The federal budget and the impact on nursing education, research, and innovative practice

The American health care system is facing a critical nursing shortage unprecedented in its complexity and future implications. The current and projected nursing shortage has presented an opportunity for the nursing profession to educate consumers to the vital role nurses play in the delivery of health care services while advocating and lobbying for federal legislation. The urgent need to fund nursing education programs and nursing research programs, and the immediate need to develop innovative practice models, has been heard in our nation's capitol. This article will present the legislative activity and status of the appropriations and bills of the 107th Congress.     

Approaching the 21st century. Congressional agenda for health care and occupational health.

1. Major health related legislative issues for occupational health nurses in the 1990s are OSH Act reform and restructure of the health care system. 2. OSHA reform issues have been consolidated into the Comprehensive Occupational Safety and Health Reform Act (S1622 and HR3160). 3. Health care reform is being addressed by many legislative initiatives and by organized nursing in Nursing's Agenda for Health Care Reform. 4. As the professional association for occupational health nurses, AAOHN serves as an advocate for the profession with the federal government.     

From Florence to fossil fuels: Nursing has always been about environmental health

BackgroundSince its founding, professional nursing has applied an environmental lens to healing.MethodsThis CANS 2020 Keynote article describes the history of nursing environmental science and nurses important contributions to the US Environmental Justice Movement. Starting with Florence Nightingale's Notes on Nursing, which established Environmental Theory, the paper introduces key figures throughout nursing history who have studied and advocated for environmental health and justice.FindingsThe paper emphasizes that nursing has always been about environmental health and that, regardless of specialty or practice setting, all nurses are called to incorporate environmental science and translation into their research and practice.ConclusionThis call to action is especially critical today in the context of urgent issues like climate change, environmental racism and racial health disparities, emerging infectious diseases like COVID-19, and chemical exposures in the home and workplace (among others).     

The Journey to the DNP Program and Beyond: What Can We Learn From Pharmacy?

Advanced practice nursing has been elevated to a new level with the introduction of the DNP (Doctorate of Nursing Practice). One of the justifications for its implementation is the promotion of parity between nurses and other health care providers who require a practice doctorate. Concerns surrounding parity, the ability of DNP-prepared nurses to affect health care outcomes, equitable salary issues, and the DNP program's effect on the academic PhD (Doctorate of Philosophy) program have been expressed. The purpose of this analysis is to explore these issues using pharmacy as an example for implementing a practice doctorate. Similarities and differences between the professions are examined, and lessons that nursing can learn from pharmacy are discussed.     

Health policy and legislation: impact on cancer nursing and care

OBJECTIVES: To review policy and legislative initiatives in which nursing has played roles and to provide insight into trends and issues that characterize the policy and political agendas in which oncology nurses can play advocacy roles in the new millennium. DATA SOURCES: Professional journals, books, newspapers, news magazines, and internet web sites. CONCLUSIONS: Oncology nurses can offer solutions to the dilemmas posed by fiscal realities, unique American values and expectations, and the complexities of cancer care in the United State's market-based health care system. Oncology nurses must assume roles as health policy specialists. IMPLICATIONS FOR NURSING PRACTICE: For nurses to gain acceptance in health policy arenas, individual nurses and groups of nurses must become expert in assessing the environment, the interpretation of cues, and the development and implementation of realistic strategies targeting priority health policy and legislative issues.     

An educated spirit

Richard Olding Beard, founder of the University of Minnesota School of Nursing, was a passionate and eloquent champion of educating rather than simply training nurses and of the contributions professional nurses make to social justice by improving the health care of society. The issues he wrote and spoke about are the same issues raised in contemporary discussions of entry-level preparation for nursing.     

Effective state EMS lobbying: it's all in the plan

Any piece of legislation needs grass roots support. If local legislators are not hearing from local EMS systems, the bill will have an uphill battle in the legislative assembly. Bill sponsors and key supporters need to be regularly informed of the bill's status. Remember the KISS theory--all testimony and communication between local EMS lobbyists and legislators needs to be kept at an understandable level. Finally, remember to never quit your lobbying until the Governor signs the bill into law.     

Clinical practice: new challenges for the advanced practice nurse

This report describes the challenges for advanced practice nurses (APNs) relative to supply and demand issues. The article also includes opportunities with the Balanced Budget Act, physician acceptance of Advanced Practice Nurses, and expanding practice opportunities. The challenges include the nursing shortage (both in nursing students and faculty), the aging of the nursing workforce, and a lag in nursing salaries; increased demand for nursing based on aging baby boomers, increasing patient acuity and technology, and new arenas for practice. The Balanced Budget Act of 1997 provided new opportunities for advanced practice nurses, including enhanced autonomy to provide services and bill independently of physicians. With these changes come new opportunities for advanced practice nurse entrepreneurs in the areas of independent practice, including opportunities to positively impact the health of families and communities in alignment with the Federal government's vision for "Healthy People 2010." As physician acceptance of advanced practice nurses continues to grow and in light of the changes in medical practice and education (residency reduction), opportunities to expand collaborative practice arrangements also exist. APNs are best suited to make the most of these changes. One example of an opportunity for independent practice, a Community Wellness Center, is developed as an entrepreneurial venture benefiting both the APN and the health of a community. Who better than registered nurses (RNs), especially those practicing at the advanced level, can ensure that these opportunities and challenges are addressed in an ethical manner and focused on the needs and health of the community?     

