Intersecting Policy Contexts of Employment-Related Geographical Mobility of Healthcare Workers: The Case of Nova Scotia, Canada.

Mobility and movement is an increasingly important part of work for many, however, Employment-Related Geographical Mobility (ERGM), defined as the extended movement of workers between places of permanent residence and employment, is relatively understudied among healthcare workers. It is critical to understand the policies that affect ERGM, and how they impact mobile healthcare workers. We outline four key intersecting policy contexts related to the ERGM of healthcare workers, focusing on the mobility of Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Continuing Care Assistants (CCAs) in Nova Scotia: international labour mobility and migration; interprovincial labour mobility; provincial credential recognition; and, workplace and occupational health and safety.

Enfermería de práctica avanzada. desarrollo de un modelo emergente / Advanced nursing practice: development of an emerging model

Objetivo. Exponer la evolución histórica de la enfermería de práctica avanzada (EPA) en el ámbito internacional, así como describir las características y competencias de este perfil enfermero, con el propósito último de fomentar la reflexión sobre la implementación de este modelo de enfermería en el contexto español. Metodología. Se realizó una revisión bibliográfica en las bases de datos CINAHL, MEDLINE y CUIDEN. Además se consultaron varias páginas web. Resultados. A nivel internacional, se ha identificado el impacto que tiene la EPA en el sistema sanitario, reduciendo el número y la duración de las estancias hospitalarias así como consiguiendo una mayor satisfacción de los usuarios. Respecto al contexto nacional queda manifiesto el interés sobre esta temática, a pesar de que la implantación de este rol de práctica avanzada es una asignatura pendiente. Conclusiones. En España, la implementación de la EPA supone un desafío por los retos legislativos, educativos, organizacionales y políticos que conlleva la introducción oficial de esta nueva figura de enfermería(AU)

Aim: To describe the historical evolution of Advanced Practice Nursing (APN) in the international arena, and to describe the characteristics and competencies of this nursing role, with the ultimate aim of encouraging reflection on the implementation of this model of nursing in the Spanish context. Methods: A literature review in the databases CINAHL, MEDLINE and CUIDEN was conducted. In addition, several websites were reviewed. Results: At the international level, there is evidence on the impact of the APN in the healthcare system, reducing the number and length of hospital stays and showing greater user satisfaction. Regarding the national context, it is clear the interest on this issue, although the implementation of this advanced practice role is a pending matter. Conclusions: In Spain, the implementation of the APN is a challenge due to the legislative, educational, organizational and political factors that are involved in the official introduction of this new nursing model(AU)

Licensed practical nurse scope of practice and quality of nursing home care.

BACKGROUND: Although higher levels of registered nurse (RN) staffing in nursing homes are related to better care quality, licensed practical nurses (LPNs) provide most licensed-nursing care; prior research is mixed regarding how this influences quality. The nature of LPN practice, and RN direction of that practice, follows in part from state nurse practice acts (NPAs). OBJECTIVE: Among the 50 states and the District of Columbia, the aims of this study were to describe regulatory differences in how LPNs contribute to nursing assessment, care planning, delegation and supervision, and RN practice in these domains and to explore how these regulatory differences relate to quality of care in nursing homes. METHODS: The study design was a sequential explanatory mixed-methods design of NPAs and Centers for Medicare and Medicaid quality measures of long-stay nursing home residents. In the qualitative strand, 51 NPAs and related administrative code were analyzed to classify guidance on RN and LPN practice; then, the coded data were transformed to quantitative indicators of specificity regarding LPN and RN scope of practice. In the quantitative strand, state NPA data were linked to facility-level Centers for Medicare and Medicaid staffing and quality measures (N = 12,698 facilities) for cross-sectional, quantitative analyses. RESULTS: States varied considerably in how NPAs guided LPN and RN scope of practice. NPA differences were related to quality indicators of resident pain, catheter use, weight loss, and restraints, even when accounting for nursing home staff mix. DISCUSSION: Care quality was better in states where the NPA clearly described LPN scope, but only when there was also greater RN availability (p < .05). Classifying scope of nursing practice regulations moves beyond traditional staffing measures to inform understanding of the effects of the RN-to-LPN staffing ratio on quality of care in nursing homes.

Engagement y resultados académicos de los estudiantes de grado / Engagement and academics results of the grade students

El engagement académico es un estado de bienestar psicológico tridimensional (vigor, absorción y dedicación) de compromiso intrínseco hacia los estudios. El conocimiento de ese estado motivacional en los alumnos y poder compararlo con el rendimiento académico fue el principal objetivo a alcanzar. Para ello se ha realizado un estudio observacional, correlacional y transversal. La población objeto comprende los estudiantes de Grado en Enfermería que están cursando prácticas clínicas en la Universidad de Málaga. Nuestros datos arrojan las siguientes puntuaciones medias: vigor 3,46 sobre 6 (DT 1,05), dedicación 5,16, igualmente sobre 6 (DT 0,97). Y absorción, 3,59, también sobre 6 (DT 1,18). El nivel global de engagement de nuestros estudiantes de enfermería se sitúa en 4,1 sobre 6. Destacan los niveles en la dimensión dedicación, con valores medios que los sitúan entre las categorías casi siempre y siempre, lo que implica una altísima vocación hacia sus estudios. Las calificaciones del Practicum II-III han mostrado asociación con las dimensiones vigor (p<0,008) y absorción (p<0,036) del engagement. No lo han hecho las calificaciones del Practicum I (AU)

