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1.
Background
Despite the large numbers in health care industry, little is known about the clinical nonlicensed personnel (CNLP) in U.S. hospitals and how their staffing has changed over time.Purpose
The purpose of this analysis is to better understand the conformation and recent trends in CNLP staffing in U.S. hospitals from 2010 to 2015.Methods
Using Premier's OperationsAdvisor database, we examined trends in staffing of 25 CNLP jobs and graduate nurses (GNs) in U.S. hospitals and by hospital units, including medical–surgical units, outpatient units, and emergency departments, from 2010 to 2015, based on their skill levels. We measured CNLP and graduate nurse staffing using the average number of full-time equivalents (FTEs) in each hospital. We performed statistical analysis to compare the changes in the number of FTEs between 2010 and 2015.Discussion
Over the 6-year period from 2010 to 2015, we observed declining trends in the average number of high-skill and middle-skill CNLP FTEs by 22% and 7%, respectively, and increases in the average number of low-skill and graduate nurse FTEs by 38% and 117%, respectively. This skill mix shift appears to be most pronounced in emergency departments.Conclusion
Changes in staffing levels and the skill mix of the hospital workforce warrant further study to understand both the reasons behind the observed changes and their effects on health outcomes. Although labor efficiency is an important goal, it is also critically important to assess whether reductions and/or the skill mix shifts among support staff impact nurse workload and, by extension, patient safety. 相似文献2.
Sheila A. Boamah Heather K. Spence Laschinger Carol Wong Sean Clarke 《Nursing outlook》2018,66(2):180-189
Background
Improving patient safety within health care organizations requires effective leadership at all levels.Purpose
The objective of this study was to investigate the effects of nurse managers' transformational leadership behaviors on job satisfaction and patient safety outcomes.Methods
A random sample of acute care nurses in Ontario (N = 378) completed the crosssectional survey. Hypothesized model was tested using structural equation modeling.Finding
The model fit the data acceptably. Transformational leadership had a strong positive influence on workplace empowerment, which in turn increased nurses' job satisfaction and decreased the frequency of adverse patient outcomes. Subsequently, job satisfaction was related to lower adverse events.Conclusion
The findings provide support for managers' use of transformational leadership behaviors as a useful strategy in creating workplace conditions that promote better safety outcomes for patients and nurses. 相似文献3.
Kathryn Wirtz Rugen Mary A. Dolansky Maya Dulay Samuel King Nancy Harada 《Nursing outlook》2018,66(1):25-34
Background
The Institute of Medicine has recommended the establishment of residency programs for advanced practice nursing graduates. Currently, the evidence about program effectiveness is limited.Purpose
To describe the nurse practitioner (NP) resident outcomes on seven competency domains established by the VA Centers of Excellence in Primary Care Education (VA CoEPCE).Methods
We evaluated mean NP resident competency self-ratings and mean mentor ratings over the 12-month program across NP residency programs at five sites. Highest and lowest rated items and differences between NP resident self-ratings and mentor ratings were analyzed.Results
Mean NP resident self-ratings and mean mentor ratings demonstrated statistically significant improvement in all domains (p < .0001). At 12 months, NP residents were rated by their mentors as able to practice without supervision in all competency domains. At 1 and 12 months, clinical, leadership and quality improvement/population management competencies were the lowest scored domains while patient-centered care, interprofessional team collaboration, shared decision-making and sustained relationships competencies were highest.Conclusions
These results provide initial evidence for the effectiveness of VA CoEPCE NP residency programs and also highlight areas of needed improvement. 相似文献4.
Ying Xue Elizabeth Greener Viji Kannan Joyce A. Smith Carol Brewer Joanne Spetz 《Nursing outlook》2018,66(3):263-272
Background
Federally qualified health centers (FQHCs) were designed to provide care in medically underserved areas. Substantial and sustained federal funding has accelerated FQHC growth.Purpose
To examine temporal trends in primary care provider supply and whether FQHCs have been successful in reducing the gap in provider supply in primary care health professional shortage areas (HPSAs).Methods
Retrospective cohort study design using national county-level data from 2009 to 2013. Primary care providers included physicians, nurse practitioners, and physician assistants.Findings
Partial-county HPSAs had the highest average provider supply and the greatest increase, followed by non-HPSA counties and whole-county HPSAs. The provider gap was larger in whole-county HPSAs compared with partial-county HPSAs. Counties with one or more FQHC sites had a smaller provider gap than those without FQHC sites. An increase of one FQHC site was statistically significantly associated with a reduction in the annual provider gap.Discussion
FQHCs reduced the gap in primary care provider supply in shortage counties and mitigated uneven distribution of the primary care workforce. 相似文献5.
