Assessing the country-level involvement of nurses in COVID-19 vaccination campaigns: A qualitative study.

BACKGROUND: As each country individually manages the COVID-19 pandemic, mass vaccination campaigns have varied considerably. Implementation campaigns often depend on nurses; however, nurses are not consistently involved in higher-level planning, prioritization, and policy development decisions. This study aimed to examine the involvement and engagement of nurses in country-level COVID-19 mass vaccination policies and practices in 10 Office of Economic Cooperation and Development countries, identify barriers and factors to enhancing the engagement of nurses in the evidence-informed mass vaccination decision-making processes, and suggest areas for improvement. METHODS: A qualitative study using in-depth semi-structured interviews was conducted as a follow-up study to an International Council of Nurses survey. The study sample included a purposeful sample of 14 country-representative nurses from 10 Office of Economic Cooperation and Development countries. Interview questions focused on each country's overall COVID-19 vaccination campaign and policies, participants' perspectives regarding the involvement of nurses in the planning, design, and implementation of the mass vaccination program observed outcomes, and the impact of nursing on the outcomes. Interviews were recorded, transcribed, translated where necessary, coded, and thematically analyzed. RESULTS: Main areas of involvement identified by participants were membership in advising and decision-making committees, operationalization planning, implementation and coordination processes, education efforts, and nurses' interactions with the media. Seven themes emerged among perceived facilitators of nursing involvement: existing systems and infrastructure, nursing profession-related skills and competencies, communication and messaging, multidisciplinary and interagency work, recognition and visibility of nurses and nursing, trust in nurses, and nursing pride. Meanwhile, perceived barriers included lack of a voice, recognition and appreciation for nursing, workforce-related challenges, decentralization of responsibility and authority, supply and access issues, downstream effects of the pandemic, and non-COVID-related nursing barriers. Three main themes emerged among suggestions made by participants for improved involvement of nursing: culture change within nursing and healthcare, opportunities and momentum to build upon, and perceptions of responsible parties. CONCLUSIONS: Nurses play a central role in providing health services but are inconsistently included in the policy, planning, and decision-making processes. Findings highlighted the critical importance of nursing leadership roles and expanded roles for nurses. Nursing should be represented by high-level leaders as part of multidisciplinary decision-making groups, educational initiatives for involvement in health policy should be implemented in nursing schools and continuing education, and advocacy and inclusion efforts should utilize bottom-up and top-down approaches concurrently.

International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Nurses' perceptions of the role of health organisations in building professional commitment: Insights from an israeli cross-sectional study during the COVID-19 pandemic.

AIMS: To reveal the factors associated with nurses' professional commitment during the COVID-19 pandemic. BACKGROUND: During the first wave of the COVID-19 pandemic, the Nursing Division at the Israeli Ministry of Health and partners conducted a study to examine the nurses' perceptions towards a set of personal and professional circumstances that may affect their performance. METHOD: A cross-sectional Web-based study was conducted in Israel. Study' participants included 817 community and hospital nurses. The Occupational Commitment Scale for Health Professionals during pandemic (PanHP-OCS) was used to gather data. Univariate and multivariate analyses explored associations between the PanHP-OCS score and demographic and professional variables. RESULTS: About 40% of 817 respondents reported having managerial roles (n = 320). Those who received specific pandemic-focused training had significantly better PanHP-OCS scores (p < .001). Most respondents expected their organisation to provide them emotional support. Linear regression explored the organisational commitment factor as the greatest contributor to nurses' professional commitment (ß = 0.284, p < .001). CONCLUSION: To enhance the nurses' professional commitment during the COVID-19 pandemic, training and emotional support must be emphasized in all types of nurses' workplaces. IMPLICATIONS FOR NURSING MANAGEMENT: In a pandemic, health organisations must provide dedicated pandemic training, including proactive emotional support for nurses. Special attention should be given to community care.

Letters to the Editor.

This article contains Letters from the Readears.

