Development and initial psychometric properties of the Research Complexity Index.

Objective: Research study complexity refers to variables that contribute to the difficulty of a clinical trial or study. This includes variables such as intervention type, design, sample, and data management. High complexity often requires more resources, advanced planning, and specialized expertise to execute studies effectively. However, there are limited instruments that scale study complexity across research designs. The purpose of this study was to develop and establish initial psychometric properties of an instrument that scales research study complexity. Methods: Technical and grammatical principles were followed to produce clear, concise items using language familiar to researchers. Items underwent face, content, and cognitive validity testing through quantitative surveys and qualitative interviews. Content validity indices were calculated, and iterative scale revision was performed. The instrument underwent pilot testing using 2 exemplar protocols, asking participants (n = 31) to score 25 items (e.g., study arms, data collection procedures). Results: The instrument (Research Complexity Index) demonstrated face, content, and cognitive validity. Item mean and standard deviation ranged from 1.0 to 2.75 (Protocol 1) and 1.31 to 2.86 (Protocol 2). Corrected item-total correlations ranged from .030 to .618. Eight elements appear to be under correlated to other elements. Cronbach's alpha was 0.586 (Protocol 1) and 0.764 (Protocol 2). Inter-rater reliability was fair (kappa = 0.338). Conclusion: Initial pilot testing demonstrates face, content, and cognitive validity, moderate internal consistency reliability and fair inter-rater reliability. Further refinement of the instrument may increase reliability thus providing a comprehensive method to assess study complexity and related resource quantification (e.g., staffing requirements).

The Impact of the Early COVID-19 Pandemic on Registered Nurses' Intent to Stay in Nursing.

The COVID-19 pandemic has been difficult for registered nurses. Media reports, most of them anecdotal, have reported upticks in nurse resignations, and plans to resign and/or leave nursing due to COVID-19. This article reports findings from an online anonymous 95-item survey completed by about 1,600 nurses from a New York City metropolitan area health system's (HS) four hospitals and ambulatory care centers about their COVID-19 experience in the spring of 2020, their intent to stay at the HS, and their intent to stay working as a nurse. Conducted early in the pandemic, this survey addresses a major gap in the literature, as there was no timely evaluation of nurses' intent to leave during the "Great Attrition" wave or to stay during the "Great Attraction" trend. Among those nurses completing the survey, 85.7% reported that they planned to work as a nurse one year later and 77.9% reported that they planned to work at the HS one year later. Those nurses who obtained a master's or doctoral degree as their first professional degree in nursing, or had a high level of mastery, were less likely to report an intent to stay at the HS. Those with no children, those who thought the HS was more supportive, and those who thought that registered nurse-medical doctor relations were higher were more likely to intend to stay at the HS. Those nurses who reported worse communication with their nurse manager were less likely to report an intent to stay in nursing. Those who reported lower stress, who were unmarried and had no children were more likely to intend to work as nurses. Our findings on nurses' intent to leave their organization and their intent to leave nursing are much lower than reports in the popular press. Our data were collected early in the pandemic and it may not reflect the accumulated stress nurses experienced from witnessing the death of so many patients.

COVID-19 and the supply and demand for Registered Nurses.

There are concerns that the future balance between the supply and demand for nurses will result in major nursing shortages around the world. Some think that nurses are leaving nursing because of the COVID-19 pandemic. In the United States, nurses may be leaving their jobs, but not nursing. Enrollments in nursing programs have increased. Nurse migration to the United States has decreased. This paper, using examples from the United States mainly, aims to explore the issue of supply of nurses and argues that it is not clear that we will have a worldwide nursing shortage going forward.

The psychosocial impact on frontline nurses of caring for patients with COVID-19 during the first wave of the pandemic in New York City.

BACKGROUND: Infectious disease pandemics, such as COVID-19, have dramatically increased in the last several decades. PURPOSE: To investigate the personal and contextual factors associated with the psychological functioning of nurses responding to COVID in the New York City area. METHOD: Cross sectional data collected via a 95-item internet-based survey sent to an email list of the 7,219 nurses employed at four hospitals. FINDINGS: 2,495 nurses responded (RR 35%). The more that nurses cared for COVID patients as well as experienced home-work conflict and work-home conflict the higher the nurses' depression and anxiety. When asked what has helped the nurses to carry out their care of patients the most common responses were support from and to co-workers, training in proper PPE, and support from family/friends. DISCUSSION: Understanding the potential triggers and vulnerability factors can inform the development of institutional resources that would help minimize their impact, reducing the risk of psychological morbidity.

