Pub Date : 2025-11-01DOI: 10.1016/j.outlook.2025.102549
Catherine L. Gilliss PhD, FAAN , Paula Milone-Nuzzo PhD, RN, FHHC, FAAN
Background
Nursing leadership is often viewed as the exclusive responsibility assigned to formal leadership roles. Our work suggests that important changes are being led by nurses, regardless of their assigned roles.
Purpose
By presenting a framework of leadership, we illustrate how nurses lead meaningful change.
Methods
Case studies from nurses in leadership roles from around the globe provided affirming examples of the relevance of the Strategic Leadership Framework. Case studies were analyzed to identify key concepts for leading change beyond traditional settings.
Discussion
The key leadership activities of understanding culture and context, effective communication and collaboration provide the foundation for the Strategic Leadership Framework.
Conclusions
These cases provide beginning confirmatory evidence of the relevance of the framework and illustrate the ways in which nurses without formal leadership titles lead outside of the organizational settings. Specifically, the framework points to the importance of considering context, leveraging collaboration and communication, and using strategic leadership interventions to bring about meaningful change.
{"title":"Rethinking global nursing leadership: The Strategic Leadership Framework","authors":"Catherine L. Gilliss PhD, FAAN , Paula Milone-Nuzzo PhD, RN, FHHC, FAAN","doi":"10.1016/j.outlook.2025.102549","DOIUrl":"10.1016/j.outlook.2025.102549","url":null,"abstract":"<div><h3>Background</h3><div>Nursing leadership is often viewed as the exclusive responsibility assigned to formal leadership roles. Our work suggests that important changes are being led by nurses, regardless of their assigned roles.</div></div><div><h3>Purpose</h3><div>By presenting a framework of leadership, we illustrate how nurses lead meaningful change.</div></div><div><h3>Methods</h3><div>Case studies from nurses in leadership roles from around the globe provided affirming examples of the relevance of the Strategic Leadership Framework. Case studies were analyzed to identify key concepts for leading change beyond traditional settings.</div></div><div><h3>Discussion</h3><div>The key leadership activities of understanding culture and context, effective communication and collaboration provide the foundation for the Strategic Leadership Framework.</div></div><div><h3>Conclusions</h3><div>These cases provide beginning confirmatory evidence of the relevance of the framework and illustrate the ways in which nurses without formal leadership titles lead outside of the organizational settings. Specifically, the framework points to the importance of considering context, leveraging collaboration and communication, and using strategic leadership interventions to bring about meaningful change.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 6","pages":"Article 102549"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Advanced nursing practice is expanding across the European Union. Although the International Council of Nurses provides a unified definition, implementation varies widely among member states.
Purpose
To assess advanced practice in the EU and identify similarities and differences in regulation and practice.
Methods
This scoping review followed Joanna Briggs Institute and PRISMA guidelines.
Findings
Of 2,205 studies screened, 184 met eligibility criteria. Advanced nursing practice shows consistent patterns in education, competencies, and practice models but remains fragmented in title recognition, regulation, and specialty development. In some countries, formal structures are still absent.
Discussion
The European Union faces shared public health challenges, particularly long-term care needs. Advanced nursing practice has proven effective in several countries, and European-level recognition could foster broader integration. This review highlights commonalities and national variations, offering comparative insights to guide international policies that strengthen the legitimacy and visibility of advanced practice nurses.
