An audit of mental health questions on U.S. nursing licensure applications: Evidence to guide urgent action for change.

BACKGROUND: Nurses often forgo needed mental healthcare due to stigma and fear of losing their license. The decision to access care or disclose mental health struggles is intensified when registered nurses (RNs) or advanced practice registered nurses (APRNs) discover that licensure applications ask invasive mental health questions that could impact their ability to work. AIMS: This study highlights findings from an audit of mental health and substance use questions included in RN and APRN licensure applications across the United States. METHODS: A sequential 4-step approach was used to retrieve RN and APRN licensure applications: (1) review of Board of Nursing (BON) websites, (2) communication with BON staff, (3) communication with Deans of Nursing to ask for retrieval assistance, and (4) creation of mock applicants. An embedded checklist within the Dr. Lorna Breen Heroes Foundation's Remove Intrusive Mental Health Questions from Licensure and Credentialing Applications Toolkit guided the audit. Two study team members reviewed the applications independently for intrusive mental health questions, which were designated as non-compliant with the Toolkit's recommendations and arbitrated for consensus. States were designated as non-compliant if ≥1 item on the checklist was violated. RESULTS: At least one RN and APRN application was obtained from 42 states. Only RN applications were obtained from five states, while only APRN applications were obtained from three states. Only 13 states (26%) fully adhered to the Took-Kit checklist. LINKING EVIDENCE TO ACTION: The majority of BONs did not fully adhere to the Took-Kit checklist. Guidance from national organizations and legislation from state governments concerning the removal or revision of probing mental health and substance use questions is urgently needed to cultivate a stigma-reducing environment where nurses are supported in seeking needed mental health treatment.

State of Mental Health, Healthy Behaviors, and Wellness Support in Big 10 University Nursing and Health Sciences Faculty, Staff, and Students During COVID-19.

BACKGROUND: Federal and national entities urge organizations to assess healthcare professionals' mental health and well-being as the COVID-19 pandemic has compounded the issue. AIMS: This study aimed to (1) describe rates of mental health issues, healthy lifestyle behaviors, and perceptions of COVID-19's impact among Big 10 University nursing and health sciences faculty, staff, and students; (2) identify predictors of depression, anxiety, stress, and burnout; and (3) assess the relationships among perceived school wellness support, healthy lifestyle behaviors, physical/mental health, and mattering. METHODS: A cross-sectional descriptive correlational design was used. Nursing and health science deans emailed invitations to faculty, staff, and students concerning an anonymous wellness assessment survey. Correlation coefficients tested associations among mental health indicators and wellness cultures. Multiple linear regression examined factors associated with mental health indicators. RESULTS: Faculty, staff, and students responded (N = 1345). Findings indicated that most respondents were not getting adequate sleep, meeting physical activity recommendations, or eating the daily recommended number of fruits/vegetables. Fourteen to 54.9 % of participants reported depression, anxiety, and burnout. Overall, students, faculty and staff at colleges that operated under a strong wellness culture had better outcomes. CONCLUSION: Wellness cultures impact the mental and physical health of faculty, staff, and students.

The State of Health, Burnout, Healthy Behaviors, Workplace Wellness Support, and Concerns of Medication Errors in Pharmacists During the COVID-19 Pandemic.

OBJECTIVES: The aims of the study were to describe the well-being and lifestyle behaviors of health-system pharmacists during the COVID-19 pandemic and to determine the relationships among well-being, perceptions of workplace wellness support, and self-reported concern of having made a medication error. METHODS: Pharmacist ( N = 10,445) were randomly sampled for a health and well-being survey. Multiple logistic regression assessed associations with wellness support and concerns of medication error. RESULTS: The response rate was 6.4% ( N = 665). Pharmacists whose workplaces very much supported wellness were 3× more likely to have no depression, anxiety, and stress; 10× more likely to have no burnout; and 15× more likely to have a higher professional quality of life. Those with burnout had double the concern of having made a medication error in the last 3 months. CONCLUSIONS: Healthcare leadership must fix system issues that cause burnout and actualize wellness cultures to improve pharmacist well-being.

