National Council of State Boards of Nursing. NCSBN's Environmental Scan COVID-19 and Its Impact on Nursing and Regulation

The Effects of the COVID-19 Pandemic on Nursing Education Programs

BACKGROUND

The U.S. Boards of Nursing (BONs) collect annual report data from their nursing programs as part of their approval process. This paper highlights the 2020 and 2021 annual report data on the effect of coronavirus disease 2019 (COVID-19) on all nursing programs in 17 BONs in 2020 and 19 in 2021.

METHOD

Nursing programs answered 16 questions on the effect of COVID-19 on their programs. Because BONs require annual report data, all programs in the participating states answered the questions, which included 798 programs in 2020 and 929 in 2021.

RESULTS

Major disruptions in nursing education occurred during the pandemic. Clinical experiences and didactic classes were greatly affected, though alternative strategies were used. Student and faculty attrition rates were particularly high in 2021.

CONCLUSION

The authors call for a national forum where nurse leaders analyze what happened and make recommendations for future crisis events. [J Nurs Educ. 2024;63(5):312-319.].

The Impact of Restricted Clinical Experiences During a Pandemic on Newly Graduated Nurses' Experiences: A Descriptive Study

A multihospital study examined the impact of restricted clinical opportunities during COVID-19 on newly graduated nurses' experiences, self-reported competence, and self-reported errors upon entry into a nurse residency program and at 6 months. Newly graduated nurses' experiences (n = 2,005) were described using comparative data from cohorts before and during restricted experiences across 22 hospitals; minimal differences were observed. Nursing professional development specialists can utilize this information when creating and sustaining transition-to-practice programs.

Improving New Graduate Nurse Retention With a Transition to Emergency Nursing Practice Program

INTRODUCTION

Emergency department turnover rates increased at Sentara Northern Virginia Medical Center. Most applicants were new graduate registered nurses. A strength, weakness, opportunity, threat analysis revealed 3 weaknesses regarding new graduate registered nurses in emergency departments. Transition to practice program was necessary, new graduate registered nurse competency needed to progress rapidly, and retention rates needed improvement.

METHODS

The emergency department registered nurse transition to practice pathway was created to address these challenges. Retention statistics were garnered through new graduate registered nurses length of employment. Improving retention rates at Sentara Northern Virginia Medical Center led to expansion of the program to the other 11 hospitals in the system. Self-report surveys were created later to evaluate the new graduate registered nursess' satisfaction with the program and perception of clinical confidence.

RESULTS

Using the emergency department registered nurse transition to practice pathway, turnover rates at Sentara Northern Virginia Medical Center dropped from 46% to 5.1%. Post expansion, the overall program retention rates were 96% at 6 months, and 86% at 1 year. The 2-year retention rate prior to COVID-19 was 82%, afterward, it dropped to 65%. Most surveyed new graduate registered nurses had a confidence level of 25% or less on the first day. After their 17-week orientation, 54% reported confidence levels had risen to 75%. Within 6 months, 81% reported 75% confidence, at 1 year, 87% reported levels between 75% and 100%, and at 2 years, 100% reported a confidence level between 75% and 100%.

DISCUSSION

This development of the emergency department registered nurse transition to practice pathway resulted in improved emergency department registered nurse retention and confidence. Savings from reduced turnover and reduced temporary labor staffing were achieved with this program. Implementation takes careful resource management, ongoing analysis, and research to validate return on investment.

Design, delivery and effectiveness of health practitioner regulation systems: an integrative review

BACKGROUND

Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions.

METHODS

We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework.

FINDINGS

This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures-processes-outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners.

CONCLUSION

We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.

Protecting the public interest while regulating health professionals providing virtual care: A scoping review

Technology is transforming service delivery in many health professions, particularly with the rapid shift to virtual care during the COVID-19 pandemic. Health profession regulators must navigate legal and ethical complexities to facilitate virtual care while upholding their mandate to protect the public interest. The objectives of this scoping review were to examine how the public interest is protected when regulating health professionals who provide virtual care, discuss policy and practice implications of virtual care, and make recommendations for future research. We searched six multidisciplinary databases for academic literature published in English between January 2015 and May 2021. We also searched specific databases and websites for relevant grey literature. After screening, 59 academic articles and 18 grey literature sources were included for analysis. We identified five key findings: the public interest when regulating health professionals providing virtual care was only implicitly considered in most of the literature; when the public interest was discussed, the dimension of access was emphasized; criticism in the literature focused on social ideologies driving regulation that may inhibit more widespread use of virtual care; subnational licensure was viewed as a barrier; and the demand for virtual care during COVID-19 catalyzed licensure and scope of practice changes. Overall, virtual care introduces new areas of risk, potential harm, and inequity that health profession regulators need to address as technology continues to evolve. Regulators have an essential role in providing clear standards and guidelines around virtual care, including what is required for competent practice. There are indications that the public interest concept is evolving in relation to virtual care as regulators continue to balance public safety, equitable access to services, and economic competitiveness.

