Self-efficacy in nurse entrepreneurs: A concept analysis.

BACKGROUND: Nursing entrepreneurship represents an important opportunity for the nursing profession to address population health challenges and improve health care access. Although nurse entrepreneurs can be agents of change, the role of self-efficacy, as a determinant of nurses' success in business, is under-studied conceptually and in research. PURPOSE: This paper presents an in-depth concept analysis and model of self-efficacy within the context of the nurse entrepreneur role. METHODS: We used Walker and Avant's concept analysis methodology. DISCUSSION: A systematic understanding of self-efficacy in nurse entrepreneurs provides insights into how it may influence their judgments and actions. Our analysis sets the stage for research on how self-efficacy in nurse entrepreneurs impacts success in the nursing business. CONCLUSION: A conceptual model of self-efficacy in nurse entrepreneurs can guide their development through education and networking activities that incorporate experiential components to improve leadership and managerial skills for success in the health care business.

Intergenerational partnerships in nursing: lessons from a plenary session at the 2019 International Council of Nurses' Singapore Conference.

This year's International Council of Nurses' global Congress in Singapore featured a theme of strengthening collaboration and partnerships across generations. In their plenary session, the two authors of this article exemplified this theme in both the development and delivery of their session. Together, they developed a set of 'common ground' attributes of nursing policy leaders, reflecting the knowledge and experiences of two very different nursing policy leaders: one a 'Baby Boomer' nurse with almost five decades of national and global policy leadership, and the other, an early career 'Millennial' leader engaged in her first decade of global policy leadership work. Their collaboration resulted in a session featuring reflections on relevance across generations, using symbolic images and a 'Ted-talk' style presentation, and active engagement of the audience. This article speaks to both the process for developing these 'common ground' attributes, and insights and lessons learned that can help inform future collaborations across generations of nurses.

Investing in nursing and midwifery enterprise to empower women and strengthen health services and systems: An emerging global body of work.

In September of 2014, the Institute of Medicine (IOM) convened a global Rockefeller Bellagio Center workshop focusing on the largely overlooked area of investment in nursing and midwifery enterprise as a means for both empowering women and strengthening health systems and services. The report of this meeting, Empowering Women and Strengthening Health Systems and Services Through Investing in Nursing and Midwifery Enterprise: Lessons from Lower-Income Countries: Workshop Summary, was released in February, 2015. This report represents a pivotal point in a growing body of work begun in 2012, providing insights and perspectives of global experts that have resulted in subsequent global discussions and are paving the way for the future. This three-part article summarizes the initial exploration leading to the IOM workshop and report, followed by highlights and insights from the report and related meetings, and authors concluding discussion of implications for the future and next steps.

Advancing nursing enterprises: A cross-country comparison.

BACKGROUND: Health system transformations in the United States are creating new opportunities for nursing innovation, although financial sustainability has limited the expansion of nurse managed clinics. PURPOSE: We explore case studies of nursing enterprises in the developing world and discuss their potential for informing related work in the United States. METHODS: Cases were selected from the Center for Health Market Innovations. DISCUSSION: We describe a professional association network of clinics in Tanzania, a social franchise in Kenya, and a cooperative in the Philippines. All programs empowered nurses to own, lead, and advance their professional influence. They had a social mission of improving access to care for disadvantaged populations, while increasing employment and autonomy of women. They also provided a shared platform for branding, purchasing, and quality assurance. CONCLUSION: Organization sponsors in these models may be relevant to different actors in the United States. Each demonstrates the importance of a collective approach to advancing nursing enterprises.

Investing in nursing and midwifery enterprise: Empowering women and strengthening health systems--A landscaping study of innovations in low- and middle-income countries.

Women's empowerment and global health promotion are both central aims in the development agenda, with positive associations and feedback loops between empowerment and health outcomes. To date, most of the work exploring connections between health and empowerment has focused on women as health consumers. This article summarizes a much longer landscape review that examines ways in which various health programs can empower women as providers, specifically nurses and midwives. We conducted a scan of the Center for Health Market Innovations database to identify how innovative health programs can create empowerment opportunities for nurses and midwives. We reviewed 94 programs, exploring nurses' and midwives' roles and inputs that contribute to their empowerment. There were four salient models: provider training, information and communications technologies, cooperatives, and clinical franchises. By documenting these approaches and their hallmarks for empowering female health workers, we hope to stimulate greater uptake of health innovations coupled with gender-empowerment opportunities globally. The full report with expanded methodology and findings is available online.

