Pub Date : 2022-07-01DOI: 10.1016/S2155-8256(22)00062-X
Nicole Kaminski-Ozturk PhD, Richard Smiley MS, Elizabeth Zhong PhD, Brendan Martin PhD
Background
Concerns about the competence of repeat NCLEX test takers have persisted, resulting in a patchwork of regulatory policies that limit the number of test attempts or the conditions under which a candidate can retest in certain U.S. jurisdictions.
Purpose
To examine possible corrolaries between repeat test-taker status and future practice discipline and to investigate the relationship between time-to-test and repeat testing.
Methods
Data were collected on nearly a quarter of a million registered nurse (RN) and practical nurse (PN) NCLEX candidates who passed the examination between 2013 and 2017. Multivariable generalized estimating equation models were used to assess the likelihood of discipline (0, 1) and the need for repeat testing (0, 1). Propensity score matching was employed to address initial group imbalance on all available covariates for models assessing discipline.
Results
The rate of discipline among the RN (1.0%, n = 2,029) and PN (1.8%, n = 749) samples was low. After applying propensity score matching, repeat test-taker status was found to be weakly aligned with practice discipline for RNs (p = .047) but was not correlated for PNs (p = .13). In contrast, adjusting for sex, race, ethnicity, and age, RN candidates who delayed taking the test for 60 days were 5% more likely to need to retake the NCLEX (p < .001). For PN candidates, a delay of 90 days was associated with a 9% increase in the likelihood of needing to retake the NCLEX (p < .001).
Conclusion
Empirical evidence supports the comparable safety profile of single– and multi–test-taker groups, underscoring the need to revaluate restrictions that limit the conditions under which candidates can retest. Furthermore, ongoing outreach to nursing programs to emphasize the importance of prompt NCLEX testing and the possible deleterious effects of delays, by even a few months, is important.
对复读NCLEX考试考生能力的担忧一直存在，导致监管政策的拼凑，限制考试次数或考生可以在某些美国司法管辖区重新考试的条件。目的探讨复试者状态与未来执业纪律之间可能存在的相关性，并调查复试时间与复试之间的关系。方法收集2013年至2017年通过NCLEX考试的近25万注册护士(RN)和执业护士(PN)考生的数据。使用多变量广义估计方程模型来评估学科的可能性(0,1)和重复检验的必要性(0,1)。倾向得分匹配用于解决评估学科模型中所有可用协变量的初始组不平衡。结果RN (1.0%， n = 2029)和PN (1.8%， n = 749)样本的纪律性较低。应用倾向得分匹配后，发现重复考生状态与RNs的练习纪律弱相关(p = 0.047)，但与PNs无关(p = 0.13)。相比之下，调整性别、种族、民族和年龄后，延迟60天参加考试的注册护士考生需要重新参加NCLEX考试的可能性增加了5% (p <措施)。对于PN考生来说，延迟90天需要重新参加NCLEX考试的可能性增加9% (p <措施)。结论:经验证据支持单考生组和多考生组的可比性安全性，强调有必要重新评估限制考生复试条件的限制。此外，不断扩大护理项目，强调及时进行NCLEX检测的重要性，以及即使延迟几个月也可能产生的有害影响，这是很重要的。
{"title":"A Retrospective Review of NCLEX Candidates’ Testing Behavior: Examining the Relationship Between Repeat Testing, Time-to-Test, and Discipline","authors":"Nicole Kaminski-Ozturk PhD, Richard Smiley MS, Elizabeth Zhong PhD, Brendan Martin PhD","doi":"10.1016/S2155-8256(22)00062-X","DOIUrl":"10.1016/S2155-8256(22)00062-X","url":null,"abstract":"<div><h3>Background</h3><p>Concerns about the competence of repeat NCLEX test takers have persisted, resulting in a patchwork of regulatory policies that limit the number of test attempts or the conditions under which a candidate can retest in certain U.S. jurisdictions.</p></div><div><h3>Purpose</h3><p>To examine possible corrolaries between repeat test-taker status and future practice discipline and to investigate the relationship between time-to-test and repeat testing.</p></div><div><h3>Methods</h3><p>Data were collected on nearly a quarter of a million registered nurse (RN) and practical nurse (PN) NCLEX candidates who passed the examination between 2013 and 2017. Multivariable generalized estimating equation models were used to assess the likelihood of discipline (0, 1) and the need for repeat testing (0, 1). Propensity score matching was employed to address initial group imbalance on all available covariates for models assessing discipline.