Workforce Planning – Spring 2018

(1) Safe staffing guidance extended to settings including acute adult and district nursing.

Nursing Standard (2014+) 2018;32(24):8

Guidance on safe nurse staffing has been published for settings in England including adult

inpatient wards, children and young people’s services and mental health.

(2) Readers’ panel - Will extra hospital volunteers relieve pressure on nurses? Nursing

Standard (2014+) 2018;32(21):33

(3) Brady C, Edmondson S, Murray A. Workforce Planning to Sustain UK Burns Services. Burns : journal of the International Society for Burn Injuries 2018 Anticipating future changes in workforce is an essential component of organising any health service. Factors such as changing retirement age, maternity and parental leave, reorganisation of services and population change all impact on the number of staff required to provide a safe and effective service. The UK burns networks provide both emergency and elective services to millions of patients affected by burn-injury every year. With the current struggles of NHS funding, we suggest that a comprehensive review of burns workforce planning is undertaken to ensure that sufficient numbers of trainees are completing appropriate burns-specific training and are ready to fill these posts, ensuring sustainability of our services.

(4) Buchan J. Nursing workforce crisis is self-inflicted. Nursing Standard (2014+) 2017;31(42):29 For years this country has been sleepwalking towards a major nursing shortage that is self-inflicted. The Brexit vote was a wake-up call, but it has merely quickened the pace towards a staffing crisis that was already coming.

(5) Carey C. Securing the future anaesthetic workforce. Best Practice & Research Clinical Anaesthesiology 2018 A suitably skilled workforce that is of an appropriate size is essential for the provision of

healthcare services. Anaesthetists play an essential role in a wide range of clinical areas, and effective workforce planning and training are essential in maintaining service provision. Workforce planning requires consideration of a number of different factors related to the workforce itself and services that are required. Long-term predictions must be made, as the process of training a consultant workforce with the flexibility to adapt to changing services takes many years. Anaesthetic training in the UK has changed considerably over the last three decades, as working hours and experience have decreased. Training and assessment have evolved from an apprenticeship model to an active and highly regulated process with a number of stakeholders, although there is little evidence regarding the impact of these changes on clinical outcomes.

(6) Carrieri D, Briscoe S, Jackson M, Mattick K, Papoutsi C, Pearson M, et al. 'Care Under Pressure': a realist review of interventions to tackle doctors' mental ill-health and its impacts on the clinical workforce and patient care. BMJ Open 2018;8(2) Introduction Mental ill-health is prevalent across all groups of health professionals and this is of great concern in many countries. In the UK, the mental health of the National Health Service (NHS) workforce is a major healthcare issue, leading to presenteeism, absenteeism and loss of staff from the workforce. Most interventions targeting doctors aim to increase their 'productivity' and 'resilience', placing responsibility for good mental health with doctors themselves and neglecting the organisational and structural contexts that may have a detrimental effect on doctors' well-being. There is a need for approaches that are sensitive to the contextual complexities of mental ill-health in doctors, and that do not treat doctors as a uniform body, but allow distinctions to account for particular characteristics, such as specialty, career stage and different working environments. Methods and analysis Our project aims to understand how, why and in what contexts support interventions can be designed to minimise the incidence of doctors' mental ill-health. We will conduct a realist review-a form of theory-driven interpretative systematic review-of interventions, drawing on diverse literature sources. The review will iteratively progress through five steps: (1) locate existing theories; (2) search for evidence; (3) select articles; (4) extract and organise data and (5) synthesise evidence and draw conclusions. The analysis will summarise how, why and in what circumstances doctors' mental ill-health is likely to develop and what can remediate the situation. Throughout the project, we will also engage iteratively with diverse stakeholders in order to produce actionable theory. Ethics and dissemination Ethical approval is not required for our review. Our dissemination strategy will be participatory. Tailored outputs will be targeted to: policy makers; NHS employers and healthcare leaders; team leaders; support organisations; doctors experiencing mental ill-health, their families and colleagues. PROSPERO registration number CRD42017069870.

