RESUMO
Background: During the COVID-19 pandemic, nursing regulatory bodies (NRBs) worldwide adopted a variety of measures to bolster the nursing workforce and ensure patient safety. Purpose: To examine the plethora of actions undertaken by the global nursing community in response to the public health emergency so that NRBs can increase transparency and better prepare for future crises. Methods: In early 2021, the National Council of State Boards of Nursing developed an online survey to capture data on the global regulatory response to the COVID-19 pandemic. The survey focused on five specific domains: (a) governance, (b) telehealth practices, (c) nurse mobility, (d) prelicensure education, and (e) the disciplinary process. The instrument was translated into 11 languages before being deployed to 150 non-U.S. regulatory representatives. Frequencies and proportions were generated for all fixed-item responses, and descriptive content analyses were applied to translated open-text responses. Results: Regulators representing 27 jurisdictions provided valid responses to the survey. Most jurisdictions reported that components of nursing education were adapted in some way during the pandemic. More than half (53.8%, n = 14) of respondents indicated that changes were made to clinical and didactic curricula to ensure students graduated on time. About one-third (30.8%, n = 8) of representatives revealed that their jurisdiction had made changes to telehealth regulations, with many granting telehealth-specific nursing licenses. Most jurisdictions (88.5%, n = 23) also reported fewer or about the same number of regulatory complaints compared to before the pandemic. Conclusions: The results of this study highlight the range of actions nursing regulators worldwide adopted, which may be drawn upon to inform best practices to ensure jurisdictions are ready for the next public health emergency.
RESUMO
Background: The COVID-19 pandemic has amplified long-standing issues of burnout and stress among the U.S. nursing workforce, renewing concerns of projected staffing shortages. Understanding how these issues affect nurses' intent to leave the profession is critical to accurate workforce modeling. Purpose: To identify the personal and professional characteristics of nurses experiencing heightened workplace burnout and stress. Methods: We used a subset of data from the 2022 National Nursing Workforce Survey for analysis. Binary logistic regression models and natural language processing were used to determine the significance of observed trends. Results: Data from a total of 29,472 registered nurses (including advanced practice registered nurses) and 24,061 licensed practical nurses/licensed vocational nurses across 45 states were included in this analysis. More than half of the sample (62%) reported an increase in their workload during the COVID-19 pandemic. Similarly high proportions reported feeling emotionally drained (50.8%), used up (56.4%), fatigued (49.7%), burned out (45.1%), or at the end of their rope (29.4%) "a few times a week" or "every day." These issues were most pronounced among nurses with 10 or fewer years of experience, driving an overall 3.3% decline in the U.S. nursing workforce during the past 2 years. Conclusion: High workloads and unprecedented levels of burnout during the COVID-19 pandemic have stressed the U.S. nursing workforce, particularly younger, less experienced RNs. These factors have already resulted in high levels of turnover with the potential for further declines. Coupled with disruptions to prelicensure nursing education and comparable declines among nursing support staff, this report calls for significant policy interventions to foster a more resilient and safe U.S. nursing workforce moving forward.
RESUMO
Background: In the early stages of the COVID-19 pandemic, as clinical site restrictions were implemented, education programs leading to licensed practical nurse/licensed vocational nurse (LPN/LVN) degrees increasingly relied on virtual simulation-based experiences to provide clinical training to their students. However, scant evidence exists regarding the extent of this change and the various modalities employed by LPN/LVN programs across the United States. Purpose: We sought to identify the degree to which virtual clinical simulation was adopted by LPN/LVN education programs during the early stages of the COVID-19 pandemic to address clinical site restrictions. In addition, we hoped to identify the practices and activities that educators included under the broad umbrella definition of virtual clinical simulation. Methods: All active U.S. prelicensure LPN/LVN nursing education programs were contacted in September 2020. Program leaders were asked to estimate the proportion of clinical hours completed in virtual clinical simulation before the pandemic and the proportion anticipated for the fall 2020 term. Descriptive statistics were generated, with repeated measures analysis of covariance applied to evaluate the average change in virtual simulation within programs stratified by reported clinical restrictions. Results: Representatives from 265 LPN/LVN programs in 44 U.S. jurisdictions responded to the survey. Responding programs significantly increased the proportion of clinical hours completed in virtual clinical simulation between fall 2019 (M = 10.7, SD = 15.3) and fall 2020 (M = 35.3, SD = 27.6, p < .001). Furthermore, there was an interaction between clinical site restrictions and term, with a more pronounced uptick in virtual simulation usage among programs that indicated they found identifying clinical sites "very difficult" (M = 41.1, SD = 28.9) relative to those who found it "somewhat more difficult" (M = 23.9, SD = 18.8, p < .001). Programs adopted a range of modalities, including simply watching videos and participating in virtual or augmented reality, online software packages, or other forms of screen-based learning. Conclusion: As the adoption of virtual simulation increases, clear definitions of what constitutes clinical virtual simulation must be established. Additionally, rigorous inquiry to support evidence-based regulatory guidelines is needed.
