Journal of Nursing Regulation最新文献

Background

Boards of nursing (BONs) investigate complaints and take disciplinary actions against the licenses of nurses in order to maintain patient safety. For nurses with prior criminal convictions, the potential risks to patient safety have not been formally evaluated.

Objective

This study aims to assess the impact of a nurse’s prior criminal conviction(s) on the risk of recidivism in nursing practice and to investigate whether nurses who were disciplined by BONs for a crime but retained an active nursing license posed a subsequent risk to public safety.

Methods

We reviewed Nursys discipline data from 2008–2018 to compare the risk of recidivism for nurses sanctioned for criminal convictions between 2012–2013 and those disciplined for other violations. The type of crimes and disciplinary actions taken by BONs were recoded and analyzed.

Results

The 5-year recidivism rate of nurses who received disciplinary actions for criminal convictions between 2012 and 2013 was 38%, which is comparable to the recidivism rate among nurses in the control group (36%). Overall, among those who had a criminal conviction history yet retained an active license, 4% committed a practice-related violation or crime within the 5-year postdisciplinary period. Three factors correlated with recidivism: (1) committing a crime related to substance use disorder, (2) committing a crime related to nursing practice, and (3) committing multiple crimes.

Conclusion

The majority of nurses who were disciplined by BONs for a criminal conviction and allowed to remain in nursing practice did not receive additional disciplinary actions by BONs for committing subsequent practice-related violations or crimes during the 5-year post disciplinary period. The current study suggests that the licensure and discipline procedures used by BONs in response to criminal convictions help to reduce the risk of patient harm in nursing practice, thereby aligning with their mission of public protection.

Background

As more states in the United States legalize marijuana for medical use, nurse leaders will play increasingly important roles in patients’ access to and use of medical marijuana.

Purpose

To examine nurse leaders’ attitudes toward and experiences with medical marijuana by state policy environment.

Methods

We conducted a national, online, cross-sectional survey of nurse leaders who were recruited through the American Organization for Nursing Leadership (n = 811). Descriptive statistics were used to examine the prevalence of responses to each item.

Results

The majority of respondents worked in inpatient settings or health systems. Nearly 90% of nurse leaders thought that people should be able to use marijuana legally to treat their medical conditions, 67% believed that nurses should facilitate access to medical marijuana for patients who would benefit from its use, and 78% agreed that state and national nursing organizations should help reduce the stigma associated with the drug. Two-thirds of nurse leaders viewed medical marijuana as less dangerous than other drugs for treating pain and viewed legalization as leading to safer marijuana products (e.g., ensuring it is not laced with other substances) and enabling clinicians to be responsive to patient preferences. In states that had legalized medical marijuana, the absence of institutional policies and clinical guidelines about medical marijuana were identified by most respondents as significant barriers to patients’ legal use of it in healthcare settings. Fourteen percent of nurse leaders were aware of NCSBN’s National Nursing Guidelines for Medical Marijuana. The vast majority of respondents (85%) believed that education about medical marijuana should be provided in prelicensure nursing education programs.

Conclusion

Nurse leaders were supportive of legalization and viewed nurses and nursing organizations as central to patients’ acceptance of, access to, and use of medical marijuana. Nurse leaders acknowledged that they lacked education and were unaware of existing guidelines on the topic.

Background

Nurses constitute the vast majority of the healthcare workers, but it is unclear how frequently they encounter ethical dilemmas in Bahrain. Thus, there is a need for nurse administrators in Bahrain to understand the ethical dilemmas their nursing staff may face.

Purpose

The study aimed to explore the ethical dilemmas experienced by nurses in Bahrain and to identify any associations between ethical dilemmas with nurse characteristics.

Methods

A descriptive cross-sectional survey design was undertaken. The setting was inpatient nursing units and the emergency department of a tertiary hospital in Bahrain. Data were collected from nurse participants through convenience sampling from July to August 2020 by using an online 24-item Ethical Dilemma Questionnaire (EDQ) on a 7-point (0-6) Likert scale. Ethical approval for the study was obtained from the hospital’s institutional review board.

Results

Among the 390 participating nurses, the mean (SD) EDQ score was 1.24 (0.80), indicating a low overall frequency of ethical dilemmas (between less than a few times per year and up to once per month). The subdomains were patients’ actions and decisions, nursing care provisions, personal and collegial actions and decisions, and sharing of information. The participants’ characteristics that were found to be statistically significant were gender, nationality, and department of work. Age was found to be negatively correlated. However, nurses’ EDQ scores based on job category and years of experience were not found to have a statistically significant difference.

Conclusion

Although nurses had infrequent encounters with ethical dilemmas, they reported more dilemmas when facing low nurse-patient ratios, contesting a prescription order, working with nonresponsive physicians, dealing with patients’ lifestyle choices, and handling nonnursing tasks.

Background

Deployment of nurse practitioners (NPs) to health professional shortage areas (HPSA) may help to address challenges in patient access to care. However, restrictive scope of practice imposed by regulatory and state legislative bodies or unsupportive organizational climates in clinical practice settings may constrain NP care delivery and perpetuate lower assessments of quality of care provided in these underserved communities.

Purpose

The purpose of this study was to investigate the associations between state NP scope of practice regulations, NP practice environment, and self-reported ratings of quality of care in primary care practices located in HPSAs.