Health disparities, social injustice, and the culture of nursing

BACKGROUND: Nurses are well positioned to challenge institutionalized social injustices that lead to health disparities. OBJECTIVE: The aim of this cross-cultural study was to collect stories of difference and fairness within nursing. METHODS: The study used a life history methodology informed by feminist theory and critical social theory. Life story interviews were conducted with 26 women nurses of varying racial, cultural, sexual identity, and specialty backgrounds in the United States (n = 13) and Aotearoa New Zealand (n = 13). Participants reported having some understanding of social justice issues. They were asked to reflect on their experience of difference and fairness in their lives and specifically within nursing. Their stories were analyzed using a life history immersion method. RESULTS: Nursing remains attached to the ideological construction of the "White good nurse." Taken-for-granted ideals privilege those who fit in and marginalize those who do not. The nurses experienced discrimination and unfairness, survived by living in two worlds, learned to live in contradiction, and worked surreptitiously for social justice. DISCUSSION: For nurses to contribute to changing the systems and structures that maintain health disparities, the privilege of not seeing difference and the processes of mainstream violence that support the construction of the "White good nurse" must be challenged. Nurses need skills to deconstruct the marginalizing social processes that sustain inequalities in nursing and healthcare. These hidden realities--racism, sexism, heterosexism, and other forms of discrimination--will then be made visible and open to challenge.     

护士组织公平感对职业承诺的影响

目的了解重庆市护士的组织公平感和职业承诺现状,并探讨二者之间的关系,为护理人力资源管理提供参考依据。方法采用便利取样法抽取重庆市某3所医院513名护士,运用一般情况调查表、组织公平感量表和职业承诺量表进行调查。结果护士组织公平感总均分为(3.01±0.53)分,处于中等水平,依维度均值降序排列为人际公平感、信息公平感、程序公平感和分配公平感;职业承诺总均分为(3.04±0.79)分,处于中等水平;分层回归分析显示,在控制了人口统计学变量后,程序公平感、信息公平感、分配公平感对职业承诺有预测作用。结论组织公平感对职业承诺有正性影响,提高护士组织公平感对提升护士职业承诺、稳定护理团队和改善护理服务质量具有重要作用。     

How Much Public Health in Public Health Nursing Practice?

Public health nursing (PHN) practice is defined by an emphasis on population health issues rather than individually focused clinical interventions, but the actual scope and focus of PHN practice have not been well documented. The purpose of this survey was to investigate the practice activities, priorities, and education of public health nurses in California. Public health nurses in five counties were surveyed about interventions targeted at individual-family, community, and system levels. Summary scales (range: 1-4) were created to measure self-rated PHN activity, importance, and education at each level. Staff were most likely to perform individual-family level interventions (mean score, m=2.55), followed by community (m=1.86) and system-level interventions (m=1.46). Managers rated individual-family level interventions as most important (m=2.91) and community-level interventions (m=2.42) as more important than those at the system level (m=1.99). Individually focused case management was the most frequently performed and highly valued intervention. Staff and manager-directors deemed individual-family interventions as the area in which public health nurses were best educated, followed by community and then system interventions. Results indicate that the population health focus of public health nursing is not reflected in the practice activities, management priorities, or educational preparation of public health nurses.     

金山区居家腹膜透析患者的护理问题现状与延续性护理需求研究

目的：明确居家腹膜透析患者的护理问题现状和护理服务需求,以指导社区卫生服务中心明确腹膜透析延续护理服务内容,以供同行参考和推广。方法：选取上海市金山区下辖11个社区的居家腹膜透析患者,开展全样本问卷调查。调查工具以奥马哈系统(OS)为理论模型依据,包含基本情况、护理问题评分、护理需求评分三个部分。由11名护理人员于2018年12月～2019年4月期间,针对各自辖区内的居家腹膜透析患者开展问卷调查,问卷当场发放和回收。共发放问卷91份,回收问卷91份,有效问卷91份,有效回收率为100.0%。结果：本次调查的91例金山区居家腹膜透析患者,男性39例(占42.9%),女性52例(占57.1%),居家腹膜透析5.21±2.7年。存在21个护理问题和42种症状体征,59.88%护理问题属于生理领域。生理护理问题2.23±0.82分,心理护理问题2.95±0.45分,认知护理问题1.87±0.67分,健康行为护理问题1.84±0.51分。不同性别患者的生理护理问题评分差异有统计学意义(p=0.028,U=742);不同街道患者的生理护理问题(p=0.002,H=27.559)、心理社会护理问题(p=0.049,H=18.341)评分差异有统计学意义。建档与随访管理需求4.14±0.69分,健康教育需求4.02±0.93分,个体化指导需求3.95±0.91分,专科护理需求3.84±1.01分。不同街道患者的专科护理需求(p<0.001,H=67.757)、建档随访需求(p<0.001,H=48.191)、健康教育需求(p<0.001,H=67.401)、个体化指导需求(p<0.001,H=65.000)评分差异有统计学意义。生理护理问题与建档随访管理需求之间呈现正相关关系(p=0.042,rs=0.214),与个体化指导需求之间呈现正相关关系(p=0.029,rs=0.229)。结论：现阶段上海市金山区居家腹膜透析患者,其护理问题集中在生理和心理方面,其护理需求集中在建档随访管理和个体化指导方面,不同居住街道的患者在护理问题和护理需求方面都存在一定差异。社区在提供相关延续护理服务时,可以将护理重点首先放在为患者建立长期随访档案、根据生理健康情况给予针对性宣教和心理疏导。     