The academic engagement is a three-feature psychological welfare (determination, knowledge absorptive capability and dedication) as an intrinsic commitment towards the studies. The main aim of this study is to know the motivational status in students and to compare this with their academic performance. For the purpose of this paper, it was carried out an observational, correlational, cross-sectional study. The target population is the students carrying out the clinical training in the University of Malaga as part of the Nursing Degree. According to the data achieved, the mean score are the followings: determination 3.46 out of 6 (ST 1.05), dedication 5.16 out of 6 (ST 0.97) and knowledge absorptive capability 3.59 out of 6 (ST 1.18). The engagement global mean score of the nursing students enrolled in this University School of Nursing is 4.1 out of 6. It is worthy to mention the levels for dedication, ranging from almost always and always, which involves a remarkable vocation towards their profession. The marks on Practicum II-III have evidenced an association with the engagement determination (p<0.008), and knowledge absorption capability (p<0.036). Marks on Practicum I have not evidenced any association (AU)

Práctica clínica directa: análisis conceptual. Competencia central para el desarrollo de la práctica avanzada en enfermería / Direct clinical practice: conceptual analysis. Central competence for the development Of advanced nursing practice

La aprobación en España del posgrado en enfermería ha posibilitado el surgimiento de nuevos perfiles profesionales más avanzados, cuya competencia central es la práctica clínica directa. Objetivo: analizar y clarificar el término de práctica clínica directa. Metodología: se realizó un análisis conceptual basado en el método evolutivo de Rogers. Para ello, se llevó a cabo una revisión de la evidencia disponible en Pubmed, CINAHL, ISI Web of Knowledge, PsychINFO (Ovid) y la Cochrane Library. Asimismo, se revisaron cinco libros referentes en la práctica avanzada de enfermería. Resultados: se seleccionaron siete artículos y cuatro libros en base a los criterios de inclusión. Del análisis de los mismos se ofrece una definición del término práctica clínica directa. Conclusiones: este trabajo clarifica el concepto de práctica clínica directa y con ello contribuye a tener una base de conocimiento más sólida que sirva de fundamento para mejorar y perfeccionar la conceptualización del término PCD(AU)

The recent implementation in Spain of post degree in nursing has made possible the emergence of new advanced profiles, which direct clinical practice is the core competence. Objective: To analyse and clarify the term of direct clinical practice. Methodology: A conceptual analysis was carried out based on Rogers’s evolutionary approach. A review of the literature was made in the following data bases: PubMed, CINAHL, ISI Web of Knowledge, Psych INFO (Ovid) and Cochrane Library. Furthermore, five books about advanced practice nursing were revised. Results: 7 articles and 4 books based on the inclusion criteria were selected. After their analysis the concept of direct clinical practice is defined. Conclusions: This paper clarifies the concept of direct clinical practice and helps to have a stronger base of knowledge. This will serve as foundation to improve and perfect the conceptualization of this term(AU)

Practice patterns of licensed practical nurses in North Carolina.

In the United States, state laws develop basic practices to define the scopes of practice for registered nurses and licensed practical nurses (LPNs). The purpose of the study was to describe the actual practice patterns of LPNs working in North Carolina. The results of the study convey an unfavorable pattern regarding LPN scope of practice. Indications are that a paradigm shift might be required in order to reverse the pattern of overpractice by LPNs.

The diffusion of innovation in nursing regulatory policy: removing a barrier to medication administration training for child care providers.

Safe medication administration is an essential component of high-quality child care. Its achievement in New Jersey was impeded by a controversy over whether teaching child care providers medication administration involves registered nurses in the process of nursing delegation. Through the theoretical framework of the Diffusion of Innovation, this paper examines how the interpretation of regulatory policy related to nursing practice in New Jersey was adjusted by the Board of Nursing following a similar interpretation of regulatory policy by the Board of Nursing in Connecticut. This adjustment enabled New Jersey nurses to continue medication administration training for child care providers. National data supporting the need for training child care providers in medication administration is presented, the Diffusion of Innovation paradigm is described; the Connecticut case and the New Jersey dilemma are discussed; the diffusion process between the two states is analyzed and an assessment of the need for further change is made.

Continued competency and board regulation: one state expands options.

State boards of nursing are mandated by state statutes to ensure the ongoing safe and competent practice of licensees. However, nursing practice is characterized by diversity in educational backgrounds, scope of practice, and variety of settings. As a result, regulatory agencies face many challenges. After years of study, the Texas Board of Nursing has identified two areas for change to the current regulatory model. The first area is a recommendation that nurses obtain continuing education credit in the individual nurse's area of practice. The second area is an acknowledgment of national specialty nursing certification as one method of demonstrating continuing competency in the nurse's specialty or area of practice. Both professional and vocational/practical nurses are affected by the rule changes.

Registered nurse circulator legislation in Connecticut.

Developing regulations or legislation in every state to mandate an RN as the circulator in operating and invasive procedure rooms is critical to patient safety. Current regulatory language is ambiguous and may lead health care facility administrators to consider using licensed practical nurses, licensed vocational nurses, or surgical technologists in the circulator role. The State of Connecticut currently has no legislative or regulatory language regarding the RN as circulator, but some nurses are trying to change this. Communication with state legislators, has made it clear that legislators are in need of education about perioperative nursing and the circulator role.

Section 5(4) of the Mental Health Act 1983: the art of applying the Act.

Section 5(4) of the Mental Health Act 1983 allows patients to be detained by nurses of the 'prescribed class' for a maximum of 6 hours. There is a paucity of research on the subject of Section 5(4); however, the little research that has been conducted has shown that there are gaps in the knowledge of registered nurses and nursing students due to be registered with regard to the following areas of Section 5(4): duration of the holding power; whether the client can be treated against their will; eligibility for detention; and criteria for implementation. This article will seek to clarify these gaps and provide nurses with a comprehensive systematic guide to follow should they have to invoke the section.