Methods

This was a cross-sectional analysis of data from 1,972 participant NPs practicing across 1,711 primary care practices in six states representing full (Arizona and Washington), reduced (Pennsylvania and New Jersey), and restricted (California and Florida) NP scope of practice regulation. Survey data were merged with the Area Health Resource Files to determine practices located in primary care HPSAs. Logistic regression models estimated the relationship between quality ratings, scope of practice regulations, and practice environment scores while accounting for NP and practice characteristics.

Results

Among all included NPs, 95.7% rated their practice as having “excellent,” “very good,” or “good” quality of care. Practice environments with higher scores had higher ratings of quality of care after accounting for NP and practice characteristics (OR = 3.73, 95% CI: 2.84, 4.89).

Conclusion

Unsupportive clinical practice environments were associated with lower ratings of quality of care in HPSAs, suggesting that improvements in working conditions may be necessary adjuncts to greater deployment of NPs to improve primary care in shortage areas.

Background

Chronic pain disproportionately impacts veterans and is often treated in primary care, where physician shortages in the Veterans Health Administration (VHA) healthcare system are well documented. Nurse practitioners (NPs) may represent a solution to the care shortage; however, concerns of NP opioid overprescribing have led to NP practice and prescribing restrictions in individual VHA facilities and at the state level. Little is known regarding the prescribing patterns of NPs and physician assistants (PAs) for veterans with chronic pain in the VHA.

Purpose

The purpose of this study was to compare opioid and non-opioid prescribing patterns of physicians, NPs, and PAs for chronic pain patients at VHA centers.

Methods

We used data from the U.S. Department of Veterans Affairs Survey of Healthcare Experience of Patients and Corporate Data Warehouse from October 2015 to September 2016. Patient medical records for the year were analyzed by provider type (physician, NP, or PA) for differences in providers’ rates of prescribing opioid and non-opioid medications, as well as characteristics of the opioid prescriptions (e.g., high daily morphine milligram equivalent [90 MME/day] dose, long-term opioid therapy [90 days]).

Results

Medical records of a total of 39,936 patients were included. In FY 2016, 55% of patients received one opioid prescription, whereas 83.8% received one non-opioid prescription. Compared to patients of NPs and PAs, patients of physicians had higher odds of receiving opioid (vs. NPs: OR = 1.13, p < 0.01; vs. PAs: OR = 1.16, p < 0.01) and non-opioid prescriptions (vs. NPs: OR = 1.08, p = 0.02; vs. PAs: OR = 1.20, p < 0.01) after adjusting for patient characteristics. There were no differences in high MME/day dose (p = 0.59) or long-term opioid therapy (p = 0.99).

Conclusion

In a national sample of veterans with chronic pain, NPs and PAs did not have higher odds of opioid prescribing. Concerns of NP or PA opioid overprescribing may be addressed by considering evidence that patients of these providers are not at higher odds of receiving an opioid prescription.

In the United Kingdom, the regulation of healthcare professions falls under the remit of one of 10 general councils, each of which has a statutory duty to ensure the continuing fitness to practice of its registrants. Among the matters that may call a practitioner’s fitness to practice into question are deviations from published standards of behavior, which include honesty and academic integrity. Through a series of related case studies from the General Medical Council, General Dental Council, General Pharmaceutical Council, and Nursing and Midwifery Council, this article examines how the common fitness-to-practice process used by U.K. regulators deals with registered healthcare professionals who have attempted to gain an advantage by falsifying academic qualifications. There was a significant degree of consistency between the processes used by each general council. During each case, the same aggravating and mitigating circumstances were considered when determining both fitness to practice and sanction. To maintain “proper standards” and public confidence in the professions in response to an act of academic dishonesty, a sanction from the lower end of the spectrum of severity may be imposed. However, if a practitioner conveys a lack of insight regarding their actions, a period of suspension from practice may be imposed, during which they are asked to reflect. When there is an ongoing risk to the safety of patients, or when a practitioner does not engage in the process, a striking-off order may be appropriate.

Background

The COVID-19 pandemic has stimulated interest in potential policy solutions to improve working conditions in hospitals and nursing homes. Policy action in the pandemic recovery period must be informed by pre-pandemic conditions.

Purpose

To describe registered nurses’ (RNs’) working conditions, job outcomes, and measures of patient safety and care quality in hospitals and nursing homes just before the pandemic.

Methods

Cross-sectional study using descriptive statistics to analyze survey data from RNs in New York and Illinois collected December 2019 through February 2020.

Results

A total of 33,462 RNs were included in the final analysis. Before the pandemic, more than 40% of RNs reported high burnout, one in four were dissatisfied with their job, and one in five planned to leave their employer within 1 year. Among nursing home RNs, one in three planned to leave their employer. RNs reported poor working conditions characterized by not having enough staff (56%), administrators who did not listen/respond to RNs’ concerns (42%), frequently missed nursing care (ranging from 8% to 34% depending on the nursing task in question), work that was interrupted or delayed by insufficient staff (88%), and performing non-nursing tasks (82%). Most RNs (68%) rated care quality at their workplace as less than excellent, and 41% gave their hospital an unfavorable patient safety rating.

Conclusion

Hospitals and nursing homes were understaffed before the COVID-19 pandemic, and many RNs were dissatisfied with their employers’ contribution to the widespread observed shortage of nursing care during the pandemic. Policy interventions to address understaffing include the implementation of safe nurse staffing standards and passage of the Nurse Licensure Compact to permit RNs to move expeditiously to locales with the greatest needs.