US nurse practitioner voluntary turnover: Development of a framework for analysis.

BACKGROUND: There is growing interest in nurse practitioner (NP) turnover with some reports indicating it is as high as 15% annually. However, there is a lack of generalizability and other conceptual weaknesses in the literature. These weaknesses support the development of a framework to operationalize NP turnover for administrators to develop workplace initiatives to reduce turnover. PURPOSE: To describe the demographic and job characteristics of four NP voluntary turnover groups (i.e., dynamic leavers, static leavers, dynamic stayers, and static stayers) representing voluntary turnover intention and actual turnover among US NPs. METHODOLOGY: A cross-sectional, descriptive secondary analysis of NPs ( N = 86,632) from the 2018 National Sample Survey of Registered Nurses (NSSRN) was used to delineate and describe four NP voluntary turnover groups. RESULTS: Nurse practitioners who left nursing (static leavers) were older and had the most work experience. Nurse practitioners who changed jobs and stayed in nursing (dynamic leavers) were younger, less experienced, and reported the least job satisfaction. Nurse practitioners who remained in their positions (stayers) regardless of whether they reported turnover intentions or not earned the most and reported the most job satisfaction. CONCLUSIONS: Four NP voluntary turnover groups were defined and described to distinguish voluntary turnover intentions from actual turnover. IMPLICATIONS: Characterizing NP voluntary turnover can help administrators mitigate losses and project organizational needs associated with NP turnover. A framework developed from the 2018 NSSRN can be used to research and develop key initiatives to strengthen the NP workforce.

Content analysis of dissertations for examination of priority areas of nursing science.

BACKGROUND: Based on current and future research priorities to inform Ph.D. education, emerging and priority areas were developed through the Idea Festival Advisory Committee of the Council for the Advancement of Nursing Science. PURPOSE: The purpose of this study was to examine the bibliographic, methodologic, study topic characteristics, and emerging and priority areas of two randomly selected samples of nursing doctoral dissertations from the Proquest Digital Dissertations and Theses database between January 2017 and September 2018. METHODS: Using human- (N = 101) and computer-coding (N = 242), we analyzed text data using descriptive statistics and data visualization. FINDINGS: Health behavior (32.7%) and quantitative sciences (17.8%) were the most common emerging and priority areas, and translation science and -omics/microbiome were absent. Health, practice, education, and leadership were four study topic themes. DISCUSSION: This approach may serve as a metric for the state of Ph.D. nursing education. A replication study is recommended in three to five years.

Communication in Pediatric Critical Care Units: A Review of the Literature.

TOPIC: Current communication styles in pediatric critical care units do not often consider the needs of providers, patients, or family members. CLINICAL RELEVANCE: The Child Hospital Consumer Assessment of Healthcare Providers and Systems score has begun real-world testing and soon will be mandatory and tied to reimbursement. Poor communication in pediatric critical care units can lead to reduced continuity of care, escalated or unnecessary care, and poor outcomes for patients and hospitals. Improving communication in pediatric critical care units is imperative. PURPOSE OF PAPER: Extant literature was reviewed to assess communication in pediatric critical care from the provider, parent, and patient perspectives. Communication tools were also reviewed. CONTENT COVERED: Twenty-eight articles met inclusion criteria and were analyzed according to study focus (provider, parent/caregiver, patient, or tool). This review links communication to outcomes related to providers, parents, and patients. Current tools are reviewed to evaluate their effectiveness in addressing communication barriers and to guide future research in communication. Findings indicate that effective communication is challenging in intensive care units despite robust evidence that effective communication improves patient outcomes and quality metrics. Repeated and varied forms of communication, especially written reinforced with verbal communication, seem to have the strongest effect and show promising results. Common barriers nurses face on their units are identified, and solutions are suggested. This review adds to current knowledge by linking communication to measurable outcomes and examining communication barriers and needs specific to pediatric critical care populations from the provider, parent, and patient perspectives.

Predicting student attrition using social determinants: Implications for a diverse nursing workforce.

BACKGROUND: Attrition of academically qualified nursing students affects the size of the nursing workforce. A better understanding of the multifaceted predictive factors of attrition is needed to inform targeted interventions to promote program progression and maintain an adequate nursing workforce. PURPOSE: The purpose of this study was to identify demographic, academic, and social determinant factors associated with attrition at the end of the first semester in an upper-division baccalaureate nursing program. METHOD: Students' demographic and academic data from an administrative database were combined with social determinants data collected via a web-based survey. RESULTS: Among this cohort (n=164), social determinants were significantly associated with attrition. A significantly greater percentage of students who failed were born outside the United States (U.S.), had one or both parents born outside the U.S., reported English was not the primary language spoken in the home, and were racially/ethnically diverse. CONCLUSIONS: Attrition was primarily among students with diverse racial, ethnic, and/or cultural backgrounds, which has implications for achieving a diverse nursing workforce. Proactive strategies to support success should be especially targeted on diverse students.

