The Similarities and Differences in Transition to Practice Experiences for New-Graduate RNs and Practical Nurses in Long-term Care.

OBJECTIVE: The aim of this study was to describe the transition-to-practice experience of new-graduate nurses (NGNs) in long-term-care (LTC) settings. BACKGROUND: Transitioning to professional practice is a challenging time for an NGN. This experience is scarcely described for RNs outside of acute care settings and not described for the LPN. METHODS: A qualitative case study was used to explore the described transition-to-practice experience of new-graduate RNs and LPNs in LTC. RESULTS: This study revealed that the transition-to-practice experience of new-graduate LPNs was similar to the experience described by RNs. Differences in experience were related to leadership roles in the setting. CONCLUSIONS: Findings contribute to new understanding of the experience of the NGN in LTC settings. This study reinforces the need for greater support for nursing graduates in this setting.

Program outcomes following implementation of a hybrid curriculum at the certificate level.

AIM: This study examined satisfaction levels and learning outcomes before and after implementation of a hybrid curriculum. BACKGROUND: Increased competition for clinical sites pressured a practical nursing program to explore alternative placement solutions. A hybrid curriculum, defined as offering 50 percent of second-semester theory course content online, was implemented in order to free students from place-bound instruction and thereby open new clinical opportunities. METHODS: A summative evaluation was conducted to compare NCLEX-PN pass rates, grade outcomes, student satisfaction, and attrition rates between a prehybrid group of 119 practical nursing students and a hybrid group of 106 practical nursing students. RESULTS: Findings indicate no significant differences in NCLEX pass rates and grade outcomes between the groups and an improvement in satisfaction and attrition rates. CONCLUSION: It was concluded that use of a hybrid curriculum can open new clinical opportunities while maintaining the learning outcomes of NCLEX-PN pass rates and course grades.

Practice patterns of licensed practical nurses in North Carolina.

In the United States, state laws develop basic practices to define the scopes of practice for registered nurses and licensed practical nurses (LPNs). The purpose of the study was to describe the actual practice patterns of LPNs working in North Carolina. The results of the study convey an unfavorable pattern regarding LPN scope of practice. Indications are that a paradigm shift might be required in order to reverse the pattern of overpractice by LPNs.

Continued competency and board regulation: one state expands options.

State boards of nursing are mandated by state statutes to ensure the ongoing safe and competent practice of licensees. However, nursing practice is characterized by diversity in educational backgrounds, scope of practice, and variety of settings. As a result, regulatory agencies face many challenges. After years of study, the Texas Board of Nursing has identified two areas for change to the current regulatory model. The first area is a recommendation that nurses obtain continuing education credit in the individual nurse's area of practice. The second area is an acknowledgment of national specialty nursing certification as one method of demonstrating continuing competency in the nurse's specialty or area of practice. Both professional and vocational/practical nurses are affected by the rule changes.

An overview of the competency movement in nursing and midwifery.

The aim of this paper is to examine the purpose and growth of the development of general, advanced and specialist competency standards in nursing and midwifery in Australia. The definitions, content, types, utility and acceptability of competencies are reviewed. This paper also reports the results of a recent survey of nurses and midwives about the uses of competency standards. Challenges in identifying and assessing the impact of competency standards on practice and professional development; reasons for their proliferation and associated shortcomings such as their lack of cultural sensitivity and inability to reflect the complexity of nursing care are also explored. The rationale for this paper is that charting these issues and identifying gaps in the field will assist the further development and refinement of competency frameworks for Australian nursing. The paper concludes by recommending that future research in this area should focus on: (1) formal analysis of the validity and suitability of competency standards in relation to the purposes for which they are designed; (2) the mapping of competency domains, elements and performance criteria to identify similarities and differences in order to provide insight into the nature of both specialist and advanced practice nursing; and (3) a systematic review of the competency literature to ascertain the level of evidence that exists to support the use of competencies in terms of standard setting, safe practice and enhancement of patient outcomes.

Intersecting Policy Contexts of Employment-Related Geographical Mobility of Healthcare Workers: The Case of Nova Scotia, Canada.

