Registered Nurses Research Articles

Reducing Adult Transgender Barriers to Care in the Emergency Department: Strategies to Improve Policies and Practices.

The Research to Practice column is intended to improve the research critique skills of the advanced practice registered nurse (APRN) and the emergency department (ED) registered nurse (RN) and to assist with translating research into practice. In this column, we review a recent qualitative research study by M. Allison, S. Marshall, G. Stewart, M. Joiner, C. Nash, and M. Stewart (2021) titled "Experiences of Transgender and Gender Nonbinary Patients in the Emergency Department and Recommendations for Health Care Policy, Education, and Practice" with discussion of how their findings can be applied to inform providers how to deliver appropriate care of transgender patients within the ED.

Advanced nurse specialist-managed pediatric extracorporeal membrane oxygenation: A 35-year single center experience

Aim: To investigate the feasibility, safety, and clinical outcomes of a solely registered nurse (RN)-managed extracorporeal membrane oxygenation (ECMO) program in a community hospital over a 35-year period. Material and Methods: A retrospective single-center review was conducted on all patients who received at least 24 hours of ECMO support in our pediatric intensive care unit (PICU) between August 1987 and August 2021. An integrated study of ECMO support type, ECMO duration, and patient survival to discharge was systematically performed. Results: 321 ECMO runs were initiated on 319 patients. 273 (85.0%) runs were for elective pulmonary support, 34 (10.6%) were for elective cardiac support, and 14 (4.36%) were for emergent cardiac support in extracorporeal cardiopulmonary resuscitation (ECPR). Of the 321 ECMO runs, 279 (86.9%) were performed on neonatal patients, 37 (11.5%) on pediatric patients, and 5 (1.56%) on adult patients (excluded from analysis). The median duration of ECMO was 120 hours for neonatal patients and 134 hours for pediatric patients. 69.5% of all patients on ECMO survived to discharge. ECPR was an independent predictor of poor outcomes, in which 28.6% of the 14 patients survived to discharge. Conclusion: A pediatric ECMO program fully managed by advanced nurse specialists was successfully implemented, maintained, and expanded. This model produced safe and efficacious outcomes that were comparable to data from the Extracorporeal Life Support Organization (ELSO) registry. Such an ECMO model is feasible even in a resource-limited setting like a community hospital. Nevertheless, for the most critical patients, the support of neonatologists, intensivists, and surgeons is imperative for enhancing favorable outcomes.

The Nurse Licensure Compact's Effect on Telemedicine Usage.

As a result of a shortage of primary care physicians, considerable portion of patients in the US have difficulty accessing primary care. Telemedicine allows healthcare professionals to reach patients in shortage areas, but state-based occupational licensing laws make interstate practice difficult. The Nurse Licensure Compact (NLC) was designed to improve interstate practice for Registered Nurses (RNs), including telemedicine. Our preliminary analysis does not find evidence that the NLC is able to significantly increase telemedicine usage from out-of-state providers. Policymakers cannot rely on just the NLC to encourage the adoption of telemedicine; other regulations currently limit its adoption.

Evaluating the effectiveness of a training program to support nurses to administer cryopreserved hematopoietic stem cells by intravenous push method.

A training program was developed to prepare registered nurses (RNs) at one cellular therapy centre to administer cryopreserved cells by intravenous (IV) push method. There are two main methods of infusion for dimethyl sulfoxide (DMSO) cryopreserved hematopoietic stem cell (HSC) products, gravity drip and IV push. Administering DMSO by either route can cause hypersensitivity reactions. Administration of HSCs by gravity drip is slower, resulting in fewer DMSO reactions. However, prolonged exposure of DMSO once the cells are thawed increases the risk of cellular damage. The faster IV push method reduces cell damage and decreases staff time. An environmental review within Canadian transplant centres found that in most adult centres, nurses administer by gravity drip, and when IV push is required, cryopreserved hematopoietic stem cells are administered by physicians. Our centre's method was IV push by a physician or nurse practitioner (NP). As transplant numbers grew, capacity to perform this skill needed to expand. To maintain the current benefits of the IV push method and increase capacity in a hematopoietic transplant program, the role of infusing stem cells by the IV push method was transitioned from the NPs and physicians to RNs. A successful training program utilizing simulation to support these oncology nurses in learning the new skill was developed and evaluated.

Effectiveness of educational video on standardized nursing language for nursing home nurses.

