More Education Means More Clinicians

Several factors influence the number of clinicians available in an area as well as clinician retention and recruitment.  Educational resources tops the list.

Location and culture are among the key factors that affect local healthcare delivery, says Allison Squires, PhD, associate professor at the NYU Rory Meyers College of Nursing.

None, she suggests, is more important than educational resources.

Squires has published her research examining the factors that lead to successful healthcare infrastructures in Human Resources for Health. Her conclusions indicate that investment in training homegrown staff is almost always a good policy for hospitals and health systems.

Squires recently answered questions from HealthLeaders Media about the implications of her findings. The transcript below has been lightly edited.

HLM: Tell us about your study and its findings.

Squires: This study looked at what national factors produce more nurses and physicians. What we found is that there's a specific combination of factors that helps to produce more nurses and physicians, from a contextual perspective.

Our study found that a more educated populace creates more nurses and physicians. Our models show that education, and educational resources, are what we want in terms of producing new clinicians. There are also other factors, such as the political environment, gender issues, and health systems factors as well.

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I would say among the most important findings were how significant the correlations were between the average years of schooling of a population and the average number of nurses and physicians in a country. Education for nurses was correlated 59% to years of schooling, and for physicians, the correlation was 72%.

That is what we call a "significant relationship," meaning that the likelihood of this occurring by chance is very, very small. That is, I think, the most significant explanatory factor in this model.

HLM: What are some of the implications of your findings for rural hospitals in the United States?

Squires: It suggests that, when working with rural health professionals, we must support medical schools and getting people educated in rural areas, because if you educate people in rural areas and they train there, they're more likely to stay working in those rural areas.

I spent a couple years working at a critical access hospital in very rural Nebraska, and they were very dependent upon getting physicians that had done rural health rotations through their facility to stay in the community, in addition to making sure their staff had a rural nursing program to attend for training.

For many people, that was an associate degree or LPN program, but it also became a priority for them to get their nurses educated at the bachelor's degree level, because they needed to increase the expertise they had on staff to increase quality.

You get more emphasis on increasing quality of care in a bachelor's degree program than you do through an associate degree or LPN program.

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HLM: And what are some implications for urban hospitals?

Squires: Urban hospitals don't have as much trouble hiring people, but I think this model has potential when looking at macro-level planning, whether on the city level or state level. We need to figure out the most efficient way to invest in education for health professionals.

HLM: How should these findings impact hiring strategy for hospitals and health systems?

Squires: The great thing about this model is that you can translate it to what it means for your local community. If your hospital is in a community with a high poverty rate, it may be worthwhile to attract members of the community who wish to become health workers and support them while they're going to school in exchange for coming back to work at the facility.

If you're investing in your local communities in terms of your people, bringing them to work back there will create a more sustainable workforce.

HLM: What should HR leaders and clinician managers take away from this?

I'd say the biggest takeaway is that investment in staff education really has the potential to pay off in terms of retention. It also might help figuring out what migration risk might be, and give a greater perspective on attrition.Several factors influence the number of clinicians available in an area as well as clinician retention and recruitment. Educational resources tops the list.