Where are nurse-scientists? Academic nursing research at critical crossroads.

BACKGROUND: Academic nursing research is at a critical impasse after the great retirement and resignation during COVID-19. Sustaining and replenishing senior nurse-scientist faculty that are clinical experts with real-world clinical practice is critical. Leveraging the mission of nursing scholarship within the business of building and sustaining externally funded research enterprises in schools of nursing presents conundrums, especially with persistent nursing faculty vacancies. PURPOSE AND METHODS: Through a lens of intersectionality within the context of academic bias and nursing education regulation, we address challenges in NIH funding for nurse-scientist faculty. Publicly available data reveal equity, inclusion, and advancement issues that make it an unequal playing field for nurse-scientist faculty if expected to achieve similar NIH funding as faculty in schools of public health and medicine. DISCUSSION: Understanding research enterprises requires appreciation of the complex interplay between academic nursing units, university infrastructures, and academic budgetary models. Creative support for both nursing deans and their faculty is needed.

The nurse+engineer as the prototype V-shaped professional.

BACKGROUND: Descriptions of convergence research include promises to solve complex societal problems, such as environmental determinants of health and social determinants of health, through the integration of diverse disciplines, such as nursing and engineering, to create novel frameworks, such as the V-shaped professional. PURPOSE: The purpose of this paper was to define the nurse+engineer as a prototypical V-shaped professional. METHODS: Starting from a description of the I-shaped discipline of nursing and the I-shaped discipline of engineering, we follow an intentional pathway to define the concept of the nurse+engineer as a new V-shaped professional. FINDINGS: Examples of the nurse+engineer at the bedside and the nurse+engineer in the community are highlighted to support a theoretical definition of the V-shaped nurse+engineer. DISCUSSION: Implications of the nurse+engineer in the workforce and practical recommendations for training nurse+engineer professionals are provided to improve healthcare policy, practice, research, and education through scientific discovery and innovation.

Nursing's Wicked Problems: Partnering With Academic Leadership to Develop Solutions.

Nursing is in a challenging place, and we are facing many incredibly complex issues that are steeped in culture and tradition. These "wicked problems" often arise when organizations face constant change or unprecedented challenges. In this article, we discuss current issues that hinder all nurse leaders from elevating nursing as a profession, with a particular focus on the role and contributions of the academic nurse leader in creating and sustaining positive change. By prioritizing meaningful collaboration, reimagining education for nursing outside the hospital walls, investing in evidence for practice, and advocating by amplifying new voices, we can identify shared goals and develop coordinated plans of action. The goal of academic nursing is to work to understand wicked disciplinary problems while also analyzing and critiquing what is not working, articulating possible solutions, and collaborating with other nurse leaders to address these complex issues. This also means that academic nursing should be held equally accountable for delivering results.

Enablers and challenges to advanced nursing and midwifery practice roles.

AIM: To describe the enablers and challenges to the development and implementation of advanced nursing and midwifery practice roles in Ireland. BACKGROUND: Leadership strategies need to be put in place to enhance the development and implementation of advanced nursing and midwifery practice roles. METHOD: A descriptive qualitative approach using semi-structured interviews with key stakeholders (n = 15) was undertaken with nurses and midwives working in specialist and advanced practice roles and participants from other areas such as legislative, regulatory, policy, pharmacy, medicine and education. RESULTS: Participant's perspectives on the enablers and challenges to enacting specialist and advanced practice roles resulted in the generation of three themes: organisational factors; collegial, interprofessional and interpersonal support; and role clarity, economic and regulatory contexts. CONCLUSION: Addressing organisational factors, encouraging collegial and interprofessional support and establishing role clarity contribute to the effective development and implementation of the role of advanced practitioners. IMPLICATIONS FOR NURSING AND MIDWIFERY MANAGEMENT: Managers of nursing services need to provide leadership in developing strategies to enhance the enablers and overcome the challenges to advanced practice role development in their own organisation.

The Nurse-Engineer: A New Role to Improve Nurse Technology Interface and Patient Care Device Innovations.

