Answering the call: Experiences of nurses of color during COVID-19.

In the years following the COVID-19 pandemic, issues such as high job demands, burnout, and turnover continue to influence the nursing workforce, with heavier impacts to marginalized groups. Understanding the work and life contexts of nurses of color can help guide strategies for workplace equity and meaningful support. This qualitative study explored the experiences of nurses of color in the United States during the pandemic, focusing on feelings about the profession and job decisions. The overarching theme was "answering the call," with subthemes of "COVID shone a light," "being consumed by COVID," and "is it worth it?" Participants shared how their racial identities shaped their perceptions and job decisions in positive and negative ways, noting how racism impacted many facets of their work and added to the stressors felt in the workplace and the community. Findings provide insight into the underrepresented perspectives of nurses of color and suggest strategies to eliminate racism in nursing.

Public School Nurses in the United States: National School Nurse Workforce Study 2.0.

The National School Nurse Workforce Study 2.0 describes the demographic characteristics and distribution patterns, school nursing models and activities, and practice environment among self-reported public school nurses in the United States. A random sample of U.S. public schools was surveyed, stratified by region, school level, and urban/rural locale. A total of 2,827 schools responded, yielding a 38.1% response rate. Using these data, we estimate 78,869 full-time equivalents of school nurses, with 65,052 registered nurses (RN) and 13,817 licensed practical/vocational nurses (LPN/LVN). Findings indicate school nurse distribution differences by region, locale, and income. The predominant model of school nursing practice was the RN only, followed by the RN and LPN model. In general, school nurse respondents felt supported by school staff and parents. Less than half of survey respondents stated they were supervised by an RN. Research, policy, and school nursing practice implications are discussed.

Developing a global partnership to adapt and deliver interprofessional education faculty training in Kenya during the COVID-19 pandemic: reporting on an innovative collaboration.

Interprofessional (IP) education is imperative to foster collaboration within and between healthcare professions to improve healthcare delivery and outcomes. Increasing the capacity of health professions faculty to effectively deliver learning about IP knowledge and skills fosters sustainability of IP care in health systems. This short report describes a series of three virtual IP faculty development workshops during 2020-2021 that used a Train-the-Trainer approach and adopted flexible and context-specific teaching methods to enhance learning. The collaboration involved interprofessional researchers from the University of Washington Center for Health Sciences Interprofessional Education, Research, and Practice and Kenyan health professions faculty and was supported by a global health grant. Learners were drawn from multiple health professions and healthcare institutions in Kenya. Content was packaged in lectures, videos, pictures, and session notes. Teaching methods adopted included lecturing, discussing, playing videos, interpretation of pictures, and reading text notes. The Train-the-Trainer approach helped ensure that workshop content and plans were relevant to participants. Workshop participants shared positive feedback about the trainings and showed a good grasp of the concepts and skills. In-built feedback mechanisms in training were key in supporting the programme and ensured continuous improvement within and between sessions. This collaboration offers an innovative example of a global partnership to support IP faculty development and mainstreaming of IPE in training and in practice.

The impact of COVID-19 on school nursing: A qualitative survey of stressors faced by school nurses.

BACKGROUND: As students returned to school, school nurses were responsible for infection control, communication, and the preparation of supplies and facilities. School nurses in the Pacific Northwest US demonstrated a higher prevalence of mental health symptoms in the years since the pandemic began, suggesting that their experience may have been unique. OBJECTIVE: This study aimed to explore the stressors of school nurses in the Pacific Northwest at two time points. DESIGN: This study is a qualitative, descriptive analysis of anonymous survey responses collected in June of 2021 (n = 333) and between October and December 2021 (n = 284). SAMPLE: Self-identifying school nurses working in K-12 schools in Washington State were invited to participate. MEASUREMENTS: Participants completed open-ended survey questions designed to elicit their experiences during the pandemic. RESULTS: Four themes emerged from the data: (1) isolation from administration and the school community, (2) COVID-19-related workload, (3) disorganized and inconsistent communication, and (4) concern for students, themselves, and others. CONCLUSIONS: School nurses played a vital public health role during the pandemic. However, their effectiveness may not have been fully utilized and sometimes undermined. Lastly, our findings highlight the difficulties encountered in implementing the changing scientific and public health guidance during the pandemic.

The Resilience of Pediatric Nurses in Context: A Mixed Methods Study.

