Board Of Nursing Research Articles

Faculty collaboration in transitioning to NGN test item writing

This article describes the process faculty used to implement National Council of State Boards of Nursing (NCSBN) Next Generation NCLEX-RN (NGN) test item writing at an urban southeast U.S. ADN program. Attendance at several NGN workshops included learning the clinical reasoning and test question composition process and incorporating NGN test items for use in the formative evaluation process which determines student proficiency in content in the ADN program. These methods integrated by faculty should help the nursing student attain the knowledge, skills, abilities, and reflection to improve critical thinking and ensure competent clinical judgment at the entry level in their careers as registered nurses. Additionally, incorporating NGN using the Clinical Judgment Measurement Model (CJMM) will preclude the potential failure by new graduates to recognize patient complications coupled with the inability to act to rescue patients. The goal for nursing programs implementing NGN is for new graduates delivering competent nursing care, intervening early, and reducing the incidence of patient harm.

Board of Nursing.

Board of Nursing.

Drivers of COVID-19 booster uptake among nurses

Nurses are at the forefront of efforts to contain COVID-19 and are thus at greater risk of infection from the virus than the general population. Unlike the initial vaccination, booster vaccinations are not always required, and some nurses have not received a booster shot. We investigate the predictors of booster uptake among nurses. We developed an original survey to study booster uptake among nurses. Using contact information from the South Dakota Board of Nursing, we contacted nurses in South Dakota in June and July of 2022. We conducted a multivariate logistic regression to analyze the data. One thousand eighty-four nurses participated in our study. We found booster uptake among nurses was associated with their partisan self-identification(OR 0.40, 95% CI 0.31-0.52), age (OR 1.04, 95% CI 1.02-1.05), flu vaccination last season (OR 5.61, 95% CI 2.6-12.1), and positive COVID-19 test in last 12 months (OR 0.51, 95% CI 0.35-0.74). Our results show that COVID-19 booster uptake has been politicized even among nurses. As public health officials continue devising interventions to increase booster uptake among healthcare workers, they should be mindful that they would be viewed through the partisan lens.

Approach to advanced practice nursing student clinical during COVID-19.

Approach to advanced practice nursing student clinical during COVID-19.

Nursing Students’ Knowledge, Skills, and Attitudes Regarding Medicinal Cannabis Care

Nursing Students’ Knowledge, Skills, and Attitudes Regarding Medicinal Cannabis Care

Nursing Students' Perceptions of Learning With NGN-Style Case Studies.

The National Council of State Boards of Nursing (NCSBN) developed Next Generation NCLEX (NGN) case studies and new test items, based on the NCSBN Clinical Judgment Measurement Model, to assess nurse graduates' clinical judgment and decision-making ability. This study investigated nursing students' perceptions of learning with NGN-style case studies. A mixed-methods approach collected nursing students' perceptions in a 6-item survey. Overall respondents agreed that the case studies were helpful in learning (n = 45; 90%), applying course concepts (n = 46; 92%), learning clinical judgment (n = 46, 92%), and promoting active learning (n = 43, 86%), and were a useful learning strategy (n = 48, 96%). Themes identified in narrative comments were critical thinking, real-life application, and a learning tool. NGN-style case studies were useful as an active learning strategy to promote clinical judgment and real-life application of course concepts.

Evolving the Assessment of Clinical Judgment: An Individual or Collective Competency?

Nurses make decisions about care individually and as part of a team. Collective competence, the effective team management of patient care situations, is partially dependent on nurses' individual confidence and clinical judgment competence. To describe individual and team-based facilitators and barriers to collective competence in teams of senior baccalaureate-level prelicensure nursing students during a team-based simulation. With a cross-sectional design, the study used a 26-item survey based on the National Council of State Boards of Nursing (NCSBN)-Clinical Judgment Measurement Model (CJMM) (α= .86) to assess individual student confidence and perceptions of clinical judgment competence while observation of team dynamics and task completion assessed collective competence. Closed-loop communication and role assignment were facilitators of collective competence when present and barriers when absent. Additional barriers were lack of student confidence and perceived competence with Layers 3 and 4 of the NCSBN-CJMM. Team-based simulation strategies can be effectively used to assess collective clinical judgment competence.

