Policy, Politics, and Nursing Practice最新文献

From October 2008 through 2010, journalists Charles Ornstein and Tracey Weber produced for the Los Angeles Times and ProPublica a series of investigative reports on the performance of the California Board of Registered Nursing (BRN), finding that it took an average of 3.5 years to act on complaints of professional misconduct by registered nurses, including sexual assault of patients, substance use, and repeat medication errors that resulted in patients dying. In June 2009, Governor Arnold Schwarzenegger announced that he was firing members of the BRN. Its executive officer resigned shortly thereafter. This case study analyzes interviews with nine participants, including the journalists and individuals who were public and nurse members of the BRN in 2009. Four themes emerged: (1) There is a tension between what are perceived to be the public's interests versus nursing's interests; (2) Political naiveté about government and organizational culture can lead to the personalization of actions directed at institutions; (3) A sense of fatalism may be reinforced by organizational culture; and (4) The role and use of media in a free society may be obscured when one is the focus of investigative journalism. Nurses who seek to operate in the public sector must be grounded in the political realities of complex governmental forces that may appear to be illogical or personally offensive. Media, particularly news media, is a powerful tool for influencing these forces. Nurses should employ strategic approaches to the use of media in order to advance their voices as advocates for the public's interests.

This article seeks to understand the changes in federal health care policy that led to greater telehealth adoption during COVID-19 pandemic. For decades, telehealth was identified as a possibility for increasing health care access, but the policies needed for greater telehealth reimbursement were stalled until the public health emergency was declared. Applying the dynamic concepts within punctuated equilibrium theory (PET) model to traditional fee-for-service Medicare policy, the influential factors are identified and specify how policy change occurred as a response to the pandemic, resulting in swift and large-scale changes in Medicare telehealth reimbursement requirements and widespread telehealth adoption. The model also explains how the same forces that led to Medicare policy response are at work to maintain and broaden or contract and limit the future of telehealth reimbursement as the public health emergency recedes.

The COVID-19 pandemic has been difficult for registered nurses. Media reports, most of them anecdotal, have reported upticks in nurse resignations, and plans to resign and/or leave nursing due to COVID-19. This article reports findings from an online anonymous 95-item survey completed by about 1,600 nurses from a New York City metropolitan area health system's (HS) four hospitals and ambulatory care centers about their COVID-19 experience in the spring of 2020, their intent to stay at the HS, and their intent to stay working as a nurse. Conducted early in the pandemic, this survey addresses a major gap in the literature, as there was no timely evaluation of nurses' intent to leave during the "Great Attrition" wave or to stay during the "Great Attraction" trend. Among those nurses completing the survey, 85.7% reported that they planned to work as a nurse one year later and 77.9% reported that they planned to work at the HS one year later. Those nurses who obtained a master's or doctoral degree as their first professional degree in nursing, or had a high level of mastery, were less likely to report an intent to stay at the HS. Those with no children, those who thought the HS was more supportive, and those who thought that registered nurse-medical doctor relations were higher were more likely to intend to stay at the HS. Those nurses who reported worse communication with their nurse manager were less likely to report an intent to stay in nursing. Those who reported lower stress, who were unmarried and had no children were more likely to intend to work as nurses. Our findings on nurses' intent to leave their organization and their intent to leave nursing are much lower than reports in the popular press. Our data were collected early in the pandemic and it may not reflect the accumulated stress nurses experienced from witnessing the death of so many patients.

Prenatal Care Coordination (PNCC) is a Medicaid fee-for-service that provides reimbursement for supportive services to mothers and infants at high risk of adverse outcomes. Services include health education, care coordination, referral to needed services, and social support. Currently, the implementation of PNCC programs is highly variable. We aimed to identify and describe the contextual factors that influence implementation of PNCC. Using a qualitative descriptive approach and theoretical reflexive thematic analysis techniques, we conducted observation and semistructured interviews with all PNCC staff at two PNCC sites in Wisconsin, representing diversity in region and patient population. We thematically analyzed interview data to examine how contextual factors influenced program implementation with the Consolidated Framework for Implementation Research as a sensitizing model. Observational field notes were used to triangulate interview data. Overall, participants endorsed the goals of PNCC and believed in its potential. However, participants asserted that the external policy context limited their impact. In response, they developed local strategies to combat barriers and work toward better outcomes. Our findings support the need to study the implementation of perinatal public and community health interventions and consider "health in all policies." Several changes would maximize PNCC's impact on maternal health: increased collaboration among policy stakeholders would reduce barriers; increased reimbursement would enable PNCC providers to better meet the complex needs of clients; and expansions in postpartum Medicaid coverage would extend the PNCC eligibility period. Nurses who provide PNCC have unique insights that should be leveraged to inform maternal-child health policy.

