Preparing nurse scientists for health services and policy research: Five-year outcomes of interprofessional postdoctoral training in the National Clinician Scholars Program

BackgroundThe National Clinician Scholars Program (NCSP) is an interprofessional postdoctoral fellowship for physicians and nurses with a PhD. or DNP focused on health services research, policy, and leadership.PurposeTo evaluate 5-year outcomes of nurse postdoctoral scholars in the NCSP.MethodsWe describe the 5-year outcomes of nurse fellows and graduates from six NCSP sites (positions, number of peer-reviewed publications, citations, and h-index).ConclusionThere were 53 nurses in the sample (34 alumni, 19 fellows). Approximately half (47%, n = 16) of alumni had tenure-track faculty positions and had bibliometric performance indicators (such as h-indices) 2 to 4 times greater than those previously reported for assistant professors in nursing schools nationally. NCSP nurse scholars and alumni also had an impact on community partnerships, health equity, and health policyDiscussionThis study highlights the potential of interprofessional postdoctoral fellowships such as the NCSP to prepare nurse scientists for health care leadership roles.     

Mentoring in nursing education: An essential element in the retention of new nurse faculty

BackgroundMentoring in nursing education is essential to retaining nurse faculty; whether they are new to academia or experienced, but new to the institution in which they teach. Furthermore, mentoring promotes awareness of faculty roles and responsibilities, decreases ambiguity and increases retention of qualified nurse faculty.PurposeThis study examined whether there was a relationship between nurse educator mentor's perception of their mentoring effectiveness and nurse educator mentee's perception of their mentor's effectiveness.MethodA Spearman's rho correlation was conducted on a convenience sample of 119 nurse educators who completed the Principles of Adult Mentoring Inventory (PAMI), which measured six core mentoring behaviors. A secondary analysis using an independent samples t-test was also performed.ResultsStatistically significant results were revealed in two of the six mentoring behaviors; relationship emphasis (p = 0.035) and confrontive focus (p = 0.043). The Mentor Role Competency Profile (MRCP), a measure accompanying the PAMI, indicated concerns that could be counterproductive within the mentoring relationship. A secondary analysis using a t-test confirmed concerns as identified in the initial analysis.ConclusionContinuous improvement and training are critical to acquiring and reinforcing effective mentoring skills. Requiring evaluation and follow up for mentors could result in increased satisfaction for both mentor and mentee and improve retention of new faculty in academia.     

First and last authorship by gender in emergency medicine publications- a comparison of 2008 vs. 2018

Background and objectivesRecently, investigators reported that there remain substantial disparities in the proportion of women within emergency medicine (EM) who have achieved promotion to higher academic rankings, received grant funding, and attained departmental leadership positions. In 2007, women were first authors on 24% of EM-based peer-reviewed articles. Currently, 28% of the academic EM physician workforce is comprised of women. The goal of this study was to identify whether the proportion of female first authors of original research published in three U.S.-based EM journals increased in 2018 as compared to 2008.MethodsThis was a retrospective review of published original research articles during 2008 and 2018 in the journals Academic Emergency Medicine (AEM), American Journal of Emergency Medicine (AJEM), and Annals of Emergency Medicine (Annals). Review articles, opinion pieces, consensus statements, practice recommendations based on current guidelines, and case reports were excluded from analysis. Investigators conducted a review of each article to identify the gender of the study's first and last authors. A study author blinded to the previous author's data abstraction reviewed a sample of 25 articles to assess for inter-rater reliability (kappa). Categorical data are presented as frequency of occurrence and analyzed by chi-square.ResultsOverall for the study journals, there were 368 original research articles published in 2008 vs. 580 in 2018. There were no significant differences noted for the proportion of female first author publications during 2008 vs 2018 overall (28% vs 30%; p = 0.38), within AJEM (29% vs 28%; p = 0.85), and observed at Annals (25% vs 24%; p = 0.82) respectively. However, there was a significant increase in the number of first author publications by females between the two periods within AEM (28% vs 45%; p < 0.01). There were no significant differences noted for the proportion of female last author publications during 2008 vs. 2018 overall (21% vs 22%; p = 0.70) and within each respective journal: AEM 22%% vs 26% (p = 0.51), AJEM 22% vs 19% (p = 0.55), and Annals 19% vs 22% (p = 0.20). Inter-rater reliability for author gender within the sample articles was excellent (0.83).ConclusionWhile female physicians make up a disproportionate 28% of the academic workforce, we found that they were proportionally represented as first authors within several of the most prominent U.S.-based EM journals. Female resident physicians remain underrepresented as first authors and women remain underrepresented as last authors in the same journals.     