Developing nursing plans using standardized taxonomy offers for a better understanding of how nursing abilities affect the achievement of better levels of outcomes for NH residents. This study aimed to investigate the effectiveness of an educational video on standardized nursing languages (SNLs) developed for nursing home nurses. We used a single group pre-post study design. We collected presurvey data from April 25 to June 22, 2022 and postsurvey data from May 23 to July 18, 2022. Sixteen nursing homes (NHs) participated in this study. We collected data on nurses' knowledge, perceptions, and attitudes towards SNLs and the evidence-based nursing practice self-efficacy. Analysis was conducted utilizing the McNemar test. The educational video about standardized nursing languages were provided to 31 registered nurses (RNs) from 16 NHs in Korea. Knowledge about the definition of SNLs and the benefits of their utilization improved after watching educational video. Study findings support the effectiveness of educational videos on SNLs in increasing knowledge ofSNLs, as well as confidence in the profession. To support NH nurses' professional development, ongoing SNL-focused education and research on innovative training methods like videos are recommended. Developing nursing plans using a common, standardized taxonomy offers a good chance to more clearly observe how nursing abilities affect the achievement of better levels of health and wellbeing. Education using audiovisual materials may help NH RNs learn how to utilize SNLs and may further enhance the development of SNL through periodic, long-term education and SNL-based nursing practice.

The Creation of an Addiction Nursing Fellowship Program for Registered Nurses: A Unique Approach to Enhancing the Addiction-Treatment Workforce.

In 2020, Boston Medical Center and the Grayken Center for Addiction launched an addiction nursing fellowship to enhance registered nurses' knowledge and skills related to the care of patients with substance use disorders and to improve patient experience and outcomes. This paper describes the development and essential components of this innovative fellowship, to our knowledge the first of its kind in the United States, with the goal of facilitating replication in other hospital settings.

Use of a Competency-Based Framework to Transition New Graduate Advanced Practice Registered Nurses into Practice

Use of a Competency-Based Framework to Transition New Graduate Advanced Practice Registered Nurses into Practice

The State of Advanced Practice Registered Nursing in Alabama

Scope of practice for advanced practice registered nurses (APRNs) varies according to U.S. jurisdiction licensure requirements. Nineteen U.S. jurisdictions currently allow independent practice in all four APRN roles: certified nurse midwife (CNM), certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS). Twenty-six U.S. jurisdictions allow full practice authority for CNPs. APRNs practicing in the remaining U.S. jurisdictions have varying practice restrictions, which are dictated by their state licensure laws. Alabama's scope and standards of practice restrict all APRN roles. During the initial months of the COVID-19 pandemic, Alabama was one of many U.S. jurisdictions that implemented emergency waivers, thereby expanding the scope of APRN practice and granting increased autonomy to APRNs while caring for more complex patients. Once the pandemic threat lessened, many U.S. jurisdictions, including Alabama, returned to pre-pandemic restrictive scope of practice regulations. Through empirical evidence, we conducted a review of APRN practice before, during, and after the pandemic. The literature included anecdotal reports of safe delivery of healthcare provided by APRNs working under the emergency waivers. The literature revealed that APRNs are prepared to practice to the full extent of their scope of practice and provide high-quality healthcare services to improve access to care. Alabama and other U.S. jurisdictions where APRN practice is restricted should advocate for legislative changes supporting APRN full practice authority commensurate with their educational training and certification.

Place of the Advanced Practice Registered Nurse (APRN) within the vascular team: A qualitative study of vascular medicine physicians and nurses caring for patients with Peripheral Artery Disease (PAD)

APRNs treat and diagnose diseases, counsel the public about health problems, manage chronic diseases, and participate in continuing education. In the cardiovascular field, PAD, one of the manifestations of atherosclerotic cardiovascular disease, is archetypal in combining multiple cardiovascular risk factors (hypertension, hyperlipidemia, diabetes mellitus smoking). Patients with PAD should benefit from APRN care, but to date there is little published on the place of APRN in vascular medicine worldwide, and none in France. As the status of APRN in France has only been enacted by law in 2018, we aim to investigate physicians and nurses working with patients suffering from PAD, to gather their opinions and draw the cooperation outlines these practitioners could have with an APRN. Multicentre exploratory qualitative study by semi-directive interview conducted until data saturation and thematic analysis carried out with healthcare practitioners taking care of patients with PAD: 10 physicians working either in private practice setting or hospital setting or both, and 8 nurses in a vascular unit for hospitalized patients. Three main themes emerged from responders’ verbatims: a specific organization of vascular medicine with its inherent challenges, particularly regarding patients with PAD (specific psychosocial profile of patients, lack of therapeutic education, time, knowledge of non-specialist physicians, tedious follow-up outside hospitals, complex care trajectory, and lack of medical-surgical collaboration). Second, a role for APRN, particularly in consultation as part of patient follow-up, with expected benefits for the patient and the care team. The expected benefits include a smoother care pathway and increased capacity for cardiovascular education and prevention, especially during consultations (Fig. 1). Third, there are certain pitfalls that need to be clarified to integrate these new practitioners into the vascular teams already in place. In particular, the need to inform the vascular medicine teams about this new profession, and the indispensable presence of the conditions necessary for the development of a relationship of trust. APRN could be the missing link in a vascular team by creating a continuum in the care of patients with PAD, ensuring clinical assessment, nursing supervision, adverse event screening, and renewing drug prescriptions with the necessary adjustments, while ensuring an essential part of therapeutic education personalized to each PAD patient.

