Objective: To identify FPs with additional training and focused practice activities relevant to the needs of older patients within health administrative data and to describe their medical practices and service provision in community-based primary care settings.

Design: Retrospective cohort study.

Setting: Ontario.

Participants: Family physicians with Certificates of Added Competence in care of the elderly from the College of Family Physicians of Canada or focused practice billing designations in care of the elderly.

Main outcome measures: Evidence of additional training or certification in care of the elderly or practice activities relevant to the care of older adults.

Results: Of 14,123 FPs, 242 had evidence of additional scope to better support older adults. These FPs mainly practised in team-based care models, tended to provide comprehensive care, and billed for core primary care services. In an unadjusted analysis, factors statistically significantly associated with greater likelihood of having additional training or focused practices relevant to the care of older patients included physician demographic characteristics (eg, female sex, having completed medical school in Canada, residential instability at the community level), primary care practice model (ie, focused practice type), primary care activities (eg, more likely to provide consultations, practise in long-term care, refer patients to psychiatry and geriatrics, bill for complex house call assessments, bill for home care applications, and bill for long-term care health report forms), and patient characteristics (ie, older average age of patients).

Conclusion: The FP workforce with additional training or focused practices in caring for older patients represents a small but specialized group of providers who contribute a portion of the total primary care activities for older adults. Health human resource planning should consider the contributions of all FPs who care for older adults, and enhancing geriatric competence across the family medicine workforce should be emphasized.

Problem: Limited research has examined and synthesized the adaptation of midwives and midwife-led interventions during crises.

Background: Evidence suggests that midwives are essential to respond to sexual and reproductive health care needs during disruptive times, and that they adapt to continue to provide their services during those circumstances.

Aim: To map the adaptations of midwives when providing care during crises globally. Secondary objectives include identifying which midwives adapted, what services were adapted and how, and the demographic receiving care.

Study methods: Scoping review using Levac’s modifications of Arksey and O’Malley’s methods. Publications and grey literature, in English and Spanish, with no limitations based on study design or date were included. Data was extracted and mapped using Wheaton and Maciver’s Adaptation framework.

Findings: We identified 3329 records, of which forty-two were included. Midwives’ prior training impacted adaptation. Midwives adapted to the COVID-19 pandemic, epidemics, natural disasters, and World War II. They adapted in hospital and community settings around the provision of antenatal, labor and birth, postpartum, and contraceptive care. However, no specific data identified population demographics. Midwifery adaptations related to their practice, role, and scope of practice.

Conclusion: The limited available evidence identified the challenges, creativity, and mutual aid activities midwives have undertaken to ensure the provision of their services. Evidence is highly concentrated around maternal health services. Further high-quality research is needed to provide a deeper understanding of how midwifery-led care can adapt to guide sustainable responses to ensure access to sexual and reproductive health services during crises.

Background
There is limited evidence about the mental health and intention to leave of the public health workforce in Canada during the COVID-19 pandemic. The objectives of this study were to determine the prevalence of burnout, symptoms of anxiety and depression, and intention to leave among the Canadian public health workforce, and associations with individual and workplace factors.

Methods
A cross-sectional study was conducted using data collected by a Canada-wide survey from November 2022 to January 2023, where participants reported sociodemographic and workplace factors. Mental health outcomes were measured using validated tools including the Oldenburg Burnout Inventory, the 7-item Generalized Anxiety Disorder scale, and the 2-item Patient Health Questionnaire to measure symptoms of depression. Participants were asked to report if they intended to leave their position in public health. Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the associations between explanatory variables such as sociodemographic, workplace factors, and outcomes of mental health, and intention to leave public health.

