Nursing: Addressing substance use in the 21st century.

Over the past two decades, there has shift from focusing on the most severe end of the substance use continuum to earlier detection of persons who are at risk given the consequences associated with alcohol and other drug use. In 2017, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) undertook the development of core competencies for specific disciplines addressing substance use in the 21st century. This article presents the core competencies for nursing in accord with the 16 standards of practice and performance for nursing. The competencies for the registered nurse and the advanced practice nurse are intended to inform and guide nursing practice with a focus on prevention, intervention, treatment, and recovery supports for persons who are affected by substance.

Integrative review of studies about nurses who have been disciplined by their professional regulatory bodies.

AIM: To synthesize knowledge in studies about nurses who had been disciplined by their professional regulatory bodies. BACKGROUND: Unprofessional conduct that violates patient safety, nursing standards or legislation can result in disciplinary action that affects nurse's professional rights to practice. However, research on disciplinary procedures in nursing is fragmented. METHODS: An integrative review was carried out with systematic searches between January 2006 and November 2018, using the CINAHL, PubMed, Scopus and Web of Science databases and manual searches. The quality of the 17 included studies was evaluated with the Mixed Method Appraisal Tool. RESULTS: The evidence in the included studies focused on various databases. Disciplined nurses were described in relation to their characteristics and disciplined because of numerous patients, practice and behaviour related violations. Similar disciplinary actions against nurses were reported. CONCLUSION: This review provides knowledge on contributory risk factors that can be used to develop professional standards and early interventions in nursing management. More systematic research is needed, together with clear definitions of disciplinary procedures. IMPLICATION FOR NURSING MANAGEMENT: This knowledge could strengthen the abilities of nurse managers to recognize and prevent events that seldom occur but seriously threaten the safety of patients and nurses when they do.

Getting Comfortable with "It Depends": Embracing the Impermanence of Scope of Practice.

Scope of practice of nursing roles is continually evolving to meet the ever-changing needs of patient populations and the healthcare system and to reflect changes in legislation, regulation and education requirements. As such, leaders must embrace the impermanence of scope of practice rather than constructing mental models, policies and practices as if the foundation will never change. Impermanence is the only constant, as the complexities within healthcare require that nurses be knowledgeable and flexible to fully leverage our individual and collective contributions to not only our patients but also our profession.

Quality of nursing schools in the Philippines: Trends and evidence from the 2010-2016 Nurse Licensure Examination results.

BACKGROUND: The quality of undergraduate nursing programs offered by higher education institutions (HEIs) in the Philippines is usually evaluated using Nurse Licensure Examination (NLE) results. PURPOSE: To describe NLE trends in 2010 to 2016, compare low- and high-performing HEIs, and examine the association of HEIs' characteristics with NLE passing rate. METHODS: NLE and HEI data were collected from two Philippine government agencies. Descriptive statistics were used to present NLE trends, while multiple linear regression was used to determine the association of HEI characteristics with NLE passing rate. DISCUSSION: There was a downward trend for NLE takers and passers from 2010 to 2016. Regression results showed that location, size, type, year of establishment, and student-faculty ratio were associated with NLE passing rate. CONCLUSION: HEIs should consider decreasing their student-faculty ratio to improve NLE performance. Relevant government agencies should take measures to improve most HEIs' NLE performance in the Philippines.

The Canadian Nurses Association: Reflections on the NCLEX-RN through the Lens of Nursing History and Evolution.

Decades of work by professional associations, regulators and educators have produced an ethical, reliable, robustly educated and regulated nursing workforce that enjoys high levels of respect in Canada and around the world. The officers of the Canadian Nurses Association comment here on the organization's history and changing role in regulatory policy over the past decade during the introduction of the American NCLEX-RN examination as the assessment tool for entry-to-practice for Canadian registered nurses. Facing forward, to maintain a strong, trusted nursing workforce the association remains committed to meaningful collaboration among nursing's professional, regulatory, education and union sectors.

