Pub Date : 2026-01-01DOI: 10.1016/j.jnr.2025.10.004
Mohamed Ahmed Aly , Ahmed Hashem El-Monshed , Asmaa Mohamed Ahmed Madkour , Shaimaa Mohamed Amin , Mubarak Aldawsare PhD, APRN, AGCNS-BC , Mohamed Hussein Ramadan Atta
Background
Effective nursing handoff is critical to patient safety and care continuity. Distributive justice (DJ; the perceived fairness of the distribution of resources, rewards, and tasks) has a strong impact on handoff competency, and cognitive biases such as missing tile syndrome (MTS; focusing excessively on what is missing) may exacerbate this association. However, the effect of MTS on nurse handoff ability has not been thoroughly investigated.
Purpose
To examine the effect of DJ on nursing handoff competency and to investigate the mediating role of MTS among nurses.
Methods
This cross-sectional study included a sample of 297 nurses from hospitals in Sohag City, Egypt. Survey data from participants were collected between January 2025 and March 2025 using three scales: (1) the Distributive Justice Index, (2) the Nursing Handoff Competency Scale, and (3) a newly developed MTS scale. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines for cross-sectional studies were followed.
Results
DJ positively predicted competency (B = 1.00, β = 0.26, p < 0.001), whereas MTS had a negative effect (B = −0.50, β = −0.30, p < 0.001). The mediation model revealed significant standardized effects between study variables.
Conclusion
Positive views of DJ were connected with improved handoff competency, whereas a greater attention on faults (MTS) had a detrimental impact on competency. These findings underline the need to promote organizational justice to increase nurses’ handoff effectiveness.
背景：有效的护理交接对患者安全和护理连续性至关重要。分配公正（DJ；感知到的资源、奖励和任务分配的公平性）对交接能力有很强的影响，而认知偏差，如缺失瓷砖综合征（MTS；过度关注缺失的东西）可能会加剧这种关联。然而，MTS对护士交接能力的影响尚未得到深入的研究。目的探讨护理交接能力对护理交接能力的影响，并探讨护理交接能力在护理交接能力中的中介作用。方法对埃及索哈格市医院的297名护士进行横断面研究。调查数据收集于2025年1月至2025年3月，采用3种量表：(1)分配公平指数，(2)护理交接能力量表，(3)新开发的MTS量表。遵循流行病学指南中加强观察性研究报告的横断面研究。结果dj对胜任力有正向影响（B = 1.00, β = 0.26, p < 0.001）， MTS对胜任力有负向影响（B = - 0.50, β = - 0.30, p < 0.001）。中介模型显示研究变量之间存在显著的标准化效应。结论积极的DJ观能提高员工的交接能力，而对失误的关注对员工的交接能力有不利影响。这些发现强调需要促进组织公正，以提高护士的交接效率。
{"title":"Examining the influence of distributive justice on nursing handoff competency and the mediating role of missing tile syndrome","authors":"Mohamed Ahmed Aly , Ahmed Hashem El-Monshed , Asmaa Mohamed Ahmed Madkour , Shaimaa Mohamed Amin , Mubarak Aldawsare PhD, APRN, AGCNS-BC , Mohamed Hussein Ramadan Atta","doi":"10.1016/j.jnr.2025.10.004","DOIUrl":"10.1016/j.jnr.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Effective nursing handoff is critical to patient safety and care continuity. Distributive justice (DJ; the perceived fairness of the distribution of resources, rewards, and tasks) has a strong impact on handoff competency, and cognitive biases such as missing tile syndrome (MTS; focusing excessively on what is missing) may exacerbate this association. However, the effect of MTS on nurse handoff ability has not been thoroughly investigated.</div></div><div><h3>Purpose</h3><div>To examine the effect of DJ on nursing handoff competency and to investigate the mediating role of MTS among nurses.</div></div><div><h3>Methods</h3><div>This cross-sectional study included a sample of 297 nurses from hospitals in Sohag City, Egypt. Survey data from participants were collected between January 2025 and March 2025 using three scales: (1) the Distributive Justice Index, (2) the Nursing Handoff Competency Scale, and (3) a newly developed MTS scale. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines for cross-sectional studies were followed.</div></div><div><h3>Results</h3><div>DJ positively predicted competency (B = 1.00, β = 0.26, <em>p</em> < 0.001), whereas MTS had a negative effect (B = −0.50, β = −0.30, <em>p</em> < 0.001). The mediation model revealed significant standardized effects between study variables.</div></div><div><h3>Conclusion</h3><div>Positive views of DJ were connected with improved handoff competency, whereas a greater attention on faults (MTS) had a detrimental impact on competency. These findings underline the need to promote organizational justice to increase nurses’ handoff effectiveness.</div></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"16 4","pages":"Pages 274-283"},"PeriodicalIF":6.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jnr.2025.07.002