Results
Among the 671 participants, the prevalence of burnout, and symptoms of depression and anxiety in the two weeks prior were 64%, 26%, and 22% respectively. 33% of participants reported they were intending to leave their public health position in the coming year. Across all outcomes, sociodemographic factors were largely not associated with mental health and intention to leave. However, an exception to this was that those with 16–20 years of work experience had higher odds of burnout (aOR = 2.16; 95% CI = 1.12–4.18) compared to those with ≤ 5 years of work experience. Many workplace factors were associated with mental health outcomes and intention to leave public health. Those who felt bullied, threatened, or harassed because of work had increased odds of depressive symptoms (aOR = 1.85; 95% CI = 1.28–2.68), burnout (aOR = 1.61; 95% CI = 1.16–2.23), and intention to leave (aOR = 1.64; 95% CI = 1.13–2.37).

Conclusions
During the COVID-19 pandemic, some of the public health workforce experienced negative impacts on their mental health. 33% of the sample indicated an intention to leave their role, which has the potential to exacerbate pre-existing challenges in workforce retention. Study findings create an impetus for policy and practice changes to mitigate risks to mental health and attrition to create safe and healthy working environments for public health workers during public health crises.

Objective: Ensuring the sustainability of the migrant workforce requires a comprehensive understanding of the psychological challenges faced by this sub-population due to concerns about the wellbeing and financial situation of family members in their home countries. Therefore, this study investigates the factors associated with psychological distress among sub-Saharan Africa (SSA) migrant workers across Australia and Canada during the COVID-19 pandemic. Method: Data were collected from 378 first-generation migrant workers with SSA ancestry residing in Australia and Canada using the Depression Anxiety and Stress Scale 21 (DASS-21). Multivariate logistic regression analysis was used to determine socio-demographic factors associated with depression, anxiety, and stress among SSA migrants’ populations. Results: Across both countries, migrants with lower levels of education were more prone to reporting feelings of depression, anxiety, and stress during the pandemic. Female participants in Australia were more likely to report feeling of depression. Participants in Australia and Canada who were separated/divorced/widowed were less likely to report stress and depression, respectively. Participants in Australia who had lived in Australia between 11 and 20 years and those between 36 and 50 years old were more likely to report feelings of depression. Participants residing in Australia whose SSA ancestry was Southern Africa/Central Africa were more likely to report anxiety. Participants in Australia who worked as part-time permanent workers and those who worked as fixed-term workers/short-term/casual workers were less likely to report anxiety. Finally, participants in Canada who reported two or more people living with them had higher odds of reporting anxiety. Conclusions: The findings from this study highlight key factors associated with SSA migrant workers’ psychological distress during the pandemic. The results can inform policies and provide insight to the development of mental health intervention strategies for migrant workers to minimize similar distress during pandemics.

Health researchers are encouraged by governments, funders, and journals to conduct research in partnership with people with lived experience. However, conducting research with authentic engagement and partnership with those who are experts by experience, but may not have research methods training, requires resources and specialized skills. The McMaster Collaborative for Health and Aging developed a fellowship program for trainees that builds their capacity to conduct research in partnership with older adults with relevant lived experience. We share this case example, with its successes and challenges, to encourage creative reformation of traditional research training.

The Collaborative used an iterative design process, involving researchers, trainees and older adult and caregiver partners, who, together, developed a fellowship program for trainees that provides support and mentorship to plan and conduct health research in partnership with people with lived experience.

Since 2022, the Partnership in Research Fellowship has been offered biannually. The application process was purposefully designed to be both constructive and supportive. Opportunities for one-on-one consultations; key resources, including a guide for developing a plan to involve people with relevant lived experience; and feedback from older adult and researcher reviewers are provided to all applicants. Successful trainees engage with older adult and caregiver partners from the Collaborative to advance and enhance a range of skills from facilitating partner meetings to forming advisory committees. Trainees are awarded $1500 CAD to foster reciprocal partnerships. Ten graduate students from various disciplines have participated. Trainees reported positive impacts on their knowledge, comfort, and approach to partnered research. However, the time required for undertaking partnered research activities and involving diverse partners remain obstacles to meaningful engagement.

Partnering with people with lived experience in the design of educational programs embeds the principles of partnership and can increase the value and reward for all involved. We share the Partnership in Research Fellowship as a case example to inspire new and transformative approaches in research training and mentorship that will move the field forward from engagement theory to meaningful enactment.

