Journal of Nursing Regulation最新文献

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.

Background: State-level nursing workforce data are important because national-level data cannot account for the local conditions that affect workforce distributions across states. The Alabama Board of Nursing collects licensure and survey data that inform registered nurse (RN) supply. However, little is known about the demand for acute care RNs in the state. Purpose: The purpose of this study was to characterize the demand for acute care RNs in Alabama. Methods: An exploratory, descriptive design was employed. Demand for acute care RNs was determined using a voluntary Survey of Acute Care Registered Nurse Employers in Alabama 2019. Chief nursing officers (CNOs) in Alabama were invited to complete the survey between July 2019 and April 2020. Results: Twenty-five CNOs representing Alabama’s acute care hospitals completed the survey, 68% of whom reported an overall high demand with difficulty filling open acute care RN positions. That proportion increased to 80% when CNOs were queried about the demand for experienced RNs. Conclusion: This study provides evidence of the increasing demand for acute care RNs in Alabama even prior to the COVID-19 pandemic. To ensure patient safety and quality care in Alabama, the development of structures and processes for ongoing data collection regarding Alabama’s acute care RN workforce supply and demand should be a legislative and regulatory priority.

Background

Coronary artery disease (CAD) is the most prevalent heart disease in the United States, and it disproportionately affects Black compared to White patients. Regular primary care and dyslipidemia screening and management are essential for optimal CAD care. Nurse practitioners (NPs) increasingly provide primary care services, though unsupportive practice environments may constrain their ability to do so.

Purpose

To examine whether disparities in lipid screening between Black and White patients with CAD were associated with the NP practice environment scores.

Methods

Cross-sectional survey data from NPs in primary care practices and Medicare claims were linked to evaluate outcomes among 111,911 CAD patients (94% White, 6% Black) across 456 primary care practices in four states (California, Florida, New Jersey, and Pennsylvania) in 2016. The NP-Primary Care Organizational Climate Questionnaire, which provides a score on the supportiveness of a respondent’s practice, was used to evaluate the NP practice environment. Multilevel regression models that accounted for patient and practice characteristics were used to evaluate the study aim.

Results

Compared to White patients with CAD, Black patients with CAD less frequently received annual lipid screening (77.0% vs. 70.6%; p < .001). In logistic regression models accounting for patient and practice characteristics, for every standard deviation increase in the practice environment score, Black patients experienced a 5% increase in odds of receiving lipid screening.

Conclusion

Investing in the NP practice environment, including increasing NP role visibility and strengthening relationships with physicians and administrators, may narrow racial disparities in CAD management.

Background

The COVID-19 pandemic impacted various aspects of life. One of its most deleterious effects was on educational programs preparing the health workforce needed to care for patients infected by the virus and other diseases.

Purpose

To examine self-reported difficulties precipitated by and programmatic changes made secondary to the COVID-19 pandemic by nurse aide education programs (NAEPs) in Virginia across four different settings: nursing homes and hospitals, community colleges, high schools, and proprietary programs.

Methods

In this exploratory study, both quantitative and qualitative data were collected through online surveys. The quantitative results were examined by setting and included the frequencies of difficulties faced and changes made. For open-ended responses, inductive thematic analysis was conducted.

Results

Of the 202 programs that participated in the study, 92% reported at least one difficulty, and several NAEPs reported multiple difficulties. The most common reported difficulties were clinical site closures among community college and proprietary NAEPs, transitioning to virtual instruction among high school NAEPs, and social distancing in skills laboratories among hospital and nursing home NAEPs. In response to these COVID-19–induced difficulties, the most-reported changes were clinical training sites among community college and proprietary NAEPs, instructors and clinical training sites among high school NAEPs, and program length and primary instructor among NAEPs in nursing homes and hospitals. However, only half of the programs that reported difficulties reported making any resultant changes.

Conclusion

The COVID-19 pandemic led to various difficulties for NAEPs, which gives urgency to designing setting-specific regulatory guidance that would help NAEPs overcome such impacts and engender recommendations for NAEPs and researchers. The ability of NAEPs to respond to future nurse aide workforce needs depends on their urgent response.

The Health Professions and Occupations Act of British Columbia is likely the most significant reform in the regulation of health professions, including nursing, ever enacted in Canada. It ends self-regulation for the health professions and creates an entirely new governance regime for regulators in this Canadian province. This act also expands the mandate of health regulators to include extensive and detailed requirements to foster cultural humility, to promote reconciliation with Indigenous peoples, and to actively address discrimination. Furthermore, it modifies the way in which regulatory activities are performed. This legislation will likely be closely monitored by nursing regulators throughout Canada. The present article highlights the more significant changes, particularly those consistent with regulatory reform initiatives elsewhere in Canada and the United Kingdom.

Background

During the COVID-19 pandemic, many boards of nursing (BONs) in the United States issued emergency orders to allow prelicensure RN nursing programs greater flexibility regarding simulation use.

Purpose

To understand how state BONs adjusted their simulation regulations to support prelicensure nursing programs and how prelicensure nursing programs in turn drew upon this revised guidance to safely deliver clinical education during the early stages of the COVID-19 pandemic.

Methods

Simulation-related BON regulations were reviewed before and during the pandemic and classified by the degree of change. All active U.S. prelicensure RN programs were then surveyed in the summer of 2020 about prior and anticipated (fall 2020) simulation usage. Data from each phase were then merged to determine how jurisdictional changes informed simulation substitution levels at the program level. Wilcoxon signed-rank tests were used to determine the significance of identified trends.

Results

Early in the pandemic, nearly half (n = 24) of states issued emergency orders to allow for the expanded use of simulation-based education (SBE) in prelicensure nursing programs. A total of 526 prelicensure RN programs participated in the survey, yielding a 32.8% response rate. Most programs increased their use of SBE, with the most pronounced changes occurring in jurisdictions in which emergency orders modified or waived existing clinical substitution thresholds.

Conclusion

Proactive BON emergency orders and policies provided the necessary flexibility for prelicensure RN programs to maintain the continuity of prelicensure RN students’ education early in the pandemic when many clinical sites imposed significant onsite restrictions.