Advanced Practice Registered Nurse Full Practice Authority, Provider Supply, and Health Outcomes: A Border Analysis

Advanced Practice Registered Nurse Full Practice Authority, Provider Supply, and Health Outcomes: A Border Analysis

Knowledge and Practices Regarding Ventilator Care Bundle for Preventing Ventilator Acquired Pneumonia (VAP) Among Intensive Care Unit Registered Nurses

Knowledge and Practices Regarding Ventilator Care Bundle for Preventing Ventilator Acquired Pneumonia (VAP) Among Intensive Care Unit Registered Nurses

Exploring the Motivations of Nursing Students in New York State

A strong nursing workforce is integral to quality healthcare. Nursing is an important aspect of healthcare outcomes and plays a critical role in patient safety. Nursing students are key to ensuring an adequate pipeline of nursing professionals. An exploratory cross-sectional online survey was conducted with a convenience sample of 158 students in nurse education programs leading to a Bachelor’s Degree in New York State. The current study sought to identify the motivation to pursue a career in nursing, including a career as a Registered Nurse (RN). Personal motivators (primarily the desire to help others) ranked as the main reason for choosing the profession (60.1%). Employment motivators (including job, benefits and monetary reasons) ranked second (26.8%), and Lifestyle motivators (including hours and schedules) ranked third (13.1%). Statistical analysis revealed consistent priorities regarding primary motivators across subgroups of nursing students. Results also indicated that students who have their RN license while pursuing a Bachelor’s Degree are a unique subset of students in nursing programs. Each of the following findings were significant at p < 0.001: Nursing students enrolled in a Bachelor’s Degree program who already hold an RN license are more likely to; be over 30 years of age, attend school part-time, attend fully online classes (pre-pandemic mode), already have an Associate’s Degree in Nursing and attend a public university. Understanding the motivations of students in nursing programs can inform both academia and employers to recruit and retain future nursing professionals.

The newly-licensed registered nurse workforce: Looking back to move forward

BackgroundNewly licensed registered nurses (NLRNs) are a vital health human resource necessary for the sustainability of the nursing workforce. There are challenges associated with the transition of NLRNs into practice; yet, new nurses continue to leave their positions within the first year. To compound the situation, a global pandemic hit in 2020. To leverage a sustainable future for our nursing workforce we must examine workforce data of NLRNs. PurposeThe purpose of this descriptive study was to review the most recent national source of workforce data to determine if the data reveals insight to help renew the focus on the NLRN workforce. MethodsThis descriptive study was a secondary analysis of demographic, education, employment, and work environment variables from the 2018 National Sample Survey of Registered Nurses. FindingsThe NLRN workforce is slightly more diverse, seeking a BSN as the first degree, and funding their initial education with federal loans. NLRNs cite inadequate staffing, stressful work environments, burnout, and salary as the reasons for leaving the first job. NLRNs cite a balanced schedule, experience in the job, and a sense of community with peers as reasons why they stay. DiscussionThis study joins the decades of literature that points to a small group of problems that account for the overwhelming majority or nursing turnover and attrition. After analyzing the data, the authors pose several questions to readers for consideration about the NLRN workforce. The authors' hope is to garner renewed attention to the issues facing NLRNs

Psychiatric Nursing Workforce Survey: Results and Implications.

