A European nursing workforce study: international...

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A European nursing workforce study: international

collaboration and results of RN4CAST

Walter SERMEUS, RN, PhD

RN4CAST Coordinator, Professor, Department of Public Health & Primary

Care, KU Leuven, Belgium

Outline

• Managing a European projecto Experience with European projectso Introducing FP7 - RN4CAST o Applying for a grant: what does it mean?o Managing a consortium: my experienceo Factors for failure/success

• RN4CAST results

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My experience with European projectsFunding Source Time frame Project name RoleConcerted Actions 1994-1996 Telenursing PartnerFP4 1997-1999 Wisecare CoordinatorFP4 1997-1999 Telenurse,

NightingalePartner

Leonardo da Vinci 2003-2005 EHTAN PartnerFP7 2009-2011 RN4CAST CoordinatorESF 2011-2015 Reflection PartnerEAHC 2013-2016 JA Health

workforcePartner

EAHC 2014-2015 Recruitment & Retention

Partner

JPND 2014-2015 ALS-Care Partner

RN4CAST STUDY

‘RN4CAST: nurse forecasting in Europe’: €3 million funding for 2009-2011Health theme 3: Optimising the delivery of health care16 partners: 12 European countries, USA, China, South-Africa,

BotswanaCo-ordination: Leuven University (W. Sermeus), U. Pennsylvania (L. Aiken)

4

7th Framework Programme for Research and Technological Development

Sermeus et al., 2011 BMC Nursing

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THE RN4CAST CONSORTIUM

Belgium Katholieke Universiteit Leuven

England King’s College London

Norway Knowledge Centre for the Health Services

Ireland Dublin City University

Sweden Karolinska Institutet

the Netherlands Radboud UMC

Spain Institute of Health Carlos III

Finland University of Eastern FinlandGermany Technische Universität BerlinPoland Jagiellonian University

Greece National and KapodistrianUniversity Athens

Switserland Basel University


Applying for a European Grant (FP7)What we know on success rate

100 proposals

ELIGIBILITY

S&T Excellence 3/5Implementation 3/5Impact 3/5

Prioritise projects

Commission

External evaluators

Panel + Commission

THRESHOLD

-5

-50

To be funded 20

-25

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Timeline preparation of RN4CAST proposal• Call due-date: Sept. 18, 2007

• First discussions January 2007, EANS Barcelona• Meeting L. Aiken, Leuven, February 2007• Meeting with Leuven research coordination office, May, 2007• Contacts LA (IHOS) and WS (WISECARE, EANS) networks• EANS summerschool• Writing first proposal: summer 2007• September 6-7, Leuven meeting with partners• Contact EU-officer K. McCarthy • Contacts with Poland• Finalising proposal and submitting Sept. 18, 2007

Writing a good proposalcriterion1: S/T Excellence

• 30-seconds-rule (role of jury: kill 80% of excellent proposals)o Why bother (what is the problem?)o Is it a European problem?o Solution already available?o Why now (what happens if we do not fund this?)o Why you (are you the best consortium?)o Stick to the instructions (call)

• Educate the evaluatoro Likely not a « real expert »o Use facts & figures, schemes & illustrationso Balance: scientific >< popularo Write to the point + convincinglyo Structure your text (alineas, bold,…)o Quantify your arguments

Thanks to Stijn Delauré and Leuven onderzoekscoordinatie, Leuven meeting 6-7 Sept 2007

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Criterion 2: implementation• Building an excellent consortium

o Provide a balanced mixo Each partner should add valueo Experienced manager, good leaders

• Appropriate management structureo Handling conflicts, decision making, care for quality,

division of worko Follow-up of milestones, decisions, …o IPR-management

Criterion 3: Impact• Write deliverables in the words of end-user (cfr.

Call)• Involve end-users in the project (e.g. advisory

board)• Answer questions:

o How does the project address EU challenges ?o How can the project affect citizens ?o How is the uptake in health industry arranged/

organized ?

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Evaluation RN4CAST

• Evaluation by panels of independent experts• Criteria:

o Scientific and technological excellence (5/5)o Implementation & management (4,5/5) o Potential impact (5/5)o Total (14,5/15)

• Remarks (for negotiation)• Change in environment and location of care• The role and participation of ICPC to be better explained; work

environment specialist inclusion and selection.