Round Six Of Partners Investing In Nursing's Future: Implications For The Health Sector, Policy Makers, And Foundations.

In its 2011 report on the future of nursing, the Institute of Medicine issued recommendations to position nursing to meet the challenges of twenty-first-century health care. Following release of the report, the Robert Wood Johnson Foundation funded eleven local and regional partnerships of nurses, foundations, and other stakeholders to begin implementing some of the recommendations in their regions. A qualitative evaluation of these partnerships found that although not all goals were met, most of the partnerships achieved meaningful gains. Partnership participants emphasized the value of engaging foundations and other stakeholders from outside nursing in the implementation process, the necessity of funding for implementation, the need for policy makers to address constraints that local and regional partnerships by themselves cannot address, and the unique leadership and convening role that local and regional foundations can play to help their regions respond to complex challenges for the nursing profession.

Refocusing medical education reform: beyond the how.

Integration of the basic and clinical sciences has been at the heart of medical education reform efforts for nearly a century. Neither the rate nor magnitude of actual progress suggests that reform is anywhere near completion, which presents a challenge to educators to seek ways to overcome significant obstacles to change. Robin Hopkins and colleagues, authors of the Perspective in this issue of Academic Medicine that has prompted this invited Commentary, are among those proposing interesting and useful answers to why integration has not been better achieved. This Commentary affirms the importance of finding better ways to accomplish curricular reform, while contending that real curricular reform must move well beyond the integration of basic and clinical sciences. Drawing from the 2014 report of the Robert Wood Johnson Foundation's Commission to Build a Healthier America, the authors cite evidence of significant disparities and growing health challenges facing Americans today. They discuss three key recommendations from the report: attending to early childhood experiences, providing healthy choices within communities, and, particularly, rethinking the education of health professionals. Next, the authors detail the implications of these recommendations for medical education, stressing both the urgency and importance of moving to adopt these as directions for real reform that will address today's health care challenges.

Nursing and midwifery regulatory reform in east, central, and southern Africa: a survey of key stakeholders.

BACKGROUND: In sub-Saharan Africa, nurses and midwives provide expanded HIV services previously seen as the sole purview of physicians. Delegation of these functions often occurs informally by shifting or sharing of tasks and responsibilities. Normalizing these arrangements through regulatory and educational reform is crucial for the attainment of global health goals and the protection of practitioners and those whom they serve. Enacting appropriate changes in both regulation and education requires engagement of national regulatory bodies, but also key stakeholders such as government chief nursing officers (CNO), professional associations, and educators. The purpose of this research is to describe the perspectives and engagement of these stakeholders in advancing critical regulatory and educational reform in east, central, and southern Africa (ECSA). METHODS: We surveyed individuals from these three stakeholder groups with regard to task shifting and the challenges related to practice and education regulation reform. The survey used a convenience sample of nursing and midwifery leaders from countries in ECSA who convened on 28 February 2011, for a meeting of the African Health Profession Regulatory Collaborative. RESULTS: A total of 32 stakeholders from 13 ECSA countries participated in the survey. The majority (72%) reported task shifting is practiced in their countries; however only 57% reported their national regulations had been revised to incorporate additional professional roles and responsibilities. Stakeholders also reported different roles and levels of involvement with regard to nursing and midwifery regulation. The most frequently cited challenge impacting nursing and midwifery regulatory reform was the absence of capacity and resources needed to implement change. DISCUSSION: While guidelines on task shifting and recommendations on transforming health professional education exist, this study provides new evidence that countries in the ECSA region face obstacles to adapting their practice and education regulations accordingly. Stakeholders such as CNOs, nursing associations, and academicians have varied and complementary roles with regard to reforming professional practice and education regulation. CONCLUSION: This study provides information for effectively engaging leaders in regulatory reform by clarifying their roles, responsibilities, and activities regarding regulation overall as well as their specific perspectives on task shifting and pre-service reform.