Regulating During Crisis: A Qualitative Comparative Case Study of Nursing Regulatory Responses to the COVID-19 Pandemic

Background

The COVID-19 pandemic placed intense pressure on nursing regulatory bodies to ensure an adequate healthcare workforce while maintaining public safety.

Purpose

Our objectives were to analyze regulatory bodies’ responses during the pandemic, examine how nursing regulators conceptualize the public interest during a public health crisis, and explore the influence of a public health crisis on the balancing of regulatory principles. We aimed to develop a clearer understanding of regulating during a crisis by identifying themes within regulatory responses.

Methods

We conducted a qualitative comparative case study examining the pandemic responses of eight nursing regulators in three Canadian provinces and three U.S. states. Data were collected from semi-structured interviews with 19 representatives of nursing regulatory bodies and 206 publicly available documents and analyzed thematically.

Results

Five themes were constructed from the data: (1) risk-based responses to reduce regulatory burden; (2) agility and flexibility in regulatory pandemic responses; (3) working with stakeholders for a systems-based approach; (4) valuing consistency in regulatory approaches across jurisdictions; and (5) the pandemic as a catalyst for innovation. Specifically, we identified that the meaning of “public interest” in the context of high workforce demand was a key consideration for regulators.

Conclusion

Our results demonstrate the intensity of effort involved in nursing regulatory responses and the significant contribution of nursing regulation to the healthcare system’s pandemic response. Our results also indicate a shift in thinking around broader public interest issues, beyond the conduct and competence of individual nurses, to include pressing societal issues. Regulators are beginning to grapple with these longer-term issues and policy tensions.

A Preliminary Examination of Healthcare Facilities’ Nurse Staffing Strategies to Address COVID-19 Surges

Background

COVID-19 surge events exacerbated many healthcare facilities’ pre-existing nursing shortages. To address staff shortfalls, nurse leaders adopted a variety of strategies to supplement their workforce.

Purpose

To identify and assess the interplay between board of nursing (BON) emergency guidance and the strategies healthcare facilities adopted to bolster their nursing workforce during peak pandemic periods.

Methods

A national survey of nurse executives, as identified by the American Organization for Nursing Leadership, was conducted. Univariable and multivariable ordinal logistic regression models were used to evaluate the significance of observed trends.

Results

Half of the 391 nurse executives who completed the survey indicated that their facility needed to supplement their RN staffing during peak periods of the COVID-19 pandemic (n = 202, 51.7%). Most relied on hiring local experienced nurses (n = 111) or some combination of travel nurses (n = 61) or support workers (n = 60) to drive a median 10% increase in nurse staffing (n = 153, range 0%–100%). A large proportion of respondents also indicated their facility simply increased the work volume and hours of their current RN staff. Respondents rated retired nurses as significantly more competent relative to licensed new nurse graduates and pre-NCLEX new nurse graduates.

Conclusion

Although the small sample limits the generalizability of these findings, preliminary evidence suggests recently retired nurses and prelicensure nursing students may provide valuable support services in the event of another public health emergency.

Protecting the public interest when regulating health professionals providing virtual care: a scoping review protocol

BACKGROUND

Virtual care is transforming the nature of healthcare, particularly with the accelerated shift to telehealth and virtual care during the COVID-19 pandemic. Health profession regulators face intense pressures to safely facilitate this type of healthcare while upholding their legislative mandate to protect the public. Challenges for health profession regulators have included providing practice guidance for virtual care, changing entry-to-practice requirements to include digital competencies, facilitating interjurisdictional virtual care through licensure and liability insurance requirements, and adapting disciplinary procedures. This scoping review will examine the literature on how the public interest is protected when regulating health professionals providing virtual care.

METHODS

This review will follow the Joanna Briggs Institute (JBI) scoping review methodology. Academic and grey literature will be retrieved from health sciences, social sciences, and legal databases using a comprehensive search strategy underpinned by Population-Concept-Context (PCC) inclusion criteria. Articles published in English since January 2015 will be considered for inclusion. Two reviewers will independently screen titles and abstracts and full-text sources against specific inclusion and exclusion criteria. Discrepancies will be resolved through discussion or by a third reviewer. One research team member will extract relevant data from the selected documents and a second will validate the extractions.