Risk Factors for Recidivism in Nursing Practice: A Criminal Conviction Case Review Cohort Study

<h3>Background</h3> Boards of nursing (BONs) investigate complaints and take disciplinary actions against the licenses of nurses in order to maintain patient safety. For nurses with prior criminal convictions, the potential risks to patient safety have not been formally evaluated. <h3>Objective</h3> This study aims to assess the impact of a nurse's prior criminal conviction(s) on the risk of recidivism in nursing practice and to investigate whether nurses who were disciplined by BONs for a crime but retained an active nursing license posed a subsequent risk to public safety. <h3>Methods</h3> We reviewed Nursys discipline data from 2008–2018 to compare the risk of recidivism for nurses sanctioned for criminal convictions between 2012–2013 and those disciplined for other violations. The type of crimes and disciplinary actions taken by BONs were recoded and analyzed. <h3>Results</h3> The 5-year recidivism rate of nurses who received disciplinary actions for criminal convictions between 2012 and 2013 was 38%, which is comparable to the recidivism rate among nurses in the control group (36%). Overall, among those who had a criminal conviction history yet retained an active license, 4% committed a practice-related violation or crime within the 5-year postdisciplinary period. Three factors correlated with recidivism: (1) committing a crime related to substance use disorder, (2) committing a crime related to nursing practice, and (3) committing multiple crimes. <h3>Conclusion</h3> The majority of nurses who were disciplined by BONs for a criminal conviction and allowed to remain in nursing practice did not receive additional disciplinary actions by BONs for committing subsequent practice-related violations or crimes during the 5-year post disciplinary period. The current study suggests that the licensure and discipline procedures used by BONs in response to criminal convictions help to reduce the risk of patient harm in nursing practice, thereby aligning with their mission of public protection.

Implementing Full Practice Authority for Advanced Practice Registered Nurses: A Case for Mitigating Critical Mental Health Services.

The COVID-19 pandemic has highlighted some perverse health disparities that we know have long existed in the United States. Disparities related to access, affordability, and cultural appropriateness of care cannot be overemphasized. More importantly, disparities related to provider shortages continue to contribute to adverse patient outcomes, particularly in rural areas and other socioeconomically deprived communities. Despite the push from the National Council of State Boards of Nursing (NCSBN) to ensure adoption and implementation of full practice authority (FPA) of advanced practice registered nurses (APRNs), currently only 28 states in the United States have achieved this goal. In addition, there are some states such as Florida that recently passed legislation supporting FPA for primary care APRNs, yet still have practice restrictions for specialty APRNs, such as mental health. The evidence is clear that patients managed by APRNs have better or comparable outcomes to those managed by physicians; thus, more advocacy is needed to ensure that all states and territories achieve this very important milestone for the profession as it has the potential to foster a collaborative interdisciplinary approach to patient care, which at the same time produces positive patient outcomes, employee satisfaction, and a work environment in which all members of the care team feel valued and autonomous.

A Comparison of Discipline Between Nurses Holding a Multi- or Single-State License