Budgetary investment in evidence-based practice by chief nurses and stronger EBP cultures are associated with less turnover and better patient outcomes.

BACKGROUND: Hospitals and healthcare systems strive to meet benchmarks for the National Database of Nursing Quality Indicator (NDNQI) measures, Centers for Medicare & Medicaid Services (CMS) Core Measures, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) outcome indicators. Prior research indicates that Chief Nursing Officers and Executives (CNOs, CNEs) believe that evidence-based practice (EBP) is important for ensuring the quality of care, but they allocate little funding to its implementation and report it as a low priority in their healthcare system. It is not known how EBP budget investment by chief nurses affects NDNQI, CMS Core Measures, and HCAHPS indicators or key EBP attributes and nurse outcomes. AIMS: This study aimed to generate evidence on the relationships among the budget devoted to EBP by chief nurses and its impact on key patient and nurse outcomes along with EBP attributes. METHODS: A descriptive correlational design was used. An online survey was sent to CNO and CNE members (N = 5026) of various national and regional nurse leader professional organizations across the United States in two recruitment rounds. Data collected included CNO/CNE EBP Beliefs, EBP Implementation, and perceived organizational culture of EBP; organizational culture, structure, personnel, and resources for EBP; percent of budget dedicated to EBP; key performance measures (NDNQI, CMS Core Measures, HCAHPS); nurse satisfaction; nurse turnover; and demographic questions. Descriptive statistics were used to summarize sample characteristics. Kendall's Tau correlation coefficients were calculated among EBP budget, nursing outcome measures, and EBP measures. RESULTS: One hundred and fifteen CNEs/CNOs completed the survey (a 2.3% response rate). The majority (60.9%) allocated <5% of their budget to EBP, with a third investing none. An increase in EBP budget was associated with fewer patient falls and trauma, less nursing turnover, and stronger EBP culture and other positive EBP attributes. A greater number of EBP projects were also associated with better patient outcomes. LINKING EVIDENCE TO ACTION: Chief nurse executives and CNOs allocate very little of their budgets to EBP. When CNEs and CNOs invest more in EBP, patient, nursing, and EBP outcomes improve. System-wide implementation of EBP, which includes appropriate EBP budget allocation, is necessary for improvements in hospital quality indicators and nursing turnover.

The state of mental health, burnout, mattering and perceived wellness culture in Doctorally prepared nursing faculty with implications for action.

BACKGROUND: Depression, anxiety, and burnout are an epidemic in the nursing profession. Unlike nurses in clinical settings, little is known about the mental health of doctorally prepared nursing faculty in academic settings, especially when separated by degree type (Doctor of Philosophy in Nursing [PhD] vs. Doctor of Nursing Practice [DNP]) and clinical or tenure track. AIMS: The study aims were to: (1) describe the current rate of depression, anxiety, and burnout in PhD and DNP-prepared nursing faculty and tenure and clinical faculty across the United States; (2) determine if differences exist in mental health outcomes between PhD and DNP-prepared faculty and tenure and clinical faculty; (3) explore whether wellness culture and mattering to the organization influence faculty mental health outcomes; and (4) gain insight into faculty's perceptions of their roles. METHODS: An online descriptive correlational survey design was used with doctorally prepared nursing faculty across the U.S. The survey was distributed to faculty by nursing deans and included: demographics; valid and reliable scales for depression, anxiety, and burnout; an assessment of wellness culture and mattering; and an open-ended question. Descriptive statistics described mental health outcomes; Cohen's d was used to determine effect sizes between PhD and DNP faculty for the mental health outcomes; and Spearman's correlations tested associations among depression, anxiety, burnout, mattering, and workplace culture. RESULTS: PhD (n = 110) and DNP (n = 114) faculty completed the survey; 70.9% of PhD faculty and 35.1% of DNP faculty were tenure track. A small effect size (0.22) was found, with more PhDs (17.3%) screening positive for depression than DNPs (9.6%). No differences were observed between tenure and clinical track. Higher perceptions of mattering and workplace culture were associated with less depression, anxiety, and burnout. Identified contributions to mental health outcomes yielded five themes: lack of appreciation, role concerns, time for scholarship, burnout cultures, and faculty preparation for teaching. LINKING EVIDENCE TO ACTION: Urgent action must be taken by college leaders to correct system issues contributing to suboptimal mental health in both faculty and students. Academic organizations need to build wellness cultures and provide infrastructures that offer evidence-based interventions to support faculty well-being.