{"title":"Advanced practice nursing in the European Union: A scoping review","authors":"Morin Galfout Sara APN , Schwingrouber Jocelyn RN, PhD , Colson Sébastien RN, PhD","doi":"10.1016/j.outlook.2025.102588","DOIUrl":"10.1016/j.outlook.2025.102588","url":null,"abstract":"<div><h3>Background</h3><div>Advanced nursing practice is expanding across the European Union. Although the International Council of Nurses provides a unified definition, implementation varies widely among member states<strong>.</strong></div></div><div><h3>Purpose</h3><div>To assess advanced practice in the EU and identify similarities and differences in regulation and practice.</div></div><div><h3>Methods</h3><div>This scoping review followed Joanna Briggs Institute and PRISMA guidelines.</div></div><div><h3>Findings</h3><div>Of 2,205 studies screened, 184 met eligibility criteria. Advanced nursing practice shows consistent patterns in education, competencies, and practice models but remains fragmented in title recognition, regulation, and specialty development. In some countries, formal structures are still absent.</div></div><div><h3>Discussion</h3><div>The European Union faces shared public health challenges, particularly long-term care needs. Advanced nursing practice has proven effective in several countries, and European-level recognition could foster broader integration. This review highlights commonalities and national variations, offering comparative insights to guide international policies that strengthen the legitimacy and visibility of advanced practice nurses.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 6","pages":"Article 102588"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.outlook.2025.102591
Vincent Guilamo-Ramos PhD, RN, MPH, LCSW, ANP-BC, PMHNP-BC, FAAN , Adam Benzekri MPH, MS , Desiree Williams MPH , Marco Thimm-Kaiser MPH , Marina Mautner Wizentier MS , Melody Goodman PhD , Brenda Amezquita-Castro MPP, MA , Holly Hagan PhD
Background
Latino and Black families experience inequities in healthcare delivery, particularly during public health emergencies.
Purpose
To evaluate whether a nurse-led, household-based clinical practice model, the Nurse-Community-Family Partnership (NCFP) increased COVID-19 testing in an underserved, minoritized community as proof-of-concept for enhancing health service reach.
Methods
In a parallel, assessor-blinded group RCT (August 2021–March 2023), 146 households (392 individuals; mean [SD] age 37.9 [20.0]; 257 [65.6%] female; 279 [71.2%] Latino; 94 [24.0%] Black) were randomized 2:1 to NCFP or standard of care and followed for 9 months. Analyses used multilevel and longitudinal logistic regression.
Discussion
At 9 months, experimental participants (n = 256) had 2.69 times the odds (95 % CI 1.06-6.78) of any COVID-19 testing during the study and 3.16 times the odds of past-month testing (95 % CI 1.96-5.08), compared with controls (n = 136)..
Conclusion
NCFP, a nurse-led, household-based clinical practice model, enhanced health service reach during a public health emergency.
拉丁裔和黑人家庭在医疗保健服务方面面临不公平待遇，特别是在突发公共卫生事件期间。为了评估护士主导的、以家庭为基础的临床实践模式，护士-社区-家庭伙伴关系（NCFP）在服务不足的少数族裔社区增加了COVID-19检测，作为扩大卫生服务覆盖面的概念验证。方法在一项平行评估盲组RCT（2021年8月- 2023年3月）中，146户家庭（392人，平均[SD]年龄37.9[20.0],257[65.6%]女性，279[71.2%]拉丁裔，94[24.0%]黑人）随机分为2:1组，接受NCFP或标准护理，随访9个月。分析采用多水平和纵向逻辑回归。在9个月时，与对照组（n = 136）相比，实验参与者（n = 256）在研究期间进行任何COVID-19检测的几率（95 % CI 1.06-6.78）为2.69倍，过去一个月检测的几率（95 % CI 1.96-5.08）为3.16倍。结论ncfp是一种以护士为主导、以家庭为基础的临床实践模式，在突发公共卫生事件中提高了卫生服务的覆盖面。试验方案和统计分析计划clinicaltrials.gov: https://clinicaltrials.gov/study/NCT04832919
{"title":"A nurse-led clinical practice model to increase healthcare reach among underserved families during public health emergencies: A randomized controlled trial","authors":"Vincent Guilamo-Ramos PhD, RN, MPH, LCSW, ANP-BC, PMHNP-BC, FAAN , Adam Benzekri MPH, MS , Desiree Williams MPH , Marco Thimm-Kaiser MPH , Marina Mautner Wizentier MS , Melody Goodman PhD , Brenda Amezquita-Castro MPP, MA , Holly Hagan PhD","doi":"10.1016/j.outlook.2025.102591","DOIUrl":"10.1016/j.outlook.2025.102591","url":null,"abstract":"<div><h3>Background</h3><div>Latino and Black families experience inequities in healthcare delivery, particularly during public health emergencies.</div></div><div><h3>Purpose</h3><div>To evaluate whether a nurse-led, household-based clinical practice model, the Nurse-Community-Family Partnership (NCFP) increased COVID-19 testing in an underserved, minoritized community as proof-of-concept for enhancing health service reach.</div></div><div><h3>Methods</h3><div>In a parallel, assessor-blinded group RCT (August 2021–March 2023), 146 households (392 individuals; mean [SD] age 37.9 [20.0]; 257 [65.6%] female; 279 [71.2%] Latino; 94 [24.0%] Black) were randomized 2:1 to NCFP or standard of care and followed for 9 months. Analyses used multilevel and longitudinal logistic regression.