Mobility and movement is an increasingly important part of work for many, however, Employment-Related Geographical Mobility (ERGM), defined as the extended movement of workers between places of permanent residence and employment, is relatively understudied among healthcare workers. It is critical to understand the policies that affect ERGM, and how they impact mobile healthcare workers. We outline four key intersecting policy contexts related to the ERGM of healthcare workers, focusing on the mobility of Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Continuing Care Assistants (CCAs) in Nova Scotia: international labour mobility and migration; interprovincial labour mobility; provincial credential recognition; and, workplace and occupational health and safety.

Blood pressure determination by traditionally trained personnel is less reliable and tends to underestimate the severity of moderate to severe hypertension.

OBJECTIVE: Blood pressure determined by nurses has been observed to be unreliable. This study was conducted to compare the reliability of blood pressure measurements performed by traditionally trained nurses with those performed by a well-trained nurse and by an automatic device. METHODS: Hypertensive patients in an outpatient clinic were studied. Each individual was subjected to three blood pressure measurements: the first one was performed by the traditionally trained nurse on duty at the time of study (TT nurse BP), the second one by a specifically trained nurse (ST nurse BP), both using sphygmomanometer; and the third one was done using Omron HEM-907 (digital BP). RESULTS: A total of 907 participants were enrolled. More than 99% of both systolic and diastolic TT nurse BP ended with zero, demonstrating that they had terminal digit preference. ST nurse BP was in better agreement with digital blood pressure measurement than with TT nurse BP. The number of differences of < or =5 mmHg between ST nurse BP and digital blood pressure measurement was approximately 60% for both systolic and diastolic blood pressure. Overall, traditionally trained nurses overestimated, rather than underestimated, blood pressure. However, systolic blood pressure underestimation was extremely prominent in participants with moderate to severe hypertension. Systolic blood pressure underestimation of >5 mmHg was as high as 57.5% by traditionally trained nurses versus 33.8% by the automatic device, indicating that traditionally trained nurses tended to underestimate blood pressure in participants with more severe hypertension.

Desinfecção de hubs e conectores de cateteres intravenosos: revisão de escopo / Desinfección de hubs y conectores de catéteres intravenosos: revisión de alcance / Disinfection of intravenous catheter hubs and connectors: scoping review

RESUMO Objetivo: identificar métodos de desinfecção de hubs e conectores sem agulha dos cateteres intravenosos em pacientes hospitalizados e verificar a efetividade das intervenções para a prevenção de infecções de corrente sanguínea associada a cateter intravenoso. Método: revisão de escopo seguindo as recomendações de Joanna Briggs Institute. Busca realizada em bases de dados eletrônicas Pubmed, Embase, Cochrane Library, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de Dados Enfermagem e Bibliografía Nacional en Ciencias de la Salud Argentina, e estudos indicados por experts. A busca foi atemporal até setembro de 2020. Protocolo registrado na Open Science Framework. Resultados: foram incluídos 27 estudos, sendo que cinco foram Guidelines e 22 foram artigos publicados em periódicos. Existe grande variedade de métodos de desinfecção de hubs e de conectores. Para a desinfecção ativa, foram indicados Gluconato de Clorexedina, Isopropanol e Iodopovedina; para a desinfecção passiva, Gluconato de Clorexedina e Isopropanol. A quantidade do agente desinfetante variou de 0,25 mL a 0,6 mL. O tempo de fricção na desinfecção ativa variou de cinco segundos a 30 segundos, e o tempo de contato na desinfecção passiva variou de três minutos a sete dias. O tempo de secagem de agentes desinfetantes foi superior a cinco segundos. Conclusão: verifica-se variedade de métodos de desinfecção; no entanto, não há consenso sobre a melhor indicação. Necessita-se de estudos que evidenciem a quantidade de desinfetante, a pressão e o tempo de fricção e o tempo de secagem. Pesquisas com práticas de desinfecção utilizadas no Brasil e ensaios clínicos randomizados são necessários.