Transition to NCLEX-RN: Reflections from a CASN Past President.

Each president of CASN has one "issue" on which he or she focuses most during the presidency - for me, it was the NCLEX. Canadian nursing graduates first wrote the NCLEX for entry to practice in 2015. Failure rates were significantly higher than for the previous exam - the CRNE. Although the pass rates have improved, this is likely a result of better practice for writing this type of test. Apprehensions remain about the negative impact of the Americanization of our Canadian nursing curriculum and the damage that this examination appears to be doing to present and future francophone nurses.

A Closer Look at the Introduction of the NCLEX-RN in Canada.

In 2015, the nursing faculty across most of Canada were informed by provincial nursing regulators that the America-based National Council Licensure Examination-Registered Nurse (NCLEX-RN) was going to replace the Canadian Registered Nurse Examination for our nursing students to become registered as nurses. This change in the exam has presented a number of challenges to both faculty and students as they transitioned from a Canadian exam for the Canadian context to an exam that was originally formulated for nursing registration in the United States. This manuscript examines the differences in the Canadian and American healthcare systems; explores the variations in Canadian and American nursing practice and education; outlines concerns surrounding the use of standardized testing that panders to corporate interests, encourages "teaching to the test" and is costing nursing programs and nursing students considerable resources; and explores the controversy surrounding the validity of the NCLEX-RN in both Canada and the United States. This manuscript asks Canadian nursing leaders, educators, clinicians and researchers to question why Canadians have taken on this exam when Americans themselves state that this exam "gives a false and incomplete picture of practice readiness."

The Adoption of NCLEX-RN in Canada: A Failure of Leadership at the Intersection of Nursing Regulation, Education and Practice.

This commentary presents perspectives of two senior nursing professors who have extensive faculty and leadership experience in both Canada and the United States. To understand more about how the adoption of the National Council Licensure Examination-Registered Nurses (NCLEX-RN) examination in Canada came to be, the authors conducted conversations with 29 Canadian nurse educators and nursing education and practice leaders. Based on these conversations as well as a review of published materials on the topic, the authors conclude that regulatory leaders failed to involve key leaders and stakeholders from nursing education and practice in this decision, and the resulting negative consequences have been borne primarily by the education and practice sectors. The authors argue that the NCLEX-RN adoption has introduced a misalignment into what had been a well-aligned model of education, regulation and practice in Canada and invite readers to consider the following discussion points. First, the NCLEX-RN has been designed to operate within a healthcare system that should not, by any reasonable argument, be replicated elsewhere; therefore, what are the contextual factors that led to the Canadian adoption of the NCLEX-RN? Second, American regulators stipulate that the examination must fit associate degree graduate competencies and that the additional knowledge and competencies gained at the baccalaureate level are irrelevant for licensure purposes; however, is this a fit for Canadian nursing licensure that requires the baccalaureate degree as an entry for practice? In conclusion, as American higher education in nursing now begins to move toward a competency-based model, further changes will have to be implemented to shape and frame the future of nursing education in the United States, and by extension, the future development of the NCLEX-RN within Canada's distinct historical, social, political and institutional context.

The NCLEX-RN as an Entry-to-Practice Exam in New Brunswick: The Rocky Road Story of Francophone Candidates to the Nursing Profession.

This article describes the experience of adopting the NCLEX-RN as an entry-to-practice exam among francophone baccalaureate nursing students in New Brunswick, Canada. The journey between 2012 and now has been difficult, and nursing leadership was necessary to inform key stakeholders regarding the inequities faced by francophone nursing students and to bring about change. Here is a description of the arduous work done by a group of concerned nurses (active and retired) to advocate for the rights of francophone nursing students.

Promoting Quality in Nursing Education in Canada through a Canadian Examination for Baccalaureate Nurses.

Since its creation in 1942, the Canadian Association of Schools of Nursing's mandate has been to foster high-quality nursing education in Canada in the interest of healthier Canadians. To this end, the Canadian Examination for Baccalaureate Nurses/l'examen canadien du baccalauréat en sciences infirmières (CEBN/ECBSI) has been developed and will be launched in 2020. Its purpose, what the Canadian Examination for Baccalaureate Nurses designation signifies and the development of the examination are described.

