Barriers and facilitators to nurse practitioner buprenorphine prescribing for opioid use disorder in primary care settings.

BACKGROUND: Increasing access to opioid use disorder (OUD) treatment is critical to curbing the opioid epidemic, particularly for rural residents who experience numerous health and health care disparities, including higher overdose death rates and limited OUD treatment access compared with urban dwellers. Buprenorphine-naloxone is an evidence-based treatment for OUD that is well suited for rural areas. However, providers must have a specialized federal waiver to prescribe the medication. Despite the acceleration of the opioid epidemic in rural areas and the recent liberalization of federal buprenorphine-naloxone prescribing laws, few providers hold buprenorphine-naloxone prescribing waivers and even fewer prescribe the medication. PURPOSE: This study explores barriers and facilitators to buprenorphine-naloxone prescribing among nurse practitioners (NPs) working in primary care settings in eastern North Carolina. METHODOLOGY: Individual interviews were conducted with 13 NPs working in primary care settings in eastern North Carolina. Qualitative thematic analysis was used to identify perceived barriers and facilitators to buprenorphine-naloxone prescribing. RESULTS: Analysis found prescribing barriers related to OUD stigma, perceived knowledge, federal and state regulation, and prescribing resources and found facilitators related to adopting a person-centered approach, developing prescriber skills, and access to prescribing resources. CONCLUSIONS: The barriers and facilitators that NPs experience related to buprenorphine prescribing for OUD are similar to those faced by physicians, although the barriers arguably more profound. Future research should consider how to mitigate these prescribing barriers to facilitate NP buprenorphine prescribing for OUD. IMPLICATIONS: To our knowledge, this is the first qualitative study of NP buprenorphine-naloxone prescribing in rural areas. Given the prominence of OUD in rural regions and the key role NPs play in primary care provision, this study lays import groundwork for developing interventions to support buprenorphine-naloxone prescribing by NPs practicing in rural regions.

Career Adaptability: An Innovative Measurement to Aid Professional Development of New Graduate Nurses.

This cross-sectional quantitative study explored career adaptability and career intentions in newly licensed nurses working in acute care hospitals throughout North Carolina. Data were analyzed from 277 registered nurses completing an online study instrument. Findings demonstrate a relationship between levels of career adaptability and career intentions, offering career adaptability as a new measurement to explore newly licensed nurses' desire to pursue career and educational change and expand transition programs to include developing career trajectories within organizations.

Relational Quality Between the RN and Nursing Assistant: Essential for Teamwork and Communication.

OBJECTIVE: Nurse (RN) and nursing assistant (NA) relational quality was examined along with associations between relational quality and evaluations of teamwork and communication. BACKGROUND: RN and NA teams constitute the primary nursing care delivery method, and the quality of their relationship affects system capacity for improving patient outcomes; adverse events are linked to communication and teamwork breakdowns. METHODS: RN (N = 889) and NA (263) relational quality was examined using a cross-sectional secondary analysis from system assessment with the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture. RESULTS: RN and NA perceived relational quality indicated significant differences in teamwork and safety grade ratings, with both groups reporting perceived teamwork as high when patient safety grade was low. CONCLUSIONS: This study supports the benefits of improving the RN-NA teamwork-communication relationship. An enhanced RN-NA relational quality can be used by nurse leaders to optimize patient care delivery outcomes.

Manager's influence on the registered nurse and nursing assistant relational quality and patient safety culture.

AIMS: The purpose of this study is to describe the perceptions of relational quality of the registered nurse and nursing assistant and examine how their view of the manager's influence impacts overall patient safety culture of a unit. BACKGROUND: The primary delivery of nursing care within acute care systems uses teams of registered nurses and nursing assistants. METHODS: A cross-sectional secondary analysis of data collected in the spring of 2018 using the Agency for Healthcare and Quality Hospital Survey of Patient Safety Culture and a seven-item questionnaire measuring relational quality was conducted. The sample included 1,152 responses. RESULTS: The manager influenced overall perceptions of safety regardless of the relational quality between the registered nurse and nursing assistant. CONCLUSIONS: This study found manager behaviours that promote patient safety and also influence overall perceptions of patient safety culture regardless of the relational quality between the registered nurse and nursing assistant. IMPLICATIONS FOR NURSING MANAGEMENT: Positive registered nurse and nursing assistant relational quality amplifies perceptions of patient safety culture, yet it is the manager's behaviours regarding safety that make the stronger contribution in building a culture of safety.

Troublesome knowledge for entry-level PhD nursing students: Threshold concepts essential for the research-focused doctorate.

