California Nurses Research Articles

Nurses Launch Billboard Campaign Against Renewal of Desert Regional Medical Center Lease

No abstract available. Article truncated after 150 words. The California Nurses Association and National Nurses United have launched a billboard campaign against the lease renewal of public-owned, Palm-Springs-based Desert Regional Medical Center to Dallas-based Tenet Healthcare (Figure 1) (1). The billboard campaign is in response to the posting of two videos that showed a water leak in Desert Regional's neurological intensive care unit and an infestation of cockroaches in the emergency department break room (2,3). Desert Regional is a public hospital governed by an elected district board. Tenet Healthcare is a private company that leases and runs the hospital. The nurses’ union said Tenet has a long-standing practice of short-staffing Desert Regional, which they said has caused patient safety issues (1). Tenet is currently in the process of renegotiating another 30-year lease with the hospital, which would include the option to purchase the hospital from the Desert Healthcare District at the end of the new lease (1). Desert …

Evidence-Based Practice Implementation: Dependent on Capacity and Capabilities.

This study was conducted to determine the benefits, facilitators, and barriers of implementing evidence-based practice (EBP) into organizational culture. Implementing EBP leads to higher quality of patient outcome care, improved patient outcomes, and decreased healthcare costs. Nurse leader (NL) influence is essential for successful EBP implementation. Data were collected using a descriptive qualitative approach with focus group interviews using 2 open-ended questions. Participants included NL attendees at the 2022 Association of California Nurse Leaders Annual Program/Conference. Data were analyzed and themes were identified using Sandelowski's method. Two overarching themes emerged: capacity (the amount something can produce) and capabilities (the power or ability to do something). Healthcare organizations need to invest in building NLs' capacity to implement EBP and allocate resources to strengthen the organization's capabilities in supporting EBP.

Knowledge and Comfort in Providing Contraception, Sexual, and Reproductive Healthcare Among Pediatric Nurses in California

To evaluate the awareness, comfort, and feeling of competence of California registered nurses (RNs) in the provision of contraception and sexual and reproductive healthcare (SRH) to adolescent patients following California Assembly Bill (AB) 2348 legislation that expanded RN scope of practice to include provision of self-administered and injectable hormonal contraception. A cross-sectional, descriptive survey was used to assess pediatric registered nurses’ awareness of AB2348, perceived level of competence and comfort in the provision of sexual and reproductive health care (N = 504). A sample of pediatric RNs in California were included in this analysis. Descriptive statistics were used to assess demographic characteristics and summarize participants responses, and Fisher's exact tests were used to identify difference between groups. Responses from 45 pediatric RNs are reported in this analysis. The majority (80.0%, n = 36) of nurses in this study had no knowledge of AB2348. Many expressed a lack of comfort dispensing contraception (34.6%, n = 16), discussing age-appropriate information on safer sex practices (62.2%, n = 28), and providing sexually transmitted infection education (49.9%, n = 22).While most of the pediatric RNs reported frequently providing care to pediatric patients of reproductive age the majority were not comfortable providing contraception, safer sex education, or sexually transmitted infection education, and were unaware that it is within their scope of practice to independently provide services using standardized procedures. Increased training the provision of SRH care is needed among pediatric RNs to increase their sense of competence and comfort in providing adolescent SRH care.

Exploration of California School Nurse perspectives on the impact of COVID-19.

To explore in a sample of school nurses (SN) in California the impact of the COVID-19 pandemic on school nurse health services, how school nurses mitigated the impact of COVID-19, and moral distress levels among school nurses. Nineteen (N=19) school nurses who work in K-12 schools in California, USA participated in a mixed-methods approach involving qualitative descriptive design, inductive content analysis, and descriptive statistics. Interviews were conducted in August and September 2021. Five themes emerged: (1) role of the SN during the COVID-19 pandemic, (2) coordination with school administration, (3) COVID-19 related challenges and disruptions to care, (4) moral distress, and (5) coping during the pandemic. The pandemic had a profound impact on school nurses. This study provides school nurse perspectives of the impact of COVID-19 on services they delivered, the unique skills of school nurses essential to mitigation strategies, and moral distress school nurses encountered during the pandemic. Understanding the important role school nurses had during the pandemic is paramount to fully contextualize the contributions they made within public health nursing practice and inform preparedness for future pandemics.