Nursing and midwifery regulation and HIV scale-up: establishing a baseline in East, Central and Southern Africa.

INTRODUCTION: Shifting HIV treatment tasks from physicians to nurses and midwives is essential to scaling-up HIV services in sub-Saharan Africa. Updating nursing and midwifery regulations to include task shifting and pre-service education reform can help facilitate reaching new HIV targets. Donor-supported initiatives to update nursing and midwifery regulations are increasing. However, there are gaps in our knowledge of current practice and education regulations and a lack of information to target and implement regulation strengthening efforts. We conducted a survey of national nursing and midwifery councils to describe current nursing and midwifery regulations in 13 African countries. METHODS: A 30-item survey was administered to a convenience sample of 13 national nursing and midwifery regulatory body leaders in attendance at the PEPFAR-supported African Health Profession Regulatory Collaborative meeting in Nairobi, Kenya on 28 February, 2011. The survey contained questions on task shifting and regulations such as registration, licensure, scope of practice, pre-service education accreditation, continuing professional development and use of international guidelines. Survey data were analyzed to present country-level, comparative and regional findings. RESULTS: Task shifting to nurses and midwives was reported in 11 of the 13 countries. Eight countries updated their scope of practice within the last five years; only one reported their regulations to reflect task shifting. Countries vary with regard to licensure, pre-service accreditation and continuing professional development regulations in place. There was no consistency in terms of what standards were used to design national practice and education regulations. DISCUSSION: Many opportunities exist to assist countries to modernise regulations to incorporate important advancements from task shifting and pre-service reform. Appropriate, revised regulations can help sustain successful health workforce strategies and contribute to further scale-up HIV services and other global health priorities. CONCLUSIONS: This study provides fundamental information from which to articulate goals and to measure the impact of regulation strengthening efforts.

The Doctor of Nursing Practice: a national workforce perspective.

In 2004, the American Association of Colleges of Nursing (AACN) adopted a position statement concerning the future of advanced practice nursing education. A target date of 2015 was articulated as the point by which master's preparation for advanced practice nurses would be replaced by doctoral level education. Seismic shifts in the realities surrounding nursing education and practice have occurred since the proposal to require a Doctor of Nursing Practice (DNP) degree for entry into advanced practice nursing was proposed. Unprecedented economic challenges have resulted in significant budget downturns for all sectors, including higher education. The consequent cutbacks, furloughs, and restructuring in educational operations of all types have placed enormous demands on faculty, staff, and students across the country. In addition, the growing incidence and earlier onset of chronic disease, a rapidly aging population, health care reform agendas, a shortage of primary care practitioners, and projected severe shortages of nursing faculty have raised fundamental questions about the capacity of nursing education to produce the numbers of advanced practice nurses needed. This article addresses the changing realities and growing concerns associated with the future of advanced practice nursing. Recommendations to ensure continuing development of advanced nursing practice that serves the interests and needs of the public now and in the future are presented within the context of a national workforce perspective.

An open letter to public health nurses.

Public health nursing celebrated its 100th anniversary in 1993. In a guest editorial for Public Health Nursing Dr. Marla Salmon, then director of the Division of Nursing, Bureau of Health Professions, U. S. Department of Health and Human Services, wrote a "retrospective vision" in which she projected the roles that American public health nurses would play in 21st century health care reform. The picture she painted was highly optimistic and 16 years later the profession has yet to realize the accomplishments Salmon envisioned: a more visible leadership in directing health policy, creation of systems that expand public health department roles in both direct and indirect services, cooperation among agencies, and empowerment of the communities and individuals served by the public health care system. As she saw it, the period between 1893 and 1993 was a prelude to the coming of age of public health nursing as a specialty. She cautioned that those who practice public health nursing between 1993 and 2093 are responsible for authoring the next volume of history through their own actions. This historical reprint originally appeared in the December 1993 issue of Public Health Nursing.

Social responsibility: conceptualization and embodiment in a school of nursing.