</div></div><div><h3>Discussion</h3><div>At 9 months, experimental participants (<em>n</em> = 256) had 2.69 times the odds (95 % CI 1.06-6.78) of any COVID-19 testing during the study and 3.16 times the odds of past-month testing (95 % CI 1.96-5.08), compared with controls (<em>n</em> = 136)..</div></div><div><h3>Conclusion</h3><div>NCFP, a nurse-led, household-based clinical practice model, enhanced health service reach during a public health emergency.</div></div><div><h3>Trial Protocol and Statistical Analysis Plan</h3><div>ClinicalTrials.gov: <span><span>https://clinicaltrials.gov/study/NCT04832919</span><svg><path></path></svg></span></div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 6","pages":"Article 102591"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite one of the world’s most advanced health systems, advanced practice nursing (APN) roles in France are less than a decade old. Globally, APNs strengthen access, quality, and efficiency of care, but sustaining these roles requires demonstrating outcomes meaningful to patients, providers, and policymakers.
Purpose
To describe consensus among French stakeholders on patient- and system-level indicators for evaluating APN contributions.
Methods
A two-round Delphi process, followed by a nominal group discussion, was conducted. Participants included APNs, nurse managers, physicians, and academics. Candidate indicators, classified using Hamric’s framework, were rated on nine-point Likert scales; indicators with ≥75% agreement were validated.
Findings
Forty indicators were retained across seven domains, reflecting outcomes such as patient access, continuity, quality of care, collaboration, and leadership.
Discussion
Consensus indicators show how APN practice is viewed in France—focused on expertise, coordination, and integration. This aligns with global APN competencies but contrasts with physician-substitution models elsewhere.
Conclusion
These validated indicators provide a foundational framework for evaluating APN contributions in France. They offer a strategic tool to support integration, and to inform policy.
{"title":"Consensus-based indicators of advanced practice nursing outcomes: Results of a Delphi study in France","authors":"Jean Toniolo , Elom Iroukora , Yann Colven , Faustine Abla Dessi , Camille Vieu , Magdeleine Duvernoy , Karen Bertet , Rebecca Rioche , Aurélie Charrié Lagarde , Camille Lebrun , Estelle Barbe , Nolga Boussely , Christelle Roux , Julien Valeille , Agnès Lohues , Marion Bigas , Amélie Beloni , Clémence Thébaut , Jérome Wittwer , Valérie Berger , Pascale Beloni","doi":"10.1016/j.outlook.2025.102580","DOIUrl":"10.1016/j.outlook.2025.102580","url":null,"abstract":"<div><h3>Background</h3><div>Despite one of the world’s most advanced health systems, advanced practice nursing (APN) roles in France are less than a decade old. Globally, APNs strengthen access, quality, and efficiency of care, but sustaining these roles requires demonstrating outcomes meaningful to patients, providers, and policymakers.</div></div><div><h3>Purpose</h3><div>To describe consensus among French stakeholders on patient- and system-level indicators for evaluating APN contributions.</div></div><div><h3>Methods</h3><div>A two-round Delphi process, followed by a nominal group discussion, was conducted. Participants included APNs, nurse managers, physicians, and academics. Candidate indicators, classified using Hamric’s framework, were rated on nine-point Likert scales; indicators with ≥75% agreement were validated.</div></div><div><h3>Findings</h3><div>Forty indicators were retained across seven domains, reflecting outcomes such as patient access, continuity, quality of care, collaboration, and leadership.</div></div><div><h3>Discussion</h3><div>Consensus indicators show how APN practice is viewed in France—focused on expertise, coordination, and integration. This aligns with global APN competencies but contrasts with physician-substitution models elsewhere.</div></div><div><h3>Conclusion</h3><div>These validated indicators provide a foundational framework for evaluating APN contributions in France. They offer a strategic tool to support integration, and to inform policy.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 6","pages":"Article 102580"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.outlook.2025.102585
Gülengün Türk PhD , Nihal Taşkıran PhD , Orhan Er PhD , Emre Ölmez PhD , Fürüzan Bozkurt Kozan PhD
Background
Nursing diagnoses are crucial for care planning and communication, yet achieving diagnostic accuracy is often challenging due to workload and complex patient data. Integrating artificial intelligence (AI) into clinical practice may enhance clinical reasoning and promote a standardized nursing language.
