RN Practice Research Articles

Trends in NP and RN enrollment, graduation, and practice: Erratum.

Trends in NP and RN enrollment, graduation, and practice: Erratum.

Changes in Telehealth Experienced by Advanced Practice RNs During COVID-19: US Survey Results.

The sudden, expanded need for telehealth during the COVID-19 pandemic added to the challenges advanced practice RNs face in the United States. The purposes of this article are to summarize advanced practice RNs' responses about the use of telehealth before and during the pandemic and to analyze free-text comments about how the use of telehealth changed during the pandemic. A 20-item survey was distributed using convenience sampling to advanced practice RNs from June 1 to September 23, 2020. Analyses of descriptive and open text responses related to telehealth were conducted. Most of the respondents did not use telehealth prior to the pandemic (n = 5441 [73%]), but during the pandemic, half used telehealth at least daily (n = 3682 [49%]). The most common barriers related to telehealth were about the difficulty some populations had in accessing the necessary technology. The most common favorable comments cited by respondents were related to some patients' improved access to care. Telehealth use is unlikely to return to prepandemic levels. As a result, considerations of telehealth-related recommendations provided for advanced practice RN education, policy, and practice are encouraged for the purpose of increasing healthcare access.

A comparison of RN licensure test plans: the United States and China with implications for the Chinese nursing licensure exam

Abstract Objectives The purpose of this paper was to compare test plans between the National Council Licensure Examination-Registered Nurse (NCLEX-RN) in the United States and the National Nursing Licensure Examination (NNLE) in China, to discuss the influence of passing standards and critical thinking in the test plans on candidates and nursing education, and to provide implications to improve the NNLE test plan. Methods After reading the 2019 NCLEX-RN test plan and the 2019 NNLE test plan, a side-by-side comparison was done to evaluate both test plans. Results In the NCLEX-RN test plan, a periodical RN practice analysis provides fundamental principles for the development of test content based on the Client Needs framework. Item writing and coding is guided by the theory of Bloom’s taxonomy. The passing standard for the NCLEX-RN is based on a criterion-referenced method to assess candidates’ competencies as newly licensed nurses. In the NNLE test plan, test content comprises primary nursing tasks, nursing knowledge, and knowledge of common diseases. The standard score, a norm-referenced method, is used as the passing standard. The NNLE test plan does not present information concerning principles used in the development of test content, and the guidance related to item writing and coding. Conclusion The NCLEX-RN provides systematic and evidence-based procedures to determine and evaluate test content and passing standards as compared with the NNLE. The standard score used in the NNLE disadvantages candidates of secondary nursing education. The lack of principles to guide item writing and coding in the NNLE fails to foster students’ critical thinking. To improve the NNLE test plan, further research should be conducted to improve test content, item writing, and examination evaluation methods.

Trends in NP and RN enrollment, graduation, and practice

Abstract: The employment outlook for NPs is expected to continue its growth trend in the coming years. This article summarizes graduation and employment trends for nursing students and provides a synopsis of data from the Bureau of Labor Statistics about the growing demand for NPs and nurses. A brief overview of the history of recent workforce trends is also provided.

Scope of Practice Barriers for Advanced Practice Registered Nurses: A State Task Force to Minimize Barriers.

Collegial relationships, administrative champions, and persistence are key components to breaking down barriers to advanced practice RN (APRN) practice. This article addresses how Iowa APRNs in a state-sanctioned task force identified barriers for practicing at the top of their licensure in a full practice authority state including defending the right to control the scope of nursing practice in court.

Psychiatric Mental Health Nursing Workforce Agenda: Optimizing Capabilities and Capacity to Address Workforce Demands.

The mental health service delivery transformation has created models of care that generate demand for a workforce with particular competencies. This article develops a psychiatric mental health (PMH) nursing workforce agenda in light of demand generated by new models of care and the capacity/capabilities of the PMH RN and advanced practice nurse (APN) workforce. Examine the current capacity of the PMH nursing workforce and how health care reform and related service delivery models create demand for a particular set of behavioral health workforce competencies. PMH RNs and APNs have an educational background that facilitates development of competencies in screening, care coordination, leveling care, and wellness education. PMH RNs are a large workforce but the size of the PMH APN group is inadequate to meet demand. The specialty must strategize on how to build requisite PMH RN and APN competencies for the evolving service landscape.

Critical Care RNs Engage in Releasing time to care™: Transforming RN Practice

In response to a regional health authority mandate, six critical care units with diverse patient populations began implementation of Releasing time to care™, a quality improvement program designed for application on individual acute and long-term care hospital units. This program originating in the United Kingdom, provides a framework for nurses working on wards to examine, measure, and improve care processes, and possibly save nursing time. The program was not designed for, nor has implementation been reported in a cohort of critical care units in clinical nursing research literature.

