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Training Opportunities and the Increase in the Number of Nurses In Morioka et al. BMC Health Services Research (2019) 19:398 https://doi.org/10.1186/s12913-019-4225-8 RESEARCHARTICLE Open Access Training opportunities and the increase in the number of nurses in home-visit nursing agencies in Japan: a panel data analysis Noriko Morioka1* , Suguru Okubo2, Yoshie Yumoto1 and Yasuko Ogata1 Abstract Background: A training opportunity in which ongoing education is encouraged is one of the determinants in recruiting and retaining nurses in home-visit nursing care agencies. We investigated the association between ensuring training opportunities through scheduled training programs and the change in the number of nurses in home-visit nursing agencies using nationwide panel data at the agency level. Methods: We used nationwide registry panel data of home-visit nursing agencies from 2012 to 2015 in Japan. To investigate the association between planning training programs and the change in the number of nurses in the following year, we conducted fixed-effect panel data regression analysis. Results: We identified 4760, 5160 and 5025 agencies in 2012, 2013, and 2014, respectively. Approximately 60–80% of the agencies planned training programs for all staff, both new and former, during the study period. The means and standard deviations of the percentage change in the number of full time equivalent (FTE) nurses in the following year were 4.2 (19.8), 5.7 (23.5), and 5.8 (25.1), respectively. Overall, we found no statistically significant association between scheduled training programs and the change in the number of FTE nurses in the following year. However, the associations varied by agency size. Results of analysis stratified by agency size suggested that the first and second quartile sized agencies (2.5–4.0 FTE nurses) with scheduled training programs for all employees were more likely to see a 9.0% (95% confidence interval [CI]: 4.5, 13.5) and 8.5% (95% CI: 2.4, 14.5) increase in the number of FTE nurses in the following year, respectively. Similarly, the first and second quartile sized agencies with scheduled training programs for new employees were more likely to see a 4.7% (95% CI: 2.1, 7.2) and 3.3% (95% CI: 0.4, 6.2) increase in the number of FTE nurses in the following year, respectively. Conclusions: Ensuring training opportunities through scheduled training programs for all staff, both new and former, in relatively small-sized home-visit nursing agencies might contribute to an increase in the number of nurses at each agency. Keywords: Home Care Services, Home health agencies, Human resources development, Home visit nursing, Nurse training * Correspondence: [email protected] 1Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Morioka et al. BMC Health Services Research (2019) 19:398 Page 2 of 8 Background might vary by agency size, we also aimed to investigate the Despite an increase in the demand for home-care owing association stratified by agency size in the previous year. to aging populations, the shortage of nursing workforce in home-care settings is a major issue in many countries Home-visit nursing in Japan [1–5]. Japan is a super-aging society, where 26.6% of In Japan, home-visit nursing services were introduced to people are elderly, that is, aged 65 years or older [6]. health insurance in 1994. Since the Long-term Care Insur- With the increase in the elderly population and the shift- ance (LTCI) was introduced in 2000, home-visit nursing ing of health policy to an integrated community care services have also been covered by LTCI [22]. To use a system that enables citizens to continue living in a famil- home-visit nursing service, an “order for nursing services” iar environment [7], the demand for home-visit nursing by a physician is required. This is done through an inter- has been increasing [8, 9]. A forecast project estimated view with the individual and an assessment of his or her that a workforce of roughly 52,000 to 63,000 home-visit needs. The home-visit nursing services provided include nurses will be needed in 2020, compared with the 33, assistance for activities of daily living (ADL, e.g., bathing 000-strong workforce in 2014 [10, 11]. In addition to the and grooming), rehabilitative training, wound care (e.g., shortage of home-visit nurses, overall, the number of bedsores), and end-of-life care [22]. nurses in small sized home-visit nursing agencies is par- As of 2015, there were approximately 33,000 FTE ticularly concerning. The majority of home-visit nursing home-visit nurses in 8000 agencies throughout Japan agencies in Japan are small sized with fewer than five [22]. The agencies should obtain a certification by the full-time equivalent (FTE) nurses [9]. In smaller sized prefectural government to be reimbursed by national agencies, operations are likely to be inefficient, resulting health insurance and/or LTCI. The certification criteria in increased burden on staff [9]. Moreover, they tend to stipulate that each agency have at least 2.5 FTE nurses. be unprofitable compared to large agencies [12]. They A Survey on the Actual Situation of Visiting Nursing in are also unable to provide end-of-life care because of 2014 by the Japanese Nursing Association showed that their inability to provide home-visit nursing 24 h a day the average age of home-visit nurses was 47 year and owing to the shortage of manpower [13]. The Japanese that they had over 20 years’ nursing experience [23, 24]. Nursing Association has promoted polices that secure Over 70% of the respondents had careers as hospital more home-visit nurses and expand the agency size [9]. and/or clinic nurse before working as home-visit Retaining nurses in a home-visit agency is a complex nurses, and only 0.6% of the respondents began work issue that is influenced by agency characteristics such as as home-visit nurses immediately after graduation from agency size and type, job characteristics, and nurse’s nursing schools. individual factors [14, 15]. Among these factors, the Japanese Nursing Association assumed that ensuring the Methods availability of training opportunities in an agency is a Design key modifiable factor [9]. Since continuing education for We conducted a longitudinal analysis of an unbalanced home-visit nursing agencies in Japan is not required, a panel of nationwide administrative data for home-visit large percentage of home-visit nurses have reported feel- nursing agencies in Japan. ing that their knowledge is insufficient [16, 17]. Training opportunities at agencies are related to decreasing the Data source burnout of nurses [18, 19], increasing nurses’ job satis- Data on home-visit nursing agencies covering the period faction [20], and increasing nurses’ intention to remain from 2012 to 2015 were drawn from the Information with their agencies [15]. Training opportunities are Publication System for Long-term Care database [25]. attractive considerations for home-visit nurses when We requested disclosure of these data to the Ministry of they decide upon their place of work [21]. However, the Health, Labour, and Welfare, based on the Act on association between ensuring that there is access to Access to Information Held by Administrative Organs. training opportunities for employees and an increase in Data included information such as ownership, location, the number of nurses in home-visit nursing agencies re- opening hours, contents of services, number of clients, mains unclear. number of staff, and training opportunities. From 2012, We, therefore, aimed to investigate the association be- the Long-Term Care Insurance Act (Article 115–35–44) tween providing training opportunities through scheduled [26] required all managers of long-term care service training programs for all employees, both new and former, agencies, including home-visit nursing agencies, to re- and an increase in the number of nurses in the following port their status to local (prefecture) governments annu- year in home-visit nursing agencies by using nationwide ally. To enable people to obtain adequate information administrative data. In addition, since the association be- on long-term care services providers, the Ministry of tween training opportunities and the number of nurses Health, Labour and Welfare discloses this information Morioka et al. BMC Health Services Research (2019) 19:398 Page 3 of 8 online [25]. We used unbalanced panel data, which in- for all employees, both new and former, as a variable by cluded both operational home-visit nursing agencies and recording responses to the statement, “We have a sched- those that were forced to close due to bankruptcy, to uled program for training all employees and new avoid the effect of survival bias on our research findings. employees,” with possible responses being yes = 1 (“with a scheduled training program”), and no = 0 (“without a Sample scheduled training program”) in the database. We were We obtained data from 5485, 6045, 6635, and 6262 agen- unable to identify the contents of the training programs cies that were registered in the database in 2012, 2013, because the database we used in this study did not in- 2014, and 2015, respectively.
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