The last national survey of psychiatric-mental health (PMH) nurses was conducted in 2016 and was limited to advanced practice registered nurses (APRNs). Data on the demographic and employment characteristics of the PMH workforce could inform how to optimize the PMH nursing workforce to address increasing demands for mental health services. The objective was to conduct a national survey of PMH registered nurses (RNs) and PMH-APRNs to gather data on their demographic, educational, and practice characteristics. An email survey was administered between October 2020 and February 2021 to all members of the American Psychiatric Nurses Association and to all PMH-APRNs certified by the American Nurses Credentialing Center. Separate surveys included 51 questions (RN) and 52 questions (APRN). Survey questions were informed by several sources including the Minimum Data Set for the Behavioral Health Workforce. Surveys were completed by 4,088 PMH-RNs and 5,158 PMH-APRNs, with a combined response rate of 12.1%. Findings suggest that the workforce is aging but has increased slightly in diversity. In all, 62.4% of RNs reported a hospital as their primary employment setting, while the majority of APRNs (70.4%) practice in outpatient settings. Forty-four percent of the PMH-APRN respondents indicated that most of their patients receive federal insurance. Nursing must plan for significant retirements in the PMH workforce in next 5 years. Hospital-based practice continues to dominate PMH-RN roles but might be expanded to community-based settings teaming with PMH-APRNs in outpatient sites. Increasing the diversity of the workforce should be prioritized.

Psychometric evaluation of the Austrian version of the Nurse Professional Competence Scale Short Form (NPC–SF–AUT)

Background and objective: The continuous assessment of nursing competence is internationally established and an important task in the further development of professional nursing. The Nurse Professional Competence Scale Short Form is a potentially appropriate instrument to assess the competence of Austrian Registered Nurses (RN). However, the translated and Austrian-specific culturally adapted version of the scale has not yet been sufficiently psychometrically tested. The aim of this study was to test the validity and internal consistency of the Austrian version of the Nurse Professional Competence Scale Short Form.Methods: We conducted an exploratory cross-sectional study. Between October 2021 and January 2022, Registered Nurses from a total of 16 hospitals were invited to assess their competencies using the Austrian version of the Nurse Professional Competence Scale Short Form. Principal axis factor analysis with Promax rotation was performed to test construct validity. Both Cronbach's Alpha and McDonald’s Omega coefficients were used to evaluate internal consistency.Results: Data from a total of 576 Registered Nurses were included in the psychometric evaluation. Both the Kaiser-Meyer-Olkin coefficient (KMO = 0.958) and the significant Bartlett test (χ2 = 12430.988; df = 595; p < .001) indicated appropriate fit of the data for factor analysis. Using principal axis factor analysis with Promax rotation, five factors were extracted, explaining a total of 60.5% of the variances. The Nurse Professional Competence Scale Short Form German Austrian language version (NPC–SF–AUT) thus comprises 35 items representing the five factors “Health promotion and safeguarding” (13 items), “Multi-professional cooperation and development” (7 items), “Process-guided nursing care” (5 items), “Inclusive decision-making” (5 items) and “Rule-governed professional practice” (5 items). Both the factor-specific Cronbach’s Alpha and McDonald’s Omega coefficients confirmed good to excellent (α = 0.83-0.92; Ω = 0.83-0.92) internal consistency of the NPC-SF-AUT.Conclusions: The NPC–SF–AUT is a valid and internal consistent instrument for the self-assessment of RNs’ competence in Austria. The instrument can be used for the continuous assessment of nursing competence and thus contribute to the advancement of the nursing profession.

New Life and Tragic Loss: A Story of Resilience

New life, tragic loss, faith, family, and resilience are key themes that abound in emergency nursing. In this story, readers also may discover examples of leadership development, clinical advancement, collaboration, and a culture of caring. Jennifer Lawson, Member, Orange Coast Chapter, is an Emergency Department Registered Nurse, Anaheim, CA.

Getting to zero: Impact of a device to reduce blood culture contamination and false-positive central-line-associated bloodstream infections.

To assess the impact of initial specimen diversion device (ISDD) on inpatient and emergency department blood culture contamination (BCC), central-line-associated bloodstream infection (CLABSI) standardized infection ratios (SIRs), and antibiotic administration. Single-center quasi-experimental prospective cohort study wherein phlebotomists used traditional venipuncture with or without the ISDD while registered nurses (RNs) used traditional venipuncture. BCC events among phlebotomists and RNs were observed and compared from March 17, 2019, through January 21, 2020, defined by contaminant detection in 1 of 4 bottles for matched sets or 1 of 2 bottles in both subsets for coagulase negative staphylococci. CLABSIs throughout this period were recorded and SIRs were calculated. Enhanced oversight took place through July 21, 2019, with chart review assessing antibiotic use for patients with possible BCC. Overall, 24% of blood cultures obtained were from patients in intensive care. Phlebotomists using traditional venipuncture (n = 4,759) had a 2.3% BCC rate; phlebotomists using the ISDD (n = 11,202) had a 0% BCC rate. RNs drew 7,411 BCs with a 0.8% BCC rate. The CLABSI SIR was decreased from 1.103 in 2017 and 0.658 in 2018 to 0.439 in 2019. The CLABSI incidence was 33%-64% of predicted value for each 2019 quarter. This range fell to 18%-37% after the exclusion of likely false-positive results. Among 42 patients with possible BCC under enhanced oversight, 2 patients were treated with prolonged antibiotic courses. ISDD use by phlebotomists was associated with BCC reduction and reduced false-positive CLABSI results. This patient-care quality improvement could constitute sustainable antibiotic stewardship expansion.

