Tackling the primary healthcare workforce crisis: time to talk about health systems and governance-a comparative assessment of nine countries in the WHO European region.

Background: Primary healthcare has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. This study aims to bridge the gap between the primary healthcare policy and the ongoing healthcare workforce crisis debate by introducing a health system and governance approach to identify capacities that may help respond effectively to the HCWF crisis in health system contexts.

Methods: A qualitative comparative methodology was employed, and a rapid assessment of the primary healthcare workforce was conducted across nine countries: Denmark, Germany, Kazakhstan, Netherlands, Portugal, Romania, Serbia, Switzerland, and the United Kingdom/ England.

Reorganizing medical care for older persons in times of scarcity: A cybernetics analysis of work pressure and organizational change.

Capacity problems in healthcare lead organizations to seek new and fluid ways of organizing care to safeguard access to services. Task reallocation, triage and stepped care models are increasingly foregrounded as promising interventions that enhance the capacity, efficiency, and resilience of medical services and through which access can be maintained for a growing client base. In this paper, we argue that interventions meant to enhance capacity and increase efficiency have their limits in a system that is already under strain.

'The night is for sleeping': how nurses care for conflicting temporal orders in older person care.

This paper examines the conflicting temporal orders of the regional nurse, a role which has been introduced to deal with the increasing demands of aged care and workforce shortages in regional settings. We build on ethnographic research in the Netherlands, in which we examine regional district nurses as a new professional role that attends to (sub)acute care needs, connecting and coordinating different places of care during out of office hours. We use the concept of 'temporal regional order' to reflect on the different ways caring practices are temporally structured by management and care practitioners, in close interaction with patients and informal care givers.

Five pathways into one profession: Fifty years of debate on differentiated nursing practice.

The persistence of multiple educational pathways into the nursing profession continues to occupy scholars internationally. In the Netherlands, various groups within the Dutch healthcare sector have tried to differentiate nursing practice on the basis of educational backgrounds for over 50 years. Proponents argue that such reforms are needed to retain bachelor-trained nurses, improve quality of care and strengthen nurses' position in the sector.

Job crafting as retention strategy: An ethnographic account of the challenges faced in crafting new nursing roles in care practice.

Nursing shortages in the global north are soaring. Of particular concern is the high turnover among bachelor-trained nurses. Nurses tend to leave the profession shortly after graduating, often citing a lack of appreciation and voice in clinical and organisational decision-making.

Post-COVID health policy responses to healthcare workforce capacities: A comparative analysis of health system resilience in six European countries.

A cross countries in Europe, health policy is seeking to adapt to the post-pandemic 'permacrisis', where high demands on the healthcare workforce and shortages continue and combine with climate change, and war. The success of these efforts depends on the capacities of the healthcare workforce. This study aims to compare health policy responses to strengthen the capacities of the healthcare workforce and to explore the underpinning dynamics between health systems, policy actors and health policies.

"We don't experiment with our patients!" An ethnographic account of the epistemic politics of (re)designing nursing work.

This article draws on ethnographic research investigating experimental reform projects in local nursing practices. These are aimed at strengthening nursing work and fostering nurses' position within healthcare through bottom-up nurse-driven innovations. Based on literature on epistemic politics and critical nursing studies, the study examines and conceptualizes how these nurses promote professional and organizational change.

Bedside Politics and Precarious Care: New Directions of Inquiry in Critical Nursing Studies.

Health care systems are facing soaring workforce shortages, challenging their ability to secure timely access to good-quality care. In this context, nurses make difficult decisions about which patients to deliver care to, transfer to other providers, or strategically ignore. Yet, we still know little about how nurses engage in situated practices of bedside rationing.

'Nurses are seen as general cargo, not the smart TVs you ship carefully': the politics of nurse staffing in England, Spain, Sweden, and the Netherlands.

Nurse workforce shortages put healthcare systems under pressure, moving the nursing profession into the core of healthcare policymaking. In this paper, we shift the focus from workforce policy to workforce and highlight the political role of nurses in healthcare systems in England, Spain, Sweden, and the Netherlands. Using a comparative discursive institutionalist approach, we study how nurses are organised and represented in these four countries.

All the good care: Valuation and task differentiation in older person care.

Task reallocation is increasingly foregrounded as a promising solution for capacity problems. Numerous studies show, however, that task reallocation between medical professionals is a highly contested issue and difficult to institutionalise. Conflicts are omnipresent and often arise from 'intraprofessional competition': Zero-sum games between professionals from different disciplinary backgrounds where one party's gains require another party's losses.

Creativity at the margins: A cross-country case study on how Dutch and Norwegian peripheries address challenges to quality work in care for older persons.