Aim
This methodological study aimed to develop an AI-based clinical decision support system that ensures diagnostic accuracy with fewer defining characteristics.
Methods
Based on Gordon’s Functional Health Patterns Model, data were collected from 122 patients, including 117 defining characteristics, 59 risk factors, and 19 nursing diagnoses. Machine learning algorithms were tested for accuracy.
Results
The Naive Bayes algorithm achieved 96.33% accuracy using all indicators, while Gradient Boosting reached 82.94% with the 50 most important variables. Both effectively identified key diagnoses such as “Obesity” and “Acute Pain.”
Conclusion
The developed AI-based decision support system demonstrated high accuracy and potential to assist nurses in making faster and more consistent diagnostic decisions.
{"title":"Developing an artificial intelligence-based clinical decision support system for nursing diagnoses","authors":"Gülengün Türk PhD , Nihal Taşkıran PhD , Orhan Er PhD , Emre Ölmez PhD , Fürüzan Bozkurt Kozan PhD","doi":"10.1016/j.outlook.2025.102585","DOIUrl":"10.1016/j.outlook.2025.102585","url":null,"abstract":"<div><h3>Background</h3><div>Nursing diagnoses are crucial for care planning and communication, yet achieving diagnostic accuracy is often challenging due to workload and complex patient data. Integrating artificial intelligence (AI) into clinical practice may enhance clinical reasoning and promote a standardized nursing language.</div></div><div><h3>Aim</h3><div>This methodological study aimed to develop an AI-based clinical decision support system that ensures diagnostic accuracy with fewer defining characteristics.</div></div><div><h3>Methods</h3><div>Based on Gordon’s Functional Health Patterns Model, data were collected from 122 patients, including 117 defining characteristics, 59 risk factors, and 19 nursing diagnoses. Machine learning algorithms were tested for accuracy.</div></div><div><h3>Results</h3><div>The Naive Bayes algorithm achieved 96.33% accuracy using all indicators, while Gradient Boosting reached 82.94% with the 50 most important variables. Both effectively identified key diagnoses such as “Obesity” and “Acute Pain.”</div></div><div><h3>Conclusion</h3><div>The developed AI-based decision support system demonstrated high accuracy and potential to assist nurses in making faster and more consistent diagnostic decisions.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 6","pages":"Article 102585"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.outlook.2025.102573
Nicholas Chong , Patricia Pittman PhD , Michael Herron , Qian “Eric” Luo , Hong-Lun Tiunn , Jamar Slocum , Kenneth Rempher , John Martin
Background
Policymaker tend to assume that the problem of low nurse staffing is a result of hospitals financial contraints.
Purpose
This study explores whether higher hospital resource levels were associated with higher nurse staffing before (2019) and then during (2020–2022) the COVID-19 pandemic, a period of increased funding to most U.S. hospitals.
Methods
We used Premier Inc.’s OperationsAdvisor database and the PINC AI Healthcare Database to explore this question in a sample of 78 hospitals. We measured resources using both (a) current ratio (assets to liabilities) and (b) days cash on hand, and our main outcome measure was nurse hours per patient day (NHPPD), including agency and overtime nurse hours. We employed a multivariate random-effects model with time interactions with the financial variables.
Findings
We found that in the pre-COVID period, there was no association between hospital financial resources and nurse staffing. During the first two periods of the pandemic, despite the overall staffing increase in the first wave, we observed an inverse association between hospitals’ current ratio and NHPPD.
Conclusion
Thus, even with the surge in government subsidies during the pandemic, greater resources were not associated with higher nurse staffing.
