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University-trained nurses in Mexico: An assessment of educational atrition and labor wastage
Abstract
To estimate and analyze the rate of wastage among university-trained nurses during their training period and in the labour market.
Wastage at the training stage was estimated using data from ANUIES for the 1978-2002 period. We used the 2000 Population and Household Census database to estimate job market wastage. Concepts and formulas were defined for the valuation of both areas.
The Rate of Education Wastage (TDE) for the generation cohort finishing in the year 2002 reached 252 per 1000, far below the 1987 rate, which was 555 per 1000. Regarding the job market, 55.2% of the total graduates who finished university studies and carried out post-graduate studies in nursing, now perform paid activities in the field of nursing, 15.4% work in activities different from their original training, and 16.2% are dedicated to household duties. The Global Rate of Labor Wastage (TGDL, per its abbreviation in Spanish) is 410 per 1000 thousand who obtained a degree in nursing at the university.
There is an important degree of wastage in the population holding a university nursing degree, both in the training and in the job market areas, an unacceptable situation that calls for immediate action by incumbent institutions.
... Salaries range from $300 to $1500 per month for staff nursing positions and the private sector pays the least. Underemployment is a common problem for nurses in the healthcare system (Nigenda et al., 2006). There is some kind of nursing leadership representative in most public sector hospitals, usually a director of nursing. ...
... Despite circumstances like those in Mexico that create a great need for nursing workforce research, few studies about the Mexican nursing workforce exist. Those that do exist have examined labor wastage, social conditions, and the influence of the North American Free Trade Agreement (NAFTA) on the profession (Diaz Olavarrieta et al., 2001;Nigenda et al., 2006;Squires, 2011). Studies of the hospital work environments of Mexican nurses have not been conducted by either Mexican or international researchers. ...
Studies of the nursing work environment are increasingly common in developed countries, but few exist in developing countries. Because of resource differences between the two contexts, researchers need to clarify what aspects of the work environments are similar and different.
To study the perspectives of Mexican nurses about their work environments to determine similarities and differences to results from developed world studies.
A secondary, directed content analysis of qualitative data from 46 Spanish language interviews using workplace-oriented themes.
Purposively selected Mexican states from four regions of the country that reflect the country's socioeconomic differences.
Practicing Mexican nurses with at least 1 year of clinical experience and currently working in nursing. Participants were recruited through convenience and snowball sampling techniques.
Initial data collection occurred in 2006 and 2008 during a broader study about professionalization processes that occurred in Mexican nursing between 1980 and 2005. The secondary, directed content analysis focused on an in-depth exploration of a central theme that emerged from the two original studies: the workplace. The directed content analysis used themes from the global nursing work environment literature to structure the analysis: professional relationships, organizational administrative practices, and quality of care and services.
The three themes from the global literature were relevant for the Mexican context and a new one emerged related to hiring practices. By category, the same factors that created positive or negative perceptions of the work environment matched findings from other international studies conducted in developed countries. The descriptors of the category, however, had different conceptual meanings that illustrate the health system challenges in Mexico.
Findings from this study suggest that studies that seek to measure nursing work environments will most likely apply in Mexico and other Latin American or middle-income countries. Instruments designed to measure the work environment of nurses in these countries may prove relevant in those contexts, but require careful adaptation and systematic translations to ensure it.
... Such traditional procedures were the primary form of treatment among traditional peoples with limited access to biomedicine. Midwives from various ethnic groups all over the country use diverse groups of plants in their practice of midwifery to treat many health issues pertaining to fertility problems, birth control, pregnancy, parturition, post-partum care, neonatal care, and primary health care of women, infants, and children (Nigenda et al. 2006;Coe 2008). Their knowledge of medicinal plants has played a major role in pre-and post-natal care in many rural and urban areas (Whitaker 2003;Gollin 2004;Hamilton 2004;McNeely 2005;Green et al. 2006). ...
... These findings also lend credence to the widespread perception of labor wastage, whereby nurses are either unemployed or qualitatively under-employed, a problem throughout Latin America (Nigenda et al., 2006). Such a situation is bound to generate acceptance of inferior positions -contingent work with low pay and no benefits. ...