(7) Charalampopoulos D, Amin R, Warner JT, Viner RM, Campbell F, Edge JA, et al. A survey of staffing levels in paediatric diabetes services throughout the UK. Diabetic Med. 2018;35(2):242-248 To assess staffing levels of healthcare professionals involved in the care of children and young people with diabetes in the UK. Methods A web-based questionnaire was distributed to lead consultant paediatricians from all paediatric diabetes services in the UK between October and December 2014. Data on staffing levels and other aspects of diabetes services

were collected and differences between the four nations of the UK and across the 10 English diabetes networks were explored. Results Some 175 services (93%) caring for 29 711 children and young people aged ≤ 24 years with diabetes participated in the survey. Northern Ireland and Wales had the lowest ratio of total staff to patient population. Nursing caseloads per one whole-time equivalent (WTE) nurse ranged from 71 patients in England to 110 patients in Northern Ireland with only 52% of the UK services meeting the Royal College of Nursing recommended nurse-to-patient ratio of > 1 : 70. Scotland and Northern Ireland had the highest ratio of consultants and fully trained doctors per 1000 patients (3.5 WTE). Overall, 17% of consultants had a Certificate of Completion of Training in Endocrinology and Diabetes. Some 44% of dietitians were able to adjust insulin dose. Only 43% of services provided 24-h access to advice from the diabetes team and 82% of services had access to a psychologist. Staffing levels adjusted for volume were not directly related to glycaemic performance of services in England and Wales. Conclusions Wide variations in staffing levels existed across the four nations of the UK and important gaps were present in key areas. What's new? The rising prevalence of diabetes and the increased complexity of intensive insulin regimens pose new challenges to paediatric diabetes services and their workforce. The latest survey of UK paediatric diabetes services in 2008 highlighted important deficiencies in staffing levels across services, but the current state is unknown. We found wide variations in staffing levels of paediatric diabetes services across the UK, with heavy caseloads for psychologists and dietitians in Northern Ireland and Wales. Half of the services in the UK met the recommended staffing levels for nurses. We observed important gaps in 24-h access to advice from the diabetes team.

(8) Davies J. Support our call for a UK-wide commitment to safe staffing levels comments. Nursing Standard (2014+) 2018;32(26):30 We’re in the middle of a long winter, and it’s hard to get away from daily reports of missed targets, cancelled operations and rising flu cases.

(9) Dean E. Advice on setting out of hours staffing levels for specialist palliative care. Nursing Standard (2014+) 2018;33(1):55 Order Essential facts While the importance of round-the-clock availability of specialist palliative care services has been recognised for more than a decade, it is often not available across all care settings.

(10) Dean E. Wales adopts safe staffing laws while the rest of the UK watches. Nursing Standard (2014+) 2018;32(30):12 A law on safe nurse staffing levels in adult acute medical and surgical inpatient wards comes into force in Wales on 6 April. The Nurse Staffing Levels (Wales) Act, the first law of its kind in Europe, places responsibility on health boards to calculate and provide sufficient numbers of nurses to care ‘sensitively’ for patients.

(11) Dean E. Staff retention: guidance for employers. Nursing Standard (2014+) 2018;32(25):15

Essential facts As nurse numbers decline, the retention of staff takes on greater importance for the NHS.

(12) Domagała A, Klich J. Planning of Polish physician workforce – Systemic inconsistencies, challenges and possible ways forward. Health Policy 2018;122(2):102-108 Physician workforce planning in Poland is inadequate and insufficient. Challenges facing Polish physicians include shortages, ageing and migration. Medical education should be adjusted to the current and forthcoming healthcare labour market. Systemic approach to health workforce planning and close cooperation between key stakeholders is needed. Background Poland has the lowest number of physicians per 1000 population (2.2/1000) in the EU. This is accompanied by a considerable migration rate of Polish physicians to other EU countries (estimated at above 7%). Among other consequences, this results in waiting lists and unmet health needs. Objective The aim of this article is an identification of the main challenges for physician workforce planning in Poland. Methods The authors analysed national and international documents, reports, official statements, publications and statistical databases. Main findings In Poland health workforce planning is inadequate and insufficient. There is no formal structure and no strategy regarding human resource planning or regular forecasts for the health workforce, which results in many negative effects for the healthcare system. Currently the shortage of physicians in some specialties is becoming one of the most important reasons for limited access to care and lengthening the average wait time. Conclusions To improve this situation operational and strategic actions should be undertaken without unnecessary delay. Effective and close cooperation between key stakeholders is needed. Health workforce planning needs to become one of the key building blocks of the Polish health system’s reforms, strongly connected to the other functions of the health system. It is essential for Poland to follow available good practices in health workforce planning.