• Grant: 2,999,988 Euro

Negotation Timeline• 08.05.2008

o First deadline for DoW and GPFs based on recommendations• 10.10.2008

o End of first round of negotations, o deadline for submission of final version of DoW and signed GPFs

• 17.10.2008o The Commission launches its internal procedures for the formal

adoption of the proposed financing and finalisation of each Grant Agreement.

• 01.01.2009o Official start of the project – first meeting 15&16/1/2009

• End June 2009o Final contract signed

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Role of coordinator• Contact person with EU and partners• Organisational and financial responsibility• Figurehead of consortium (conferences, policy,…)• Motivation, stimulation of partners• Supports collaboration between partners (mutual respect,

teamwork,…)

Mandatory readings for coordinators• Hofstede G. & G.J. Hofstede, Cultures and organizations: software of

the mind, McGraw Hill, 2004, 300pp.

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E. g. Uncertainty avoidance - Power distance Dimensions (Hofstede, 1991)

Results RN4CAST• Milestones on time• Final conference dec. 2011 (together with 2 other projects -

Prometheus, MohProf)• More than 40 scientific papers

o BMJ 2012o Special issue IJNS 2013o The Lancet 2014o Preparing book volume (end 2014)

• Policy impact via international organizations: WHO, OECD, ILO, ICN, EHMA, MEPs, …

http://www.rn4cast.eu/en/articles.php

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Elements of success• Enough manpower and support for coordination

o Administrative (0.3 FTE)o Scientific (0.5 FTE postdoc + 1 FTE researchero Financial (Leuven LRD)

• Coordination requires experience (cfr. KU Leuven)• Coordinator role requires a lot of time• Grant/consortium agreement is important (more than

just administration)• Publication policy• Learning EU-language, presence on important EU

meetings

SWOT• Strengths:

o Preparatory funding KULeuven in preparing consortium, proposalo KUL experience with FP7 projects. o Strong Leuven research team: administrative, scientifico Balanced consortiumo Specific roles: scientific lead, advisory committee,…o Pro-active meetingso Structured consortium communication

• Weakness:o Extended length of project: 2y before + 3y after projecto Changing partnerso Changing EU-officerso Post-project management (no funding)

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Outline

• Managing a European project• RN4CAST results

o RN4CAST framework and designo Descriptive resultso Impact on patient outcomeso Impact on nurse outcomeso Policy impact

Dubois et al., 2012, BMC HSR

Framework: A nursing organization modelFramework

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RN4CAST DESIGNMulticountry, multilevel, cross-sectional design to obtain important

unmeasured factors in forecasting models, collected at the hospital,

nursing unit and individual nurse and patient level:

Nurse survey: working environment, quality & safety, staffingPatient survey: patient experiences with nursing staff, hospital, information

Hospital survey: type of hospital, inflow & outflowHospital Discharge data: ICD9/10, length-of-stay, adverse events, mortality

Setting

At least 30 general acute hospitals in each European country.

At least 2 general surgical and internal medicine wards in each hospital.

21Sermeus et al., 2011 BMC Nursing

RN4CAST STUDY DESIGN

RN4CAST USRN4CAST Europe

RN4CAST ICPC

Europe (12 countries)33731 nurses in 486 hospitals11318 patients in 210 hospitals

South Africa (6 provinces)4657 nurses in 62 hospitals

China (6 provinces)9698 nurses in 181 hospitals6494 patients in 181 hospitals

USA (PA, CA, NJ, FL)27509 nurses in 617 hospitalsMillions of patients in 430 hospitals

A UNIQUE DATA SET


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RN4CAST FINDINGS

Aiken, Sloane, Bruyneel, Van den Heede, Griffiths, Busse...Sermeus. 2014.

Nurse staffing and education and hospital mortality in nine European countries:

a retrospective observational study. The Lancet

Ausserhofer, Zander, Busse, Schubert, De Geest, Rafferty...Schwendimann.

2014. Prevalence, patterns and predictors of nursing care left undone in

European hospitals: results from the multicountry cross-sectional RN4CAST

study. BMJ Qual Saf

Aiken, Sermeus, Van den Heede, Sloane, Busse, McKee, Bruyneel...Kutney-

Lee. 2012. Patient safety, satisfaction, and quality of hospital care: cross

sectional surveys of nurses and patients in Europe and the United States. BMJ

KEY PUBLICATIONS

14 articles on topics such as:

Descriptive findings

Nurse-perceived quality of care,

wellbeing

Nurse migration and tasks below skill

level

RN4CAST follow-up study with

qualitative research design

Rationing of nursing care

Instrument validation

Advanced statistical analysis

RN4CAST FINDINGS

SPECIAL ISSUE IJNS 2012

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Country Mean 25th Pctl 50th Pctl 75th PctlBelgium 10.7 9.1 10.1 12.2

