Integrating Virtual Simulation into Nursing Education: A Roadmap

Background: Simulation education is needed to train a highly competent nursing workforce. In-person simulation requires many resources, such as faculty, space, and time, that can negatively affect its feasibility. These barriers have prompted educators to seek new technologies to provide experiential learning opportunities, such as virtual simulation (VS). The COVID-19 pandemic further highlighted the need for educators to investigate alternative learning opportunities.Methods: A quantitative cross-sectional study was conducted with pre-licensure and advanced practice nursing students. They participated in a VS learning experience that was evaluated using the System Usability Scale (SUS)(R), the Clinical Learning Environment Comparison Survey (CLECS 2.0), and the Simulation Effectiveness Tool-Modified (SET-M).Result: 197 pre-licensure and 11 advanced nursing practice students completed post-simulation eval-uations. The results from the SUS scale found the overall virtual system effective. Evaluating the CLECS tool found students' perceived experience was relatively similar for face-to-face simulation and screen-based simulation. The SET-M indicated students rated the VS simulation experience positively. Conclusion: VS for nursing education can be an effective experiential learning tool.

Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19.

Advanced practice registered nurses (APRNs) play a pivotal role in providing healthcare, including preventive care services, to the public. However, barriers to APRN practice exist that impact the provision of vital healthcare services that APRNs are authorized to provide based on their education, training, licensure, and certification. This article provides an overview of APRN barriers to practice, including in the face of the COVID-19 pandemic, and discusses key policy and regulatory implications.

Substance Use Disorders and Medication-Assisted Therapies: Current Practices and Implications for Nursing.

In the United States, the opioid epidemic and COVID-19-related substance use have exacerbated the overall incidence of substance use disorders (SUDs). Medication-assisted therapy (MAT), or cognitive and behavioral therapy that combines medications that reduce substance use or acute withdrawal symptoms, has dramatically improved outcomes for SUD patients, including preventing mortality. With recent US Congressional funding for MAT, patients presenting for acute care on MAT-related medications will continue to increase. Nurses should be aware of these medications' mechanism of action, typical side effects, and implications on treating acute pain to optimize their care.

Advanced Practice Nursing Roles: A Comparison Between Mexico and the United Kingdom

The COVID-19 pandemic has placed nursing at the forefront of public attention across the globe and has highlighted the criti-cal role of nursing in healthcare service provision. Advanced practice nursing has been recognized for more than 50 years, but the rate of its growth and development varies significantly across the world. One of the key aims of the Better Health Programme Mexico, which commenced in 2019, was to develop advanced practice nursing in Mexico. The Programme was based on the United Kingdom model, where advanced practice nursing has been in place-though not subject to statutory regulation-for more than 40 years. The aim of this article is to compare the frameworks that underpin advanced practice nursing in the United Kingdom and in Mexico. In the present article, current practice in both countries was researched, and the structure, systems, and processes relating to nursing regulation and the frameworks to support advanced practice nursing were examined. A gap analysis report undertaken as part of the Better Health Programme identified challenges in developing advanced practice nursing in Mexico and the United Kingdom and highlighted the need for stakeholders to agree on an approach toward a rigorous regulatory framework in both settings. In summary, this article highlights the issues facing nurses and regulators in both countries in terms of advanced practice nursing and identifies strategies that can be used to strengthen the advanced practice nurse role.

Student Interviews Exploring the Influence of the Coronavirus Pandemic on Graduate Nursing Education.

Introduction: Advanced practice nurses are needed to fill the primary healthcare gap in the United States. Advanced practice/graduate nursing students were profoundly affected by the coronavirus pandemic in ways that may impact their educational experience. Objective: The objective of this study was to explore the influence of the coronavirus pandemic on the educational experience of graduate nursing students. Methods: An exploratory descriptive qualitative study using semistructured video conferencing interviews of 11 graduate nursing students at one university in the United States was conducted during July 2020. Data were explored using theme analysis. Results: Four themes expressing the pandemic's impact on graduate student experience were identified: Alteration in human connections; Agility in action; Collaborative construction of change; and Metamorphosis emerging from disruption. The pandemic brought an alteration in how students connected with faculty, other students, and family. Many faculty and students responded with agility to the new mandates for social distancing. The students and faculty worked together to construct changes needed to provide the students with the required components of graduate education. These factors together created a metamorphosis in the functioning of the institution, breaking through hierarchical barriers in academia. Conclusion: The disruption in graduate nursing education due to the pandemic led to opportunities, including swift faculty innovation, a collaborative spirit between faculty and students, and new appreciation for connections with faculty and fellow students. Continuing intentional implementation of these opportunities would benefit students' experiences moving forward.

