Journal of Nursing Regulation最新文献

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.

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.