BACKGROUND: Evidence supports that PhD doctoral students experience conceptually difficult knowledge, or troublesome knowledge, during their studies. These areas of troublesome knowledge are often associated with threshold concepts, those ideas specific to a discipline that must be understood to advance ways of thinking and making knowledge in the discipline. PURPOSE: To examine troublesome knowledge identified by a group of PhD nursing students during an introductory course and to consider threshold concepts related to that knowledge. METHOD: Design: Case study research methodology. SAMPLE: 18 entry-level PhD nursing students recruited with convenience sampling. DATA COLLECTION: Content analysis was used to analyze data collected from student reflective learning journals. Journal data was triangulated with formative and summative faculty assessments of student learning. RESULTS: Three essential threshold concepts for entry-level PhD nursing students were identified: developing new ways of knowing, constructing researcher and writer identity, and positioning within the nursing research community. Analysis indicates that entry-level students found the threshold concept of constructing researcher and writer identity most troublesome. CONCLUSION: A PhD introductory nursing course which includes metacognitive activities, scaffolding of assignments, and early positioning within the research community can assist students with mastery of threshold concepts for the research-focused doctorate.

New Graduate Nurses' Perceptions of Patient Safety: Describing and Comparing Responses With Experienced Nurses.

BACKGROUND: A significant proportion of the acute health system workforce is composed of new graduate nurses, yet there is a limited understanding of patient safety perceptions among new graduate nurses and how they compare with nurses who have more experience. METHOD: This study used a descriptive approach to complete secondary analysis on two sources of data containing new graduate nurses' (n = 1,613) and experienced nurses' (n = 64,906) responses to the Hospital Survey on Patient Safety Culture. RESULTS: New graduate nurses had a more positive perception of safety culture than more experienced nurses. The greatest differences were observed in perceptions of how nurse managers respond to mistakes. Similarities in perceptions were observed on items associated with communication. CONCLUSION: Educational systems and transitional programs must prepare new graduate nurses for patient care. There is an opportunity for academic and practice partners to collaborate on programs that facilitate the transition of new graduate nurses to the workforce. [J Contin Educ Nurs. 2020;51(7):309-315.].

Strategies for progression in a PhD nursing program within a transition model.

BACKGROUND: There is a need for interventions to improve the PhD pipeline for nursing program enrollment. PhD nursing students who have navigated the program successfully are in a strategic position to help by sharing their stories. Several strategies for successful completion of a PhD program and some common expected barriers have been documented in the literature. METHOD: The authors used personal reflections from their first and second years of study in a PhD nursing program to identify strategies to progress through a program. The personal reflections were analyzed by their student cohort and a faculty advisor using the Bridges' Transition Model as a theoretical framework. The cohort members included five females and one male, ages 29-48, attending a PhD nursing program in the Southeastern, US. RESULTS: The following strategies were identified from the personal reflections: seeking and offering support within your cohort; establishing a relationship with mentors; identifying and using a reference manager; mastering time management; soaking up statistics; and focusing on your focus. The strategies listed above occurred within the ending and/or neutral zone phases of the Bridges' Transition Model. CONCLUSION: It is important to note the early phases of transition and need for success strategies in these specific phases of transition. PhD nursing students are in a strategic position to positively influence the PhD pipeline by providing personal reflections that inform future PhD nursing students as well as PhD nursing programs.

Help or hindrance: Exploring nurse practitioners' perceptions of transition to practice legislation.

BACKGROUND: Fourteen states have adopted transition to practice (TP) legislation, which requires newly certified nurse practitioners (NPs) to practice under a senior clinician. States have adopted such legislation despite vast evidence indicating NPs provide safe care. PURPOSE: The purpose of this study is to explore NPs' perceptions of the effects of this legislation and to describe communication between NPs and senior clinicians working in TP states. METHODS: Using a cross-sectional, descriptive design, we surveyed a convenience sample of NPs working in TP states. Descriptive statistical analysis and qualitative content analysis were conducted. RESULTS: Most respondents believed TP legislation posed unnecessary regulatory barriers but also believed it promoted professional development. No statistically significant relationships between professional characteristics, regulatory variations, and these perceptions were identified. IMPLICATIONS FOR PRACTICE: Given the increasing number of states considering TP legislation, and the vast variability in TP models, additional research into the effects of this regulation is needed.

Getting work done: a grounded theory study of resident physician value of nursing communication.

