The evaluation of evidence-informed changes to an internationally educated nurse registration process.

AIM: To evaluate effectiveness of specific policy and practice changes to the process of registration for internationally educated nurses. BACKGROUND: Little research exists to inform registration policy for internationally educated health professionals. INTRODUCTION: Internationally educated nurse employment can help address nursing shortages. Regulators assess competencies for equivalency to Canadian-educated nurses, but differences in health systems, education and practice create challenges. METHODS: The study setting was a Canadian province. We used a mixed methods approach, with a pre-post-quasi-experimental design and a qualitative evaluation. Previous analysis of relationships between applicant variables, registration outcomes and timelines informed changes to our registration process. Implementation of these changes composes the intervention. Comparisons between pre- and post-implementation exemplar subgroups and timeline analyses were conducted using descriptive statistics, univariate analysis and non-parametric tests. Data were collected from complete application files before (n = 426) and after (n = 287) implementation of the intervention. Interviews, focus groups and consultations were completed with various stakeholders. FINDINGS: The time between steps in the process was significantly reduced following implementation. Stakeholders reported an increase in perceived efficiency, transparency and use of evidence. DISCUSSION: Results indicated that initial impacts of the policy changes streamlined the process for applicants and staff. CONCLUSION: Maintaining a consistent and systematic review of an organization's data coupled with implementation of findings to effect policy and practice change may have an important impact on regulatory policy. IMPLICATIONS FOR NURSING POLICY: These findings represent the beginning of an international policy conversation. Policy changes based on organizational data can underlie major process improvement initiatives. Ongoing nursing shortages across the globe and increasing mobility of nurses make it important to have efficient and transparent regulatory policy informed by evidence.

Wisdom within: unlocking the potential of big data for nursing regulators.

AIM: This paper explores the potential for incorporating big data in nursing regulators' decision-making and policy development. Big data, commonly described as the extensive volume of information that individuals and agencies generate daily, is a concept familiar to the business community but is only beginning to be explored by the public sector. BACKGROUND: Using insights gained from a recent research project, the College and Association of Registered Nurses of Alberta, in Canada is creating an organizational culture of data-driven decision-making throughout its regulatory and professional functions. The goal is to enable the organization to respond quickly and profoundly to nursing issues in a rapidly changing healthcare environment. SOURCES OF EVIDENCE: The evidence includes a review of the Learning from Experience: Improving the Process of Internationally Educated Nurses' Applications for Registration (LFE) research project (2011-2016), combined with a literature review on data-driven decision-making within nursing and healthcare settings, and the incorporation of big data in the private and public sectors, primarily in North America. DISCUSSION: This paper discusses experience and, more broadly, how data can enhance the rigour and integrity of nursing and health policy. CONCLUSION: Nursing regulatory bodies have access to extensive data, and the opportunity to use these data to inform decision-making and policy development by investing in how it is captured, analysed and incorporated into decision-making processes. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Understanding and using big data is a critical part of developing relevant, sound and credible policy. Rigorous collection and analysis of big data supports the integrity of the evidence used by nurse regulators in developing nursing and health policy.

Birth incidence and prevalence of tumor-prone syndromes: estimates from a UK family genetic register service.

Autosomal dominantly inherited tumor-prone syndromes are a substantial health problem and are amenable to epidemiologic studies by combining cancer surveillance registries with a genetic register (GR)-based approach. Knowledge of the frequency of the conditions provides a basis for appropriate health-resources allocations. GRs for five tumor-prone syndromes were established in the Manchester region of North West England in 1989 and 1990. Mapping birth dates of affected individuals from families onto regional birth rates has allowed an estimate of birth incidence, disease prevalence, and de novo mutation rates. Disease prevalence in order of frequency were for neurofibromatosis type 1 (NF1): 1 in 4,560; familial adenomatous polyposis (FAP): 1 in 18,976; nevoid basal cell carcinoma [Gorlin syndrome (GS)]: 1 in 30,827; neurofibromatosis type 2 (NF2) 1 in 56,161; and von Hippel Lindau (VHL) 1 in 91,111. Best estimates for birth incidence were: 1 in 2,699; 1 in 8,619; 1 in 14,963, 1 in 33,000; and 1 in 42,987, respectively. The proportions due to de novo mutation were: 42% (NF1); 16% (FAP); 26% (GS); 56% (NF2); and 21% (VHL). Estimates for NF1, NF2, FAP, and VHL are in line with previous estimates, and we provide the first estimates of birth incidence and de novo mutation rate for GS.

Effects of shift length on quality of patient care and health provider outcomes: systematic review.

BACKGROUND: Healthcare providers work increasingly under a variety of shift work systems to cover the continuous care required by patients. However, the effects of shift work on patient and provider outcomes in healthcare settings has not been systematically evaluated. OBJECTIVE: To identify and analyse the available evidence on the effect of shift length (8-h vs 12-h shifts) on quality of patient care and healthcare provider outcomes. METHODS: Systematic searching of eight online databases, key governmental/organisational websites and academic journals with ancestry search of relevant articles (limited to articles published in English and Spanish). RESULTS: Of 562 articles that were retrieved from 20 446 titles identified through database and manual searches, 27 satisfied the inclusion criteria, of which 15 were rejected because of low methodological quality. The 12 final studies included cross-sectional/survey (7), before-after (3) and prospective cohort (2) designs. The main primary outcomes evaluated were: (1) quality of patient care and (2) healthcare provider outcomes. The results were equivocal. With respect to the effect of shift length on quality of patient care, two studies found that errors and near errors were associated with working longer shifts, and another study reported decreased patient complications and length of stay with longer shifts. Specific healthcare provider outcomes such as health complaints, well-being, drug and alcohol consumption, stress and job satisfaction were mostly evaluated by single studies and therefore there was insufficient evidence from which to draw conclusions. CONCLUSIONS: Methodological quality of the studies generally was low and results equivocal with insufficient evidence to determine the effects of shift length on quality of patient care and healthcare provider outcomes. Clearly, robust well-designed studies are needed to examine the effect of shift length on patient and healthcare provider outcomes.

Health Index Plus: a CD-ROM product for consumer health information.

Health Index Plus, a consumer health information CD-ROM database, was field-tested by staff and patrons at a public library in Harrisburg, Pennsylvania. Ease-of-use, database content and quality, and appropriateness for audience were evaluated. Overall, patrons found the database simple to use. The contents focus on topics of popular interest and provide access to scientific material that is normally not available or comprehended by many public library users. Although some indexing problems and other shortcomings were noted, the database is recommended for public and other libraries providing consumer health information.