Journal of Nursing Regulation最新文献

Background

Travel nurses play a pivotal role in filling acute staffing gaps, thereby adding resilience to the country’s healthcare service. Never has the value of travel nurses been clearer than it was during the COVID-19 pandemic. However, a comprehensive national assessment of travel nurses’ demographic and professional profiles has not yet been conducted, nor is there any detailed accounting of the specific challenges these nurses encountered.

Purpose

To gain a better understanding of the demographic and practice characteristics of travel nurses.

Methods

This is a cross-sectional descriptive analysis of 2,006 travel nurses (1,239 registered nurses [RNs] and 767 licensed practical nurses/licensed vocational nurses [simply referred to as licensed practical nurses, or LPNs, throughout the abstract]) who participated in the 2022 National Nursing Workforce Survey. Information on their demographic characteristics, practice experiences during the pandemic, and future practice plans was collected and evaluated. The comparison group was made up of 41,729 nontravel nurses (22,803 RNs and 18,926 LPNs) who participated in the same survey.

Results

Travel nurses tended to be younger, exhibit greater gender diversity, and report better pay than nontravel nurses. A significantly higher proportion of travel nurses held multistate licenses (64% versus 34% for RNs, and 55% versus 31% for LPNs). The odds of travel nurses using their multistate license in practice were about 5 times greater than they were for nontravel nurses (RNs: OR = 5.93; 95% CI: 5.02–7.00, p < .01; LPNs: OR = 5.09; 95% CI: 4.11–6.29, p < .01). Travel nurses reported higher work stress and burnout than nontravel nurses: 64% versus 47% of RNs and 53% versus 48% of LPNs reported being emotionally drained either a few times per week or every day. A significantly higher proportion of travel nurses younger than 60 years planned to leave nursing in the next 5 years compared to nontravel nurses (33% versus 17% for RNs, OR = 2.27, 95% CI: 2.00–2.59, p < .01, and 21% versus 17% for LPNs, OR = 1.28, 95% CI: 1.05–1.56, p < .05).

Conclusion

Despite comparatively higher pay and younger age, travel nurses experienced elevated work stress and were more likely than nontravel nurses to consider leaving their nursing career early. Healthcare regulators, travel nurse agencies, and nursing employers should be aware of the unique demographics and practice characteristics of travel nurses to develop more effective retention strategies to maintain a healthy and stable nursing workforce.

Background:

Licensed practical nurses/licensed vocational nurses, referred to as licensed practical nurses (LPNs) in the present article, provide foundational, direct patient care under the direction of registered nurses (RNs), advanced practice registered nurses (APRNs), and physicians. Overall, the LPN workforce is the most racially and ethnically diverse cohort of nurses in the United States, but their numbers are in decline as a result of slowing educational program growth, reduced program enrollment, and broader workforce turnover.

Purpose:

This descriptive cross-sectional study seeks to more closely examine the LPN workforce through the lens of race and ethnicity. In particular, this work seeks to understand the unique experiences of self-identified Black, Indigenous, and other People of Color (BIPOC) and Hispanic/Latino LPNs during the COVID-19 pandemic.

Methods:

Data from the 2022 National Nursing Workforce Survey were drawn upon for analysis. Descriptive statistics along with generalized logit statistical models were employed.

Results:

Proportionally, more BIPOC LPNs indicated they work in nursing homes or extended care facilities (36.5%, n = 90,219) relative to their White/Caucasian peers (27.3%, n = 126,223). BIPOC LPNs were more than two times more likely (OR = 2.34, 95% CI: 2.28–2.39, p < .001) to become travel nurses relative to White/Caucasian LPNs; similarly, Hispanic/Latino LPNs were more likely to become travel nurses relative to their non-Hispanic/ Latino peers, even after controlling for the highest nursing education credential earned, gender, and years of experience (adjusted OR = 1.23, 95% CI: 1.20–1.27, p < .001). Additionally, more BIPOC LPNs (12.1%, n = 34,286) changed their practice setting compared to White/Caucasian LPNs (10.9%, n = 58,498). Nearly half of all LPNs reported feeling burned out, and around a third indicated they were at the end of their rope.

