Nurses' Attitudes Toward Patients With Perinatal Substance Use Disorder.

Introduction: A multi-patient simulation involving patients with acute health challenges was co-created by nursing faculty at the University of New Brunswick, Canada. The integration of this simulation occurred during the 2023 Fall term. Presented findings are focussed on data collected in the 2024 Fall term as research leads obtained ethical approval prior to this second offering. Although simulation-based experiences (SBEs) are well established as effective tools in building capacity in health care programs [1], the use of multi-patient simulations in support of skills such as clinical judgement and time management remain underexplored. The National Council State Boards of Nursing’s Clinical Judgement Measurement Model (CJMM)[2] helped frame learning objectives while INASCL standards were adhered to in the design of this simulation [3]. The purpose of this presentation is to share key findings and recommendations for a study exploring student perceptions of this multi-patient SBE. Methods: A mixed-methods approach was used in this study. Quantitative data were collected using pre- (n=70) and post-(n=60) simulation quizzes, with questions aligned to learning objectives. These quizzes assessed students’ knowledge and clinical judgement before and after the simulation. Qualitative data were collected through two focus groups (n=7) which included an exploration of students’ perceptions of elements impacting their ability to meet learning objectives. Quantitative data were analysed using descriptive statistics. Content analysis was used to identify key concepts which were organized into categories. Results: Quiz responses between subgroups of students were compared – students were either enrolled in the BN program through a bridging model or entered through a four-year pathway. All students scored poorly on questions involving teamwork and scope of practice considerations. In contrast, students who entered the BN program through the bridging model scored significantly higher on time management. Content analysis of focus group data revealed key categories: 1) knowing what to expect and what is expected of me; 2) realism as a performance factor; and; 3) acknowledging the impact of past experience. Discussion: Findings from this study offer insights into how senior nursing students experience and respond to a multi-patient simulation. Relationships between previous clinical experience, preparation, perceived realism, and the link to performance have implications for simulation design and teaching and learning strategies beyond a simulation context. A limitation of this study is the focus group participants included only students enrolled in the four-year pathway. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Examinations are used widely in nursing education to evaluate knowledge attainment. New item types were initiated in April 2023 by the National Council of State Boards of Nursing (NCSBN) for use on the Next Generation National Council Licensure Examination for Registered Nurses (NGN NCLEX-RN). Little evidence exists for how much time is needed for exams that use the new item types. Item analysis was conducted on 772 questions that were answered by 14,728 nursing students. Seven item types were analyzed, including calculation, cloze, matrix, ordered response, hot spot, multiple choice, and multiple response. Calculation questions required additional time. Multiple choice items required 1 minute per question. Questions that were more difficult required more time. Exams administered early in the nursing curriculum need more time allocated. Nursing educators should focus on time allotment for examinations based on the item types and difficulty.

Following the merger of three state universities in a large geographic region, a nursing department recognized the need to develop a cohesive, functional structure to effectively manage the complexities of the newly formed department. A quality improvement initiative was enacted to establish a departmental structure that empowered faculty to participate in decision making by implementing a shared governance model. The nursing department successfully formed a structure that provided uniformity among multiple nursing programs and resulted in approval from the State Board of Nursing and other accrediting bodies. Adopting a shared governance model during a multi-university merger facilitated a nursing department's ability to develop a cohesive, functional nursing department structure. Use of the shared government model empowered faculty, enhanced collaboration, and contributed to the successful development of a functional nursing department that met accreditation requirements.

For more than 45years, the Tri-Council for Nursing (Tri-Council), representing nursing regulation, education, and practice, has advanced common policy goals and addressed shared concerns of its members-the American Association of Colleges of Nursing, American Nurses Association, American Organization for Nursing Leadership, National Council of State Boards of Nursing, and National League for Nursing. The Tri-Council's tradition of influencing public policy and decision makers continues at a crucial time in health care. The Tri-Council produces a legislative agenda annually to advance federal policies throughout the year and continues to emphasize workforce issues. In response to crises resulting from the Covid-19 pandemic, the Tri-Council convened a summit on December 3, 2020, to identify critical lessons and future opportunities for transforming nursing and health care. The Tri-Council committed to identify implications, opportunities, and actions for its member organizations, while engaging nurses, educators, policymakers, and health care experts in new ways to inspire focused action that delivers innovations in nursing practice, education, and regulation. The Tri-Council will continue to use its united voice to advance the nursing profession.

