Strategies to expand the distribution of nursing talent in the United States.

This panel paper is the third installment in a six-part Nursing Outlook special edition based on the 2022 Emory Business Case for Nursing Summit. The 2022 summit was led by Emory School of Nursing in partnership with Emory School of Business. It convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises, including the nursing shortage. Each of the summit's four panels authored a paper in this special edition on their respective topic(s). This panel paper focuses on strategies to optimally distribute nursing talent in rural and underserved areas. It discusses the role of nursing talent distribution in ensuring equity in access to care for U.S. populations. Topics covered include the need for expanded and standardized advanced practice registered nurse (APRN) scope of practice, an expanded nurse licensure compact, reimbursement reforms, and competitive nursing salaries.

A Conceptual Model for Professional Identity in Nursing: An Interdependent Perspective.

The purpose of this initiative was to define the development, verification, and evolution of the conceptual model for Professional Identity in Nursing. This action research design occurred over two phases, utilizing observations, a modified Norris process for model development, and focus groups. Analysis consisted of conventional content analysis and the Fawcett method for conceptual model analysis and evaluation. The model was modified, and results are presented based on the model's philosophical underpinnings, content, socialness, and evolution. The model resonates with nurses both in the United States and internationally. The interdependency shown in the model encourages collaboration, accountability, and sustainability within the profession and society.

A Profession Disrupted: Looking Back to Go Forward.

Nurses face unprecedented harms from the COVID-19 pandemic. A survey by AMN Healthcare found that registered nurses experienced significantly elevated levels of stress, burnout, and other challenges that led nearly 1 million to consider leaving nursing altogether. Despite the challenges, a confluence of positive factors present great confidence that the nursing profession can bounce back and become much stronger due to lessons learned and hardships overcome during the pandemic. There is near-universal awareness that solving the significant challenges to nursing is vitally important, because the health of the American people depends on the health of the nation's nurses.

Stethoscope hygiene: A call to action. Recommendations to update the CDC guidelines.

Healthcare-acquired infections are a tremendous challenge to the US medical system. Stethoscopes touch many patients, but current guidance from the Centers for Disease Control and Prevention does not support disinfection between each patient. Stethoscopes are rarely disinfected between patients by healthcare providers. When cultured, even after disinfection, stethoscopes have high rates of pathogen contamination, identical to that of unwashed hands. The consequence of these practices may bode poorly in the coronavirus 2019 disease (COVID-19) pandemic. Alternatively, the CDC recommends the use of disposable stethoscopes. However, these instruments have poor acoustic properties, and misdiagnoses have been documented. They may also serve as pathogen vectors among staff sharing them. Disposable aseptic stethoscope diaphragm barriers can provide increased safety without sacrificing stethoscope function. We recommend that the CDC consider the research regarding stethoscope hygiene and effective solutions to contemporize this guidance and elevate stethoscope hygiene to that of the hands, by requiring stethoscope disinfection or change of disposable barrier between every patient encounter.

Creating a Healthier Workplace Environment in an Era of Rising Workforce Pressures.

Challenges in the nurse work environment, particularly those resulting from nurse shortages and the retirement wave, can affect the health and well-being of all Americans, not just nurses themselves or the health care organizations where they work. Many of the solutions to significantly expand the number of nurses in America will take many years to realize. However, there are some important changes that health care organizations can put into effect relatively quickly to enhance the work environment for nurses, which can improve care quality and safety, patient satisfaction, and the well-being of nurses. The biennial Survey of Registered Nurses by AMN Healthcare, which polled nearly 20 000 RNs, found that nurses are eager for many workplace changes that would create a healthier workplace while enhancing their professional and personal lives. These institutional changes also create opportunities for improving the health of the organizations themselves. Analysis of survey data found that improving professional development, flexibility and work-life balance, safety and team engagement, and organizational response to workplace violence can create a healthier workplace for nurses. These are known solutions that have yet to be fully engaged.

Stress Mitigation Strategies for Trauma Nurses: A Case Study.

Trauma nurses encounter multiple intense stressors on a regular basis. These nurses not only treat the injured patient following a traumatic event but then interact with family members who are also impacted by the event. Repeated experiences with significant trauma can have cumulative effects and negatively impact these nurses and the entire trauma team. Professional nursing associations make recommendations promoting wellness, and health care organizations implement wellness programs that foster and support mind, body, and spirit health. Individuals cope with and respond to stress in different ways, dependent on their unique backgrounds, beliefs, and support systems. Because of these differences, it is important for organizations to offer various ways for nurses and team members to process their reactions and use effective strategies to effectively manage stress. The organization highlighted in this case study offers several stress mitigation programs and techniques designed to support the overall health of trauma nurses and restore their emotional well-being, so that they are best able to care for their injured patients.

