Education and Career Advancement Opportunities in Polish and English Nursing—A Comparative Study of Intensive Care Unit Nurses

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you very much for giving me the opportunity to comment on this paper, which aims to explore an intersting research question and reports valid data in a well-written manuscript.

I have only some minor recommendations for improvement before a publication is warranted from my perspective.

1. In the theortical part I was wondering if it is possible to report at least some quantitative and representative statistics about the variables under investigation  (education, job satisfaction, job promotion) in Poland and the Uk. For instance, the RN4Cast Study and the NEXT Study were rather large scale studies on the working conditions of European nurses.

Maybe there are also some statistics from the Eurpean Workning Conditions survey.

2.  I would like to recommend integrating Tables

6+7

8+9

10+11

each into on table because information reproted is repertitive otherwise and

more confusing regarding information integration.

3. Regarding eduaction satisfaction: Is it an explanation taht more well-educated and highly qualified Polish nurses move to the UK?

Thank you very much!

Author Response

Review 1

Many thanks for your useful comments, we did our best to integrate them in order to improve the paper.

1. In the theortical part I was wondering if it is possible to report at least some quantitative and representative statistics about the variables under investigation  (education, job satisfaction, job promotion) in Poland and the Uk. For instance, the RN4Cast Study and the NEXT Study were rather large scale studies on the working conditions of European nurses. Maybe there are also some statistics from the Eurpean Workning Conditions survey.

Reply: the problem is that there is no representative comparative data on Poland and England; however, the aim of this research, as presented in the introduction, was to explore the issue of career planning and development as experienced by intensive care unit nurses, which was later interpreted in the context of stress and burnout, and not to conduct a larger scale statistical data analysis. This would require another review paper. We hope that you would agree.

2. I would like to recommend integrating Tables 6+7, 8+9, and 10+11each into one table because the information reported is repetitive otherwise and more confusing regarding information integration.

Reply: We fully agree and have now integrated the tables following your suggestion. We believe the paper is much clearer now.

3. Regarding education satisfaction: Is it an explanation that more well-educated and highly qualified Polish nurses move to the UK?

Reply: this could indeed be an explanation; however, because we can’t provide explanations based on the data gathered and only speculations, we have removed the reference to this issue from the paper background; we are now saying only that the English professional nursing solutions should be possibly adapted in Poland.

Reviewer 2 Report

Comments and Suggestions for Authors

An interesting paper but requires some work to improve the presentation of the content  to make it suitable for publication. 

1.  Avoid Great Britain, British and be careful with UK. The UK is four devolved countries with different health systems  and your study was conducted in one -  England. But citizens tend to be referred to as UK. So check throughout the document. 

2. Please ensure the aim in the abstract is the same as your aim in the main body of the text. currently different.  In the aims P2 L 68 you use the phrase "higher levels of desire for advancement." is advancement motivation to undertake further continuing professional development (CPD) or apply for promotion. I think you need to explain. 

3. The design is not clear. I think you administered a structured interview based survey. You used an 11-item instrument with  two  additional open questions which were subjected to content analysis. Other items were analysed using descriptive statistics.  But you describe it clearly please. You need to be precise and in main body reference your design methods for purposes of transparency. 

4. I think it is inappropriate to name the hospitals and it will not tell the reader much. It would be better to describe the type of hospital (General hospital with x beds)  and critical care services (general or cardiac or trauma, etc)  and number of ITU beds. So describe each study site maybe in a table? It might be useful to say critical care units in the UK are aligned with national standards and service specification (NHS England D05 Adult Critical Care Service Specifications 2021. NHS.)  and audited (Faculty of Intensive Care Medicine Guidelines for the Provision of Intensive Care Services (GPICS) Version 2.1  2022: FICM. London).  To meet the standards must be accessible  CPD for nursing staff (e.g. 50% must be certified as ITU trained and ITUs are required to have clinical educators. That needs explaining and the equivalent or not in Poland.  

5. You report (p2 83-87 that staff are better trained in the UK and clearly a high proportion internationally educated nurses (IENs)  so more likely to be graduate if economically mobile. You might want to mention that the study conducted pre-Brexit and therefore home country of IENs might be different today  as many EU nurses moved on. 

6. All you tables need re-formatting. The style makes them really difficult to read. I think the values rather than below might be better in the tables. Some of the descriptors such as 'medical secondary school' will be meaningless and better to mention years of education or tertiary education to 18 years.  Also the BNurs/MNurs statistics are problematic in the UK as there are pre-registration Masters as well as graduate-entry nursing with Masters as the end award. I am unsure if the Masters indicates post-registration education e.g. critical care training

7. P3 L100-102 you describe the method used to analysis the two open questions. You need to reference the approach you used and explain the extraction process. Also make it clearer you audio-recorded and then transcribed the open questions

8. Unclear what you mean by "categories are only convention (2.3 L110)  and "results of the statistical analysis on the various dimensions of education and work" (Ls110-112). In fact that paragraph really needs quite a lot of attention. 

9. I am not sure what Tables 2 and 3 offer to the reader as currently presented. The use of bullet points adds to confusion and text in columns would be better left justified not aligned centrally. It make reading very difficult. I do wonder if these two tables if you retain could be condensed into one and illustrating the overlap. them might be better presented   

10. You provide a lengthy description (Ls125-L147) of the transformation of content analysis through applying Cohen's Kappa but aren't they usually presented as a range? and I think Table 4 it should be clear that your interest was inter-rater reliability, 

11. Could tables 6- 11 be presented in a composite table rather than separate ones? with the values in the main body of the table? 

12. Re-visit the discussion about education in light of standards and requirements. Ls251-252 really unclear. Section 4.1 explain why difficult to be promoted in Poland. 