Elizabeth H. Zhong PhD , Michaela Reid BA, BS , Albert Hincapie BS , Brendan Martin PhD
Background and purpose
The COVID-19 pandemic imposed unique and far-reaching challenges on the nursing workforce and on health systems. Aiming to determine the impact of COVID-19 on safe nursing practice, we conducted a quantitative comparative ex post facto study of disciplinary actions issued by State Boards of Nursing (BONs) between 2017 and 2023.
Methods
Discipline records were sourced from Nursys. Data were analyzed and cross-referenced with national workforce statistics and National Council Licensure Examination (NCLEX) statistics.
Results
From 2017 to 2023, 64,957 nurses were subject to disciplinary actions by BONs. The annual aggregate discipline rate remained consistently low, with sustained declines across all major disciplinary categories. The primary offences for discipline shifted from “Criminal convictions” and “Substance use disorder” to “Substandard care”, despite declines. While the discipline rate for “Substandard care” stayed steady for nurses over 50 years old, signaling consistent disciplinary practices by BONs, it declined by half for those under 35, despite the reported disproportionate impacts of COVID-19 on younger nurses. As a result of pandemic-related disruptions in nursing education, NCLEX pass rates fell temporarily in 2021–2022, which may have helped curb the risk of unsafe practice by preventing a larger-than-usual number of underprepared candidates from entering the workforce in an unprecedented high-pressure environment.
Conclusion
Despite COVID-19, the U.S. nursing discipline rate stayed low from 2017 to 2023, reflecting the resilience of the nursing workforce and the efficacy of BONs policies and practices. The NCLEX serves as a vital guardrail in both routine and large-scale emergency contexts.
{"title":"Impact of COVID-19 on safe nursing practice: A national study of nursing disciplinary trends from 2017 to 2023","authors":"Elizabeth H. Zhong PhD , Michaela Reid BA, BS , Albert Hincapie BS , Brendan Martin PhD","doi":"10.1016/j.jnr.2025.07.002","DOIUrl":"10.1016/j.jnr.2025.07.002","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The COVID-19 pandemic imposed unique and far-reaching challenges on the nursing workforce and on health systems. Aiming to determine the impact of COVID-19 on safe nursing practice, we conducted a quantitative comparative ex post facto study of disciplinary actions issued by State Boards of Nursing (BONs) between 2017 and 2023.</div></div><div><h3>Methods</h3><div>Discipline records were sourced from Nursys. Data were analyzed and cross-referenced with national workforce statistics and National Council Licensure Examination (NCLEX) statistics.</div></div><div><h3>Results</h3><div>From 2017 to 2023, 64,957 nurses were subject to disciplinary actions by BONs. The annual aggregate discipline rate remained consistently low, with sustained declines across all major disciplinary categories. The primary offences for discipline shifted from “Criminal convictions” and “Substance use disorder” to “Substandard care”, despite declines. While the discipline rate for “Substandard care” stayed steady for nurses over 50 years old, signaling consistent disciplinary practices by BONs, it declined by half for those under 35, despite the reported disproportionate impacts of COVID-19 on younger nurses. As a result of pandemic-related disruptions in nursing education, NCLEX pass rates fell temporarily in 2021–2022, which may have helped curb the risk of unsafe practice by preventing a larger-than-usual number of underprepared candidates from entering the workforce in an unprecedented high-pressure environment.</div></div><div><h3>Conclusion</h3><div>Despite COVID-19, the U.S. nursing discipline rate stayed low from 2017 to 2023, reflecting the resilience of the nursing workforce and the efficacy of BONs policies and practices. The NCLEX serves as a vital guardrail in both routine and large-scale emergency contexts.</div></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"16 4","pages":"Pages 311-318"},"PeriodicalIF":6.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jnr.2025.10.001
Nicole Letourneau PhD, MN, BN, RN, FCAHS, FAAN, FCAN, FRSC Pro Dir , Joy Peacock MSc, BSN, RN , Damon Mayes MSc, BSc, CStat (FRSS), PStat , Alexandria Lozowchuk BSc , Jason Novick MA, BA , Andrew Douglas MCJ, BA , Elisha Vadnais MScN, RN
