Nursing Outlook最新文献

Background/Purpose

To characterize the representation of racial and ethnic minoritized faculty in leadership positions at the top 50 National Institutes of Health-ranked academic nursing institutions.

Methods

We conducted a cross-sectional observational study to characterize the racial/ethnic composition of academic leaders, including those in diversity, equity, and inclusion (DEI) positions from September 2020 to December 2020.

Discussion

Among the 409 leaders, the sample was predominantly composed of females (86.6%), White leaders (80.9%), affiliated with public institutions (75.1%), and in the southern region (42.1%). Exactly 13.6% were from minoritized groups. Minoritized leaders were less likely to hold dean and higher executive positions than their nonminoritized counterparts (p < .002). DEI leadership positions were mostly concentrated in lower executive positions (e.g., director) and primarily consisted of minoritized leaders (>60%).

Conclusion

Underrepresentation of racial and ethnic minoritized individuals in academic nursing leadership persists, necessitating structural interventions within nursing academia to promote inclusivity. Achieving this goal requires a concerted investment in diversifying academic nursing leadership and ensuring positions that minoritized leaders are in, hold weight.

Background

Doctorate of Nursing Practice preparation is recommended for entry to nurse practitioner (NP) practice but there are few comparative studies, and their designs conflate educational pathways.

Purpose

To investigate time use, functional autonomy, and job outcomes among NPs without a doctorate, NPs whose initial NP preparation and doctorate were separated by 2 or more years, and NPs whose NP preparation and doctorate were concurrent.

Method

We selected all NPs from the 2018 National Sample Survey of Registered Nurses, except those whose doctorates focused on research. We controlled for confounding and applied sample weights to produce nationally representative results.

Discussion

NPs' educational pathways are associated with distinct practice roles and, moving forward, policy should be informed by evidence that accounts for their differences.

Conclusion

Concurrent NPs had higher levels of functional autonomy compared with NPs without a doctorate, but patterns of time use were essentially the same. Separate doctoral education was associated with teaching and administration.

Background

Exploring decolonization in nursing knowledge, particularly through Latin American nursologists, is crucial. Initially focused on underrecognized thought schools in Latin America and the concept of “Cuidado” versus Eurocentric paradigms, this paper extends the discussion on decolonization as potentially colonizing.

Purpose

This paper examines the decolonization discourse in nursing reinforcing colonization, arguing that the nursing metaparadigm remains Eurocentric, neglecting Global South contributions.

Methods

The article critically discusses emerging theoretical ideas and situational theories from Latin America relevant to decolonizing nursing knowledge, providing analysis and proposing decolonization paths in nursing.

Discussion

The paper calls for genuine decolonization, urging Global North scholars to engage with indigenous, marginalized, and non-Western perspectives. It stresses the importance of acknowledging historical injustices, fostering cultural sensitivity, and revising nursing curricula for inclusivity and equity.

Conclusion

Ultimately, the paper advocates for a transformative approach to nursing knowledge that challenges colonial legacies, promoting a more inclusive and equitable field.

Background

The U.S. health system is burdened by rising costs, workforce shortages, and unremitting burnout. Well-being interventions have emerged in response, yet data suggest that the work environment is the problem. Nurse practitioner (NP) burnout is associated with structural and relational factors in the work environment, practice autonomy, and hierarchical leadership.

Purpose

We explore the unique social, cultural, and political environment in which NPs work through the lens of social ecology and present the Social Ecology of Burnout (SEB) framework.

Methods

We review current burnout frameworks in the context of the NP practice environment and discuss the SEB, specifically exploring psychological safety and its influence on burnout.

Findings

Psychological safety, work environment, and policy are presented within the SEB and solutions which empower NPs are considered.

Discussion

Our framework can serve as a guide for future nursing research, practice, and policy.

Background

Nurse practitioners (NPs) can enhance NP care and improve access to care by autonomously managing their patient panels. Yet, its impact on workforce outcomes such as burnout, job satisfaction, and turnover intention remains unexplored.

Purpose

To estimate the impact of NP panel management on workforce outcomes.

Methods

Structural equation modeling was conducted using survey data from 1,244 primary care NPs. NP panel management was categorized into co-managing patients with other providers, both co-managing and autonomously managing, and fully autonomous management.

Discussion

Fully autonomous management led to more burnout than co-managing (B = 0.089, bias-corrected 95% bootstrap confidence interval [0.028, 0.151]). Work hours partially (27%) mediated this relationship. This findings indicate that greater autonomy in panel management among NPs may lead to increased burnout, partially due to longer work hours.

Conclusion

Interventions to reduce work hours could help NPs deliver quality care without burnout.

The National Institute of Health (NIH) policy, Consideration of Sex as a Biological Variable (SABV) in NIH-funded Research (2015), focuses on the expectation that researchers account for the influence of SABV in vertebrate animal and human studies and provide a strong justification for single-sex investigations. When SABV is considered in the research design, data analyses, and reporting, the rigor and reproducibility of the research are elevated and inform best practices and precision health for all people. Additional recommendations include the appropriate use of terminology, integration into curricula, intersection with social determinants of health, and application of sex and gender equity guidelines when disseminating research. This paper is a “call to action” for nurse researchers to lean into and apply this policy’s principles and our recommendations, from the bench to the bedside, to advance the equity and health of all people.

Background

Medicaid payment reforms and delivery model innovations are needed to fully transform U.S. healthcare structuring and provision.

Purpose

To synthesize nurse-led models of care and their implications for improving health care access, quality, and reducing costs for Medicaid recipients.

Methods

A critical review of the literature regarding nurse-led models and implications for addressing social determinants of health (SDOH), adopting population health approaches, managing complex care, and integrating behavioral and physical health care within Medicaid.

Discussion

Three interrelated findings emerged (a) investing in dynamic nurse-led models is important for mitigating SDOH and adopting value-based care, (b) regulations preventing nurses from practicing at the fullest extent of their training and licensure limit clinical impact and value, and (c) directed payments can establish value-based expectations for Medicaid managed care.

Conclusion

Adoption of a nurse-led model of care has the potential to advance the goals of reducing inequity and promoting whole-person health within Medicaid and nationally.

Background

Fear tactics were used in the pandemic of Coronavirus Disease 2019.

Purpose

We tested how messaging style, fear vs. hope, and differences in age and political affiliation related to intentions to engage in preventive behaviors during Coronavirus Disease 2019.

Methods

Participants (N = 606) aged 18 to 94 were randomly assigned to receive health messages that emphasized the dangers of the virus (fear messages) or the ability of health behaviors to mitigate the impact of the virus (hope messages). The primary outcome was health behavior intentions.

Discussion

Hope messaging rather than fear messaging promoted health behavior intentions with no moderation by age or political affiliation. Older and Democratic-identified adults had higher health behavior intentions. Health behaviors were mediated by death anxiety and perceived credibility of the messages.

Conclusion

Tailored hope messaging may improve health behaviors by increasing the credibility of messages.