COVID-19 effects on practice: Perspectives of Tennessee APRNs.

BACKGROUND: In response to the COVID-19 pandemic, Tennessee's Governor issued executive orders temporarily suspending certain practice restrictions on advanced practice registered nurses (APRN), which expired after 2 months as the pandemic worsened. PURPOSE: This purpose of this qualitative study was to analyze APRN interview data to evaluate how prepandemic APRN practice barriers, executive orders, and the pandemic affected APRN practice in Tennessee. METHODS: Fifteen Tennessee APRNs who completed the National APRN Practice and Pandemic study also completed follow-up interviews via a HIPAA-compliant Zoom platform. Given the unprecedented circumstances associated with the COVID-19 pandemic, we conducted a qualitative descriptive study seeking descriptions and unique perspectives of Tennessee APRNs. Consistent with qualitative study design, we conducted an atheoretical study that featured interviews, purposeful sampling with maximum variation sampling, and content analysis. RESULTS: The major themes were practice changes, impact of executive orders, and ongoing care barriers. The data revealed that patients, APRNs, and other health care providers were strained in new and profound ways during the pandemic. An underlying theme was Tennessee APRNs' frustration with continued regulatory and other practice barriers despite their state's health and health care disparities and under resourced health care system. CONCLUSION: These findings indicate the need to improve care access and health outcomes, advocate for full practice authority for APRNs, support telehealth expansion, address transportation deficiencies, and respond to the pandemic-precipitated mental health crisis.

The impact of COVID19 on advanced practice nursing education and practice: A qualitative study.

AIM: To explore Master of Nursing students' perspectives toward the impact of coronavirus disease 2019 (COVID-19) on the advanced practice nurse preparatory education and practice. BACKGROUND: Like many nursing education programmes, the advanced practice nurse preparatory training was greatly affected and had to radically change to adapt to the disruptions caused by the pandemic. The COVID-19 pandemic has created a strain on the healthcare system and advanced practice nurses have been expected to modify their normal practice to provide care in unprecedented ways. METHODS: The study used a descriptive qualitative design. Semi-structured video-conference interviews were conducted in an autonomous university (June-July 2020). The recruitment of participants (n = 14) concluded upon data saturation. A thematic analysis was conducted. The COnsolidated criteria for REporting Qualitative research (COREQ) guidelines were used. FINDINGS: Three main themes were identified: (1) overcome adversity through innovation, (2) acceptance of remote learning and (3) versatility of advanced practice nurses in an ongoing pandemic. Each theme was further explained by two subthemes to further elucidate the impact of COVID-19 on the advanced practice nurse preparatory training and practice. DISCUSSION: The evolution of the advanced practice nurse preparatory education catalysed by the COVID-19 pandemic brought on innovation. The ability of advanced practice nurses to adapt to evolving healthcare needs was also highlighted. CONCLUSION: Although face-to-face teaching and services are gradually returning, some innovations that arose during the pandemic may be worth keeping. IMPLICATIONS FOR NURSING: Nursing educators in higher education institutions can benefit from adopting technology to mitigate the challenges posed by the ongoing pandemic IMPLICATIONS FOR NURSING POLICY: Nurse leaders should review the role of advanced practice nurses to determine how best to capitalise on their practice to meet rising healthcare needs.

Rapid Curricular Innovations During COVID-19 Clinical Suspension: Maintaining Student Engagement with Simulation Experiences.

Health care education programs were faced with the need to quickly adapt to a new reality during the coronavirus disease 2019 pandemic. Students were temporarily suspended from campus and clinical sites, requiring prompt changes in structure to their didactic and clinical learning. This article describes the rapid adjustments that one midwifery and women's health nurse practitioner education program created using both synchronous and asynchronous simulation experiences to promote student learning and ongoing engagement. Flexibility and reflexivity were needed by faculty and students alike in the face of the multiple changes wrought by the pandemic. Curricular changes were made simultaneously in many courses. Objective structured clinical examinations simulate telehealth experiences that assess knowledge, clinical reasoning, and professional behaviors via a scripted scenario and an actor patient. On-call simulations mimic telephone triage and provide students the opportunity to build listening, assessment, and management skills for prenatal and intrapartum scenarios. Students are provided equipment and virtual instruction in an intrauterine device insertion session, which promotes skill acquisition and self-confidence. Trigger films are used to visualize real-life or scripted clinical encounters, leading to discussion and decision-making, particularly in the affective domain. Bilateral learning tools, similar to case studies, provide students an opportunity to demonstrate their knowledge and critical thinking with a mechanism for faculty feedback. Web-based virtual clinical encounter learning tools using patient avatars prompt additional student learning. Suturing skills introduced in live remote group sessions are augmented with video-guided individual practice. This article describes each of these adapted and innovative simulation methods and shares lessons learned during their development and implementation.

