Journal of Nursing Regulation最新文献

Background

The current global environment has led to increased mobility of nurses—and increasing pressure from governments to recruit more nurses into their workforces.

Purpose

To explore whether transjurisdictional mobility was possible, members of the International Nurse Regulator Collaborative (INRC) participated in research to investigate the possibility of recognizing existing licensure or registration and thereby reducing barriers and allowing for more streamlined mobility between INRC jurisdictions.

Methods

Using a mixed methods, multi-phased, multiple-case study design, regulatory processes and practices were investigated in each jurisdiction; findings were then compared across eight participating jurisdictions. Three research phases moved from a high-level jurisdictional overview, through expected standards underpinning nursing practice, to specific operational processes and outcomes. Issues and challenges in licensing/registering transjurisdictional INRC applicants were identified.

Results

A high level of consistency was found in the expectations, standards, and operational processes across jurisdictions. Challenges existed in relation to requirements for and assessments of educational qualifications despite entry to practice competencies and educational program approval requirements being largely the same. Jurisdictional regulators worked under different legislative frameworks, which may potentially create different challenges and timelines for moving toward transjurisdictional mobility. Balancing mobility with the core regulatory responsibility of maintaining public safety will be a key challenge.

Conclusion

Transjurisdictional mobility could potentially exist between jurisdictions with common regulatory principles, processes, and standards. Applicants moving between these jurisdictions present low risk. Streamlining processes could reduce regulatory workload while maintaining safety to the public.

Background

Boards of nursing need empirical evidence to guide the regulation of simulation in nursing education and to make decisions about how simulation should count toward required clinical hours.

Purpose

The purposes of this study were to (a) compare cognitive learning and patient care performance outcomes between prelicensure nursing students who participated in 4 hours of traditional clinical experience, 2 hours of mannequin-based simulation, or 2 hours of screen-based virtual simulation and (b) examine students’ self-perceptions about the efficacy of each experiential learning activity.

Methods

Participants were randomly assigned to one of three groups: 4 hours of traditional clinical experience, 2 hours of mannequin-based simulation, or 2 hours of screen-based virtual simulation. After completing their first experiential learning activity and posttest assessments, participants completed the two experiential learning activities they were not originally assigned as well as a survey regarding their self-perceptions about the effectiveness of each activity. Learning and patient care performance scores were compared between groups.

Results

There was no significant difference in cognitive learning outcomes between groups. On the measure of patient care performance, students who were randomized to the mannequin-based simulation group performed as well as or significantly better than students who were randomized to the other two groups. Overall, students reported that screen-based virtual simulation was the least effective of the three experiential learning activities in meeting their learning needs.

Conclusion

Additional research is needed to make the most effective and efficient use of our resources for experiential learning in nursing education.

Scope of practice for advanced practice registered nurses (APRNs) varies according to U.S. jurisdiction licensure requirements. Nineteen U.S. jurisdictions currently allow independent practice in all four APRN roles: certified nurse midwife (CNM), certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS). Twenty-six U.S. jurisdictions allow full practice authority for CNPs. APRNs practicing in the remaining U.S. jurisdictions have varying practice restrictions, which are dictated by their state licensure laws. Alabama’s scope and standards of practice restrict all APRN roles. During the initial months of the COVID-19 pandemic, Alabama was one of many U.S. jurisdictions that implemented emergency waivers, thereby expanding the scope of APRN practice and granting increased autonomy to APRNs while caring for more complex patients. Once the pandemic threat lessened, many U.S. jurisdictions, including Alabama, returned to pre-pandemic restrictive scope of practice regulations. Through empirical evidence, we conducted a review of APRN practice before, during, and after the pandemic. The literature included anecdotal reports of safe delivery of healthcare provided by APRNs working under the emergency waivers. The literature revealed that APRNs are prepared to practice to the full extent of their scope of practice and provide high-quality healthcare services to improve access to care. Alabama and other U.S. jurisdictions where APRN practice is restricted should advocate for legislative changes supporting APRN full practice authority commensurate with their educational training and certification.

Background

Understanding alcohol use among nurses may inform interventions related to the coping mechanisms nurses use for workplace stress and trauma. Alcohol use can be caused by a variety of factors and has serious implications on a nurse’s personal health and professional practice. Understanding psychosocial factors and preventive measures may assist in the development of interventions to improve coping mechanisms and reduce the incidence of alcohol misuse.

Purpose

To review the psychosocial factors and preventive measures associated with alcohol use among nurses.

Methods

For this integrative review, systematic searches were conducted in CINAHL, PubMed, PsychNet, and ProQuest Central. Included studies were peer-reviewed and addressed alcohol use among nurses in the United States. Articles were appraised using methods-specific tools indicated by the Whittemore and Knafl framework. Data were extracted and themes identified using constant comparison.

Results

Of 6,214 nonduplicate articles screened, 78 were selected for full-text review and 13 were included after application of inclusion criteria. Synthesis resulted in four themes: (1) occupational stress and trauma, (2) workplace characteristics, (3) mental health implications, and (4) protective factors. The data show that workplace stress and trauma contribute to alcohol use among nurses. Night shifts, rotating shifts, and shift length are factors related to alcohol use, as are mental health problems such as anxiety, depression, trauma, and suicide. Protective factors that reduce alcohol use among nurses include faith, resilience, and perceived organizational support.

Conclusion

Alcohol use among nurses presents challenges for the nursing profession and regulatory bodies with specific and interrelated phenomena related to the role and identity of nurses. A better understanding of these factors through research will facilitate a healthier nursing workforce that is better prepared to take on the rewards and challenges of a nursing career.

Background

The COVID-19 pandemic put extreme stress on an already strained healthcare workforce. Suboptimal work organization, exacerbated by the pandemic, is associated with poor worker, patient, and organizational outcomes. However, there are limited qualitative studies exploring how the interconnections of work organization factors related to shift work, sleep, and work stress influence registered nurses and their work performance in the United States.

Purpose

We sought to understand how nurses perceive work organization factors that impact their performance. Knowledge in this area could direct efforts to implement policies and design tailored interventions to support nurses in the post-pandemic period.

Methods

We used a qualitative descriptive design with the Work, Stress, and Health framework as an overarching guide to understand the interconnectedness of work organization factors, work stress, and outcomes. Participants were randomly assigned to one of two anonymous, asynchronous virtual focus groups (i.e., threaded discussion boards) in 2019. Registered nurses (N = 23) working across the United States were recruited and engaged until data saturation was achieved. Directed content analysis was used to analyze the data.

Results

Findings aligned with the Work, Stress, and Health framework and revealed three themes: (1) “Our Voice Should Matter” (nurses’ desire to have their voices heard in staffing policies); (2) “Tired But Wired” (the harmful cycle of work stress, rumination, and poor sleep); and (3) “We’re Only Human” (nurses’ physical, emotional, and mental exhaustion linked to critical performance impairments).

Conclusion

These findings underscore that high work stress and poor sleep were present before the pandemic and impacted nurses’ perceptions of their performance. As leaders look forward to recovery and work redesign efforts, these findings can guide decision-making and resource allocation for optimal nurse, patient, and organization outcomes.