Neoliberal cut-backs in health-care spending have had numerous negative impacts on nurses, but we know less about how they fare when governments move from neoliberal austerity to reinvestment in their health-care systems. El Salvador is an apt case to examine for how a post-neoliberal health-care reform, launched in 2010 by the newly elected FMLN government, addresses the deterioration in nurses’ work conditions caused by austerity policies. Based mainly on focus groups, interviews and participant observation conducted in the first three years of the reform’s implementation, the analysis finds important strides for nurses, especially in increased hiring in the expanded components of public health-care, and the reduction of labor precarity in formal employment. But several problems continue to imperil nurses’ well-being, reflecting, in part, a persistent devaluation of the care work that is performed mainly by women.
Background:
The third Sustainable Development Goal aims to ensure healthy lives and to promote well-being for all at all ages. The health system plays a key role in achieving these goals and must have sufficient human resources in order to provide care to the population according to their needs and expectations.
Methods:
This paper explores the issues of unemployment, underemployment, and labor wastage in physicians and nurses in Mexico, all of which serve as barriers to achieving universal health coverage. We conducted a descriptive, observational, and longitudinal study to analyze the rates of employment, underemployment, unemployment, and labor wastage during the period 2005-2017 by gender. We used data from the National Occupation and Employment Survey. Calculating the average annual rates (AAR) for the period, we describe trends of the calculated rates. In addition, for 2017, we calculated health workforce densities for each of the 32 Mexican states and estimated the gaps with respect to the threshold of 4.45 health workers per 1000 inhabitants, as proposed in the Global Strategy on Human Resources for Health.
Results:
The AAR of employed female physicians was lower than men, and the AARs of qualitative underemployment, unemployment, and labor wastage for female physicians are higher than those of men. Female nurses, however, had a higher AAR in employment than male nurses and a lower AAR of qualitative underemployment and unemployment rates. Both female physicians and nurses showed a higher AAR in labor wastage rates than men. The density of health workers per 1000 inhabitants employed in the health sector was 4.20, and the estimated deficit of workers needed to match the threshold proposed in the Global Strategy is 70 161 workers distributed among the 16 states that do not reach the threshold.
Conclusions:
We provide evidence of the existence of gender gaps among physicians and nurses in the labor market with evident disadvantages for female physicians, particularly in labor wastage. In addition, our results suggest that the lack of physicians and nurses working in the health sector contributes to the inability to reach the health worker density threshold proposed by the Global Strategy.
Background:
Precarization of labor conditions has been expanding over the last three decades as a consequence of global economic transformations. The health workforce labor market is exposed to these transformations as well. In Mexico, analyses of the nursing labor market have documented high levels of unemployment and underemployment; however, precarization has been not considered as a relevant indicator in these analyses. In this study, precarization is analyzed using a quantitative approach to show its prevalence and geographic distribution between 2005 and 2018.
Methods:
A repeated cross-sectional study was carried out with data from the population-based National Occupation and Employment Survey (ENOE in Spanish) which is administered quarterly to people 15 years or older in over 120 000 households. All individuals who reported having nursing training (technical or university level) were selected for this study. Our main variable was labor precariousness, which included three dimensions: (i) economic, (ii) regulatory, and (iii) occupational safety. We show the evolution of the relative weight of nursing activity between the years 2005 and 2018, the main socio-demographic characteristics of nurses as well as their main labor conditions, and the geographic distribution of precariousness for the 32 federal states in México.
Results:
Four of the five indicators of labor precariousness increased among the group of nurses analyzed: (a) the percentage of people with no written contract, (b) the percentage of people with incomes lower than two times the minimum wage, (c) the percentage of nurses without social security, and (d) the percentage of nurses without social benefits. The percentage of nurses that work under some condition of work precariousness increased from 46% in 2005-2006 to 54% in 2018. Finally, the number of states with high precariousness level increased from seven in 2005-2006 to 17 in 2018.
Conclusions:
Throughout Mexico, nursing precariousness has expanded reaching 53% by 2018. The advancement of precarization of nursing jobs implies a reduction in the capacity of the Mexican health system to reach its coverage and care goals as nurses represent 52% of all available workers that provide direct services to the population.