Background
An examination of best practices in nursing regulation and corporate governance suggests that sole mandate regulation, right-touch regulation, and reform governance models are optimal. In late 2019, the Council of the College and Association of Registered Nurses of Alberta (the College) began to explore a transition to achieve these best practices. Despite the COVID-19 pandemic, in 2022, the College successfully transitioned to a sole-mandate regulator: the College of Registered Nurses of Alberta.
Purpose
We sought to uncover (a) experiences that supported excellence during regulatory transitions, (b) benefits of undertaking regulatory transitions, and (c) recommendations for others starting regulatory transitions.
Methods
Twenty-one college staff, board members, and governance and regulatory experts engaged in the College transitions were invited to complete a qualitative survey regarding the transitions.
Results
Qualitative thematic analysis of 16 completed surveys revealed that barriers to transition included (a) challenges associated with accepting the transition to sole mandate regulation, (b) knowledge gaps related to right-touch regulation and reform governance, (c) lack of motivation among councilors, and (d) culturally embedded practices that inhibited the transition to reform governance. The vital facilitators that were associated with these transitions included (a) strong leadership, (b) robust internal review team, (c) staff support, (d) educational opportunities for Council members, and (e) well-defined project and change management principles.
Conclusion
An improvement to external and internal College effectiveness was regarded as the predominant benefit of undertaking the transitions. Strong, visionary leadership; engaged staff and Council members; and well-supported change management activities contributed to achieving regulatory excellence despite these complex transitions.
{"title":"The successful transition to sole mandate regulator, right-touch regulation, and reform governance for registered nurses in Alberta, Canada","authors":"Nicole Letourneau PhD, MN, BN, RN, FCAHS, FAAN, FCAN, FRSC Pro Dir , Joy Peacock MSc, BSN, RN , Damon Mayes MSc, BSc, CStat (FRSS), PStat , Alexandria Lozowchuk BSc , Jason Novick MA, BA , Andrew Douglas MCJ, BA , Elisha Vadnais MScN, RN","doi":"10.1016/j.jnr.2025.10.001","DOIUrl":"10.1016/j.jnr.2025.10.001","url":null,"abstract":"<div><h3>Background</h3><div>An examination of best practices in nursing regulation and corporate governance suggests that sole mandate regulation, right-touch regulation, and reform governance models are optimal. In late 2019, the Council of the College and Association of Registered Nurses of Alberta (the College) began to explore a transition to achieve these best practices. Despite the COVID-19 pandemic, in 2022, the College successfully transitioned to a sole-mandate regulator: the College of Registered Nurses of Alberta.</div></div><div><h3>Purpose</h3><div>We sought to uncover (a) experiences that supported excellence during regulatory transitions, (b) benefits of undertaking regulatory transitions, and (c) recommendations for others starting regulatory transitions.</div></div><div><h3>Methods</h3><div>Twenty-one college staff, board members, and governance and regulatory experts engaged in the College transitions were invited to complete a qualitative survey regarding the transitions.</div></div><div><h3>Results</h3><div>Qualitative thematic analysis of 16 completed surveys revealed that barriers to transition included (a) challenges associated with accepting the transition to sole mandate regulation, (b) knowledge gaps related to right-touch regulation and reform governance, (c) lack of motivation among councilors, and (d) culturally embedded practices that inhibited the transition to reform governance. The vital facilitators that were associated with these transitions included (a) strong leadership, (b) robust internal review team, (c) staff support, (d) educational opportunities for Council members, and (e) well-defined project and change management principles.</div></div><div><h3>Conclusion</h3><div>An improvement to external and internal College effectiveness was regarded as the predominant benefit of undertaking the transitions. Strong, visionary leadership; engaged staff and Council members; and well-supported change management activities contributed to achieving regulatory excellence despite these complex transitions.</div></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"16 4","pages":"Pages 326-332"},"PeriodicalIF":6.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jnr.2025.11.002