Nursing student and faculty competency improvement through a nurse-bridging program in Cambodia

BackgroundAn adequate number of high-quality nurses are a key factor for superior patient outcomes. However, in 2015, Cambodia reported only 52 nurses with bachelor's degrees, three with master's degrees, and one with a doctorate. The fast track to getting a highly educated nursing workforce requires providing a bridging program for associate's degree nurses to achieve baccalaureate degrees.ObjectivesTo assess improvement in the competency of nursing students and faculty members through a program that prepares associate's degree nurses to obtain bachelor's degrees in Cambodia.DesignMixed methods.SettingEducational institutes in Phnom Penh, Cambodia.ParticipantsA total of 45 Cambodian nursing students participated in the Cambodian nurse-bridging program and 12 Cambodian faculty members served as co-teachers.MethodsWe conducted three surveys to compare the competence of nursing students and faculty members before, during, and after the bridging program. We conducted focus-group interviews to support the qualitative results and explored changes in student and faculty competencies after the program.ResultsQuantitative analysis revealed significant improvements in students' nursing competency (p < .001), critical thinking (p < .001), and research competency (p < .001) and faculty members' teaching competency (p < .001) and research competency (p < .001) after the program. Through qualitative analysis, students showed improvement in physical assessment, patient communication, critical thinking, evidence-based nursing, and research competency. Faculty members indicated they had experienced new teaching strategies and subjects, gained increased confidence in teaching, and even though research competency had been improved, more training was required.ConclusionsThis study provides evidence to support the effectiveness of higher nurse education in developing countries, and illustrates an opportunity to produce high-quality human resources in nursing.     

Academic achievement and gender among adult critical care program directors

PurposeAccreditation Council for Graduate Medical Education (ACGME) program director (PD) qualifications includes scholarly activity with demonstrated academic productivity and dissemination. Our hypothesis: academic productivity among adult critical care medicine (CCM) fellowship PDs is affected by gender with women having lower productivity.Materials and methodsPDs in 39 institutions with CCM fellowships in anesthesiology, surgery, and pulmonary medicine were analyzed using data from ACGME website, PubMed, and NIH Research Portfolio Online Reporting Tools. Primary outcomes were total publications and h-index. Secondary outcomes included NIH funding and past five year publications. Independent variables and covariates included gender, academic rank, year appointed as program director, years certified in CCM, and specialty.ResultsPDs who were women had fewer total publications (median: 13 vs: 20, p = 0.030), past 5 years publications (median: 6 vs median: 9; p = 0.025), and less NIH funding (12% vs 32%; p = 0.046) compared to men. In exploratory analyses stratified by rank, assistant professor ranked women had fewer total (p = 0.027) and recent publications (p = 0.031) compared to men.ConclusionsWomen who were PDs had fewer publications and less NIH funding compared to men with differences in publications more prominent in early career faculty.     

Nurse faculty perceptions of readiness for practice among new nurses graduating during the pandemic

BackgroundThe COVID-19 pandemic caused major changes in nursing education, namely a shift to remote learning and significant reduction of clinical practice experience. It is not known how these changes will affect new graduate nurses transitioning to practice.PurposeTo provide guidance to transition-to-practice programs, this study quantitatively described and compared nurse faculty perceptions of readiness for practice among students who graduated pre-pandemic and those who will graduate during the pandemic.MethodsA convenience sample of 116 nurse faculty across North Carolina completed surveys online. Surveys collected information on demographics, professional experience, and teaching changes experienced during the pandemic. The Nursing Practice Readiness Tool was used to measure perceptions of readiness for practice.ResultsNurse faculty reported a wide range of changes due to the pandemic, with limitations in clinical learning prevalent. There was a statistically significant decrease in practice readiness scores for the total scale, six subscales, and all tool items at p < 0.001 for all paired comparisons.ConclusionsWhile there was an overall significant decrease in scores for all competency areas, further analysis of the tool subscales and items can provide guidance for clinical nurses working with new graduates and nurse faculty working with continuing students.     

