Opening the doors to the OR: providing students with perioperative clinical experiences

For the past two decades, perioperative nurse leaders have written about the need for more perioperative nurses. Only a small percentage of all nurses are perioperative nurses, and within the next five years, it is estimated that nearly 20% of those currently employed will retire while demand for nurses will continue to increase. This is occurring at a time when most nursing schools have eliminated the theoretical content and clinical exposure to a perioperative curriculum. In response to these issues, faculty members at the State University of New York at Stony Brook, in collaboration with perioperative educators, developed programs to provide nursing students and RNs with the opportunity to experience perioperative nursing. We offered senior nursing students a 15-week clinical practicum and capstone experience at North Shore University Hospital, Manhasset, NY, and we offered RNs and students a two-week introductory OR experience at Stony Brook University Medical Center, Stony Brook, NY. We believe these types of programs could offer a partial solution to the perioperative nursing shortage and reduce nurse attrition in the perioperative setting.     

Registered nurse leadership style and confidence in delegation

Saccomano S.J. & Pinto- Zipp G. (2011) Journal of Nursing Management 19 , 522–533
Registered nurse leadership style and confidence in delegation Background and aims Leadership and confidence in delegation are two important explanatory constructs of nursing practice. The relationship between these constructs, however, is not clearly understood. To be successful in their roles as leaders, regardless of their experience, registered nurses (RNs) need to understand how to best delegate. The present study explored and described the relationship between RN leadership styles, demographic variables and confidence in delegation in a community teaching hospital. Methods Utilizing a cross-sectional survey design, RNs employed in one acute care hospital completed questionnaires that measured leadership style [Path-Goal Leadership Questionnaire (PGLQ)] and confidence in delegating patient care tasks [Confidence and Intent to Delegate Scale (CIDS)]. Results Contrary to expectations, the data did not confirm a relationship between confidence in delegating tasks to unlicensed assistive personnel (UAPs) and leadership style. Nurses who were diploma or associate degree prepared were initially less confident in delegating tasks to UAPs as compared with RNs holding a bachelor’s degree or higher. Further, after 5 years of clinical nursing experience, nurses with less educational experience reported more confidence in delegating tasks as compared with RNs with more educational experience. Conclusions The lack of a relationship between leadership style and confidence in delegating patient care tasks were discussed in terms of the PGLQ classification criteria and hospital unit differences. As suggested by the significant two-way interaction between educational preparation and clinical nursing experience, changes in the nurse’s confidence in delegating patient care tasks to UAPs was a dynamic changing variable that resulted from the interplay between amount of educational preparation and years of clinical nursing experience in this population of nurses. Clearly, generalizability of these findings to nurses outside the US is questionable, thus nurse managers must be familiar with the Nurse Practice Act in their country in order to ensure proper delegation of tasks to appropriate assistive personnel. Implications for nurse managers It is imperative that nurse managers provide nurses with the educational opportunities necessary to develop delegation and supervision strategies to adapt to the changing RN role while adhering to differences in scope of practice. Globally, RNs are caring for increasing numbers of acutely ill patients with scarce resources ensuring an adequately trained RN/UAP team can help support optimal patient care.     

Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey

Patrick A., Laschinger H.K.S., Wong C. & Finegan J. (2011) Journal of Nursing Management 19 , 449–460
Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey Aim To test the psychometric properties of a newly developed measure of staff nurse clinical leadership derived from Kouzes and Posner’s model of transformational leadership. Background While nurses have been recognized for their essential role in keeping patients safe, there has been little empirical research that has examined clinical leadership at the staff nurse level. Methods A non-experimental survey design was used to test the psychometric properties of the clinical leadership survey (CLS). Four hundred and eighty registered nurses (RNs) providing direct patient care in Ontario acute care hospitals returned useable questionnaires. Results Confirmatory factor analysis provided preliminary evidence for the construct validity for the new measure of staff nurse clinical leadership. Structural empowerment fully mediated the relationship between nursing leadership and staff nurse clinical leadership. Conclusion The results provide encouraging evidence for the construct validity of the CLS. Implications for nursing management Nursing administrators must create empowering work environments to ensure staff nurses have access to work structures which enable them to enact clinical leadership behaviours while providing direct patient care.     