Background
Further efforts are warranted to identify innovative approaches to best implement competencies in nursing education. To bridge the gap between competency-based education, practice, and implementation of knowledge, skills, and attitudes, one emerging approach is entrustable professional activities (EPAs).Purpose
The objective of this study was to introduce the concept of EPAs as a framework for curriculum and assessment in graduate nursing education and training.Methods
Seven steps are provided to develop EPAs for nurses through the example of a quality and safety EPA. The example incorporates the Quality and Safety Education for Nurses (QSEN) patient safety competencies and evidence-based literature.Findings
EPAs provide a practical approach to integrating competencies in nursing as quality and safety are the cornerstones of nursing practice, education, and research.Discussion
Introducing the EPA concept in nursing is timely as we look to identify opportunities to enhance nurse practitioner (NP) training models and implement nurse residency programs. 相似文献6.
Donna Felber Neff Sul Hee Yoon Ruth L. Steiner Ilir Bejleri Michael D. Bumbach Damian Everhart Jeffrey S. Harman 《Nursing outlook》2018,66(4):379-385
Background
By 2025, experts estimate a significant shortage of primary care providers in the United States, and expansion of the nurse practitioner (NP) workforce may reduce this burden. However, barriers imposed by state NP regulations could reduce access to primary care.Purpose
The objectives of this study were to examine the association between three levels of NP state practice regulation (independent, minimum restrictive, and most restrictive) and the proportion of the population with a greater than 30-min travel time to a primary care provider using geocoding.Methods
Logistic regression models were conducted to calculate the adjusted odds of having a greater than 30-min drive time.Findings
Compared with the most restrictive NP states, states with independent practice had 19.2% lower odds (p?=?.001) of a greater than 30-min drive to the closest primary care provider.Discussion
Allowing NPs full autonomy to practice may be a relatively simple policy mechanism for states to improve access to primary care. 相似文献7.
The effect of team-based CPR on outcomes in out of hospital cardiac arrest patients: A meta-analysis
Objectives
The objective of this systematic review and meta-analysis was to determine the effects of team cardiopulmonary resuscitation (CPR) on outcomes of patients with out-of-hospital cardiac arrest (OHCA).Methods
A systematic literature review was performed using PubMed, EMBASE, and the Cochrane database to identify relevant articles for this meta-analysis. All studies that described the implementation of team CPR performed by emergency medical services for OHCA patients with presumed cardiac etiology were included in this study. Outcomes included return of spontaneous circulation (ROSC), survival to hospital discharge, and good neurological recovery.Results
A total of 2504 studies were reviewed. After excluding studies according to exclusion criteria, 4 studies with 15,455 OHCA patients were included in this study. The odds of survival and neurologic recovery for patients who received team CPR were higher than those for patients who did not (survival odds ratio [OR]: 1.68; 95% confidence interval [CI]: 1.48–1.91; neurologic recovery OR: 1.52; 95% CI: 1.31–1.77). There was no significant difference in the odds of ROSC between the two patient groups (OR: 1.59; 95% CI: 0.76–3.33).Conclusions
In this meta-analysis, team CPR improved the outcomes of OHCA patients, consistently increasing their odds of survival to discharge and neurologic recovery. 相似文献8.
Mahdieh Arian Mohsen Soleimani Mohammad Bagher Oghazian 《Journal of Professional Nursing》2018,34(5):389-399
Objectives
The present study seeks to answer the following two questions: Are nurse educators satisfied with their job? What are the factors affecting job satisfaction in nurse educators?Background
Nurse educators' job satisfaction has a significant role in the efficiency and performance of nursing schools. Identifying the factors affecting job satisfaction in nurse educators is essential to improving their quality of work and ultimately training efficient students and nurses.Evaluation
The present systematic review searched databases including PubMed, Medline, Cochrane Library, Scopus, Web of Science, Science Direct, ProQuest, Google Scholar and SID for articles published up to April 24, 2018, using keywords including Nurse Teachers, Nurse Faculty, Academic Nurses, Nurse Educators, Dis/Satisfaction, Work, Career, Professional, Practice and Job. Of the total of 971 articles extracted, only 74 remained for the final analysis after the qualitative assessment.Key issue
The articles included in the analysis investigated the relationship between job satisfaction and its contributing factors rather than providing an accurate report on job satisfaction. Nonetheless, a number of the articles had reported fairly to very favorable levels of job satisfaction. The factors affecting nurse educators' job satisfaction were categorized into six levels, including personal, organizational, managerial, academic, professional and economic levels.Conclusion
Although job satisfaction was reported relatively well in the nurse educators, this condition depends on several indices. The lack of positive steps toward job satisfaction in nurse educators leads to destructive behaviors and turnover intentions; meanwhile, it is satisfied educators who can train competent nurses. 相似文献9.