Retaining Graduate Nurses Who Experience NCLEX Failure: Recommendations for Supporting Retest Success

Current turbulent times in health care are exacerbated by a shortage of registered nurses (RNs), challenging nurse leaders to explore opportunities for improving RN retention. National Council Licensure Examination (NCLEX) pass rates are declining, and an upcoming change in the NCLEX-RN exam is likely to intensify that decline. On average, 18% of graduate nurses (GNs) fail on their first NCLEX-RN attempt, and less than 43% are successful on retest attempts. Therefore, the GN who fails on the first attempt is likely to not be retained for the RN position for which they were hired. A consideration in supporting the GN who fails to retest success is that the most prevalent demographic among GNs is Generation Z. Individuals in this generation display characteristics that impact their ability to negotiate the high-stakes NCLEX-RN exam. Based on experience coaching Generation Z GNs to NCLEX-RN success, the author provides recommendations for coaching to support NCLEX retest success. Nurse leaders in hospital settings are encouraged to consider adopting these recommendations to improve RN retention among GNs who experience NCLEX failure.

STAFFING DIFFERENCES IN NURSING HOME SPECIAL FOCUS FACILITIES AND SPECIAL FOCUS FACILITY CANDIDATES

Abstract Introduction Centers for Medicare and Medicaid Services designates “Special Focus Facilities” (SFF), which are nursing homes receiving special oversight for persistent quality problems. “Special Focus Facility Candidates” (SFFc) are nursing homes with quality problems that are designated as candidates to be future SFFs. Recent academic literature has not examined if SFF and SFFc have significant differences in staffing hours per resident day (HPRD). Methods Nursing homes that were SFF or SFFc in 2020 were matched to 5-star nursing homes. Monthly staffing averages were aggregated, and two-way ANOVAs with Tukey Post Hoc were conducted to detect level differences in HPRD across the three facility groups. Gross and Case-Mix staffing HPRD were analyzed, along with daily resident census. Results The final sample was n=197 SFFc, and n= 50 SFF, which were matched with n=247 5-star nursing homes for a total sample of Nf494. Over 2020, daily census for 5-star nursing homes was lower (M=72.36, SD=52.5) than SFFc (M=93.77, SD=68.34) or SFFs (M=97.88, SD=44.06). There was a significant difference between SFF and SFFc HPRD in Case-Mix Aide F(2, 5748)=187.6, p= < .005, and Registered Nurse (RN), F(2,5748)=323,p=.003 care. There were no significant differences between SFF and SFFc in HPRD Aide F(2,5748)=380,p=.63, Practical Nurse F(2,5748)=1.1, p=.211, Case-Mix Practical Nurse F(2,5748)=19.57,p=.39, Case-Mix RN F(2,5748)=9.51,p=.91 or Total HPRD F(2,5748)=472.6,p=.16, care. Discussion: There is only a significant difference in staffing levels observed between SFF and SFFc for Aide staffing and RN staffing. This information supports researchers and policymakers in delineating the differences and similarities between SFF and SFFcs.

TEXAS NURSING HOMES INCREASED DIRECT-CARE STAFFING LEVELS DURING WINTER STORM URI

Abstract Prior work suggests that nursing homes (NHs) increase their registered nurse (RN), licensed practical nurse (LPN), and certified nursing assistant (CNA) staffing levels in anticipation of a major hurricane. However, less is known about NHs’ ability to increase staffing levels during a winter storm. We examined RN, LPN, and CNA staffing levels in 1,170 Texas NHs during Winter Storm Uri from February 13-20, 2021. This storm was characterized by cold temperatures and snow/ice accretion that affected the Texas power grid. Linear mixed effects models were adjusted for profit status, continuing-care retirement community status, resident census, overall star rating, a weighted deficiency score, number of citations for infection control, number of substantiated complaints, and county fixed-effects. After adjustment, Texas NHs decreased RN (β=-0.005;b=-0.002;p=.004) but increased LPN (β=0.022;b=0.009;p<.001) and CNA (β=0.044;b=0.026;p<.001) staffing levels. NHs face unprecedented challenges during winter storms, including maintaining adequate staffing levels to meet the needs of their residents.