People in Recovery from Substance Use Disorders: What Motivates Them to Enter Addiction Treatment Agencies as Counselors?

This qualitative study aimed to understand the motivations of people recovering from substance use disorders (SUDs) to work in addiction treatment agencies as counselors. A purposive and snowball sampling technique was used to recruit 18 recovering counselors from Long Island, New York. Most of the participants self-identified as Caucasian, and a third identified as African American. All interviews were audio-recorded and transcribed verbatim. The results indicate that want to give back, perceived self-efficacy to work with SUD clients, and previous experiences with addiction treatment services motivated people in recovery from SUD to become counselors. The respondents also reported the role of intrinsic rewards, such as witnessing clients’ progress over time and the opportunity to sustain their recovery, which influenced their decision to continue working in the addiction treatment field. Understanding work motivations has significant implications for assessing the staffing needs and professional development of SUD treatment programs, including recruitment, retention, and the overall size and capacity of the addiction treatment workforce.

Constructability Reviews Utilization Practices for Traditional and Alternative Project Delivery Methods Across State Transportation Agencies

State Transportation Agencies (STAs) recognized that to enhance the quality of construction documents, a review process must be incorporated into project planning, design, and procurement to evaluate projects for constructability. The benefits promised by constructability reviews (CRs) encouraged STAs to adopt it as part of their operations. This approach soon evolved into a structured process, recognized by researchers and practitioners as, the constructability review process (CRP). A significant component to the CRP success is to involve experienced construction personnel in CRs during the design phase; a major limitation of the traditional design-bid-build (DBB) delivery method. To overcome this limitation, more emphasis is being placed towards alternative project delivery methods (APDMs). As such, design–build (DB) and construction manager/general contractor (CM/GC) are among the APDMs most utilized by STAs to deliver transportation projects. Although extensive research has investigated CRs under DBB projects, research on CRs implementation under APDMs is remarkably absent. This study examines CRs utilization and staffing practices adopted by STAs across DBB, DB, and CM/GC projects. The results of this study were drawn utilizing data collected through a national survey questionnaire and interviews with selected STAs. The study found that CRs are initiated and implemented at proportionally similar phases across DBB, DB, and CM/GC projects. Investigation of staffing needs revealed that although the agency holds the executive role in implementation of CRs on DBB projects, their role shifts on DB projects to become more administrative. The agency continues to be involved in CRs under CM/GC projects, along with their allocated design consultant, in conjunction with the GC. The results of this study are anticipated to provide STAs with guidance for CRs utilization on DBB, DB and CM/GC projects.

Workload Analysis of Pharmacy Technicians at Pharmacy Department of Universitas Padjadjaran Dental and Oral Hospital Using Workload Indicators of Staffing Needs

Job responsibilities are significantly accomplished with sufficient and appropriate labor, although it differs in various fields. A major challenge in health facilities involves the ability to balance the number of staff and workloads to ensure quality, effective and efficient performance. Developing countries continue to struggle, in terms of fulfilling these objectives, mainly due to limited resources and budget. Therefore, this study aimed to analyze the workload at the Pharmacy of Universitas Padjadjaran Dental and Oral Hospital (RSGM Unpad) using WHO’s workload indicators of staffing needs (WISN) technique. This study also applied a descriptive cross-sectional design and conducted the WISN methodology between May-September 2020. Subsequently, observations, discussions and interviews were used to generate relevant information from the hospital’s workforce and its 2019 records. The results showed the availability of 7 employees and an annual estimate of 97,440 minutes in work duration. As a consequence, the manpower demands for inpatient-outpatient and logistic-purchasing departments were 4 and 2 persons, respectively. The resulting WISN ratio was 1.17 (> 1), indicating an inadequate workload and staff number. Based on the WISN analysis, it is concluded that the pharmacy is overstaffed under the existing workload conditions. Therefore, employee redistribution and the development of pharmaceutical satellites towards enhancing effectiveness and efficiency are significantly recommended.