Introduction: The International Labor Organization encourages improvement in the quality of life for workers, highlighting poor working conditions and promoting Decent Work for all.Objective: To reflect on the implications of the work of nursing in relation to the concept of Decent Work.Development: Decent Work responds to the increasing vulnerability of workers, mainly young people, women and the poor. Nursing as a profession is made up mostly of women, faces multiple occupational hazards, including psychosocial risk factors, biological, physical, chemical and ergonomic, which means that this health care profession has higher health risks, is not the best paid job, nor is well recognized socially around the world. Conclusion: Decent Work involves competitive salaries, social security, fair globalization, education, gender equality, low risk, with labor rights and fairness. Nursing professionals, health institutions and governments should reconsider attending to the multiple risks that are faced in any hospital to make nursing work comply with all the features of Decent Work, promoting the reduction of occupational hazards and providing better salaries and working conditions in general to all nurses and improving the quality of their working life.
Objective: Describe the employability of students majoring in nursing and psychology with respect to their job expectations and success in finding work. Materials and Methods: This is a descriptive, cross-sectional study conducted among nursing and psychology students at the Autonomous University of the State of Morelos (UAEM) in Cuernavaca, Mexico. The sampling universe was comprised of 1,060 students, and a purposive sample of 297 students was obtained: 126 who are majoring in nursing and 171 in psychology. The variables studied include the job market, employment future, job appreciation, contribution to the company or organization, ideal job profile and socio-demographic variables. A survey was developed to measure the dependent variable. Results: A higher prevalence of women (74.7%) was observed; 20.9 % of the graduates are currently employed; 18.1% of those who are working are psychologists and 24.3% are nurses (71% women). As for job appreciation, contribution to the company or organization and ideal job profile, the students majoring in nursing had better scores than those majoring in psychology. Conclusion: Employability is a complex construct. Professional training should assess to what extent the graduate's profile coincides with the demands of the job market, which is subject to precarious employment conditions, cultural factors, demonstrated skills and the potential of the human factor.
Background
Here, the educational and labour market characteristics of Mexican dentists are revised. Dentistry is a health profession that has been scarcely studied in developing countries. This analysis attempts to understand the relationships and gaps between the supply and demand of dentists in the country. Around 5000 new dentists graduate every year looking for a place in the labour market.
Methods
A cross-sectional study with exploratory, descriptive and correlational scope was carried out between 2006 and 2008. Analyses of quantitative data on dentists from national surveys and occupational statistics were complemented with qualitative information provided by 43 key informants in five Mexican states.
Results
The 2008 dentist labour market can be characterized as follows: 75% worked in the private sector, most of them independently; more than two-thirds were women; the proportion of specialists was low (slightly more than 10%); unemployment was more than 20% and labour wastage was nearly 40%, with most wastage corresponding with female dentists. The increase in the number of dentists entering the labour market during the last two decades is more related to the educational market than to the population’s health needs and the number of dentists actually required to meet them.
Conclusions
The problems identified in the Mexican dentist labour market necessitate urgent intervention on behalf of regulatory bodies in order to balance the tendencies of supply and demand in the number of trained professionals as well as in their incorporation into different market areas. Adequate policies are required to increase the likelihood of achieving this objective.
Despite the fact that plants have played an important role in midwifery in many cultures, there are very few in-depth studies on the plants traditionally used by midwives. The aim of this study is to analyse the perceptions and the uses of medicinal plants for reproductive health among indigenous midwives in the city of Otavalo, Ecuador. The article also aims to analyse the perceptions of traditional midwives regarding allopathic drugs for reproductive health and their possible overlapping uses of medicinal plants and allopathic drugs. The data are drawn from an ethnographic study carried out in Ecuador. In total, 20 traditional midwives have been interviewed. Individual and in-depth interviews also took place with a sample of 35 women as well as with five nurses and two doctors working at San Luis Hospital in Otavalo. The study shows that cultural health management and the incorporation of the beliefs and practices relating to women's reproductive health can represent a starting point towards the search for more successful strategies in reproductive health.
Research that links macro-level socioeconomic development variables to health care human resources workforce composition is scarce at best. The purpose of this study was to explore the links between nonnursing factors and nursing workforce composition through a secondary, descriptive analysis of year 2000, publicly available national nursing human resources data from Mexico. Building on previous research, the authors conducted multiple robust regression analysis by federal typing of nursing human resources from 31 Mexican states against macro-level socioeconomic development variables. Average education in a state was significantly associated in predicting all types of formally educated nurses in Mexico. Other results suggest that macro-level indicators have a different association with each type of nurse. Context may play a greater role in determining nursing workforce composition than previously thought. Further studies may help to explain differences both within and between countries.