(13) Draper J. Brexit should not be seen as death sentence for the NHS. Nursing Management (2014+) 2018;25(1):21 To put it simply: without nurses, the NHS doesn’t work. Yet recent statistics from NHS Digital ( 2018 ) suggest that in certain areas of Britain healthcare organisations have been hiring just one nurse for every 400 jobs advertised.

(14) Evans N. Have your say on building the NHS workforce. Nursing Management (2014+) 2018;24(9):8 Nurse leaders are being asked to help shape the latest strategy for recruiting, training and supporting the health service workforce in England as the NHS enters its eighth decade.

(15) Finnesgard E, Pandian T, Kendrick M, Farley D. Do not break up the surgical team! Familiarity and expertise affect operative time in complex surgery. The American Journal of Surgery 2018;215(3):447-449 The effects of replacing a surgeon's familiar, experienced certified surgical assistant (CSA) on perioperative outcomes in complex surgery were investigated. Methods An interrupted time

series of totally laparoscopic pancreatoduodenectomies performed by a single surgeon was retrospectively studied. Segmented regression analysis estimated replacement effects on estimated blood loss (EBL) and operative time. Results The cohort was composed of the last 100 cases with the familiar CSA and the first 100 cases with the replacement CSA. Study groups were similar. Unadjusted segmented regression of operative time and EBL predicted replacement effects of 70 min (95%CI, 18-122;p= 0.008) and 114 cc (95%CI, -93-320;p= 0.3), respectively. Adjusted regression predicted replacement effects of 40 min (95%CI, 0.9-78;p= 0.04) and 27 cc (95%CI, -156-210;p= 0.3). Conclusions The replacement of a familiar, experienced CSA was associated with longer operative times. Despite confinement to a single surgeon and procedure, these results suggest what all surgeons know: excellent help is priceless.

(16) Gillet N, Fouquereau E, Coillot H, Cougot B, Moret L, Dupont S, et al. The effects of work factors on nurses’ job satisfaction, quality of care and turnover intentions in oncology. J.Adv.Nurs. 2018;74(5):1208-1219 We examined the effects of perceived supervisor support, value congruence and hospital nurse staffing on nurses’ job satisfaction through the satisfaction of the three psychological needs for autonomy, competence and relatedness. Then, we examined the links between job satisfaction and quality of care as well as turnover intentions from the workplace. Background There is growing interest in the relationships between work factors and nurses’ job satisfaction. However, minimal research has investigated the effects of perceived supervisor support, value congruence and staffing on nurses’ job satisfaction and the psychological mechanisms by which these factors lead to positive outcomes. Design A cross‐sectional questionnaire was distributed in 11 oncology units between September 2015 ‐ February 2016. Method Data were collected from a sample of 144 French nurses who completed measures of perceived supervisor support, value congruence, staffing adequacy, psychological need satisfaction, job satisfaction, quality of care and turnover intentions. Results The hypothesized model was tested with path analyses. Results revealed that psychological need satisfaction partially mediated the effects of perceived supervisor support, value congruence and hospital nurse staffing on job satisfaction. Moreover, job satisfaction was positively associated with quality of care and negatively linked to turnover intentions. Conclusion Overall, these findings provide insight into the influence of perceived supervisor support, value congruence and staffing on nurses’ attitudes and behaviours.

(17) The nursing workforce : second report of session 2017-19. Great Britain Parliament House of Commons,Health Committee. The nursing workforce : second report of session 2017-19. : London : House of Commons; 2018 Reviews issues and developments affecting the current nursing workforce in England. Discusses retention, new nurses, nursing associates, nurses from overseas, workforce planning. Puts forward conclusions and recommendations.

(18) Griffiths P, Norman I. The impact of "Brexit" on nursing and health services: Editorial debate. Int.J.Nurs.Stud. 2018;77:A1-A2

(19) Hahnenkamp K, Hasebrook J, Buhre W, Van Aken H. Securing the continuity of medical competence in times of demographic change. Best Practice & Research Clinical Anaesthesiology 2018