Associations among infection prevention professionals' mental/physical health, lifestyle behaviors, shift length, race, and workplace wellness support during COVID-19.

BACKGROUND: COVID-19 added stress to infection prevention professionals' (IPs) work-life that may have impacted their well-being. This study aimed to describe IPs' mental and physical health and lifestyle behaviors during the pandemic and their associations with IP role, perceived worksite wellness support, shift length, and race and/or ethnicity. METHODS: A random sample of Association for Professionals in Infection Control and Epidemiology members (6,000) were emailed a survey assessing mental and physical well-being, lifestyle behaviors, and perceived worksite wellness support. RESULTS: A total of 926 IPs responded (15% response rate). Few met guidelines for sleep (34.1%), physical activity (18.8%), and fruit and vegetable consumption (7.3%). Rates of depression, anxiety, and burnout were 21.5%, 29.8%, and 65%. Front line and practicing IPs and IP administrators and directors had more negative mental health impacts than IPs in other roles. IPs with organizational wellness support were less likely to report negative COVID-19 impacts. IPs working 9-11+ hours/day were more likely to report worsening physical and mental health due to COVID-19. There were no significant differences in odds of negative COVID-19 impacts on lifestyle behaviors between white and racial and ethnically diverse IPs. CONCLUSIONS: IPs who worked shorter shifts and had more organizational wellness support had better well-being outcomes. Organizations must fix system issues that result in poor health and invest in workforce wellness.

Beliefs, mental health, healthy lifestyle behaviors and coping strategies of college faculty and staff during the COVID-19 pandemic.

Objective: To assess faculty and staff beliefs about returning to campus as well as their mental health and healthy lifestyle behaviors. Participants: Faculty and staff at a large Mid-west public land-grant university. Methods: A survey was emailed to a random sample of faculty and staff (N = 6,000 faculty; N = 6,000 staff). Results: Response rate was 35.6% for faculty (n = 2,138) and 37.8% (n = 2,226) for staff. Participants who were working from home (>60%) had less confidence about returning to campus safely than those who had been working on campus. Eighteen to 27% of faculty and 25%-31% of staff met the cutoff for clinical anxiety and the rates of depression were 4.4%-8.3% and 9.7%-10.0% respectively. Conclusion: Institutions of higher education must build wellness cultures and accelerate access to mental health services, which should be evidence-based and include a focus on promoting and maintaining overall wellness.

Psychometric properties of the Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice.

BACKGROUND: Patient safety metrics declined due to COVID-19-related strains placed on hospitals and hospital systems. Because evidence-based practice (EBP) can improve patient outcomes and quality of care and empower clinicians, a renewed focus on organizational EBP culture is needed. The Advancing Research and Clinical practice through close Collaboration (ARCC©) Model describes how to use a system-wide approach to advance and sustain EBP in hospital systems to improve outcomes. EBP culture is a key variable that directly impacts EBP knowledge, beliefs, competency, and implementation. The ARCC© Model uses the Organizational Culture and Readiness Scale for System-Wide Integration of Evidence-Based Practice (OCRSIEP) to identify organizational characteristics that influence clinician and patient outcomes. Although the scale has been reported to have excellent reliability, a comprehensive psychometric analysis has yet to be performed that confirms its construct validity. AIMS: The aim of this study was to describe the OCRSIEP's construct validity and reliability via an in-depth psychometric analysis. METHODS: OCRSIEP assessment data were obtained from a prior national study with 2344 nurses from 19 hospitals and healthcare systems. Descriptive statistics summarized the sample and distributions of the 25 scale items. Construct validity was assessed via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Cronbach's alpha assessed reliability. RESULTS: A one-factor model was supported by EFA with item Q17b excluded (i.e., to what extent are decisions generated from upper administration). Model fit indices for CFA indicated a good fit (CFI = 0.978, TLI = 0.973, RMSEA = 0.077, SRMR = 0.027). Cronbach's alpha was 0.96 for all items and 0.97 with item Q17b excluded, both indicating outstanding internal consistency. LINKING EVIDENCE TO ACTION: The OCRSIEP is valid and reliable and can be used to assess EBP culture and readiness in hospitals and healthcare systems at the organizational level.