Unreconciled inconsistencies: a critical review of the concept of social justice in 3 national nursing documents

A critical review of the American Nurses Association Code of Ethics for Nurses with Interpretive Statements, Nursing's Social Policy Statement, and Nursing: Scope and Standards of Practice provides evidence that these documents present an inconsistent, ambiguous, and superficial conceptualization of social justice, and do not offer an adequate framework for nurses to address underlying issues that affect health outcomes. Despite expansive references to the historic role of nursing in social reform, the documents implicitly reinforce nursing practice directed toward the individual nurse-patient relationship and give short shrift to nursing models that endorse broad systems change intended to improve health.     

The relevance of globalization to nursing: a concept analysis

GROOTJANS J. & NEWMAN S. (2013) The relevance of globalization to nursing: a concept analysis. International Nursing Review 60 , 78–85 Background: This paper emerged alongside the development of learning materials for a new unit of study on global health and nursing. The proposed unit was for inclusion in a graduate entry master of nursing course leading to registration. It became evident that there has been growing attention within the nursing literature to the demands of an increasingly globalized world and the subsequent challenges confronting nursing as a profession. At the same time, the literature is inconsistent and contains mixed messages with regard to how nurses and nursing might respond to these challenges. Aim: This paper aims to (i) present the findings of a narrative analysis of the current nursing discourse on globalization, and (ii) to identify directional cohesiveness for the nursing profession in the seemingly disparate literature. Method: Concept analysis following extensive literature review. Findings: Several nursing authors argue that nurses globally are increasingly sharing concerns expressed by nurses at a local level. Concerns such as the future sustainability of the profession and more specifically practice concerns such as the continuing failure of nurses to adequately deal with social justice issues requires careful consideration by every nurse. While strategies recommended for dealing with these concerns lack a cohesive thread, some interesting themes and innovative recommendations have emerged. For example, the need for nurses to consider replacing environmental considerations with ecological considerations and that nurses consider preventative nursing practice beyond the immediate needs of clients and from a more global perspective.     

The changing division of labour between nurses and nursing assistants in New Brunswick

BACKGROUND: In 1989, the professional nursing organization that represents nurses in New Brunswick adopted baccalaureate entry to practice in nursing. This decision coincided with a major restructuring of provincial health care. Consequently, there has been a reorganization of health care worker roles which affects nurses and nursing assistants. AIM: This paper explores the changing division of labour between nurses and nursing assistants in the province of New Brunswick, Canada. METHODS: The study used archival material, from the period 1978-1990, of three nursing organizations that played a significant role in initiating baccalaureate entry to practice. Interviews with 19 key people involved in the decision to upgrade nurse education were conducted. Data from the archival material and interviews were analysed jointly. FINDINGS: There are ongoing tensions between nurses and nursing assistants. Although nurses would like a support worker, they remain ambiguous about the role of nursing assistants in health care and which tasks should be delegated to this group. Nursing leaders are concerned about the ease with which some patient-related tasks are moved to nursing assistants. In the past, these concerns have led nursing leaders to attempt to limit nursing assistant responsibilities through both legislative means and ways of organizing nursing labour (primary nursing). As a result of health care reforms and baccalaureate entry to practice for nurses, nursing assistant responsibilities are currently expanding. CONCLUSION: Upgrading nurse education, which came into effect in 1996 with the closure of diploma schools in New Brunswick, is likely to entrench the role of nursing assistants in health care because of the economic value of their work during a period of restructuring and rationalization of health care.     

Maine's nursing workforce legislation: lessons from a rural state

As the aging baby boom generation begins to place additional pressures on the health care system and the nursing workforce of the same generation begins to retire, the worsening nursing shortage has the potential to seriously impact the delivery of health care in the United States and is receiving considerable attention nationwide. Although federal initiatives such as the Nurse Reinvestment Act are critical, issues of supply and demand for registered nurses must also be addressed at the state level. In Maine, nursing leadership has partnered with state policy makers and health care industry leaders in a multi-year initiative that has included the nursing community's envisioning its "preferred future," formal data collection on the nursing workforce, ongoing education of the Maine State Legislature about the nursing shortage, and legislative initiatives.