Applying the Workload Indicators of Staffing Needs Method in Nursing Health Workforce Planning: Evidences from Four Hospitals in Vietnam

Background: Vietnam has encountered difficulties in ensuring an adequate and equitable distribution of health workforce. The traditional staffing norms stated in the Circular 08/TT-BYT issued in 2007 based solely on population or institutional size and do not adequately take into consideration the variations of need such as population density, mortality and morbidity patterns. To address this problem, more rigorous approaches are needed to determine the number of personnel in health facilities. One such approach is Workload Indicators of Staffing Need (WISN) developed by the World Health Organization (WHO), a facility-based workforce planning method that assists managers in defining the responsibilities of different workforce categories and improving the appropriateness and efficiency of a staff mix. Methods: This study applied the WISN approach and was employed in 22 clinical departments at four hospitals in Vietnam between 2015 and 2018. 22 targeted group discussions involving nurses were conducted. Hospital personnel records have been retrieved. The data were analyzed according to WISN instructions. Results: Of the 22 departments, there was a shortage of 1 to 2 nurses in 10 departments, with WISN ratios ranging between 0.88 and 0.95. Only 01 clinical colleges at Can Tho Hospital lacked 05 nurses, facing a high workload with a WISN ratio of 0.78. Administrative time represented 20-40% of the total work time of a nurse. In comparison, nurses at Can Tho Hospital spent time on administration from 24 onwards. 5% to 41.7% of their working time while nurses at Thanh Hoa Hospital spent 21% to 33%. Conclusion: The application of the WISN enabled health managers to analyze the workload of nurses, calculate staffing needs, and thus effectively contribute to the workforce planning process. It is expected that the results of this research will encourage the use of the WISN tool in other hospitals and health facilities across the health system. At provincial and national levels, this study provides important evidence to help policy makers develop guidelines for personnel norms for health facilities in the context of limited resources, while the existing regulation is no longer appropriate.

Assessment of Staffing Needs for Registered Nurses and Licensed Practical Nurses at Primary Care Units in Brazil Using the Workload Indicators of Staffing Need (WISN) Method

Background The balance between supply and demand for primary health care (PHC) services is one of the main challenges to the health system in Brazil. In this context, the application of planning methods could benefit the decision-making process for human resources organizations. Hence, the objective of this study was to assess the staffing needs for registered nurses (RNs) and licensed practical nurses (LPNs) at PHC services using the WISN method. Methods The Workload Indicators of Staffing Need (WISN) methodology was applied at 13 Primary Care Units (PCU) located in the city of São Paulo, Brazil. It included 87 RNs and 174 LPNs, and used data from 2017 to 2019. Results The WISN results found that RNs were under high workload pressure at 10 PCUs (77%) in 2017 and 2018, with a decrease to 8 PCUs (61%) in 2019. For LPNs, high workload pressure increased from 2 PCUs (15%) in 2017 to 13 PCUs (100%) in 2018, with a decrease to 11 (85%) in 2019. Conclusion The assessment of staffing needs for RNs and LPNs at the PCUs included in the study identified a consistent deficit in the number of professionals, and high workload pressure in most services throughout the study period.

How to Make the Best Use of the Workload Indicators of Staffing Needs Method in Determining the Proportion of Time Spent in Each of the Workload Components and Its Implication in Decision Making: the Experience of the Sultanate of Oman

BackgroundThe Ministry of Health in the Sultanate of Oman decided to have better distribution of the health workforce among all health facilities through evidenced-based staffing norms. Four directorates worked together to develop the staffing norms through making use of the workload indicators of staffing needs (WISN) method. The aim of this study is to describe the process of applying the WISN method in Primary Health Care institutions and how to make the best use of method in determining the proportion of time spent in each of the workload components and its implication in decision making. MethodsThe WISN was applied for five priority categories namely doctors, nurses, pharmacists, laboratory technicians, and radiology technicians at PHC institutions. The WISN ratio has been translated into workload pressure as a percentage through applying the formula [workload pressure as % (in case of shortage) = (1 - WISN ratio) x 100%]. While the proportion of time spent in each of the workload components was calculated through making use of the category allowance standard, the individual allowance standard to determine the time spent in support and additional activities. The sum is subtracted from 100% to give the time spent in the health service activities.ResultsDetermining the workload pressure as a percent and its interpretation is based on the fact that one cadre or as a group can bear up to 10% of extra workload. Thus, managers can undertake sensible short-term arrangements or decisions in redistributing the cadres among the health facilities on expectation of deploying more staff. DiscussionCareful and detailed analysis of the proportion of time spent in each of the workload components will allow to have better understanding of the context and dynamics of work. ConclusionDecision makers and planners can undertake rational short-term decisions in redistributing the cadres among the health facilities based on the workload pressure. In addition, they can as well as easily decide on the optimal proportions of time for each staff category, and hence choose what activities and tasks to be shifted or delegated to other staff category.