Do Health Promotion Behaviors Affect Levels of Job Satisfaction and Job Stress for Nurses in an Acute Care Hospital?

OBJECTIVE: The aim of this study was to explore the relationships between nurse-reported health-promoting behaviors (HPBs), job stress, and job satisfaction in a hospital setting. BACKGROUND: Job stress and satisfaction are key components of the nursing work environment; however, evidence of the relationship between HPB and job stress and satisfaction is lacking. METHODS: A cross-sectional, 144-item survey was administered to nurses working in an acute care, community hospital in the southeastern United States. RESULTS: Higher levels of HPB were associated with lower job stress and higher job satisfaction. Total HPB was associated with the competence subscale of job stress. Lower job stress was significantly associated with HPB subscales: spiritual growth, interpersonal relations, and stress management. CONCLUSIONS: Nursing organizations can implement interventions that support HPB for nurses to reduce job stress and improve satisfaction.

Transforming Care to Evidence-Based Practice With Scripted Messages: An Improvement Project for Pain Management in Outpatient Surgical Patients.

BACKGROUND: Outpatient surgeries are common and most patients experience pain postoperatively requiring nursing attention to pain management. Scripting, recommended for consistent, targeted communication to improve patient satisfaction, has limited evidence to support its use. AIMS: To explore the effect of scripted messages on self-reported pain control and patient satisfaction with care in outpatient surgical patients. METHODS: A retrospective medical record review pre- and postintervention evaluated a pain management scripted message delivered at two time points (preoperatively and postoperatively). Intention to treat analysis compared patient reports of pain control and patient satisfaction with care 48 hours postdischarge from outpatient surgical procedures. RESULTS: A total of 231 records (98 preintervention; 133 postintervention) were analyzed. The sample included 144 (62%) male, 156 (68%) married with mean age of 57.6 (SD = 16.1) years. The majority (90%) received general anesthesia, and the most common surgical procedures were urologic (24%), colorectal (17%), and laparoscopy (13%). A Mann-Whitney U test indicated patient reported pain control was statistically significantly greater for the postintervention group (mean rank = 62.66) compared to the preintervention group (mean rank = 51.95), U = 1,258, p = .01 with an effect size φ = .223. LINKING EVIDENCE TO ACTION: A scripted message showed statistical significance and a small clinical effect in pain control that adds to the body of knowledge around the effectiveness of scripting delivered by nurses. Although it is encouraging that even the small dose of scripting had a significant effect on postoperative pain control, the feasibility issues around similar study designs will require considerable resources to surmount. Practice change is a complex process requiring sensitivity to work and patient flow especially in specialty care units. Resistance to change when evidence is not robust may be especially difficult related to scripting, often perceived as a mandated intrusion into the nurse-patient relationship.

Searching for Simplicity in the Complexity of Symptom Clusters.

Occam's razor proposes that the simplest solution is preferable; however, in the science of cancer and cancer symptoms, simple solutions have been elusive. Understanding individual symptoms continues to confound the science community, and symptom cluster science appears to be an incredibly complex schema of individual symptoms co-occurring and interacting with one another. The simplest explanation for symptom clusters would be a common underlying mechanism at the human genome level. Such a finding could greatly simplify and perhaps revolutionize symptom management.

Elderly cancer survivorship: an integrative review and conceptual framework.

UNLABELLED: The intersection of ageing and cancer in the phase of post-treatment survivorship represents a large and growing population with unique needs. PURPOSE: The goal of this work is to review and integrate the current gerontology and oncology literature relevant to elderly cancer survivorship, to identify knowledge gaps and research opportunities and to propose a conceptual model to guide future research. The long-term, global goal is the prevention of morbidity and mortality in elderly cancer survivors by identification of vulnerable elders, maintenance of independence, tailoring of treatment, establishing intervention guidelines and planning for necessary resources within the entire trajectory of cancer survival for older survivors. METHODS: Targeted and integrative review of selected literature from multiple disciplines. Search engines included PubMed, article reference lists and internet searches for epidemiological data (US Census, World Health Organization, American Cancer Society, Canadian Cancer Cancer Society, etc). RESULTS: A conceptual model that incorporates the gerontologic, oncologic and personal characteristics of older cancer survivors is proposed that may provide a comprehensive approach by which to frame elderly survivorship research. CONCLUSION: Cancer survivorship among the elderly is quantitatively and qualitatively different from cancer survivorship among other age groups. The current large numbers and predicted increase in elderly cancer survivors in the near future mandate attention to this population. Future research must consider the complexity of intersecting needs in the gero-oncology population.