Adult student satisfaction in traditional and accelerated RN-to-BSN programs.

The pressures and complexities that the registered nurse (RN) encounters in today's health care system have motivated many RNs to return to college to obtain their baccalaureate degrees. Competition among institutions of higher education has led faculty to develop and offer more nontraditional delivery models of nursing education. In developing these new models of educational delivery, it is important for faculty to determine what items of education are essential to adult learners. A survey was conducted to assess two delivery formats, traditional and accelerated, for a bachelor of science in nursing (BSN) program for RNs. The goal of the research was to determine what items of education are essential to students and whether one group of students was more satisfied with one delivery system over the other. Items of importance and the concomitant level of satisfaction were surveyed by using an adult students' priorities scale. The survey was distributed to 53 RN students. The results demonstrated that the students in the accelerated format were more satisfied with the institution, program, and services than the students in the traditional format.     

Use of the professional nurse case study as a method to earn credit in an RN to BSN program.

This article describes the author's experience in developing a professional nurse case study as a means of allowing registered nurse students enrolled in a baccalaureate degree nursing program to satisfy the clinical requirement at a public institution in New Jersey. The author used a survey to assess the lower level competencies of their RN students. In addition, a survey was mailed to the BSN graduates who completed the program within the past five years to determine if they would have selected an alternative to the clinical examination. Results showed that the PNCS could validate prior learning of basic nursing competencies for RNs returning to obtain a BSN degree.     

Cultural competence in nursing education: practicing what we preach

Nurse educators face challenges in how to teach and mentor an increasingly diverse student nurse population. This article reviews some of the difficulties and challenges associate degree nurse educators face in providing culturally competent nursing education for today's community college nursing students. Excerpts from interviews with students are provided to promote an enhanced understanding of the issues faced by this group. Strategies for use in the classroom and clinical setting are described.     

New graduate RNs in a float pool. An inner-city hospital experience

Nurse managers and nurse educators alike have historically discouraged hiring new graduate RNs into a float pool and have preferred experienced nurses with multiple clinical skills. With a nursing shortage and changing marketplace, we need different strategies for recruitment and retention and ways to improve our clinical practice. A new graduate RN offers a nursing service an opportunity to employ a motivated, ready-to-learn, educationally prepared and intellectually stimulated nurse who happens to have limited clinical experience. The authors present a program for training new graduate RNs to practice nursing in a float pool. The training program focuses on their clinical practice needs and on transitioning them to the RN role. This program resulted in a 96% retention rate. The program offered our medical surgical units a strong clinical support float nurse, our managers a staffing solution in times of need, and the new graduate RN a broad range of clinical experiences making them more valuable members of the healthcare team. This training model is one approach to increasing recruitment and retention and can be replicated in other institutions.     

University COVID -19 Surveillance Testing Center: Challenges and Opportunities for Schools of Nursing

As the impact of the COVID-19 pandemic became clear, it was evident that higher education schools and Universities, including schools of nursing were facing enormous challenges to create a safe environment for educational instruction to continue. Clinical education in particular was affected as clinical sites were increasingly unable to accommodate student clinical rotations due to crushing volumes and overwhelming care needs of COVID patients. This article outlines the innovative efforts of one university that set up a robust surveillance testing program that required and provided weekly COVID-19 testing of all students, faculty and staff that were on-campus. The testing center is nurse led and nurse managed, providing a clinical experience for over 50 nursing students each semester, allowing them to accrue community clinical hours so that they can progress through their nursing program. Clinical quality and patient experience outcomes are shared, and lessons learned described.     