Poor communication between nurses and physicians results in patient injury and increased healthcare costs. While multiple attempts have been made to improve communication between the two professions, evidence confirms little progress has been made. Previous research focused on standardizing communication processes and protocols between nurses and physicians rather than examining the relational component of these human interactions. The purpose of this study was to explore physician valuing of nursing communication in the context of patient care. Interviews were conducted with 15 internal medicine resident physicians. A constructivist grounded theory approach was used to develop the substantive theory of Getting Work Done. Getting Work Done incorporated three major categories: discerning the team, shifting communication, and accessing nurse knowledge and abilities. Hierarchical behaviors and language, and nurse collusion in both, characterized nurse-physician communication and situated the nurse outside the decision-making team. Complex work environments further devalued nurse-physician communication. Interprofessional education and practice must advance the unique and essential role of all health care professionals such that mutual valuing replaces hierarchical actions with collaborative systems for determining the most effective approaches to patient care.

Strategies to promote the professional transition of new graduate nurse practitioners: A systematic review.

New graduate nurse practitioner (NP) postgraduate support programs and interventions have proliferated, sparking controversy. The Institute of Medicine/National Academy of Medicine recommends residency programs for new graduate NPs; however, the NP community debates whether new graduate NPs need additional training and whether such training compromises patient access to care. This systematic review aimed to synthesize evidence regarding the effectiveness of interventions and strategies to promote the professional transition of new graduate NPs. Interventions identified in the current literature included fellowship programs and a webinar. Strategies included mentorship, experiential learning, interprofessional training, and professional socialization. The studies reviewed primarily evaluated NPs' perceptions of the interventions' effects on their professional transitions. The findings from this systematic review highlight challenges in evidencing postgraduate support programs. The small number of available studies underscores a critical problem for the NP community: additional evidence is needed to inform whether and how to support new graduate NPs as they transition to practice.

A New Leadership Development Model for Nursing Education.

BACKGROUND: Leadership competency is required throughout nursing. Students have difficulty understanding leadership as integral to education and practice. A consistent framework for nursing leadership education, strong scholarship and an evidence base are limited. PURPOSE: To establish an integrated leadership development model for prelicensure nursing students that recognizes leadership as a fundamental skill for nursing practice and promotes development of nursing leadership education scholarship. METHOD: Summarizing definitions of nursing leadership, conceptualizing leadership development capacity through reviewing trends, and synthesizing existing leadership theories through directed content analysis. DISCUSSION: Nine leadership skills form the organizing structure for the Nursing Leadership Development Model. Leadership identity development is supported via dimensions of knowing, doing, being and context. CONCLUSION: The Nursing Leadership Development Model is a conceptual map offering a structure to facilitate leadership development within prelicensure nursing students, promoting student ability to internalize leadership capacity and apply leadership skills upon entry to practice.

Changing New Graduate Nurse Profiles and Retention Recommendations for Nurse Leaders.

OBJECTIVE: This study compares and contrasts new graduate nurse attributes and perceptions using findings from a 2010 study and a recent analysis of new graduate nurses participating in the same residency program. BACKGROUND: As millennials saturate the healthcare work environment, their unique views and needs will influence the evolution of new graduate nurse residencies. METHODS: This study used previously reported data on new graduate nurses between 1999 and 2009 and compared it with a secondary analysis of data collected on new graduate nurses between 2011 and 2016. RESULTS: This study provides evidence that millennial new graduate nurses' levels of commitment and satisfaction do not moderate turnover intentions in the 1st 2 years of practice as they did in the previous group of new graduate nurses. CONCLUSIONS: Job embeddedness, a construct that measures the likelihood of whether a person is going to stay, may be a better measurement among new graduate nurses than commitment or satisfaction because millennials, a generation that is predominant in current new graduate nurses, are more engaged than loyal.

Threshold Concepts in Doctoral Education: A Framework for Writing Development in Novice Nurse Scientists.

Pedagogical practices for writing development in doctoral programs are often the by-product of completing dissertation research and may lack deliberate strategies to assist students with complex genres of writing. This article proposes a framework for doctoral education to assist students with mastery of threshold concepts in writing. Threshold concepts in writing are examined for their applicability to the evolution of writing in PhD nursing students as they begin to think and write like nurse scientists.

The Impact of New Graduate Nurse Transition Programs on Competency Development and Patient Safety: An Integrative Review.

Stronger evidence on the value of new graduate nurse transition programs is needed to justify the cost and warrant expansion of these programs to more health systems. The aim of this integrative review was to critically analyze published research on the relationship between new graduate nurse transition programs and patient safety outcomes. Limited evidence was found on actual safety improvement; rather, transition programs have predominately measured the development of competency as a process outcome variable for improving patient safety. A systems model is proposed to guide future research examining structure, process, and outcome variables, linking transition programs with patient outcomes.

