Emerging roles for research intensive Ph.D. prepared nurses as leaders and innovators: Views from funders/sponsors.

Given the complexity and rapidly changing pace of 21st-century healthcare, the need for research intensive Ph.D. prepared nurses has never been greater. Philanthropic funders and sponsors of Ph.D. nursing education have important insights into how investments in Ph.D. education have direct and positive impacts on healthcare, and consequently bring important perspectives to emerging roles for Ph.D. prepared nurses. To elicit these perspectives focused questions were posed to four leading philanthropic funders/sponsors of Ph.D. nursing education: The Rita and Alex Hillman Foundation; The Robert Wood Johnson Foundation, Sigma Theta Tau- International Honor Society of Nursing, and the Jonas Nursing & Veterans Healthcare of Jonas Philanthropies. The interviews were conducted as part of a special session from the October 2019 PhD Summit "Re-Envisioning PhD Programs of the Future". A common theme that emerged from these discussions was the compelling need to prepare research intensive Ph.D. prepared nurses with advanced skills in leadership and innovation in order to leverage the larger impact of their work on health, health care and health policy. Lessons learned from the programs supported by these sponsors can be used to refine and implement future Ph.D. programs that provide the leadership and innovation skills required of research intensive Ph.D. prepared nurses.

Innovation in Health Policy Education: Examples From Jonas Policy Scholars.

In the decade since the Institute of Medicine published the Future of Nursing report, the development of a pipeline of doctorally prepared nursing leaders proficient in research, leadership, teaching, and practice has been one of great successes. The investment of Jonas Philanthropies, in collaboration with donors and foundation partners, has supported scholarships to more than 1,000 scholars nationwide. Scholars are prepared to lead health care reform in education, practice, and leadership. This article shares four examples of creative approaches to teaching health policy with students and professionals who may inspire similarly creative approaches to prepare future health policy leaders.

Transforming Primary Care for Lesbian, Gay, Bisexual, and Transgender People: A Collaborative Quality Improvement Initiative.

PURPOSE: Lesbian, gay, bisexual, and transgender (LGBT) people experience multiple disparities in access to care and health outcomes. We developed a quality improvement initiative, Transforming Primary Care for LGBT People, to enhance the capacity of federally qualified health centers (FQHCs) to provide culturally affirming care for this population. METHODS: The 1-year intervention blended the models of Practice Improvement Collaboratives and Project ECHO (Extension for Community Health Outcomes) to facilitate learning and translate knowledge into action. FQHC teams received coaching in creating LGBT-inclusive environments, collecting sexual orientation and gender identity (SOGI) data, taking risk-based sexual histories, and screening LGBT people for syphilis, chlamydia and gonorrhea, and HIV. We used a preintervention-postintervention evaluation design. RESULTS: We selected 10 FQHCs serving 441,387 patients in 123 clinical sites in 9 states. The intervention spread from 10 clinicians in 10 clinical sites to 431 clinicians in 79 clinical sites. FQHCs reported increases in culturally affirming practices, including collecting patient pronoun information (42.9% increase) and identifying LGBT patient liaisons (300.0% increase). Postintervention, among 9 FQHCs reporting SOGI data from electronic health records, SOGI documentation increased from 13.5% to 50.8% of patients (276.3% increase). Among 8 FQHCs reporting number of LGBT patients, screening of LGBT patients increased from 22.3% (95% CI, 4.9%-40.0%) to 34.6% (95% CI, 19.4%-48.6%) for syphilis (86.5% increase); from 25.3% (95% CI, 7.6%-43.1%) to 44.1% (95% CI, 30.2%-58.1%) for chlamydia and gonorrhea (109.0% increase); and from 14.8% (95% CI, 3.2%-26.5%) to 30.5% (95% CI, 26.7%-34.3%) for HIV (132.4% increase). CONCLUSIONS: FQHCs participating in this initiative reported improved capacity to provide culturally affirming care and targeted screening for LGBT patients.

The Jonas Scholars Program-Evaluation of a decade-long program to advance doctoral-prepared nurses.

BACKGROUND: The Jonas Scholars Program of Jonas Nursing & Veterans Healthcare aims to advance the pipeline of doctoral-prepared, research-focused, and practice-focused faculty via student financial support and leadership training. PURPOSE: Program evaluation of the Jonas Scholars Program. We describe the reach of the program over time, scholar characteristics, and report on graduated scholars that are currently employed in faculty and clinical positions. METHOD: Retrospective analysis of administrative records from the Jonas Scholars Program spanning 2008 to 2016. FINDINGS: The Jonas Scholars Program has grown substantially since its inception. From 2008 to 2016, a total of 1,032 doctoral students at 174 universities across the United States have received financial support through the program. Scholars have a mean age of 38 and nearly two-thirds are enrolled in a research-focused PhD program. Most graduated scholars for which data are available are primarily faculty in nursing schools 185 (30.7%), providing direct patient care 171 (28.4%), or conducting research 118 (19.8%). DISCUSSION: The Jonas Scholars Program supports the pipeline of a younger generation of doctoral-prepared nurses that are faculty in schools of nursing, providing direct patient care and conducting research.

Mentoring Nurses in Political Skill to Navigate Organizational Politics.