</p></div><div><h3>Results</h3><p>The rate of discipline among the RN (1.0%, <em>n</em> = 2,029) and PN (1.8%, <em>n</em> = 749) samples was low. After applying propensity score matching, repeat test-taker status was found to be weakly aligned with practice discipline for RNs (<em>p</em> = .047) but was not correlated for PNs (<em>p</em> = .13). In contrast, adjusting for sex, race, ethnicity, and age, RN candidates who delayed taking the test for 60 days were 5% more likely to need to retake the NCLEX (<em>p</em> < .001). For PN candidates, a delay of 90 days was associated with a 9% increase in the likelihood of needing to retake the NCLEX (<em>p</em> < .001).</p></div><div><h3>Conclusion</h3><p>Empirical evidence supports the comparable safety profile of single– and multi–test-taker groups, underscoring the need to revaluate restrictions that limit the conditions under which candidates can retest. Furthermore, ongoing outreach to nursing programs to emphasize the importance of prompt NCLEX testing and the possible deleterious effects of delays, by even a few months, is important.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41425240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1016/S2155-8256(22)00059-X
Tracey L. Adams PhD
Background
In Canada and the United Kingdom, there is discussion about amalgamating nursing and other professional regulatory bodies to improve efficiency; however, there is a dearth of research on the advantages and disadvantages of amalgamation.
Purpose
To begin to address this gap, this article explores Canadian regulatory leaders’ views about professional regulator amalgamation.
Methods
In-depth interviews were conducted with 83 Canadian regulatory leaders (in regulatory bodies, government, and other related roles). Qualitative description analyses were conducted on interview transcripts.
Results
Participants identified several advantages of amalgamation, believing it was valuable for small, under-resourced regulators, as well as for regulators in the same field, such as nursing and oral healthcare. Some participants anticipated improvements in regulatory effectiveness that would benefit regulators, governments, and society. However, participants also raised concerns about amalgamation: prioritizing efficiency over effectiveness, lack of evidence of success, and concerns about inequality. Participants also provided advice to facilitate amalgamation.
Conclusion
Limited evidence and conflicting views on this regulatory change encourage caution among those pursuing amalgamation of professional regulators. It is clear that collaboration is key to successful amalgamation; thus, it should not be forced or mandated.
{"title":"Amalgamation of Professional Regulators: Conflicting Perceptions and Beliefs Among Canadian Regulatory Leaders","authors":"Tracey L. Adams PhD","doi":"10.1016/S2155-8256(22)00059-X","DOIUrl":"10.1016/S2155-8256(22)00059-X","url":null,"abstract":"<div><h3>Background</h3><p>In Canada and the United Kingdom, there is discussion about amalgamating nursing and other professional regulatory bodies to improve efficiency; however, there is a dearth of research on the advantages and disadvantages of amalgamation.</p></div><div><h3>Purpose</h3><p>To begin to address this gap, this article explores Canadian regulatory leaders’ views about professional regulator amalgamation.</p></div><div><h3>Methods</h3><p>In-depth interviews were conducted with 83 Canadian regulatory leaders (in regulatory bodies, government, and other related roles). Qualitative description analyses were conducted on interview transcripts.</p></div><div><h3>Results</h3><p>Participants identified several advantages of amalgamation, believing it was valuable for small, under-resourced regulators, as well as for regulators in the same field, such as nursing and oral healthcare. Some participants anticipated improvements in regulatory effectiveness that would benefit regulators, governments, and society. However, participants also raised concerns about amalgamation: prioritizing efficiency over effectiveness, lack of evidence of success, and concerns about inequality. Participants also provided advice to facilitate amalgamation.