The Canadian Family-Friendly Community Resources for Better Balance, Health, and Well-Being study (FFCR) is the first study in North America to comprehensively examine the impact of regional community context on work-family conflict, health, and wellbeing. The study was designed to collate data from disparate sources on a variety of community characteristics across Canada over time, including education services, food stores, recreational facilities, religious organizations, police, and fire protection services, for example. These data were then linked to individual-level data from the Canadian Work, Stress and Health study – a longitudinal national sample of Canadians across a myriad of work and family circumstances. These data are more comprehensive than any other dataset attempting to link work, family, and community data. We situate our contribution of the FFCR in literature on ‘work-family conflict’, which is defined as the incompatibility between role obligations. Context-level data were compiled at years corresponding to the individual-level data (2011–2019). Using multilevel analyses based on both cross-sectional and longitudinal data, we find that that resources, like the prevalence of food stores, education resources, recreation facilities, and public safety outlets are negatively associated with residents’ work-family conflict levels. However, these findings are more pronounced across a combination of FFCR overtime.

During an organizational crisis, we investigate the nature of team members’ relationship with their leader, team dynamics, and outcomes for individuals and teams. We studied an organizational crisis unfolding at three public hospitals facing a bed shortage crisis. Leaders (n = 24) and their team members (n = 150) completed surveys that were matched. Leaders rated themselves and each team member individually; and team members independently rated themselves and their leader. The survey data was analyzed to differentiate the effects of between-team versus within-team variance using multilevel models. Overall, our results speak to the positive associations of leader-member exchange (LMX). When individuals felt higher on LMX than their team average, they were rated as performing better, had lower turnover intentions and higher team potency. Further, teams that were higher on LMX reported fewer turnover intentions, and were more creative. Core self-evaluations (CSE) were also linked to positive outcomes. Particularly in contexts of weak leaders (i.e., when their team rated them low in LMX and low in expertise), positive core self-evaluations were associated with better leader-rated performance. Moreover, teams with higher CSE had higher team potency. Implications for this research and future research directions are provided.

In this article, we offer a theory of firm-driven political polarization that explains how firms intensify societal political polarization through ideological homogenization processes inside firms. Drawing from research on corporate sociopolitical activism and ideologies in and around organizations, we develop a conceptual framework that describes how firms taking public stances on contentious social issues triggers divergent processes in stakeholders connected to the firm: ideology threat and ideology affirmation. These processes engender distinct organizational and individual outcomes in ideologically aligned and misaligned stakeholders that promote ideological homogeneity inside firms. We then theorize how ideological homogeneity works to intensify societal polarization through group polarization and echo chamber effects. We describe the implications of our theorizing for research on corporate sociopolitical activism, ideologies in organizations, and political polarization.

Despite a surge in the number of organizations using surveillance technology to monitor their workers, understanding of the health impacts of these technologies in the broader working population is limited. The current study addresses this omission using a novel measure of an individual’s overall perception of workplace surveillance, which enables it to be asked of all workers, rather than only those in specific occupations or work contexts that have historically been vulnerable to electronic performance monitoring. Structural equation modeling analyses based on a national sample of Canadian workers (N = 3,508) reveal that surveillance perceptions are indirectly associated with increased psychological distress and lower job satisfaction through stress proliferation. Findings demonstrate that the negative consequences of surveillance are explained by its positive association with three secondary work stressors: job pressures, reduced autonomy, and privacy violations. In the case of psychological distress, these stressors fully mediate a positive association with surveillance. The relationship between surveillance and job satisfaction is more complex, however, with the indirect effects of stress proliferation balanced out by a positive direct effect of surveillance on satisfaction. These results support the use of a stress process framework to examine how surveillance impacts worker well-being through stress proliferation.