Original Research: COVID-19 Vaccine Hesitancy Among Southern California Nurses.

The purpose of this study was to elucidate characteristics of vaccine-hesitant nurses at two large Southern California medical centers where rates of COVID-19 vaccination were lower than expected. This study is a secondary analysis of nurse participants in a cross-sectional study conducted at the two medical centers. Participants completed an online survey regarding their demographics; work setting and role characteristics; influenza vaccination history; COVID-19 knowledge and beliefs; and personal history of COVID-19 exposure, diagnosis, and disease impact (infection or death) on those closest to them. Of 869 nurse participants, most (78.6%) were vaccinated and 21.4% were unvaccinated; more than half of the unvaccinated participants reported being unwilling to be vaccinated ("vaccine hesitant"). The χ 2 comparisons revealed no significant differences between vaccinated and vaccine-hesitant nurses in terms of education, contact with COVID-19 patients, work environment, or having friends and family impacted by COVID-19. Binary logistic regression showed that nurses who had no history of recent influenza vaccination were 10 times more likely to be vaccine hesitant, those who had inaccurate knowledge about COVID-19 vaccines were seven times more likely to be vaccine hesitant, and younger nurses and those with a prior COVID-19 diagnosis were approximately three times more likely to be vaccine hesitant. Furthermore, 17.3% of all participants were unwilling to recommend COVID-19 vaccination to others. The findings offer a nuanced understanding of vaccine hesitancy among nurses and will be useful to the planning and development of policies, campaigns, and interventions aimed at increasing vaccination rates among nurses. Changing attitudes is essential, and particular attention must be paid to nurses who are unwilling to recommend vaccination to others. Effective interventions are needed.

Equipping Nurses to Lead Evidence-Based Practice: An Opportunity for Professional Nursing Associations.

The aim of this study was to describe the evidence-based practice (EBP) attributes among California nurse leaders who are members of a professional nursing organization. Nurse leaders are pivotal for successful EBP implementation. The Association of California Nurse Leaders' (ACNL) mission to equip nurses to lead self, others, and systems propelled them to conduct a study of members' EBP beliefs, knowledge, competencies, and implementation. Evidence-based practice attributes of California nurse leaders were measured using valid and reliable scales via an anonymous, electronic survey. Although ahead in the subjective EBP scales, California nurse leaders' perceptions of organizational EBP culture were comparable with those of a similar national sample. Scores still indicated opportunities for improvement. Nurse leaders must be prepared to lead EBP in their organizations. Professional organizations such as ACNL have an opportunity to help leaders by conducting research and assessing and meeting their members' learning needs.

Informing Policy from Prices: An Overview of California Nursing Homes

Introduction: The rising cost of healthcare along with the aging demographic requires the attention of policy makers. The United States’ nursing home industry is costly to older adults, requiring many to resort to government funded Medicare to offset these costs. This study aims to understand determinants of nursing home prices in the state of California. Variables included in the analysis are selected based on previous literature on the costs of nursing homes in the US.
 Methods: The data were analyzed using a multi-variable regression analysis. The analysis sample included 1,121 nursing homes across California, using facility level and governmental data that is publically available for the years of 2016-2017. Data collected included financial indicators (net income), ownership (for-profit, non-profit) represented as a dummy variable, occupancy rates, reimbursement rates (Medicare & Medicaid), staffing, quality and competition variables such as nursing homes per county.
 Results: The regression analysis indicated that ownership type (for-profit), competition and occupancy rates have a negative significant effect on nursing home prices. Whereas, reimbursement rates of both Medicare and Medicaid, home income and staffing levels have a positive significant effect, driving further nursing home prices.
 Conclusion: The study aimed to understand the relevant variables that influence nursing home prices in the state of Califronia. The regression analysis yielded significant results for various factors including reimbursement rates, occupancy rates and the number of nursing homes per county. However, a notable limitation to the study is the inability to generalize these factors to the rest of the US due to state specific health policies. Determinants such as reimbursement rates and nursing homes per county vary by governmental decisions, therefore, a comprehensive policy tool could be designed to alter nursing home costs through state health policies.