Confidence in Health-Services Availability during Disasters and Emergency Situations-Does it Matter?-Lessons Learned from an Israeli Population Survey.

The association between health and community resilience is well established in the literature. However, maintaining continuity of healthcare services during emergencies, and their contribution in the context of community resiliency have not been sufficiently studied. This study aims to explore the relationship between the public's confidence in the availability of healthcare services during and following emergencies, and community resilience. A cross-sectional study was conducted among 3478 Israeli adults, using the Conjoint Community Resilience Assessment Measurement (CCRAM) tool. Associations between confidence in health services availability during emergencies, socio-demographic variables, and community resilience as measured by the CCRAM score were analyzed. The results revealed that confidence in the availability of health services positively correlated with community resilience score (r(3377) = 0.580, p < 0.001), and that it contributed significantly to increasing resilience (OR = 2.67, 95% CI (2.4-2.9), p < 0.001). Maintaining continuity of healthcare services during emergencies has effects beyond the provision of medical treatment. For instance, the confidence of the population in the availability of these services contributes to community resilience. In turn, this finding can be translated into practical resilience building actions and to facilitate community health.

Nursing and midwifery advocacy to lead the United Nations Sustainable Development Agenda.

The United Nations 2030 Agenda for Sustainable Development was implemented on January 1, 2016 and is composed of 17 Sustainable Development Goals (SDGs) and further delineated by 169 targets. This article offers background information on the 2030 Agenda as it relates to nursing and midwifery, professional organizational initiatives currently advancing the SDGs, the ethos of global citizenship, the urgency to respond to dwindling planetary health, the salience of nursing and midwifery advocacy in SDG attainment, and the myriad opportunities for nurses to lead and collaborate toward realizing these Global Goals. A US-based perspective is employed to underscore the Agenda's relevance to the US nursing workforce and healthcare system. The SDGs, with their holistic bio-psycho-social-environmental approach to health, present enormous opportunities for nurses and midwives. The SDG framework is naturally aligned with the foundational philosophy and purpose of our professions.

Predictors of new graduate nurses' health over the first 4 years of practice.

AIM: To examine predictors of Canadian new graduate nurses' health outcomes over 1 year. DESIGN: A time-lagged mail survey was conducted. METHOD: New graduate nurses across Canada (N = 406) responded to a mail survey at two time points: November 2012-March 2013 (Time 1) and May-July 2014 (Time 2). Multiple linear regression (mental and overall health) and logistic regression (post-traumatic stress disorder risk) analyses were conducted to assess the impact of Time 1 predictors on Time 2 health outcomes. RESULTS: Both situational and personal factors were significantly related to mental and overall health and post-traumatic stress disorder risk. Regression analysis identified that cynicism was a significant predictor of all three health outcomes, while occupational coping self-efficacy explained unique variance in mental health and work-life interference explained unique variance in post-traumatic stress disorder risk.

Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice.

AIM: To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles. BACKGROUND: Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services. METHOD: A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces. RESULTS: New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads. CONCLUSIONS: The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility.

The UN High-Level Commission on Health Employment and Economic Growth: The Opportunity for Communities and their Primary Health Systems.

Focusing on the UN High-Level Commission on Health Employment and Economic Growth, this paper examines its potential impact on primary health-care to communities. It contains a set of curated interviews with key decision-makers who are determining how health workers are trained and employed all over the world. The commentaries come from individuals who have either been or have not been directly involved in the work of the Commission, exploring the necessary actions needed in support of implementing these recommendations, highlighting the ultimate potential impact at the local level - health systems and health workers working in communities and their primary health systems. Please note that the full submissions for these individuals are contained in Appendix 1 (available at: www.longwoods.com/content/25309).

A Formative Assessment of Nurses' Leadership Role in Zambia's Community Health System.