</p></div><div><h3>Conclusion</h3><p>Limited evidence and conflicting views on this regulatory change encourage caution among those pursuing amalgamation of professional regulators. It is clear that collaboration is key to successful amalgamation; thus, it should not be forced or mandated.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47742448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1016/S2155-8256(22)00061-8
Ellen T. Kurtzman PhD, MPH, RN, FAAN, Lauren V. Ghazal PhD, FNP-BC, Shirley Girouard PhD, RN, FAAN, Chenjuan Ma PhD, MSN, Barbara Martin PhD, ACNP-MPH, Blake T. McGee PhD, MPH, RN, Colleen A. Pogue PhD, RN, Kathryn A. Riman PhD, RN, Maggie C. Root MSN, RN, CPNP-AC, CHPPN, Amelia E. Schlak PhD, RN, Jamie M. Smith PhD, RN, Deonni P. Stolldorf PhD, RN, Jacqueline Nikpour Townley PhD, RN, Eleanor Turi MPhil, BSN, RN, CCRN, Hay-ley Germack PhD, MHS, RN
{"title":"Nursing Workforce Challenges in the Postpandemic World","authors":"Ellen T. Kurtzman PhD, MPH, RN, FAAN, Lauren V. Ghazal PhD, FNP-BC, Shirley Girouard PhD, RN, FAAN, Chenjuan Ma PhD, MSN, Barbara Martin PhD, ACNP-MPH, Blake T. McGee PhD, MPH, RN, Colleen A. Pogue PhD, RN, Kathryn A. Riman PhD, RN, Maggie C. Root MSN, RN, CPNP-AC, CHPPN, Amelia E. Schlak PhD, RN, Jamie M. Smith PhD, RN, Deonni P. Stolldorf PhD, RN, Jacqueline Nikpour Townley PhD, RN, Eleanor Turi MPhil, BSN, RN, CCRN, Hay-ley Germack PhD, MHS, RN","doi":"10.1016/S2155-8256(22)00061-8","DOIUrl":"10.1016/S2155-8256(22)00061-8","url":null,"abstract":"","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9299514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9318754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1016/S2155-8256(22)00066-7
Fairouz Alhourani RN, MSN, PhD, Francis Byron Opinion RN, MAN, Asha Raj Sudha RN, MSN, MA, PhD, Maha O. Mihdawi RN, MSN, Vishnu Renjith RN, MSN, PhD
Background
Nurses constitute the vast majority of the healthcare workers, but it is unclear how frequently they encounter ethical dilemmas in Bahrain. Thus, there is a need for nurse administrators in Bahrain to understand the ethical dilemmas their nursing staff may face.
Purpose
The study aimed to explore the ethical dilemmas experienced by nurses in Bahrain and to identify any associations between ethical dilemmas with nurse characteristics.
Methods
A descriptive cross-sectional survey design was undertaken. The setting was inpatient nursing units and the emergency department of a tertiary hospital in Bahrain. Data were collected from nurse participants through convenience sampling from July to August 2020 by using an online 24-item Ethical Dilemma Questionnaire (EDQ) on a 7-point (0-6) Likert scale. Ethical approval for the study was obtained from the hospital’s institutional review board.
Results
Among the 390 participating nurses, the mean (SD) EDQ score was 1.24 (0.80), indicating a low overall frequency of ethical dilemmas (between less than a few times per year and up to once per month). The subdomains were patients’ actions and decisions, nursing care provisions, personal and collegial actions and decisions, and sharing of information. The participants’ characteristics that were found to be statistically significant were gender, nationality, and department of work. Age was found to be negatively correlated. However, nurses’ EDQ scores based on job category and years of experience were not found to have a statistically significant difference.
Conclusion
Although nurses had infrequent encounters with ethical dilemmas, they reported more dilemmas when facing low nurse-patient ratios, contesting a prescription order, working with nonresponsive physicians, dealing with patients’ lifestyle choices, and handling nonnursing tasks.
