Public health nursing workforce and learning needs: A national sample survey analysis.

OBJECTIVES: Generate national estimates of the public health nursing workforce's (1) demographic and work characteristics and (2) continuing education learning needs in the United States. DESIGN: Secondary data analysis of the 2018 National Sample Survey of Registered Nurses. SAMPLE: Total 7352 of the 50,273 survey respondents were categorized as public health nurses (PHNs), representing an estimated 467,271 national workforce. MEASUREMENTS: Survey items for demographics, practice setting, training topics, and language(s) spoken fluently were analyzed. RESULTS: Workforce demographic characteristics are included. Mental health training was the most frequently endorsed topic by PHNs, followed by patient-centered care and evidence-based care. Training topic needs vary by practice setting. CONCLUSIONS: Results here can be used as a needs assessment for national public health nursing professional development and education initiatives. Further research is needed to refine and survey a nationally representative sample in a manner meaningful to public health nursing practice.

Emergency Nursing Workforce, Burnout, and Job Turnover in the United States: A National Sample Survey Analysis.

INTRODUCTION: Few studies have examined emergency nurses who have left their job to better understand the reason behind job turnover. It also remains unclear whether emergency nurses differ from other nurses regarding burnout and job turnover reasons. Our study aimed to test differences in reasons for turnover or not currently working between emergency nurses and other nurses; and ascertain factors associated with burnout as a reason for turnover among emergency nurses. METHODS: We conducted a secondary analysis of 2018 National Sample Survey for Registered Nurses data (weighted N = 3,004,589) from Health Resources and Services Administration. Data were analyzed using descriptive statistics, chi-square and t-test, and unadjusted and adjusted logistic regression applying design sampling weights. RESULTS: There were no significant differences in burnout comparing emergency nurses with other nurses. Seven job turnover reasons were endorsed by emergency nurses and were significantly higher than other nurses: insufficient staffing (11.1%, 95% confidence interval [CI] 8.6-14.2, P = .01), physical demands (5.1%, 95% CI 3.4-7.6, P = .44), patient population (4.3%, 95% CI 2.9-6.3, P < .001), better pay elsewhere (11.5%, 95% CI 9-14.7, P < .001), career advancement/promotion (9.6%, 95% CI 7.0-13.2, P = .01), length of commute (5.1%, 95% CI 3.4-7.5, P = .01), and relocation (5%, 95% CI 3.6-7.0, P = .01). Increasing age and increased years since nursing licensure was associated with decreased odds of burnout. DISCUSSION: Several modifiable factors appear associated with job turnover. Interventions and future research should account for unit-specific factors that may precipitate nursing job turnover.

Generating Data Visualizations of Longitudinal Cohort Ambient Air Pollution Exposure: Report-Back Intervention Development in Participatory Action Research.

A civic engagement and data science design was used to develop a report-back intervention to address stakeholder concerns related to air emissions surrounding a coke oven factory near Buffalo, NY. This factory had historically emitted high levels of benzene pollution and ceased operation in October 2018 because of violations of the US Clean Air Act and US Resource Conservation and Recovery Act. Using publicly available air pollution and weather data, descriptive time series and wind-rose data visualizations were developed using open-source software as part of a two-page report-back brief. Data from two air toxics monitoring sites in this direction suggest that industrial sources were likely the major contributor to the benzene in the air at these locations prior to May 2018, after which traffic emissions became the likely major contributor. Wind-rose visualizations demonstrated that the wind typically blew toward the northeast, which was qualitatively consistent with locations of stakeholder concerns. With the factory closed, collective efforts subsequently shifted to address traffic emission air pollution sources, factory site cleanup, and ground and water pollution mitigation. Because this intervention utilized open-source software and publicly available data, it can serve as a blueprint for future data-driven nursing interventions and community-led environmental justice efforts.

National Estimates of Workplace Telehealth Use Among Emergency Nurses and All Registered Nurses in the United States.