{"title":"Were hospital financial resources associated with nurse staffing levels before and during COVID-19?","authors":"Nicholas Chong , Patricia Pittman PhD , Michael Herron , Qian “Eric” Luo , Hong-Lun Tiunn , Jamar Slocum , Kenneth Rempher , John Martin","doi":"10.1016/j.outlook.2025.102573","DOIUrl":"10.1016/j.outlook.2025.102573","url":null,"abstract":"<div><h3>Background</h3><div>Policymaker tend to assume that the problem of low nurse staffing is a result of hospitals financial contraints.</div></div><div><h3>Purpose</h3><div>This study explores whether higher hospital resource levels were associated with higher nurse staffing before (2019) and then during (2020–2022) the COVID-19 pandemic, a period of increased funding to most U.S. hospitals.</div></div><div><h3>Methods</h3><div>We used Premier Inc.’s OperationsAdvisor database and the PINC AI Healthcare Database to explore this question in a sample of 78 hospitals. We measured resources using both (a) current ratio (assets to liabilities) and (b) days cash on hand, and our main outcome measure was nurse hours per patient day (NHPPD), including agency and overtime nurse hours. We employed a multivariate random-effects model with time interactions with the financial variables.</div></div><div><h3>Findings</h3><div>We found that in the pre-COVID period, there was no association between hospital financial resources and nurse staffing. During the first two periods of the pandemic, despite the overall staffing increase in the first wave, we observed an inverse association between hospitals’ current ratio and NHPPD.</div></div><div><h3>Conclusion</h3><div>Thus, even with the surge in government subsidies during the pandemic, greater resources were not associated with higher nurse staffing.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 6","pages":"Article 102573"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.outlook.2025.102587
DeAnna Jan Emory PhD, RN, CNE, Thomas A. Kippenbrock EdD, RN, FAAN
Background
Patient safety is a foundational component of healthcare quality, shaped by organizational culture and frontline engagement. A strong patient safety culture (PSC) promotes transparency, teamwork, and accountability to reduce harm and improve outcomes.
Purpose
This study examined differences in PSC perceptions among registered nurses (RNs), managers, and executives in U.S. hospitals to identify gaps that may impact safety initiatives.
Methods
A retrospective analysis was conducted using data from the AHRQ Patient Safety Culture Survey 2.0, collected between 2020 and 2022. The final analysis included 77,981 responses.
Discussion
Statistically significant differences (p < .001) were found across roles. RNs reported less favorable perceptions of PSC, particularly regarding staffing adequacy, psychological safety, and leadership responsiveness. Effect sizes were largest among RNs and executives.
Conclusion
These findings highlight a disconnect between frontline experiences and leadership perceptions. Addressing these gaps through inclusive safety planning and cross-level collaboration is essential to strengthening PSC systemwide.
{"title":"Patient safety ratings of hospitals by registered nurses, managers, and executives: A retrospective analysis of patient safety culture data","authors":"DeAnna Jan Emory PhD, RN, CNE, Thomas A. Kippenbrock EdD, RN, FAAN","doi":"10.1016/j.outlook.2025.102587","DOIUrl":"10.1016/j.outlook.2025.102587","url":null,"abstract":"<div><h3>Background</h3><div>Patient safety is a foundational component of healthcare quality, shaped by organizational culture and frontline engagement. A strong patient safety culture (PSC) promotes transparency, teamwork, and accountability to reduce harm and improve outcomes.</div></div><div><h3>Purpose</h3><div>This study examined differences in PSC perceptions among registered nurses (RNs), managers, and executives in U.S. hospitals to identify gaps that may impact safety initiatives.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using data from the AHRQ Patient Safety Culture Survey 2.0, collected between 2020 and 2022. The final analysis included 77,981 responses.</div></div><div><h3>Discussion</h3><div>Statistically significant differences (<em>p</em> < .001) were found across roles. RNs reported less favorable perceptions of PSC, particularly regarding staffing adequacy, psychological safety, and leadership responsiveness. Effect sizes were largest among RNs and executives.</div></div><div><h3>Conclusion</h3><div>These findings highlight a disconnect between frontline experiences and leadership perceptions. Addressing these gaps through inclusive safety planning and cross-level collaboration is essential to strengthening PSC systemwide.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 6","pages":"Article 102587"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.outlook.2025.102582
Robert Atkins PhD, RN, FAAN , Kristen M. Brown DNP, CPNP-AC, FAAN , Shawna S. Mudd DNP, MBA, CPNP-AC, FAAN , Kimia Ghobadi PhD , Deborah J. Baker DNP, RN, FAAN , Sarah Szanton PhD, RN, FAAN
Background
Nurses represent the largest share of the U.S. health-care workforce and are central to improving population health. Transforming nursing education into a responsive, adaptive, competency-based system is essential to prepare a diverse, practice-ready workforce.