{"title":"Ethical Dilemma Experiences of Nurses in a Tertiary Hospital, Kingdom of Bahrain: A Cross-sectional Survey","authors":"Fairouz Alhourani RN, MSN, PhD, Francis Byron Opinion RN, MAN, Asha Raj Sudha RN, MSN, MA, PhD, Maha O. Mihdawi RN, MSN, Vishnu Renjith RN, MSN, PhD","doi":"10.1016/S2155-8256(22)00066-7","DOIUrl":"10.1016/S2155-8256(22)00066-7","url":null,"abstract":"<div><h3>Background</h3><p>Nurses constitute the vast majority of the healthcare workers, but it is unclear how frequently they encounter ethical dilemmas in Bahrain. Thus, there is a need for nurse administrators in Bahrain to understand the ethical dilemmas their nursing staff may face.</p></div><div><h3>Purpose</h3><p>The study aimed to explore the ethical dilemmas experienced by nurses in Bahrain and to identify any associations between ethical dilemmas with nurse characteristics.</p></div><div><h3>Methods</h3><p><span>A descriptive cross-sectional survey design was undertaken. The setting was inpatient nursing units and the emergency department<span> of a tertiary hospital in Bahrain. Data were collected from nurse participants through convenience sampling from July to August 2020 by using an online 24-item Ethical Dilemma Questionnaire (EDQ) on a 7-point (0-6) </span></span>Likert scale. Ethical approval for the study was obtained from the hospital’s institutional review board.</p></div><div><h3>Results</h3><p>Among the 390 participating nurses, the mean (SD) EDQ score was 1.24 (0.80), indicating a low overall frequency of ethical dilemmas (between less than a few times per year and up to once per month). The subdomains were patients’ actions and decisions, nursing care provisions, personal and collegial actions and decisions, and sharing of information. The participants’ characteristics that were found to be statistically significant were gender, nationality, and department of work. Age was found to be negatively correlated. However, nurses’ EDQ scores based on job category and years of experience were not found to have a statistically significant difference.</p></div><div><h3>Conclusion</h3><p>Although nurses had infrequent encounters with ethical dilemmas, they reported more dilemmas when facing low nurse-patient ratios, contesting a prescription order, working with nonresponsive physicians, dealing with patients’ lifestyle choices, and handling nonnursing tasks.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44671564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1016/S2155-8256(22)00063-1
Ellen T. Kurtzman PhD, MPH, RN, FAAN, Jessica Greene PhD, Robyn Begley DNP, RN, FAAN, Karen Neil Drenkard PhD, RN, FAAN
Background
As more states in the United States legalize marijuana for medical use, nurse leaders will play increasingly important roles in patients’ access to and use of medical marijuana.
Purpose
To examine nurse leaders’ attitudes toward and experiences with medical marijuana by state policy environment.
Methods
We conducted a national, online, cross-sectional survey of nurse leaders who were recruited through the American Organization for Nursing Leadership (n = 811). Descriptive statistics were used to examine the prevalence of responses to each item.
Results
The majority of respondents worked in inpatient settings or health systems. Nearly 90% of nurse leaders thought that people should be able to use marijuana legally to treat their medical conditions, 67% believed that nurses should facilitate access to medical marijuana for patients who would benefit from its use, and 78% agreed that state and national nursing organizations should help reduce the stigma associated with the drug. Two-thirds of nurse leaders viewed medical marijuana as less dangerous than other drugs for treating pain and viewed legalization as leading to safer marijuana products (e.g., ensuring it is not laced with other substances) and enabling clinicians to be responsive to patient preferences. In states that had legalized medical marijuana, the absence of institutional policies and clinical guidelines about medical marijuana were identified by most respondents as significant barriers to patients’ legal use of it in healthcare settings. Fourteen percent of nurse leaders were aware of NCSBN’s National Nursing Guidelines for Medical Marijuana. The vast majority of respondents (85%) believed that education about medical marijuana should be provided in prelicensure nursing education programs.
Conclusion
Nurse leaders were supportive of legalization and viewed nurses and nursing organizations as central to patients’ acceptance of, access to, and use of medical marijuana. Nurse leaders acknowledged that they lacked education and were unaware of existing guidelines on the topic.
