Building research infrastructure and multisite studies in merged health care settings: A framework for nurse scientists and health care leaders.

BACKGROUND: Merged healthcare settings, particularly those with Magnet designated sites, present distinct opportunities for PhD nurse scientists developing nursing research infrastructure. PURPOSE: This article aims to assist nurse scientists and healthcare leaders in defining nurse scientist roles, and in developing research infrastructure for conducting multi-site research in merged settings. METHOD: Practical strategies and a framework are provided to assist in building and navigating nurse scientist roles and research infrastructure development. DISCUSSION: Emphasizing the necessity of organizational support, the article underscores the importance of clear role delineation and leadership support. CONCLUSION: To optimize the contributions of nurse scientists in merged healthcare settings, especially in Magnet organizations, clear role definitions, robust research infrastructure, and strong organizational support are imperative.

The Impact of DNP Scholarly Projects on Healthcare Organizations: A Road Map for Success.

Many DNP scholarly projects occur in healthcare organizations, often taking various forms based on specific academic requirements. Projects require site mentorship, project facilitation, and institutional review board resources. This article highlights the impact of DNP scholarly projects on healthcare organizations and provides a road map for success for healthcare leaders and site mentors.

Optimizing the productivity and placement of nurse practitioners and physician assistants in outpatient primary care sites.

BACKGROUND: It is increasingly imperative that organizational leaders continually assess nurse practitioners' (NPs) and physician assistants' (PAs) productivity, turnover, and vacancies. Optimizing the feasibility, impact, strategic placement, and monitoring increases patient access, improves wait times and affordability, and increases revenue. LOCAL PROBLEM: A healthcare system needed a systematic, data-driven approach aimed at optimizing productivity and placement of NPs and PAs in outpatient primary care sites. METHOD: Results from this project are reported using the Revised Standards for Quality Improvement Reporting Excellence framework. After formation of a QI team, a gap analysis, and action plans were developed and implemented. INTERVENTION/RESULTS: Priority areas requiring action included the development of an integrated position justification algorithm and tracking form addressing NPs' and PAs' placement, establishing consistent patient contact hours, setting workload expectations, and consistently communicating these via an organization-specific situation background, assessment, and recommendation communication tool. CONCLUSION: Health care leaders should leverage the talents of NPs and PAs meeting organizational benchmarks and goals as well as the needs of patients. Nurse practitioner and PA leaders should focus on benchmarking performance and analyzing barriers to optimization. These efforts are most beneficial when multidisciplinary in nature.

Differences in Marginality Between Nursing Students With and Without Disabilities.

BACKGROUND: Barriers exist in nursing education for students with disabilities. Students with disabilities often experience associated stigma and a perceived lack of support by nursing faculty and academic leaders. METHOD: A nonexperimental descriptive design was used to examine differences in perceived marginality between nursing students with and without disabilities (n = 7,399) in the United States. RESULTS: Participants who identified as having a disability described more marginalization (M = 45.9, SD = 10.5) than participants who did not identify as having a disability (M = 38.3, SD = 9.2), t(927) = 19.4, p < .001. CONCLUSION: Findings suggest marginalization exists for students with disabilities. Academic leaders and faculty should address systems, structures, and polices that potentially pose barriers to self-reporting, matriculation, and progression of students with disabilities. [J Nurs Educ. 2022;61(8):429-438.].

Optimizing the productivity and placement of NPs and PAs in outpatient primary care sites.

OBJECTIVE: Organizational leaders must continually assess the productivity, turnover, and vacancies of physician assistants (PAs) and NPs. Optimizing the feasibility, effect, strategic placement, and monitoring increases patient access, improves wait times and affordability, and increases revenue. This quality improvement project sought to develop a systematic, data-driven approach to optimize productivity and placement of NPs and PAs in outpatient primary care sites. METHODS: Results from this project are reported using the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE) framework. Postformation of a quality improvement team, a gap analysis, and action plans were developed and implemented. RESULTS: Priority areas requiring action included the development of an integrated position justification algorithm and tracking form addressing NP and PA placement, establishing consistent patient contact hours, setting workload expectations, and consistently communicating these via an organization-specific situation, background, assessment, and recommendation communication tool. CONCLUSIONS: Healthcare leaders should leverage the talents of NPs and PAs meeting organizational benchmarks and goals as well as the needs of patients. NP and PA leaders should focus on benchmarking performance and analyzing barriers to optimization. These efforts are most beneficial when multidisciplinary in nature.

Perceived marginality in veteran and nonveteran nursing students in baccalaureate programs.