Jacqueline Herd DNP, RN, NEA-BC

Jacqueline Herd, DNP, MSN, RN, NEA-BC is the Executive Vice President and Chief Nursing Officer (CNO) at Grady Health System in Atlanta, Georgia. She is a California native and moved to Georgia in 2009 as the chief nursing officer at Grady Health Care in Atlanta (Tenet Health Care). With over 20 years’ experience as a nurse executive, her passion is inspiring and empowering nurses to lead. Before moving to Georgia, she was a member of the Association of California Nurse Leaders (ACNL), and since moving to Georgia, she is a member of the Georgia Nurses Association, American Nurses Association, and an active member of Georgia Organization of Nurse Leaders (GONL). She has served as a member at large, president elect, president and immediate past president on the GONL State Board. She is an active member of American Organization of Nurse Leaders (AONL), has volunteered on the by-laws committee and the publication committee for the “Voice of Nursing Leadership,” and is current AONL board member elected to represent Region 4. She is a strong advocate for the March of Dimes (MOD) and has served on the MOD Atlanta Planning Committee and the Nurse of the Year nominating committee. She has also served on the Georgia State Community Advisory Board and is currently on the Emory University Nell Hodgson Woodruff School of Nursing DNP Community Advisory Board. She is married with 3 children and 7 grandchildren.

Nurse Practitioner Role and Practice Environment in Primary and in Nonprimary Care in California.

Between 2008 and 2016, there was an increase in nurse practitioners in specialty care. This study explores some differences in role and practice environment between primary care and nonprimary care nurse practitioners in the domains of time spent on activities, barriers to providing care, working to scope of practice, full skill utilization, and satisfaction. This cross-sectional quantitative study, based on data from the 2017 Survey of California Nurse Practitioners and Certified Nurse Midwives, found that nurse practitioners in nonprimary care practices have lower odds of reporting time as a barrier to practice, lower odds of reporting practice to full scope, and higher odds of reporting a hierarchical or supervisory relationship with the physician. Future exploration of these differences may shed light on ways to promote nonprimary care practice environments to foster more effective collaboration and fewer barriers to providing care.

Nurse Staffing and Coronavirus Infections in California Nursing Homes.

In the United States, 1.4 million nursing home residents have been severely impacted by the COVID-19 pandemic with at least 25,923 resident and 449 staff deaths reported from the virus by June 1, 2020. The majority of residents have chronic illnesses and conditions and are vulnerable to infections and many share rooms and have congregate meals. There was evidence of inadequate registered nurse (RN) staffing levels and infection control procedures in many nursing homes prior to the outbreak of the virus. The aim of this study was to examine the relationship of nurse staffing in California nursing homes and compare homes with and without COVID-19 residents. Study data were from both the California and Los Angeles Departments of Public Health and as well as news organizations on nursing homes reporting COVID-19 infections between March and May 4, 2020. Results indicate that nursing homes with total RN staffing levels under the recommended minimum standard (0.75 hours per resident day) had a two times greater probability of having COVID-19 resident infections. Nursing homes with lower Medicare five-star ratings on total nurse and RN staffing levels (adjusted for acuity), higher total health deficiencies, and more beds had a higher probability of having COVID-19 residents. Nursing homes with low RN and total staffing levels appear to leave residents vulnerable to COVID-19 infections. Establishing minimum staffing standards at the federal and state levels could prevent this in the future.