(20) Hyatt E, Coslor E. Compressed lives: how "flexible" are employer-imposed compressed work schedules? Personnel Review 2018;47(2):278-293 The purpose of this paper is to examine employee satisfaction with an employer-imposed compressed workweek (CWW) schedule within a US municipality (City). Design/methodology/approach The study utilizes an employee survey (n=779) to test factors related to employee satisfaction with the CWW, a four-day, ten-hours/day workweek (4/10 schedule). Findings Employee satisfaction with the schedule is influenced by previous 4/10 pilot experience, work schedule preference, and happiness with the 4/10 schedule's implementation. Additionally, sick leave figures and survey results regarding informal substitute work schedules suggest that worker fatigue may limit the overall organizational value of the 4/10 schedule. Research limitations/implications The study is opportunistic in nature and therefore constrained by the City's HR Department concerns for survey length and respondent anonymity. This meant an inability to collect demographic data or to utilize validated scales. Practical implications Analysis suggests that the potential work-life benefits of flexible work schedules may not apply equally to employer-imposed vs employee-chosen compressed work schedules. Further, CWWs engender greater fatigue despite employee satisfaction, an issue managers should consider when weighing schedule costs and benefits. Originality/value The study highlights the importance of employee choice in conceptualizing flexibility and for capturing CWW benefits, namely: an initiative's voluntary or involuntary nature should be considered when determining whether it is likely to be beneficial for employees.

(21) Ighravwe D, Oke S, Adebiyi K. An enhanced reliability-oriented workforce planning model for process industry using combined fuzzy goal programming and differential evolution approach. J Ind Eng Int 2018;14(1):185-212 This paper draws on the “human reliability” concept as a structure for gaining insight into the maintenance workforce assessment in a process industry. Human reliability hinges on developing the reliability of humans to a threshold that guides the maintenance workforce to execute accurate decisions within the limits of resources and time allocations. This concept offers a worthwhile point of deviation to encompass three elegant adjustments to literature model in terms of maintenance time, workforce performance and return-on-workforce investments. These fully explain the results of our influence. The presented structure breaks new grounds in maintenance workforce theory and practice from a number of perspectives. First, we have successfully implemented fuzzy goal programming (FGP) and differential evolution (DE) techniques for the solution of optimisation problem in maintenance of a process plant for the first time. The results obtained in this work showed better quality of solution from the DE algorithm compared with those of genetic algorithm and particle swarm optimisation algorithm, thus expressing superiority of the proposed procedure over them. Second, the analytical discourse, which was framed on stochastic theory, focusing on specific application to a process plant in Nigeria is a novelty. The work provides more insights into maintenance workforce planning during overhaul rework and

overtime maintenance activities in manufacturing systems and demonstrated capacity in generating substantially helpful information for practice.

(22) Jones-Berry S. Devolved UK may mean pay rises vary between countries. Nursing Standard (2014+) 2018;32(28):12 Pay and staffing dominate the nursing workforce debate across the four countries of the UK, so how does the picture differ in England, Wales, Scotland and Northern Ireland as the prospect of a new pay deal looms?.

(23) Jones-Berry S. Falling EU nurse figures spark fresh concerns over Brexit. Nursing Standard (2014+) 2017;31(43):12 Concern about the effect of Brexit on the UK nursing workforce could intensify, with new figures showing fewer EU nurses in post at certain NHS trusts and fewer registering to work in the UK.

(24) Kroezen M, Van Hoegaerden M, Batenburg R. The Joint Action on Health Workforce Planning and Forecasting: Results of a European programme to improve health workforce policies. Health Policy 2018;122(2):87-93 The Joint Action Health Workforce Planning and Forecasting (JAHWF) ran from 2013 to 2016.•The JAHWF has provided the basic tools and insights to start a planning process.•The JAHWF showed that health workforce planning is a context-sensitive process.•Investments are needed in the context-sensitivity and evaluation of health workforce planning. Health workforce (HWF) planning and forecasting is faced with a number of challenges, most notably a lack of consistent terminology, a lack of data, limited model-, demand-based- and future-based planning, and limited inter-country collaboration. The Joint Action on Health Workforce Planning and Forecasting (JAHWF, 2013–2016) aimed to move forward on the HWF planning process and support countries in tackling the key challenges facing the HWF and HWF planning. This paper synthesizes and discusses the results of the JAHWF. It is shown that the JAHWF has provided important steps towards improved HWF planning and forecasting across Europe, among others through the creation of a minimum data set for HWF planning and the ‘Handbook on Health Workforce Planning Methodologies across EU countries’. At the same time, the context-sensitivity of HWF planning was repeatedly noticeable in the application of the tools through pilot- and feasibility studies. Further investments should be made by all actors involved to support and stimulate countries in their HWF efforts, among others by implementing the tools developed by the JAHWF in diverse national and regional contexts. Simultaneously, investments should be made in evaluation to build a more robust evidence base for HWF planning methods.