Criminalizing homelessness is ineffective, costly, and immoral; yet it remains a dominant feature in the management of this global social issue. There has been little analysis investigating why punitive homeless policies have remained popular despite their ineffectiveness. In applying Bacchi's What's the Problem Represented to Be (WPR) framework to a Canadian encampment bylaw, our analysis demonstrated that public policies criminalizing homelessness continue to prevail because homelessness is fundamentally understood as a problem of deviant, criminal individual behavior. We argue that reframing understandings of homelessness from one of criminality to a human rights issue gives way to more dignified, just, and effective solutions, such as the Housing First Model. We suggest that community health nurses can serve a key role in disrupting these criminalizing discourses across domains of policy, research, and practice by advocating for holistic, rights-based, and equity-oriented policy solutions related to homelessness.

Uptake of the COVID-19 vaccine by nurses lags behind that of other health care professionals with minimal empirical evidence to understand this phenomenon. In this secondary analysis, we examined nurses' individual and work-related characteristics and their association with COVID-19 vaccination status. Alumni of three Ohio nursing colleges and members of a professional organization were invited to complete questionnaires from June through August 2021. Logistic regression models were used to evaluate associations between nurse characteristics and vaccination status. Among 844 respondents, 754 (80.30%) had received at least one dose of the vaccine. Older age, having a bachelor's degree or higher, and working in critical care were associated with vaccination. Providing direct care for COVID-19 patients in the last 7 days and a higher perception of one's work being affected by COVID-19 were significantly associated with being vaccinated, whereas prior COVID-19 infection was inversely associated with vaccination status. Our findings suggest that COVID-19 vaccine uptake among nurses is influenced by a host of factors related to virus knowledge, beliefs, and risk perceptions. Awareness of these factors can aid the development of interventions to increase nurses' acceptance of vaccines.

Lack of access to birth facilities and maternity care providers has contributed to rising US maternal mortality and morbidity rates, especially among women in rural areas. Evidence supports the increased use of midwives as a potential solution for access-to-care issues. This observational survey was conducted to identify the practice environment for Certified Nurse-Midwives® in Colorado for the purpose of informing future workforce expansion. Study results indicate that midwives provide services aligned with the midwifery model of care and have mostly autonomous practice in hospitals where midwifery practices are already established. However, there is limited use of midwives, as fewer than half of Colorado's 69 birthing hospitals have midwifery practices, and financial constraint created by low Medicaid reimbursement could be a limiting factor in establishing new midwifery practices. Policy recommendations based on survey results include (a) support for midwifery education and workforce development, (b) removal of hospital-level restrictions for privileges of midwives, and (c) consideration for public payment models that promote expansion of midwifery practices.

Missed nursing care is a multifaceted patient safety issue receiving increased attention among healthcare scholars worldwide. There is limited research on missed nursing care in the Jordanian healthcare context. The current study sought to examine the perceptions of Jordanian nurses toward the amount and types of missed nursing care in medical and surgical wards. We also examined the differences in missed care items between public, private, and university hospitals in Jordan. This was a cross-sectional study using the MISSCARE Survey tool. Data collection spanned 4 months between March and July 2021. The final study sample consisted of 672 registered nurses employed in five public, three private, and two university hospitals in Jordan. Data were analyzed using descriptive statistics, Analysis of variance, and Pearson correlation coefficent test. Of the 672 registered nurses who participated, the majority were females (n = 421; 62.6%). Most participants held a bachelor's degree in nursing (n = 577; 85.9%). The three most common missed nursing activities in the participating hospitals were: ambulation, oral care, and emotional support. Nurses working in public hospitals reported the highest missed nursing care. The age and number of patients under care significantly correlated with missed nursing care. The findings could help nursing managers develop plans to reduce missed nursing care in their healthcare institutions.