{"title":"Nurse Leaders’ Attitudes Toward and Experiences With Medical Marijuana","authors":"Ellen T. Kurtzman PhD, MPH, RN, FAAN, Jessica Greene PhD, Robyn Begley DNP, RN, FAAN, Karen Neil Drenkard PhD, RN, FAAN","doi":"10.1016/S2155-8256(22)00063-1","DOIUrl":"10.1016/S2155-8256(22)00063-1","url":null,"abstract":"<div><h3>Background</h3><p>As more states in the United States legalize marijuana for medical use, nurse leaders will play increasingly important roles in patients’ access to and use of medical marijuana.</p></div><div><h3>Purpose</h3><p>To examine nurse leaders’ attitudes toward and experiences with medical marijuana by state policy environment.</p></div><div><h3>Methods</h3><p>We conducted a national, online, cross-sectional survey of nurse leaders who were recruited through the American Organization for Nursing Leadership (<em>n</em> = 811). Descriptive statistics were used to examine the prevalence of responses to each item.</p></div><div><h3>Results</h3><p><span>The majority of respondents worked in inpatient settings or health systems<span><span>. Nearly 90% of nurse leaders thought that people should be able to use marijuana legally to treat their medical conditions, 67% believed that nurses should facilitate access to medical marijuana for patients who would benefit from its use, and 78% agreed that state and national nursing organizations should help reduce the stigma associated with the </span>drug. Two-thirds of nurse leaders viewed medical marijuana as less dangerous than other drugs for treating pain and viewed legalization as leading to safer marijuana products (e.g., ensuring it is not laced with other substances) and enabling clinicians to be responsive to patient preferences. In states that had legalized medical marijuana, the absence of institutional policies and clinical guidelines about medical marijuana were identified by most respondents as significant barriers to patients’ legal use of it in healthcare settings. Fourteen percent of nurse leaders were aware of NCSBN’s </span></span><em>National Nursing Guidelines for Medical Marijuana</em><span>. The vast majority of respondents (85%) believed that education about medical marijuana should be provided in prelicensure nursing education programs.</span></p></div><div><h3>Conclusion</h3><p>Nurse leaders were supportive of legalization and viewed nurses and nursing organizations as central to patients’ acceptance of, access to, and use of medical marijuana. Nurse leaders acknowledged that they lacked education and were unaware of existing guidelines on the topic.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47771277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1016/S2155-8256(22)00067-9
Elizabeth H. Zhong PhD, Brendan Martin PhD
Background
Boards of nursing (BONs) investigate complaints and take disciplinary actions against the licenses of nurses in order to maintain patient safety. For nurses with prior criminal convictions, the potential risks to patient safety have not been formally evaluated.
Objective
This study aims to assess the impact of a nurse’s prior criminal conviction(s) on the risk of recidivism in nursing practice and to investigate whether nurses who were disciplined by BONs for a crime but retained an active nursing license posed a subsequent risk to public safety.
Methods
We reviewed Nursys discipline data from 2008–2018 to compare the risk of recidivism for nurses sanctioned for criminal convictions between 2012–2013 and those disciplined for other violations. The type of crimes and disciplinary actions taken by BONs were recoded and analyzed.
Results
The 5-year recidivism rate of nurses who received disciplinary actions for criminal convictions between 2012 and 2013 was 38%, which is comparable to the recidivism rate among nurses in the control group (36%). Overall, among those who had a criminal conviction history yet retained an active license, 4% committed a practice-related violation or crime within the 5-year postdisciplinary period. Three factors correlated with recidivism: (1) committing a crime related to substance use disorder, (2) committing a crime related to nursing practice, and (3) committing multiple crimes.
Conclusion
The majority of nurses who were disciplined by BONs for a criminal conviction and allowed to remain in nursing practice did not receive additional disciplinary actions by BONs for committing subsequent practice-related violations or crimes during the 5-year post disciplinary period. The current study suggests that the licensure and discipline procedures used by BONs in response to criminal convictions help to reduce the risk of patient harm in nursing practice, thereby aligning with their mission of public protection.