INTRODUCTION: The goal of this research was to quantify the baseline status of prepandemic workplace emergency nursing telehealth as a key consideration for ongoing telehealth growth and sustainable emergency nursing care model planning. The purpose of this research was to: (1) generate national estimates of prepandemic workplace telehealth use among emergency and other inpatient hospital nurses and (2) map the geographic distribution of prepandemic workplace emergency nurse telehealth use by state of nurse residence. METHODS: We generated national estimates using data from the 2018 National Sample Survey of Registered Nurses. Data were analyzed using jack-knife estimation procedures coherent with the complex sampling design selected as representative of the population and requiring analysis with survey weights. RESULTS: Weighted estimates of the 161 865 emergency nurses, compared with 1 191 287 other inpatient nurses revealed more reported telehealth in the workplace setting (49% vs 34%) and individual clinical practice telehealth use (36% vs 15%) among emergency nurses. The geographic distribution of individual clinical practice emergency nurse telehealth use indicates greatest adoption per 10 000 state residents in Maine, Alaska, and Missouri with more states in the Midwest demonstrating emergency nurse adoption of telehealth into clinical practice per population than other regions in the United States. DISCUSSION: By quantifying prepandemic national telehealth use, the results provide corroborating evidence to the potential long-term adoptability and sustainability of telenursing in the emergency nursing specialty. The results also implicate the need to proactively define emergency nursing telehealth care model standards of practice, nurse competencies, and reimbursement.

Racial Identity and Transcultural Adoption.

Transracial/transcultural adoption is defined as a child of one race or ethnic group placed with parent(s) of a different race or ethnic group. An estimated 2 million children in the United States were identified as adopted in the 2010 census, and approximately one-fourth of these were transracial adoptions. Both a history of adoption and a strong ethnic or racial identity are specifically associated with health-related risk and protective factors for psychosocial, academic, and health behavior outcomes. A patient with a history of transracial adoption presents unique and important considerations for culturally responsive nursing care. This article begins with nursing practice considerations for transracially adoptive patients and provides an overview of epidemiology; relevant trauma informed nursing care;. laws and racial identity formation, and a mental model of health disparities to guide future directions. We synthesize information relevant to nursing care of individuals who are transracially adopted and racial/ethnic identity formation, including socialization and a merging model to conceptualize identities. The article also discusses principles of trauma informed care and health disparities and future improvements in the context of this population.

National Estimates of the Reserve Capacity of Registered Nurses Not Currently Employed in Nursing and Emergency Nursing Job Mobility in the United States.

STUDY OBJECTIVE: In a large-scale disaster, recruiting from all retired and nonworking registered nurses is one strategy to address surge demands in the emergency nursing workforce. The purpose of this research was to estimate the workforce capacity of all registered nurses who are not currently working in the nursing field in the United States by state of residence and to describe the job mobility of emergency nurses. METHODS: Weighted population estimates were calculated using the 2018 National Sample Survey of Registered Nurses. Estimates of all registered nurses, including nurse practitioners who were not actively working in nursing as well as only those who were retired, based on demographics, place of residence, and per 1,000 state population, were visualized on choropleth maps. Workforce mobility into and out of the emergency nursing specialty between 2016 and 2017 was quantified. RESULTS: Of the survey participants, 61% (weighted n=2,413,382) worked full time as registered nurses at the end of both 2016 and 2017. At the end of 2017, 17.3% (weighted n=684,675) were not working in nursing. The Great Lakes states and Maine demonstrated the highest per capita rate of those not working in nursing, including those who had retired. The largest proportion of those entering the emergency nursing specialty were newly licensed nurses (15%; weighted n=33,979). CONCLUSION: There is an additional and reserve capacity available for recruitment that may help to meet the workforce needs for nursing, specifically emergency nurses and nurse practitioners, across the United States under conditions of a large-scale disaster. The results from this study may be used by the emergency care sector leaders to inform policies, workforce recruitment, workforce geographic mobility, new graduate nurse training, and job accommodation strategies to fully leverage the potential productive human capacity in emergency department care for registered nurses who are not currently working.

Efficacy of Precise Foot Massage Therapy on Pain and Anxiety Following Cardiac Surgery: Pilot Study.