BACKGROUND: Veteran nursing students often have difficulty transitioning to campus life. Barriers include issues with admissions, financial support, as well as classroom environments. These barriers often push veterans and their unique needs to the periphery. METHOD: The purpose of this descriptive cross-sectional study was to examine mean differences in perceived marginality between veteran and nonveteran nursing students enrolled in baccalaureate programs using the Englund Marginality Index. RESULTS: Results indicate that veteran nursing students report higher perceived marginality (M = 40.18, SD = 10.68) than nonveteran nursing students (M = 38.82, SD = 9.51); t (1154) =2.09, p = 0.036. CONCLUSION: Veteran nursing students in this study demonstrate higher levels of perceived marginalization. Strategies aimed at decreasing attrition and marginalization should be implemented, thus improving the diversity of the nursing workforce.

Differences in perceived marginalization in doctorally prepared nursing faculty.

BACKGROUND: Debate regarding the role of Doctor of Nursing Practice-prepared faculty in academic settings continues. Perceived barriers to successful integration include a lack of respect, inadequate infrastructure, and insufficient resources. PURPOSE: The purpose of this study was to compare differences in self-reported marginalization in doctorally prepared (Doctor of Philosophy/Doctor of Nursing Practice) nursing faculty working in academic settings. METHOD: A descriptive cross-sectional design was implemented to compare differences in self-reported marginalization between doctorally prepared faculty teaching in Commission on Collegiate Nursing Education accredited colleges. Marginality was measured using the Englund Marginality Index. FINDINGS: Results of an independent-samples t-test indicate that Doctor of Nursing Practice -prepared faculty self-reported higher levels of marginalization (M = 41.7, SD = 9.6) than Doctor of Philosophy -prepared faculty (M = 39.1, SD = 10.5); t(583) = 2.8, p = .006. DISCUSSION: Strategies to decrease marginalization include improving systemic issues surrounding shared governance and outdated tenure systems as well as enhancing infrastructures that improve collaboration among doctorally prepared faculty.

A qualitative examination of graduating nurses' response to the Covid-19 pandemic.

BACKGROUND: Currently, graduating nurses face pandemic-related uncertainty including gaps in risk perception, unexpected Covid-19 moral dilemmas, and distress surrounding personal health risk. RESEARCH QUESTION/AIM/OBJECTIVES/METHOD: The purpose of this basic qualitative descriptive study is to describe the willingness of graduating nurses to provide care during the Covid-19 pandemic. PARTICIPANTS AND RESEARCH CONTEXT: One week prior to graduation, students were required to submit a written assignment describing willingness to practice in light of the ongoing pandemic. ETHICAL CONSIDERATIONS: This study was approved by an Institutional Review Board. FINDINGS/RESULTS: Eighty-four (n = 84) assignments were used for analysis. Of these, 82% (n = 69) of the graduating nurses describe a willingness to voluntarily care for Covid-19 patients. After summarizing narrative responses, two themes emerged including self-assessment of personal and familial risk and conflicting obligations. DISCUSSION: The assessment of risk to self and family are key in determining whether graduating nurses will care for Covid-19 patients. Conflicting obligations may contribute to stress and uncertainty potentially leading to early burnout. CONCLUSION: Findings from this study can inform academicians of the need to adequality prepare graduating nurses for Covid-19-associated risks and ethical decision making. Organizations should alter residencies and orientation to support the needs of new nurses.

Huddling as an Academic Quality Improvement Initiative.

ABSTRACT: A huddle is described as a tight group gathered together to talk privately for the purpose of reviewing performance and engaging in future planning. Although huddles are described as an effective communication tool to enhance patient safety in hospital settings, little is known about their use in academe. This article describes a quality improvement initiative involving weekly huddles of faculty teaching medical/surgical nursing and provides preliminary findings after one year.

A quality improvement project: Defining and operationalizing a holistic admission selection policy.

Nationwide, faculty in colleges of nursing are struggling to define practices surrounding holistic admission. Faculty may support the idea of holistic admissions however, little is known about how policies and procedures are developed, operationalized and applied across pools of applicants. The objective of this article is to describe the quality improvement (QI) process surrounding the development of a holistic admission selection policy by faculty in a college of nursing. The Experience-Attributes- Metrics Model was altered and adopted for use in our prelicensure programs. Selection criteria were defined and operationalized. Findings indicate that the QI process took approximately two years. The new policy and tiering are currently being applied to our pools of admission candidates.

Intravenous Lidocaine for Chronic Neuropathic Pain A Systematic Review Addressing Nursing Care.

BACKGROUND: The intravenous administration of lidocaine for patients with chronic neuropathic pain is well documented in the literature. However, little is known about the role of the nurse caring for patients receiving the infusion. AIM: The purpose of this systematic review was to examine and describe common side effects associated with the intravenous administration of lidocaine to patients with chronic neuropathic pain and outline nursing care described in an effort to develop evidence-based protocols for care. METHOD: A comprehensive search of databases was completed and yielded eleven (n = 11) articles and one care protocol for analysis. RESULTS: Evidence was appraised and findings suggest intravenous lidocaine has a low risk of causing adverse events, however patients should be monitored closely. CONCLUSIONS: Nursing care focuses on pain assessment, close observation and intervention if neurological changes occur.

