Board Of Nursing Research Articles

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

BackgroundThe National Council State Boards of Nursing (NCSBN) clinical judgment model (CJM) is integral to prelicensure nursing education, necessitating consistent strategies to develop students’ clinical judgment. Effective strategies should guide students’ decision-making, emphasize priorities, and support deep learning. InnovationThis article introduces a mapping template aligned with the NSCBN CJM, facilitating a systematic approach to clinical judgment. The template offers visual organization, specific actions for each step, and prompts for critical thinking. ImplicationsThe mapping template can enhance student engagement, repetition of concepts, and reflective learning to support clinical judgment consistently across a prelicensure nursing curriculum. Faculty can integrate it into various teaching contexts, clinical instructors can assess students’ decision-making in real-life situations, and students can employ it for independent study. ConclusionsConsistent use of the mapping template fosters a common language, reinforces CJM steps, and serves as a formative assessment tool. Integrating the template into prelicensure nursing education aligns with best practices for developing clinical judgment.

Well-earned awards and new initiatives

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

The Effects of the COVID-19 Pandemic on Nursing Education Programs.

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.].

Reflective Clinical Judgment Questions to Educate the Next Generation of Nurses.

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

Clinical judgment is an essential component of safe nursing practice that pre-licensure nursing students should develop by graduation from accredited nursing programs. For novice nurses, the consequences of underdeveloped clinical judgment skills that do not meet the demands of clinical practice are serious. This theory-practice gap correlates with increased numbers of errors occurring during care delivery, resulting in poorer patient outcomes. From a student perspective, this problem correlates with lower first-time pass rates on the NCLEX licensing exam. For nurse educators, there are uncertainties about how to resolve this complex and costly problem, but faculty development is one evidence-based solution to explore. The purpose of this article is to describe a three-pronged quality improvement project consisting of: 1) a faculty development session to teach faculty to implement the National Council State Boards of Nursing's Clinical Judgment Model (CJM) in their courses; 2) the use of the Clinical Judgment Tool; and 3) the implementation of a faculty champion to sustain and maintain ongoing faculty momentum to foster clinical judgment. This article focuses on how faculty can develop their own CJM faculty development session and use a CJM across the course curriculum.

CULTURALLY SENSITIVE STRATEGIES TO RECRUIT FOREIGN EDUCATED NURSES FOR US LONG-TERM CARE RESEARCH

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

BackgroundNew graduate nurses are expected to have the clinical decision making (CDM) skills necessary to safely care for multiple patients with complex, competing needs. Limited opportunities to care for multiple patients in the clinical setting hinders the development of students’ CDM and clinical judgment abilities. This study aimed to ascertain the impact of commercially designed screen-based simulations (SBS) on students’ performance across CDM elements of the National Council for State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (CJMM). SampleThe purposive sample included 68 students enrolled in an adult medical-surgical course. MethodsA quasi-experimental posttest design was implemented by integrating two prioritization of care SBS across a semester (weeks four and nine) as part of required clinical hours. ResultsIncreases in intervention selection (p = .001, d = 0.404) and intervention prioritization (p = .012, d = 0.313), in less time (p = < .001, d = −0.763), were noted with a small to medium effect size. Decreases in level of care selection (p = .063, d = −0.229) and patient prioritization (p = .001, d = −0.440) were noted with a small to medium effect size. Trends were noted in overall score increases with a small effect size (p = .096, d = 0.204). ConclusionsStudy outcomes suggest that prelicensure nursing students need repetitive practice in multiple-patient triage and prioritization of care opportunities. Prelicensure coursework and direct care clinical experiences can be supplemented with targeted SBS to facilitate the development of all foundational components of CDM to help bridge the knowledge-to-practice gap.

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

ObjectivesNurses are at greater risk of infection from COVID-19. However, mistrust of the vaccine exists even among this group. In the United States, the government implemented a vaccine mandate for health care workers to increase vaccination rates. This study investigated the drivers of nurses’ attitudes toward the mandate. MethodsWe fielded a survey to study the attitudes of nurses toward COVID-19 vaccine mandate for HCWs. We contacted nurses in South Dakota, United States, based on the information from the South Dakota Board of Nursing. The survey was open in June and July 2022. We conducted a multivariate regression analysis to identify the factors that predict attitudes toward this regulation. ResultsWe received 1,084 responses. Results of regression analysis showed statistically significant relationships between partisan self-identification, evangelical identity, gender, and COVID-19 vaccination status and support for COVID-19 vaccine mandate for healthcare workers. Age, time with patients, positive COIVD-19 test in the last year, education, and nurse classification variables were not statistically significant. ConclusionsThe same factors that drive people's attitudes toward COVID-19 mitigation policies also explain nurses’ attitudes toward a vaccine mandate for healthcare workers. The politicization of the COVID-19 pandemic is present also among nurses. Health care officials should be mindful of the influence of these biases as they evaluate the vaccine mandate and develop new regulations.