DISCUSSION

Results will be presented in a descriptive synthesis that highlights implications for regulatory policy and professional practice, as well as study limitations and knowledge gaps that warrant further research. Given the rapid expansion of virtual care provision by regulated health professionals in response to the COVID-19 pandemic, mapping the literature on how the public interest is protected in this rapidly evolving digital health sector may help inform future regulatory reform and innovation.

SYSTEMATIC REVIEW REGISTRATION

This protocol is registered with the Open Science Framework ( https://doi.org/10.17605/OSF.IO/BD2ZX ).

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.

The changes in the nursing practice environment brought by COVID-19 and improvement recommendations from the nurses' perspective: a cross-sectional study

BACKGROUND

The COVID-19 pandemic has brought an opportunity to increase investment in the nursing practice environment, which has greatly impacted patients, nurses, and organizations. However, there were limited studies concerning the changes in the practice environment since the COVID-19 pandemic and the way to improve it from nurses' perspectives.

METHODS

A cross-sectional study was conducted among 460 nurses from seven hospitals in Sichuan, China. Both the quantitative and qualitative data were collected from an online questionnaire. The quantitative data were collected using the Chinese version of the Practice Environment Scale-Nursing Work Index and compared with available norms in 2010. The qualitative data were collected through an open question following the scale and analyzed by content analysis.

RESULTS

The mean of the score of the practice environment scale was 3.44 (SD = 0.56) out of 4.00. The score of the total scale and the dimensions were significantly higher than the norms, apart from nurse-physician relations and nurse participation in hospital affairs. The qualitative findings revealed positive changes in nursing foundations for quality of care, nurse participation in hospital affairs and nurse-physician relations, and poor staffing and resource adequacy. The improvement in the working model and ward environment is the primary concern of nurses.

CONCLUSIONS

The COVID-19 pandemic brought some positive changes in the nursing practice environment, but more efforts are needed to solve those nagging and important problems, such as staff shortages and low participation. Nursing managers and hospital leaders were encouraged to listen to nurses' concerns and value this suitable opportunity for changing and improving to achieve better health services and coping ability to deal with emergency events going forward. Improving the ward environment and taking a professional model instead of sticking to the tedious process might be worthwhile.

Impact of the COVID-19 Pandemic on the Future of Nursing Education

Nursing is the largest health profession, with nearly 4 million providers practicing across acute, primary, and public health care settings. In response to the pandemic, nursing schools halted on-site course delivery and redesigned programs to attenuate risks to students and faculty. Key challenges faced by schools included financial cutbacks, rapid increases in online learning technology, maintaining student academic progression, disruption to clinical learning opportunities, and meeting accreditation standards, while addressing the stress and loss experienced by faculty, staff, and students. Despite challenges, nursing organizations provided guidance for decision making, new learning resources, and faculty development opportunities. Schools of nursing leveraged their resources to redesign nursing curricula, strengthen partnerships for student clinical experiences, and address needs of the community. Nursing education will look different from its prepandemic profile in the future. Lessons learned during the pandemic point to gaps in nursing education, particularly related to disaster and public health preparedness, health equity, and technology. The American Association of Colleges of Nursing's new Essentials-standards for professional nursing education-were finalized during the pandemic and reflect these lessons. The need for nurse scientists to conduct emergency response research was made evident. The importance of strong academic-practice partnerships was highlighted for rapid communication, flexibility, and responses to dynamic environments. For the future, nursing education and practice must collaborate to ensure that students and practicing nurses are prepared to address emergencies and pandemics, as well as the needs of vulnerable populations.

Impact of COVID-19 on New Graduate Nurses' Transition to Practice: Loss or Gain?

BACKGROUND

The COVID-19 pandemic disrupted nursing education and required modification of instructional methods and clinical experiences. Given the variation in education, rapid transition to virtual platforms, and NCLEX-RN testing stressors, this cohort faced unique losses and gains influencing their transition into clinical practice.

PURPOSE

This study examined the impact of COVID-19 and preparedness for professional practice of 340 new graduate nurses (NGNs) at an academic medical center.

METHODS

This was a mixed-methods descriptive study focusing on how clinical experience loss or gains in the final semester affected the fears, concerns, and recommendations for NGNs.

RESULTS

More than half (67.5%, n = 295) of NGNs reported changes to clinical experiences, ranging from 0 to 240 hours transitioned to virtual (n = 187; median, 51; interquartile range, 24-80). NGNs fear missing important details or doing something wrong in providing patient care. They identified the need for preceptor support, guidance, teaching, and continued practice of skills.

CONCLUSION

Recommendations are clear communication with leadership, advocacy from the nurse residency program, and targeted clinical and emotional support for NGNs.