Reframing Hospital Nursing as a Specialty to Address the Staffing Crisis.

Academia and nursing practice are at a crossroads.

Educating generation Z: Psychosocial dimensions of the clinical learning environment that predict student satisfaction.

Generation Z (Gen Z) nursing students have characteristics that differentiate them from previous cohorts. They are entrenched in technology, prefer to work at their own pace, seek a great deal of feedback, and can be anxious. Because Gen Z is also entrepreneurial, it is important to identify strategies for promoting satisfaction among Gen Z nursing students to retain them in nursing. This study sought to identify the psychosocial dimensions of the clinical learning environment that best predict Gen Z nursing student satisfaction in the medical-surgical clinical learning environment. A secondary analysis was performed on data collected using the Revised Clinical Learning Environment Inventory-32. Maximum Likelihood regression analysis identified predictors of satisfaction. Three subscales of the CLEI-32, reflecting 3 psychosocial dimensions of the clinical learning environment, significantly predicted student satisfaction in the clinical learning environment, after controlling for clustering effects of students within hospitals. Findings were consistent with the literature on Gen Z learners and revealed that their satisfaction improves when they can make decisions, work at their own pace, and receive direction, feedback, and support. The effect of hospital environment on the clinical learning environment should be investigated further; other variables that predict satisfaction remain to be identified.

Examination of the Structural Validity of the Clinical Learning Environment Inventory Using Exploratory Factor Analysis.

BACKGROUND AND PURPOSE: This study tested the psychometrics of the Clinical Learning Environment Inventory (CLEI-actual version), a tool designed to measure the perceptions of nursing students' clinical learning. The developer of the CLEI did not report structural validity. METHOD: Exploratory factor analysis (EFA) was performed using data from 311 licensure nursing students to assess the CLEI's proposed dimensions or structural validity. RESULTS: The Kaiser-Meyer-Olkin (KMO) test indicated acceptable sampling adequacy. Analysis of four different models, while retaining items with factor loadings >0.35, resulted in a four-factor solution with 32 items. The factors were renamed: Concern for Student Welfare (the highest weighted factor); Organized/Effective Teaching; Enjoyment of Clinical Learning; and Student Decision-Making. CONCLUSIONS: This study suggests that the 32 item four-factor CLEI is sufficiently structurally valid and reliable for further testing.

From Academic-Practice Partnership to Professional Nursing Practice Model.

HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "From Academic-Practice Partnership to Professional Nursing Practice Model," found on pages 104-112, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 28, 2020. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Describe the benefits and barriers to participation in a community-based academic-practice partnership. Identify three changes in the practice environment that transform the practice of staff nurses working in partnership model clinical units. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. This study used a qualitative descriptive design to examine the role of the expert staff nurse or clinical liaison nurse (CLN) participating in a community-based academic-practice partnership. Little is known about the influence of participation by expert nurses in community hospital settings. Focus groups were conducted with nine CLNs to explicate their experiences in a unit-based leadership practice model. Eight themes were identified: Reciprocal Learning Between Staff Nurses and Students; Reciprocal Learning Between Student and Patient; Working Around the System; Building Relationships; Valuing the CLN Role; Faculty Recognition of CLNs; Transforming Practice; and a variant theme, Recognition That Some Nurses Neither Value nor Enjoy Working With Students. The benefits of developing partnerships in community hospitals can be far reaching and may be of interest to educators and leaders in the profession. When a practice environment focused on evidence and was fueled by student enthusiasm reinvigorates staff nurses, their work world suddenly transforms. J Contin Educ Nurs. 2017;48(3):104-112.

Predictors of Undergraduate Nursing Student Satisfaction with Clinical Learning Environment: A Secondary Analysis.

Nurse educators must develop evidence-based strategies that prepare new graduates to function in a dynamic health care environment. Student satisfaction with their clinical learning has been identified as a particular outcome of interest. A secondary analysis of pilot study data was performed to determine predictors of student satisfaction in the medical-surgical clinical environment. All dimensions of the clinical learning environment were measured using a published, validated instrument. Two dimensions, Task Orientation and Individualization, significantly predicted satisfaction, explaining 57 percent of the variance. To improve satisfaction, clinical faculty should make clear assignments, provide specific instructions, maintain organization, and provide individualized attention.

Clinical liaison nurse model in a community hospital: a unique academic-practice partnership that strengthens clinical nursing education.

The necessity to help baccalaureate nursing students transition to clinical practice in a health care environment governed by change has compelled nurse educators to investigate alternative clinical instruction models that nurture academic-practice partnerships and facilitate student clinical learning. This article describes an academic-practice partnership in a community hospital using the Clinical Liaison Nurse (CLN) model as a link between students and clinical faculty and reports results of a quasi-experimental study that compared perceptions of the clinical learning environment between students participating in the CLN model (experimental group) and those in a traditional, instructor-led clinical model (control group). Students assigned to the CLN model had statistically significantly higher individualization, satisfaction, and task orientation scores on the Clinical Learning Environment Inventory. The findings provide evidence that academic-practice partnerships can be successful in community hospital settings and enhance students' perceptions in the clinical learning environment.