The Path Toward Fellow Designation in the Academy of Emergency Nursing: Understanding and Navigating the Process to Ensure Your Success

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

Demetrius Porche is currently the Dean of Louisiana State University (LSU) Health Sciences Center School of Nursing (HSC SON) in New Orleans. Demetrius’ long and successful career has ranged from rebuilding the School of Nursing after Hurricane Katrina to leading national efforts to support both community and men’s health. He is a confident, innovative leader; a generous mentor; and a strong partner to nurse leaders in the practice arena. Among many volunteer leadership roles, Dr. Porche has served as president of the Louisiana State Board of Nursing, president of the American Assembly for Men in Nursing, member of the Governing Council of the American Public Health Association, and currently serves on the board of the American Association of Colleges of Nursing (AACN). Demetrius has been inducted as a fellow in the American Academy of Nurse Practitioners, the American Academy of Nursing, and National League for Nursing. He has been the associate editor of the Journal of the Association of Nurses in AIDS Care and currently is the chief editor of American Journal of Men’s Health. Demetrius Porche is currently the Dean of Louisiana State University (LSU) Health Sciences Center School of Nursing (HSC SON) in New Orleans. Demetrius’ long and successful career has ranged from rebuilding the School of Nursing after Hurricane Katrina to leading national efforts to support both community and men’s health. He is a confident, innovative leader; a generous mentor; and a strong partner to nurse leaders in the practice arena. Among many volunteer leadership roles, Dr. Porche has served as president of the Louisiana State Board of Nursing, president of the American Assembly for Men in Nursing, member of the Governing Council of the American Public Health Association, and currently serves on the board of the American Association of Colleges of Nursing (AACN). Demetrius has been inducted as a fellow in the American Academy of Nurse Practitioners, the American Academy of Nursing, and National League for Nursing. He has been the associate editor of the Journal of the Association of Nurses in AIDS Care and currently is the chief editor of American Journal of Men’s Health. Marla J. Weston, PhD, RN, FAAN, is chief executive officer at Weston Consulting LLC in Washington, DC. She can be reached at [email protected]

Effectiveness of a nursing board games in psychiatric nursing course for undergraduate nursing students: An experimental design

AimTo examine the effectiveness of a psychiatric nursing board game in an undergraduate psychiatric nursing course. BackgroundDidactic teaching fails to assist students in deepening their understanding of abstract concepts in psychiatric nursing. The game-based learning of professional courses can address the demands of digital-age students, which may improve their learning outcomes. DesignA parallel two-arm experimental design was adopted in a nursing college in southern Taiwan. MethodsThe participants were fourth-year students enroled in a college nursing programme in southern Taiwan. Simple random sampling was used to divide the class into intervention and control groups. The former participated in an eight-week game-based intervention course, while the latter continued to receive traditional instruction. In addition to collecting the students’ demographic data, three structural questionnaires were developed to examine the variation in students’ nursing knowledge and attitudes toward psychiatric nursing, as well as their learning satisfaction before and after the intervention. ResultsThere were a total of 106 participants, with 53 in each group. After the intervention, the two groups were significantly different in terms of their psychiatric nursing knowledge, attitudes and self-reported learning satisfaction. The intervention group’s scores were significantly higher than those of the control group across all three dimensions. This suggests the positive effects of the board game intervention on students’ learning outcomes. ConclusionThe research outcome can be applied in formative and undergraduate nursing education in teaching psychiatric nursing globally. The game-based learning materials developed can be used to train psychiatric nursing teachers. Future studies should recruit a larger sample and increase the follow-up time for assessing students’ learning outcomes, as well as examine the similarities and differences in the learning outcomes of students from different educational systems.