Psychometric properties of the evidence-based practice mentorship scale.

BACKGROUND: Evidence-based practice (EBP) improves the quality of care, decreases healthcare costs, and improves job satisfaction. However, nurses and other clinicians, as well as their institutions, struggle to consistently implement EBP. The Advancing Research and Clinical practice through close Collaboration (ARCC©) Model established that a cadre of EBP mentors is key to improving EBP knowledge, beliefs, competency, and implementation in clinicians. Yet, there has not been a valid and reliable measure of EBP mentorship. AIMS: The aim of this study was to determine the psychometric properties of the new 8-item EBP Mentorship Scale. This scale measures the degree to which clinicians perceive that EBP mentorship is available to them. METHODS: The EBP Mentorship Scale data were obtained from a previous national cross-sectional descriptive study with 2344 nurses from 19 hospitals and healthcare systems. Descriptive statistics summarized the sample and distributions of the scale items. Cronbach's alpha, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were conducted. RESULTS: Cronbach's alpha of the scale was 0.99. A one-factor model was supported by EFA and retained for CFA. Model fit indices for CFA indicated a good fit. LINKING EVIDENCE TO ACTION: The new EBP Mentorship Scale is valid and reliable and can be used to assess the level of EBP mentorship support available in hospitals and healthcare systems. EBP mentors are key in sustaining an EBP organizational culture and enhancing clinician EBP knowledge, beliefs, competency, and implementation.

Associations Among Nurses' Mental/Physical Health, Lifestyle Behaviors, Shift Length, and Workplace Wellness Support During COVID-19: Important Implications for Health Care Systems.

Work cultures supportive of wellness and shorter shift length have been associated with better mental/physical health outcomes in nurses, but how the coronavirus disease-19 (COVID-19) pandemic impacted such outcomes is not known. This study's aims were to (1) describe the mental/physical health, well-being, and healthy lifestyle behaviors of nurses during the pandemic; (2) explore the pandemic's impact on their health and healthy lifestyle behaviors; and (3) determine the associations of perceived workplace wellness support and shift length with nurses' health, well-being, and healthy lifestyle behaviors. A cross-sectional descriptive design was used with 264 nurses associated with Trusted Health. Nurses completed a survey containing valid and reliable scales measuring depression, anxiety, burnout and quality of life, perceived wellness culture, and healthy lifestyle behaviors. Results indicated that more than 50% of nurses had worsening mental/physical health relating to the pandemic. Compared with nurses whose workplaces provided little/no wellness support, nurses with workplaces that supported their wellness were 3 to 9 times as likely to have better mental/physical health, no/little stress, no burnout, and high quality of life. Nurses who worked longer shifts had poorer health outcomes. These findings indicate that workplace wellness support and shorter shifts positively impacted nurse mental/physical health and professional quality of life amidst the pandemic.

The state of mental health and healthy lifestyle behaviors in nursing, medicine and health sciences faculty and students at Big 10 Universities with implications for action.