The migration of health workers remains one of the most pressing challenges facing many countries in the global South. This short communication seeks to reignite debate on the effectiveness of the World Health Organisation (WHO) Code as a tool for managing the migration of health workers from the South. While the WHO Code was somewhat effective in reducing the migration of health workers from countries such as Zimbabwe during the first five years of its implementation, demand for health workers in the UK after Brexit and the COVID-19 pandemic has accelerated the rate of migration of health workers from countries facing critical shortages. Clearly, new solutions are needed that strike a balance between the right of health workers in the South to migrate and the right of citizens in the region to a stable supply of health workers.

Our study reevaluates the impact of commuting on mental health, challenging the prevailing view of commuting solely as a job-related demand or stressor that leads to increased mental health problems. Using the 2011 Neighbourhood Effects on Health and Well-Being Study from Toronto, we explore the dual perspectives of commuting distance as a stressful demand versus a potentially beneficial resource among parents of minor children (n = 299). Multivariate results reveal that commuting distance alone is not significantly linked to mental health as measured by psychological distress. However, the nature of commuting—whether it is viewed as a demand or a resource—depends on other factors in parents’ lives. Specifically, our results indicate that an increase in commuting distance exacerbates the negative effects of work hours on psychological distress while simultaneously buffering against the impact of work-to-family conflict on this outcome irrespective of gender.

Purpose
This paper aims to examine how individuals’ attachment dispositions relate to interactional justice perceptions, how work stressors moderate this association, and how together they associate with attitudes (satisfaction, turnover intention, commitment) and citizenship behaviors at work.

Design/methodology/approach
Survey data were used in an observed variable path analysis examining mediation by interactional justice and moderation by stressors on the associations between attachment dimensions and work outcomes.

Findings
Attachment avoidance was negatively related to interactional justice perceptions and attachment anxiety was also negatively related to interactional justice perceptions, but only under conditions of higher work stressors. Interactional justice mediated the associations between attachment avoidance and work outcomes, and between the interaction of attachment anxiety and work stressors on work outcomes.

Practical implications
These findings are particularly relevant to multiple aspects of HR practice, including performance feedback, managing stressors, building resilience, reward allocation and recognition, designing wellness programs and other aspects of human resource management.

Originality/value
This research goes beyond contextual predictors of justice perceptions and demonstrates that jointly considering attachment dimensions and work stressors uniquely contributes to understanding the formation of justice perceptions and their combined influence on work attitudes and behavior.

Health systems worldwide are at a critical juncture due to an increasing demand for health services and a diminishing pool of health human resources. While COVID-19 exacerbated nursing deficits, the need to strengthen and sustain the health workforce in Canada was evident decades prior and supported by numerous studies that warned of significant shortages. Post pandemic, building health system capacity has become paramount. This article examines innovative nursing employment initiatives in Canada. It provides a snapshot of federal, provincial and territorial approaches, with a particular focus on Internationally Educated Nurses (IENs) due to burgeoning interest in and competition for their skills and services. However, recognizing that health human resource planning is a persistent challenge, further initiatives are suggested. These include complementary policy development to improve retention and policy frameworks that support proactive long-term strategies to address the cyclical shortage of nurses.

This research investigates how and why the digitalization of work can disrupt age-based earnings stratification in an occupation. Analysing a service archive dataset from a major online legal service platform in China, the study finds that, contrary to the traditional patterns of income inequality, younger lawyers earn more than older lawyers in the digital legal field. Further analyses of the platform’s service records and interviews with lawyers working on this platform suggest that the platform’s work content and work distribution mechanism make mature lawyers’ human, social and symbolic capital less useful. Meanwhile, the preferences of platform clients place added value on younger lawyers’ digital habitus and turn it into a new form of cultural capital, manifested in their proficiency and effectiveness in digital communication. By examining habitus and capital in the emerging digital legal field, this research deepens the understanding of the impact of digital technologies on knowledge-intensive occupations.

