A questionnaire developed by the authors was sent to 1000 nurses in various specialty areas. It was used to assess degree of job satisfaction, reasons for dissatisfaction, and the relationships of the work setting and sociodemographic data. Because the authors wanted to compare nurses who work primarily with older adults within and outside long-term care, the percentage of time spent caring for patients aged over 60 was also studied. The degree of job satisfaction between nurses working in long-term care was compared. A comparison of job satisfaction was also made between nurses working at least 75% of the time with older adults and nurses not working primarily with older adults. Factors causing job dissatisfaction in the long-term care group and the non-long-term care group were identified. Strategies to increase job satisfaction in long-term care were presented.

In the midst of a pandemic, many social work students are currently displaced from their field education, while the needs of their communities are exacerbated. Due to stay-at-home orders, the risk of experiencing social isolation and loneliness, already a major social problem prior to the crisis, has increased, especially for older adults. Seeking to step up in the context of a public emergency, graduate social work students in the United States created a project called GiftsofGab.org, which is a volunteer call-based companion coordination project that connects social work students with those in need of social interaction. We provide a case study of this project and argue that this kind of student-initiated action learning project can provide a workable alternative field placement model in times of crisis and is consistent with the community practice mission of social work.

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ObjectivesTo understand approaches to priority setting for healthcare service resource allocation at an operational level in a nationally commissioned but regionally delivered service.DesignQualitative study using semistructured interviews and a Framework analysis.SettingNational Health Service dentistry commissioning teams within subregional offices in England.ParticipantsAll 31 individuals holding the relevant role (dental lead commissioner in subregional offices) were approached directly and from this 14 participants were recruited, with 12 interviews completed. Both male and female genders and all regions were represented in the final sample.ResultsThree major themes arose. First, ‘Methods of priority setting and barriers to explicit approaches’ was a common theme, specifically identifying the main methods as: perpetuating historical allocations, pressure from politicians and clinicians and use of needs assessments while barriers were time and skill deficits, a lack of national guidance and an inflexible contracting arrangements stopping resource allocation. Second, ‘Relationships with key stakeholders and advisors’ were discussed, showing the important nature of relationships with clinical advisors but variation in the quality of these relationships was noted. Finally, ‘Tensions between national and local responsibilities’ were illustrated, where there was confusion about where power and autonomy lay.ConclusionsCommissioners recognised a need for resource allocation but relied on clinical advice and needs assessment in order to set priorities. More explicit priority setting was prevented by structure of the commissioning system and standard national contracts with providers. Further research is required to embed and simplify adoption of tools to aid priority setting.

BackgroundResources in any healthcare systems are scarce relative to need and therefore choices need to be made which often involve difficult decisions about the best allocation of these resources. One pragmatic and robust tool to aid resource allocation is Programme Budgeting and Marginal Analysis (PBMA), but there is mixed evidence on its uptake and effectiveness. Furthermore, there is also no evidence on the incorporation of the preferences of a large and representative sample of the general public into such a process. The study therefore aims to undertake, evaluate and refine a PBMA process within the exemplar of NHS dentistry in England whilst also using an established methodology (Willingness to Pay (WTP)) to systematically gather views from a representative sample of the public.MethodsStakeholders including service buyers (commissioners), dentists, dental public health representatives and patient representatives will be recruited to participate in a PBMA process involving defining current spend, agreeing criteria to judge services/interventions, defining areas for investment and disinvestment, rating these areas against the criteria and making final recommendations. The process will be refined based on participatory action research principles and evaluated through semi-structured interviews, focus groups and observation of the process by the research team. In parallel a representative sample of English adults will be recruited to complete a series of four surveys including WTP valuations of programmes being considered by the PBMA panel. In addition a methodological experiment comparing two ways of eliciting WTP will be undertaken.DiscussionThe project will allow the PBMA process and particularly the use of WTP within it to be investigated and developed. There will be challenges around engagement with the task by the panel undertaking it and with the outputs by stakeholders but careful relationship building will help to mitigate this. The large volume of data will be managed through careful segmenting of the analysis and the use of the well-established Framework approach to qualitative data analysis. WTP has various potential biases but the elicitation will be carefully designed to minimise these and some methodological investigation will take place.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3302-8) contains supplementary material, which is available to authorized users.