Health care is an important sector in all European countries showing a high dynamic in the past. In 2011 about 23 million persons were employed in health and social care, that is to say 10.4% of total employment. The share of health care expenditures in GDP was 10%. The health care workforce increased despite the overall trend of declining employment also during the economic crisis. The high dynamic in health care can be explained by demographic changes as well as by other non-demographic drivers. Due to the ageing of the population a further increase in the demand for health workforce is expected.
This paper gives an overview of the health and social workforce in the EU Member States based on the EU labour force survey. It focuses on the current situation and the changes in the last years as well as the differences across the Member States in the three main areas human health care, residential care, and social work.

Human resources in health care. Up-to–date trends and projections

The article presents the diagnosis of trends in health care sector personnel in Poland, particularly physicians and nurses, and projections of the future personnel taking into account population ageing. The article is based on the NEUJOBS project research performed within the European Commission 7th Framework Programme. The analysis and projections use quantitative data: administrative, Eurostat data and GUS survey results. The density of employment of the health personnel per 1000 inhabitants is lower in Poland than in other EU-countries. In the future the demand for the medical personnel will be growing due to the increased needs for health care and ageing. The projections show that shortages of personnel will be faced by hospitals, particularly for specializations related to treatment of chronic diseases, while this is not the case in primary care. The size of the demand for medical personnel will be subjected to increase in technical efficiency of hospitals.

Human resources planning in health care system – the need or the necessity?

The article presents the main assumptions and limitations of human resources planning in health care system and conditions of this process in Poland. The results of the WHO research inform about the world crisis of medical staff. The situation in our country is extremely difficult due to lack of formal organization/structure responsible for planning of human resources for health. Moreover the core indicators of Polish medical staff (physicians-per population ratio, nurses- per population ratio) are one of the lowest in Europe. Public health experts and professional associations of medical staff (e.g. National Chamber of Nurses and Midwifes) have developed worrisome forecasts of the availability of the medical staff in our country but policy makers don’t undertake activity in this field.
For the purpose of dealing with problems of medical staff shortages in Poland it is necessary to establish cooperation of different partners and institutions (Ministry of Health, Ministry of Science and Higher Education, professional association, medical universities, data collection institutions, unions, health service providers). Planners and decision makers should develop and implement models and strategies for planning of medical staff which are need-based, outcome-directed and that recognize the complex and dynamic nature of health care services.
 

Doctors and nurses payment in comparison with other occupations (2001-2010)

This article aims is presenting relationship doctors and nurses payment in public health services, after the reform from 1999. Increase salaries for medical personnel was very important government problem in ninetieth years. Doctors and nurses to wait increase their salaries. Trade unions to demand level of salaries adequate to importance and function health service in whole economy and doctors and nurses qualifications. Between government suggestions and medical personnel expectation of salary increase was considerable difference. One rule of reform in public health service in 1999 was finance wages budget from National Health Fund. Article presenting factors influence on level of payment medical personnel, payment relationship between health service and other occupations, influence of employment seniority on payment diversity, relationship between women and men as well as payment influence on doctors emigration. Results of information presenting in this article is, that payment relationship doctors and nurses in comparison with other occupations changing between 2001 and 2010 for the better.

Migration of the medical professionals

Migration of the healthcare personnel started long before Poland joined the EU. However, with the accession more and more people, especially doctors, decided to migrate. The main reason for migration was of a financial nature. In recent years the dynamics of this migration slowed down among physicians, but it increased among nurses. Though at the moment migration does not pose a serious problem for the healthcare system in Poland it may be one of the factors which will cause problems in the future. Majority of migrants are relatively young. There is a threat that there will be no replacement for nurses who will retire in the nearest future. State involvement / action is required to sustain the system.