(25) Lancet T. Brexit and the NHS. The Lancet 2018;391(10126):1122 Furthermore, in an analysis of 15 similar countries done by the Nuffield Trust and the Royal College of Paediatrics and Child Health, the UK compares badly in seven of 16 indicators of child health. Public health measures are threatened, with blood, organ, and tissue safety standards to be agreed, as is communicable disease control across borders.

(26) Lopes M, Almeida Á, Almada-Lobo B. Forecasting the medical workforce: a stochastic agent-based simulation approach. Health Care Manag.Sci. 2018;21(1):52-75 Starting in the 50s, healthcare workforce planning became a major concern for researchers and policy makers, since an imbalance of health professionals may create a serious insufficiency in the health system, and eventually lead to avoidable patient deaths. As such, methodologies and techniques have evolved significantly throughout the years, and simulation, in particular system dynamics, has been used broadly. However, tools such as stochastic agent-based simulation offer additional advantages for conducting forecasts, making it straightforward to incorporate microeconomic foundations and behavior rules into the agents. Surprisingly, we found no application of agent-based simulation to healthcare workforce planning above the hospital level. In this paper we develop a stochastic agent-based simulation model to forecast the supply of physicians and apply it to the Portuguese physician workforce. Moreover, we study the effect of variability in key input parameters using Monte Carlo simulation, concluding that small deviations in emigration or dropout rates may originate disparate forecasts. We also present different scenarios reflecting opposing policy directions and quantify their effect using the model. Finally, we perform an analysis of the impact of existing demographic projections on the demand for healthcare services. Results suggest that despite a declining population there may not be enough physicians to deliver all the care an ageing population may require. Such conclusion challenges anecdotal evidence of a surplus of physicians, supported mainly by the observation that Portugal has more physicians than the EU average.

(27) Mckee M. Empty promises. What will Brexit really mean for nurses and the British National Health Service? Int.J.Nurs.Stud. 2018;77:A3-A5

(28) Mckew M. ‘Dependence on overseas nurses is no longer viable’. Nursing Standard (2014+) 2018;32(30):9 A world-leading safe staffing expert has attacked what she says is poor workforce planning and an over-reliance on overseas nurses in England.

(29) Munn F. Why nurturing homegrown talent is best for every nation. Nursing Standard (2014+) 2018;32(20):12 Nurses worldwide need to be better valued and better treated to ensure they return to their home countries after working abroad, says an international nursing leader.

(30) Perry L. 2018—The year of (evidence‐based) nurse workforce planning? Int.J.Nurs.Pract. 2018;24(1):n/a-n/a.

(31) Phillips T, Evans JL, Tooley S, Shirey MR. Nurse manager succession planning: A cost-benefit analysis. J.Nurs.Manag. 2017 This commentary presents a cost-benefit analysis to advocate for the use of succession planning to mitigate the problems ensuing from nurse manager turnover.

(32) Radcliffe M. 'We don't need Brexit stealing the credit for our staffing crisis'. Nurs.Times 2016;112(29-31):9 To recap, Britain will no longer be in the EU and although they don't really know what that means, they can't stop talking about it. As far as one can tell, it is more important than always coming 23rd at Eurovision, but not quite as important as being knocked out of football's European Championship by Iceland, a country that quite likes archery and has a population the size of Leicester. Meanwhile, the most right-wing prime minister in recent memory has handed in his notice and will probably now try to get his own gameshow on channel 5. Here, Radcliffe argues they don't need Brexit stealing the credit for their staffing crisis.

(33) Rees GH, Crampton P, Gauld R, Macdonell S. Rethinking health workforce planning: Capturing health system social and power interactions through actor analysis. Futures 2018;99:16-27 Health workforce forecasting methods tend to be inappropriate for social systems. Actor analysis provides deeper understanding of system evolution. A few actors are found to have influence and dominate discourses. The actors’ preferences are different from forecasting variables. The preferences align with leverage points effective for system change. Future health systems will be required to accommodate changing social and treatment environments along with new and not-before-contemplated health care roles. Thus, health workforce planning is likely to benefit from improved problem identification, response formulation and data and methods that provide deeper understandings of socially influenced systems. Actor analysis is able to facilitate this through its examination of actor goals, interactions, and influences. We explore the use of this infrequently reported method in the context of health workforce planning. Through an embedded mixed methods design, we draw on data from inductive document analysis, deductively coded semi-structured interview responses from two separate but interconnected health sub sectors and numerically transform these to comply with the selected actor analysis software’s input requirements. Our findings underline the importance of actor analysis as an investigative resource for delineating actor positions on a range of strategic issues pertinent to health workforce futures to reveal a different perspective of the system’s evolution than that derived from conventional health workforce forecasting methods. A hierarchy of critical issues and the influential actors that hold sway over the workforce discourse are found, providing some insight into why conventional workforce plans can provide less than expected results.

