NCSBN’s Environmental Scan A Portrait of Nursing and Healthcare in 2020 and Beyond

The Lived Experience of DACA Recipients Who Are US Nursing Program Graduates and Their Pathways to Professional Licensure: A Phenomenological Study

AIM

This phenomenological study explored the experiences of Deferred Action for Childhood Arrivals (DACA) recipients who are nursing program graduates in the United States and their pathways to professional licensure.

BACKGROUND

DACA is a federal program facilitating lawful employment and higher education to qualified US immigrants. Understanding the experience of DACA recipients who have become registered nurses will inform nurse educators' advocacy to create a more diverse nursing workforce.

METHOD

DACA recipients ( n = 17) who were US nursing program graduates were interviewed to explore the phenomenon of a pathway to professional licensure.

RESULTS

The pathway to professional licensure emerged within four themes: pursuing the dream, finding support, figuring it out, and advocating for others.

CONCLUSION

To contribute to a diverse nursing workforce, the authors recommend that nurse educators advocate for policies to support DACA recipients who graduate from US nursing programs to achieve professional nursing licensure.

Documentation Burden in Nursing and Its Role in Clinician Burnout Syndrome

OBJECTIVES

The purpose of this study is to understand the relationship between documentation burden and clinician burnout syndrome in nurses working in direct patient care. The Office of the National Coordinator considers documentation burden a high priority problem. However, the presence of documentation burden in nurses working in direct patient care is not well known. Furthermore, the presence of documentation burden has not been linked to the development of clinician burnout syndrome.

METHODS

This paper reports that the results of a cross-sectional survey study comprised of three tools: (1) The burden of documentation for nurses and mid-wives survey, (2) the system usability scale, and (3) Maslach's burnout inventory for medical professionals.

RESULTS

Documentation burden has a weak to moderate correlation to clinician burnout syndrome. Furthermore, poor usability of the electronic health record (EHR) is also associated with documentation burden and clinician burnout syndrome.

CONCLUSION

This study suggests that there is a relationship between documentation burden and clinician burnout syndrome. The correlation of poor usability and domains of clinician burnout syndrome implies the need for more work on improving the usability of EHR for nursing documentation. Further study regarding the presence of documentation burden and its correlation to clinician burnout syndrome should focus on specific areas of nursing to understand the drivers of documentation burden variation within and across specialty domains.

Evaluating the Costs of Nurse Burnout-Attributed Turnover: A Markov Modeling Approach

OBJECTIVE

Burnout is a public health crisis that impacts 1 in 3 registered nurses in the United States and the safe provision of patient care. This study sought to understand the cost of nurse burnout-attributed turnover using hypothetical hospital scenarios.

METHODS

A cost-consequence analysis with a Markov model structure was used to assess nurse burnout-attributed turnover costs under the following scenarios: (1) a hospital with "status quo" nurse burnout prevalence and (2) a hospital with a "burnout reduction program" and decreased nurse burnout prevalence. The model evaluated turnover costs from a hospital payer perspective and modeled a cohort of nurses who were new to a hospital. The outcome measures were defined as years in burnout among the nurse cohort and years retained/employed in the hospital. Data inputs derived from the health services literature base.

RESULTS

The expected model results demonstrated that at status quo, a hospital spends an expected $16,736 per nurse per year employed on nurse burnout-attributed turnover costs. In a hospital with a burnout reduction program, such costs were $11,592 per nurse per year employed. Nurses spent more time in burnout under the status quo scenario compared with the burnout reduction scenario (1.5 versus 1.1 y of employment) as well as less time employed at the hospital (2.9 versus 3.5 y of employment).

CONCLUSIONS

Given that status quo costs of burnout are higher than those in a hospital that invests in a nurse burnout reduction program, hospitals should strongly consider proactively supporting programs that reduce nurse burnout prevalence and associated costs.

US Nurses’ Challenges with Personal Protective Equipment during COVID-19: Interview Findings from the Frontline Workforce

This study aimed to describe nurses’ experiences with personal protective equipment while providing patient care during the first wave of the COVID-19 pandemic in the US. From May 2020 to September 2020, 100 individual interviews were conducted with nurses from diverse backgrounds and practice settings. Interviews were audio-recorded, transcribed, and verified for thematic analysis. Three key themes emerged related to personal protective equipment during COVID-19: (1) concerns with safety, (2) concerns with personal protective equipment supply, and (3) concerns with health care systems changing personal protective equipment policies. These findings support the importance of transparent and equitable institution-wide PPE standards in creating safe working environments. Clear communication around personal protective equipment policies and procedures, personal protective equipment education, and assurance of equitable access to equipment that can mitigate risk and disability while also reducing fear, confusion, and frustration among nurses. Maintaining clear and consistent personal protective equipment guidelines and communication regarding supplies and procedures enhances transparency during both routine and critical times de-escalating the inevitable strain concomitant with providing patient care during a global pandemic.

