Reliability and Validity of Measures Commonly Utilized to Assess Nurse Well-Being.

BACKGROUND: A healthy nursing workforce is vital to ensuring that patients are provided quality care. Assessing nurses' well-being and related factors requires routine evaluations from health system leaders that leverage brief psychometrically sound measures. To date, measures used to assess nurses' well-being have primarily been psychometrically tested among other clinicians or nurses working in specific clinical practice settings rather than in large, representative, heterogeneous samples of nurses. OBJECTIVES: This study aimed to psychometrically test measures frequently used to evaluate factors linked to nurse well-being in a heterogeneous sample of nurses within a large academic health system. METHODS: This cross-sectional, survey-based study used a convenience sample of nurses working across acute care practice settings. A total of 177 nurses completed the measures that included the Professional Quality of Life (proQOL), the short form of the Professional Quality of Life measure, the Connor Davidson Resiliency 2-Item (CD-RISC-2), the World Health Organization Well-being Index (WHO-5), the Secondary Traumatic Stress Scale (STSS), and the single item Mini-Z. Internal reliability and convergent validity were assessed for each measure. RESULTS: All the measures were found to be reliable. Brief measures used to assess domains of well-being demonstrated validity with longer measures, as evident by significant correlation coefficients. DISCUSSION: This study provides support for the reliability and validity of measures commonly used to assess well-being in a diverse sample of nurses working across acute care settings. Data from routine assessments of the nursing workforce hold the potential to guide the implementation and evaluation of interventions capable of promoting workplace well-being. Assessments should include psychometrically sound, low-burden measures, such as those evaluated in this study.

The nurse's role in a patient-centered approach for reducing COVID-19 vaccine hesitancy during pregnancy: An American Academy of Nursing consensus paper.

The evidence shows that COVID-19 vaccines can reduce the risks of poor pregnancy outcomes. Yet, reluctance to vaccinate remains high in pregnant populations. In this paper, we take a precision health and patient-centered approach to vaccine hesitancy. We adopted the society-to-cells vaccine hesitancy framework to identify society, community, family, individual, and physiologic factors contributing to COVID-19 vaccine hesitancy in pregnancy. Nurses are particularly well-suited to impact the factors associated with vaccine hesitancy. Because of their proximity to the patient, nurses are positioned to provide individualized, timely health information, and clinical guidelines to assist patients with decision-making related to vaccinations. Recommendations are provided to bolster nurses' engagement in precision health and patient-centered models of care to mitigate COVID-19 vaccine hesitancy in pregnancy.

Nurse Work Environment and Hospital-Onset Clostridioides difficile Infection.

BACKGROUND: Clostridioides difficile is the leading cause of hospital-onset diarrhea and is associated with increased lengths of stay and mortality. While some hospitals have successfully reduced the burden of C. difficile infection (CDI), many still struggle to reduce hospital-onset CDI. Nurses-because of their close proximity to patients-are an important resource in the prevention of hospital-onset CDI. OBJECTIVE: Determine whether there is an association between the nurse work environment and hospital-onset CDI. METHODS: Survey data of 2016 were available from 15,982 nurses employed in 353 acute care hospitals. These data, aggregated to the hospital level, provided measures of the nurse work environments. They were merged with 2016 hospital-onset CDI data from Hospital Compare, which provided our outcome measure-whether a hospital had a standardized infection ratio (SIR) above or below the national average SIR. Hospitals above the average SIR had more infections than predicted when compared to the national average. RESULTS: In all, 188 hospitals (53%) had SIRs higher than the national average. The odds of hospitals having higher than average SIRs were significantly lower, with odds ratios ranging from 0.35 to 0.45, in hospitals in the highest quartile for all four nurse work environment subscales (managerial support, nurse participation in hospital governance, physician-nurse relations, and adequate staffing) than in hospitals in the lowest quartile. CONCLUSIONS: Findings show an association between the work environment of nurses and hospital-onset CDI. A promising strategy to lower hospital-onset CDI and other infections is a serious and sustained commitment by hospital leaders to significantly improve nurse work environments.

Registered nurses: can our supply meet the demand during a disaster?