(34) Rees GH, Crampton P, Gauld R, MacDonell S. The promise of complementarity: Using the methods of foresight for health workforce planning. Health Services Management Research 2018 Health workforce planning aims to meet a health system’s needs with a sustainable and fit-for-purpose workforce, although its efficacy is reduced in conditions of uncertainty. This PhD breakthrough article offers foresight as a means of addressing this uncertainty and models its complementarity in the context of the health workforce planning problem. The article summarises the findings of a two-case multi-phase mixed method study that

incorporates actor analysis, scenario development and policy Delphi. This reveals a few dominant actors of considerable influence who are in conflict over a few critical workforce issues. Using these to augment normative scenarios, developed from existing clinically developed model of care visions, a number of exploratory alternative descriptions of future workforce situations are produced for each case. Their analysis reveals that these scenarios are a reasonable facsimile of plausible futures, though some are favoured over others. Policy directions to support these favoured aspects can also be identified. This novel approach offers workforce planners and policy makers some guidance on the use of complimentary data, methods to overcome the limitations of conventional workforce forecasting and a framework for exploring the complexities and ambiguities of a health workforce’s evolution.

(35) Scanlan GM, Cleland J, Johnston P, Walker K, Krucien N, Skåtun D. What factors are critical to attracting NHS foundation doctors into specialty or core training? A discrete choice experiment. BMJ Open 2018;8(3) Multiple personal and work-related factors influence medical trainees’ career decision-making. The relative value of these diverse factors is under-researched, yet this intelligence is crucially important for informing medical workforce planning and retention and recruitment policies. Our aim was to investigate the relative value of UK doctors’ preferences for different training post characteristics during the time period when they either apply for specialty or core training or take time out.

(36) Taylor N. Workforce planning: Meeting future needs. BDJ 2018;224(6):393. Order

(37) Theodoulou I, Reddy AM, Wong J. Is innovative workforce planning software the solution to NHS staffing and cost crisis? An exploration of the locum industry. BMC health services research 2018;18(1):188 Workforce planning in the British healthcare system (NHS) is associated with significant costs of agency staff employment. The introduction of a novel software (ABG) as a 'people to people economy' (P2PE) platform for temporary staff recruitment offers a potential solution to this problem. Consequently, the focus of this study was twofold - primarily to explore the locum doctor landscape, and secondarily to evaluate the implementation of P2PE in the healthcare industry.

(38) Trueland J. Resilience is not about trying harder. Nursing Standard (2014+) 2018;32(24):18 As an assistant chief nurse, Paul Jebb has a busy and demanding job. At this time of year in particular, with winter pressures in the headlines, it would not be surprising if he was working relentlessly, skipping lunch and breaks, never switching off - and expecting nursing teams to do the same.

(39) Twycross A. A firm foundation for the future workforce. Nursing Standard (2014+)

2018;32(29):29

Most people living in the UK will be aware there is a crisis in the registered nursing

workforce, with around 40,000 unfilled posts in England alone. There are many reasons for

this, including incredibly poor planning in the NHS over many years.

(40) White E. A Comparison of Nursing Education and Workforce Planning Initiatives in the United States and England. Policy, Politics, & Nursing Practice 2018 Health care systems in England and the United States are under similar pressures to provide higher quality, more efficient care in the face of aging populations, increasing care complexity, and rising costs. In 2010 and 2011, major strategic reports were published in the two countries with recommendations for how to strengthen their respective nursing workforces to address these challenges. In England, it was the 2010 report of the Prime Minister’s Commission on the Future of Nursing and Midwifery, Front Line Care: The Future of Nursing and Midwifery in England . In the United States, it was the Institute of Medicine’s report The Future of Nursing: Leading Change, Advancing Health . The authors of both reports recommended shifting entry level nursing education to the baccalaureate degree and building capacity within their educational systems to prepare nurses as leaders, educators, and researchers. This article will explore how, with contrasting degrees of success, the nursing education systems in the United States and England have responded to these recommendations and examine how different regulatory and funding structures have hindered or enabled these efforts.

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