Conditions of Nursing Practice in Hospitals and Nursing Homes Before COVID-19: Implications for Policy Action

Background

The COVID-19 pandemic has stimulated interest in potential policy solutions to improve working conditions in hospitals and nursing homes. Policy action in the pandemic recovery period must be informed by pre-pandemic conditions.

Purpose

To describe registered nurses' (RNs') working conditions, job outcomes, and measures of patient safety and care quality in hospitals and nursing homes just before the pandemic.

Methods

Cross-sectional study using descriptive statistics to analyze survey data from RNs in New York and Illinois collected December 2019 through February 2020.

Results

A total of 33,462 RNs were included in the final analysis. Before the pandemic, more than 40% of RNs reported high burnout, one in four were dissatisfied with their job, and one in five planned to leave their employer within 1 year. Among nursing home RNs, one in three planned to leave their employer. RNs reported poor working conditions characterized by not having enough staff (56%), administrators who did not listen/respond to RNs' concerns (42%), frequently missed nursing care (ranging from 8% to 34% depending on the nursing task in question), work that was interrupted or delayed by insufficient staff (88%), and performing non-nursing tasks (82%). Most RNs (68%) rated care quality at their workplace as less than excellent, and 41% gave their hospital an unfavorable patient safety rating.

Conclusion

Hospitals and nursing homes were understaffed before the COVID-19 pandemic, and many RNs were dissatisfied with their employers' contribution to the widespread observed shortage of nursing care during the pandemic. Policy interventions to address understaffing include the implementation of safe nurse staffing standards and passage of the Nurse Licensure Compact to permit RNs to move expeditiously to locales with the greatest needs.

Personal Resources and Work Engagement: A Literature Review

The level of nurse work engagement affects retention, burnout, job satisfaction, patient satisfaction, and outcomes. However, there is a paucity of evidence identifying the specific personal resources that benefit nurse work engagement and mechanisms to develop personal resources. The purpose of this review was to examine which personal resources affect work engagement, reveal strategies to improve work engagement, and uncover implications for the nursing professional development practitioner. A total of 400 articles resulted from a review of the literature, with 14 studies meeting inclusion criteria. Personal resources varied. Interventions to promote the development of personal resources are described. [J Contin Educ Nurs. 2022;53(3):115-121.].

Monitoring Programs for Nurses With Substance Use Disorders: One Nurse's Journey and Recommendations

Estimates of nurses with substance use disorders (SUDs) are approximately equal to those of the general public. Historically, nurses with SUDs faced public disciplinary action for any violations of the nurse practice act in their respective states, but now many states have alternative-to-discipline (ATD) programs available. Although the consent agreement for disciplinary and non-disciplinary programs are often similar, ATD programs are, in contrast, confidential and assist nurses to safely return to practice. As a RN and person in long-term recovery, I have first-hand experience with an ATD program. I credit the program with saving my career; however, it is not without criticism. Recommendations for improvements include increased education about ATD programs, research to evaluate efficacy of mandated interventions, including nurses in recovery within shared governance of these programs, implementing true peer support with nurses in long-term recovery, defraying the costs of the program to participants, and ensuring all staff within the programs receive standardized onboarding training followed by ongoing education. [Journal of Psychosocial Nursing and Mental Health Services, 59(3), 13-17.].

Specialization Within a Specialty: Advanced Practice Psychiatric Nursing Pathways for the Greatest Good

Dr. Hildegard Peplau's theory on the primacy of the therapeutic interpersonal relationship remains central to the role of the psychiatric-mental health advanced practice nurse (PMH APN). In 1989, Peplau published her thoughts on how World War II (WWII) shaped early PMH APN practice. Following WWII and the return of hundreds of thousands of previously mentally healthy service members with combat-related psychiatric symptoms and disorders, the prevailing societal beliefs about mental illness began to shift from an innate/inherited etiological perspective to a broader appreciation of the additional contributions of social and environmental factors to mental well-being. With that awareness came a decrease in stigma and a shift from housing patients in psychiatric hospitals to treating them in community settings. The coronavirus 2019 (COVID-19) pandemic has likewise affected societal beliefs through exposure to the mental toll of massive infection rates, loss of life, social isolation, and other downstream consequences. During these times of crises, psychiatric nurses and educators are challenged to provide innovative solutions to meet the increased demands for psychosocial care. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].