Casey R. Shillam Jeffrey M. Adams Debbie Chatman Bryant Joy P. Deupree Suzanne Miyamoto Matt Gregas 《Nursing outlook》2018,66(2):130-137
Purpose
This study aims to describe the development and psychometric evaluation of the Leadership Influence Self-Assessment (LISA©) tool.Background
LISA© was designed to help nurse leaders assess and enhance their influence capacity by measuring influence traits and practices and identifying areas of strength and weakness.Methods
Concepts identified in the Adams Influence Model and input from content experts guided the development of 145 items for testing. Administered to 165 nurse leaders, the assessment was subjected to exploratory factor analysis (EFA).Findings
EFA yielded a four-factor solution that comprised 80 items. Cronbach's alpha for factors ranged between 0.912 and 0.938. All factor loadings were >0.4; the smallest factor contained 14 items. Items grouped together in the theoretical model also clustered together in the EFA.Conclusions
Preliminary psychometric testing supports validity and reliability of the LISA© and its potential use as a tool to assess influence capacity for purposes of leadership development and research. 相似文献10.
Background
Nurses’ modifiable lifestyles have important health-related consequences.Purpose
To examine the literature on U.S. hospital nurses’ activity, diet, and health outcomes of cardiovascular disease (CVD) risks and health-related quality of life (HRQOL).Method
A systematic review using of the literature from June 2006 to June 2016 resulted in 13 studies on U.S. hospital nurses’ diet, physical activity and CVD and HRQOL outcomes. Methodological rigor was assessed using Cummings et al., adapted quality rating tool.Discussion
Nurses are at risk for poor health outcomes due to inadequate physical activity (60%–74%) and eating a poor quality diet (53%–61%). Fewer than 5% of U.S. nurses engage in five healthy lifestyle behaviors (diet, activity, no tobacco, alcohol, and weight). Adequate physical activity contributes to better HRQOL and a healthy diet reduces CVD risks (hypertension, diabetes mellitus, obesity, stroke).Conclusions
Nurses’ inactivity and poor diet increases risks for CVD and diminished HRQOL. 相似文献11.
Demetrius A. Abshire Janessa M. Graves Mary Lee Roberts Janet Katz Celestina Barbosa-Leiker Cynthia F. Corbett 《Nursing outlook》2018,66(1):84-93.e3
Background
Factors that contribute to student success in accelerated degree nursing programs are poorly understood and may vary by gender.Purpose
Examine associations between satisfaction with peer and mentor support, gender, and academic outcomes among students in accelerated degree nursing programs.Methods
We used data (demographic variables, satisfaction with peer and mentor support, graduation, and attempts of National Council Licensure Examination for Registered Nurses) from the American Association of Colleges of Nursing and Robert Wood Johnson Foundation's New Career in Nursing Program. Multivariable mixed effects regression models were used to examine associations among gender, satisfaction with support, and academic outcomes.Findings
Males had an increased probability of reporting high satisfaction with peer support. Both males and females who were very dissatisfied with peer support were less likely to graduate than students who were very satisfied with peer support. Gender did not moderate the relationships between satisfaction with peer and mentor support and academic outcomes.Conclusion
Peer support is an important aspect of graduation among students in accelerated degree nursing programs. Continuous quality improvement strategies to improve student peer support may be warranted. 相似文献12.
13.
Background
The Precision Medicine Initiative will accelerate genomic discoveries that improve health care, necessitating a genomic competent workforce.Purpose
This study assessed leadership team (administrator/educator) year-long interventions to improve registered nurses' (RNs) capacity to integrate genomics into practice.Methods
We examined genomic competency outcomes in 8,150 RNs.Findings
Awareness and intention to learn more increased compared with controls. Findings suggest achieving genomic competency requires a longer intervention and support strategies such as infrastructure and policies. Leadership played a role in mobilizing staff, resources, and supporting infrastructure to sustain a large-scale competency effort on an institutional basis.Discussion
Results demonstrate genomic workforce competency can be attained with leadership support and sufficient time. Our study provides evidence of the critical role health-care leaders play in facilitating genomic integration into health care to improve patient outcomes. Genomics' impact on quality, safety, and cost indicate a leader-initiated national competency effort is achievable and warranted. 相似文献14.
Background
The National Hartford Center of Gerontological Nursing Excellence (NHCGNE) Scholars/Fellows Award Program was designed to promote the growth and development of nurse scientists, educators, and leaders in aging.Purpose
McBride’s conceptual framework of the growth and development of nurse leaders was used to examine the NHCGNE impact on health and aging policy work among scholars/fellows, including barriers, facilitators, and resources.Methods
A multimethod two-phased approach included an online survey (phase I) focused on research and policy impact at local, state, or national level. Telephone interviews (phase II) were conducted to further understand the nature, depth, and focus of respondents' policy work.Discussion
Based on our findings, we propose multilevel recommendations for advancing nurse scientists' capacity to be leaders in shaping policy.Keen research skills are influential in policy advancement but not sufficient to advance policy. Preparing nurse scientists with competencies in translating research into policy can ultimately transform health and health care for older adults. 相似文献15.
