Journal of Nursing Regulation最新文献

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.

Background:

Early career nurses face higher levels of burnout and stress than other nurses, and burnout and stress among this group was amplified by the COVID-19 pandemic. The sustainability of the U.S. nursing workforce is dependent upon understanding whether these issues are causing young nurses to leave the workforce at increased rates.

Purpose:

To identify the personal and professional characteristics that distinguish early career registered nurses (RNs) and to examine factors that may contribute to early career nurses reporting an intent to leave the profession in the next 5 years.

Methods:

The National Council of State Boards of Nursing’s 2022 National Nursing Workforce Survey data were used for analysis. Binary logistic regression analysis was used to assess the significance of observed trends, and inductive thematic analysis was used to develop an understanding of free response data.

Results:

The sample in this study represents 1,011,972 RNs younger than 35 years (24% of the RN workforce). Younger nurses were overrepresented in hospital settings as well as among travel and staff nurses. Although nontravel nurses younger than 35 years were less likely to indicate they plan to leave nursing in the next 5 years (14.5%) compared to older nurses (31.8%), young travel nurses reported a high rate that was comparable to older travel nurses’ high rate (35.4% vs. 36.2%). Young nurses were more likely to attribute their burnout and stress to staffing issues rather than the COVID-19 pandemic.

Conclusion:

Nurses younger than 35 years disproportionately reported high levels of stress and burnout during the COVID-19 pandemic. However, a majority identified long-standing issues as the source of their stress and burnout rather than the transient aspects of the pandemic that may fade with time. Travel nurses seem particularly unlikely to return to staff nursing, which would likely result in lower wages and less control over their working conditions. To retain young nurses and reintegrate some of the young nurses who have already left the workforce, nursing leaders will need to be intentional about retention efforts and recruitment strategies.

Background:

Nurse educators represent a key component of the nursing workforce and typically serve in two critical roles: they train nurses who may one day provide direct patient care or educational services, and they often practice themselves. However, the number of nurse educators is declining as enrollment in master’s and PhD programs slows and as the current set of educators retire and leave the profession.

Purpose:

This descriptive cross-sectional study sought to more closely examine how the COVID-19 pandemic has impacted the nurse educator cohort. More specifically, this work sought to understand how the pandemic has affected nurse educators embedded in traditional academic as well as clinical settings.

Methods:

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

Results:

Educators in both settings report they were profoundly impacted by the COVID-19 pandemic. However, educators in clinical settings were more likely (adjustedOR= 1.41, 95% CI: 1.37–1.44,p <.001) to report an increase in workload when adjusting for race, ethnicity, gender, and years’ experience. Educators who reported specializing in geriatrics (adjustedOR= 3.09, 95% CI: 2.87–3.32,p <.001) and acute/critical care (adjustedOR= 2.89, 95% CI: 2.70–3.08,p <.001) were also more likely to report plans to leave or retire within 5 years relative to educators in medical/surgical specialized positions when controlling for years’ experience, race, ethnicity, and gender. Additionally, 40.2% (n= 2,908) of nurse educators in maternal-child health/obstetrics reported they plan to leave or retire within the next 5 years.

Conclusion:

As the need for nurse educators continues to grow, clinical educators’ unique and acute experiences of emotional exhaustion during the COVID-19 pandemic warrant further consideration. Policymakers, program administrators, and employers must identify and implement methods to improve working conditions to retain and recruit more nurses to education, particularly among those employed in in-demand clinical practice specialty areas. The results of this analysis offer insights into the practice profiles of educators in both clinical and academic settings, as well as how their experiences during the COVID-19 pandemic may inform their intent to leave the profession in the years to come.