Conclusion:

The LPN workforce is the most diverse cohort of nurses in the United States. However, as the discrepancy between the supply and demand of LPNs continues to grow, regulators and employers need to collaborate on ways to support and grow this diverse and critical workforce. The results of this analysis offer insights into the practice profiles of these historically marginalized LPNs and how their experiences during the COVID-19 pandemic may inform their intent to leave the profession in the years to come.

Background

Many Western countries rely on internationally educated health professionals (IEHPs) to complement the domestically educated workforce and meet healthcare workforce needs. Traditionally, health regulators have focused on potential registrants’ required technical competencies rather than their cultural and workplace integration. As a result, the workplace integration experience of IEHPs has not been well studied, nor have systems evolved to enhance the workforce integration experience with the objective of optimizing delivery of patient care.

Objective

This study sought to examine and characterize the workforce integration of IEHPs into Canadian health systems with particular emphasis on implications for regulators.

Methods

We recruited IEHPs as well as representatives from regulatory bodies and health systems to participate in semistructured interviews over the telephone. Interviews were recorded, and transcripts were used for qualitative analysis, coding, and generation of themes related to IEHPs’ integration into the Canadian workforce.

Results

A total of 48 individuals, including 29 IEHPs and 19 representatives from health regulatory bodies and health systems, participated in this study. Six major themes were identified, highlighting various roadblocks to successful integration of IEHPs. Themes concerned roadblocks to integration, including IEHPs’ unmet complex personal integration needs, that mastery of domestic professional culture is essential, that social/contextual skills and communication (not just language) skills are crucial, and that patient-centeredness and interprofessionalism in Canada often are very different that those in IEHPs’ home countries.

Conclusion

Additional work is required to support IEHPs as they become a more prominent component of the healthcare workforce in many jurisdictions, including the United States, the United Kingdom, Australia, New Zealand, and Ireland.

Background: Before the COVID-19 pandemic, telehealth was limited by patient and provider skepticism, privacy concerns and regulations, and limited funding. However, during the pandemic, necessity led to sharp increases in telehealth practice and the easing of regulatory restrictions. Since the acute phases of COVID-19, telehealth use has waned but remains above prepandemic levels, and the patterns of practice appear to have changed. Purpose: This study aims to describe this new status quo by characterizing the workforce of registered nurses (RNs) in the United States who are providing telehealth services. Methods: This analysis was based on the National Council of State Boards of Nursing’s 2022 National Nursing Workforce Study. RNs were first separated into three bins based on the amount of telehealth they reported performing. Agglomerative hierarchical clustering was then used to develop an analysis of four general groups of RN professional profiles based on their use of different telehealth modalities. Results: Telehealth was more likely to be performed by female RNs and RNs of color. Rural RNs were more likely to perform telehealth than their urban peers, although urban RNs were more likely to participate in high levels of telehealth (>25% of their time). There were no major differences in salary, age, experience, or intent to leave nursing across the three levels of telehealth. Both rates of telehealth practice and modalities used tended to differ substantially based on RN professional profile (job title, primary specialty, and primary setting). RNs who hold multistate licenses were more likely to perform telehealth across state borders, particularly RNs who actively practice in more than three U.S. jurisdictions. Conclusion: Patterns of telehealth usage across the RN workforce were fairly heterogenous. Stakeholders in workforce planning and telehealth interventions must be cognizant of the distinct ways telehealth is employed across different types of professional profiles. Furthermore, as RNs with multistate licenses are more likely to perform interstate telehealth (and to present particular professional profiles), it may be that the National Licensure Compact facilitates nurse employment in particular types of roles.

Background

Over the past decade, the registered nurse (RN) workforce has grown increasingly more diverse. However, while evidence of progress is clear, so too are signs that such gains lag behind documented shifts in the general demographic makeup of the United States.

Purpose

The goal of the present study was to provide current evidence to overcome potential barriers to ongoing efforts to diversify the nursing workforce and thereby inform future workforce planning.

Methods

Data from the National Council of State Boards of Nursing’s 2022 National Nursing Workforce Survey were used for this analysis. This study provides a descriptive breakdown of the RN workforce by race and ethnicity and compares observed trends to national demographic shifts over the past decade.

Results

Despite an uptick in the racial diversity of the RN workforce over the past decade, the gap between the racial makeup of the RN workforce and that of the broader U.S. population has grown. By contrast, while a gap in ethnic diversity (e.g., those of Hispanic/Latino origin) certainly persists in the RN workforce, the overall trajectory related to ethnic diversity growth is more in line with that of the U.S. population during the same timeframe. Overall, the employment profile of minority RNs, across various racial subcategories, is strikingly different from their White/Caucasian counterparts, contributing to increased workloads and emotional exhaustion during the pandemic.