A regional model of interprofessional education.

This paper describes the innovative features of the first regional model of interprofessional education (IPE) in the US, developed by The Commonwealth Medical College, Scranton, PA, USA, as a new, independent, community-based medical school in northeastern Pennsylvania. Essential educational components include collaborative care seminars, interprofessional sessions, simulations, live web-based seminars and newly innovative virtual environment interactive exercises. All of these elements are being integrated into the curricula of 14 undergraduate and allied professional schools, and three graduate medical education programs located in the region. Activities incorporate simulation, standardized patients, student leadership, and faculty and student facilitation. As this new regional model of interprofessional education is fully implemented, its impact will be assessed using both quantitative and qualitative outcomes measurements. Appropriate ongoing modifications to the model will be made to ensure improvement and further applicability to collaborative learning.

Intent to stay: a pilot study of baccalaureate nurses and hospital nursing.

Hospitals want to hire baccalaureate nurses. Even if there were sufficient numbers of baccalaureate nurses to fill hospital vacancies, however, it is unclear how long these nurses stay at the "bedside." Until the profession can ascertain how many baccalaureate nurses stay in hospital nursing, simply preparing enough of them will not suffice. Because no published studies were identified that examined either how long baccalaureate nurses stay in hospital nursing or these nurses' reasons for leaving hospital nursing, we undertook a pilot study of our own baccalaureate graduates. Specifically, this comparative descriptive pilot study examined baccalaureate nurses' average number of years in hospital nursing and their reasons for leaving or intending to leave hospital nursing. Three hundred ninety graduates responded. Forty percent had left hospital nursing after an average of 6.4 years, with a median of 5 years. Just over 56% were still practicing hospital nursing, and of these, 81.8% were staff RNs, 26.9% of whom intended to leave hospital nursing in the next 3-5 years. Nurses who intended to leave were less satisfied in their jobs (P < .0001) than those who did not intend to leave. They were also more likely to disagree that RNs played a participatory role in hospital affairs (P = .048), that there were adequate staffing and resources (P = .041), and that RN-physician relationships were collegial (P = .048). The most frequent reasons for intent to leave were the following: to advance education or to take new positions (43%), stress/burnout, long hours, and lack of administrative support/respect (21%, respectively). Only 17% cited poor pay/benefits as a reason for intent to leave. Respondents who had already left hospital nursing cited similar reasons. Dissatisfaction with the practice environment results in baccalaureate nurses leaving hospital nursing at a time when there is a critical shortage of nurses in all practice settings, but especially hospitals. Considering the accumulating evidence of superior patient outcomes in hospitals well staffed by baccalaureate nurses, it is critical to identify and implement solutions to ensure that adequate numbers of experienced, baccalaureate nurses stay at the bedside.

Recruitment and retention of women in two longitudinal studies of recovery from coronary events: A secondary analysis.

OBJECTIVE: The objective of this study was to identify demographic and clinical characteristics of women who refused, dropped out of, or completed 2 longitudinal studies about recovery from coronary events and to identify reasons for refusal or drop out. DESIGN: The study was a secondary analysis of data from 2 longitudinal studies on women's recovery from coronary events. SAMPLE: The subjects for this study were 254 women recovering from coronary events. RESULTS: Demographics did not distinguish refusers from completers or dropouts from completers. Completers were more likely than dropouts to have had surgery and to have diabetes mellitus and hypertension. Reasons for refusal and dropout were identified. CONCLUSIONS: Clinical and psychosocial variables might play a more important role than demographics in refusal and dropout. Researchers should collect demographic and refusal data at the outset of studies and consider collecting baseline psychosocial data. Researchers should over sample for women without coexisting chronic conditions, and clinicians should educate women about the importance of their participation in studies.

A longitudinal study of functional status and correlates following coronary artery bypass graft surgery in women.

BACKGROUND: There is limited information available to help women gauge their functional status following coronary artery bypass graft surgery. OBJECTIVE: This article describes changes in functional status and the influence of comorbidity, household composition, fatigue, and surgical pain on functional status in women during the first 6 weeks at home following coronary artery bypass surgery. METHOD: A single-group longitudinal design was used for this research. Women were interviewed in person before hospital discharge and by telephone at 2, 4, and 6 weeks after discharge. Functional status was assessed by (a) the Inventory of Functional Status in the Elderly and subscales of the Sickness Impact Profile; (b) comorbid conditions by simple tally; and (c) fatigue and surgical pain by the Energy/Fatigue and Pain Severity subscales of the MOS Patient Assessment Questionnaire. RESULTS: Women experienced significant gains in functional status over 6 weeks, particularly between 2 and 4 weeks. They engaged most frequently in personal care and low-level household activities during the study period, and most reported improvement in their overall functional status. None of the women were completely recovered or had regained baseline functional status by 6 weeks. The women experienced significant decreases in fatigue and surgical pain, but continued to experience both at 6 weeks. Fatigue and surgical pain were significantly correlated at all time periods. DISCUSSION: Information about recovery following coronary artery bypass graft, and particularly the finding that recovery is incomplete by 6 weeks, should be incorporated into discharge planning and follow-up for this patient population.