Background
Requiring parental consent in studies with sexual minority youth (SMY) can sometimes be problematic as participants may have yet to disclose their sexual orientation, may not feel comfortable asking parents' permission, and may promote a self-selection bias.Purpose
We discuss rationale for waiving parental consent, strategies to secure waivers from review boards, and present participants' feedback on research without parents' permission.Methods
We share our institutional review board proposal in which we made a case that excluding SMY from research violates ethical research principles, does not recognize their autonomy, and limits collection of sexuality data.Discussion
Standard consent policies may inadvertently exclude youth who are at high risk for negative health outcomes or may potentially put them at risk because of forced disclosure of sexual orientation. Securing a waiver addresses these concerns and allows for rich data, which is critical for providers to have a deeper understanding of their unique sexual health needs.Conclusion
To properly safeguard and encourage research informed by SMY, parental consent waivers may be necessary. 相似文献16.
17.
Marilyn H. Oermann Leslie H. Nicoll Peggy L. Chinn Kathleen S. Ashton Jamie L. Conklin Alison H. Edie Sathya Amarasekara Brittany L. Williams 《Nursing outlook》2018,66(1):4-10
Background
Predatory journals exist in nursing and lack the safeguards of traditional publishing practices.Purpose
To examine the quality of articles published in predatory nursing journals.Method
Randomly selected articles (n = 358) were reviewed for structural content and eight quality indicators.Findings
Two-thirds (67.4%) of the articles were published between 2014 and 2016, demonstrating the acceleration of publications in predatory nursing journals. The majority (75.9%) of the articles were research reports. Most followed the IMRAD presentation of a research report but contained errors, or the study was not pertinent to the nursing discipline.Conclusions
Nursing research published in predatory journals may appear legitimate by conforming to an expected structure. However, a lack of quality is apparent, representing inadequate peer review and editorial processes. Poor quality research erodes the scholarly nursing literature. 相似文献18.
Christine T. Kovner Maja Djukic Jin Jun Jason Fletcher Farida K. Fatehi Carol S. Brewer 《Nursing outlook》2018,66(2):160-167
Background
The Institute of Medicine (IOM) report, The Future of Nursing, included recommendations to increase nurse diversity, the percent of nurses obtaining a bachelor’s degree, and inter-professional education.Purpose
The purpose of this paper is to report the progress toward achievement of these recommendations.Methods
We used a longitudinal, multi-state data from four cohorts of nurses newly licensed in 2004 to 2005, 2007 to 2008, 2010 to 2011, and 2014 to 2015 to examine and compare the trends.Finding
The percentage of males who became licensed increased, from 8.8% in 2004 to 2005 cohort to 13.6% in the 2014 to 2015 cohort. The percentage of white-non-Hispanic nurses who were licensed decreased from 78.9% in 2007 to 2008 to 73.8% in 2014 to 2015. These differences primarily reflect an increase in white-Hispanic nurses. More nurses are obtaining a bachelor’s degree as their first professional degree, from 36.6% in 2004 to 2005 cohort to 48.5% in 2014 to 2015 cohort. About 40% of the 2014 to 2015 cohort reported that they learned to work in inter-professional teams. Collegial nurse-physician relations had an upward positive trajectory over time increasing almost 7%.Discussion
The diversity and education of new nurses have increased, but are short of meeting the IOM recommendations. 相似文献19.
Kathryn Wirtz Rugen Nancy Harada Faith Harrington Mary A. Dolansky Judith L. Bowen 《Nursing outlook》2018,66(4):352-364
Background
Nurse Practitioner (NP) Postgraduate Residency programs are rapidly expanding. Currently, little is known about trainees' self-perceptions during these experiences.Purpose
Describe NP residents' perceptions of their strengths, areas for improvement, and goals while participating in the Veterans Affairs Centers of Excellence in Primary Care Education NP Residency program.Methods
NP residents responded to open-ended questions at three time points across their training year. Responses were analyzed using inductive and deductive approaches.Findings
NP residents self-reported strengths in patient-centered care and interprofessional teamwork. They identified clinical skill acquisition as the major area for improvement. Their short- and long-term goals focused on personal and professional growth.Discussion
These results suggest NPs prioritize clinical skill acquisition during a primary care residency. In contrast, leadership and performance improvement skills did not capture their attention. When aggregated at the programmatic level, assessments identified opportunities to improve the NP Residency program curriculum. 相似文献20.
Tracy M. Mroz Ann Meadow Elizabeth Colantuoni Bruce Leff Jennifer L. Wolff 《Archives of physical medicine and rehabilitation》2018,99(6):1090-1098.e4