PURPOSE: The purpose of this article is to describe two innovative biomedical engineering and nursing collaborations designed to educate a new cadre of professionals and develop new knowledge and innovations (robots, patient care devices, and computer simulation). ORGANIZING CONSTRUCT: Complex health problems demand a highly skilled response that uses teams of professionals from various disciplines. When the biomedical engineering lens is expanded to include the practical perspective of nursing, opportunities emerge for greater technology-nurse interface and subsequent innovation. A joint nursing-engineering degree program provides the ideal preparation for a well-informed nurse-engineer who can explore new and innovative solutions that will improve care and patient outcomes. APPROACH: A review of the literature provides the background on innovation and engineering in nursing and a rationale for the development of two innovative joint degrees, as well as a description of those programs. FINDINGS: These innovative programs will advance healthcare-related technology and maximize the potential contribution of the nursing profession in the design and implementation of creative solutions. They also have the potential to increase the skills and knowledge for students enrolled in biomedical engineering or Bachelor of Science in nursing programs individually, providing them with interdisciplinary training and exposure. CLINICAL RELEVANCE: Important patient care improvement opportunities are missed when nurses are not actively engaged in patient care device innovation and creation. Innovative nurse and engineer collaborations are needed in various forms to leverage nurse ingenuity and create patient care innovations.

The universal, collaborative and dynamic model of specialist and advanced nursing and midwifery practice: A way forward?

AIMS AND OBJECTIVES: To inform and guide the development of a future model of specialist and advanced nursing and midwifery practice. BACKGROUND: There is a sizable body of empirical literature supporting the unique contributions of specialist and advanced practice roles to health care. However, there is very little international evidence to inform the integration of a future model for advanced or specialist practice in the Irish healthcare system. DESIGN: A qualitative study was conducted to initiate this important area of inquiry. METHODS: Purposive sampling was used to generate a sample of informants (n = 15) for the interviews. Nurses and midwives working in specialist and advanced practice and participants from other areas such as legislative, regulatory, policy, medicine and education were included in the sampling frame. RESULTS: Arguments for a new model of specialist and advanced practice were voiced. A number of participants proposed that flexibility within specialist and advanced practitioner career pathways was essential. Otherwise, there existed the possibility of being directed into specialised "silos," precluding movement to another area of integrated practice. Future specialist and advanced practice education programmes need to include topics such as the development of emotional and political intelligence. CONCLUSION: The contribution of specialist and advanced practice roles to the health service includes providing rapid access to care, seamless patient flow across services, early discharge and lead coordinator of the patient's care trajectory. There was a recommendation of moving towards a universal model to cultivate specialist and advanced nurse and midwife practitioners. RELEVANCE TO CLINICAL PRACTICE: The model design has Universal application in a range of contexts "U." It is Collaborative in its inclusivity of all key stakeholders "C." The model is Dynamic pertinent to accommodating movement of nurses and midwives across health continua rather than plateauing in very specialised "silos" "D."

Career advancement and professional development in nursing.

BACKGROUND: Excellence underscores the need for nurses to keep their skills and competencies current through participation in professional development and career advancement. Evidence suggests that internationally educated nurses (IENs) progress relatively slowly through the career ladder and participate less in professional development compared with nurses educated in the United States (UENs). Mentorship and self-efficacy are considered major determinants of career advancement. PURPOSE: The aim of the study was to understand the differences in levels of mentorship function and self-efficacy as well as the differences in participation in professional development and career advancement between UENs and IENs. METHOD: A descriptive survey design was implemented using a Web-based survey. RESULTS: Significant disparities were noted in the role model function of mentoring and some professional development and career advancement measures between UENs and IENs. Mentorship is essential for professional growth. Sociodemographic characteristics of mentors are important because mentors are role models. CONCLUSION: Standardized career advancement structures are needed to promote professional growth.

Transdisciplinary teamwork simulation in obstetrics-gynecology health care education.