BACKGROUND: Pain is the most pervasive distressing symptom following cardiac surgery. Forty percent of postoperative cardiac patients report inadequate pain management. Undertreated acute pain results in increased anxiety, delayed wound healing, and increased chance of persistent chronic pain. Foot massage is a safe, visible complementary approach to manage acute pain following surgery. AIM: The aim of this study is to evaluate the efficacy of integrating foot massage therapy for managing postcardiac pain. METHOD: A randomized placebo controlled single blinded trial comparing foot massage to placebo was conducted at a large hospital in Saudi Arabia. Thirty-one patients who had undergone cardiac surgery (16 in experimental and 15 in placebo group) participated in the study. Ten-minute foot massage was delivered to the experimental group by a nurse researcher, twice during one day, within 30 minutes after receiving an opioid pain medication. RESULTS: The findings of this study indicate that foot massage significantly (p < .05) decreases pain intensity and anxiety in patients who have undergone cardiac surgery compared with a placebo control group. CONCLUSION: Providing non-pharmacologic interventions for pain is the responsibility of the nursing staff. Foot massage is within the scope of nursing practice and is a safe and effective manner of improving patient care. Foot massage in conjunction with pharmacological interventions is effective in improving pain and anxiety. Future studies should consider focusing on frequency, dose, feasibility, acceptability, and participants' satisfaction.

State Laws and Regulations Addressing Nurse-Initiated Protocols and Use of Nurse-Initiated Protocols in Emergency Departments: A Cross-Sectional Survey Study.

INTRODUCTION: State regulations may impede the use of nurse-initiated protocols to begin life-saving treatments when patients arrive to the emergency department. In crowding and small-scale disaster events, this could translate to life and death practice differences. Nevertheless, research demonstrates nurses do utilize nurse-initiated protocols despite legal prohibitions. The purpose of this study was to explore the relationship of the state regulatory environment as expressed in nurse practice acts and interpretive statements prohibiting the use of nurse-initiated protocols with hospital use of nurse-initiated protocols in emergency departments. METHODS: A cross-sectional approach was used with a nationwide survey. The independent variable categorized the location of the hospital in states that have a protocol prohibition. Outcomes included protocols for blood laboratory tests, X-rays, over-the-counter medication, and electrocardiograms. A second analysis was completed with New York State alone because this state has the strongest language prohibiting nurse-initiated protocols. RESULTS: A total of 350 participants returned surveys from 48 states and the District of Columbia. A hospital was more likely to have policies supporting nurse-initiated protocols if they were not in a state with the scope of practice prohibitions. Four categories emerged such as advantages, approval, prohibition, and conditions under which the protocols can be used. Prohibitive language was associated with less protocol use for emergency care. CONCLUSION: State scope of practice inconsistencies create misalignment with emergency nurse education and training, which may impede timely care and contribute to inequalities and inefficiencies in emergency care. In addition, prohibitive language places practicing nurses responding to emergencies in crowded work environments at risk.

Validation of fitness tracker for sleep measures in women with asthma.

OBJECTIVE: Nighttime wakening with asthma symptoms is a key to assessment and therapy decisions, with no gold standard objective measure. The study aims were to (1) determine the feasibility, (2) explore equivalence, and (3) test concordance of a consumer-based accelerometer with standard actigraphy for measurement of sleep patterns in women with asthma as an adjunct to self-report. METHODS: Panel study design of women with poorly controlled asthma from a university-affiliated primary care clinic system was used. We assessed sensitivity and specificity, equivalence and concordance of sleep time, sleep efficiency, and wake counts between the consumer-based accelerometer Fitbit Charge™ and Actigraph wGT3X+. We linked data between devices for comparison both automatically by 24-hour period and manually by sleep segment. RESULTS: Analysis included 424 938 minutes, 738 nights, and 833 unique sleep segments from 47 women. The fitness tracker demonstrated 97% sensitivity and 40% specificity to identify sleep. Between device equivalence for total sleep time (15 and 42-minute threshold) was demonstrated by sleep segment. Concordance improved for wake counts and sleep efficiency when adjusting for a linear trend. CONCLUSIONS: There were important differences in total sleep time, efficiency, and wake count measures when comparing individual sleep segments versus 24-hour measures of sleep. Fitbit overestimates sleep efficiency and underestimates wake counts in this population compared to actigraphy. Low levels of systematic bias indicate the potential for raw measurements from the devices to achieve equivalence and concordance with additional processing, algorithm modification, and modeling. Fitness trackers offer an accessible and inexpensive method to quantify sleep patterns in the home environment as an adjunct to subjective reports, and require further informatics development.