Background: Peripheral areas are often overlooked in health-care research but they in fact deserve specific attention. Such areas struggle to maintain access to good quality health-care services due to their geographical context. At the same time, new interventions or promising innovations often emerge in places where creativity is urgently needed.

Any lessons to learn? Pathways and impasses towards health system resilience in post-pandemic times.

The COVID-19 pandemic has been an ultimate challenge for health systems as a whole rather than just single sectors (e.g. hospital care).

Linking Costs and Quality in Healthcare: Towards Sustainable Healthcare Systems Comment on "Hospitals Bending the Cost Curve With Increased Quality: A Scoping Review Into Integrated Hospital Strategies".

Organisation-wide studies in cost and quality of care are rare, and Wackers et al make a valuable contribution in synthesizing the literature on this issue. Their paper provides a good overview of initiatives and a list of factors that help in furthering organisation-wide change. The eleven factors they distill from the literate however remain rather abstract and more work needs to be done to contextualize the factors and the work that is needed to accomplish them and to see how they are aligned.

Fostering a just culture in healthcare organizations: experiences in practice.

Background: A just culture is regarded as vital for learning from errors and fostering patient safety. Key to a just culture after incidents is a focus on learning rather than blaming. Existing research on just culture is mostly theoretical in nature.

Assembling care: How nurses organise care in uncharted territory and in times of pandemic.

This article draws on ethnographic research to conceptualise how nurses mobilise assemblages of caring to organise and deliver COVID care; particularly so by reorganising organisational infrastructures and practices of safe and good care. Based on participatory observations, interviews and nurse diaries, all collected during the early phase of the pandemic, the research shows how the organising work of nurses unfolds at different health-care layers: in the daily care for patients and their families, in the coordination of care in and between hospitals, and at the level of the health-care system. These findings contrast with the dominant pandemic-image of nurses as 'heroes at the bedside', which fosters the classic and microlevel view of nursing and leaves the broader contribution of nurses to the pandemic unaddressed.

Role of the regulator in enabling a just culture: a qualitative study in mental health and hospital care.

Objectives: A just culture is considered a promising way to improve patient safety and working conditions in the healthcare sector, and as such is also of relevance to healthcare regulators who are tasked with monitoring and overseeing quality and safety of care. The objective of the current study is to explore the experiences in healthcare organisations regarding the role of the healthcare inspectorate in enabling a just culture.

Design: Qualitative study using interviews and focus groups that were transcribed verbatim, and observations of which written reports were made.

Health system resilience and health workforce capacities: Comparing health system responses during the COVID-19 pandemic in six European countries.

Background: The health workforce is a key component of any health system and the present crisis offers a unique opportunity to better understand its specific contribution to health system resilience. The literature acknowledges the importance of the health workforce, but there is little systematic knowledge about how the health workforce matters across different countries.

Aims: We aim to analyse the adaptive, absorptive and transformative capacities of the health workforce during the first wave of the COVID-19 pandemic in Europe (January-May/June 2020), and to assess how health systems prerequisites influence these capacities.

Role of Dutch internal policy advisors in a hospital quality improvement programme and their influence on nurses' role development: a qualitative study.

Objective: Nurses are vital in providing and improving quality of care. To enhance the quality improvement (QI) competencies of nurses, hospitals in the Netherlands run developmental programmes generally led by internal policy advisors (IPAs). In this study, we identify the roles IPAs play during these programmes to enhance the development of nurses' QI competencies and studied how these roles influenced nurses and management.

Triage as an infrastructure of care: The intimate work of redistributing medical care in nursing homes.

This article explores how professionals in older persons care work on a triage system in the daily care setting. We follow how triage is introduced in older persons care organizations in The Netherlands, to deal with a scarcity of physicians and distribute care among health workers in the region. We offer a sociological analysis in which we use the notion of infrastructure and infrastructural work to study how professionals work with triage in the daily care setting.

Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice.

Background: Transitions in healthcare delivery, such as the rapidly growing numbers of older people and increasing social and healthcare needs, combined with nursing shortages has sparked renewed interest in differentiations in nursing staff and skill mix. Policy attempts to implement new competency frameworks and job profiles often fails for not serving existing nursing practices. This study is aimed to understand how licensed vocational nurses (VNs) and nurses with a Bachelor of Science degree (BNs) shape distinct nursing roles in daily practice.

Unmasking a health care system: the Dutch policy response to the Covid-19 crisis.

The Covid-19 pandemic has put policy systems to the test. In this paper, we unmask the institutionalized resilience of the Dutch health care system to pandemic crisis. Building on logics of crisis decision-making and on the notion of 'tact', we reveal how the Dutch government initially succeeded in orchestrating collective action through aligning public health purposes and installing socio-economic policies to soften societal impact.