This program evaluation was designed to assess whether a transdisciplinary teamwork simulation experience improves collaborative attitudes among women's health students toward the goals of reducing medical errors and improving patient outcomes. This program evaluation used a pretest-posttest comparative design to measure changes in collaborative attitudes among 35 multidisciplinary women's health students before and after a transdisciplinary simulation experience. Collaborative attitudes were measured by the Team Attitudes Questionnaire. Data analysis consisted of descriptive analysis, paired t tests, and post hoc item analysis. Findings suggest significant increases in collaborative attitudes for mutual support and communication but no significant increases in attitudes for structure, situation monitoring, or leadership from pretest to posttest. Trans-disciplinary simulation experiences among women's health students may enhance mutual support and communication and promote better patient outcomes. Future research should focus on mechanisms to facilitate improvements in structure, situation monitoring, and leadership.

Support Methods for Healthcare Professionals Who Are Second Victims: An Integrative Review.

A second victim is a healthcare provider who has been involved in a critical event. A critical event is a clinical situation in which an unforeseen clinical outcome occurs, or the clinical deterioration of the patient takes place for many different reasons. The patient and his/her family are the first victims. The healthcare provider(s) involved in the event are second victims. After such an event, the healthcare provider may experience a constellation of negative emotions, such as guilt, sadness, depression, somatic symptoms, hypervigilance, and fear. Most second victims require support to cope with the adverse clinical situation. Many of the studies addressed in this integrative review, revealed that having a trusted colleague or staff member with whom to discuss the critical event is therapeutic. Some organizations have developed programs to support second victims in which specially trained staff members are deployed to discuss critical events with those involved, if the participant(s) desire the support. Other clinical facilities do not have established support programs; however, healthcare providers have expressed desire to discuss the critical event with supportive colleagues.

Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care.

Background: Despite representing the largest occupational group within the healthcare workforce, evidence suggests that due to the complexity of nursing practice, nurses' contribution remains 'invisible'. Quality Care Metrics aligned to standards can offer valuable numerical information that quantify input, output and dimensions of nursing care processes in complex clinical and interprofessional milieus. Aims and objectives: Progress an evidence-based metric system to measure the quality and clinical safety of nursing care within acute care in Ireland. The objectives were to: classify quality care process nursing metrics and corresponding indicators pertinent to acute care; reach agreement on a selected set of robust metrics and corresponding indicators; and implement the findings of the study. Design: A modified four-round Delphi study. Methods: The modified Delphi study integrated a four-round survey of 422 nurses, face-to-face meetings with a patient representative and key stakeholders within acute services with a final consensus meeting inclusive of a panel of 26 expert nurse clinicians. Results: There was consensus on 11 quality care process nursing metrics and 53 corresponding indicators for the acute care setting. Despite the rating of 'critical' in the Delphi rounds, a concern was reported by participants on the subjective nature of three of the developed metrics: 'patient experience', 'patient engagement' and 'professional and ethical approach to care' based on the absence of objective measurement tools that include patient input. Conversely, this led to the conundrum for the panel of experts at the final consensus meeting who were divided in their views on objectively observing, recording and subsequent auditing of those three developed metrics in real-time clinical practice. Conclusion: This paper describes the operationalisation of a modified Delphi technique that progressed a set of 11 quality care process metrics and 53 corresponding indicators. The challenge now is the implementation of these quality care process metrics so that nurses' contribution to patient-centred care is tangible in acute care.

Innovative nursing educational curriculum for the 21st century.

The changing landscape of health care in America requires that clinicians be skilled in responding to varying patient expectations and values; provide ongoing patient management; deliver and coordinate care across teams, settings, and time frames; and support patients' endeavors to change behavior and lifestyle--education that is in short supply in today's academic and clinical settings (Institute of Medicine, 2003). Nursing education needs to innovate at the micro and macro system levels for the 21st century. It cannot be business as usual. In order to truly transform care, practice and education will need to partner on curriculum development and the professional socialization of the new nurse.

An examination of nurse-authored patents: Implications for nursing practice.