BACKGROUND: Death and destructions are often reported during natural disasters; yet little is known about how hospitals operate during disasters and if there are sufficient resources available for hospitals to provide ongoing care during these catastrophic events. The purpose of this study was to determine if the State of New Jersey had a supply of registered nurses (RNs) that was sufficient to meet the needs of hospitalized patients during a natural disaster - Hurricane Sandy. METHODS: Secondary data were used to forecast the demand and supply of New Jersey RNs during Hurricane Sandy. Data sources from November 2011 and 2012 included the State Inpatient Databases (SID), American Hospital Association (AHA) Annual Survey on hospital characteristics and staffing data from New Jersey Department of Health. Three models were used to estimate the RN shortage for each hospital, which was the difference between the demand and supply of RN full-time equivalents. RESULTS: Data were available on 66 New Jersey hospitals, more than half of which experienced a shortage of RNs during Hurricane Sandy. For hospitals with a RN shortage in ICUs, a 20% increase in observed RN supply was needed to meet the demand; and a 10% increase in observed RN supply was necessary to meet the demand for hospitals with a RN shortage in non-ICUs. CONCLUSION: Findings from this study suggest that many hospitals in New Jersey had a shortage of RNs during Hurricane Sandy. Efforts are needed to improve the availability of nurse resources during a natural disaster.

State and national data on the Georgia nursing workforce.

BACKGROUND: The enduring absence of robust nursing workforce data creates gaps to support evidence-based workforce planning and policy development. PURPOSE: The purpose of this study was to examine Georgia nursing workforce data available through state and national agencies to determine if significance differences exist among data sources. METHODS: A cross-sectional, descriptive analysis of 2017 Georgia nursing workforce data was used to examine and compare workforce characteristics available from five data sources. The advantages and limitations of each data source were reviewed. FINDINGS: Significant differences were noted in the quality and quantity of data collected on the Georgia nursing workforce as reported by state and national agencies. None of the datasets include in our analysis had comprehensive and timely data on the Georgia nursing workforce. DISCUSSION: Nursing workforce stakeholders must work collaboratively to require and implement a comprehensive re-licensure survey. It is only though a standardized national minimum dataset that we can ensure an adequate nursing workforce.

Diversity in nursing and challenges with the NCLEX-RN.

High-stakes, standardized testing has historically impeded education/career attainment for members of underrepresented minority groups and people needing testing accommodations. This study was to understand how high-stakes, standardized testing, particularly the NCLEX-RN, impacts diversity, equity, and inclusion (DEI) in nursing. This study explored the history, context, perspectives surrounding standardized testing, with a focus on the NCLEX-RN. The authors consider content, form, and delivery of testing, including accommodations. They identify available data and data collection gaps relevant to DEI and the NCLEX-RN. No nursing organization published the national data necessary to evaluate/refine the NCLEX-RN from a DEI perspective. Preliminary nursing studies and data from other professions indicated disparities in testing outcomes. Nursing must determine if prospective nurses are experiencing disparities in testing outcomes. The authors highlight opportunities to advance DEI through improved data collection, reformed licensure processes, and the reframing of standardized testing as one of many tools to determine competency.

The characteristics and practice proficiency of nurse practitioners who care for older adults.

Roughly 54 million Americans are 65 years of age or older. Given the number of comorbid diseases reported in older adults, healthcare tailored to the specific needs of this population is imperative. Nurse practitioners (NPs) are uniquely positioned to provide care to older adults; yet little is known about the geriatric-oriented NP workforce. In this study, four professional organizations distributed a survey link to their members who were queried on their demographic, employment, and practice characteristics; one organization's members responded to a previous survey, providing two time points for comparison. Compared with 2016 respondents, there was minimal growth in diversity, fewer who practice in suburban or rural areas, and restrictions on clinical education related to the ongoing pandemic. The findings from this study should alert policymakers of the need to address the development of an adequate workforce of clinicians who specialize in geriatrics.

Urosepsis in Older Adults: Epidemiologic Trends in Florida.

The incidence and geographic distribution of urosepsis, a life-threatening condition in older adults, is not well understood. The Florida State Inpatient Databases (2012-2014) showed an increase in the incidence of community-acquired urosepsis (5.37 to 6.16 per 1000), particularly among Hispanic older adults residing in low socioeconomic, urban areas with large numbers of nursing homes. These findings suggest a state policy is needed to address community-based preventative care and education for early detection of urosepsis in low-income urban areas. It is important for local health departments to partner with nursing homes to address disparities in care that disproportionally impact Hispanics.

Value of Nurse Practitioner Inpatient Hospital Staffing.