Advancing the symptom science model with environmental health.

OBJECTIVE: Globally, indoor and outdoor pollutants are leading risk factors for death and reduced quality of life. Few theories explicitly address environmental health within the nursing discipline with a focus on harmful environmental exposures. The objective here is to expand the National Institutes of Health Symptom Science Model to include the environmental health concepts of environmental endotype (causative pathway) and environmental exposure. DESIGN: Meleis' research to theory strategy for theory refinement was used. Research workshop proceedings, environmental health nursing research expert consensus, panelist research trajectories, and review of the literature were utilized as data sources. RESULTS: Ongoing emphasis on the physical environment as a key determinant of health and theoretical perspectives for including environmental exposures and endotypes in symptom science are presented. Definitions of these concepts, further developed, are provided. Recommendations to strengthen environmental health nursing research and practice through capacity building/infrastructure, methods/outcomes, translational/clinical research, and basic/mechanistic research are included. CONCLUSION: The revised model deepens theoretical support for clinical actions that include environmental modification, environmental health education, and exposure reduction. This modification will enable a middle-range theory and shared mental model to inspire the prioritization of environmental health in nursing leadership, research, practice, and education.

Air pollution and emergency department visits for respiratory diseases: A multi-city case crossover study.

Increasing evidence suggests that ambient air pollution is a major risk factor for both acute and chronic respiratory disease exacerbations and emergencies. The objective of this study was to determine the association between ambient air pollutants and emergency department (ED) visits for respiratory conditions in nine districts across the province of Ontario in Canada. Health, air pollutant (PM2.5, NO2, O3, and SO2), and meteorological data were retrieved from April 2004 to December 2011. Respiratory diseases were categorized as: chronic obstructive pulmonary disease (COPD, including bronchiectasis) and acute upper respiratory diseases. A case-crossover design was used to test the associations between ED visits and ambient air pollutants, stratified by sex and season. For COPD among males, positive results were observed for NO2 with lags of 3-6 days, for PM2.5 with lags 1-8, and for SO2 with lags of 4-8 days. For COPD among females, positive results were observed for O3 with lags 2-4 days, and for SO2 among lags of 3-6 days. For upper respiratory disease emergencies among males, positive results were observed for NO2 (lags 5-8 days), for O3, (lags 0-6 days), PM2.5 (all lags), and SO2 (lag 8), and among females, positive results were observed for NO2 for lag 8 days, for O3, PM2.5 among all lags. Our study provides evidence of the associations between short-term exposure to air pollution and increased risk of ED visits for upper and lower respiratory diseases in an environment where air pollutant concentrations are relatively low.

Ambient air pollution and emergency department visits for asthma in Erie County, New York 2007-2012.

PURPOSE: 8% of the US population has asthma. Air pollution is linked to exacerbation in susceptible individuals. The objective was to identify air pollutants that increased the risk of asthma emergency department visits during a time wherein a polluting factory was criminally convicted, changing local air pollutant levels. METHODS: An ecological time-series design used a daily count of asthma emergency visits from 2007 to 2012 as the dependent variable. Independent variables air pollutants (NO2, PM2.5 CO, and O3), controlling for meteorological conditions, were analyzed using time-series and Poisson GLM models. RESULTS: 76,651 emergency asthma visits were included with an average of 35 visits per day (SD = 9.2, range 11-80) in a stationary time series. Increased visit volume in fall and spring had no associations to the air pollutants. Associations between individual air pollutants occurred in otherwise low-volume months for asthma emergency visits. The strongest relationship was an 11.6% increase in the asthma emergency visit rate during the month of June. In monthly groupings that removed most of the autumn and spring months, O3, PM2.5, CO, and NO2 were associated with 5, 4, 2, and 2% increases in asthma emergency visits, respectively. CO was the only pollutant with a negative association with asthma emergency visits, occurring in the month of April. CONCLUSIONS: Pollutants NO2, PM2.5 CO, and O3 were associated with increased emergency asthma visits in some, but not all months of the year. Air pollution's impact on asthma emergencies may be masked by other, more influential seasonal triggers, such as infections or allergies.