{"title":"Risk Factors for Recidivism in Nursing Practice: A Criminal Conviction Case Review Cohort Study","authors":"Elizabeth H. Zhong PhD, Brendan Martin PhD","doi":"10.1016/S2155-8256(22)00067-9","DOIUrl":"10.1016/S2155-8256(22)00067-9","url":null,"abstract":"<div><h3>Background</h3><p>Boards of nursing (BONs) investigate complaints and take disciplinary actions against the licenses of nurses in order to maintain patient safety. For nurses with prior criminal convictions, the potential risks to patient safety have not been formally evaluated.</p></div><div><h3>Objective</h3><p>This study aims to assess the impact of a nurse’s prior criminal conviction(s) on the risk of recidivism in nursing practice and to investigate whether nurses who were disciplined by BONs for a crime but retained an active nursing license posed a subsequent risk to public safety.</p></div><div><h3>Methods</h3><p>We reviewed Nursys discipline data from 2008–2018 to compare the risk of recidivism for nurses sanctioned for criminal convictions between 2012–2013 and those disciplined for other violations. The type of crimes and disciplinary actions taken by BONs were recoded and analyzed.</p></div><div><h3>Results</h3><p>The 5-year recidivism rate of nurses who received disciplinary actions for criminal convictions between 2012 and 2013 was 38%, which is comparable to the recidivism rate among nurses in the control group (36%). Overall, among those who had a criminal conviction history yet retained an active license, 4% committed a practice-related violation or crime within the 5-year postdisciplinary period. Three factors correlated with recidivism: (1) committing a crime related to substance use disorder, (2) committing a crime related to nursing practice, and (3) committing multiple crimes.</p></div><div><h3>Conclusion</h3><p>The majority of nurses who were disciplined by BONs for a criminal conviction and allowed to remain in nursing practice did not receive additional disciplinary actions by BONs for committing subsequent practice-related violations or crimes during the 5-year post disciplinary period. The current study suggests that the licensure and discipline procedures used by BONs in response to criminal convictions help to reduce the risk of patient harm in nursing practice, thereby aligning with their mission of public protection.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48783017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1016/S2155-8256(22)00060-6
Maryann Alexander PhD, RN, FAAN (Editor-in-Chief)
{"title":"Preventing Tragedies Through Shared Learning","authors":"Maryann Alexander PhD, RN, FAAN (Editor-in-Chief)","doi":"10.1016/S2155-8256(22)00060-6","DOIUrl":"10.1016/S2155-8256(22)00060-6","url":null,"abstract":"","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42750379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1016/S2155-8256(22)00036-9
Rebecca Fotsch JD
{"title":"Who to Believe? Consequences for Physicians and Nurses Who Spread Misinformation","authors":"Rebecca Fotsch JD","doi":"10.1016/S2155-8256(22)00036-9","DOIUrl":"10.1016/S2155-8256(22)00036-9","url":null,"abstract":"","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2155825622000369/pdfft?md5=40ecc320af86cbfd138bf5c542893358&pid=1-s2.0-S2155825622000369-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44703689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deployment of nurse practitioners (NPs) to health professional shortage areas (HPSA) may help to address challenges in patient access to care. However, restrictive scope of practice imposed by regulatory and state legislative bodies or unsupportive organizational climates in clinical practice settings may constrain NP care delivery and perpetuate lower assessments of quality of care provided in these underserved communities.
Purpose
The purpose of this study was to investigate the associations between state NP scope of practice regulations, NP practice environment, and self-reported ratings of quality of care in primary care practices located in HPSAs.
Methods
This was a cross-sectional analysis of data from 1,972 participant NPs practicing across 1,711 primary care practices in six states representing full (Arizona and Washington), reduced (Pennsylvania and New Jersey), and restricted (California and Florida) NP scope of practice regulation. Survey data were merged with the Area Health Resource Files to determine practices located in primary care HPSAs. Logistic regression models estimated the relationship between quality ratings, scope of practice regulations, and practice environment scores while accounting for NP and practice characteristics.
Results
Among all included NPs, 95.7% rated their practice as having “excellent,” “very good,” or “good” quality of care. Practice environments with higher scores had higher ratings of quality of care after accounting for NP and practice characteristics (OR = 3.73, 95% CI: 2.84, 4.89).
Conclusion
Unsupportive clinical practice environments were associated with lower ratings of quality of care in HPSAs, suggesting that improvements in working conditions may be necessary adjuncts to greater deployment of NPs to improve primary care in shortage areas.