13. 4.4 what is "conventional sampling"? Please explain 

14 Overall draw on relevant policy, guidelines, and literature to make the overall submission stronger. 

Comments on the Quality of English Language

This manuscript really needs a review by someone who can correct the syntax and idioms for you. Remember you audience is likely to be global if this article is accepted and therefore you need to explain things that may be peculiar to a health system and not others. 

Author Response

Review 2

Many thanks for your useful comments, we did our best to integrate them in order to improve the paper.

Comment 1:  Avoid Great Britain, British and be careful with UK. The UK is four devolved countries with different health systems  and your study was conducted in one -  England. But citizens tend to be referred to as UK. So check throughout the document. 

Reply 1: we surely agree and have changed everywhere to “England”.

Comment 2: Please ensure the aim in the abstract is the same as your aim in the main body of the text. Currently different.  In the aims P2 L 68 you use the phrase "higher levels of desire for advancement." is advancement motivation to undertake further continuing professional development (CPD) or apply for promotion. I think you need to explain. 

Reply 2: we have now clarified that by career advancement, we mean a desire for promotion.

Comment 3: The design is not clear. I think you administered a structured interview based survey. You used an 11-item instrument with  two  additional open questions which were subjected to content analysis. Other items were analysed using descriptive statistics.  But you describe it clearly please. You need to be precise and in main body reference your design methods for purposes of transparency. –

Reply 3: we have now clarified the design and the instrument used.  

Comment 4: I think it is inappropriate to name the hospitals and it will not tell the reader much. It would be better to describe the type of hospital (General hospital with x beds)  and critical care services (general or cardiac or trauma, etc)  and number of ITU beds. So describe each study site maybe in a table? It might be useful to say critical care units in the UK are aligned with national standards and service specification (NHS England D05 Adult Critical Care Service Specifications 2021. NHS.)  and audited (Faculty of Intensive Care Medicine Guidelines for the Provision of Intensive Care Services (GPICS) Version 2.1  2022: FICM. London).  To meet the standards must be accessible  CPD for nursing staff (e.g. 50% must be certified as ITU trained and ITUs are required to have clinical educators. That needs explaining and the equivalent or not in Poland.  

Reply 4: We have followed your suggestions and clarified the hospital type and the number of beds, but also retained the names of the hospitals for the transparency of research findings. We hope that you will agree.

Comment 5: You report (p2 83-87 that staff are better trained in the UK and clearly a high proportion internationally educated nurses (IENs)  so more likely to be graduate if economically mobile. You might want to mention that the study conducted pre-Brexit and therefore home country of IENs might be different today  as many EU nurses moved on. 

Reply 5: Yes, fully agreed, we have included this information in the revised manuscript.

Comment 6. All you tables need re-formatting. The style makes them really difficult to read. I think the values rather than below might be better in the tables. Some of the descriptors such as 'medical secondary school' will be meaningless and better to mention years of education or tertiary education to 18 years.  Also the BNurs/MNurs statistics are problematic in the UK as there are pre-registration Masters as well as graduate-entry nursing with Masters as the end award. I am unsure if the Masters indicates post-registration education e.g. critical care training

Reply 6: We have re-formated the tables following your advice. We have better explained the differences in education and the labels of education degrees in the sample sections.

Comment 7: P3 L100-102 you describe the method used to analysis the two open questions. You need to reference the approach you used and explain the extraction process. Also make it clearer you audio-recorded and then transcribed the open questions

Reply 7: We have indicated the data collection and analysis procedure more clearly.

Comment 8: Unclear what you mean by "categories are only convention (2.3 L110)  and "results of the statistical analysis on the various dimensions of education and work" (Ls110-112). In fact that paragraph really needs quite a lot of attention. 

Reply 8: It means that the names of categories as we used them are merely conventional, but their content is not. We have now substantially rewritten the whole paragraph to make the whole procedure clearer.

Comment 9: I am not sure what Tables 2 and 3 offer to the reader as currently presented. The use of bullet points adds to confusion and text in columns would be better left justified not aligned centrally. It make reading very difficult. I do wonder if these two tables if you retain could be condensed into one and illustrating the overlap. them might be better presented

Reply 9: We have combined Tables 2 and 3 into one – though still having two separate parts, and both the questions and the categories and their contents were different in the answers to those questions, so we can’t put them all together because that would be confusing.

Comment 10: You provide a lengthy description (Ls125-L147) of the transformation of content analysis through applying Cohen's Kappa but aren't they usually presented as a range? and I think Table 4 it should be clear that your interest was inter-rater reliability

Reply 10: We now changed these tables, combined them into one, and changed the name

Comment 11: Could tables 6- 11 be presented in a composite table rather than separate ones? with the values in the main body of the table? 

Reply 11: Yes, we have now made composite tables, which are much clearer hopefully.

Comment 12: Re-visit the discussion about education in light of standards and requirements. Ls251-252 really unclear. Section 4.1 explain why difficult to be promoted in Poland. 

Reply 12: We have explained this and the key difference between Poland and England being the single one-step path of promotion in the Polish system and the more diverse options of the UK system.

Comment 13: 4.4 what is "conventional sampling"? Please explain

Reply: changed now to the proper term “convenience sampling”

Comment 14: Overall draw on relevant policy, guidelines, and literature to make the overall submission stronger. 

Reply 14: We have added a paragraph to the discussion. However, please take into account that we are no healthcare policy advisors and that our aim is more modest, which is the presentation of empirical study results based on a survey and interview. We are not writing a policy advice paper or a review paper. A thorough discussion of policy and guidelines would require writing another article.