Community interest and feasibility of using a novel smartphone-based formaldehyde exposure detection technology.

OBJECTIVE: This study is the first community engagement phase of a project to develop a residential formaldehyde detection system. The objectives were to conduct a feasibility assessment for device use, and identify factors associated with concerns about environmental exposure and community interest in this device. DESIGN AND SAMPLE: A cross-sectional, internet-based survey employing community-based participatory research principles was utilized. 147 individuals participated from a focused Waycross, Georgia (58.5%) and broader national sample (41.5%). MEASURES: Variables included acceptable cost and number of testing samples, interest in conducting tests, levels of concern over pollutants, health status, housing, and demographics. RESULTS: The majority of participants desired a system with fewer than 10 samples at ≤$15.00 per sample. Statistically significant higher levels of concern over air quality, formaldehyde exposure, and interest in testing formaldehyde were observed for those with overall worse health status and living in the Waycross, Georgia geographic region. Significant differences in formaldehyde testing interest were observed by health status (OR = 0.31, 95% CI = 0.12-0.81 for home testing) and geographic location (OR = 3.16, 95% CI = 1.22-8.14 for home and OR = 4.06, 95% CI = 1.48-11.12 for ambient testing) in multivariate models. CONCLUSIONS: Geographic location and poorer general health status were associated with concerns over and interest in formaldehyde testing.

Emergency Department Crowding and Time at the Bedside: A Wearable Technology Feasibility Study.

INTRODUCTION: ED crowding is a public health crisis, limiting quality and access to lifesaving care. The purpose of this study was to (1) evaluate the feasibility of radio-frequency identification tags to measure clinician-patient contact and (2) to test the relationship between ED occupancy and clinician-patient contact time. METHODS: In this 4-week observational study, radio-frequency identification tags were worn by emergency clinicians in a 21-bay urban teaching hospital emergency department. The time-motion data were merged with electronic medical repository patient information (N = 3,237) to adjust for occupancy, age, gender, and acuity. Qualitative themes were generated from focus group (N = 39) debriefings of the quantitative results. RESULTS: Data were collected on 56,342 total clinician events. Adjusting for patient age, increasing ED occupancy increased the number of times the attending physician entered and left the patient room (b = 0 .008, 95% confidence interval [CI] = [0.001-0.016], P = 0.03). There was no relationship for patient gender, triage acuity, shift at arrival, disposition to home, or discharge diagnosis category with either total minutes or number of encounters per patient visit. No time-motion and occupancy associations were observed for nurses, residents, or nurse practitioners/physician assistants. Debriefings indicated occupancy influenced the quality of care, despite maintaining the same quantity of contact time. DISCUSSION: The physical environment and clinician privacy concerns limit the feasibility of wearable tracking technology in the emergency setting. Attending physician care becomes more fragmented with increasing ED occupancy. Other clinicians report changes in the quality of care, whereas the quantity of time and encounters were unchanged with occupancy rates.

Nursing teams: behind the charts.

AIMS: To examine the nature and characteristics of both received and provided mutual support in a social network within an acute care hospital unit. BACKGROUND: Current evidence regarding the social network in the health care workforce reveals the nature of social ties. Most studies of social network-related support that measured the characteristics of social support used self-reported perception from workers receiving support. There is a gap in studies that focus on back-up behaviour. METHODS: The evaluation included a social network analysis of a nursing unit employing 54 staff members. A 12 item electronic survey was administered. Descriptive statistics were calculated using the Statistical Package for the Social Sciences. Social network analyses were carried out using ucinet, r 3.2.3 and gephi. RESULTS: Based on the study findings, as providers of mutual support the nursing staff claimed to give their peers more help than these peers gave them credit for. Those who worked overtime provided more mutual support. CONCLUSION: Mutual support is a key teamwork characteristic, essential to quality and safety in hospital nursing teams that can be evaluated using social network analysis. IMPLICATIONS FOR NURSING MANAGEMENT: Because of a discrepancy regarding receiving and providing help, examining both receiver and provider networks is a superior approach to understanding mutual support.