BACKGROUND: Resilience, an individual's ability to cope with and recover from stressors, is supported by contextually specific factors. Factors in the work environment may support or hinder nurses' resilience to the specific stressors present in pediatric nursing, an understudied population. OBJECTIVE: We aimed to explore the contextual factors in the work environment of pediatric nurses with varying levels of resilience, including social support, the work environment, and opportunities for coping from an individual approach. METHODS: This study is a secondary mixed-methods analysis using ordinal logistic regression and a meta-matrix of survey responses and semi-structured interview transcripts from 30 pediatric nurses. RESULTS: 5 themes, 3 supporting and 2 hindering resilience, emerged from the interviews. Nurses described their resilience as supported by sharing the burden, support from administration, and taking a break. Participants described resilience as hindered when they found it challenging to provide quality nursing care and when they felt unappreciated or undervalued. No theme significantly changed the odds of having higher resilience. CONCLUSIONS: Our findings suggest that nurses recognize resources and conditions within their work environment as influencing their resilience. However, workplace resources and conditions are only one contributor to pediatric nurse resilience. Encouraging breaks and informal opportunities for nurses to support each other may support resilience in pediatric nurses. In addition, nursing leaders can support pediatric nurse resilience by regularly spending time connecting with nurses. Finally, health care organizations should consider how changes in the work environment may hinder nurse resilience by adding stress or changing access to supportive factors.

Multilevel perspectives on school-based opportunities to improve HPV vaccination among medically underserved adolescents: Beyond school entry mandates.

School-based HPV vaccination programs have improved vaccine uptake among adolescents globally. However, school-based HPV vaccination strategies in the United States (US) have mainly focused on school-entry mandates for vaccination, which have passed in only five states/jurisdictions. Many schools and school-based health centers (SBHCs) already provide health services to medically underserved adolescents and opportunities to improve disparities in HPV vaccine education and uptake are underexplored. This qualitative study of clinic and community members assessed potential opportunities within and outside schools to increase HPV vaccination. Data were generated from a larger mixed-methods study designed to understand experiences with HPV vaccination evidence-based strategies in medically underserved communities. The parent study included interviews and focus groups conducted with clinic (providers, clinic leaders, staff) and community (racial/ethnic minority parents, advocates, payers, policy representatives) members in Los Angeles and New Jersey between December 2020-January 2022. We created a reduced dataset of text related to schools/SBHCs (30 in-depth interviews, 7 focus groups) and conducted a directed content analysis. Participants indicated that schools and SBHCs are ideal venues for reaching medically underserved adolescents experiencing barriers to primary care access. Parents/providers expressed mutual interest in HPV vaccine administration/education in schools, but some advocates/policy participants experienced challenges due to increasing politicization of vaccines. Participants highlighted policies for expanding HPV vaccine education and administration in schools, including minor consent and increasing SBHC funding for HPV vaccines. More research is needed to explore existing infrastructure, partner motivation, and opportunities to improve HPV vaccination among medically underserved adolescents within schools beyond vaccine mandates.

A Contemporary Model for Improving RN Job Outcomes.

The pandemic has highlighted three critical nursing workforce issues: turnover, wellbeing, and equity. A comprehensive framework is needed to understand the interactions between these concepts. This paper proposes a model that allows for more inclusive understanding of professional outcomes for RNs, with attention not just to job outcomes, but also to equity for underrepresented groups in the workforce and individual wellbeing. The model highlights the importance of systems and societal elements, contextual elements, and individual responses to the dynamic conditions of work and life, and can be used to advance research and practice to create effective retention and support strategies.

COVID-19 Related Job Outcomes for Nurses of Color in the United States.

The purpose of this study was to examine factors associated with negative job outcomes for nurses during the initial phase of the COVID-19 pandemic, with a focus on nurses of color. The study used data from 3,782 nurses in the Current Population Survey to examine the relationship between nurse characteristics and COVID-19-related inability to work or look for work during May through December 2020. The analysis showed that race and gender did not significantly impact nurses' job outcomes. The odds of a negative impact were increased by age (1.5% per year, p < .05), having a child in the home (43%, p < .01), having no spouse present (36%, p < .01), and working in an outpatient role (48%, p < .001). While race alone was not linked to negative outcomes, nurses of color had higher rates of other factors that were associated with negative outcomes, indicating a need for a more nuanced examination of their work and life contexts and job outcomes throughout the pandemic.

RWJF Future of Nursing Scholars experience and recommendations: Focus group results at final convening.

BACKGROUND: The Robert Wood Johnson Foundation launched the Future of Nursing Scholars program to support nurses to complete PhDs in 3 years in schools across the United States. PURPOSE: To explore why scholars participated in the program and to articulate challenges and facilitators to successful completion of their doctoral degrees. METHOD: Thirty-one scholars representing 18 different schools participated in focus groups at a convening in January 2022. FINDINGS: Scholars identified that funding and planned length of degree completion were important factors in their choosing the accelerated program. Mentorship, networking, and support were identified as facilitators to program completion with the tight timeline of three years noted as a challenge. DISCUSSION: Accelerated students require adequate resources including access to data, mentoring, and financing to overcome challenges presented by accelerated PhD training programs. Cohort models provide support and clarity of expectations for both students and mentors is critical.