Describing clinical faculty experiences with patient safety and quality care in acute care settings: A mixed methods study

BackgroundA major safety initiative in acute care settings across the United States has been to transform hospitals into High Reliability Organizations. The initiative requires developing cognitive awareness, best practices, and infrastructure so that all healthcare providers including clinical faculty are accountable to deliver quality and safe care.ObjectiveTo describe the experience of baccalaureate clinical nursing faculty concerning safety and near miss events, in acute care hospital settings.MethodsA mixed method approach was used to conduct the pilot study. Nurse faculty (n = 18) completed study surveys from the Agency for Healthcare Research and Quality (AHRQ) to track patient safety concerns: Incidents; Near misses; or Unsafe conditions, during one academic semester, within 9 different acute care hospitals. Additionally, seven nurse faculty participated in end of the semester focus groups to discuss the semester long experience.ResultsClinical faculty identified a total of 24 patient occurrences: 15 Incidents, 1 Near miss event, and 8 Unsafe conditions. Focus group participants (n = 7) described benefits and challenges experienced by nursing clinical faculty and students in relation to the culture of safety in acute care hospital settings. Six themes resulted from the content analysis.ConclusionsUtilizing nursing clinical faculty and students may add significant value to promoting patient safety and the delivery of quality care, within acute care hospital settings.     

Women's representation in emergency medicine journals across two decades: 2000–2019

ObjectivesThe primary aim was to determine women's representation as authors in emergency medicine journals in various authorship positions over the last 20 years. The secondary aim was to compare the two decades to analyze the development over time.MethodWe conducted a retrospective bibliometric analysis of three emergency medicine journals from the online archives of 2000–2019.ResultsWe analyzed a total of 7939 original research and review articles. Female authorships at the first (25,8%), last (18,7%), and corresponding (21,6%) positions were limited, despite the relatively high presence rate (72,5%). Women authored 13,1% of all single-authored publications. When the number of authors increased, the odds for women as co-authors increased. However, the odds for last and corresponding authorship decreased, while the odds for the first authorship remained unchanged. When two decades were compared, we found that proportions of women as first and corresponding authorship increased ([23,8% vs. 27,0%] p = 0.001 and [20,0% vs. 22,6%] p = 0.228, respectively) while the representation as the last author remained unchanged ([19,4% vs 18,3%] p = 0.006). The presence of women in any authorship position also increased significantly ([66,1% vs. 76,5%] p = 0.000) across two decades, with similar trends for the different journals studied. However, the yearly analysis shows that women's representation follows a fluctuating pattern with a minimal increase. When analyzing specific journals, we found that the increase in female authors as first and corresponding authors was limited to Academic Emergency Medicine ([24,7% vs 34,5%] p = 0.000 and [21,4% vs 32,1%] p = 0.000).ConclusionsResults of this study are promising in showing that the representation of women in emergency medicine publications is rising during the recent decade. Although the academic gender gap has not been closed, steps taken for gender equality in academic emergency medicine are clearly notable.     

Publishing trends in the field of urgent care medicine from 2000 to 2020: A bibliometric analysis

BackgroundWith a steady rise in the number of urgent care centers in the United States and the establishment of urgent care medicine as a specialty, research in the field is likely to emerge.ObjectivesTo perform a bibliometric analysis of published studies in the field of urgent care medicine over the past two decades.MethodsA comprehensive literature review was conducted, including original and review articles pertaining to urgent care medicine published 2000–2020. Data abstracted from each article included publication year, journal, research study design, study population, clinical relevance (clinical or non-clinical), and study topics.ResultsA total of 144 publications from 94 peer-reviewed journals were analyzed. There has been a steady increase in the annual number of publications from 2010 to 2019. The most common study designs were retrospective (55.5%), study specific (24.3%), prospective (15.3%), and quality improvement (4.9%). Adults were the most frequently identified study population (33.3%), followed by pediatrics (18%), and both adults and pediatrics (16.7%). Publications were categorized as clinical (48.6%) and non-clinical (51.4%). The most common research topics were urgent care utilization [n = 34, 23.6%; especially effectiveness (n = 9) and disease based (n = 7)], diagnostic testing [(n = 20, 13.9%; especially HIV (n = 7) and sexually transmitted infections (n = 6)], and antibiotic stewardship (n = 17, 11.8%).ConclusionBased on our sample, published research in the field of urgent care medicine has evolved. By describing current trends, we hope that clinicians and researchers continue to advance the field by developing high quality research, including prospective, multi-institutional/center studies involving both clinical and non-clinical topics.     

