Journal of Nursing Regulation最新文献

Background

The healthcare industry is experiencing a rise in substance use disorder (SUD) as healthcare professionals who have access to controlled substances are at increased risk of developing SUD. However, individuals with SUD do not typically self-report, leaving authorities and state licensing boards to depend on whistleblowers to report suspected SUD or drug diversion, placing considerable psychosocial stress on those reporting.

Purpose

The present study examined existing literature on whistleblowing, drug diversion, and substance use disorder (SUD) among healthcare professionals. The present study’s primary aim was to identify unexplored areas related to whistleblowing, especially the psychosocial effects experienced by whistleblowers.

Methods

The authors performed a scoping review to investigate existing literature regarding whistleblowing, drug diversion, and SUD among healthcare professionals

Results

Forty-seven articles met inclusion criteria and were chosen for comprehensive data extraction. A gap in the literature regarding the psychosocial impact on the whistleblower reporting SUD was identified. Based on the articles reviewed, healthcare professionals do not always report colleagues for suspected SUD, despite this being a professional obligation. Fear of retribution is the most commonly cited barrier to whistleblowing. This is not surprising considering that whistleblowing laws in the United States vary and have led to legal charges against nurse whistleblowers.

Conclusion

The present review highlights numerous unaddressed areas in the current literature related to whistleblowing in healthcare. Creating a safety-centric and whistleblowing ethos within healthcare settings is essential to improved handling of whistleblower allegations and to alleviate associated psychosocial burdens.

The COVID-19 pandemic brought virtual care to the forefront of healthcare delivery. Virtual care can provide many benefits and in fact supports the proposed quadruple aim of (a) optimizing the patient’s experience with care, (b) promoting population health, (c) reducing per capita healthcare costs, and (d) improving healthcare worker experience. However, establishing interjurisdictional regulations in virtual care is key to expanding healthcare access. In 2021, the College of Registered Nurses of Alberta (CRNA) collaborated with the College of Registered Nurses of Saskatchewan (CRNS, formerly the Saskatchewan Registered Nurses Association) to develop a memorandum of agreement (MOA) to facilitate and expedite the registration of registered nurses and nurse practitioners for the provision of virtual care across provincial borders. The MOA addressed key regulatory requirements (including registration, licensing, continuing competence, professional liability insurance, complaints and discipline, and information sharing) for the provision of interjurisdictional virtual care services. This pilot program enabled both regulators to adopt a common regulatory framework while ensuring that quality of care, accountability, and protection of the public were not compromised. In late 2021, the CRNA and the CRNS also engaged the Registered Nurses Association of the Northwest Territories and Nunavut to join, which they did in 2022. This enabled a streamlined approach to virtual care between Alberta, Saskatchewan, the Northwest Territories, and Nunavut. The present article discusses the CRNA’s approach to meeting the healthcare system’s ongoing challenges and needs related to virtual care, as highlighted by a pandemic-era MOA across four Canadian jurisdictions to facilitate access to care while maintaining public protection.

Background

The 2022 National Nursing Workforce study projected a worsening nursing shortage in the wake of the COVID-19 pandemic. An International Council of Nurses report also identified the shortage of nurses as a global health emergency. In response, policymakers and researchers are now exploring interstate licensure compacts as a long-term policy option to mitigate healthcare workforce crises and improve access to care through increased workforce mobility.

Purpose

To assess and quantify the interest and possible concerns of advanced practice registered nurses (APRNs) regarding the APRN Compact licensure model.

Methods

This study is an aggregate report of findings from state-based online surveys conducted by the National Council of State Boards of Nursing from 2021 to 2023. APRN responses from Arizona, Maryland, Montana, West Virginia, and Wyoming are included. The survey instrument contained 12 questions, which included respondents’ demographics (e.g., license type, APRN practice experience) and opinions about adopting the APRN Compact.

Results

A total of 8,453 APRNs completed the survey for an overall response rate of 26%. At the time of the survey, 46% of respondents held an active APRN license in at least one state other than the state in which they were surveyed. Eighty-six percent of respondents supported the APRN Compact, 4% opposed it, and the remaining 10% did not specify an opinion. Of the 7,409 respondents who expressed their support or opposition, 96% reported a favorable opinion of the APRN Compact. Increased patient access to high-quality healthcare was the most frequently cited reason for supporting the APRN Compact, whereas the 2,080 hours of experience requirement was the most frequently cited concern. The high support rate for the APRN Compact was consistent across practice patterns, provider roles, experience, and state of residency. Eighty-four percent of respondents indicated that they would apply for an APRN Compact license if it becomes available.