Nicole Livanos JD, MPP
{"title":"Policy for dollars and dollars for policy: States seek opportunities in new rural health transformation program","authors":"Nicole Livanos JD, MPP","doi":"10.1016/j.jnr.2025.11.002","DOIUrl":"10.1016/j.jnr.2025.11.002","url":null,"abstract":"","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"16 4","pages":"Pages 342-344"},"PeriodicalIF":6.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jnr.2025.11.004
Carol Anne Timmings
{"title":"A year of achievement","authors":"Carol Anne Timmings","doi":"10.1016/j.jnr.2025.11.004","DOIUrl":"10.1016/j.jnr.2025.11.004","url":null,"abstract":"","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"16 4","pages":"Pages 265-266"},"PeriodicalIF":6.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Healthcare regulation is essential for protecting the public and maintaining professional standards, yet traditional compliance-based models are often rigid and resource intensive. Risk-based regulation (RBR) has emerged as an additional tool that can assist regulators in focusing on preventing harm rather than eliminating all risk. This article examines the application of RBR to nursing and midwifery with a focus on healthcare assistants, who deliver substantial patient care but are frequently unregulated. Using responsive regulation theory and right-touch assurance models, this article considers how intrinsic and extrinsic risks can guide proportionate oversight. Although RBR enhances efficiency, adaptability, and patient safety, challenges include data limitations, varied perceptions of risk, and political pressures. It is asserted that proportionate mechanisms, including delegation frameworks, can contribute to public safety without imposing unnecessary burdens. Thus, RBR offers regulators a flexible framework to support workforce optimization and ensure safe, high-quality care.
{"title":"From compliance to risk: A paradigm for nursing and midwifery regulation in Ireland","authors":"Martin Duignan DN, MSc, MSc, PG Dip (Policy Analysis), FFNMRCSI, RGN , Margrieta Langins BSc, MPH, FFNMRCSI, RN , Ray Healy BSc, Prof Doc, FFNMRCSI, RGN , Karen Greene BSc, MSc, FFNMRCSI, RGN , Michael Shannon PhD, MBA, BSc, Dip ED, PG Cert ImpSC, FFNMRCSI, RGN , Thomas Kearns EdD, FAAN, MA, FFNMRCSI, MED, BNS, RNT, RGN, RPN","doi":"10.1016/j.jnr.2025.10.002","DOIUrl":"10.1016/j.jnr.2025.10.002","url":null,"abstract":"<div><div>Healthcare regulation is essential for protecting the public and maintaining professional standards, yet traditional compliance-based models are often rigid and resource intensive. Risk-based regulation (RBR) has emerged as an additional tool that can assist regulators in focusing on preventing harm rather than eliminating all risk. This article examines the application of RBR to nursing and midwifery with a focus on healthcare assistants, who deliver substantial patient care but are frequently unregulated. Using responsive regulation theory and right-touch assurance models, this article considers how intrinsic and extrinsic risks can guide proportionate oversight. Although RBR enhances efficiency, adaptability, and patient safety, challenges include data limitations, varied perceptions of risk, and political pressures. It is asserted that proportionate mechanisms, including delegation frameworks, can contribute to public safety without imposing unnecessary burdens. Thus, RBR offers regulators a flexible framework to support workforce optimization and ensure safe, high-quality care.</div></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"16 4","pages":"Pages 304-310"},"PeriodicalIF":6.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nursing education is facing critical challenges, including an aging faculty, delayed doctoral preparation, and pedagogical training that varies across institutions and countries. These dynamics restrict generational renewal in the profession and limit program capacity, jeopardizing nursing's ability to meet global workforce demands.