HEADLINES from the NLN

NLN Annual Survey Finds Education Pipeline Expanding, But Lack of Clinical Settings Still Crimps Entry into PN and ADN ProgramsThis year's NLN Annual Survey of Schools of Nursing finds the nation's nursing education capacity expanding and some of the long-standing unmet demand for seats in nursing schools beginning to subside. Waiting lists for entry into nursing programs were persistently long throughout the late aughts, with both national statistics and news reports and anecdotes from around the country describing a widespread lack of capacity in nursing education programs.From 2009 to 2011, the percentage of nursing programs that turned away qualified applicants was peaking across all types of nursing education programs, with shortage levels most acute among programs that prepare students for initial licensure. In 2011, 43 percent and 48 percent of master's and doctoral programs, respectively, rejected qualified applicants. More dramatically, well over 80 percent of programs offering practical nursing and associate degrees were forced to turn away qualified candidates, as did almost two thirds of baccalaureate programs.Current Data Show Some Reduction in the Acuity of Capacity Shortages The number of pre-licensure RN programs grew throughout the mid-aughts, peaking at a growth rate of 10 percent in 2006. Although growth then slowed to just 1 to 2 percent per year, admissions statistics indicate that capacity shortages have begun to ease. In 2012, the percentage of programs that turned away qualified applicants dropped substantially for every program type with the exception of those offering the baccalaureate degree. Moreover, as a measure of volume, the percentage of all qualified applications rejected by programs also declined, almost across the board. With some states considering the requirement of a baccalaureate degree for RN practice, only RN-to-BSN programs maintained their 2011 seating shortage levels. And, in another indication that nursing education capacity has grown to meet demand, the percentage of programs that could not fill all available seats for new students also fell in 2012.In a new analysis conducted this year, the NLN examined capacity shortage indicators by the urban-rural location of nursing programs. About two thirds of PN and associate degree programs are located in urban centers (64 percent and 67 percent, respectively), in contrast to 80 to 90 percent of baccalaureate and higher degree programs. Approximately one in five PN and ADN programs are located in large rural areas, with 10 percent in small rural locations.Although one might expect metropolitan-based programs to benefit from their proximity to dense population centers, in actuality, urban programs experienced student vacancy rates that were similar to their more rural counterparts. Moreover, among urban-based diploma and RN-to-BSN programs, the percentage of programs that could not fill all available spots for admission was notably higher than in programs located in less dense population centers. (See Figure 1.)Shortage of Clinical Placement Settings Increasingly Crimps PN and ADN Program Expansion Deans and directors of schools providing programs that did not accept all eligible applicants were asked to identify the primary obstacle to expanding their program's capacity. Since 2010, the percentage of those directing ADN and PN programs who cited a shortage of clinical sites as the primary impediment to expansion has steadily increased. For PN programs in particular, the percentage jumped to 52 percent in 2012, a 10 percent rise over 2011 levels. By contrast, graduate programs consistently cite a lack of faculty as the primary obstacle to expansion. However, the percentage of all types of programs citing a faculty shortage has declined since peaking in 2009. …

Findings from the Annual Sur vey of Schools of Nursing, Academic Year 2011-2012

This year's NLN Annual Survey of Schools of Nursing finds the nation's nursing education capacity expanding and some of the long-standing unmet demand for seats in nursing schools beginning to subside. Waiting lists for entry into nursing programs were persistently long throughout the late aughts, with both national statistics and news reports and anecdotes from around the country describing a widespread lack of capacity in nursing education programs. From 2009 to 2011, the percentage of nursing programs that turned away qualified applicants was peaking across all types of nursing education programs, with shortage levels most acute among programs that prepare students for initial licensure. In 2011, 43 percent and 48 percent of master's and doctoral programs, respectively, rejected qualified applicants. More dramatically, well over 80 percent of programs offering practical nursing and associate degrees were forced to turn away qualified candidates, as did almost two thirds of baccalaureate programs. Current Data Show Some Reduction in the Acuity of Capacity Shortages The number of pre-licensure RN programs grew throughout the mid-aughts, peaking at a growth rate of 10 percent in 2006. Although growth then slowed to just 1 to 2 percent per year, admissions statistics indicate that capacity shortages have begun to ease. In 2012, the percentage of programs that turned away qualified applicants dropped substantially for every program type with the exception of those offering the baccalaureate degree. Moreover, as a measure of volume, the percentage of all qualified applications rejected by programs also declined, almost across the board. With some states considering the requirement of a baccalaureate degree for RN practice, only RN-to-BSN programs maintained their 2011 seating shortage levels. And, in another indication that nursing education capacity has grown to meet demand, the percentage of programs that could not fill all available seats for new students also fell in 2012. In a new analysis conducted this year, the NLN examined capacity shortage indicators by the urban-rural location of nursing programs. About two thirds of PN and associate degree programs are located in urban centers (64 percent and 67 percent, respectively), in contrast to 80 to 90 percent of baccalaureate and higher degree programs. Approximately one in five PN and ADN programs are located in large rural areas, with 10 percent in small rural locations. Although one might expect metropolitan-based programs to benefit from their proximity to dense population centers, in actuality, urban programs experienced student vacancy rates that were similar to their more rural counterparts. Moreover, among urban-based diploma and RN-to-BSN programs, the percentage of programs that could not fill all available spots for admission was notably higher than in programs located in less dense population centers. (See Figure 1.) Shortage of Clinical Placement Settings Increasingly Crimps PN and ADN Program Expansion Deans and directors of schools providing programs that did not accept all eligible applicants were asked to identify the primary obstacle to expanding their program's capacity. Since 2010, the percentage of those directing ADN and PN programs who cited a shortage of clinical sites as the primary impediment to expansion has steadily increased. For PN programs in particular, the percentage jumped to 52 percent in 2012, a 10 percent rise over 2011 levels. By contrast, graduate programs consistently cite a lack of faculty as the primary obstacle to expansion. However, the percentage of all types of programs citing a faculty shortage has declined since peaking in 2009. Age of Associate Degree Students Rises Last year saw a substantial increase in the percentage of associate degree students who were over 30 years old--an unexpected finding given that adult students typically leave school and return to the labor market as recessions ebb, reducing the overall age of the college student population. …