Our Own Worst Enemies: The Nurse Bullying Epidemic.

Nurse bullying is a systemic, pervasive problem that begins well before nursing school and continues throughout a nurse's career. A significant percentage of nurses leave their first job due to the negative behaviors of their coworkers, and bullying is likely to exacerbate the growing nurse shortage. A bullying culture contributes to a poor nurse work environment, increased risk to patients, lower Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores, and greater nurse turnover, which costs the average hospital $4 million to $7 million a year. Addressing nurse bullying begins with acknowledging the problem, raising awareness, mitigating contributing factors, and creating and enforcing a strong antibullying policy. Nurses and stakeholders also must actively work to change the culture, and understand that bullying has no place in the nursing profession or anywhere else in health care.

The Nurse Leader Role in Crisis Management.

Leaders from the American Organization of Nurse Executives describe the dynamic state of today's healthcare system related to crisis management. Adaptive leadership, driven by strong values and morality, can guide leaders and organizations through the most difficult times.

Pioneering through chaos.

The 2014 International Nursing Administration Research Conference, "Pioneering Through Chaos: Leadership for a Changing World," was held at the Texas Woman's University in Dallas, Texas, in the fall of 2014. The program drew more than 100 attendees from 4 countries. The conference informed attendees from both academe and practice about the role of nursing administration in navigating the dynamic healthcare climate. This article will report on the insights from the conference presenters.

Moving forward: lessons from unplanned change.

The article focuses on the concept of unplanned change in a large tertiary facility in Texas related to the 1st Ebola patient to be diagnosed in the United States. The chief nurse executive relates the general reactions, impacts, and challenges faced in this unprecedented event.

Strengthening Moral Courage Among Nurse Leaders.

Moral distress among practicing nurses is frequently discussed in the nursing literature, along with well-developed recommendations for increasing moral courage in practicing nurses. Implementing these recommendations depends on nurse leaders being morally fit to lead and to create an environment in which moral courage actions can emerge. The literature is lacking pertaining to nurse leaders' preparation to lead in a morally courageous and transformational manner in our current corporate environments and hierarchies of healthcare. In this article, the author reviews the literature addressing moral distress and moral courage among direct care nurses; describes the development of an intervention to strengthen the moral courage of nurse leaders; reports a study that involved implementing this intervention; presents the findings of this study; evaluates the effectiveness of the intervention; and discusses the findings in terms of lessons learned and future directions. He concludes with a call for healthcare leaders to demonstrate moral courage and create environments that promote morally courageous acts that enable nurses to remain centered on the patients, families, and communities we serve.

An exploration of relational aggression in the nursing workplace.

OBJECTIVE: This study provides a 1st look at relational aggression (RA) and the consequences among nurses. BACKGROUND: Interpersonal hostility, bullying, and a toxic work environment (WE) can impact patient care delivery as well as nurses' personal health and job satisfaction. METHODS: The Relational Aggression Assessment Scale, measuring aggressors, victims, and bystanders, was used to measure RA in a sample of 842 nurses. Additional variables measured included a demographic profile, job satisfaction, and intent to leave. RESULTS: Nurses were most likely to identify with victim behaviors, but a minority of nurses reported relying on aggressor behaviors and bystander behaviors. There was a positive correlation among aggressor, victim, and bystander items, suggesting overlap in roles. CONCLUSIONS: A few relationally aggressive individuals can create a toxic WE. Interventions to address RA among nurses must be tested, as well as strategies for improving job satisfaction and promoting healthy WEs through positive relationships.

Balancing interests of hospitals and nurse researchers: lessons learned.

While nurse researchers and administrators in health care organizations need to collaborate to understand the variables that affect nursing practice environments and patient care outcomes, there are inherent risks associated with these collaborations that require careful consideration. A team of academic and hospital researchers found that in studying the off-peak (nights and weekends) nursing environment using institutional ethnography, which involved interviews of nurses and administrators, the subject of the research was frequently the hospitals where these individuals worked. Although the individuals who participated in the research consented to be interviewed about their work, it was less clear how and to what extent the anonymity of their organizations could be maintained. The risks and benefits encountered suggest the need for a decision-making process to be undertaken by collaborative research teams. This decision process and analysis can help ensure a fruitful research relationship that protects sensitive concerns of hospital entities while advancing our understanding of nursing practice environments and patient care outcomes. Important strategies include having all leaders and research team members discuss the agendas of all entities and individuals involved, including clearly delineating the roles, responsibilities, and contributions of all parties. In addition, any constraints or expectations of first right of review of publications needs to be negotiated from the outset. Collaborators need to review their agreements throughout the research process to avoid pitfalls that could adversely impact the relationships as well as the dissemination of knowledge gained.