This paper describes how a school of nursing has conceptualized and embodied social responsibility in its core values, curricular design, admission standards, clinical practice, and service learning opportunities. The school's engagement in the process of practicing social responsibility and clarifying its meaning and application has made apparent the natural linkage between social responsibility and professionalism and the deep and complex relationship between social responsibility and nursing itself. It has also revealed how a commitment to social responsibility impacts and determines for whom nurses care. Claiming social responsibility as a core value and working to refine its meaning and place has increased the school's commitment to it, concomitantly impacting education, practice, and recruitment and evaluation of faculty and students. The school views the conceptualization of social responsibility as a deepening and unfolding evolution, rather than as a formulaic understanding, and expects that its ongoing work of claiming social responsibility as a core value will continue to be enriching.

Managed migration: the Caribbean approach to addressing nursing services capacity.

OBJECTIVE: To (1) provide a contextual analysis of the Caribbean region with respect to forces shaping the current and emerging nursing workforce picture in the region; (2) discuss country-specific case(s) within the Caribbean; and (3) describe the Managed Migration Program as a potential framework for addressing regional and global nurse migration issues. PRINCIPAL FINDINGS: The Caribbean is in the midst of a crisis of shortages of nurses with an average vacancy rate of 42 percent. Low pay, poor career prospects, and lack of education opportunities are among the reasons nurses resign. Many of these nurses look outside the region for job opportunities in the United Kingdom, Canada, the United States, and other countries. Compounding the situation is the lack of resources to train nurses to fill the vacancies. The Managed Migration Program of the Caribbean is a multilateral, cross-sector, multi-interventional, long-term strategy for developing and maintaining an adequate supply of nurses for the region. CONCLUSIONS: The Managed Migration Program of the Caribbean has made progress in establishing regional support for addressing the nursing shortage crisis and developing a number of interesting initiatives such as training for export and temporary migration. Recommendations to move the Managed Migration Program of the Caribbean forward focus on advocacy, integration of the program into regional policy decisions, and integration of the program with regional health programming.

Developing a nursing database system in Kenya.

OBJECTIVE: To describe the development, initial findings, and implications of a national nursing workforce database system in Kenya. PRINCIPAL FINDINGS: Creating a national electronic nursing workforce database provides more reliable information on nurse demographics, migration patterns, and workforce capacity. Data analyses are most useful for human resources for health (HRH) planning when workforce capacity data can be linked to worksite staffing requirements. As a result of establishing this database, the Kenya Ministry of Health has improved capability to assess its nursing workforce and document important workforce trends, such as out-migration. Current data identify the United States as the leading recipient country of Kenyan nurses. The overwhelming majority of Kenyan nurses who elect to out-migrate are among Kenya's most qualified. CONCLUSIONS: The Kenya nursing database is a first step toward facilitating evidence-based decision making in HRH. This database is unique to developing countries in sub-Saharan Africa. Establishing an electronic workforce database requires long-term investment and sustained support by national and global stakeholders.

Global biological threats to health: an imperative for collaboration.

Biological threats to health are challenging governments worldwide. National strategies for preventing and managing existing and emerging threats require significant collaboration across borders, sectors, services, agencies and professions. Perhaps most important are the partnerships of key national health leaders who can develop and foster these relationships. Government Chief Nursing Officers (CNOs) and Chief Medical Officers (CMOs), providing leadership in more than 100 countries worldwide, play crucial roles in addressing biological threats to health. However, much of this leadership is exercised without the benefit of strong collaborative relationships between these two key national leaders. Unfortunately, without functional partnerships between nurses and physicians at all levels, national and global capacity to address biological and other threats will be greatly compromised. For these reasons, the first ever global forum for CNOs and CMOs teams was hosted by the Lillian Carter Center for International Nursing in Atlanta, in June 2004. Representatives from 70 countries focused on biological threats in relation to three key purposes: (1) gaining shared scientific and practical knowledge; (2) developing and strengthening collaboration and partnerships among CNOs and CMOs; and, (3) creating a joint plan for advancing national preparedness. This article describes the content, process and outcomes of this historic meeting.