Purpose
To analyze the trajectories of nurse educators in consolidating their academic and pedagogical capital, and to assess the implications of those trajectories for the sustainability of nursing education.
Methods
A cross-sectional study was conducted with 326 nurse educators from Spanish universities. Data included demographics, qualifications, pedagogical training, and teaching domains. Participants were classified as practice-oriented faculty (POF), transitional faculty (TF), or scholarly-integrated faculty (SIF). Comparative analyses (analysis of variance, χ2), multinomial logistic regression, Kaplan–Meier survival curves, and Cox regression were used to identify predictors and model progression. Projections were estimated using age distribution and retirement trends.
Results
SIF comprised 35.6 % of participants, who were primarily older women (median age, 54 years) with longer academic careers. Younger cohorts were concentrated in the POF group, while mid-career participants tended to fall into the TF group. Predictors of nurse educator progression included age, teaching experience, gender, and teaching domain. Projections indicate that retirements will disproportionately affect SIF, reducing the share of SIF classifications below 30 % within a decade.
Conclusion
The delayed consolidation of academic and pedagogical capital among nurse educators threatens the timely preparation of competent nurses and undermines the sustainability of nursing education. These findings underscore the need for regulatory strategies that accelerate doctoral preparation, ensure structured pedagogical training, and stabilize early academic careers. By addressing faculty development as a regulatory priority, nursing education systems can safeguard program quality, strengthen generational renewal, and ultimately protect patient safety across healthcare systems.
{"title":"Running out of time: Delayed faculty consolidation and the future of nursing education","authors":"Raúl Quintana-Alonso PhD, MSN, RN, Lucía Carton Erlandsson PhD, MSN, RN, Elena Chamorro-Rebollo PhD, MSN, RN","doi":"10.1016/j.jnr.2025.11.001","DOIUrl":"10.1016/j.jnr.2025.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Nursing education is facing critical challenges, including an aging faculty, delayed doctoral preparation, and pedagogical training that varies across institutions and countries. These dynamics restrict generational renewal in the profession and limit program capacity, jeopardizing nursing's ability to meet global workforce demands.</div></div><div><h3>Purpose</h3><div>To analyze the trajectories of nurse educators in consolidating their academic and pedagogical capital, and to assess the implications of those trajectories for the sustainability of nursing education.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted with 326 nurse educators from Spanish universities. Data included demographics, qualifications, pedagogical training, and teaching domains. Participants were classified as practice-oriented faculty (POF), transitional faculty (TF), or scholarly-integrated faculty (SIF). Comparative analyses (analysis of variance, χ<sup>2</sup>), multinomial logistic regression, Kaplan–Meier survival curves, and Cox regression were used to identify predictors and model progression. Projections were estimated using age distribution and retirement trends.</div></div><div><h3>Results</h3><div>SIF comprised 35.6 % of participants, who were primarily older women (median age, 54 years) with longer academic careers. Younger cohorts were concentrated in the POF group, while mid-career participants tended to fall into the TF group. Predictors of nurse educator progression included age, teaching experience, gender, and teaching domain. Projections indicate that retirements will disproportionately affect SIF, reducing the share of SIF classifications below 30 % within a decade.</div></div><div><h3>Conclusion</h3><div>The delayed consolidation of academic and pedagogical capital among nurse educators threatens the timely preparation of competent nurses and undermines the sustainability of nursing education. These findings underscore the need for regulatory strategies that accelerate doctoral preparation, ensure structured pedagogical training, and stabilize early academic careers. By addressing faculty development as a regulatory priority, nursing education systems can safeguard program quality, strengthen generational renewal, and ultimately protect patient safety across healthcare systems.</div></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"16 4","pages":"Pages 319-325"},"PeriodicalIF":6.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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