Responding to the COVID-19 pandemic: Development of a critical care nursing surge model to meet patient needs and maximise competencies.

BACKGROUND: The current coronavirus disease 2019 (COVID-19) pandemic is creating unprecedented and unchartered demands on critical care units to meet patient needs and adapt the delivery of health services. Critical care nurses play a pivotal role in developing models of care that are effective, flexible, and safe. OBJECTIVES: We report on the accelerated development of a critical care nursing surge model responsive to escalating needs for intensive care capacity. METHODS: We conducted an exploratory prospective observational cohort study that included (i) a self-assessment and survey of learning needs of noncritical care nurses identified as candidate groups for redeployment in the intensive care unit and (ii) a pilot implementation of a team nursing model evaluated by individual questionnaires and the conduct of focus groups. We used descriptive statistics and qualitative content analysis to analyse the exploratory findings. RESULTS: We surveyed 147 noncritical care nurses; 99 (67.3%) self-assessed at the lowest level of critical care competency, whereas 33 (24.3%) reported feeling able to help care for a critically ill patient under the direction of a critical care nurse. Identified learning needs included appropriate use of personal protective equipment in the intensive care unit (n = 123, 83.7%), use of specialised equipment (n = 103, 85.1%), basic mechanical ventilation, and vasoactive medication. We completed 11 team nursing pilot assignments with dyads of critical care and noncritical care nurses categorised in tiers of competencies. Nurses reported high levels of perceived support and provision of safe care; multiple recommendations were identified to improve the model of care delivery and communication. CONCLUSIONS: The complexity, acuity, and unpredictability of the COVID-19 pandemic is placing new demands on critical care nurses to modify existing processes for care delivery while ensuring excellent outcomes and professional satisfaction. The study findings provide a road map to support nursing engagement in meeting patient needs.

Impact of COVID-19 pandemic on APRN practice: Results from a national survey.

BACKGROUND: The impact of the COVID-19 pandemic on Advanced Practice Registered Nurse (APRN) practice is not well known. PURPOSE: This study aimed to describe state practice barriers and explore the effects of the COVID-19 pandemic on APRN practice. METHODS: A descriptive study design used a 20-item web-based survey open from June 1 through September 23, 2020. FINDINGS: A total of 7,467 APRNs responded from all 50 states, including nurse practitioners (n = 6,478, 86.8%), certified registered nurse anesthetists (n = 592, 7.9%), certified nurse-midwives (n = 278, 3.7%), and clinical nurse specialists (n = 242, 3.2%). A number of barriers to practice prior to the pandemic were identified. Most respondents (n = 6334, 84.8%) identified that practice barriers limited the ability of APRNs to provide care during the pandemic. DISCUSSION: Barriers to APRN practice continue to restrict aspects of patient care and patient access to care, even in states with Full Practice Authority (FPA), during the COVID-19 pandemic and with state executive orders waiving practice restrictions. The study findings can be used to advocate for policy changes to support APRN practice authority.

Evaluation of Respiratory Therapist Extender Comfort With Mechanical Ventilation During COVID-19 Pandemic.

BACKGROUND: Staffing strategies used to meet the needs of respiratory care departments during the COVID-19 pandemic included the deployment of respiratory therapist extenders. The purpose of this study was to evaluate respiratory therapist extenders' comfort level with critical care ventilators while caring for patients with COVID-19. To our knowledge, this is the first study to evaluate the deployment of certified registered nurse anesthetists (CRNAs) in a critical care setting. METHODS: A qualitative survey method was used to assess CRNA experience with critical care ventilators. Prior to deployment in the ICU, CRNAs were trained by clinical lead respiratory therapists. Education included respiratory clinical practices and ventilator management. Sixty-minute sessions were held with demonstration stations set up in ICUs for hands-on experience. RESULTS: Fifty-six CRNAs responded to our survey (63%). A mean ± SD of 9.48 ± 12.27 h was spent training prior to deployment in the ICU. CRNAs were at the bedside a mean ± SD of 73.0 ± 40.6 h during the pandemic. While CRNA comfort level with critical care ventilators increased significantly (P < .001) from the beginning to the end of their work experience, no statistically significant differences were found between CRNA comfort based on years of experience. Differences in comfort level were not found after training (chi-squared test 23.82, P = .09) or after ICU experience was completed (chi-squared test = 15.99, P = .45). Similarly, mean comfort level did not increase based on the number of hours spent working in the ICU (chi-squared test = 13.67, P = .55). CONCLUSIONS: Comfort level with mechanical ventilation increased for CRNAs working alongside respiratory therapists during the COVID-19 pandemic.