Background The Nurse Licensure Compact (NLC) is a modernized licensure system designed to facilitate nurse mobility in a safe and standardized way. It has demonstrated particular usefulness during the COVID-19 pandemic and other emergencies, allowing nurses to practice where they are needed without the time and cost burdens of obtaining multiple state licenses. In 2018, uniform licensure requirements were added to the NLC to strengthen the requirements for a multistate license. Nevertheless, some states have been reluctant to join the NLC, expressing safety concerns. Purpose The National Council of State Boards of Nursing compared the discipline rates of multistate license holders to nurses holding single-state licenses. Methods This cross-sectional study used discipline data from the calendar year 2019, which was chosen because it contained the most current pre-pandemic data. Discipline cases among nurses with and without a multistate license were evaluated. Using the national Nursys database, we compared discipline rates and types of violations leading to disciplinary actions by 33 NLC Boards of Nursing (BONs) and 24 non-NLC BONs. Results The overall discipline rates of nurses in NLC and non-NLC states were virtually identical (0.24% versus 0.23%). However, a further breakdown of the data revealed the annual discipline rate of nurses holding single-state licenses across both non-NLC and NLC states was between two to four times higher than the rate of multistate license holders. Conclusion Multistate license holders’ consistently low discipline rates hold across all available demographic categories, suggesting the overall safety of the NLC. The Nurse Licensure Compact (NLC) is a modernized licensure system designed to facilitate nurse mobility in a safe and standardized way. It has demonstrated particular usefulness during the COVID-19 pandemic and other emergencies, allowing nurses to practice where they are needed without the time and cost burdens of obtaining multiple state licenses. In 2018, uniform licensure requirements were added to the NLC to strengthen the requirements for a multistate license. Nevertheless, some states have been reluctant to join the NLC, expressing safety concerns. The National Council of State Boards of Nursing compared the discipline rates of multistate license holders to nurses holding single-state licenses. This cross-sectional study used discipline data from the calendar year 2019, which was chosen because it contained the most current pre-pandemic data. Discipline cases among nurses with and without a multistate license were evaluated. Using the national Nursys database, we compared discipline rates and types of violations leading to disciplinary actions by 33 NLC Boards of Nursing (BONs) and 24 non-NLC BONs. The overall discipline rates of nurses in NLC and non-NLC states were virtually identical (0.24% versus 0.23%). However, a further breakdown of the data revealed the annual discipline rate of nurses holding single-state licenses across both non-NLC and NLC states was between two to four times higher than the rate of multistate license holders. Multistate license holders’ consistently low discipline rates hold across all available demographic categories, suggesting the overall safety of the NLC.

Nursing Activities and Job Satisfaction of the Licensed Practical Nurse Workforce in New Jersey

Background Licensed practical nurses (LPNs) are important members of the nursing workforce in the United States, particularly in long-term care and home care settings. A previous qualitative study found LPNs have expanded their role, yet detailed information about the nursing activities performed by LPNs is lacking in New Jersey (NJ). Purpose The purpose of this study was to describe current nursing activities and job satisfaction of LPNs in NJ and to determine whether there is a difference in the nursing activities and job satisfaction of LPNs working in nursing homes and those working in other settings. Methods For this descriptive, cross-sectional study, LPNs who had email addresses listed with the NJ Board of Nursing were sent a survey about their nursing activities and job satisfaction. Results The 804 LPNs who completed the survey were representative of the NJ LPN workforce. The top nursing activities that LPNs performed daily were documenting, providing basic nursing care, checking vital signs, and administering medications. LPNs working in nursing homes also identified supervising unlicensed assistive personnel as an additional top nursing activity. Many LPNs also reported independently performing comprehensive and focused assessments and formulating care plans. Compared with LPNs working in other settings, LPNs working in nursing homes had less job satisfaction. Conclusion Our findings reveal that LPN scope of practice has increased, and some LPNs are functioning beyond their scope of practice. With a shared agenda, nurse leaders in practice, academe, trade organizations, and regulatory bodies should convene to discuss and ensure a clear understanding of the LPN role and scope of practice. Licensed practical nurses (LPNs) are important members of the nursing workforce in the United States, particularly in long-term care and home care settings. A previous qualitative study found LPNs have expanded their role, yet detailed information about the nursing activities performed by LPNs is lacking in New Jersey (NJ). The purpose of this study was to describe current nursing activities and job satisfaction of LPNs in NJ and to determine whether there is a difference in the nursing activities and job satisfaction of LPNs working in nursing homes and those working in other settings. For this descriptive, cross-sectional study, LPNs who had email addresses listed with the NJ Board of Nursing were sent a survey about their nursing activities and job satisfaction. The 804 LPNs who completed the survey were representative of the NJ LPN workforce. The top nursing activities that LPNs performed daily were documenting, providing basic nursing care, checking vital signs, and administering medications. LPNs working in nursing homes also identified supervising unlicensed assistive personnel as an additional top nursing activity. Many LPNs also reported independently performing comprehensive and focused assessments and formulating care plans. Compared with LPNs working in other settings, LPNs working in nursing homes had less job satisfaction. Our findings reveal that LPN scope of practice has increased, and some LPNs are functioning beyond their scope of practice. With a shared agenda, nurse leaders in practice, academe, trade organizations, and regulatory bodies should convene to discuss and ensure a clear understanding of the LPN role and scope of practice.