Nurse position on the labour market

Purpose of the paper is description of nurse position on the labour market and vis a vis employers in health care system. Shrinking of the personnel supply and low attractiveness of the nurse occupation due to low wages has been indicated. High labour unionisation and capacity for strike organizing were described. A thesis of the article it is that the defensive strategy of nurses is concentrated now more around the collective action than across competing on the labour market. The alterability of this strategy is sketched as one to be more oriented on the market balance in consequence of the lack of sufficient inflow to the occupation of young candidates. The empirical base of analysis constitutes: public statistics presented by Ministry of Health, Central Statistical Office, Chambers of Nurses and Midwives, and research findings coming from project: “Municipal Hospitals under the pressure of changes”, done in years 2012–2013 in Warsaw.

Motivation in nurse’s work and job satisfaction

With the gradual expansion of the nurse scope of duties there is a necessity for a new definition of a nurse role in the therapeutic team. New skills must go hand in hand with the predisposition and extensive knowledge not only in medicine, but also in the management skills. The aim of research is to analyze the impact of different factors, which determine motivation and job satisfaction within their new role. The research comprised 200 nurses: 100 employees of public health care facilities and 100 nurses hired in private medical sector. The method used in the study was a questionnaire survey. The χ2 test was used to check hypotheses. The majority of nurses (total 80%) made a conscious choice of profession. 80.5% of respondents indicated satisfaction with their work, most of them are employed in private medical facilities. Nurses employed in private medical sector are more satisfied and more motivated for job than nurses employed in public health care facilities. The reason to this conclusion may well be better work organization in private health care institutions. Job satisfaction affects work incentives and quality of services. Except money motivating factor can be for example training

Workload during the last shift in the opinion of hospital nurses involved in RN4CAST project

Background
The issue of workload is one of the most important ones as far as the nurses’ profession is concerned.
Numerous analyses prove the relationship between excessive workload and job dissatisfaction, which may lead to low morale, absenteeism, high rotation and low work efficiency and, consequently, result in deterioration of the care provided to the patient and even put the patient’s safety at risk. RN4CAST project is aimed at the evaluation of the workload which the nurses are exposed to during their shifts. Such a survey focuses on all structural determinants of hospital workload depending on: type of the ward, professional role, number of patients and their health condition as well as work conditions and organization: the number of working hours and shift staffing.

Aim of the survey
The survey is aimed at determining the factors responsible for the workload which the nurses are exposed to during their shifts in hospitals involved in RN4CAST project.

Material and Methods
The study included 2605 nurses working in 30 acute hospitals in Poland. The respondents were mainly women. Men made up only 0.4% of the population examined. The average age was 40.3 (SD = 7.8 years old). 23.5% of the respondents had the Bachelor’s degree in nursing. The average seniority was 18.6 years (SD = 8,6), and the seniority in the hospital involved in the survey – 15.6 years (SD = 9,2).
The material was collected by means of a survey and a structurised questionnaire completed by the nurses on their own. A correlational model was used to evaluate the workload determinants.

Results
During their last shift 84% of the nurses worked, on average, 11.3 hours (SD = 2.4). The number of patients on the ward was 31.1, on average (SD = 12.6) it varied significantly (p = 0.000) depending on the ward type. The nursing care was provided by 3.4 qualified nurses on average (SD = 2.2). One nurse was responsible for 20.4 patients on average (SD = 11.1), [median = 18, first quartile (Q1) = 12, third quartile (Q3) = 29)].
It was proved that the increase in the total number of the patients on the ward was accompanied by the increase in the number of patients who required assistance with everyday routines (tau-b = 0.17; p = 0.000) and in the number of patients who required monitoring or hourly (or even more frequent) treatment (tau-b=0.37; p=0.000).
Close examination of the variables responsible for individual workload showed that there is a little but noticeable correlation between the increase of the total number of patients on the ward (tau-b = 0.28; p = 0.000) and the increase in the number of patients each nurses was directly responsible for on her shift.
There was a positive correlation (tau-b = 0.40; p = 0.000) between the total number of patients and the total number of qualified nurses providing direct care to these patients during their shifts.
Also a slight negative correlation was observed (tau-b = –0.061; p = 0.000) between the total number of nurses and the number of patients each nurse was directly responsible for.
There was also a slight positive correlation (tau-b = 0.18; p = 0.000) between the number of nurses and the number of helping staff who provided direct care to the patients during their shifts. And also a slight correlation was observed (tau-b = 0.061; p = 0.000) between the number of patients and the number of helping staff during the shifts.
The analysis of the findings from both wards leads to the conclusion that the seven most frequent and common routines, which did not require nursing qualifications constituted a significant workload for nurses on all shifts (p = 0,000) and that the nurses who solely provided care to the patients were significantly more often responsible for routines which did not require any professional skills.
The nurses examined, evaluated their hospital working conditions as poor – 28.9%; satisfactory – 46.8%; good – 23.2%; excellent – 1.1%.
Majority of nurses (59.3%) claim that the number of hospital staff is definitely too low to work efficiently; 64.5% pointed out the lack of qualified nurses and 31.7% the lack of technical and helping staff. Vast majority of nurses (64%) claim that they can rely on the hospital management support only in some situations. Most nurses (77%) complained that their relations with the doctors were not always good, whereas 13.6% complained about lack of good professional relations between nurses and doctors.