The Impact of Music and Memory on Resident Level Outcomes in California Nursing Homes

ObjectivesTo study the effects of a nonpharmacologic intervention, Music and Memory (M&M), on residents with dementia and/or behavioral problems living in nursing homes (NHs). DesignThis was a prospective, mixed-methods cohort study. Setting and ParticipantsIn total, 4107 residents in 265 California NHs and that reported data at least twice during the 3-year study period were enrolled. MeasuresWe used a quarterly rolling enrollment process; participants provided data at baseline and quarterly via an online survey that included select resident level data from the Minimum Data Set (psychotropic drug use, cognition, behaviors, mood, pain, and falls), experience with the M&M program, and resident use of music. NHs were eligible if they were Medicare- and Medicaid-certified and had 15 residents with a diagnosis of dementia or cognitive impairment or exhibited significant behavioral symptoms. ResultsM&M was associated with reductions in psychotropic medication use, reduced behaviors, and improved mood. The odds of antipsychotic use declined by about 11%, of antianxiety medications by 17%, and antidepressants by 9% per quarter. Aggressive behaviors, depressive symptoms, pain, and falls also declined significantly over time. The odds of residents exhibiting aggressive behaviors declined by 20% per quarter, depressive symptoms by 16%, reported pain by 17%, and falls by 8%. Conclusions and ImplicationsThis is the largest study of M&M to date. We found clinically and statistically significant reductions in psychotropic medications and improved behaviors in residents using M&M. Although the study showed positive results overall, the lack of a control group was a significant limitation that precluded determining how much more improvement participating residents experienced compared with nonparticipants. Future studies should include a control group so that better conclusions can be drawn regarding the effectiveness of the M&M program.

The Determinants of Nursing Turnover: A Multi-Year Analysis

Using cross section random surveys (2008, 2010, 2012, 2014, and 2016) of 7,000 nurses in California, we examine the influence of nursing demographics and four groups of self-reported determinants of nursing career-choice decisions: FAMILY CONCERNS (childcare, other family concerns, moving, and non-job illness), ECON (salary and benefits), STRESS (job stress, job illness, other job dissatisfaction, nurse job dissatisfaction, and lay off concerns), and OTHER group (travel, another occupation, and school). For nurses leaving for at least one year of absence and then returning to nursing, the FAMILY CONCERNS were consistently rated most important by nurses, followed by a distant second by the equivalent STRESS and OTHER group influencers. The ECON group rated least important. The nurses permanently leaving the health care profession, FAMILY CONCERNS were once again rated most important during the first three years of our sample (2008, 2010, 2012), but then faded as STRESS and OTHER factors took over in relative importance.

Comparison of lift use, perceptions, and musculoskeletal symptoms between ceiling lifts and floor-based lifts in patient handling

Lifting equipment can reduce the risk of injury from patient handling, but limited availability and adoption have been a persistent problem. Data from statewide surveys of California nurses (N = 389) in 2013 and 2016 were analyzed to evaluate lift use, perceptions about lifts and injury risk, and musculoskeletal symptoms by type of available lifts. Nurses with ceiling lifts (23%) were significantly more likely to use lifts and had more positive perceptions about lifts, regarding worker safety, patient safety and comfort, ease of use, access, and storing, than nurses with only floor lifts (77%). Nurses with ceiling lifts reported less low back pain and shoulder pain. Our study findings suggest that providing ceiling lifts can result in superior outcomes to floor-based lifts in multiple aspects, including better acceptance and use by nurses for patient handling, as well as being associated with reduced work-related musculoskeletal symptoms in the low back and shoulders.

An Exploratory, Descriptive Study of Nurse Leaders' Personal and Work Experiences During Union Negotiations and Strike Events.