Conclusion

A diverse nursing workforce is critical to ensuring culturally competent care that improves access, quality of care, and patient outcomes for underserved populations. As such, continued efforts to diversify the nursing workforce are a critical priority for the long-term health of our nation. Only by identifying and overcoming potential barriers to diversify the RN workforce can we foster a more inclusive, more effective, and safer U.S. healthcare system.

Background

The COVID-19 pandemic has amplified long-standing issues of burnout and stress among the U.S. nursing workforce, including advanced practice registered nurses (APRNs). Understanding how these issues inform APRNs’ intent to leave and the possible implications for workforce modeling is imperative to fostering a more sustainable and safer U.S. nursing workforce.

Purpose

To identify the personal and professional characteristics of APRNs experiencing heightened workplace burnout and stress.

Methods

The National Council of State Boards of Nursing’s 2022 National Nursing Workforce Survey data were used for analysis. Binary logistic regression and natural language processing were used to determine the significance of observed trends and to develop a better understanding of possible drivers.

Results

A weighted total of 522,425 APRNs (11.8% of the RN workforce) are represented in this analysis. Certified nurse practitioners accounted for the bulk of the workforce (71.1%), followed by clinical nurse specialists (16.8%), certified registered nurse anesthetists (9.1%), and certified nurse midwives (3.0%). Half the sample (55.4%) reported an increase in their workload during the pandemic, and similarly high proportions reported some form of emotional distress at least a few times per week.

Conclusion

Acute experiences of stress and burnout during the COVID-19 pandemic have been felt disproportionately by younger, less experienced APRNs. However, perhaps equally concerning is the potential loss of the diverse educational training and skill sets of a generation of more experienced APRNs. To ensure current models of care remain fit for the future, policymakers, nursing leaders, employers, and educators must be intentional in how they recruit, train, and support the current and future APRN workforce.

Background

Research regarding the rural nursing workforce in the United States prior to the COVID-19 pandemic suggested steady growth but lagging diversity and educational attainment. Limited data are available regarding the effects of the global health crisis on the rural nursing workforce.

Purpose

To extend the literature on the rural nursing workforce and examine the impact of the COVID-19 pandemic on rural nurses’ self-reported emotional exhaustion and intent to leave.

Methods

The National Council of State Boards of Nursing’s 2022 National Nursing Workforce Survey was used for this analysis. Rural–Urban Commuting Area (RUCA) codes developed by the University of Washington and the U.S. Department of Agriculture Economic Research Service were used to classify providers’ primary place of employment as either urban or rural.

Results

In total, 3,480,612 registered nurses (RNs) and 669,338 licensed practical nurses/licensed vocational nurses (simply referred to as licensed practical nurses, or LPNs, throughout the study) were represented in the analysis. Rural RNs were significantly older (aged 47.6 vs. 45.9 years), were less diverse (male 10% vs. 12%; White/Caucasian 92% vs. 78%; Hispanic/Latino 3% vs. 8%), and reported lower educational attainment (baccalaureate 54% vs. 40%) than their urban peers. Rural LPNs were also less diverse than urban LPNs (male 6% vs. 12%; White/Caucasian 92% vs. 78%; Hispanic/Latino 3% vs. 8%), but they were similar in age (47.2 vs. 48.0 years) and education attainment (vocational/practical certificate 73% vs. 70%). More than half of all nurses reported some form of regular emotional exhaustion; results were consistent across RUCA classification. Practitioners younger than 35 years in both urban and rural areas reported significantly elevated workloads during the COVID-19 pandemic and heighted emotional distress, driving 12%–16% of these younger respondents to indicate they intend to leave nursing by 2027.

Conclusion

The rural nursing workforce in the United States provides a vital lifeline to patients who often present with more complex health issues and experience poorer health outcomes. Sustainable workforce development and planning requires attention to the impact of the COVID-19 pandemic on rural nurses’ emotional exhaustion and intent to leave. The work of the National Council of State Boards of Nursing on these issues provides critical insight to ensuring the timely and equitable delivery of high-quality care to all Americans.