A study on the subjectivity of South Korean parents regarding corporal punishment in early childhood

BackgroundWe conducted this study after South Korea abolished parental disciplinary rights in 2021. ObjectiveThis study identifies the characteristics of parental perceptions regarding types of corporal punishment administered to children by discovering the in-depth subjective structure of perceptions. ParticipantsWe recruited 40 participants (parents with children aged two to six years) after posting a notice on the bulletin boards of infant nursing and education institutions in Seoul. MethodsThe study employed Q methodology. The research procedure involved 40 Q-samples (selected from the Q-concourse) classified according to P-samples of 40 participants. We used the QUANL program to analyze data. ResultsWe categorized parents' perceptions into four types: removal (corporal punishment is wrong and should not be used), discipline (corporal punishment is a disciplinary method), trigger (certain triggers induce corporal punishment), and habit (corporal punishment occurs habitually). While all parents in the four types perceived corporal punishment as an action to avoid, stopping it in childcare settings was difficult. Some parents viewed it as necessary and revealed the importance of setting standards. Results showed that support measures (such as parental education and legal measures) are required to correct misconceptions and inaccurate knowledge about corporal punishment and create a quality, nurturing environment for children. ConclusionsThe findings provide meaningful data supporting measures to reduce parental corporal punishment that inhibits growth in early childhood.

A Preliminary Examination of Healthcare Facilities’ Nurse Staffing Strategies to Address COVID-19 Surges

COVID-19 surge events exacerbated many healthcare facilities' pre-existing nursing shortages. To address staff shortfalls, nurse leaders adopted a variety of strategies to supplement their workforce. To identify and assess the interplay between board of nursing (BON) emergency guidance and the strategies healthcare facilities adopted to bolster their nursing workforce during peak pandemic periods. A national survey of nurse executives, as identified by the American Organization for Nursing Leadership, was conducted. Univariable and multivariable ordinal logistic regression models were used to evaluate the significance of observed trends. Half of the 391 nurse executives who completed the survey indicated that their facility needed to supplement their RN staffing during peak periods of the COVID-19 pandemic (n = 202, 51.7%). Most relied on hiring local experienced nurses (n = 111) or some combination of travel nurses (n = 61) or support workers (n = 60) to drive a median 10% increase in nurse staffing (n = 153, range 0%-100%). A large proportion of respondents also indicated their facility simply increased the work volume and hours of their current RN staff. Respondents rated retired nurses as significantly more competent relative to licensed new nurse graduates and pre-NCLEX new nurse graduates. Although the small sample limits the generalizability of these findings, preliminary evidence suggests recently retired nurses and prelicensure nursing students may provide valuable support services in the event of another public health emergency.

Examining the Global Nursing Regulatory Response to the COVID-19 Pandemic

During the COVID-19 pandemic, nursing regulatory bodies (NRBs) worldwide adopted a variety of measures to bolster the nursing workforce and ensure patient safety. To examine the plethora of actions undertaken by the global nursing community in response to the public health emergency so that NRBs can increase transparency and better prepare for future crises. In early 2021, the National Council of State Boards of Nursing developed an online survey to capture data on the global regulatory response to the COVID-19 pandemic. The survey focused on five specific domains: (a) governance, (b) telehealth practices, (c) nurse mobility, (d) prelicensure education, and (e) the disciplinary process. The instrument was translated into 11 languages before being deployed to 150 non-U.S. regulatory representatives. Frequencies and proportions were generated for all fixed-item responses, and descriptive content analyses were applied to translated open-text responses. Regulators representing 27 jurisdictions provided valid responses to the survey. Most jurisdictions reported that components of nursing education were adapted in some way during the pandemic. More than half (53.8%, n = 14) of respondents indicated that changes were made to clinical and didactic curricula to ensure students graduated on time. About one-third (30.8%, n = 8) of representatives revealed that their jurisdiction had made changes to telehealth regulations, with many granting telehealth-specific nursing licenses. Most jurisdictions (88.5%, n = 23) also reported fewer or about the same number of regulatory complaints compared to before the pandemic. The results of this study highlight the range of actions nursing regulators worldwide adopted, which may be drawn upon to inform best practices to ensure jurisdictions are ready for the next public health emergency.

Evaluating the Impact of Executive Orders Lifting Restrictions on Advanced Practice Registered Nurses During the COVID-19 Pandemic

In the early stages of the COVID-19 pandemic, strains on the healthcare system forced many U.S. states to revisit long-standing statutory limitations on the care coordinated by advanced practice registered nurses (APRNs). This was done by issuing waivers via executive, legislative, or board of nursing orders. To identify the impact of temporary practice waivers on APRNs' direct patient care during the COVID-19 pandemic. This cross-sectional study utilized a two-phased approach. First, a confidential online survey was conducted of APRNs practicing across 27 U.S. states. Second, comprehensive APRN discipline data from 2019 to 2021 were retrieved from the National Council of State Boards of Nursing's Nursys database and reviewed. Univariable and multivariable binary logistic regression models were used to determine the significance of observed trends. A total of 16,699 APRNs responded to the survey for a response rate of 14.2%. APRNs practicing in private outpatient clinics, in rural areas, and in health provider shortage areas were more likely to report a positive effect of the practice waiver (all p < .05). Providers noted that the waivers allowed them more time with their current patients and expanded the geographic boundaries of their direct patient care to take on new patients. Furthermore, despite the changing profile of APRN care during the early stages of the pandemic, including a pronounced increase in telehealth usage, the current review found no evidence of an uptick in discipline cases brought against APRNs in 2021. Full practice authority for APRNs benefits patients by promoting expanded access to care and increasing the resiliency of our healthcare system without compromising patient safety. It is time for states and organizations that employ APRNs to recognize that permanently removing barriers to APRN practice is essential to the health of our nation.