Conclusions
1. The analysis of the findings shows that structural factors (such as type of the ward, professional role, number and condition of patients) as well as organisational factors (such as number of shift hours, shift staffing and work environment) determined the nurses’ workload.
2. The shift survey as a device for evaluating nurses’ workload should be recommended to ward nurses and hospital management because of the simplicity with which particular elements can be observed. The observation can be carried out during a relatively short period of time (8–12-hour shift), which allows for a better and faster explanation of the reasons of excessive workload and consequently may lead to implementing solutions, which would eliminate this negative phenomenon.

RN4CAST HEALTH-2007-3.2-4: Health care human resource planning in nursing Grant agreement no.: 223468

Although leadership is a well-known concept within organisational science, public health leadership is still not well-defined. Further, leadership is not commonly included in most public health training programs. Faced with immense changes in population health needs, public health professionals require a broader range of skills and expertise than ever before. In response to these issues the article aims to describe the development of a public health leadership curriculum as part of the European project entitled “Leaders for European Public Health” (LEPHIE) supported by the European Commission Lifelong Learning Programme. The article first discusses the theoretical underpinnings related to the public health leadership curriculum development. Secondly, its mission and objectives will be discussed. Thirdly, the methodological approaches and architecture of the programme are presented, and finally illustrates the features for quality assurance and the potential for future use in different contexts.

Objective: The aim of this study was to assess the necessary level of abilities and competencies of family physicians from the decision-makers’ perspective in Kosovo, a post-war country in the Western Balkans.

Methods: Our study was conducted in May-July 2013 and included a nationwide representative sample of 100 decision-makers operating at different primary health care institutions or public health agencies in Kosovo (63 men aged 48.6±5.5 years, and 65 women aged 46.2±5.7 years). A structured self-administered questionnaire was employed aiming to assess the necessary level of skills, abilities and competencies of family physicians in Kosovo regarding  different domains of the quality of health care. The questionnaire included 37 items organized into six subscales/domains. Answers for each item of the tool ranged from 1 (“novice” physicians) to 5 (“expert” physicians). An overall summary score (range: 37-185) and a subscale summary score for each domain were calculated for each participant. Cronbach’s alpha was used to assess the internal consistency of the instrument, whereas Mann-Whitney’s U-test was employed to assess sex-differences in the mean values of the summary score of 37-item instrument and the summary scores of each of the six subscales.

Results: The internal consistency of the whole scale (37 items) was Cronbach’s alpha=0.92. The summary score of the 37-item instrument was higher in men than in women (162.3±17.9 vs. 156.1±17.5, respectively, P=0.071). The subscale scores were all higher in men than in women, a finding which was borderline statistically significant for the “patient care and safety” domain only (33.4±4.4 vs. 32.0±4.0, respectively, P=0.057). There was a weak correlation between the overall summary score of the tool and the work experience of decision-makers (Spearman’s rho=0.234, P<0.001).

Conclusion: In the context of Kosovo, this study provides important evidence on the expected skills and competencies of family physicians from the decision-makers’ viewpoint. Future studies in Kosovo should compare our findings related to the necessary skills and competencies vis-à-vis the actual self-perceived skills and competencies of family physicians.