Diversity and education of the nursing workforce 2006-2016.

BACKGROUND: The Institute of Medicine (IOM) report, The Future of Nursing, included recommendations to increase nurse diversity, the percent of nurses obtaining a bachelor's degree, and inter-professional education. PURPOSE: The purpose of this paper is to report the progress toward achievement of these recommendations. METHODS: We used a longitudinal, multi-state data from four cohorts of nurses newly licensed in 2004 to 2005, 2007 to 2008, 2010 to 2011, and 2014 to 2015 to examine and compare the trends. FINDING: The percentage of males who became licensed increased, from 8.8% in 2004 to 2005 cohort to 13.6% in the 2014 to 2015 cohort. The percentage of white-non-Hispanic nurses who were licensed decreased from 78.9% in 2007 to 2008 to 73.8% in 2014 to 2015. These differences primarily reflect an increase in white-Hispanic nurses. More nurses are obtaining a bachelor's degree as their first professional degree, from 36.6% in 2004 to 2005 cohort to 48.5% in 2014 to 2015 cohort. About 40% of the 2014 to 2015 cohort reported that they learned to work in inter-professional teams. Collegial nurse-physician relations had an upward positive trajectory over time increasing almost 7%. DISCUSSION: The diversity and education of new nurses have increased, but are short of meeting the IOM recommendations.

Trends in geographic distribution of nursing staff in Japan from 2000 to 2010: a multilevel analysis.

The aim of this study was to examine trends in the geographic distribution of nursing staff in Japan from 2000 to 2010. We examined time trends in the rates of nursing staff per 100,000 population across 349 secondary health service areas. Using the Gini coefficient as a measure of inequality, we separately analyzed the data of 4 nursing staff types:public health nurses (PHN), midwives (MW), nurses (NS), and associate nurses (AN). Then, using multilevel Poisson regression models, we calculated the rate ratios (RRs) and their 95% confidence intervals (CIs) for each type of nursing staff per 1-year change. Overall, the distribution of PHN, MW, and NS improved slightly in terms of the Gini coefficient. After adjusting for prefectural capital and population density, PHN, MW, and NS significantly increased;the RRs per 1-year increment were 1.022 (95% CI:1.020-1.023), 1.021 (95% CI:1.019-1.022), and 1.037 (95% CI:1.037-1.038), respectively. In contrast, AN significantly decreased;the RR per 1-year increment was 0.993 (95% CI:0.993-0.994). Despite the considerable increase in the absolute number of nursing staff in Japan (excluding AN), this increase did not lead to a sufficient improvement in distribution over the last decade.

Changing trends in newly licensed RNs.

OBJECTIVE: Recent changes in U.S. health care and economics may influence the demand for nurses and the work choices of newly licensed RNs (NLRNs). We sought to compare the work lives of two cohorts of NLRNs licensed six years apart. METHODS: Data were collected from two groups of NLRNs in 14 states via mailed surveys. The first group consisted of a subset of NLRNs surveyed for a larger study in 2004-05; the second group was surveyed by similar methods in 2010-11. Responses were weighted to adjust for differences in response rates according to geographic area. RESULTS: Response rates were 58% and 47%, respectively, for the 2004-05 cohort (N = 774) and the 2010-11 cohort (N = 1,613). The NLRNs in the later cohort were less likely to work in hospitals, special-care units, and direct care and more likely to work as managers, be enrolled in formal education programs, and view their work environments positively, resulting in more commitment to the organization. Also, those in the later cohort reported fewer local job opportunities, and a greater number held a second job CONCLUSIONS: : These findings indicate a shift from the traditional work patterns of NLRNs, who often began their careers in hospitals. Employers' heightened awareness of such changing trends among NLRNs may help them in planning for RN recruitment and retention.