Journal of Nursing Regulation最新文献

Background

The National Council of State Boards of Nursing (NCSBN) Survey of Simulation Use in Prelicensure Nursing Programs tool was employed to gather descriptive information from nursing programs in the Middle East and North Africa (MENA). A total of 39 nursing programs from 10 countries participated.

Purpose

To benchmark the prevalence, use, and regulation of simulation in MENA nursing programs.

Methods

The NCSBN Survey of Simulation Use in Prelicensure Nursing Programs tool was communicated either electronically or in person to multiple nursing programs in the MENA region. Descriptive data, ideas, and opinions were collected.

Results

Of the 93 MENA programs contacted, 39 returned a completed survey. According to survey responses, simulation use in nursing programs is widespread. Simulation is commonly used to enhance instruction, to support skill acquisition, and as a substitute for clinical hours. Respondents viewed therapeutic communication, patient education, compassion, and demonstration of critical thinking as unsuitable for simulation.

Conclusion

Simulation is appreciated as a critical tool in nursing education in the MENA region. Limitations in clinical space, time, and complex patient situations and opposite gender care are driving factors for simulation use. Challenges related to space, funding, and training limit the availability of simulation in a region where more simulation is both needed and desired.

Background

The use of simulation-based clinical experiences in prelicensure nursing education has increased dramatically over the past 2 decades. This trend accelerated after the onset of the COVID-19 pandemic in the United States.

Purpose

To quantify advancements in the regulation of simulation use in nursing education since the publication of the National Simulation Study and its accompanying guidelines.

Methods

This cohort study included 61 of the National Council of State Boards of Nursing’s U.S.-based member and associate member jurisdictions. For each included jurisdiction, explicit simulation regulation information regarding either registered nurse (RN) or licensed practical nurse/licensed vocational nurse (LPN/LVN) programs was obtained in 2014. Comparisons were made between 2014 and 2022 nursing simulation regulations. Generalized estimating equation models were used to assess the significance of the observed changes.

Results

The number of jurisdictions with specific regulations regarding simulation use in prelicensure RN programs doubled from 21 in 2014 to 41 in 2022. Additionally, the number of nursing regulatory bodies (NRBs) that allowed a maximum substitution of up to 50% simulated clinical hours rose from 1 to 23 over the same time frame. Similarly, specific regulations regarding simulation use in LPN/LVN programs rose from 20 programs in 2014 to 36 in 2022. As with RN programs, the number of NRBs that permit a maximum of up to 50% simulation substitution for LPN/LVN programs rose from 0 to 22 during the 8-year period.

Conclusion

The impact of the guidelines that emerged from the National Simulation Study is evident. The proactive efforts of NRBs to adopt evidence-based best practices on simulation regulation before and shortly after the onset of the COVID-19 pandemic provided appropriate flexibility for prelicensure RN programs to respond to the global health crisis efficiently and safely.

Background

Recruiting foreign-educated nurses (FENs) is a strategy to reduce staffing shortages of registered nurses (RNs) practicing in long-term care (LTC) in the United States. However, little is known about how FENs compare to U.S.-educated nurses (USENs) in their innate abilities and skills, also known as human capital.

Purpose

To compare human capital among FENs and USENs practicing in LTC.

Methods

This cross-sectional study used data from the 2018 National Sample Survey of Registered Nurses to compare human capital scores between FENs and USENs. Human capital scores consisting of highest nursing qualification, skill-based certifications, number of state licensures, years of experience, multi-state employment, and multilingual ability were constructed and compared using analysis of covariance. Covariates were race, ethnicity, marriage/partnership, adults at home, children at home, direct patient care, and practice scope.

Results

The sample included 1,887 RNs (92.8% USENs and 7.2% FENs). Most RNs were female (92.3%), were aged ≥50 years (56.4%), were non-Hispanic White (78.3%), were married/partnered (68.0%), provided direct care (44%), and had full practice scope (71.7%). FENs versus USENs had a higher proportion reporting full scope of practice (80.7% vs. 71.0%, p = .0155). The mean human capital score for the total sample was 9.8 ± 1.3. Human capital scores were higher among FENs (M = 11.3, SD = 1.2) than USENs (M = 9.6, SD = 1.3, p < .0001).

Conclusion

FENs bring a higher level of human capital to LTC settings, which suggests that they have an increased capacity to provide the needed person-centered care to positively impact care quality and improve outcomes in LTC.

Background

Artificial intelligence (AI) refers to a broad group of technologies that are increasingly commonplace in everyday life; however, they have had only limited application in regulatory practice.

Purpose

The present study explored nursing regulators’ perceptions of the role and value of AI in regulation and potential barriers and facilitators to the uptake and implementation of AI.

Methods

Three facilitated focus group sessions with 28 representatives of regulators from Australia, the United Kingdom, and the United States were conducted. Content analysis of verbatim transcripts was completed.