Nurse practitioners (NPs) are essential to meeting the demand for primary care and improving quality. Variation in primary care work environment has implications for outcomes. One opportunity to better support NP practice includes increasing NP access to support staff. However, given statutory regulation of NP's ability to delegate to unlicensed personnel, there may be limited effect of these interventions. To describe state regulations on NP delegation to unlicensed personnel and consider implications of NP delegation regulations on opportunities to improve NP work environment. We conducted a cross-sectional, six state policy surveillance of state nursing regulations related to NP delegation to unlicensed personnel. Using an iterative data identification process, we review of documents from six state boards of nursing. Analysis included nominal and textual data. Five states prohibited NPs from delegating medication administration to unlicensed personnel. One state permitted delegation of mediation administration to unlicensed personnel but only in community settings. Delegation limitations prevent NPs from practicing to the full extent of their education. Nurse practitioners must be aware of the delegation regulations when working with unlicensed personnel to prevent disciplinary actions. Nurse practitioner-specific delegation regulations can facilitate greater use of unlicensed personnel in NP-led primary care. Boards of Nursing should consider NP delegation regulations that promote public safety, minimize unintended consequences, and increase access to NP-led primary care.

The National Organization of Nurse Practitioner Faculties advocates for the doctoral level as the entry-to-practice standard for NPs. Understanding the impact of Doctor of Nursing Practice NPs (DNP-NPs) on health care systems is vital for shaping policy, regulations, and practice. This study quantitatively assesses the relationship between DNP-NP staffing levels and hospital quality and cost outcomes using major datasets. Data from the 2022 Iowa and Kentucky State Boards of Nursing (BON) and the Centers for Medicaid & Medicare Services (CMS) were used. The BON databases identified DNP-NPs matched to CMS data, with hospital affiliation determined by Hospital CMS Certification Number codes. Doctor of Nursing Practice NP counts were scaled by hospital size, with DNP-NPs per 100 beds as the treatment variable. Outcome variables and hospital characteristics were analyzed by DNP-NP quintiles. Hospitals in the lowest quintile of DNP-NP staffing had a significantly higher mean readmission rate of 14.84% (SE = 0.245), which was 0.39% points higher ( p = .005) than the adjusted mean of 14.45% (SE = 0.214) for other hospitals. No systematic relationship was found between DNP-NP staffing and readmission rates across the remaining distribution, and no correlation was detected between DNP-NP staffing and other hospital quality or cost efficiency measures. The study underscores the need for improving data infrastructure to further research the relationship between DNP-NP staffing and hospital quality outcomes and address hospital staffing questions. Recommendations are provided for enhanced data sources on NP education and practice to inform health care workforce research, staffing, policies, and regulations.

While many metrics may be used to assess the quality of U.S. prelicensure nursing programs, one commonly accepted metric is the student pass rate on the National Council Licensure Exam (NCLEX). NCLEX pass rates are increasingly being used in research projects, and it is critical to have consistent and complete data for such projects. These data are also important to the public for informed decision-making. In the age of open science and data sharing, there is no reason that these data should not be readily available and consistently reported to the public. The aim of this study was to determine how many, and which, state boards of nursing (BONs) publicly report NCLEX pass rates by nursing program. A descriptive, cross-sectional study design was used to examine each state BON website for NCELX pass rate data by program. Initial results indicated that 47 states and the District of Columbia reported NCLEX pass rate data by nursing program through their BON website. At the outset of this study, Alaska, Michigan, and Vermont did not report NCELX pass rate data by program. Michigan posted four years (2021-2024) of NCLEX pass rates by nursing program in February 2025. Amounts and types of data reported were reported inconsistently across states. NCLEX pass rate data by program should be transparently and consistently reported, in a standardized format by all states to facilitate nursing research, equitably inform the public, and increase trust.

Objectives. To estimate the size of the US governmental public health nurse (PHN) workforce by setting and specialty, including those working outside of health departments. Methods. We used 2022 data from the National Council of State Boards of Nursing, representing 2846 registered nurses (RNs) in almost all states, with weights applied. We examined "setting" and "specialty" of PHNs according to broad and more restricted definitions. Results. Using a broad definition, PHNs in government settings made up 3.7% of the RN workforce, and 1.8% when specialty areas were narrowly defined. These percentages varied by state. PHNs working in public health, school health, and correctional health settings largely indicated their specialty practice areas as public health, school health, and "unspecified" rather than more narrow specialty areas. Conclusions. PHNs are a small proportion of the RN workforce. They consider themselves generalists and can be identified by specialty and when working in governmental settings outside of health departments. Public Health Implications. States with few PHNs may be underserving their communities. Better data are needed to understand specific functions and activities of the PHN workforce. (Am J Public Health. 2025;115(4):536-545. https://doi.org/10.2105/AJPH.2024.307950).

End-of-program predictive examinations have been in existence in nursing education for over 10 years. Nursing schools have used these examinations to prepare students on the testable content from National Council of State Boards of Nursing (NCSBN), which has been delivering the NCLEX-RN since 1994. Nursing students, in the final semester of the nursing program, took the Predictable Ability Measurement Readiness (PAMR) 1 and/or 2. The 100-question exam was developed by nursing subject matter experts following the 2019 NCLEX-RN blueprint content, item types, and scoring. The PAMR scores were examined and compared with the results of the nursing students on the NCLEX-RN. Statistical analysis revealed that the students who passed the NCLEX-RN on their first attempt had higher scores on the PAMR1. A cut-point scale using regression modeling was developed to determine a minimal score compared with the probability of passing NCLEX-RN. Nursing faculty have a reliable and predictable exam to use to prepare students to take the NCLEX-RN. The PAMR 1 and 2 have demonstrated the ability to predict passing on the NCLEX-RN and can be used confidently in nursing programs for licensure examination preparation.