{"title":"Supportive Practice Environments Are Associated With Higher Quality Ratings Among Nurse Practitioners Working in Underserved Areas","authors":"Margo Brooks Carthon PhD, APRN, FAAN, Heather Brom PhD, NP-C, Jacqueline Nikpour PhD, RN, Barbara Todd DNP, CRNP, FAANP, Linda Aiken PhD, FAAN, Lusine Poghosyan PhD, MPH, RN, FAAN","doi":"10.1016/S2155-8256(22)00028-X","DOIUrl":"10.1016/S2155-8256(22)00028-X","url":null,"abstract":"<div><h3>Background</h3><p><span>Deployment of nurse practitioners (NPs) to health professional shortage areas (HPSA) may help to address challenges in patient access to care. However, restrictive </span>scope of practice imposed by regulatory and state legislative bodies or unsupportive organizational climates in clinical practice settings may constrain NP care delivery and perpetuate lower assessments of quality of care provided in these underserved communities.</p></div><div><h3>Purpose</h3><p>The purpose of this study was to investigate the associations between state NP scope of practice regulations, NP practice environment, and self-reported ratings of quality of care in primary care practices located in HPSAs.</p></div><div><h3>Methods</h3><p>This was a cross-sectional analysis of data from 1,972 participant NPs practicing across 1,711 primary care practices in six states representing full (Arizona and Washington), reduced (Pennsylvania and New Jersey), and restricted (California and Florida) NP scope of practice regulation. Survey data were merged with the Area Health Resource<span> Files to determine practices located in primary care HPSAs. Logistic regression models estimated the relationship between quality ratings, scope of practice regulations, and practice environment scores while accounting for NP and practice characteristics.</span></p></div><div><h3>Results</h3><p>Among all included NPs, 95.7% rated their practice as having “excellent,” “very good,” or “good” quality of care. Practice environments with higher scores had higher ratings of quality of care after accounting for NP and practice characteristics (OR = 3.73, 95% CI: 2.84, 4.89).</p></div><div><h3>Conclusion</h3><p>Unsupportive clinical practice environments were associated with lower ratings of quality of care in HPSAs, suggesting that improvements in working conditions may be necessary adjuncts to greater deployment of NPs to improve primary care in shortage areas.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9316781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1016/S2155-8256(22)00032-1
Jacqueline Nikpour PhD, RN, Marion Broome PhD, RN, FAAN, Susan Silva PhD, Kelli D. Allen PhD
Background
Chronic pain disproportionately impacts veterans and is often treated in primary care, where physician shortages in the Veterans Health Administration (VHA) healthcare system are well documented. Nurse practitioners (NPs) may represent a solution to the care shortage; however, concerns of NP opioid overprescribing have led to NP practice and prescribing restrictions in individual VHA facilities and at the state level. Little is known regarding the prescribing patterns of NPs and physician assistants (PAs) for veterans with chronic pain in the VHA.
Purpose
The purpose of this study was to compare opioid and non-opioid prescribing patterns of physicians, NPs, and PAs for chronic pain patients at VHA centers.
Methods
We used data from the U.S. Department of Veterans Affairs Survey of Healthcare Experience of Patients and Corporate Data Warehouse from October 2015 to September 2016. Patient medical records for the year were analyzed by provider type (physician, NP, or PA) for differences in providers’ rates of prescribing opioid and non-opioid medications, as well as characteristics of the opioid prescriptions (e.g., high daily morphine milligram equivalent [90 MME/day] dose, long-term opioid therapy [90 days]).
Results
Medical records of a total of 39,936 patients were included. In FY 2016, 55% of patients received one opioid prescription, whereas 83.8% received one non-opioid prescription. Compared to patients of NPs and PAs, patients of physicians had higher odds of receiving opioid (vs. NPs: OR = 1.13, p < 0.01; vs. PAs: OR = 1.16, p < 0.01) and non-opioid prescriptions (vs. NPs: OR = 1.08, p = 0.02; vs. PAs: OR = 1.20, p < 0.01) after adjusting for patient characteristics. There were no differences in high MME/day dose (p = 0.59) or long-term opioid therapy (p = 0.99).
Conclusion
In a national sample of veterans with chronic pain, NPs and PAs did not have higher odds of opioid prescribing. Concerns of NP or PA opioid overprescribing may be addressed by considering evidence that patients of these providers are not at higher odds of receiving an opioid prescription.