This study explored the experiences, perceptions and emotional state of nurse leaders during union activities to understand the impact on their personal and professional lives. Other than anecdotal stories shared during union negotiations and strike preparations, very little evidence exists in nursing and healthcare literature about nursing unions and their impact on nurse leaders and their organizational priorities. This study used an exploratory, descriptive design with a convenience and snowball sample of Association of California Nurse Leaders members. The findings indicate nurse leaders experience a range of emotional states in response to union activities with perceptions of increased workload, job stress, and constrained and deliberate communications with their staff. This study adds to the body of knowledge about nurse leader experiences and feelings during union activities.

California Nurse Practitioners Are Positioned To Fill The Primary Care Gap, But They Face Barriers To Practice.

Nurse practitioners are well prepared to help fill care gaps arising from shortages of primary care physicians in California. This article reports findings from a survey of California nurse practitioners that examined their employment and practice barriers. The number of nurse practitioners per capita varies across California counties and is positively correlated with the number of physicians per capita. Hispanic and Filipino nurse practitioners are more likely to live in underserved areas. Nurse practitioners and their education programs are concentrated in the same counties that have high physician-to-population ratios. In these counties, recently graduated nurse practitioners are more likely to report that they plan to relocate to another state in the next five years. Expanding education programs in underserved areas, increasing the diversity of the nurse practitioner workforce, and ensuring that nurse practitioners feel empowered to fully use their skills are necessary to meet both current and future primary care needs.

Registered nurses’ preferences for rural and urban jobs: A discrete choice experiment

BackgroundRecruitment and retention of nurses is an ongoing challenge for employers in rural areas worldwide. There is limited information available regarding influences on nurses’ job choice in the U.S. and little understanding of how nurses make trade-offs between desired and less desirable job characteristics when choosing between jobs. ObjectivesThe purpose of this research was to examine the hospital job preferences of registered nurses in the U.S. The specific objectives of the study were: 1) To identify the relative importance of key job attributes on registered nurse job choice, and 2) To predict the impact of changes in the levels of attributes on the probability of registered nurses choosing one job over another. Design and SettingA discrete choice experiment was developed and applied in the U.S. using California as a study site. Participants190 registered nurses currently working in nursing or intending to return to work in nursing from urban, large-, small- and isolated-rural communities. MethodsThe survey instrument was developed through a literature review and semi-structured interviews with nurse experts, utilizing a hypothetical job in a hospital medical / surgical unit. Experimental design principles were applied to create a discrete choice experiment which was pilot tested with urban and rural nurses. The survey was mailed to a random sample of 1000 licensed registered nurses in California. A mixed logit model was used to estimate nurses’ preferences for different levels of the job attributes. Willingness to pay estimates and simulations of job uptake rates were calculated. ResultsEight factors were identified as important to job choice: earnings, nursing voice in management, tuition reimbursement, scheduling, patient care team, leadership, location and nursing sensitive patient care outcomes. Respondents valued a cohesive patient care team (coefficient 1.95, [SE 0.23]) and a strong nursing voice in management (coefficient 1.56, [SE 0.22]) highest. A job in a large urban inland location was negatively valued (coefficient -0.69, [SE 0.25]). Around 72% of respondents chose to stay in their current job when this choice was offered. While earnings were important, nurses were willing to sacrifice earnings to secure other valued job characteristics when choosing between jobs. ConclusionsStudy findings provide information on how job characteristics are valued by nurses in California. Findings suggest job seekers may be 65–75 percent more likely to choose a job when valued job characteristics are present. Our findings are particularly relevant to rural hospitals with limited financial resources.

Relationships of Musculoskeletal Symptoms, Sociodemographics, and Body Mass Index With Leisure-Time Physical Activity Among Nurses.