BACKGROUND: Despite its achievements in decreasing HIV prevalence and under-five mortality, Zambia still faces high maternal and neonatal mortality, particularly in the rural and remote areas where almost 60% of the population resides. After significant investments in developing its community health system, the Zambian Ministry of Health was interested to understand how to leverage the role of nurses to sustain achievements made and further improve the quality of care in rural communities. The Ministry joined research partners in an assessment into the role and leadership capacity of nurses heading rural health facilities. METHODS: A seven-member research team conducted 30 in-depth interviews and 10 focus group discussions in four provinces with four categories of respondents: national decision-makers, provincial and district managers, rural facility staff and community respondents (neighborhood health committee members and volunteers). An initial scoping visit and literature review informed the development of specific interview guides for each category of respondent. After audio-recording and transcription, research team members identified and reached consensus on key themes, and presented and validated the findings at a national stakeholder workshop. RESULTS: Zambia's front-line health teams are a complex mixture of professional facility staff, community providers, community-based volunteers and neighborhood health committees. Nurses and nurse-midwives head over half the rural facilities in Zambia, where they are expected to lead the delivery of safe, high-quality care with staff and volunteers who often operate beyond their level of training. Nurses and midwives who are assigned to head rural facilities are not adequately prepared or recognized for the leadership responsibilities they are expected to fulfill. CONCLUSIONS: This paper highlights opportunities to support rural facility heads in effectively leading front-line health teams to deliver primary healthcare to rural communities. Front-line teams require a leader to coordinate and motivate seamless and sustainable quality services that are accessible to all. Zambia has the potential to support integrated, responsive quality care and advance toward universal health coverage if nurses are adequately prepared and recognized with job descriptions that reflect their responsibilities and opportunities for career advancement.

In Setting Global Policy, Nursing's Voice Is Needed.

It's time to reach beyond the bedside.

The role of nurses and nurse leaders on realizing the clinical, social, and economic return on investment of nursing care.

There is a limited understanding of the significance and the potential contribution that nursing can make through practice, policy, science, and profession to the global health agenda. In this article, we present some of the evidence to demonstrate the clinical, social, and economic returns on investment in nursing. We conclude by addressing the issues that nurse and system leaders need to address in order to achieve these returns on investments, and unless nurses get involved at the leadership level, these returns on investment will not be attained.

Starting Out: A time-lagged study of new graduate nurses' transition to practice.

BACKGROUND: As the nursing profession ages, new graduate nurses are an invaluable health human resource. OBJECTIVES: The purpose of this study was to investigate factors influencing new graduate nurses' successful transition to their full professional role in Canadian hospital settings and to determine predictors of job and career satisfaction and turnover intentions over a one-year time period in their early employment. DESIGN: A national two-wave survey of new graduate nurses across Canada. PARTICIPANTS: A random sample of 3906 Registered Nurses with less than 3 years of experience currently working in direct patient care was obtained from the provincial registry databases across Canada. At Time 1, 1020 of 3743 eligible nurses returned completed questionnaires (usable response rate=27.3%). One year later, Time 1 respondents were mailed a follow-up survey; 406 returned a completed questionnaire (response rate=39.8%). METHODS: Surveys containing standardized questionnaires were mailed to participants' home address. Descriptive statistics, correlations, and hierarchical linear regression analyses were conducted using SPSS software. RESULTS: Overall, new graduate nurses were positive about their experiences and committed to nursing. However, over half of new nurses in the first year of practice reported high levels of emotional exhaustion and many witnessed or experienced incivility (24-42%) at work. Findings from hierarchical linear regression analyses revealed that situational and personal factors explained significant amounts of variance in new graduate nurses' job and career satisfaction and turnover intentions. Cynicism was a significant predictor of all four outcomes one year later, while Psycap predicted job and career satisfaction and career turnover intentions. CONCLUSIONS: Results provide a look into the worklife experiences of Canadian new graduate nurses over a one-year time period and identify factors that influence their job-related outcomes. These findings show that working conditions for new graduate nurses are generally positive and stable over time, although workplace mistreatment is an issue to be addressed.

No health without a workforce, no workforce without nurses.

Judith Shamian, President of the International Council of Nurses, looks back over 2015 and considers how nurses across the world can address the challenges ahead.