RN-BSN education: 21st century barriers and incentives

DESIGN: Qualitative using phenomenological inquiry. Methods Purposive sample of six RN-BSN students participated in focus group interviews. Data were analysed using Colaizzi's phenomenological method. FINDINGS: Incentives included: (1) being at the right time in life; (2) working with options; (3) Achieving a personal goal; (4) BSN provides a credible professional identity; (5) encouragement from contemporaries; and (6) user-friendly RN-BSN programmes. Barriers included: (1) time; (2) fear; (3) lack of recognition for past educational and life accomplishments; (4) equal treatment of BSN, ASN and diploma RNs; and (5) negative ASN or diploma school experience. CONCLUSIONS: RN-BSN educational mobility is imperative as: (a) 70% of practicing RNs (USA) are educated at the ASN or diploma level; (b) nurse academicians and leaders are retiring in large numbers; and (c) research links BSN-educated RNs with improved patient outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: RN-BSN educational mobility is imperative to nurse managers and nurse administrators because: (a) research links BSN-educated RNs with improved patient outcomes; (b) nurse leaders and academicians are retiring in large numbers; and (c) approximately 70% of practicing RNs (USA) are educated at the associate degree or diploma level with only 15% moving on to achieve a degree past the associate level. Measures to foster incentives and inhibit barriers (caring curricula and recognition of different educational levels) should be implemented at all levels of nursing practice, management and academia.     

Pedagogical content knowledge for nurse educators: An intersection of disciplines

Pedagogical content knowledge (PCK) is the proverbial bar over which novice nurse educators must leap. However, relatively few nurse educators receive the formal graduate pedagogical training needed to smoothly transition from bedside nursing or advanced practice roles to the nurse educator role. Novice nurse educators who lack pedagogical preparation may experience frustration and failure when attempting to clear those bars and therein lays a problem. Novices nurse educators bring their own expectations to the teaching endeavor. They expect their clinical knowledge and experience to have equipped them with all that is necessary to teach nursing. Faculty are content experts but not yet experts of teaching, excelling only in providing or directing client care and providing clinical supervision to students. The lack of PCK creates a sometimes insurmountable disconnect between bedside nursing practice and nursing academia. Such dissonance often leaves the nurse educator in unfamiliar territory teaching by trial and error.     

The technical competence of registered nurses in the administration of oral medications

An individual who desires to become a registered nurse (RN) may choose from three types of education: associate degree, diploma, and baccalaureate degree programs. The dilemma of this decision is heightened by the strong disagreement within the nursing profession regarding which of the three modes best prepares a nurse to become a competent practitioner. The purpose of this study was to examine variables which might explain variance in the technical competence of RNs as evidenced by skill in administering oral medications. Six variables were investigated as possible predictors of the variance in oral medication administration procedure, i.e., basic nursing education, drug knowledge, age, previous RN experience, previous nursing experience, and highest nursing education completed. Sixty volunteer RNs in a Baltimore community hospital (252 beds) were observed twice each as they administered two oral medications to a patient. A Technical Competence Tool (TCT) was used to record performance of the 16 critical behaviors deemed essential for safe and accurate drug administration. The total scores from observation one and two were summed to obtain a total competence score. Each nurse also completed a 14-item Drug Knowledge Profile (DKP) and Demographic Data Sheet (DDS). Although there was a wide range of total competence scores, only three percent of the variance was explained by the six predictor variables. It was concluded that the selected variables were not significant predictors of the technical competence of RNs in the administration of oral medications.(ABSTRACT TRUNCATED AT 250 WORDS)     

实习护生对护理应急预案认知的调查

目的了解护生临床实习后对护理应急预案知识掌握的情况,为临床带教中增加应急预案知识的教学内容及其必要性提供依据。方法采用自行设计的护理应急预案知识测试量表,以北京市某三级医院75名实习护生作为调查研究对象进行问卷测试调查,对问卷得分进行分析,运用独立样本t检验,比较不同学历实习护生问卷得分情况。结果问卷回收率为100％,有效率为96％,100％的实习护生认为有进行护理应急预案学习的必要性;中专生应急预案知识总分为（39．00±2．716）分,大专生应急预案知识总分为（38．67±2．474）分,且间比较差异无统计学意义（t=0．545,P=0．588）。结论实习护生普遍缺乏医院护理应急预案的知识,l临床教学中应加强护生对护理应急预案知识的教育和危机意识、应对能力的培养。     