Understanding RN and LPN Patterns of Practice in Nursing Homes

Understanding how nurse regulators can ensure optimal registered nurse-licensed practical/vocational nurse (RN-LPN) collaborations for patient safety and care quality is critically important.To aid this understanding, researchers conducted a comparative, multiple-case study on RN and LPN practice in the areas of assessment, care planning, supervision, and delegation in two states, Minnesota and North Carolina. The researchers identified three factors that differentiated nursing practice patterns in nursing homes: the quality of the connections between RNs and LPNs, the degree of interchangeability between RNs and LPNs, and RN-to-LPN staffing ratios. Findings indicate several levers for improving RN-LPN collaborations and the capacity to provide higher quality care.

SAFETY: An Integrated Clinical Reasoning and Reflection Framework for Undergraduate Nursing Students

Nurse educators can no longer focus on imparting to students knowledge that is merely factual and content specific. Activities that provide students with opportunities to apply concepts in real-world scenarios can be powerful tools. Nurse educators should take advantage of student-patient interactions to model clinical reasoning and allow students to practice complex decision making throughout the entire curriculum. In response to this change in nursing education, faculty in a pediatric course designed a reflective clinical reasoning activity based on the SAFETY template, which is derived from the National Council of State Boards of Nursing RN practice analysis. Students were able to prioritize key components of nursing care, as well as integrate practice issues such as delegation, Health Insurance Portability and Accountability Act violations, and questioning the accuracy of orders. SAFETY is proposed as a framework for integration of content knowledge, clinical reasoning, and reflection on authentic professional nursing concerns.

A Return to Diploma-Prepared Registered Nurses

A quarter of a century ago, the nursing profession in Canada took a bold step: to establish baccalaureate preparation in nursing as the standard for practice as a registered nurse in Canada. Towards that end, hospital schools of nursing gave way to collaborative programs designed to help hospital and college diploma nursing students make the transition into baccalaureate nursing programs. It is thus paradoxical that, today, the nursing profession in Canada should do anything to jeopardize its goal to have RNs prepared at the baccalaureate level. The purpose of this paper is to focus Canadian nurse leaders' attention on that very possibility, given that some professional nursing organizations in Canada have conceptualized a future RN practice that could result in the emergence of a new kind of healthcare professional and a return to diploma preparation of RNs.

Competence of Accelerated Second Degree Students after Studying in a Collaborative Model of Nursing Practice Education

The article, "CAN-Care: An Innovative Model of Practice-Based Learning" was published in the International Journal of Nursing Education Scholarship in 2006 (Article 20). Reported in this paper are the findings of a program evaluation study with 58 participants who completed a survey questionnaire at the end of the program of study and six-months post graduation. The data reveal that the model resulted in graduates who perceived themselves to be competent and effectively prepared for real-world nursing practice. This is contrary to the existing literature which reports graduates' perceived lack of readiness for RN practice. The participants in this study also identified the opportunity to work with a consistent unit-based nurse and having the nursing practice course experiences on consecutive days and for the entire 12-hour shift as significant factors in the effectiveness of their learning experience.

Experts support RN practice

Experts support RN practice

Analysis of differences in entry-level RN practice by educational preparation.

The National Council of State Boards of Nursing performs a practice (or job) analysis every 3 years linking the NCLEX-RN to practice through assessment of current RN job tasks. Although the primary purpose of the practice analyses is validation of the examination, data also may be used to assess for differences in practice by subsets of nurses. A secondary analysis of the 1999 RN Practice Analysis was performed to explore any divergence in practice attributable to educational preparation. The average frequencies of performance of 189 nursing activities were computed separately for graduates of associate degree (ADN) and baccalaureate degree (BSN) nursing programs and compared. Results demonstrated a .98 Pearson r correlation between the averages of the two groups. Both groups performed routine nursing care activities with the greatest frequencies and demonstrated more complex or advanced skills, such as teaching and managing care, at similar lower rates. Differences in the averages between the two groups were negligible. For 144 (76%) of the activities, differences were less than .25 on a scale of 0 to 5.

The link between entry-level RN practice and the NCLEX-RN(R) examination.

Author affiliation: National Council of State Boards of Nursing, Chicago, Ill. Corresponding author: June E Smith, PhD, RN, National Council of State Boards of Nursing, 676 North St. Clair Street, Suite 550, Chicago, IL 60611 ([email protected]).