Nurses have a high prevalence of musculoskeletal symptoms from patient handling tasks such as lifting, transferring, and repositioning. Comorbidities such as musculoskeletal symptoms may negatively affect engagement in leisure-time physical activity (LTPA). However, limited data are available on the relationship between musculoskeletal symptoms and LTPA among nurses. The purpose of this study was to describe musculoskeletal symptoms and LTPA, and to examine the relationships of musculoskeletal symptoms, sociodemographics, and body mass index with LTPA among nurses. Cross-sectional data on sociodemographics, employment characteristics, musculoskeletal symptoms, body mass index, and LTPA were collected from a statewide random sample of 454 California nurses from January to July 2013. Descriptive statistics, bivariate and multiple logistic regressions were performed. We observed that non-White nurses were less likely to engage in regular aerobic physical activity than White nurses (odds ratio [OR] = 0.61; 95% confidence interval [CI] = [0.40, 0.94]). Currently working nurses were less likely to engage in regular aerobic physical activity than their counterparts (OR = 0.48; 95% CI = [0.25, 0.91]). Nurses with higher body mass index were less likely to perform regular aerobic physical activity (OR = 0.93; 95% CI = [0.89, 0.97]) or muscle-strengthening physical activity (OR = 0.92; 95% CI = [0.88, 0.96]). This study found no evidence that musculoskeletal symptoms may interfere with regular engagement in LTPA. Physical activity promotion interventions should address employment-related barriers, and particularly target racial minority nurses and those who have a high body mass index.

Interdisciplinary Guidelines for Care of Women Presenting to the Emergency Department With Pregnancy Loss.

In April 2016, the National Perinatal Association and Kaiser Permanente Northern California Nursing Research Community Benefits Grant sponsored an interdisciplinary summit to explore the needs of women who present with actual or potential pregnancy loss to the emergency department (ED). Thirty-two experts in the field of pregnancy loss, 17 of whom represented their professional organizations, participated. These experts, which included nurses, physicians, social workers, counselors, authors, and parents, worked together to create guidelines for care of women with a pregnancy loss in the ED. Recommendations for ED healthcare providers are included. Emergency department personnel agreed that improvements in care could be offered and were willing to endorse education for their staff. The guidelines delineate how to better provide physical, emotional, and bereavement support at any stage of gestational loss. Administrative support for policies in the ED is essential to ensure the delivery of family-centered, culturally sensitive practices when a pregnancy ends.

Safe patient handling behaviors and lift use among hospital nurses: A cross-sectional study

PurposePatient handling is well known for the risk of musculoskeletal injury. Safe work practices are important to reduce risk of injury while performing patient handling tasks. This study investigated factors associated with safe patient handling behaviors and lift use among hospital nurses in the United States. MethodsThis study analyzed cross-sectional survey data from a statewide random sample of 221 hospital nurses in California who had patient handling duties. Safe patient handling behaviors and lift use were examined for the relationships with demographic characteristics, organizational safety practices, physical and psychosocial job factors, musculoskeletal symptoms, and perceptions about lift use and risk of injury. ResultsIn multivariable logistic regression, high safe patient handling behaviors were significantly associated with a positive organizational safety climate (Odds Ratio [OR]=2.76, 95% Confidence Interval [CI] 1.51–5.03), people-oriented culture (OR=2.59, 95% CI 1.45–4.62), and ergonomic practices (OR=1.67, 95% CI 1.04–2.67). High lift use (>50% of the time when needed) were significantly associated with high lift availability (OR=3.1, 95% CI 1.06–9.01) and positive perceptions about lift use (OR=3.48, 95% CI 1.63–7.44). In bivariate analysis, high safe patient handling behaviors were associated with shorter height, non-White race, lower physical workload, lower job strain, higher job satisfaction, and less musculoskeletal symptoms. ConclusionsThe study findings underscore the importance of organizational safety practices and culture to promote safe work practices for patient handling injury prevention. Also, making lift equipment readily available and improving positive perceptions and experiences about lifts can be crucial to ensure the use of lift equipment.

Findings From a Sexual and Reproductive Health and Abortion Care Survey of California Nurses

Findings From a Sexual and Reproductive Health and Abortion Care Survey of California Nurses