The utilization and role of the preceptor in undergraduate nursing programs

Over the past several decades, utilization of nurse preceptors has gained increasing popularity within academic settings providing nursing degrees. Although not a new phefsnomenon, the preceptorship experience has traditionally helped to facilitate the clinical preparation for students in nursing programs (Oermann, M.N. and Heinrich, R.T. (Eds). Annual Review of Nursing Education (Vol. 1), chapter 5. New York, NY: Springer 2003). Today, nurse preceptors continue to be utilized in student nurses' clinical education. Therefore, it is imperative that nurse educators understand the role of the preceptor and how to provide the necessary guidance for a successful preceptorship experience.     

Partnerships,Succession, and Student Engagement: A Perioperative Immersion Program

The current shortage of operating room (OR) nurses will be critically impacted by the planned retirement of 65% of its workforce by 2022 with more vacancies expected in the years to come. Another likely contributor to the OR nursing shortage may be because most clinical education experiences in nursing programs do not include rotations in the perioperative setting, thus limiting student exposure. One solution to introduce student nurses to the perioperative environment and mitigate the limitations of passive learning for today’s learners is providing an on-site perioperative immersion experience delivered by the OR nurse education team. Nurse educators teaching in a baccalaureate nursing program at a midwestern college collaborated with the perioperative nursing education team from a large metropolitan hospital to implement a perioperative immersion program for entry-level undergraduate nursing students. In qualitative evaluations, the perioperative immersion increased knowledge of the patient perioperative experience, exposed students to both OR nursing and interdisciplinary team roles and responsibilities, and generated interest in the OR as a future career path.     

Primary care clinical placements: The views of Australian registered nurse mentors and pre-registration nursing students (part 2)

An increased burden of chronic and complex conditions treated in the community and an aging population have exacerbated the primary care workload. Predicted nursing shortages will place further stressors on this workforce. High quality clinical placements may provide a strategic pathway to introduce and recruit new nurses to this speciality. This paper is Part 2 of a two part series reporting the findings of a mixed methods project. Part 1 reported on the qualitative study and Part 2 reports on the quantitative study. Forty-five pre-registration nursing students from a single Australian tertiary institution and 22 primary care Registered Nurse (RN) mentors who supervised student learning completed an online survey. Students largely regarded their primary care placement positively and felt this to be an appropriate learning opportunity. Most RNs were satisfied with mentoring pre-registration nursing students in their setting. Furthermore, the RNs desire to mentor students and the support of general practitioners (GPs) and consumers were seen as key enablers of pre-registration nursing placements. Findings from this study provide a preliminary impression of primary care clinical placements from the perspective of pre-registration nursing students and registered nurse mentors. Further research should examine whether a broader scope of non-traditional health settings such as non-government organisations, charities, pharmacies, welfare and social services can also provide appropriate learning environments for pre-registration nursing students.     

Clinical placements in general practice: Relationships between practice nurses and tertiary institutions

As a practice-based discipline a key component of undergraduate nurse education is clinical practice experience. The quality of clinical experiences has a significant impact on the students' ability to function competently post graduation. The relationship between higher education institutions (HEIs) and health service placement providers impacts upon the quality of clinical placements. In Australia, the growth of primary care nursing and the shortage of acute clinical places has prompted HEIs to explore the placement of students in general practice. Given the increasing attention being paid to non-traditional clinical placements, it is timely to explore how universities are establishing relationships and models of clinical placement. This paper uses qualitative research methods to explore the perspectives of 12 Australian general practice nurses who have experience in facilitating undergraduate clinical placements about the relationships between HEIs and nurses. Findings are presented in the following three themes: (1) Appropriate preparation for placement: They don't know what primary health really means, (2) Seeking greater consultation in the organisation of clinical placements: they’ve got to do it one way for everyone, and (3) Uncertainty and lack of support: I had no contact with the university. Clinical placements in general practice can be an innovative strategy providing non-traditional, yet high quality, teaching and learning experiences for undergraduate nursing students. To optimise the quality of these placements, however, it is essential that HEIs provide appropriate support to the practice nurses mentoring these students.     