Overcoming Stigma: Asking for and Receiving Mental Health Support.

Overcoming Stigma: Asking for and Receiving Mental Health Support.

Next generation NCLEX stand-alone items: Bowtie & trend

The National Council of State Boards of Nursing (NCSBN) is making changes to the national council licensure exam (NCLEX) to improve measurement of nursing clinical judgment. Good clinical judgment is crucial in promoting patient safety. A review of the literature reveals that one-half of all nurses make a significant error within the first year of their practice. The NCSBN is instituting new formatted questions on the NCLEX to assess candidates’ level of clinical judgment. This new format includes case studies, new formatted question types within case studies, and new format stand-alone questions. A review of some of the changes and analysis of two new question types is included. Two new stand-alone types are Bow-tie and trend. These questions require the candidate to incorporate multiple aspects of the nurse clinical judgement model to successfully answer the question. Constructing these types of questions as well as implementation strategies to incorporate these item types is described. The NCLEX will be challenging for educators and students with the new format and unfamiliar question types. Nurse educators can implement active learning strategies into the classroom to prepare students.

The NCSBN 2023 Environmental Scan: Nursing at a Crossroads—An Opportunity for Action: Nursing at a Crossroads: An Opportunity for Action

Nursing is at a crossroads. Emerging from the peak of one of the worst pandemics in history, the nursing profession is facing multiple challenges: hospitals and other facilities report a growing nurse shortage, new graduates express uncertainty about their readiness to practice, nursing education is both grappling with a faculty shortage and scrutinizing the best methods for educating students, and violence toward healthcare providers is of major concern along with stress and burnout. But with challenges come opportunities. To provide insight for regulators, nursing leaders, and policymakers on the extraordinary circumstances currently confronting nursing, the National Council of State Boards of Nursing (NCSBN) presents the embodiment of this information and data in its annual Environmental Scan.

Transforming Teaching of Foundational Nursing Skills to Enhance Clinical Reasoning Development: A Proposed Simulation Based Learning Activity

Over the past decade nurse educators have been called to transform nursing academia in order to better prepare our future nurses for the tremendous changes in the healthcare environment. The advancing medical technology, aging population, nursing shortages and recent COVID pandemic have provided unique challenges that require complex decision-making abilities. The National Council of State Boards of Nursing (NCSBN) has made significant changes in their licensure examination to accommodate the need to assess vital clinical judgment and decision-making skills in entry level graduate nurses. A model to measure clinical judgment was developed by NCSBN in 2019 to assist faculty in evaluating students beyond textbook nursing knowledge to actively perform and evaluate safe, effective clinical decisions. In order for students to fully grasp the clinical judgment process, faculty need to create active learning opportunities that provide patient context so students can cultivate clinical decision-making skills parallel to clinical knowledge. In nursing curricula, students learn fundamental skills in the first year of their education that provide them with a strong foundation to assess and care for thousands of patients. Transforming how these vital nursing skills are taught from solely performing the psychomotor learning domain to incorporating patient specific scenarios can foster development of clinical reasoning and sound clinical judgment in practice. This article outlines the transformation and redesign of teaching clinical skills to first semester nursing students to enhance clinical reasoning development and a proposed future study of assessing student outcomes using a simulation-based approach.

Development of Nurse Practitioner Student Self-Perception of Clinical Reasoning and Diagnostic Ability.

Nurse practitioner faculty identified student struggles to gain diagnostic reasoning competence. The National Council of State Boards of Nursing developed a clinical judgment action model (CJAM) for the NCLEX (NextGen) that can be used in prelicensure nursing education to design educational interventions and has potential applicability toward diagnostic reasoning development in nurse practitioner students. The purpose of this project was to evaluate the impact of a didactic education intervention aligned with the CJAM on the development of clinical reasoning cognitive skills. The use of the CJAM demonstrated a positive outcome among nurse practitioner students in clinical reasoning development.