Nurses' sleep, work hours, and patient care quality, and safety.

OBJECTIVES: To describe sleep duration and work characteristics among registered nurses ("nurses") across health care settings and unit types and determine the association between sleep duration and quality of care and patient safety. DESIGN: We used an observational, retrospective design. Survey data were collected from two cohorts of nurses in 2015 and 2016. SETTING: Health care and community settings across the United States, primarily acute care hospitals. PARTICIPANTS: Nurses working in a staff or general duty position (N=1,568). MEASUREMENTS: The independent variable was nurses' sleep duration before work and nonwork days. The two dependent variables were nurse reported quality of care (single item rating) and overall patient safety, measured by the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture. RESULTS: Nurses reported an average of 414 minutes, or just less than 7 hours, of sleep before a work day and 497 minutes, or just over 8 hours, before a nonwork day. Short sleep duration was statistically significantly associated with lower ratings of quality of care (p=.002) and patient safety (p=.000). CONCLUSIONS: Nurses are sleeping, on average, less than recommended amounts before work, which may be impacting their health and performance on the job. Health care managers may consider interventions to support nurses' sleep to improve patient care. Further research is warranted.

Cardiovascular Risk in Middle-Aged and Older Immigrants: Exploring Residency Period and Health Insurance Coverage.

PURPOSE: It is reported that while immigrants are, initially, healthier than the native-born upon resettlement, this advantage erodes over time. In the United States, uninsured aging immigrants are increasingly experiencing severe complications of cardiovascular disease (CVD). The purpose of this study was to compare overall CVD risk and explore the importance of health insurance coverage on CVD risk relative to other health access barriers, from 2007 to 2012, in recent and long-term immigrants >50 years of age. METHODS: This study was based on secondary cross-sectional analysis of the National Health and Nutrition Examination Survey (N = 1,920). The primary outcome, CVD risk category (high or low), was determined using the American College of Cardiology and American Heart Association Pooled Cohort equation. Differences between immigrant groups were examined using independent-samples t tests and chi-square analysis. The association between insurance and CVD risk was explored using a hierarchical block logistic regression model, in which variables were entered in a predetermined order. Changes in pseudo R2 measured whether health insurance explained variance in cardiac risk beyond other variables. RESULTS: Recent immigrants had lower overall CVD risk than long-term immigrants but were twice as likely to be uninsured and had higher serum glucose and lipid levels. Based on regression models, being uninsured contributed to CVD risk beyond other health access determinants, and CVD risk was pronounced among recent immigrants who were uninsured. CONCLUSIONS: Health insurance coverage plays an essential part in a comprehensive approach to mitigating CVD risk for aging immigrants, particularly recent immigrants whose cardiovascular health is susceptible to deterioration. CLINICAL RELEVANCE: Nurses are tasked with recognizing the unique social and physical vulnerabilities of aging immigrants and accounting for these in care plans. In addition to helping them access healthcare coverage and affordable medication, nurses and clinicians should prioritize low-cost lifestyle interventions that reduce CVD risk, especially diet and exercise programs.

A comparison of scheduling, work hours, overtime, and work preferences across four cohorts of newly licensed Registered Nurses.

AIMS: To conduct a comparative analysis of four cohorts of newly licensed Registered Nurses and their work schedule, daily shift length, weekly work hours, second job, and weekly overtime hours. Nurses also reported their preferences regarding work schedule and daily shift length. DESIGN: We used a retrospective, comparative design analysing four cross-sectional surveys from new nurses first licensed between 2004-2015. METHODS: Using state licensure lists, nurses who were first licensed between 1 August 2004 and 31 July 2005 were randomly sampled using a nested design in 23 geographical areas in 13 states and Washington, DC. The same sampling strategy was conducted for subsequent cohorts in January 2009, 2012, and 2016. We sent a mailed survey measuring demographics, education, work attributes, and attitudes to participants with a $5 incentive, following methods by Dillman. RESULTS: There were no statistically significant differences in average weekly work hours (39.4 hrs) or holding more than one job for pay (11.6-14.6% across all cohorts). There were statistically significant differences in overtime across cohorts and shift length by unit type. The preferred shift length was 12 hrs and day shift was the preferred work schedule. CONCLUSION: New nurses are predominantly scheduled for 12-hrs shifts and nearly half work weekly overtime, trends that have remained relatively stable over the past 10 years. Nurse managers, policy-makers, and researchers should pay attention to new nurses' schedule and shift preferences and guard against mandatory overtime hours.