RESUMEN Objetivo: identificar los métodos de desinfección de los hubs y conectores sin aguja de los catéteres intravenosos en pacientes hospitalizados, y verificar la eficacia de las intervenciones para la prevención de las infecciones del torrente sanguíneo asociadas a los catéteres intravenosos. Método: revisión del alcance siguiendo las recomendaciones del Instituto Joanna Briggs. Búsqueda realizada en las bases de datos electrónicas Pubmed, Embase, Biblioteca Cochrane, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Base de Datos de Enfermería y Bibliografía Nacional en Ciencias de la Salud Argentina, y estudios indicados por expertos. La búsqueda era atemporal hasta septiembre de 2020. Protocolo registrado en el Open Science Framework. Resultados: se incluyeron 27 estudios, cinco de los cuales eran Guidelines y 22 eran artículos publicados en revistas. Existe una gran variedad de métodos para la desinfección de hubs y conectores, siendo el gluconato de clorhexedina, el isopropanol y la yodopovedina los indicados para la desinfección activa, y el gluconato de clorhexedina y el isopropanol para la desinfección pasiva. La cantidad del agente desinfectante osciló entre 0,25 mL y 0,6 mL. El tiempo de fricción para la desinfección activa osciló entre cinco segundos y 30 segundos, y el tiempo de contacto para la desinfección pasiva osciló entre tres minutos y siete días. El tiempo de secado de los agentes desinfectantes fue superior a cinco segundos. Conclusión: se comprueba la variedad de métodos de desinfección, aunque no hay consenso sobre la mejor indicación. Se necesitan estudios que evidencien la cantidad de desinfectante, la presión y el tiempo de fricción, y el tiempo de secado. Es necesario investigar las prácticas de desinfección utilizadas en Brasil y realizar ensayos clínicos aleatorios.

ABSTRACT Objective: to identify disinfection methods for intravenous catheter hubs and needleless connectors in hospitalized patients, as well as to verify the effectiveness of the interventions to prevent bloodstream infections associated with intravenous catheters. Method: a scoping review following the Joanna Briggs Institute recommendations. The search was conducted in the following electronic databases: PubMed, Embase, Cochrane Library, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de Dados Enfermagem and Bibliografía Nacional en Ciencias de la Salud Argentina, as well as in studies indicated by experts. The search was conducted until September 2020. The review protocol was registered in the Open Science Framework. Results: a total of 27 studies were included, of which five were Guidelines and 22 were articles published in journals. There is a significant variety of disinfection methods for hubs and connectors. Chlorhexidine Gluconate, Isopropanol and Povidone-iodine were indicated for active disinfection; and Chlorhexidine Gluconate and Isopropanol, for passive disinfection. The disinfectant volume varied from 0.25 mL to 0.6 mL. Friction time in active disinfection ranged from five to 30 seconds, and contact time in passive disinfection varied from three minutes to seven days. The disinfectants' drying time was over five minutes. Conclusion: a variety of disinfection methods is verified, although with no consensus on the best indication. Studies that show the amount of disinfectant, pressure, friction and drying time are required. There is a need to conduct research studies with disinfection practices used in Brazil and randomized clinical trials.

We have gone full circle.

In 1983 I qualified as a state enrolled nurse (SEN). Our role was supposed to be complementary to the registered nurses, but most SENs carried out the same duties as their registered colleagues. We were valued members of the nursing team.

Readers' panel - Should staff extend their roles to meet rising demand?

Our experts consider a hot topic of the day.

Optune®: Practical Nursing Applications.

BACKGROUND: After receiving U.S. Food and Drug Administration approval for the treatment of newly diagnosed glioblastoma (GBM) in 2015, following initial approval for treatment of recurrent GBM in 2011, Optune®, a device that uses tumor-treating fields (TTFields) therapy, continues to gain acceptance in the practice environment. OBJECTIVES: This article reviews how TTFields differ from traditional GBM treatment approaches and discusses the pivotal role nurses play in helping patients successfully use this therapy. This includes the importance of adherence to daily continuous therapy because adherence optimizes patient outcomes. METHODS: This article provides oncology nurses with practical guidance to share with patients who are candidates for treatment with TTFields, as well as information to facilitate patients' understanding of the use of Optune and how best to incorporate it into their activities of daily living. FINDINGS: Nurses are key members of the multidisciplinary treatment team that manages patients with GBM. Therefore, oncology nurses are well equipped to educate patients and caregivers about the use of and benefits of adherence to TTFields.