慢性疼痛对退伍军人的影响尤为严重，通常在初级保健中治疗，而退伍军人健康管理局(VHA)医疗保健系统的医生短缺是有据可查的。执业护士(NPs)可能代表护理短缺的解决方案;然而，对NP阿片类药物过度处方的担忧导致了个体VHA设施和州一级的NP实践和处方限制。关于NPs和医师助理(PAs)在VHA慢性疼痛退伍军人的处方模式知之甚少。目的本研究的目的是比较VHA中心慢性疼痛患者的医生、NPs和PAs的阿片类药物和非阿片类药物处方模式。方法使用2015年10月至2016年9月美国退伍军人事务部患者医疗体验调查和企业数据仓库的数据。按提供者类型(医生、NP或PA)分析该年的患者医疗记录，以了解提供者开具阿片类药物和非阿片类药物处方率的差异，以及阿片类药物处方的特征(例如，每日高吗啡毫克当量[90 MME/天]剂量，长期阿片类药物治疗[90天])。结果共纳入39936例患者的病历。在2016财年，55%的患者接受了一次阿片类药物处方，而83.8%的患者接受了一次非阿片类药物处方。与NPs和PAs患者相比，内科医生患者接受阿片类药物的几率更高(与NPs相比:OR = 1.13, p <0.01;vs. PAs: OR = 1.16, p <0.01)和非阿片类药物处方(相对于NPs: OR = 1.08, p = 0.02;vs. PAs: OR = 1.20, p <0.01)。高MME/天剂量(p = 0.59)和长期阿片类药物治疗(p = 0.99)无差异。结论在全国范围内患有慢性疼痛的退伍军人样本中，NPs和PAs的阿片类药物处方率并不高。通过考虑这些提供者的患者接受阿片类药物处方的可能性并不高的证据，可以解决NP或PA阿片类药物过度处方的问题。
{"title":"Influence of Primary Care Provider Type on Chronic Pain Management Among Veterans","authors":"Jacqueline Nikpour PhD, RN, Marion Broome PhD, RN, FAAN, Susan Silva PhD, Kelli D. Allen PhD","doi":"10.1016/S2155-8256(22)00032-1","DOIUrl":"10.1016/S2155-8256(22)00032-1","url":null,"abstract":"<div><h3>Background</h3><p><span>Chronic pain disproportionately impacts veterans and is often treated in primary care, where physician shortages in the Veterans </span>Health Administration<span> (VHA) healthcare system are well documented. Nurse practitioners (NPs) may represent a solution to the care shortage; however, concerns of NP opioid overprescribing have led to NP practice and prescribing restrictions in individual VHA facilities and at the state level. Little is known regarding the prescribing patterns of NPs and physician assistants (PAs) for veterans with chronic pain in the VHA.</span></p></div><div><h3>Purpose</h3><p>The purpose of this study was to compare opioid and non-opioid prescribing patterns of physicians, NPs, and PAs for chronic pain patients at VHA centers.</p></div><div><h3>Methods</h3><p><span>We used data from the U.S. Department of Veterans Affairs Survey of Healthcare Experience of Patients and Corporate </span>Data Warehouse<span> from October 2015 to September 2016. Patient medical records for the year were analyzed by provider type (physician, NP, or PA) for differences in providers’ rates of prescribing opioid and non-opioid medications, as well as characteristics of the opioid prescriptions (e.g., high daily morphine milligram equivalent [90 MME/day] dose, long-term opioid therapy [90 days]).</span></p></div><div><h3>Results</h3><p>Medical records of a total of 39,936 patients were included. In FY 2016, 55% of patients received one opioid prescription, whereas 83.8% received one non-opioid prescription. Compared to patients of NPs and PAs, patients of physicians had higher odds of receiving opioid (vs. NPs: OR = 1.13, <em>p</em> < 0.01; vs. PAs: OR = 1.16, <em>p</em> < 0.01) and non-opioid prescriptions (vs. NPs: OR<!--> <!-->=<!--> <!-->1.08, <em>p</em> = 0.02; vs. PAs: OR<!--> <!-->=<!--> <!-->1.20, <em>p</em><span> < 0.01) after adjusting for patient characteristics. There were no differences in high MME/day dose (</span><em>p</em> = 0.59) or long-term opioid therapy (<em>p</em> = 0.99).</p></div><div><h3>Conclusion</h3><p>In a national sample of veterans with chronic pain, NPs and PAs did not have higher odds of opioid prescribing. Concerns of NP or PA opioid overprescribing may be addressed by considering evidence that patients of these providers are not at higher odds of receiving an opioid prescription.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9311854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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