Journal of Nursing Regulation最新文献

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.

Background

In the United States and across the globe, differences in staffing, operations, terminology, and other critical measures have historically made it difficult for nursing regulatory bodies (NRBs) to create a standardized method for objectively evaluating nurse performance.

Purpose

To identify indicators of operational efficiency that transcend individual jurisdictions for the disciplinary process.

Methods

Investigative staff at 10 U.S. NRBs entered detailed de-identified discipline case management information into a secure online database between June 2018 and June 2020. Generalized estimating equation models, receiver operating characteristic curves, and natural language processing techniques were then used to assess the efficiency of case resolution.

Results

A total of 55 cases from 10 states in various regions of the United States were submitted. Nearly three-quarters of all cases (73%) were resolved, and the median closure time was 177 calendar days. On multivariable analysis, the volume of open caseloads (adjusted OR = 1.12, 95% CI = 1.06, 1.19, p < .001), number of case steps (adjusted OR = 1.08, 95% CI = 1.03, 1.13, p < .001), and umbrella agency type (adjusted OR = 1.71, 95% CI = 1.06, 2.78, p = .02) had the strongest associations with inefficient case resolution.

Conclusion

To achieve their mandate of ensuring public safety, NRBs must remain agile and utilize evidence-based approaches to manage disciplinary cases. In the United States and internationally, NRBs that efficiently and effectively execute the disciplinary process facilitate the appropriate and safe return to practice of effective nurses.

The COVID-19 pandemic has placed nursing at the forefront of public attention across the globe and has highlighted the critical role of nursing in healthcare service provision. Advanced practice nursing has been recognized for more than 50 years, but the rate of its growth and development varies significantly across the world. One of the key aims of the Better Health Programme Mexico, which commenced in 2019, was to develop advanced practice nursing in Mexico. The Programme was based on the United Kingdom model, where advanced practice nursing has been in place—though not subject to statutory regulation—for more than 40 years. The aim of this article is to compare the frameworks that underpin advanced practice nursing in the United Kingdom and in Mexico. In the present article, current practice in both countries was researched, and the structure, systems, and processes relating to nursing regulation and the frameworks to support advanced practice nursing were examined. A gap analysis report undertaken as part of the Better Health Programme identified challenges in developing advanced practice nursing in Mexico and the United Kingdom and highlighted the need for stakeholders to agree on an approach toward a rigorous regulatory framework in both settings. In summary, this article highlights the issues facing nurses and regulators in both countries in terms of advanced practice nursing and identifies strategies that can be used to strengthen the advanced practice nurse role.

Background

Licensed practical nurses (LPNs) are important members of the nursing workforce in the United States, particularly in long-term care and home care settings. A previous qualitative study found LPNs have expanded their role, yet detailed information about the nursing activities performed by LPNs is lacking in New Jersey (NJ).

Purpose

The purpose of this study was to describe current nursing activities and job satisfaction of LPNs in NJ and to determine whether there is a difference in the nursing activities and job satisfaction of LPNs working in nursing homes and those working in other settings.

Methods

For this descriptive, cross-sectional study, LPNs who had email addresses listed with the NJ Board of Nursing were sent a survey about their nursing activities and job satisfaction.

Results

The 804 LPNs who completed the survey were representative of the NJ LPN workforce. The top nursing activities that LPNs performed daily were documenting, providing basic nursing care, checking vital signs, and administering medications. LPNs working in nursing homes also identified supervising unlicensed assistive personnel as an additional top nursing activity. Many LPNs also reported independently performing comprehensive and focused assessments and formulating care plans. Compared with LPNs working in other settings, LPNs working in nursing homes had less job satisfaction.

Conclusion

Our findings reveal that LPN scope of practice has increased, and some LPNs are functioning beyond their scope of practice. With a shared agenda, nurse leaders in practice, academe, trade organizations, and regulatory bodies should convene to discuss and ensure a clear understanding of the LPN role and scope of practice.

Background

The Nurse Licensure Compact (NLC) is a modernized licensure system designed to facilitate nurse mobility in a safe and standardized way. It has demonstrated particular usefulness during the COVID-19 pandemic and other emergencies, allowing nurses to practice where they are needed without the time and cost burdens of obtaining multiple state licenses. In 2018, uniform licensure requirements were added to the NLC to strengthen the requirements for a multistate license. Nevertheless, some states have been reluctant to join the NLC, expressing safety concerns.

Purpose

The National Council of State Boards of Nursing compared the discipline rates of multistate license holders to nurses holding single-state licenses.

Methods

This cross-sectional study used discipline data from the calendar year 2019, which was chosen because it contained the most current pre-pandemic data. Discipline cases among nurses with and without a multistate license were evaluated. Using the national Nursys database, we compared discipline rates and types of violations leading to disciplinary actions by 33 NLC Boards of Nursing (BONs) and 24 non-NLC BONs.

Results

The overall discipline rates of nurses in NLC and non-NLC states were virtually identical (0.24% versus 0.23%). However, a further breakdown of the data revealed the annual discipline rate of nurses holding single-state licenses across both non-NLC and NLC states was between two to four times higher than the rate of multistate license holders.

Conclusion

Multistate license holders’ consistently low discipline rates hold across all available demographic categories, suggesting the overall safety of the NLC.

Background

Substance use (SU) or substance use disorder (SUD) prevalence among U.S. nurses has not been assessed foralmost 25 years.

Purpose

The purpose of this current study, known as the Nurse Worklife and Wellness Study, is to generate population-based prevalence estimates for SU and related problems, including SUDs, among registered nurses and to examine other personal and work characteristics related to nurse SU.

Methods

A mixed-mode survey of a nationally representative sample of randomly selected nurses in nine states, using a cross-sectional design, obtained 1,215 responses (30.6% response rate), with 1,170 usable surveys for analysis. Substance use and problems were assessed based on standardized criteria.

Results

Past year illicit drug use was 5.7%, and prescription-type drug misuse was 9.9%, with nurses working in home health/hospice (19%) and nursing homes (15.8%) having the highest rates. Energy drink use was reported by 23.7% of nurses younger than 45 years, with emergency and multi-specialty nurses having three to five times the odds of use versus the reference group. Overall, 18.0% of nurses screened positive for SU problems, with one-third of those (6.6% of the total) screening positive for SUD. Staff, charge nurses/coordinators/nurse managers, and other administrators had 9 to 12 times the odds of having a SUD as opposed to educators and researchers.

Conclusion

Prescription-type drug misuse rates exceeded the U.S. population rates, and rates varied by specialty. Energy drink use and SUD risk were significantly higher among nurses in certain positions and specialties. Focusing on higher risk groups can help target nurse prevention and treatment efforts and guide policy for identifying and addressing SU problems among nurses.

In April 2021, member deans of the American Association of Colleges of Nursing approved new standards for nursing education, with competency-based education as its foundation. The revised Essentials framework includes competencies organized within 10 domains at two levels of nursing education: entry level and advanced level. An advantage of this approach is greater clarity and confirmation regarding the knowledge and skills of nursing school graduates. Implementation of the new Essentials will occur over the next several years, and substantial changes to the curriculum, learning activities, and learner assessment is expected. The revision of the Essentials presents a significant opportunity for regulators to collaborate with schools and practice partners. To that end, this article provides an overview of the newly revised Essentials, discusses considerations and implications for nursing regulation, and puts forth recommendations for boards of nursing.