Evolving the Assessment of Clinical Judgment: An Individual or Collective Competency?

BACKGROUND: Nurses make decisions about care individually and as part of a team. Collective competence, the effective team management of patient care situations, is partially dependent on nurses' individual confidence and clinical judgment competence. PURPOSE: To describe individual and team-based facilitators and barriers to collective competence in teams of senior baccalaureate-level prelicensure nursing students during a team-based simulation. METHODS: With a cross-sectional design, the study used a 26-item survey based on the National Council of State Boards of Nursing (NCSBN)-Clinical Judgment Measurement Model (CJMM) (α= .86) to assess individual student confidence and perceptions of clinical judgment competence while observation of team dynamics and task completion assessed collective competence. RESULTS: Closed-loop communication and role assignment were facilitators of collective competence when present and barriers when absent. Additional barriers were lack of student confidence and perceived competence with Layers 3 and 4 of the NCSBN-CJMM. CONCLUSIONS: Team-based simulation strategies can be effectively used to assess collective clinical judgment competence.

Advocating for Multimodal Pain Management and Reducing the Need for Opioids in the Acute and Chronic Pain Setting.

The opioid epidemic skyrocketed around 2017 when many pharmaceutical companies guaranteed effective pain relief with nonaddictive properties of prescription opioids. However, this has proven to be inadequate because opioid misuse has increased in the United States. These catastrophic consequences led many providers to take on a different approach to pain management in the acute and chronic setting. In the last few years, a great deal of research has focused more on a multimodal pain management approach, in hopes to decrease the rate of opioid misuse and related overdoses and help assist in putting an end to this public health crisis.

Assessing and addressing practitioner burnout: Results from an advanced practice registered nurse health and well-being study.

BACKGROUND: Numerous nursing and physician studies have reported the effects of workload, environment, and life circumstances contributing to burnout. Effects may include job dissatisfaction, poor quality of life, and associated negative patient outcomes. Although assessing clinician burnout to determine effective interventions has become a topic of great importance, there are minimal studies specific to advanced practice registered nurses (APRNs). PURPOSE: This single-center study was conducted to assess the prevalence and impact of APRN burnout and to recommend targeted interventions toward improvement of overall health and well-being. METHODS: A cross-sectional, mixed methods design was used. The voluntary, anonymous survey examined perceptions of wellness, inclusion, social support, personal coping mechanisms, and status of burnout. RESULTS: The 78-question survey was sent to 1,014 APRNs (94%) and PAs (6%), with a 43.6% response rate (n = 433); 76.4% were nurse practitioners. Participants were identified as currently experiencing burnout, formerly burned out, or never having experienced burnout. Profiles were developed, and similarities and differences between each group were compared. Of 433 respondents, 40.4% (n = 175) reported having never experienced burnout, 33.3% (n = 144) reported they had formerly experienced burnout, and 26.3% (n = 114) reported they were currently experiencing burnout. IMPLICATIONS FOR PRACTICE: The results of the study identified that some APRNs report experiencing burnout at different times in their careers. Recommendations by participants to mitigate burnout included self-care, organizational promotion of health and well-being, career development, and leadership support. This study is one of the first to report on burnout among APRNs and potential interventions to build resilience; however, additional research is warranted.