Nursing's Response to the Executive Order to Advance American Kidney Health.

The state of American kidney health is currently under the microscope. In the United States, approximately 20,000 persons advance to end-stage renal disease annually. Trends indicate accelerating increases in cost of care and a high mortality rate among patients with end-stage renal disease, with only 57% of patients surviving after 3 years. An executive order by the White House has placed the transformation of kidney care at the forefront of the country's health care agenda. The order focuses on key issues including improving outcomes, reducing treatment-related expenditures and increasing kidney donations. Mobilization of health care resources directed toward policymaking, workforce growth and development, and research will be critical to effectively achieve this executive order. Nursing's response, as the health care profession with the most members, will be crucial to achieving response implementation and success of the order. This article describes immediate and future actions including policy, leadership, clinical, educational, and research initiatives that the nursing profession should take to advance kidney health. It calls for specific actions by nursing and focuses on nursing organizations, nursing research, quality improvement initiatives, nursing innovation, advanced practice nursing, and the nephrology and transplant nursing workforce in order to improve kidney health nationally. The impact of the SARS-CoV-2 pandemic on kidney health and the implications for the profession of nursing are outlined. Although there are still many unknowns about the pandemic, nursing's voice is necessary to ensure the ongoing delivery of high-quality care.

Leveraging nurse practitioner capacities to achieve global health for all: COVID-19 and beyond.

AIM: To argue that nurse practitioners have been under-utilized generally in the current global health environment, creating barriers to achieving universal health coverage and the Sustainable Development Goals. BACKGROUND: Nurse practitioners are advanced practice nurses possessing expert knowledge and leadership skills that can be optimized to narrow disparities and ensure access to high-quality health care globally. Nurses worldwide have been challenged to meet global public health needs in the context of COVID-19 (SARS-CoV-2 virus), and there are early indications that nurse practitioners are being called upon to the full extent of their capabilities in the current pandemic. SOURCES OF EVIDENCE: PubMed; Google Scholar; the International Council of Nurses; World Health Organization; United Nations; and the experiences of the authors. DISCUSSION: Several international reports, nursing and health organizations have called for continued investment in and development of nursing to improve mechanisms that promote cost-effective and universally accessible care. Expanding nurse practitioner scopes of practice across nations will leverage their clinical capacities, policy and advocacy skills, and talents to lead at all levels. CONCLUSION: Ongoing empirical data and policy change is needed to enable the full scope and strategic utilization of nurse practitioners across healthcare systems and contexts. IMPLICATIONS FOR NURSING PRACTICE, AND NURSING AND HEALTH POLICY: Widespread education regarding nurse practitioner capacities for interdisciplinary partners, policymakers and the public is needed. Policies that safely expand their roles are critical. Role titles and remuneration reflective of their scope and service are required to lead, sustain and grow the workforce internationally.

Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track.

BACKGROUND: In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs) and transition to doctor of nursing practice (DNP) preparation only by 2015. Today, five years after the AACN's deadline, nursing has not yet adopted a universal DNP standard for APRN practice entry. PURPOSE: The purpose of this paper is to examine the factors influencing the ability of nursing schools to implement a universal DNP standard for APRNs. METHODS: Deans from top-ranked nursing schools explore the current state of the DNP degree in the US. The authors draw upon their collective experience as national leaders in academic nursing, long-time influencers on this debate, and heads of DNP programs themselves. This insight is combined with a synthesis of the literature and analysis of previously unpublished data from the AACN on trends in nursing doctoral education. FINDINGS: This paper highlights issues such as the long history of inconsistency (in messaging, curricula, etc.) surrounding the DNP, certification and accreditation challenges, cost barriers, and more. The authors apply COVID-19 as a case study to help place DNP graduates within a real-world context for health system stakeholders whose buy-in is essential for the success of this professional transition. DISCUSSION: This paper describes the DNP's standing in today's professional environment and advances the conversation on key barriers to its adoption. Insights are shared regarding critical next steps to ensure national acceptance of the DNP as nursing's terminal practice degree.