The effects of group supervision of nurses: a systematic literature review

ObjectivesTo gain insight into the existing scientific evidence on the effects of group supervision for nurses.DesignA systematic literature study of original research publications.Data sourcesSearches were performed in February 2010 in PubMed, CINAHL, Cochrane Library, Embase, ERIC, the NIVEL catalogue, and PsycINFO. No limitations were applied regarding date of publication, language or country.Review methodsOriginal research publications were eligible for review when they described group supervision programmes directed at nurses; used a control group or a pre-test post-test design; and gave information about the effects of group supervision on nurse or patient outcomes. The two review authors independently assessed studies for inclusion. The methodological quality of included studies was also independently assessed by the review authors, using a check list developed by Van Tulder et al. in collaboration with the Dutch Cochrane Centre. Data related to the original publications were extracted by one review author and checked by a second review author. No statistical pooling of outcomes was performed, because there was large heterogeneity of outcomes.ResultsA total of 1087 potentially relevant references were found. After screening of the references, eight studies with a control group and nine with a pre-test post-test design were included. Most of the 17 studies included have serious methodological limitations, but four Swedish publications in the field of dementia care had high methodological quality and all point to positive effects on nurses’ attitudes and skills and/or nurse–patient interactions. However, in interpreting these positive results, it must be taken into account that these four high-quality publications concern sub-studies of one ‘sliced’ research project using the same study sample. Moreover, these four publications combined a group supervision intervention with the introduction of individual care planning, which also hampers conclusions about the effectiveness of group supervision alone.ConclusionsAlthough there are rather a lot of indications that group supervision of nurses is effective, evidence on the effects is still scarce. Further methodologically sound research is needed.     

Onboarding orientation for novice nurse faculty: A quality improvement pilot project

BackgroundNovice nurse faculty have a challenging time transitioning into academia, resulting in reduced satisfaction and retention. After conducting a thorough literature review, it was determined that formalized mentoring combined with professional development workshops could improve the transition into academia, thus improving the satisfaction and retention of novice nurse faculty.MethodsIn fall 2020, an onboarding orientation program for novice nurse faculty was implemented. The objectives included matching mentoring dyads based on similar interests and goals, developing mentoring guidelines, implementing the Department of Nursing (DON) Orientation Checklist, and providing five monthly professional development workshops with topics ranging from creating learning objectives to the promotion and tenure requirements. Five novice nurse faculty participated in the study, and each was matched with a mentor with similar goals.ResultsAfter 6 months of project implementation, overall faculty satisfaction dropped slightly from 4.1 to 4.0. A dependent t-test (p = 0.83) and Wilcoxon signed ranks test (p = 0.461) both indicated no significant difference in satisfaction post project implementation. Although, the results indicate the novice nurse faculty and mentors agreed that the program was effective and should continue. The novice nurse faculty reported that the DON Orientation Checklist, mentoring relationships, and professional development workshops contributed to their successful transition into academia. Retention was 100% 2 years after project implementation. One significant factor noted after program evaluation was conducted is that there should be regular meetings with mentors to support them in their role.ConclusionsThe onboarding orientation program for novice nurse faculty was an effective strategy to ease the transition into academia and maintain satisfaction within the role.     