ABSTRACT:
One of the components of the Health Observatory for Latin American and the Caribbean (HO-LAC) is the design and implementation of metrics for human resources for health. Under the HO-LAC initiative, researchers from nine countries in the region formed the Collaborative Community on Human Resources for Health in Latin America and the Caribbean to identify common metrics applicable to the field of human resources for health (HRH).
The case description comprises three stages: a) the origins of an initiative in which a non-governmental organization brings together researchers involved in HRH policy in LAC, b) a literature search to identify initiatives to develop methods and metrics to assess the HRH field in the region, and c) subsequent discussions held by the group of researchers regarding the possibilities of identifying an appropriate set of metrics and indicators to assess HRH throughout the region.
A total of 101 documents produced between 1985 and 2008 in the LAC region were identified. Thirty-three of the papers included a variety of measurements comprising counts, percentages, proportions, indicators, averages and metrics, but only 13 were able to fully describe the methods used to identify these metrics and indicators. Of the 33 articles with measurements, 47% addressed labor market issues, 25% were about working conditions, 23% were on HRH training and 5% addressed regulations. Based on these results, through iterative discussions, metrics were defined into three broad categories (training, labor market and working conditions) and available sources of information for their estimation were proposed. While only three of the countries have data on working conditions, all countries have sufficient data to measure at least one aspect of HRH training and the HRH labor market.
Information gleaned from HRH metrics makes it possible to carry out comparisons on a determined experience in space and time, in a given country and/or region. The results should then constitute evidence for policy formulation and HRH planning and programs, with improved health system performance ultimately contributing to improved population health. The results of this study are expected to guide decision making by incentivizing the construction of metrics that provide information about HRH problems in LAC countries.
Although the majority of births in Mexico are attended by skilled birth attendants, maternal mortality remains moderately high, raising questions about the quality of training and delivery care. We conducted an exhaustive review of the curricula of three representative schools for the education and clinical preparation of three types of birth attendant - obstetric nurses, professional midwives and general physicians - National Autonomous University of Mexico (UNAM) School of Obstetric Nursing; CASA Professional Midwifery School; and UNAM School of Medicine, Iztacala Campus. All curricular materials were measured against the 214 indicators of knowledge and ability in the International Confederation of Midwives (ICM) skilled attendant training guidelines. The CASA curriculum covered 83% of the competencies, 93% of basic knowledge and 86% of basic abilities, compared with 54%, 59% and 64% for UNAM Obstetric Nursing School and 43%, 60% and 36% for UNAM School of Medicine, respectively. Neither the Obstetric Nursing School nor the School of Medicine documented the quantity or types of clinical experience required for graduation. General physicians attend the most births in Mexico, yet based on our analysis, professional midwives had the most complete education and training as measured against the ICM competencies. We recommend that professional midwives and obstetric nurses should be formally integrated into the public health system to attend deliveries.