"The curriculum brings equity to the forefront": Pediatric residents' perspectives and experiences in a longitudinal EDI curriculum.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements include training in caring for diverse populations and understanding social determinants of health. Our large pediatric residency program implemented a longitudinal equity, diversity and inclusion (EDI) curriculum. OBJECTIVE: To explore pediatric residents' perspectives and experiences in our longitudinal EDI curriculum. METHODS: We applied the holistic framework by Haji et al. to characterize the effect of our EDI curriculum. We conducted 4 focus groups from November 2019 to September 2020 with trained facilitators using a structured question guide. We approached all eligible senior residents (n = 87) via email to participate. Project members coded written notes and transcripts and analyzed data using inductive thematic analysis. RESULTS: 26 pediatric senior residents participated either in person (n = 13) or online (n = 13). Themes emerged from domains of knowledge, attitudes and behavioral change. These included having: (1) increased knowledge surrounding EDI issues, (2) a framework and language to better engage in EDI efforts and (3) increased confidence interrupting bias and microaggressions. Additional themes demonstrated: an increased need for EDI education at the institutional level, the unique experiences of Black, Indigenous, People of Color (BIPOC) trainees, and systemic barriers to equitable care. CONCLUSION: A longitudinal EDI curriculum has the potential to influence individual trainees, their work, and perceptions of the broader institutions in which they operate. Residents recognized and valued the curriculum and felt driven to use this knowledge to ensure that institutional policies and practices led to equitable clinical care.

School Nurses' Diabetes-Related Attitudes and Self-efficacy in Diabetes Education and Management.

This study explored relationships between school nurses' diabetes-related attitudes, self-efficacy in diabetes management and education, and care practices. One-hundred fourteen school nurses who have taken care of students with type 1 diabetes in public schools comprised this descriptive study sample. Participants completed online surveys. School nurses' diabetes-related attitudes were not related to their self-efficacy in diabetes education, but nurses' attitudes towards the psychosocial impact of diabetes were significantly related to their self-efficacy in diabetes management, and the number of students with diabetes was a significant contributor to this relationship. Nurses' full-time status and the type of school they worked in were significantly related to their self-efficacy in providing diabetes education. School nurses' positive attitudes about providing care for students with diabetes were related to having a higher level of self-efficacy in providing diabetes management. Based on the findings, recommendations are made for health consolidated schools and full-time school nurses.

The Frontline Health Care Workers in Schools: Health Equity, the Distribution of School Nurses, and Student Access.

The extent to which observed disparities in access to primary pediatric care are mirrored in student access to school nursing services is unknown. Using school employment records, we linked 1,346 nurses to school districts serving 1,141,495 students in Washington state. The percentage of students who are Black is negatively associated with the student-to-nurse ratio, while the percentage of students eligible for free-or-reduced-price lunch is positively associated, and relative to urban districts, rural districts have higher student-to-nurse ratios. Disparities in access to school nursing services mirror access gaps for pediatric care along socioeconomic status and geography. The increased number of nurses working in districts with more racial/ethnic minority students may play a protective role and ameliorate access gaps observed in pediatric primary care. States can likely use existing employment and licensing data to understand where school nurses work and therefore guide resource allocation decisions.

Using an academic-practice partnership to enhance ambulatory care nursing skills.

BACKGROUND: Ambulatory nursing services are essential to healthcare in communities, but nursing curricula often omit ambulatory care training. The purpose of this project was to enhance ambulatory care competencies among nursing students and provide ongoing education for practicing nurses through an academic-practice partnership. METHODS: A four-year externally funded project targeted enhancements to undergraduate nursing curricula and development activities. Students received didactic content and clinical experiences and were evaluated to assess critical ambulatory care nursing skills. Existing continuing education offerings were enhanced with team-based practice content. RESULTS: Despite pandemic-related clinical training changes, data from multiple quarters showed improvement in students' perceptions of self-efficacy (1.7-4.28-point increases) and actual performance (3.46-4.05-point increases) of core competencies on the 20-point evaluation scales. In addition, students rated simulations favorably, with scores ranging from 1.4 to 1.9 on the 2-point subscales. CONCLUSION: An academic-practice partnership provides mutually beneficial opportunities for enhancing the ambulatory care nursing workforce through undergraduate education and training and professional development for practicing nurses.

Supporting adolescents' mental health during COVID-19 by utilising lessons from the aftermath of the Great East Japan Earthquake.