BACKGROUND: Evidence indicates hospitals with better registered nurse (RN) staffing have better patient outcomes. Whether involving more nurse practitioners (NPs) in inpatient care produces better outcomes is largely unknown. OBJECTIVE: The objective of this study was to determine whether the presence of more NPs produces better inpatient outcomes net of RN staffing. RESEARCH DESIGN: This was a 2015-2016 cross-sectional data on 579 hospitals linked from: (1) RN4CAST-US nurse surveys; (2) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient surveys; (3) surgical patient discharge abstracts; (4) Medicare Spending per Beneficiary (MSPB) reports; (5) American Hospital Association (AHA) Annual Survey. Hospitals were grouped according to their NP/beds ratios [<1 NP/100 beds (N=132), 1-2.99 NPs/100 beds (N=279), and 3+ NPs/100 beds (N=168)]. SUBJECTS: RNs randomly sampled nurses from licensure lists yielded 22,273 RNs in study hospitals; discharge data for 1.4 million surgical patients; HCAHPS data for 86% of study hospitals. MEASURES: Mortality, readmissions, lengths of stay, MSPB, patient experience, and quality reported by patients and nurses. RESULTS: After adjustments, patients in hospitals with 3+ NPs/100 beds had lower odds than patients in hospitals with <1 NP/100 beds of 30-day mortality [odds ratio (OR)2=0.76; 95% confidence interval (CI)=0.67-0.82; P<0.001] and 7-day readmissions (OR2=0.90; 95% CI=0.86-0.96; P<0.001), shorter average length of stay (incident rate ratio2=0.92; 95% CI=0.88-0.96; P<0.001) and 5.4% lower average MSPB (95% CI=3.8%-7.1%). Patients and nurses in the hospitals with higher NP/bed ratios were significantly more likely to report better care quality and safety, and nurses reported lower burnout, higher job satisfaction, greater intentions of staying in their jobs. CONCLUSIONS: Having more NPs in hospitals has favorable effects on patients, staff nurse satisfaction, and efficiency. NPs add value to existing labor resources.

The Weekend Effect in Older Adult Urosepsis Admissions.

BACKGROUND: Urosepsis is common in older adults with more infections identified as community-acquired as opposed to hospital-acquired. Despite the prevalence of urosepsis and its high mortality rates, very little is known about the care outcomes of older adult patients with community-acquired urosepsis who are admitted to the hospital on a weekend. OBJECTIVES: To determine if a weekend admission was associated with inpatient mortality in older adults admitted to an acute care hospital with a diagnosis of community-acquired urosepsis. METHODS: Data from the State Inpatient Datasets for Florida were merged with data from the American Hospital Association Annual Survey on hospital characteristics for the year 2014. Logistic regression models with a sizable number of patient and hospital controls were used to identify factors associated with inpatient mortality in patients 65 years of age and older with a primary or secondary diagnosis of community-acquired urosepsis. RESULTS: In total 21,904 older adults were admitted to a Florida hospital with a diagnosis of community-acquired urosepsis; 5736 of these patients were admitted on a weekend. In a fully adjusted logistic regression model, weekend admission was associated with a 12% increase in the odds of mortality, and each additional hour of nursing care per patient day was associated with a 2% decrease in the odds of mortality. CONCLUSIONS: Our findings suggest that weekend admission was associated with an increase in the odds of mortality in older adults with community-acquired urosepsis. Small increases in nurse staffing seem to reduce the odds of mortality.

Language equivalence of the modified falls efficacy scale (MFES) among English- and Spanish-speaking older adults: Rasch analysis.

BACKGROUND: To investigate item-level measurement properties of the Modified Falls Efficacy (MFES) Scale among English- and Spanish-speaking urban-dwelling older adults as a means to evaluate language equivalence of the tool. METHODS: Secondary analysis of survey data from 170 English (n = 83) and Spanish (n = 87) speaking older adults who reported to the emergency department of a quaternary medical center in New York City between February 2010 and August 2011. The Rasch rating scale model was used to investigate item statistics and ordering of items, item and person reliability, and model performance of the Modified Falls Efficacy Scale. RESULTS: The Modified Falls Efficacy Scale, for English- and Spanish-speakers, demonstrated acceptable fit to the Rasch model of a unidimensional measure. While the range of the construct is more limited for the Spanish group, the interval between tasks are much closer, reflecting little to no construct under-representation. CONCLUSION: There is rationale for continued testing of a unidemsional English- and Spanish-MFES among urban community-dwelling older adults. Large-scale international studies linking the unidemsional MFES to patient outcomes will support the validity of this tool for research and practice.

The relationships between coping, occupational stress, and emotional intelligence in newly hired oncology nurses.