RESUMO
Background: COVID-19 surge events exacerbated many healthcare facilities' pre-existing nursing shortages. To address staff shortfalls, nurse leaders adopted a variety of strategies to supplement their workforce. Purpose: To identify and assess the interplay between board of nursing (BON) emergency guidance and the strategies healthcare facilities adopted to bolster their nursing workforce during peak pandemic periods. Methods: A national survey of nurse executives, as identified by the American Organization for Nursing Leadership, was conducted. Univariable and multivariable ordinal logistic regression models were used to evaluate the significance of observed trends. Results: Half of the 391 nurse executives who completed the survey indicated that their facility needed to supplement their RN staffing during peak periods of the COVID-19 pandemic (n = 202, 51.7%). Most relied on hiring local experienced nurses (n = 111) or some combination of travel nurses (n = 61) or support workers (n = 60) to drive a median 10% increase in nurse staffing (n = 153, range 0%-100%). A large proportion of respondents also indicated their facility simply increased the work volume and hours of their current RN staff. Respondents rated retired nurses as significantly more competent relative to licensed new nurse graduates and pre-NCLEX new nurse graduates. Conclusion: Although the small sample limits the generalizability of these findings, preliminary evidence suggests recently retired nurses and prelicensure nursing students may provide valuable support services in the event of another public health emergency.
RESUMO
Background: The COVID-19 pandemic has had a profound impact on prelicensure nursing education, leading to widespread disruptions that may have implications for nursing students' learning and engagement outcomes. Understanding how the rapid shift to online and simulation-based teaching methods has affected new graduates' clinical preparedness is critical to ensure patient safety moving forward. Purpose: To assess the impact of institutional, academic, and demographic characteristics on prelicensure nursing students' academic, initial postgraduation, and early career outcomes during the COVID-19 pandemic. Methods: We conducted a mixed-methods longitudinal study focused on prelicensure registered nurse (RN) students entering the core of their didactic and clinical nursing coursework during the pandemic. This study uses a combination of real-time student and faculty self-report data, including externally validated instruments, within and end-of-program standardized test scores, and focus group findings. Various statistical methods, ranging from simpler descriptive and non-parametric methods to Generalized Estimating Equation (GEE) models and detailed textual analysis, are applied to assess student, faculty, and institution-level data. Results: The final sample includes more than 1,100 student and faculty participants affiliated with 51 prelicensure RN programs located across 27 states. Leveraging more than 4,000 course observations collected from fall 2020 to spring 2022 and supplemented by the rich personal narratives of over 60 focus group participants, this study illuminates the breadth, scale, and ever-evolving nature of prelicensure RN programs' efforts to maintain the continuity of nursing students' education during the public health crisis. In doing so, it captures the many ways in which nursing administrators, faculty, and students sought to address the unparalleled challenges they confronted on a day-to-day basis. In particular, the findings provide critical insights into the efficacy of the changes nursing programs made to their course delivery formats to adjust to the confluence of rapidly evolving federal, state, and private restrictions to stem the spread of COVID-19. Conclusion: This study stands as the most comprehensive assessment of prelicensure nursing education in the United States since the onset of COVID-19. It extends knowledge by linking potential deficiencies in students' didactic and clinical education during the pandemic and their early career preparedness, clinical competence, and the patient safety implications therein.