Objective. The aim of this study was to describe and analyze the correlations between mentoring functions and political skill development among nurses who have earned or are candidates for a Ph.D. or doctorate of nursing practice (DNP) degree. Background. The healthcare system is in flux; future generations of Ph.D. and DNP nurse leaders will be required to demonstrate political acumen. Political skill to navigate organizational politics has had limited research within nursing. Methods. A cross-sectional research design using a web-based survey of 222 nurses who have earned or are candidates for a Ph.D. or DNP. This study utilized two validated tools to measure mentoring functions and political skill. Results. The response rate was 52% (n = 115) of which 86 were Ph.D. and 29 were DNPs. An informal mentoring relationship was described by 62% of the respondents and formal mentoring by 35% of the protégés; only 25% (n = 74) established a mentoring contract. Mentoring score showed significance for total political skill and moderate effect on the networking ability. The mentoring functions of advocacy, career development facilitation, learning facilitation, and friendship were found to correlate significantly with total political skill scores. Conclusions. This study established a benefit for nurses who have earned or are candidates for a Ph.D. or DNP from mentoring to support political skill development.

Political Skill and Its Relevance to Nursing: An Integrative Review.

OBJECTIVE: The aim of this study was to conduct an integrative analysis of literature for the concept of political skill and relevance to nursing. BACKGROUND: Political skill has been extensively studied in organizational psychology for several decades but limited in the nursing literature. METHODS: Inclusion criteria were literature reviews, primary qualitative, quantitative, and mixed-methods studies written in English between 2000 and 2014, with 147 articles being identified. RESULTS: Of 147 articles, 38 met criteria by defining political skill as the ability to effectively understand others at work and to use such knowledge to influence others to act in ways that enhance personal and/or organizational goals. CONCLUSIONS: Political skill influences leadership and an individual's ability to navigate organizational politics, performance evaluation, interpersonal skills, networking ability, stress level, and social capital in the work environment.

Participant comprehension of research for which they volunteer: a systematic review.

PURPOSE: Evidence indicates that research participants often do not fully understand the studies for which they have volunteered. The aim of this systematic review was to examine the relationship between the process of obtaining informed consent for research and participant comprehension and satisfaction with the research. DESIGN: Systematic review of published research on informed consent and participant comprehension of research for which they volunteer using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement as a guide. METHODS: PubMed, Cumulative Index for Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trails, and Cochrane Database of Systematic Reviews were used to search the literature for studies meeting the following inclusion criteria: (a) published between January 1, 2006, and December 31, 2013, (b) interventional or descriptive quantitative design, (c) published in a peer-reviewed journal, (d) written in English, and (e) assessed participant comprehension or satisfaction with the research process. Studies were assessed for quality using seven indicators: sampling method, use of controls or comparison groups, response rate, description of intervention, description of outcome, statistical method, and health literacy assessment. FINDINGS: Of 176 studies identified, 27 met inclusion criteria: 13 (48%) were randomized interventional designs and 14 (52%) were descriptive. Three categories of studies included projects assessing (a) enhanced consent process or form, (b) multimedia methods, and (c) education to improve participant understanding. Most (78%) used investigator-developed tools to assess participant comprehension, did not assess participant health literacy (74%), or did not assess the readability level of the consent form (89%). Researchers found participants lacked basic understanding of research elements: randomization, placebo, risks, and therapeutic misconception. CONCLUSIONS: Findings indicate (a) inconsistent assessment of participant reading or health literacy level, (b) measurement variation associated with use of nonstandardized tools, and (c) continued therapeutic misconception and lack of understanding among research participants of randomization, placebo, benefit, and risk. While the Agency for Healthcare and Quality and National Quality Forum have published informed consent and authorization toolkits, previously published validated tools are underutilized. CLINICAL RELEVANCE: Informed consent requires the assessment of health literacy, reading level, and comprehension of research participants using validated assessment tools and methods.

Implementing colorectal cancer screening in community health centers: addressing cancer health disparities through a regional cancer collaborative.

BACKGROUND: The population served by Federally Qualified Health Centers (FQHCs) has lower levels of cancer screening compared with the general population and suffers a disproportionate cancer burden. To address these disparities, 3 federal agencies and a primary care association established and tested the feasibility of a Regional Cancer Collaborative (RCC) in 2005. METHODS: RCC faculty implemented a learning model to improve cancer screening across 4 FQHCs that met explicit organizational readiness criteria. Regional faculty trained "care process leaders," who worked with primary care teams to plan and implement practice changes. FQHCs monitored progress across the following measures of screening implementation: self-management goal-setting; number and percent screened for breast, cervical, and colorectal cancer; percent timely results notification; and percent abnormal screens evaluated within 90 days. Progress and plans were reviewed in regular teleconferences. FQHCs were encouraged to create local communities of practice (LCOP) involving community resources to support cancer screening and to participate in a monthly teleconference that linked the LCOPs into a regional community of practice. Summary reports and administrative data facilitated a process evaluation of the RCC. chi test and test of trends compared baseline and follow-up screening rates. RESULTS: The RCC taught the collaborative process using process leader training, teleconferences, 2 regional meetings, and local process improvement efforts. All organizations created clinical tracking capabilities and 3 of the 4 established LCOPs, which met monthly in an regional community of practice. Screening documentation increased for all 3 cancers from 2005 to 2007. Colorectal cancer screening increased from 8.6% to 21.2%. CONCLUSIONS: A regional plan to enable collaborative learning for cancer screening implementation is feasible, and improvements in screening rates can occur among carefully selected organizations.