The fast track back to registered nurses employment

The registered nurse (RN) workforce continues to decline. One method to attract experienced RNs into the workforce is through RN refresher courses. To determine if our RN refresher program is successful in returning RNs to the workforce, we sought to measure the: characteristics of RNs who participate in our program; relationship among participants' employment and demographics; effect of high fidelity human simulation (HFHS) on participants' learning, and; program's ability to meet participants' preparation for employment. Seventy-three participants were surveyed to measure their demographics and employment; they ranked the HFHS experience and program experience on their learning and employment. Thirty-four (47%) surveys were returned. Thirty-three participants (97%) were female (mean age=50.44 years, SD=6.2). Their mean years of RN licensure was 24.93 years (SD=8.8), and their mean time out of nursing practice was 13.30 years (SD=8.0). Twenty-six (76.5%) were employed, with 20 (60.6%) employed as RNs at acute care facilities. Employed participants were licensed for less years than non-employed participants (p=0.047). Employed participants ranked their HFHS experience highly (p=0.04) and the program highly (p=0.04) on benefiting their current employment. Our refresher program appears to be successful in helping RNs re-enter the nursing workforce.     

护理专业学生实习前专业承诺状况及其影响因素

目的了解护理本科生及大专生实习前的专业承诺状况,并分析其影响因素。方法应用护理专业承诺量表对371名护理本科生及541名护理专科生进行问卷调查。结果实习前护理大专生总体专业承诺得分为(2.91±0.34)分,本科生为(2.79±0.35)分;不同性别、学历、成绩、专业兴趣、护理角色感觉、就读原因的学生,专业承诺水平差异有统计学意义。结论实习前护理专业学生专业承诺总体水平处于中等偏上,大专生的专业承诺水平高于本科生;性别、成绩、专业兴趣、角色感觉、就读原因对专业承诺有一定影响。     

Role stress among first-line nurse managers and registered nurses – a comparative study

Background Studies show that first-line nurse managers (F-LNMs) experience high psychological job demands and inadequate managerial guidance. The purpose of this study was to investigate whether F-LNMs have higher stress levels and show more signs of stress-related ill health than registered nurses (RNs). Aim The aim of this study was to examine possible differences in self-rated health between F-LNMs and RNs on various psychosocial factors (e.g. job demand, job control and managerial support). Methods Data were collected at a university hospital in Sweden. Sixty-four F-LNMs and 908 RNs filled in a web-based questionnaire. Results Both F-LNMs and RNs reported having good health. Approximately 10–15% of the F-LNMs and RNs showed signs of being at risk for stress-related ill health. Statistically significant differences (Mann–Whitney U-test) were found in the distribution between the F-LNMs and the RNs on three indices of job control, job demand and managerial support. Conclusion Our findings suggest that F-LNMs were able to cope with high-demand job situations because of relatively high control over work. Implication for nursing management The implication for nursing management shows the needs for a work environment for both F-LNMs and RNs that includes high job control and good managerial support.     

Nursing students'' initial clinical experience: a phenomenological study

Nursing students have revealed that one of the most anxiety-producing aspects of their clinical experience is the initial clinical experience. In order to help students through their initial clinical experience, faculty must first understand more fully the meaning of this experience for nursing students. A phenomenological study was conducted to explore the lived experience of nursing students' first clinical experience. Eighteen undergraduate nursing students described in writing an experience they had during their first day of clinical. Data were analyzed using Colaizzi's phenomenological method. Six theme clusters emerged: pervading anxiety, feeling abandoned, encountering reality shock, envisioning self as incompetent, doubting choices, and uplifting consequences. Implications for nurse educators are addressed.