Who to Believe? Consequences for Physicians and Nurses Who Spread Misinformation

Who to Believe? Consequences for Physicians and Nurses Who Spread Misinformation

Outcomes of Remediation Strategies Implemented by the Illinois Board of Nursing to Improve Program NCLEX Pass Rates: A Five-Year Follow-Up.

After noting a marked decline in National Council Licensure Examination (NCLEX) pass rates for Illinois programs, the Illinois Board of Nursing created its remediation strategies tool based on standards of two accrediting bodies for use by programs with NCLEX pass rates of less than the state-mandated 75 percent. Five-year follow-up data demonstrated a marked decrease in number and percentage of programs with unsatisfactory results, which were consistent over time. Qualitative survey data across Illinois programs further supported the tool as a valuable resource.

A call to reform undergraduate nursing clinical placements

A call to reform undergraduate nursing clinical placements

Level of Satisfaction of Delivery Room Exposure among Senior Nursing Students of West Visayas State University

The Board of Nursing, in accordance with its mandated powers and functions, emphasizes that competencies in intra-partal and immediate care of the newborn must be developed among nursing students. Thus, it is important to determine whether provisions for such to come up to the expectations of the students. This study aimed to evaluate the level of satisfaction of delivery room exposure among senior nursing students. Likewise, it aimed to ascertain if the sex, academic performance in NCM 202 B and NRS 203, span of completion and number of hospitals of actual delivery exposure and influence their level of satisfaction. This descriptive study included 106 senior nursing students as participants. Simple random sampling method was employed in the selection of participants, utilizing a 34- item researcher-made questionnaire in evaluating the level of satisfaction on the delivery room exposure. Generally, the results of the study revealed that senior nursing students were satisfied with their previous delivery room exposure. Students were also satisfied with the teaching-learning experience, followed by the support of the hospital staff and facilities. No significant differences existed in the level of satisfaction on the delivery room exposure when grouped according to sex, academic performance, span of completion and number of hospitals of actual delivery

The Revised AACN Essentials: Implications for Nursing Regulation

In April 2021, member deans of the American Association of Colleges of Nursing approved new standards for nursing education, with competency-based education as its foundation. The revised Essentials framework includes competencies organized within 10 domains at two levels of nursing education: entry level and advanced level. An advantage of this approach is greater clarity and confirmation regarding the knowledge and skills of nursing school graduates. Implementation of the new Essentials will occur over the next several years, and substantial changes to the curriculum, learning activities, and learner assessment is expected. The revision of the Essentials presents a significant opportunity for regulators to collaborate with schools and practice partners. To that end, this article provides an overview of the newly revised Essentials, discusses considerations and implications for nursing regulation, and puts forth recommendations for boards of nursing.

North Carolina Board of Nursing's Alternative Program COVID-19 Response.

The North Carolina Board of Nursing (NCBON) implemented an alternative-to-discipline program (AP) in 1995 for nurses experiencing a substance use disorder. There have been programmatic changes since the inception of the AP. However, COVID-19 posed significant challenges related to balancing the NCBON's public protection mandate against COVID-19 impacts on the nurse's ability to comply with the AP conditions. The changes to the AP structure in response to COVID-19 included transition from in-person orientation interviews to virtual, drug screening process modifications, acceptance of virtual treatment and 12-step meeting attendance, and specific employment condition waiver accommodations. The NCBON identified modifications facilitated opportunities for nurses to remain compliant with the conditions of the AP while meeting the mandate of public protection.