OBJECTIVES: Associations between the varying levels of emotional intelligence in newly hired oncology nurses and their responses to stress and coping were examined. The secondary aim was to analyze whether emotional intelligence could moderate their choice of problem-focused or emotion-focused coping strategies. METHODS: Newly hired nurses (n = 114) were recruited from a national cancer institute. Data were collected through surveys using the Ways of Coping Questionnaire, the Nursing Stress Scale, and the Emotional Quotient Inventory between the eighth and twelfth weeks post-hire date. Descriptive and bivariate statistical analyses were conducted on all variables. Regression models determined whether emotional intelligence moderated the choice of coping strategies. RESULTS: Emotional intelligence had a mean value of M = 105.24, SD = 13.02, and occupational stress scores were M = 65.57, SD = 15.68. Significant negative correlations were found for occupational stress and problem-focused coping (r = -.189, P = .022), emotional intelligence and emotion-focused coping (r = -.340, P = .000), and emotional intelligence and occupational stress (r = -.428, P < 0.001). Positive correlations were noted between occupational stress and emotion-focused coping (r = .189, P = .022) and emotional intelligence and problem-focused coping (r = .340, P = .000). Emotional intelligence did not predict the choice of coping strategies. CONCLUSIONS: Although emotional intelligence did not moderate coping strategies in newly hired nurses, using problem focused coping to address occupational stress during the initial employment period may be a protective factor for coping with stress in the oncology workplace.

Nurse work environment and job-related outcomes in Brazilian hospitals.

BACKGROUND: It has been reported that a work environment that does not support nurses, and high levels of emotional exhaustion and job dissatisfaction are associated with nurses' intent to leave their job. The aim of this study was to determine if these work-related factors and job-related outcomes are common in Brazilian nurses. METHODS: This cross-sectional study included a 2015 survey of nursing professionals who worked in 48 units of three Brazilian, acute care hospitals. Descriptive statistics were used to examine the sample and a series of logistic regression models were fit to examine two job-related outcomes of interest: job dissatisfaction and intent to leave during the next 12 months. RESULTS: A total of 450 completed surveys were available, where nurses reported high emotional exhaustion (26%), job dissatisfaction (28%), and an intent to leave (12%). Poor control over the work environment (OR = 2.19) and high emotional exhaustion (OR = 4.47) were associated with an increase in the odds of job dissatisfaction. Inadequate staffing (OR = 2.43), high emotional exhaustion (OR = 2.24) and job dissatisfaction (OR = 5.74) were associated with an increase in the odds that nurses would leave their job in the next 12 months. CONCLUSION: Features of the nurse work environment and high emotional exhaustion were associated with job dissatisfaction. Job dissatisfaction and inadequate staffing are likely to result in nurses leaving their job. It is imperative that hospital administrators provide a work environment that supports nursing and improves nurse outcomes and the quality of patient care.

Emergency Department Weekend Presentation and Mortality in Patients With Acute Myocardial Infarction.

BACKGROUND: Patients admitted to acute care hospitals on weekends have poorer outcomes than those admitted on weekdays, and patients admitted to hospitals for acute myocardial infarction (AMI) on weekends have a higher mortality rate than those admitted during the week. Very few studies have examined weekend presentation for patients with AMI with respect to mortality in the emergency department (ED). OBJECTIVE: The purpose of this research was to determine if weekend and holiday presentation is associated with increased mortality in EDs among patients with AMI in New Jersey. METHODS: A retrospective cohort and three data sources representing all hospitals in New Jersey, including patients 18-90 years of age who presented to the ED with symptoms of AMI from January 1, 2008 to January 31, 2010, were used. "Weekend" was defined as Saturday and Sunday, and "holiday" was defined as one of the six major U.S. holidays. Propensity score matching with probit regression was used to estimate the unbiased treatment effect of weekend/holiday presentation on mortality in the ED. RESULTS: A total of 1,343 patients with a diagnosis of AMI presented to 73 EDs in New Jersey. Of these, 382 (28%) presented on a weekend/holiday and 961 (72%) during weekday hours. After propensity score matching and using probit regression, weekend/holiday presentation was significantly associated with mortality (b = 0.30, 95% CI [0.03, 0.57]). Other statistically significant covariates include patient age (b = 0.03, 95% CI [0.02, 0.04], hospital technology status (b = 0.75, 95% CI [0.20, 1.30]), and nurse staffing (b = -0.08, 95% CI [-0.13, -0.04]). DISCUSSION: Weekend/holiday presentation to the ED for AMI was associated with increased mortality. The effect may be related to the limited availability of resources on weekend/holidays compared to weekdays. Future studies should examine potential variations of resources, nursing workload, and education and expertise of healthcare providers in the ED during the weekend.

Improving collection and use of interprofessional health workforce data: Progress and peril.