Fostering clinical judgment in prelicensure nursing: utilizing a concept map template

British Association of Cosmetic Nurses (BACN) board member Clare Amrani discusses the latest updates

The U.S. Boards of Nursing (BONs) collect annual report data from their nursing programs as part of their approval process. This paper highlights the 2020 and 2021 annual report data on the effect of coronavirus disease 2019 (COVID-19) on all nursing programs in 17 BONs in 2020 and 19 in 2021. Nursing programs answered 16 questions on the effect of COVID-19 on their programs. Because BONs require annual report data, all programs in the participating states answered the questions, which included 798 programs in 2020 and 929 in 2021. Major disruptions in nursing education occurred during the pandemic. Clinical experiences and didactic classes were greatly affected, though alternative strategies were used. Student and faculty attrition rates were particularly high in 2021. The authors call for a national forum where nurse leaders analyze what happened and make recommendations for future crisis events. [J Nurs Educ. 2024;63(5):312-319.].

The complexity of health care requires entry-level nurses to have competent clinical judgment skills. In response, a nursing program created Reflective Clinical Judgment Questions (RCJQ) to guide students in the development of clinical judgment. The RCJQ incorporates the Clinical Judgment Measurement Model, the National Council of State Boards of Nursing's action questions, and the American Association of Colleges of Nursing's core competencies for professional nursing education. The RCJQ includes cognitive process questions and self-reflection questions aligned to the prelicensure subcompetencies to direct student thinking and build a routine for clinical decision making. The RCJQ provides faculty with a framework to teach clinical judgment and incorporates self-reflective questions to guide decision making for safe and effective client care. The RCJQ streamlines the clinical judgment process and guides students to achieve essential outcomes in classroom, clinical, and simulation settings to prepare for clinical practice. [J Nurs Educ. 2024;63(3):182-185.].

Faculty Development on the Use of a Clinical Judgment Model in the Pre-licensure Nursing Curriculum

Abstract Long-term care (LTC) facilities experience chronic nursing staff instability which negatively impacts resident health outcomes. Recruiting Foreign Educated Nurses (FENs) is one strategy to stabilize the nursing workforce but most studies on FENs, use secondary data from: American Community Survey and the National Sample Survey of Registered Nurses. Few empirical studies have examined FEN experiences, employment outcomes, and impact on US LTC facilities. Since LTC facilities are dependent on FENs to meet minimum staffing requirements, additional research is needed to better understand FEN workforce issues in LTC, how to improve its sustainability, and the links to resident outcomes. Mistrust of researchers, however, may make FENs hard to reach. Therefore, conducting primary research on FENs in LTC requires culturally sensitive and community-engaged recruitment strategies. Drawing from existing literature and lessons learned from primary research conducted with FENs working in LTC facilities in the southeastern US, we will review best practices for recruitment so researchers can understand the cultural and structural issues that may affect research conduct in facilities where FENs are employed and their recruitment as participants. Developing relationships with FEN leaders as well as the Nigerian, Jamaican, Filipino, and/or Asian nurses associations can facilitate access to the population. Key stakeholder relationships also include the American Nurses Association, State Boards of Nursing, and Commission on Graduates of Foreign Nursing Schools as they can facilitate entrée into data sources and networks for recruitment. Understanding recruitment strategies will strengthen research that deepens our understanding of workforce issues among FENs in LTC.

Fostering Clinical Decision-Making Using Screen-Based Simulations Aligned with the NCSBN Clinical Judgment Measurement Model

Partisan self-identification predicts attitudes of South Dakota nurses toward COVID-19 vaccine mandate for healthcare workers

The Academy of Emergency Nursing was established to honor emergency nurses who have made enduring and substantial contributions that have had significant impact and continue to advance the emergency nursing specialty. Nurses who have been recognized as having made enduring and substantial contributions to emergency nursing achieve fellow status in the Academy of Emergency Nursing and are conferred the credential, Fellow of the Academy of Emergency Nursing. Academy of Emergency Nursing Board Members want to dismantle any structural barriers, clarify any misunderstandings or mysteries, and support diverse candidates by providing clear and equitable resources about the path toward fellow designation and the application process. Therefore, the purpose of this article is to support interested persons in their path toward Academy of Emergency Nursing fellow designation and give explicit details of each section of the application to develop a shared understanding among potential applicants, sponsors, and Fellows of the Academy of Emergency Nursing.

Demetrius Porche, DNS, RN, CS, FNP