Introducción El sistema de salud en México enfrenta hoy grandes retos, a la vez que se encuentra ante importantes oportunidades para resolverlos; una de sus principa-les paradojas es que coexiste un notable desperdicio de recursos humanos junto con la falta de servicios de salud para amplios grupos de la población (SSA, 2001). Las políticas de formación y ordenamiento del mercado laboral de los recursos humanos en salud es un aspecto fundamental para el buen funcionamien-to del sistema de salud y de la prestación de servicios de calidad. Los desequilibrios en los recursos huma-nos pueden afectar a todo el sector, desde su finan-ciamiento hasta la prestación de servicios. En México, la distribución de los servicios de sa-lud es desigual y está concentrada en las zonas urba-nas y de mayores ingresos, lo cual acentúa la escasez de recursos que sufre gran parte de la población. Co-mo ejemplo, mientras en los municipios de muy ba-ja marginación todos los casos de parto son atendi-dos por personal calificado, se calcula que cada año se dejan sin atención 370 mil partos, lo que provoca la muerte de 1 400 mujeres en los municipios de muy alta marginación (SSA, 2001). Ante este panorama de falta de servicios de salud, se vive de forma paralela un gran desperdicio de re-cursos humanos, ejemplificado por la inactividad, el desempleo y el subempleo de médicas y médicos. Para el año 2000, 28% de los titulados en medicina no trabajaban en el sector salud, ya fuera porque es-taban desempleados o inactivos, o porque desempe-ñaban actividades no relacionadas con su profesión. Este desequilibrio tiene un fuerte componente de gé-nero, pues la inactividad, el desempleo y el subem-pleo, además de los salarios más bajos, se concentran entre las médicas (Knaul et al., 2000; CASEsalud, 2002). El presente capítulo describe los desequilibrios en el mercado laboral de la profesión médica y de enfer-mería en México, a partir de los datos de la Encuesta Nacional de Empleo Urbano de 1990 y de 2000. Es-te estudio del mercado laboral de las y los médicos y de las y los enferm e ros se enfoca en el patrón de par-ticipación, en la distribución por educación y en el p e rfil de ingresos. Aquí se ofrecen avances import a n-tes en el conocimiento del desperdicio de los re c u r-sos humanos, se actualizan las cifras publicadas en o t ros artículos acerca de esta problemática (Frenk e t a l ., 1991 y 1999; Knaul et al., 2000; Nigenda y Knaul, 2003). Dada la evolución constante de este m e rcado, también se incluye un comparativo entre la situación de 1990 y la de 2000. Asimismo, se ofre c e i n f o rmación cuantitativa sobre el mercado laboral de las y los enferm e ros, tema que ha sido poco tratado en la literatura en México, y se efectúa un examen del p roceso de feminización de la profesión médica. En la primera sección de este texto se resume la i n f o rmación de estudios anteriores sobre la situación laboral de las y los médicos y las y los enferm e ros. En la siguiente sección se describe la metodología y los datos que se utilizan para desarrollar el estudio; a continuación se ofrece un resumen de la situación del m e rcado laboral de las y los médicos y las y los enfer-m e ros en México. En las posteriores secciones se de-fine la distribución por educación, empleo, ingre s o s y horas laboradas para ambos grupos ocupacionales.
Objetivo: Determinar los factores de riesgo asociados a la interrupción de los estudios de enfermería en algunas universidades del Perú, así como determinar la magnitud de la deserción según factor de riesgo. Diseño: Tipo caso–control, durante 1999-2000. Material y métodos: Se estudió los siguientes factores de riesgo: salud, económicos, personales, familiares, vocacionales, laborales, judiciales-policiales, académicos y de adaptación a la vida universitaria. La muestra estuvo conformada por 88 casos distribuídos como sigue: 24 estudiantes de las ciudades de Huacho e Iquitos y 20 de las ciudades de Lima y Trujillo. La muestra no incluyó estudiantes de la UNMSM, por no contar con la autorización correspondiente. Los controles estuvieron conformados por 65 alumnos no desertores de las mismas universidades. Resultados: El factor de riesgo de deserción que tuvo la mayor fuerza de asociación fue el factor vocacional, seguido del factor económico y del factor académico, acorde al odds ratio y sus limites inferiores de intervalo de confianza 95% superiores a 1. Un 42% de estudiantes presentó a la falta vocación como factor de riesgo de deserción, seguido del factor económico con 36%. Conclusiones: Existe una alta asociación entre los factores vocacional y económico, así como, una leve a moderada asociación del factor académico-rendimiento con la deserción de los estudiantes de enfermería de las universidades estudiadas.
This study examined the extreme medical unemployment and underemployment in the urban areas of Mexico. The conceptual and methodological approach may be relevant to many countries that have experienced substantial increases in the supply of physicians during the last decades.
On the basis of 2 surveys carried out in 1986 and 1993, the study analyzed the performance of physicians in the labor market as a function of ascription variables (social origin and gender), achievement variables (quality of medical education and specialty studies), and contextual variables (educational generation).
The study reveals, despite some improvement, persistently high levels of open unemployment, qualitative underemployment (i.e., work in activities completely outside of medicine), and quantitative underemployment (i.e., work in medical activities but with very low levels of productivity and remuneration). The growing proportion of female doctors presents new challenges, because they are more likely than men to be unemployed and underemployed.