BACKGROUND: Recognition for medical inventions and innovations is largely associated with physician-researchers, scientists, and engineers. The term "nurse" is largely absent from patents awarded in the United States. Yet, as front-line healthcare providers, who better to add to the current population of inventors and innovators of new, meaningful scientific and engineering medical discoveries than specialized advanced practice nurses and their registered nurse colleagues? Although medical inventions and innovations are not entirely new activities for nurses, the authors speculate that greater opportunities exist for these healthcare professionals to lead in and be officially recognized for medical care discoveries and advancements by having their names on patents awarded. Also, we surmise that without the active and dedicated participation of nurses, important and significant discoveries may be missed. AIMS: The purpose of this paper is to address the importance of having nurses at all levels and specialties engaged in healthcare inventions and innovations. The foundation for this thesis begins by describing the findings from the first quantitative analysis of nurses' participation and/or recognition for the invention and innovation of medical devices and instruments, defined by having their names on awarded United States patents. In addition, we identify meaningful pathways for nurses to engage in this space. METHODS: Data to evaluate nurse participation and recognition for medical device and instrument inventions and innovations were collected through a publicly accessible website, the United States Patent and Trademark Office database, and analyzed with respect to whether the patent author(s) were nurses or nonnurses. RESULTS: More than 65 000 patents were identified with the terms "medical device" and "medical instrument." From the 65 000+ patent-population, 100 random patents were analyzed for the purposes of this first study and none were determined to have a nurse listed as a participating inventor or innovator. As a result of this analysis, the authors: (a) identify that nurses are largely unrecognized in the medical device invention and innovation space and (b) create models that explain nurses' engagement in this space from (i) historical and contemporary perspectives and (ii) for enhanced future involvement in healthcare patent activities. The future model is especially important as it provides a pathway for nurses to enhance their inventive and innovative competencies, effectiveness, and efficiency through new professional roles, additional education, creation of new educational programs, and formation of professional collaborations. It also calls for organizations that employ nurses to overtly allocate time, resources, and support for invention and innovation activities. We posit that fostering and facilitating nurses to enter the medical invention and innovation space stimulates discoveries that can improve patient care experiences, operations, and outcomes, reduce healthcare costs and provide myriad benefits to these professionals and the organizations that employ them. Examples of benefits from nursing inventions and innovations include prestige, scholarship, and the financial assets associated with intellectual property (ie, patents awarded) for both the nurse and the employing institution. Furthermore, direct involvement and engagement in inventions and innovations define a new practice space and contribution for nurses.

Teaching innovation.

Innovation in healthcare is essential to solve the "wicked problems" currently facing healthcare. This article focuses on nature of innovation and how it operates, how innovators think and view problems, how the theory and practice of innovation can be taught in novel ways, and how organizational cultures foster or suppress innovation. Examples of teaching strategies and nurse-driven innovation illustrate the theory and practice of innovation.

The use of "high-stakes testing" in nursing education: Rhetoric or rigor?

The expectations for clinically ready graduates have increased over the years, paralleling changes in the NCLEX exam with increasingly cognitively difficult items in preparation for professional nursing practice. Yet, it is widely recognized that nursing program exit standardized exams have come under increased scrutiny in several public cases. Several articles have frequently been cited in the opposing argument against use of the HESI Exit Exam or other standardized nursing exit exams. We review two of these for logical coherence and standard psychometric adherence given their recurrent use in arguing against nursing program exit standardized testing. In light of patient safety implications and school accreditation consequences, it's more important that schools use exit standardized testing and assess minimum competency of students based on an exit program standardized exam. Measurement standards are critical to these analyses. The use of a program exit standardized exam also alerts students that faculty are holding them accountable for their time in the program.

Standardized testing in nursing education: Preparing students for NCLEX-RN® and practice.

Standardized testing that predicts nursing student success accurately and identifies weak content areas has played a critical role in nursing education. Critics of such testing lament the harm of this type of testing, often misinterpreting common practices as well as overlooking all value. The goal of nursing school is to graduate competent professionals with adequate knowledge to practice safely, who can pass the NCLEX-RN® and gain employment. The use of standardized exit exams or comprehensive exams that are valid and reliable should be embraced as evidence-based, academically rigorous evaluation tools, much like the discipline of education has embraced the Praxis Exam. This paper will present evidence supporting the value of "program exit standardized testing" and address the importance of assessing students and focusing on minimum competency. As a profession that prides itself on the use of evidence to guide practice, we need to use evidence to guide policy development with respect to the use of standardized testing in nursing education.