Conclusion

The majority of responding APRNs would welcome the APRN Compact, would apply for the multistate license, and reasoned that the Compact would increase patient access to high-quality care.

Health equity is achieved by addressing social determinants of health, which include a healthy workplace. Since the early stages of the COVID-19 pandemic, healthcare workers have endured unprecedented stress, and many have left the healthcare field. Their departure has led many organizations to examine the underlying causes of this exodus and to create and promote a positive workplace environment in which healthcare workers can provide optimal care for their patients, even under stress. One opportunity for improving health and health equity for healthcare workers is supporting those struggling with substance use disorders. In recent years, special programs have been developed to support healthcare workers’ recovery from such disorders and return to work. In the present article, we identify an opportunity to improve care and support for healthcare workers with opioid use disorder—namely, providing healthcare workers with appropriate access to evidence-based medications. As argued in the present article, full support for such treatment will not only save the lives of many healthcare workers but also destigmatize the use of such medications for patients, thus improving health and health equity across the country.

Background: Nurse practitioners (NPs) are a critical part of the opioid use disorder treatment workforce. However, in states where regulations restrict NPs’ scope of practice, fewer NPs are eligible to provide this important treatment than in states where NPs have full practice authority. Purpose: To evaluate the cost-effectiveness of full practice authority relative to restricted scope of practice for NPs intending to prescribe buprenorphine for opioid use disorder in the historical context (before implementation of the Mainstreaming Addiction Treatment Act and the Medication Access and Training Expansion Act, collectively referred to as the MAT/MATE Acts) and in scenarios modeling various implementations of these acts. Methods: A simulated cohort of 10,000 NPs progressed through a decision tree model with a 1-year time horizon. Outcomes included the number of NPs prescribing buprenorphine, the number of patients treated, and the incremental cost-effectiveness ratio for both outcomes. Model inputs were sourced from existing literature. We examined uncertainty and variability in the outcomes using a probabilistic uncertainty analysis of 10,000 simulated Markov trials. Several scenarios depicting various implementations of the MAT/MATE Acts were examined, such as adoption of the Acts “as written” and increased physician prescribing. Results: In our base-case pre-MAT/MATE analysis, full practice authority produced 245 more NPs prescribing buprenorphine than restricted scope of practice (377 vs. 132) and 2,162 more patients treated (3,329 vs. 1,167) while saving $59.7 million ($0.6 million vs $60.3 million). Across 10,000 probabilistic uncertainty analysis simulations, there was a 100% probability of full practice authority being the dominant strategy (i.e., saving money while improving outcomes). These results were robust across all MAT/MATE scenarios we examined. Conclusion: Adopting full practice authority for NPs appears to be a cost-effective policy lever for increasing the available substance use treatment workforce and increasing the number of patients receiving treatment with buprenorphine.

Background

The population of adults aged 65 years or older in the United States has continued to expand, reaching 17% of the total population in 2020. This increase has consequently led to a growing demand for geriatric care and a corresponding need for more geriatric clinicians. Given these demographic trends, it is essential to understand the relationship between state nurse practitioner (NP) scope-of-practice (SOP) laws and geriatric nurse practitioner (GNP) supply.

Purpose

To investigate the relationship between SOP laws and GNP supply in the United States.

Methods

We constructed a county-level national dataset that included data from 2009 to 2019. We explored trends in SOP laws as well as trends in GNP supply by type of SOP laws. To assess the relationship between state SOP laws and GNP supply, we performed a random effect repeated measures zero-inflated Poisson regression.

Results

Twelve states and the District of Columbia had full SOP for NPs in 2009, and 10 additional states adopted full SOP laws for NPs between 2009 and 2019. Although the GNP supply increased nationwide, a considerable proportion of counties did not have any GNPs during the study period. Among counties with any GNPs, we found that states with full SOP laws experienced higher growth in GNP supply during the study period. However, we did not find that adoption of a full SOP law was significantly associated with a decrease in the number of counties without GNPs over time, particularly among small, nonmetropolitan counties.

Conclusion

The growing GNP supply is an encouraging trend. Our findings highlight the potential benefits of supportive SOP laws in expanding GNP supply, which can enhance the geriatric workforce and improve access to care for the aging population.