While corrective policies can have a positive impact, it is clear that decisions regarding physician supply must be carefully considered, because they have long-lasting effects. An area deserving special attention is the improvement of professional opportunities for female doctors.
Background
Imbalance in the distribution of human resources for health (HRH), eventually leading to inequities in health services delivery and population health outcomes, is an issue of social and political concern in many countries. However, the empirical evidence to support decision-making is often fragmented, and many standard data sources that can potentially produce statistics relevant to the issue remain underused, especially in developing countries. This study investigated the uses of demographic census data for monitoring geographical imbalance in the health workforce for three developing countries, as a basis for formulation of evidence-based health policy options.
Methods
Population-based indicators of geographical variations among HRH were extracted from census microdata samples for Kenya, Mexico and Viet Nam. Health workforce statistics were matched against international standards of occupational classification to control for cross-national comparability. Summary measures of inequality were calculated to monitor the distribution of health workers across spatial units and by occupational group.
Results
Strong inequalities were found in the geographical distribution of the health workforce in all three countries, with the highest densities of HRH tending to be found in the capital areas. Cross-national differences were found in the magnitude of distributional inequality according to occupational group, with health professionals most susceptible to inequitable distribution in Kenya and Viet Nam but less so in Mexico compared to their associate professional counterparts. Some discrepancies were suggested between mappings of occupational information from the raw data with the international system, especially for nursing and midwifery specializations.
Conclusions
The problem of geographical imbalance among HRH across countries in the developing world holds important implications at the local, national and international levels, in terms of constraints for the effective deployment, management and retention of HRH, and ultimately for the equitable delivery of health services. A number of advantages were revealed of using census data in health research, notably the potential for producing detailed statistics on health workforce characteristics at the sub-national level. However, lack of consistency in the compilation and processing of occupational information over time and across countries continues to hamper comparative analyses for HRH policy monitoring and evaluation.
Background
This paper addresses the problem of wastage of the qualified labor force, which takes place both during the education process and when trained personnel try to find jobs in the local market.
Methods
Secondary sources were used, mainly the Statistical yearbooks of the National Association of Universities and Higher Education Institutions (ANUIES in Spanish). Also, the 2000 Population Census was used to estimate the different sources of labor market wastage. The formulas were modified to estimate educational and labor wastage rates.
Results
Out of every 1000 students who started a medical training in 1996, over 20% were not able to finish the training by 2000. Furthermore, out of every 1000 graduates, 31% were not able to find a remunerated position in the labor market that would enable them to put into practice the abilities and capacities obtained at school. Important differences can be observed between generalists and specialists, as well as between men and women. In the case of specialists and men, lower wastage rates can be observed as compared to the wastage rates of generalists and women. A large percentage of women dedicate themselves exclusively to household duties, which in labor terms represents a wastage of their capacity to participate in the production of formal health services.
Conclusion
Women are becoming a majority in most medical schools, yet their participation in the labor market does not reflect the same trend. Among men, policies should be formulated to incorporate doctors in the specific health field for which they were trained. Regarding women, specific policies should target those who are dedicated full-time to household activities in order to create the possibility of having them occupy a remunerated job if they are willing to do so. Reducing wastage at both the educational and labor levels should improve the capacity of social investment, thereby increasing the capacity of the health system as a whole to provide services, particularly to those populations who are most in need.
This study examines unemployment and underemployment of physicians in urban Mexico. The framework is relevant to countries with substantial increases in physician supply. Based on surveys from 1986 and 1993, the study analyses physician performance in the labour market as a function of ascription (social origin and gender), achievement (quality of medical education and specialization) and contextual variables (policy environments). By comparing two points in time, the article examines the impact of policies. The study reveals persistently high open unemployment, qualitative underemployment (that is, working outside medicine) and quantitative underemployment (that is, working in medical activities but with low productivity and remuneration). Improvements over time can be in part attributed to policies to control the supply of physicians. The growing proportion of female doctors presents challenges, since they are more likely to be unemployed or underemployed. The article concludes that health systems must strive to reduce the perverse effects of unbalanced labour markets in order to avoid reproducing rather than correcting social inequalities. Corrective policies regarding physician supply can be effective. The professional opportunities available to female doctors deserve attention.
La investigación en la enfermería mexicana: Análisis del contexto nacional e internacional
- R Benavides-Torres