Clinical Judgment Development: Six Steps to Establish Professional Identity and Role-Specific Competencies in Caring for a Sexual Assault Survivor

Background: Clinical judgment is a specific role that establishes a professional identity. The purpose of this paper is to prepare nursing students to make better judgments in the clinical setting and realign learning and teaching. Methods: We used six steps to arrive at a competent clinical judgment suggested by the National Council State Board of Nursing (NSCBN) as a clinical judgment model 1) recognizing cues, 2) analyzing cues, 3) prioritizing hypotheses, 4) generating solutions, 5) taking an action, and 6) evaluating outcomes during the head-to-toe examination of the patient. Results: The primary outcomes are stabilization of the hemodynamics of the patient and prevention of further blood loss. Fluids are being given to help keep the vascular volume from being depleted, but they cannot solve the underlying problem. Continued assessment, intervention, and monitoring of vital signs through the course of the hospital stay ending with the patient’s discharge. Discussion: Survivors of sexual assault are unique for a nurse to provide care. The nurse needs to assess, intervene, monitor, and pay attention to detail of the 6 steps to clinical judgment, resulting in positive outcomes for their patient. Conclusions: Forensic nursing is a field of nursing that focuses on sexual assault survivor care and works to make the aftermath of their tragic situation easier to cope with. Strengthening clinical judgment skills could remedy significant mistakes made by novice forensic nurses. Critical thinking and clinical ethical reasoning are the building blocks of clinical judgment.

Holistic Nurse Practitioner Care Including Promotion of Shared Decision-Making.

The purpose of this quantitative, descriptive, exploratory study was to gauge the degree to which nurse practitioners (NPs) incorporate holistic nursing values in their care, with a special focus on shared decision-making (SDM), using the Nurse Practitioner Holistic Caring Instrument (NPHCI), an investigator-developed scale. A single open-ended question inviting free-text comment was also included, soliciting participants' views on the holistic attributes of their care. A convenience sample of NPs (n = 573) was recruited from a southeastern U.S. state Board of Nursing's (BON) publicly available list of licensed NPs. Results suggest that NPs do indeed perceive their care to be holistic, and that they routinely incorporate elements of SDM in their care. Highest scores were accorded to listening, taking time to talk to patients, knowledge of physical condition, soliciting patient input in care decisions, considering how other areas of a patient's life may affect their medical condition, and attention to "what matters most" to the patient. Age, gender, level of education, practice specialty, and location were also associated with inclusion of holistic care. Free-text responses revealed that NPs value holistic care and desire to practice holistically, but identify "lack of time" to incorporate or practice holistic care as a barrier.

Adoption of e-portfolios for Registered Nurses &amp; Midwives Professional Registration and Revalidation in Ireland

In many countries, such as Australia, Canada, the United Kingdom (UK), and the United States of America, Nursing and Midwifery Professional Bodies undergo a revalidation process demonstrating evidence of continuing professional development (CPD) and clinical practice hours in order to remain an active member on the professional register. In most countries this process involves documenting evidence in paper format. However, in the UK, our closest neighbour, eportfolio submission is now offered as an option for revalidation. Ireland is imminently moving towards introducing documented evidence as a requirement for continued registration as currently, there are no requirements to demonstrate evidence of continuing professional development or clinical practice as part of the annual re-registration process. While there are plans to address this in the near future, there are no details regarding the revalidation requirements or process. Irish undergraduate and postgraduate nursing and midwifery students are beginning to use eportfolios for assessment purposes and are increasingly familiar with the online eportfolio platforms. In this paper, we provide a rationale for the Irish Nursing and Midwifery Board (NMBI) to adopt eportfolios for the submission of documentary evidence for both initial registration and revalidation. We will examine the advantages and the barriers to the introduction of eportfolios in this context. The use of eportfolios would provide the NMBI an opportunity to lead the way in registration and revalidation processes internationally, enabling nurses and midwives in Ireland to embrace the opportunities that the digital age presents.