Results

Key themes that emerged included (a) interest in how AI could enhance sustainability and improve cost-effectiveness of certain regulatory processes and (b) concerns regarding how the term “artificial intelligence” itself could be problematic. Specific barriers to the uptake of AI in regulation included concerns regarding codification of system bias, negative public perception, and lack of clarity around accountability for decision-making. Facilitators to implementation included enhancing the consistency of processes and improving the decision-making and utility in supporting trend analyses and audit functions.

Conclusion

Additional work in exploring how best to incorporate evolving AI technologies in regulatory practice—and what they should be named—is required, but these findings suggest that promising outcomes may lie ahead.

Background

The COVID-19 pandemic placed intense pressure on nursing regulatory bodies to ensure an adequate healthcare workforce while maintaining public safety.

Purpose

Our objectives were to analyze regulatory bodies’ responses during the pandemic, examine how nursing regulators conceptualize the public interest during a public health crisis, and explore the influence of a public health crisis on the balancing of regulatory principles. We aimed to develop a clearer understanding of regulating during a crisis by identifying themes within regulatory responses.

Methods

We conducted a qualitative comparative case study examining the pandemic responses of eight nursing regulators in three Canadian provinces and three U.S. states. Data were collected from semi-structured interviews with 19 representatives of nursing regulatory bodies and 206 publicly available documents and analyzed thematically.

Results

Five themes were constructed from the data: (1) risk-based responses to reduce regulatory burden; (2) agility and flexibility in regulatory pandemic responses; (3) working with stakeholders for a systems-based approach; (4) valuing consistency in regulatory approaches across jurisdictions; and (5) the pandemic as a catalyst for innovation. Specifically, we identified that the meaning of “public interest” in the context of high workforce demand was a key consideration for regulators.

Conclusion

Our results demonstrate the intensity of effort involved in nursing regulatory responses and the significant contribution of nursing regulation to the healthcare system’s pandemic response. Our results also indicate a shift in thinking around broader public interest issues, beyond the conduct and competence of individual nurses, to include pressing societal issues. Regulators are beginning to grapple with these longer-term issues and policy tensions.

Management of the COVID-19 pandemic required healthcare leaders and frontline workers to rapidly innovate and adjust to a new reality that has forever transformed nursing education and practice. Throughout the pandemic, key stakeholders in Alabama lobbied for transformations in clinical training practice that ultimately improved students’ exposure to clinical environments and alleviated the pressure on practicing nurses and other healthcare workers during pandemic hospitalization surges. The present article highlights the key partners and regulatory innovations that led to these successes in Alabama.

Background: Every two years, the National Council of State Boards of Nursing (NCSBN) and the National Forum of State Nursing Workforce Centers (Forum) conduct the only national-level survey focused on the entire U.S. nursing workforce. The survey generates data on the supply of registered nurses (RNs) and licensed practical nurses/licensed vocational nurses (LPNs/LVNs). These data are especially crucial in providing information on emerging nursing issues, which in 2022, was the impact of the (COVID-19) pandemic on the nursing workforce. Purpose: To provide data critical to planning for enough adequately prepared nurses and ensuring a safe, diverse, and effective healthcare system. Methods: This study used a mixed-mode approach, involving mailing a national, randomized sample survey to licensed RNs and LPNs/LVNs in most jurisdictions, supplemented by a national, randomized sample survey emailed to licensed RNs and LPNs/LVNs in four jurisdictions and data from the e-Notify nurse licensure notification system for five jurisdictions. Data from RN and LPN/LVN respondents were collected between April 11, 2022, and September 30, 2022. Data included nurse demographics, educational attainment, employment, practice characteristics, and trends. Results: The total number of active RN and LPN/LVN licenses in the United States were 5,239,499 and 973,788, respectively. The median age of RNs was 46 years and 47 years for LPNs/LVNs, which reflects a decrease of 6 years for each cohort from the 2020 data. This decline was associated with estimated losses to the workforce of at least 200,000 experienced RNs and 60,000 experienced LPNs/LVNs. An average of 89% of all nurses who maintain licensure are employed in nursing with roughly 70% working full-time. Hospitals and nursing/extended care facilities continue to be the primary practice setting for RNs and LPNs, respectively. Increased proportions of male and Hispanic/Latino nurses have introduced greater racial diversity in the nursing workforce. The nursing workforce is becoming increasingly more educated with more than 70% of RNs holding a baccalaureate degree or higher. More than one-quarter of all nurses report that they plan to leave nursing or retire over the next 5 years. Increased demand from the COVID-19 pandemic and inflation led nursing incomes to rise significantly across the country. Nurses were also specifically asked how the COVID-19 pandemic impacted them, and more than 60% of all nurses reported an increase in their workload because of the pandemic. Conclusion: In the wake of the COVID-19 pandemic, the nursing workforce has undergone a dramatic shift with the loss of hundreds of thousands of experienced RNs and LPNs/LVNs. The nursing workforce has become younger and more diverse with increases reflected for Hispanic/Latino and male nurses. An increasing proportion of the