Purpose
This concept paper presents a vision for integrating artificial intelligence (AI), competency-based education (CBE), and simulation to personalize learning, enhance skill acquisition, and foster cultural respect in nursing education.
Methods
We propose shifting from rigid, time-bound curricula to flexible, competency-driven pathways that allow learners to progress at their own pace. Hypothetical student and faculty scenarios illustrate how these innovations can accommodate diverse life circumstances and learning styles.
Discussion
This approach expands access for underrepresented groups—including adult learners and those with caregiving responsibilities—while cultivating a workforce equipped to deliver community-oriented care and address social determinants of health such as housing, education, and nutrition.
Conclusions
By embracing AI, CBE, and simulation, nursing education can be reimagined to build a diverse, inclusive, and practice-ready workforce positioned to advance health equity and improve population health outcomes across the United States.
{"title":"Reimagining nursing education: Leveraging competency-based education, artificial intelligence, and simulation for a diverse and practice-ready workforce","authors":"Robert Atkins PhD, RN, FAAN , Kristen M. Brown DNP, CPNP-AC, FAAN , Shawna S. Mudd DNP, MBA, CPNP-AC, FAAN , Kimia Ghobadi PhD , Deborah J. Baker DNP, RN, FAAN , Sarah Szanton PhD, RN, FAAN","doi":"10.1016/j.outlook.2025.102582","DOIUrl":"10.1016/j.outlook.2025.102582","url":null,"abstract":"<div><h3>Background</h3><div>Nurses represent the largest share of the U.S. health-care workforce and are central to improving population health. Transforming nursing education into a responsive, adaptive, competency-based system is essential to prepare a diverse, practice-ready workforce.</div></div><div><h3>Purpose</h3><div>This concept paper presents a vision for integrating artificial intelligence (AI), competency-based education (CBE), and simulation to personalize learning, enhance skill acquisition, and foster cultural respect in nursing education.</div></div><div><h3>Methods</h3><div>We propose shifting from rigid, time-bound curricula to flexible, competency-driven pathways that allow learners to progress at their own pace. Hypothetical student and faculty scenarios illustrate how these innovations can accommodate diverse life circumstances and learning styles.</div></div><div><h3>Discussion</h3><div>This approach expands access for underrepresented groups—including adult learners and those with caregiving responsibilities—while cultivating a workforce equipped to deliver community-oriented care and address social determinants of health such as housing, education, and nutrition.</div></div><div><h3>Conclusions</h3><div>By embracing AI, CBE, and simulation, nursing education can be reimagined to build a diverse, inclusive, and practice-ready workforce positioned to advance health equity and improve population health outcomes across the United States.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 6","pages":"Article 102582"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.outlook.2025.102574
Junhua Zhang PhD, RN , Brianna Lin BScN, RN , Yilei Yang BS, MS , Hyun Jin Jung PharmD, MS , Simon Paul P. Navarro MA, BSN, RN , Allison A. Norful PhD, RN, FAAN
Background
International migration of nurses is a common strategy to address workforce shortages in the United States.
Purpose
To compare workforce retention factors between U.S.-trained nurses and internationally educated nurses (IENs) working in the United States.
Methods
A secondary analysis of the 2018 and 2022 National Sample Survey of Registered Nurses (NSSRN) was conducted. Weighted descriptive statistics, linear regression, and stepwise analyses (unadjusted and adjusted) were applied.
Discussion
U.S.-trained and IENs differed significantly in demographics, professional characteristics, and predictors of turnover. Burnout consistently emerged as a significant driver of turnover for both groups. IENs more often cited factors related to professional autonomy, patient population, and personal caregiving responsibilities, whereas U.S.-trained nurses more frequently identified inadequate staffing, poor management, and stressful work environments.
Conclusion
Retention strategies should address distinct organizational and personal factors influencing turnover in different nurse subgroups to strengthen workforce stability.
