Anticoagulation under-utilization in atrial fibrillation patients is responsible for a large proportion of strokes requiring endovascular therapy.

OBJECTIVES: Atrial fibrillation (AF) is responsible for 30-50% of large strokes requiring endovascular thrombectomy (EVT). Anticoagulation (AC) underutilization is a common source of AF-related stroke. We compared antithrombotic medications among stroke patients with AF that did or did not undergo EVT to determine if AC underutilization disproportionately results in strokes requiring EVT, while quantifying the proportion of likely preventable thrombectomies. METHODS: This retrospective single-center cohort included consecutive patients admitted with acute ischemic stroke between 2016 and 2021. Patients were categorized based on the presence of AF, and pre-admission antithrombotic medications were compared between those who underwent EVT and those who didn't. The reason for not being on AC was abstracted from the medical record, and patients were categorized as either AC eligible or AC contraindicated. RESULTS: Of 3092 acute ischemic stroke patients, 644 had a history of AF, 213 of whom underwent EVT. Patients who required EVT were more likely to not be taking any antithrombotics prior to admission (34% vs 24%, p=0.007) or have subtherapeutic INR on admission if taking warfarin (83% vs 63%; p = 0.046). Among the AF-EVT patients, 44% were taking AC, and only 31% were adequately anticoagulated. Only 8% of AF-EVT patients who were not on pre-admission AC had a clear contraindication, and 94% were ultimately discharged on AC. CONCLUSIONS: Lack of antithrombotic therapy in AF patients disproportionately contributes to strokes requiring EVT. A small minority of AF patients have contraindications to AC, so adequate anticoagulation can prevent a remarkable number of strokes requiring EVT.

Huddling as an Academic Quality Improvement Initiative.

ABSTRACT: A huddle is described as a tight group gathered together to talk privately for the purpose of reviewing performance and engaging in future planning. Although huddles are described as an effective communication tool to enhance patient safety in hospital settings, little is known about their use in academe. This article describes a quality improvement initiative involving weekly huddles of faculty teaching medical/surgical nursing and provides preliminary findings after one year.

A qualitative examination of graduating nurses' response to the Covid-19 pandemic.

BACKGROUND: Currently, graduating nurses face pandemic-related uncertainty including gaps in risk perception, unexpected Covid-19 moral dilemmas, and distress surrounding personal health risk. RESEARCH QUESTION/AIM/OBJECTIVES/METHOD: The purpose of this basic qualitative descriptive study is to describe the willingness of graduating nurses to provide care during the Covid-19 pandemic. PARTICIPANTS AND RESEARCH CONTEXT: One week prior to graduation, students were required to submit a written assignment describing willingness to practice in light of the ongoing pandemic. ETHICAL CONSIDERATIONS: This study was approved by an Institutional Review Board. FINDINGS/RESULTS: Eighty-four (n = 84) assignments were used for analysis. Of these, 82% (n = 69) of the graduating nurses describe a willingness to voluntarily care for Covid-19 patients. After summarizing narrative responses, two themes emerged including self-assessment of personal and familial risk and conflicting obligations. DISCUSSION: The assessment of risk to self and family are key in determining whether graduating nurses will care for Covid-19 patients. Conflicting obligations may contribute to stress and uncertainty potentially leading to early burnout. CONCLUSION: Findings from this study can inform academicians of the need to adequality prepare graduating nurses for Covid-19-associated risks and ethical decision making. Organizations should alter residencies and orientation to support the needs of new nurses.

Simulation STEPS Ahead: Preparing to Engage in Systematic Evaluations of Simulation Activities.

Nursing programs need to be prepared to engage in systematic evaluations of simulation activities specifically linked to course and program outcomes. This article describes how components of the Jeffries simulation framework and S.T.E.P. Educator Preparation Plan were used to guide construction, implementation, and evaluation of cost-effective, program-wide simulation experiences with the addition of "S" for systematic evaluation. Expanding the Jeffries plan to STEPS offers a strategic way to evaluate simulation systematically in nursing programs.

Perceived needs and coping resources of newly hired nurses.

OBJECTIVE: Newly hired nurses who do not transition well often leave their first nursing position or nursing prematurely, at great cost to themselves, the profession, hiring organizations and patients. The purpose of this secondary analysis study was to better understand the transition experience of new graduate nurses and experienced nurses as they moved to a new setting in nursing, and the preceptor's role in that transition. METHODS: Schlossberg's Transition Theory provided the framework for the secondary analysis of a large qualitative data set that were collected from 118 newly hired nurses who were predominantly female and Caucasian with the majority being under the age of 30 years and having less than 1-year experience. The data available for secondary analysis included all transcripts from the original study. RESULTS: Two main themes were identified: Institutional Support and Sense of Self. DISCUSSION: Preceptors are critical early in the transition and the newly hired nurse continues to look for support beyond the first year of the transition. Hospitals should consider implementing transition to practice programs that support the newly hired nurse, to include those with prior experience, throughout the first year of transition and should also consider a mentorship program of support after the first year.

Readiness to Practice in Generation Z Nursing Students.

BACKGROUND: Generation Z nursing students born after 1995 have been described as true digital natives with a short attention span and tendencies toward boredom. The purpose of this pilot study is to compare readiness for practice and anxiety and self-confidence during decision making between Generation Z students who completed a 4-week immersive clinical and those in a 14-week immersive clinical. METHOD: A convenience sample (n = 46) of Generation Z graduating baccalaureate nursing students was surveyed. RESULTS: Independent samples t tests were conducted, with no statistical differences between groups on any measures. CONCLUSION: Findings suggest that extended periods of time in an immersive clinical do not influence readiness to practice or anxiety and self-confidence during decision making in the next generation of students. [J Nurs Educ. 2019;58(10):604-606.].

Lessons Learned: Newly Hired Nurses' Perspectives on Transition Into Practice.

This descriptive qualitative study explored data from debriefs of all newly hired nurses at 3, 6, and 12 months posthire during a newly designed transition-to-practice program at a pediatric hospital. Four major themes emerged: preceptors, education process, adaptation to the organization, and role transition. Supportive factors included staged orientation, limited preceptors, mentors, regular communication with leaders, and a culture of teamwork. Stressors included too many preceptors, mentorship needs, floating, communication challenges, and organizational changes.

Transition of Experienced and New Graduate Nurses to a Pediatric Hospital.

This study reports on the 3-, 6-, 12-, and 18-month outcomes of 118 newly hired registered nurses (RNs) who completed a 12-month transition-to-practice program at a pediatric hospital. Experienced RNs (n = 42) and new graduate RNs (n = 76) showed improved organization, prioritization, communication, and leadership skills over time. The experienced RNs reported better communication and leadership skills than the new graduate nurses. Results inform transition program development for both new and experienced nurses.