England 8.6 7.2 8.8 9.6

Finland 8.3 6.8 7.8 9.5

Germany 13.0 11.5 13.1 14.3

Greece 10.2 7.6 9.8 11.8

Ireland 6.9 6.2 6.8 7.7

Netherlands 7.0 6.4 7.2 7.7

Norway 5.4 4.8 5.2 6.0

Poland 10.5 9.1 10.6 11.5

Spain 12.5 11.5 12.6 13.5

Sweden 7.7 6.9 7.5 8.5

Switzerland 7.9 6.8 7.8 8.7

Nurse to Patient Ratios (3 shifts)

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Aiken et al., 2013 IJNS

Percent Bachelor prepared Nurses

51

56

52

0

20

60

32

100

22

100

59

10

0102030405060708090

100

26


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Captures 5 dimensions:Staffing adequacyNursing foundations for qualityNurse manager ability & leadershipNurse-physician relationsNurse involvement in hospital affairs

Hospitals classified into quartiles by PES scores

Nurses’ work environment

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0% 50% 100%

BelgiumSwitzerland

GermanySpain

FinlandGreeceIreland

NetherlandsNorwayPoland

SwedenEngland

Total

poor

mixed

better


RN4CAST FINDINGS

NURSES’ WORK ENVIRONMENT

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Effect of nurse staffing on patient mortality

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Aiken et al. 2014 The Lancet

Significant effect

Aiken et al. 2014 The Lancet

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RN4CAST FINDINGS

MISSED NURSING CARE: DESCRIPTIVE FINDINGS

Ausserhofer et al. 2014 BMJ Q&S

Scope of practice: Nursing Care Left Undone because of Lack of Time

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Ausserhofer et al. 2014 BMJ Q&S

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Patient satisfaction rates (1-10)

Aiken et al. 2012 BMJ

RN4CAST FINDINGS

PATIENTS’ EXPERIENCES WITH CARE: RELATION TO NURSING

Aiken et al. 2012. BMJ

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Relationship of nurse satisfaction and patient satisfaction


Jobsatisfaction of nurses in Europe


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Hospitals with Better Work Environments: Lower Nurse Burnout, in every country

Best37


Effect of nurse staffing on nurse outcomes


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PROGRESS OF RN4CASTEU

PROPOSAL

PROTOCOL FINALI-SATION

DATA COLLECTION DATA ANALYSIS AND POLICY IMPLICATIONS

2007-2008

RN4CAST STUDY

2010WP1:

Management & CoordinationWP Leader: K.U.Leuven (a)

WP4: Protocol

Finalization/ Harmonization

WP Leader: UPenn

WP5: Nurse Survey

Data CollectionWP Leader:

ISCIII

WP6: Patient

Outcomes Data Collection

WP Leader: KCL

WP3: Workforce Planning/

ForecastingWP Leader: UKU

WP7: Data integration

& analysisWP Leader:

K.U.Leuven (b)

WP8: Human

Resources Policy Synthesis

WP Leader: DCU

WP2: Dissemination & Stakeholders engagement

WP Leader: KCL

DISSEMINATION AND POLICY IMPLEMENTATION

RN4CAST FOLLOW-UP

2011 2012-20142009 ....

PUBLICATIONS

CONFERENCES

POLICY IMPACT

BRIDGING SCIENCE – POLICY GAP

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IMPACT ?• Mainly Lancet paper got a lot of attention

o Altmetric score of 1208

o Debates in many countries on nurse staffing and qualification levels

Lancet letters

[email protected]

www.thelancet.com Vol 384 September 6, 2014

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RN4CAST POLICY IMPLEMENTATION• COUNTRY IMPLEMENTATIONS• STRATEGIC INITIATIVES

o OECD: Skill mixo EU-DG SANCO: Joint Action on health workforce planning

and forecastingo EU-DG SANCO/EHMA: Health Professional recruitment and

retentiono WHO- European Observatory: Prometheus and migration of

health professionalso WHO-Europe: Ethical recruitmento ILO Nursing Personnel Convention 149

• INTEREST OTHER COUNTRIESo Portugal, Cyprus, Italy, …

Conclusion and my advice

Never see a project as just a project, but see it as a long term

commitment to society

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On behalf of RN4CAST consortium

Thank you for your attention

A European nursing workforce study: international...

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