{"title":"Variations in job turnover factors among internationally educated and U.S.-trained nurses: Insights from the 2018 and 2022 National Sample Survey of Registered Nurses","authors":"Junhua Zhang PhD, RN , Brianna Lin BScN, RN , Yilei Yang BS, MS , Hyun Jin Jung PharmD, MS , Simon Paul P. Navarro MA, BSN, RN , Allison A. Norful PhD, RN, FAAN","doi":"10.1016/j.outlook.2025.102574","DOIUrl":"10.1016/j.outlook.2025.102574","url":null,"abstract":"<div><h3>Background</h3><div>International migration of nurses is a common strategy to address workforce shortages in the United States.</div></div><div><h3>Purpose</h3><div>To compare workforce retention factors between U.S.-trained nurses and internationally educated nurses (IENs) working in the United States.</div></div><div><h3>Methods</h3><div>A secondary analysis of the 2018 and 2022 National Sample Survey of Registered Nurses (NSSRN) was conducted. Weighted descriptive statistics, linear regression, and stepwise analyses (unadjusted and adjusted) were applied.</div></div><div><h3>Discussion</h3><div>U.S.-trained and IENs differed significantly in demographics, professional characteristics, and predictors of turnover. Burnout consistently emerged as a significant driver of turnover for both groups. IENs more often cited factors related to professional autonomy, patient population, and personal caregiving responsibilities, whereas U.S.-trained nurses more frequently identified inadequate staffing, poor management, and stressful work environments.</div></div><div><h3>Conclusion</h3><div>Retention strategies should address distinct organizational and personal factors influencing turnover in different nurse subgroups to strengthen workforce stability.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 6","pages":"Article 102574"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.outlook.2025.102579
Victor G. Petreca PhD, DNP , Joanne T. Barros PhD , Ann W. Burgess DNSc
Background
Healthcare organizations increasingly implement active shooter drills for emergency preparedness, yet research rarely examines how poorly coordinated drills may cause workplace trauma.
Purpose
This study examined healthcare staff experiences following an inappropriately conducted active shooter drill at a healthcare facility providing inpatient behavioral health care for children and adolescents.
Methods
A qualitative descriptive design analyzed deidentified statements from 88 healthcare workers collected 8 months post incident. Inductive thematic analysis identified patterns across experiences.
Discussion
Five themes emerged: organizational chaos and communication breakdown, immediate physical and emotional responses, pressure to resume normal duties, development of trauma symptoms, and long-term professional disruption. Many participants reported clinically significant symptoms, career instability, and loss of institutional trust.
Conclusion
Poorly coordinated preparedness drills without trauma-informed planning can cause lasting harm to staff well-being, patient care, and organizational trust. Healthcare systems must integrate trauma-informed principles into emergency preparedness to protect psychological safety.
{"title":"When active shooter drills become the threat: Organizational trauma and nursing implications","authors":"Victor G. Petreca PhD, DNP , Joanne T. Barros PhD , Ann W. Burgess DNSc","doi":"10.1016/j.outlook.2025.102579","DOIUrl":"10.1016/j.outlook.2025.102579","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare organizations increasingly implement active shooter drills for emergency preparedness, yet research rarely examines how poorly coordinated drills may cause workplace trauma.</div></div><div><h3>Purpose</h3><div>This study examined healthcare staff experiences following an inappropriately conducted active shooter drill at a healthcare facility providing inpatient behavioral health care for children and adolescents.</div></div><div><h3>Methods</h3><div>A qualitative descriptive design analyzed deidentified statements from 88 healthcare workers collected 8 months post incident. Inductive thematic analysis identified patterns across experiences.</div></div><div><h3>Discussion</h3><div>Five themes emerged: organizational chaos and communication breakdown, immediate physical and emotional responses, pressure to resume normal duties, development of trauma symptoms, and long-term professional disruption. Many participants reported clinically significant symptoms, career instability, and loss of institutional trust.</div></div><div><h3>Conclusion</h3><div>Poorly coordinated preparedness drills without trauma-informed planning can cause lasting harm to staff well-being, patient care, and organizational trust. Healthcare systems must integrate trauma-informed principles into emergency preparedness to protect psychological safety.</div></div>","PeriodicalId":54705,"journal":{"name":"Nursing Outlook","volume":"73 6","pages":"Article 102579"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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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