 18 to 20 years in young adults to 15 in adolescents. A statistically significant social gradient in disfavor of the lower education level was observed for overweight in all age groups of women above 16 (odds ratios (ORs) 2.4 to 3.3, P < 0.01), for inactivity in adult males (ORs 1.6 to 2.0, P < 0.05), and for regular smoking in older adolescents (OR 1.9 for males, 2.7 for females, P < 0.005), but not for elevated blood pressure. CONCLUSION: Discontinuities in the cross-sectional age patterns of CRF indicated the emergence of a social gradient and the need for preventive actions against the early adoption of persistent unhealthy behaviors, to which low-educated girls and women are particularly exposed.