The effectiveness of faecal collection devices in preventing incontinence-associated dermatitis in critically ill patients with faecal incontinence: A systematic review and meta-analysis

ObjectiveThe objective of this study was to investigate the effects of different types of faecal collection devices on incontinence-associated dermatitis (IAD) in critically ill patients with faecal incontinence.Review method usedThis was a systematic review and meta-analysis.Data sourcesA comprehensive electronic literature search was performed in PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang, and WeiPu. All the databases were searched from their inception to July 31, 2019, and the data were updated on November 2, 2019.Review methodsRandomised controlled trials (RCTs) and quasi-experimental studies were included. Participants were critically ill patients with faecal incontinence, and the interventions involved care with faecal collection devices. Comparisons were usual care, and the outcome was the incidence of IAD. Odds ratios (ORs) were used to calculate the pooled effect sizes. Heterogeneity was tested using the inconsistency index (I²) method.ResultsNineteen studies were included in this systematic review including 16 RCTs and three quasi-experimental studies. Twelve RCTs were included in the meta-analysis, which showed that the use of faecal collection devices significantly reduced the incidence of IAD. Subgroup analyses based on device type showed significant effects for anal pouch collection devices (OR, 0.14; 95% confidence interval [CI], 0.07–0.26; P < 0.00001), anal pouch connected to negative-pressure suction devices (OR, 0.18; 95% CI, 0.08–0.42; P < 0.00001), anal catheter/tube collection devices (OR, 0.24; 95% CI, 0.13–0.44; P < 0.00001), and anal catheter/tube connected to negative-pressure suction devices (OR, 0.20; 95% CI, 0.07–0.59, P < 0.00001).ConclusionsFaecal collection devices can reduce the incidence of IAD in critically ill patients with faecal incontinence. It is suggested that when using a device to care for critically ill patients with faecal incontinence, an anal pouch connected to continuous low-negative-pressure suction device should be preferred. Further high-quality research is still needed regarding anal catheter/tube collection devices and anal catheter/tube connected to continuous low-negative-pressure suction devices.     

Covid-19 vaccine confidence and hesitancy in nursing students and faculty at a large academic medical center

BackgroundLittle is known about nursing faculty and nursing student's confidence or potential hesitancy to receive the Covid-19 vaccine once it was available.MethodsAn anonymous electronic survey of nursing students and faculty was conducted at a large academic center in the eastern U.S.FindingsBoth students and faculty reported they were fairly or completely confident that the vaccine was safe (n = 235, 89.4%) and that it would effectively mitigate their risk (n = 230, 87.5%). There was a 52.6% decrease in vaccine hesitancy from 6 months prior (p <.01); 22% (n = 58) of those currently willing to receive the vaccine reported moderate to high concern about its side-effects and/or long-term efficacy. Access to vaccine research, vaccine education, and watching others be inoculated, had mitigated their concerns from the previous six months.DiscussionWhile both nursing students and faculty reported having high confidence in the efficacy and safety of the Covid-19 vaccine, concerns remained.     

Role Delineation of the Code Blue Team: A Quasi-Experimental Study During COVID-19

IntroductionThe purpose of this study was to assess if implementing a code role delineation intervention in an emergency department would improve the times to defibrillation and medication administration and improve the nurse perception of teamwork.MethodsA quantitative quasi-experimental study used a retrospective chart review to gather data. A pre- and post-test measured nurse perception of teamwork in a code using the Mayo High Performance Teamwork Scale (MHPTS) after a code role delineation intervention using a paired samples t-test. Pearson r correlations were used to determine relationships between nurse participant (N = 30) demographics and results of the MHPTS scores.ResultsA significant increase in teamwork was noted in 5 of the 16 items on the MHPTS regarding improved communication and identified roles in a code: the team leader assures maintenance of an appropriate balance between command authority and team member participation (t = −5.607, P < .001), team members demonstrated a clear understanding of roles (t = −5.415, P < .001), team members repeat back instructions and clarifications to indicate that they heard them correctly (t = −2.400, P = .029), all members of the team are appropriately involved and participate in the activity (t = −2.236, P = .041), and conflicts among team members are addressed without a loss of situation awareness (t = −2.704, P = .016). There was significance between total pre- and post-test scores (t = −3.938, P = .001).DiscussionImplementation of code role delineation identifiers is an effective method of improving teamwork in a code in an emergency department setting.