Historical data can determine how adolescents recover from difficult situations such as the Coronavirus disease 2019 (COVID-19) pandemic. This study analysed 3 years of data obtained from high-school students who had been affected by the 2011 Great East Japan Earthquake and consequently evidenced the importance of increasing resilience among affected adolescents. This involved identifying factors contributing to resilience through a model that assessed for each tsunami disaster. This model was determined by assessing the correlation between survivors' resilience scores and their measured psychological and lifestyle scores. This approach showed that, in all tsunami damage models, resilience was most affected by the depressed emotions. Thus, our approach suggests that interventions for improving the depressed mood may improve resilience in adolescents during the COVID-19 pandemic.

A systematic review of registered nurse turnover and retention in the United States.

BACKGROUND: The pandemic has highlighted the struggles of nurses and risks of workforce shortages. Analysis of nurses' job decisions is necessary to mitigate these risks. PURPOSE: The purpose of this systematic review was to understand factors associated with registered nurse (RN) work outcomes in the United States, and to examine the inclusion of equity and wellness concepts in this body of literature. METHODS: This review utilized the Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol. Studies from PubMed and CINAHL were included if they focused on RNs in the United States in the past 10 years. A total of 34 studies are included in the review. FINDINGS: RN work outcomes are impacted by individual, unit level, and organizational factors. Few studies address equity, and many only address RN health in terms of burnout. DISCUSSION: Future work needs to draw samples from broader practice settings, focus on interventions that promote positive outcomes, and focus on equity and the wellbeing of RNs.

Can relational coordination theory be used to understand and improve interprofessional care coordination in schools? A pilot study.

Attending to the health needs of students with chronic conditions requires a fluid exchange of information and coordination between parents, educators, administrators, and school healthcare professionals. Previous research often omits school nurses in this exchange, although their role is key to successful outcomes. Relational Coordination (RC) theory posits that cohesive relationships help support communication, enabling stakeholders to coordinate their work. This article preliminarily explores whether RC domains might be relevant in school health settings, utilizing existing qualitative data. Responses from focus group sessions were analyzed using a deductive and inductive analytic approach. Data were coded using the 7 RC domains as a priori codes. Frequent, timely, and accurate communication emerged as major themes in the communication domain. Shared knowledge was a major theme within the relationship domain. Problem-solving communication, shared goals, and mutual respect were minor themes. The results suggest that improving interprofessional collaboration (IPC) and health outcomes in children with chronic conditions using RC theory-informed interventions will be important to deepen the understanding of how these different domains interact and influence student health outcomes.

A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals.

Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.

Examination of Social Determinants of Health, District Health Needs, School Nurse Caseload, and Academic Outcomes in Washington State.

The purpose of this study was to examine associations between caseload, social determinants, health needs, students meeting grade-level English and Math standards, and attendance. Data from the Washington State Open Data Portal and Report Card were combined with District Health Assessment data from 264 school districts. Analyses of variance and linear stepwise regression analyses were conducted. Key findings indicate significant differences in English and Math outcomes by caseloads, with higher caseload districts have lower percentages of students meeting English and Math standards, but not attendance. Caseload is a significant predictor of students meeting English and Math standards, after controlling for social determinants and district health needs. Findings point to the complexity of school nursing work and builds a foundation to guide future nursing research. Large prospective studies that allow for comprehensive measurement of structure, process and outcomes variables are needed to advance school nursing research.

A Realist Evaluation of Team Interventions in Acute Hospital Contexts-Use of Two Case Studies to Test Initial Programme Theories.

BACKGROUND: Designing and implementing team interventions to improve quality and safety of care in acute hospital contexts is challenging. There is little emphasis in the literature on how contextual conditions impact interventions or how specific active ingredients of interventions impact on team members' reasoning and enact change. This realist evaluation helps to deepen the understanding of the enablers and barriers for effective team interventions in these contexts. METHODS: Five previously developed initial programme theories were tested using case studies from two diverse hospital contexts. Data were collected from theory driven interviews (n = 19) in an Irish context and from previously conducted evaluative interviews (n = 16) in a US context. Data were explored to unpack the underlying social and psychological drivers that drove both intended and unintended outcomes. Patterns of regularity were identified and synthesised to develop middle-range theories (MRTs). RESULTS: Eleven MRTs demonstrate how and why intervention resources introduced in specific contextual conditions enact reasoning mechanisms and generate intended and unintended outcomes for patients, team members, the team and organisational leaders. The triggered mechanisms relate to shared mental models; openness, inclusivity and connectedness; leadership and engagement; social identity and intrinsic motivational factors. CONCLUSIONS: The findings provide valuable information for architects and facilitators of team interventions in acute hospital contexts, as well as help identify avenues for future research. Dataset: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to their sensitive nature and potential identification of participants.