Expanding access to nurse-managed medication for opioid use disorder.

BACKGROUND: Advanced practice registered nurses (APRNs) are increasingly caring for individuals with opioid use disorder. Advances have been made to increase APRN education, outreach, and prescribing privileges, but as demand for medication for opioid use disorder (MOUD) grows, evidence suggests that policy and care barriers inhibit the ability of APRNs to support MOUD. PURPOSE: This paper highlights the significant challenges of expanding access to buprenorphine prescribing by APRNs. FINDINGS: Barriers and recommendations were derived from the culmination of literature review, expert consensus discussions among a diverse stakeholder panel including patient representatives, and feedback from community webinars with care providers. DISCUSSION: We provide an overview of existing care barriers, promising practices, and proposed recommendations to enhance the care of individuals and communities with opioid use disorder.

High-Impact Community Clinical Experiences to Promote Health and Enhance Well-Being of Older Adults.

Given the complex needs of the aging population, nurse educators must prepare future registered nurses to help older adults remain safe and healthy in their homes. This article describes partnerships between a school of nursing and low-income senior housing providers to develop new, high-impact community-based learning experiences. Baccalaureate nursing students conducted home visits in low-income senior housing communities and engaged in a research study to quantify activities conducted by students and the impact the home visits had on client personal health goal attainment.

Use of the Creighton Tool During a Home Visit Simulation Experience.

This article describes implementation of the Creighton Simulation Evaluation Instrument to evaluate student performance during a simulated home visit experience. A total of 48 groups of students participating in the simulation were evaluated by peer evaluators and faculty. Interrater reliability was found to be low to fair. Low agreement between raters may be a result of a number of factors, including enhanced faculty familiarity with the instrument and being able to identify evidence of critical thinking being displayed by the students engaged in the simulation.

A model of care for the uninsured population in Southeastern North Carolina.

BACKGROUND Cape Fear HealthNet is a unique collaborative model that was established to address coordination of care for low-income, uninsured individuals in the Lower Cape Fear Region of North Carolina. This model involves a centralized referral network to direct uninsured clients to medical homes among safety-net providers, a system for specialty referrals, and a short-term episodic or urgent care clinic (HealthNet Clinic) to address immediate or urgent health needs. METHODS We provide a descriptive analysis of patients seen in the episodic care clinic during the period August 2010 through July 2012. RESULTS Our data suggests that, compared to county population estimates, the HealthNet Clinic patients were more likely to be people of color, and a higher percentage of clinic patients had chronic diseases or lifestyle determinants of chronic diseases, such as diabetes, obesity, or smoking. Almost half of clinic patients (43.7%) required some type of laboratory or diagnostic service; less than 10% of clinic patients were referred to a specialty provider. Findings from this study can inform community collaborative efforts and planning by other safety-net providers to help leverage limited resources and increase access to care among uninsured individuals in North Carolina. LIMITATIONS Patient characteristics cannot be generalized to all uninsured individuals in the region, as there are other safety-net providers in the Lower Cape Fear region, and their clinical data were not included in this analysis. CONCLUSIONS The Cape Fear HealthNet collaborative model is successful in directing patients, many of whom have significant chronic illness burdens, to a medical home in the community safety net.

Structural empowerment and professional nursing practice behaviors of baccalaureate nursing students in clinical learning environments.

This study examines the associations between professional behaviors of baccalaureate nursing students and student perceptions of select factors within the clinical learning environment, including the role of clinical faculty leadership. Participants (n=243) were recruited from a randomly selected list of 1000 members of the National Student Nurses Association (NSNA) among sixteen states within the Southern region of the United States. Results revealed a direct relationship exists between student perceptions of structural empowerment in their clinical learning environment and professional nursing practice behaviors among students. Also found was that relationships between variables in the model are significantly strengthened by student perceptions of strong leadership behaviors of clinical faculty. Findings from this study may assist nurse educators by contributing knowledge relevant to support/facilitate the transition of individuals from student nurses to professional registered nurses and, thus enhance the impact of professional nurses' contributions in healthcare delivery.

Yesterday, today, and tomorrow: challenges in securing federal support for graduate nursing education.

The nursing shortage continues to escalate while literally thousands of qualified applicants are being turned away from nursing schools across the nation, largely because of insufficient numbers of nursing faculty. In this article, we attempt to summarize the scope of the current nursing faculty shortage, discuss the role of federal policies in contributing to and addressing the problem, and propose policy strategies for expanding the capacity of the current and future pool of nursing faculty.