Alternate care sites during the COVID-19 pandemic: Policy Implications for pandemic surge planning

Alternate care sites across the US were widely underutilized during the COVID-19 outbreak, while the volume and severity of COVID-19 cases overwhelmed health systems across the United States. The challenges presented by the pandemic have shown the need to design surge capacity principles with consideration for demand that strains multiple response capabilities. We reviewed current policy and previous literature from past ACS as well as highlight challenges from the COVID-19 pandemic, to make recommendations that can inform future surge capacity planning. Our recommendations include: 1) Preparedness actions need to be continuous and flexible; 2) Staffing needs must be met as they arise with solutions that are specific to the pandemic; 3) Health equity must be a focus of ACS establishment and planning; and 4) ACS should be designed to function without compromising safe and effective care. A critical opportunity exists to identify improvements for future use of ACS in pandemics.

Peningkatan Service Level pada Sistem Antrian Pengambilan Obat di Puskesmas Bojong Rawalumbu Menggunakan Metode Simulasi

Antrian adalah keadaan di mana sekumpulan orang yang membutuhkan pelayanan harus menunggu dalam suatu urutan baris tertentu sebelum memperoleh pelayanan. Hal ini disebabkan oleh kemampuan memberikan pelayanan lebih kecil bila dibandingkan dengan kebutuhan akan suatu pelayanan. Permasalahan yang dihadapi oleh Puskesmas Bojong Rawalumbu adalah adanya antrian yang panjang pada loket pengambilan obat khususnya pada jam 08:00-09:00 WIB. Tujuan penelitian ini adalah untuk memperbaiki kinerja sistem antrian dan menentukan jumlah petugas loket pengambilan obat yang terbaik. Metode penyelesaian yang digunakan adalah metode simulasi sistem dan analisis workload indicator staffing needs. Berdasarkan hasil perhitungan menunjukkan bahwa kinerja awal sistem antrian pada Puskesmas Bojong Rawalumbu dengan jumlah petugas loket pengambilan obat sebanyak satu orang dengan waktu tunggu antrian selama 2,70 menit. Selanjutnya, berdasarkan usulan perbaikan kinerja sistem antrian, jumlah petugas loket sebanyak dua orang dan rata-rata waktu menunggu dalam antriannya turun menjadi 0,16 menit. Hal ini didukung dengan hasil analisis metode Workload Indicators Staffing Needs yang menunjukkan bahwa kebutuhan tenaga kerja untuk loket pengambilan obat sebanyak dua sampai tiga orang. Kata kunci: Simulasi Antrian; Workload Indicators Staffing Needs; Optimasi Sistem Antrian

The Relationship Between Staffing Sufficiently by the Workload Indicator of Staffing Needs and HIV Outcomes in Namibia

Background: No study in inpatient or outpatient nurse staffing research have examined nurse staffing using the measure of the World Health Organization’s Workload Indicator of Staffing Needs, despite this being a commonly used tool to make staffing decisions across various healthcare settings around the world. This study aimed to understand the relationship between nurse staffing in HIV clinics and the patient outcomes of viral load documentation and viral load suppression in order to better understand the best ways of staffing nurses to provide the best HIV services to clients. Methods: This study modeled nurse staffing measured as the Workload Indicator of Staffing Needs, with two HIV outcomes of viral load documentation and viral load suppression in remotely located 66 hospitals, health centers and clinics in Northern Namibia. Various control variables were taken into account. Results: Sufficient nurse staffing based on the Workload Indicator of Staffing Needs was associated with better viral load documentation, however overly sufficient staffing made no difference on viral load documentation. There was no association between sufficient staffing by the Workload Indicator of Staffing Needs and viral load suppression. Conclusions: Our findings suggest that staffing sufficiently by the Workload Indicator of Staffing Needs was associated with better HIV outcomes of viral load documentation and viral load suppression at the facility level. This suggests that policy makers should continue using the Workload Indicator of Staffing Needs tool to staff their clients in order to have the best HIV outcomes possible at their facilities.