BACKGROUND: High rates of mental health conditions and poor healthy lifestyle behaviors are reported in nurses, other clinicians, and health science students but have not been compared across different professions. PURPOSE: The purpose of this study was threefold: (1) describe rates of mental health problems and healthy lifestyle behaviors across the Big 10 health professional faculty and students, (2) compare the health and healthy lifestyle behaviors of the Big 10 health sciences faculty and students across health sciences' professions, and (3) identify factors predictive of depression, stress, and anxiety. METHODS: Faculty and students from eight health science colleges at the Big 10 Universities responded to the study survey, which included: demographics, healthy lifestyle behavior questions, and three valid/reliable mental health scales. Descriptive statistics described the findings and multiple linear regression identified factors associated with mental health conditions. RESULTS: Eight-hundred and sixty-nine faculty and 1087 students responded. Approximately 50% of faculty and students reported 7 h of sleep/night, a third achieved 150 min of physical activity/week; 5.5%-9.9% screened positive for depression; and 11.5%-25.5% had anxiety. Age, sleep, and physical activity were associated with lower depression and anxiety. CONCLUSIONS: University leadership must build wellness cultures that make healthy lifestyle behaviors easy to engage in and enhance mental well-being.

Evidence-Based Practice Culture and Mentorship Predict EBP Implementation, Nurse Job Satisfaction, and Intent to Stay: Support for the ARCC© Model.

BACKGROUND: The Advancing Research and Clinical practice through close Collaboration (ARCC© ) Model is a system-wide framework for implementing and sustaining evidence-based practice (EBP) in hospitals and healthcare systems. The model involves assessing organizational culture and readiness for EBP in addition to the development of a critical mass of EBP mentors who work with point-of-care clinicians to facilitate the implementation of evidence-based care. Determining how the various components of the ARCC© Model relate to one another is important for understanding how EBP culture and mentorship impact EBP implementation, nurses' job satisfaction, and intent to stay. AIMS: The current study aimed to test a model that could explain the relationships and direct pathways among eight key variables in the ARCC© Model: (1) EBP culture, (2) mentorship, (3) knowledge, (4) beliefs, (5) competency, (6) implementation, (7) nurses' job satisfaction, and (8) intent to stay. METHODS: Structural equation modeling was used to test relationships among the variables in the ARCC© Model with data obtained from an earlier cross-sectional descriptive study with 2,344 nurses from 19 hospitals and healthcare systems across the United States. RESULTS: The final structural equation model found that EBP culture and mentorship were key variables that positively impacted EBP knowledge, beliefs, competency, implementation, job satisfaction, and intent to stay among nurses. LINKING EVIDENCE TO ACTION: As described in the ARCC© Model, establishing a strong sustainable EBP culture along with a critical mass of EBP mentors is crucial for the development of EBP competency and consistent implementation of evidence-based care by nurses. A strong EBP culture along with EBP mentorship also can result in higher job satisfaction and intent to stay. Implementation of the ARCC© Model is a key strategy in assisting systems to reach health care's Quadruple Aim.

Psychometric Properties of the Short Versions of the EBP Beliefs Scale, the EBP Implementation Scale, and the EBP Organizational Culture and Readiness Scale.

BACKGROUND: Evidence-based practice (EBP) is a problem-solving approach to clinical decision making that leads to a higher quality and safety of health care. Three valid and reliable scales that measure EBP attributes, including the EBP Beliefs Scale, the EBP Implementation Scale, and the Organizational Culture and Readiness Scale for System-Wide Integration of EBP, are widely used but require approximately 5 min each to complete. Shorter valid and reliable versions of these scales could offer the benefit of less time for completion, thereby decreasing participant burden. AIM: The aim of this study was to determine the psychometric properties of the three shortened EBP scales, adapted from the longer versions. METHODS: This study used a descriptive survey design with 498 nurses who completed the three original EBP scales along with a shortened version of each scale. Exploratory factor analysis was conducted with principal components extracted to examine the factor structure of each EBP measure for the three shortened EBP scales. Item intercorrelations and the Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) were used to confirm the validity of using factor analysis. Reliability of each scale using Cronbach's α was examined. Convergent validity of the three shortened EBP scales was assessed by correlating each shortened scale with its longer scale. RESULTS: Factor analysis supported the construct validity of each of the three shortened scales, as all item intercorrelations were greater than 0.40, and KMO values were 0.62 to 0.74. The shortened scales Cronbach alphas were 0.81 for the EBP Beliefs Scale, 0.89 for the EBP Implementation Scale, and 0.87 for the EBP Culture and Readiness Scale. The three shortened EBP scales had acceptable convergent validity (r = 0.42-.072) for the correlations between the shortened and longer scales. LINKING EVIDENCE TO ACTION: The three shortened EBP scales, which are valid and reliable, can be used as an alternative to the longer three scales to decrease participant burden when conducting program evaluations, research, or organizational assessments.