BACKGROUND: Policymakers and other stakeholders need robust data to understand how health care system changes affect the health care workforce and the care it provides, evaluate the effectiveness of health care finance and delivery innovations, and build an adequate supply of nurses and other health professionals to care for an aging and diverse population of patients. In 2011, the Institute of Medicine released a report that called for the creation of an infrastructure to collect and analyze interprofessional health workforce data and issued specific recommendations to reach that overarching goal. PURPOSE: This paper examines progress toward each of the main data-related recommendations of the Institute of Medicine Committee on the Future of Nursing, and identifies strategies that can achieve further gains in health workforce data collection. METHODS: Multiple documents and websites were reviewed to identify the extent to which each of the Institute of Medicine's recommendations have been implemented. DISCUSSION: There has been little progress toward the Institute of Medicine recommendations regarding data collection, with a few exceptions related to improvements in national data on ambulatory care. This can largely be attributed to a lack of funding. CONCLUSION: Although there are active and strong collaborative relationships across many key stakeholders, there have not been sufficient resources dedicated to ensuring that new programs advance. More leadership, advocacy, and resources will be needed to build the robust data infrastructure called for by the Institute of Medicine.

Changes in patient and nurse outcomes associated with magnet hospital recognition.

BACKGROUND: Research has documented an association between Magnet hospitals and better outcomes for nurses and patients. However, little longitudinal evidence exists to support a causal link between Magnet recognition and outcomes. OBJECTIVE: To compare changes over time in surgical patient outcomes, nurse-reported quality, and nurse outcomes in a sample of hospitals that attained Magnet recognition between 1999 and 2007 with hospitals that remained non-Magnet. RESEARCH DESIGN: Retrospective, 2-stage panel design using 4 secondary data sources. SUBJECTS: One hundred thirty-six Pennsylvania hospitals (11 emerging Magnets and 125 non-Magnets). MEASURES: American Nurses Credentialing Center Magnet recognition; risk-adjusted rates of surgical 30-day mortality and failure-to-rescue, nurse-reported quality measures, and nurse outcomes; the Practice Environment Scale of the Nursing Work Index. METHODS: Fixed-effects difference models were used to compare changes in outcomes between emerging Magnet hospitals and hospitals that remained non-Magnet. RESULTS: Emerging Magnet hospitals demonstrated markedly greater improvements in their work environments than other hospitals. On average, the changes in 30-day surgical mortality and failure-to-rescue rates over the study period were more pronounced in emerging Magnet hospitals than in non-Magnet hospitals, by 2.4 fewer deaths per 1000 patients (P<0.01) and 6.1 fewer deaths per 1000 patients (P=0.02), respectively. Similar differences in the changes for emerging Magnet hospitals and non-Magnet hospitals were observed in nurse-reported quality of care and nurse outcomes. CONCLUSIONS: In general, Magnet recognition is associated with significant improvements over time in the quality of the work environment, and in patient and nurse outcomes that exceed those of non-Magnet hospitals.

The implications of nurse resources on cardiac care in the emergency department.

During a stay in the emergency department the treatment that cardiac patients receive can have a significant effect on health outcomes; yet, little is known about the process of care in emergency departments. In this study we examined the effect of nurse resources on the process of care in all New Jersey hospital-based emergency departments. Patient-to-nurse ratio, nurse skill mix, and Magnet accreditation were associated with aspirin on arrival and percutaneous coronary intervention within 90 minutes of arrival.

Impact of Heath Information Technology on the Quality of Patient Care.

OBJECTIVE: To examine the relationships among Electronic Health Record (EHR) adoption and adverse outcomes and satisfaction in hospitalized patients. MATERIALS AND METHODS: This secondary analysis of cross sectional data was compiled from four sources: (1) State Inpatient Database from the Healthcare Cost Utilization Project; (2) Healthcare Information and Management Systems Society (HIMSS) Dorenfest Institute; (3) Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) and (4) New Jersey nurse survey data. The final analytic sample consisted of data on 854,258 adult patients discharged from 70 New Jersey hospitals in 2006 and 7,679 nurses working in those same hospitals. The analytic approach used ordinary least squares and multiple regression models to estimate the effects of EHR adoption stage on the delivery of nursing care and patient outcomes, controlling for characteristics of patients, nurses, and hospitals. RESULTS: Advanced EHR adoption was independently associated with fewer patients with prolonged length of stay and seven-day readmissions. Advanced EHR adoption was not associated with patient satisfaction even when controlling for the strong relationships between better nursing practice environments, particularly staffing and resource adequacy, and missed nursing care and more patients reporting "Top-Box," satisfaction ratings. CONCLUSIONS: This innovative study demonstrated that advanced stages of EHR adoption show some promise in improving important patient outcomes of prolonged length of stay and hospital readmissions. Strongly evident by the relationships among better nursing work environments, better quality nursing care, and patient satisfaction is the importance of supporting the fundamentals of quality nursing care as technology is integrated into practice.