Factors Facilitating Publication by Clinical Nurses in a Magnet® Hospital.

OBJECTIVE: This study examined the cognitive, behavioral, and environmental factors that facilitate publication by clinical nurses in Magnet® hospitals. BACKGROUND: The culture promoted by the Magnet Recognition Program® promotes nurses practicing in those settings to use, generate, and disseminate best practices. Successful and promising models of care and nursing practice are rarely disseminated beyond the organization where they are practiced. The questions persist: what barriers to writing for publication exist for clinical nurses, and how do we overcome them to advance emergent evidence? METHODS: A focused ethnographic, multiple-case study design examined 5 well-published nurses with high levels of dissemination occurring outside the Magnet organization where they were employed. RESULTS: Nurses in this study most often credited cognitive and behavioral factors for promoting publication. Although the organization encouraged peer-reviewed publication, there were limited environmental efforts to support efforts to publish in peer-reviewed journals by clinical nurses. CONCLUSIONS: The results of this case study call for more research on the multifaceted factors that promote publication by clinical nurses in the practice environment. Publication of research in peer-reviewed journals was supported by environmental influences of time to write, collaborative writing opportunities, and supportive and accurate guidance from editors.

Writing Development in Associate Degree in Nursing-to-Baccalaureate Degree in Nursing Students: Moving Out of the Comfort Zone.

BACKGROUND: The nursing profession has made several unsuccessful attempts to differentiate practice between nurses with associate degrees and baccalaureate degrees entering the workforce. Writing competency has been identified as one potential area of differentiation. METHOD: A descriptive, qualitative research design was used to explore Associate Degree in Nursing-to-Baccalaureate Degree in Nursing (ADN-to-BSN) graduates' perceptions of scholarly writing development in their baccalaureate studies. Nine recent graduates from a public college of nursing participated in semistructured interviews. RESULTS: Findings from content analysis revealed three phases of awareness in development of a scholarly writer: being a scholarly writer, assessing writing abilities, and connecting to practice. CONCLUSION: The study findings provide insight into competencies that could differentiate practice between ADN and BSN nurses entering the workforce. Although this study aimed to find out how ADN-to-BSN students are shaped as writers, findings suggest that the experience of learning to write may also be shaping students as professional nurses. [J Nurs Educ. 2017;56(3):182-185.].

Nursing Administration Research Priorities: Findings From a Delphi Study.

OBJECTIVE: The aim of this study is to determine the priorities for nursing administration research (NAR) in the United States. BACKGROUND: Previously known as the Council of Graduate Educators in Administrative Nursing, CGEAN provides an avenue for researchers and educators focused on NAR to partner, dialogue, obtain funding resources, and present their findings at a biennial International Nursing Administration Research Conference (INARC). In late 2013, with a goal of building consensus, CGEAN convened an INARC postconference to initiate the process of establishing critical NAR priorities for the future. METHODS: Data from a 3-staged Delphi study were used to identify relevant research topics and determine administrative research priorities. RESULTS: Eight final categories of NAR were determined. CONCLUSIONS: This study found economic valuing of nursing and designing effective future healthcare delivery systems to be high priorities for NAR.

Application of CGEAN's Research Priorities: PhD, DNP Scholarship.

The Accountable Care Act of 2010 is stimulating rapid transformations of healthcare systems. The shift from a focus on providing healthcare in a closed system to improving the health of communities demands rapid innovation by nurse leaders. Nurse leaders prepared at the doctorate of nursing practice level and PhD-prepared nursing health services researchers are needed to develop and evaluate best practices as they emerge. This column expands on the findings from CGEAN's Delphi study.

Revising the Scope and Standards for Nurse Administrators.

In the fall of 2013, the American Nurses Association began the process of redesigning the scope and standards for the nurse administrator. This article provides a synthesis of the top 10 changes in the new Scope and Standards for Nurse Administrators that are being reviewed for approval. These changes reflect the continuing evolution of practice for nurses serving as leaders across the United States.

Nursing administration research: an evolving science.

The nature and focus of nursing administrative research have evolved over time. Recently, the research agenda has primarily reflected the national health policy agenda. Although nursing research has traditionally been dominated by clinical interests, nursing administrative research has historically addressed the interface of reimbursement, quality, and care delivery systems. This article traces the evolution of nursing administrative research to answer questions relevant to scope, practice, and policy and suggests future directions.