Curriculum innovation in an accelerated BSN program: the ACE Model.

As the demand for registered nurses continues to rise, so too has the creation of accelerated baccalaureate nursing programs for second-degree students. This article describes an 11-month Accelerated Career Entry (ACE) Nursing Program's innovative curriculum design, which has a heavy emphasis on technology, professional socialization, and the use of a standardized patient experience as a form of summative evaluation. In addition, challenges of this program are presented. Since 2002, the ACE Program has graduated over 500 students with an average first-time NCLEX pass rate of 95-100%. Although the number of graduates from accelerated programs does not solve the severe nursing shortage, the contributions of these intelligent, assertive, pioneering graduates are important for health care.

An overview of the outcomes and impact of specialist and advanced nursing and midwifery practice, on quality of care, cost and access to services: A narrative review.

OBJECTIVES: This paper presents the results of a systematic rapid review and narrative synthesis of the literature of the outcomes and impact of specialist and advanced nursing and midwifery practice regarding quality of care, cost and access to services. DESIGN: A rapid review was undertaken of the relevant national and international literature, regulatory and policy documents relating to the establishment and definition of nurses' and midwives' specialist and advanced practice roles. DATA SOURCES: A search of the Cumulative Index to the Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE) was undertaken from 2012 to 2015. The study also included primary data collection on the perceived impact of specialist and advanced practice nursing and midwifery roles and enablers and barriers to these roles using semi-structured interviews. These are not included in this paper. REVIEW METHOD: To facilitate a systematic approach to searching the literature, the PICO framework, was adapted. RESULTS: The database search yielded 437 articles relevant to the analysis of specialist and advanced practice in relation to quality care, cost and access to services with additional articles added in a manual review of reference lists. In the final review a total of 86 articles were included as they fulfilled the eligibility criteria. CONCLUSION: The evidence presented in the 86 articles indicates that nursing and midwifery practitioners continue to be under-utilised despite the evidence that greater reliance on advanced nurse practitioners could improve accessibility of primary care services while also saving on cost. Results point to continued difficulties associated with accurate measurement of the impact of these roles on patient outcomes. This review demonstrates that there is a need for robust measurement of the impact of these roles on patient outcomes.

The standardized patient experience in undergraduate nursing education.

Drexel University College of Nursing and Health Professions was the first Undergraduate Nursing Program to incorporate the Standardized Patient Experience as a requirement for the completion of the Undergraduate Nursing Degree. This requirement has resulted in positive student outcomes and increased student satisfaction.

Benefits and costs of integrating technology into undergraduate nursing programs.

Advances in technology over the last decade have resulted in increased opportunities for educators to become more innovative in classroom and clinical teaching. These innovations have allowed students and faculty to access essential clinical information at the point of care/need. By capitalizing on technologies such as personal digital assistants and course delivery shells, faculty and students have both portable and remote access to information that can guide practice and learning activities in clinical, classroom, and distance settings. For instance, a student can use a personal digital assistant to research a patient's new medication at the bedside, study course information, access references during class in response to a question, or download clinical materials from home. Although the benefits of having ready access to information seem obvious, there are costs and strategic planning activities associated with implementing these projects. Clearly, the objective of any academic nursing program is to develop skills among students so they can efficiently access information and use that information to guide their nursing practice. To do so, academic nursing administrators must have the forethought to envision how new technologies can support achieving this goal as well as the ability to put in place the infrastructure supports needed for success. This article presents a case study of how one institution developed the necessary infrastructure and garnished the appropriate resources to implement an ambitious technology initiative integrated throughout a large undergraduate nursing program. In addition, how the integration of technology, online and mobile, can enhance clinical learning will be discussed.