Directly-Funded (DF) home care allows users to organize and purchase their own care services and is expanding globally. Little is known about the career pathways of home care workers. Our study asks, what experiences and factors do home care workers consider when choosing a work setting? And, specifically, what influences their decisions to work directly for their clients? Framed with Cranford’s (2020) flexibility-security matrix for analyzing home care dynamics, we remotely interviewed 20 home care workers in two Canadian provinces. Three team members conducted axial coding and thematic analysis using Dedoose software. We identified personal and material factors at the intimate and labor market level that workers weigh when choosing whether to work for an agency or directly for a client. At the intimate level, workers value the flexibility, autonomy, and respect facilitated in care relations when working directly for a client. At the labor market level, agencies provide better job security and the benefit of supervisory support but lower wages. Additionally, as care work often serves as a stepping stone for immigration and citizenship agency positions are considered a more “legitimate” option than working directly for a client. Our study shows that workers directly employed by their clients enjoy more flexibility but lack security, whereas agency employed workers risk immediate reductions in working conditions in exchange for limited improvements in safety and supervision and, like other frontline care work, DF home care represents a key career pathway for immigrants with previous experience in health and social care settings.

Double-Duty Carers (DDCs) refer to people who work in the healthcare industry while also providing unpaid care to relatives, friends, or neighbours. The expectations placed on DDCs is expected to grow, and these employees already experience a high caring burden. As such it is important to understand how best to support their health and wellbeing. This paper explores DDCs’ wellbeing during the COVID-19 pandemic, focusing an understudied factor: their mobility constraints. Following the Mobility of the Care Economy framework and a qualitative research design, it does so through a thematic analysis of 16 semi-structured interviews with female DDCs in Southern Ontario, Canada. Once data saturation was reached, three mobility pathways during the pandemic were identified, all of which negatively affected DDCs wellbeing. First, some COVID-19 policies (e.g., testing requirements) resulted in increased mobility demands and increased spatiotemporal constraints. Second, the closure of institutions that care for dependents (schools, daycares, day centres) resulted in forced reduced mobility, which increased financial stress. Finally, indirect mobility effects were identified: the reduced mobility of other informal carers increased the workload and emotional strain on DDCs. The paper concludes with a discussion of mobility-related policies that could improve DDC wellbeing.

Canadians’ health outcomes are inextricably tied to social inequities. Family medicine is uniquely situated to provide care that addresses social factors through longitudinal knowledge of patients and the contexts of their lives. However, family physicians have come under increased practice demands shaped by neoliberal ideological structuring of health care, compounding difficulties in providing care for persons experiencing health needs related to social inequities. Nursing scholar Ruth Malone has argued that remaining proximal, or close to patients, is a form of resistance to these demands. Using a critical narrative methodology, this paper presents the stories of 20 family physicians working with persons experiencing health needs related to inequity in Ontario, Canada, that express and expand upon Malone’s proximity. We highlight how participants invoke notions of proximity through their stories, describing the role of the family physician in: i) generating physical proximity based on the patients’ needs for more time, space, and care; ii) developing narrative proximity through storytelling over time in these shared spaces, both between colleagues and patient communities; and iii) engaging in moral proximity, or recognizing the vulnerabilities of their patients, by going “above and beyond” in their care and advocacy roles inspired by the needs of their patients. The findings add theoretical depth to proximity, extending this conceptualization into a new clinical context. These stories also complement current health services and health policy research that advocates for collaborative primary care approaches, as elements of these approaches are conducive to establishing proximity with patients who need care the most.

Objective: This article examines whether performing location-based platform work is associated with greater work–family conflict—and if this association is stronger for those relying on labor platforms for their primary employment.

Background: Digital labor platforms project a vision of flexibility and improved work-family balance for workers; however, empirical evidence supporting these promises remains elusive. While platform workers are normally offered the freedom to choose their work hours, the efforts of labor platforms to algorithmically manage workers’ schedules may encourage an ‘always-on’ approach to work that pressures workers to prioritize work availability that exacerbates work–family conflicts.