Critical Care Nurses' Physical and Mental Health, Worksite Wellness Support, and Medical Errors.

BACKGROUND: Critical care nurses experience higher rates of mental distress and poor health than other nurses, adversely affecting health care quality and safety. It is not known, however, how critical care nurses' overall health affects the occurrence of medical errors. OBJECTIVE: To examine the associations among critical care nurses' physical and mental health, perception of workplace wellness support, and self-reported medical errors. METHODS: This survey-based study used a cross-sectional, descriptive correlational design. A random sample of 2500 members of the American Association of Critical-Care Nurses was recruited to participate in the study. The outcomes of interest were level of overall health, symptoms of depression and anxiety, stress, burnout, perceived worksite wellness support, and medical errors. RESULTS: A total of 771 critical care nurses participated in the study. Nurses in poor physical and mental health reported significantly more medical errors than nurses in better health (odds ratio [95% CI]: 1.31 [0.96-1.78] for physical health, 1.62 [1.17-2.29] for depressive symptoms). Nurses who perceived that their worksite was very supportive of their well-being were twice as likely to have better physical health (odds ratio [95% CI], 2.16 [1.33-3.52]; 55.8%). CONCLUSION: Hospital leaders and health care systems need to prioritize the health of their nurses by resolving system issues, building wellness cultures, and providing evidence-based wellness support and programming, which will ultimately increase the quality of patient care and reduce the incidence of preventable medical errors.

Differences Between Magnet and Non-Magnet-Designated Hospitals in Nurses' Evidence-Based Practice Knowledge, Competencies, Mentoring, and Culture.

BACKGROUND: Obtaining Magnet recognition is important to hospitals as it has been linked to positive nursing and patient outcomes. Evidence-based practice (EBP) also has been shown to positively impact these same outcomes. However, the effect that Magnet designation has on different facets of EBP when compared to non-designated institutions is less understood. AIMS: To determine the differences between Magnet-designated versus non-Magnet-designated hospitals on nurses' EBP knowledge, competency, mentoring, and culture. METHODS: A secondary analysis was performed on data obtained from the Melnyk et al. (2018) national study of U.S. nurses' EBP competencies. RESULTS: 2,344 nurses completed the survey (n = 1,622 Magnet and n = 638 non-Magnet). Magnet-designated hospital nurses had higher scores in EBP knowledge (mean ± SD: 19.9 ± 6.8 vs. 19.1 ± 7.0, Cohen's d = 0.12), mentoring (22.6 ± 11.1 vs. 18.6 ± 10.1, d = 0.38), and culture (82.9 ± 21.8 vs. 74.1 ± 21.3, d = 0.41). There was no difference between the two groups in EBP competency scores (53.8 ± 16.2 vs. 53.0 ± 15.9, d = 0.05), and average scores for the 24 EBP competency items were less than competent in both groups. LINKING EVIDENCE TO PRACTICE: Despite having higher knowledge, stronger perceived EBP cultures, and greater EBP mentoring than non-Magnet-designated nurses, Magnet nurses did not meet the EBP competencies. A tremendous need exists to provide nurses with the knowledge and skills to achieve the EBP competencies in both Magnet and non-Magnet-designated hospitals. A critical mass of EBP mentors who also meet the EBP competencies is needed to work with point-of-care nurses to ensure that EBP competency is achieved in order to ultimately ensure healthcare quality and safety. Rigorous studies are needed to determine which interventions at the academic and clinical education level result in improved EBP competency.