Readiness to Practice in Generation Z Nursing Students.

BACKGROUND: Generation Z nursing students born after 1995 have been described as true digital natives with a short attention span and tendencies toward boredom. The purpose of this pilot study is to compare readiness for practice and anxiety and self-confidence during decision making between Generation Z students who completed a 4-week immersive clinical and those in a 14-week immersive clinical. METHOD: A convenience sample (n = 46) of Generation Z graduating baccalaureate nursing students was surveyed. RESULTS: Independent samples t tests were conducted, with no statistical differences between groups on any measures. CONCLUSION: Findings suggest that extended periods of time in an immersive clinical do not influence readiness to practice or anxiety and self-confidence during decision making in the next generation of students. [J Nurs Educ. 2019;58(10):604-606.].

Intravenous Lidocaine for Relief of Chronic Neuropathic Pain.

The purpose of this study was to describe the therapeutic effectiveness/pain relief of moderate-dose lidocaine infusions in patients with chronic neuropathic pain. Retrospective reviews of medical records were conducted for 40 patients referred to a midwestern pain clinic for management of intractable neuropathic pain despite use of multiple medications and treatment modalities. Descriptive statistics were used to summarize patients' demographic data, lidocaine dosing and infusion rate, daily opioid intake, adjuvant medication use, and medication allergies and intolerances. Paired samples t test was used to determine significance between preinfusion and postinfusion pain scores. A significant decrease in pain levels (P < .001) after infusion was found.

A Cost-Benefit Analysis of A Community Free Clinic.

Uninsured patients lacking access to primary and preventive care continues to be an issue. The purpose of this analysis is to describe operating costs surrounding a nurse-driven freestanding community clinic and to calculate quality of life benefits using clinically preventable burden scores. A retrospective records review of patients (n = 200) receiving care at a free clinic were used. Annual costs were $387,252. The benefit gained in quality-adjusted life years is estimated to be 57.47-203.94 yielding a return on investment ranging from $1,200,264-$8,948,184. Free clinics have sustained cost savings over time. Policies addressing this form of care are imperative.

Teaching Culturally Competent Veteran Nursing Care in Prelicensure Programs.

With the publication of Healthy People 2020, health disparities have been redefined to expand concepts beyond traditional racial and ethnic minorities and include a broader range of populations. Veterans, with their unique experiences and values, comprise a distinct culture with health risks and potential disparities. Although accrediting agencies require programs of nursing to teach culturally competent care, it is unknown whether nurse faculty recognize veterans as having a culture distinct from the rest of the population. Recognizing veterans as possessing a distinct culture is a first step in the provision of culturally competent care.

Attitudes of nurses towards care of the dying patient in India.

BACKGROUND: Worldwide, end-of-life care is coming under increasing scrutiny as nurses struggle to balance cultural norms and legal requirements with the desires of patients and families. The purpose of this descriptive pilot study was to examine and describe nurses' attitudes when caring for dying patients in India, and whether participation in an educational conference, which included two scenario-based, low-fidelity simulations increased knowledge of end-of-life care. METHOD: Participants' attitudes were measured with the 30-item Frommelt Attitudes Toward Care of the Dying (FATCOD-B) scale. Knowledge was measured with a researcher-developed 15-item content-focused test before and after the conference. RESULTS: The mean attitude scores of nurses (n=101) were M=101.45 (range 65-143, SD=15.99). Participation in the educational conference and end-of-life care simulations increased the knowledge of most nurses (P<0.05). CONCLUSION: Conferences and low-fidelity simulation are effective methods for improving nurses' knowledge of end-of-life care in India. Improved education surrounding end of life may positively affect attitudes.

Encouraging Specialty Certification: How Multilevel Support Can Help.

Professional development through specialty certification is positively associated with nurses' increased confidence in clinical skills, commitment to learning, empowerment, and professional credibility. This translates to improved patient outcomes, with higher organizational reimbursement, in addition to nurse retention and job satisfaction. Despite the call for lifelong learning from the Institute of Medicine, certification rates, especially among nurses in direct patient care, remain low. This article provides a three-tiered approach for organizational leaders and administrators of continuing education programs to establish resources and support for nurses seeking specialty certification.

Using SBAR to promote clinical judgment in undergraduate nursing students.

The purpose of this study was to describe how students identify and interpret multiple embedded clinical cues in a case study, and then reflect these using SBAR (Situation, Background, Assessment, and Recommendation). Using Tanner's model of clinical judgment, a descriptive design was used to examine SBAR assignments completed by second-semester nursing students (n = 80). The majority of students (n = 62, 77.5%) in the study were unable to successfully follow all of the clinical judgment phases of the model: noticing, interpreting, responding, and reflecting. Although SBAR is an important tool for communicating clinical information, gaps exist between noticing and interpreting clinical cues, and forming an appropriate course of action.