Method: We conducted three national surveys of Canadian workers in 2020, 2021, and 2022. Based on pooled survey data (N = 10,483), structural equational modeling was used to investigate (1) the relationship between location-based platform work and work–family conflict and (2) the mediating role of work-family role blurring—captured by work contact outside of normal working hours.

Results: We discovered that platform workers, compared to employees and the traditional self-employed, reported greater work–family conflict—conflicts that were especially pronounced for those relying on labor platforms as their primary source of income. These patterns were partially explained by platform workers’ increased exposure to work contact outside of work hours.

Conclusion: Our findings question the assertion that digital labor platforms provide enhanced flexibility for managing work and family demands. Instead, we contend that the instability inherent in platform work blurs and disrupts work-family role boundaries, disproportionately favoring labor platforms and their clientele at the expense of workers’ familial responsibilities.

Technology-enabled recruitment and selection technologies, such as chatbots, assessment games, and asynchronous video interviews, are becoming more widely used. However, their impact on people with disabilities is frequently ignored; this has potentially significant implications for the perceived fairness of hiring decisions. We advance eight theoretical propositions on the positive and negative implications of technology-enabled recruitment and selection technologies for applicant reactions of people with disabilities. Our propositions are based on three key design features of these technologies: separation in time and space, automated administration, and automated evaluation. We provide recommendations for future research and discuss practical implications for the use of advanced technology in recruitment and selection.

While burnout among health care workers has been well studied, little is known about the extent to which burnout among health care workers impacts the outcomes of their care recipients. To test this, we used a multi-year (2014–2020) survey of care aides working in approximately 90 nursing homes (NHs); the survey focused on work–life measures, including the Maslach Burnout Inventory (MBI) and work-unit identifier. Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) data were obtained on all residents in the sampled NHs during this time and included a unit identifier for each resident. We used multi-level models to test associations between the MBI emotional exhaustion and cynicism sub-scales reported by care aides and the resident outcomes of antipsychotics without indication, depressive symptoms, and responsive behaviors among residents on units. In 2019/2020, our sample included 3,547 care aides and 10,117 residents in 282 units. The mean frequency of emotional exhaustion and cynicism across units was 43% and 50%, respectively. While residents frequently experienced antipsychotics without indication 1,852 (18.3%), depressive symptoms 2,089 (20.7%), and responsive behaviors 3,891 (38.5%), none were found to be associated with either emotional exhaustion or cynicism among care aides.

Aim:
Identify and map international evidence regarding innovations led by or involving advanced practice nurses in response to COVID-19.

Background
COVID-19 necessitated unprecedented innovation in the organization and delivery of healthcare. Although advanced practice nurses have played a pivotal role during the pandemic, evidence of their contributions to innovations has not been synthesized. Evidence is needed to inform policies, practices, and research about the optimal use of advanced practice nurses.

Methods
A scoping review was conducted and reported using the PRISMA-ScR checklist. Electronic databases were searched for peer-reviewed articles published between January 2020 and December 2021. Papers were included that focused on innovations emerging in response to COVID-19 and involved advanced practice nurses.

Results
Fifty-one articles were included. Four themes were identified including telehealth, supporting and transforming care, multifaceted approaches, and provider education. Half of the articles used brief and mostly noncomparative approaches to evaluate innovations.

Conclusion
This is the first synthesis of international evidence examining the contributions of advanced practice nurses during the pandemic. Advanced practice nurses provided leadership for the innovation needed to rapidly respond to healthcare needs resulting from COVID-19. Innovations challenged legislative restrictions on practice, enabled implementation of telehealth and new models of care, and promoted evidence-informed and patient-centered care.

Implications for practice
Advanced practice nurses led, designed, implemented, and evaluated innovations in response to COVID-19. They facilitated the use of telehealth, supported or transformed models of care, and enabled health providers through education, mentorship, and mental health support.

Implication for policy
Advanced practice nurses are a critical resource for innovation and health system improvement. Permanent removal of legislative and regulatory barriers to their full scope of practice is needed.