Non-physician practitioners in radiation oncology: advanced practice nurses and physician assistants.

PURPOSE: With changes in reimbursement and a decrease in the number of residents, there is a need to explore new ways of achieving high quality patient care in radiation oncology. One mechanism is the implementation of non-physician practitioner roles, such as the advanced practice nurse (APN) and physician assistant (PA). This paper provides information for radiation oncologists and nurses making decisions about: (1) whether or not APNs or PAs are appropriate for their practice, (2) which type of provider would be most effective, and (3) how best to implement this role. METHODS: Review of the literature and personal perspective. CONCLUSIONS: Specific issues addressed regarding APN and PA roles in radiation oncology include: definition of roles, regulation, prescriptive authority, reimbursement, considerations in implementation of the role, educational needs, and impact on resident training. A point of emphasis is that the non-physician practitioner is not a replacement or substitute for either a resident or a radiation oncologist. Instead, this role is a complementary one. The non-physician practitioner can assist in the diagnostic work-up of patients, manage symptoms, provide education to patients and families, and assist them in coping. This support facilitates the physician's ability to focus on the technical aspects of prescribing radiotherapy.

Accuracy of heart rate assessment in atrial fibrillation.

OBJECTIVE: To determine the most accurate technique to measure the heart rate during atrial fibrillation by use of three counting intervals, 15, 30, and 60 seconds, and two methods, apical and radial pulse measurement. DESIGN: A quasi-experimental, repeated measures factorial design was used to determine absolute error (amount of error ignoring direction of error) between heart rates obtained from six randomly ordered pulse measurements taken of one man in chronic atrial fibrillation by the 94 nurses in the sample and the heart rate recorded by simultaneous electrocardiographic (ECG) and plethysmographic (pleth) recordings. SUBJECTS: Nurses in four groups comprised the sample; registered nurses (N = 29), licensed practical nurses (N = 23), nursing students (N = 21), and registered nurses with advanced degrees who are clinical specialists and in faculty positions. RESULTS: The heart rate of the man varied from 57 to 111 beats/min (mean 81 beats/min). The mean absolute error rates for the six measurements ranged from 8 beats/min to 20 beats/min, all considered to be important when a 10% error was used as the criteria for clinical significance. The apical method was significantly more accurate than the radial method regardless of whether the ECG or pleth standard was used (ECG--F1.90 = 72.91, p less than 0.0001; pleth--F1.144 = 4.68, p = 0.036). The 60-second counting interval was significantly more accurate regardless of the standard (ECG--F2.180 = 5.19, p = 0.006; pleth--F2.88 = 3.95, p = 0.02). CONCLUSIONS: Atrial fibrillation occurs in 2% to 4% of people over 60 years of age and is one of the most difficult dysrhythmias to count. Accurate counts are important when making clinical decisions, yet measurement of heart rate in this study was quite inaccurate. The 60-second count and the apical method were the most accurate statistically, although differences in counting interval error rates were not clinically significant.

Ethical practice guidelines: an evaluation.

Ethical practice guidelines (EPGs) were developed for use in Central Sydney Area Mental Health Service to guide contemporary mental health nursing practice and serve as a resource for clinical mental health nurses in relation to their professional conduct and practice. This survey of mental health nurses aimed to ascertain feedback on the application of the EPGs in the clinical arena. Nurses from the Central Sydney Area Mental Health Service (n = 350) were asked to complete a 15-item survey developed by the authors. A total of 121 nurses completed the survey. Findings from the survey reveal that the information provided in the EPGs is useful (91%) and the EPGs provide sufficient guidance for practice (94%). Most respondents (96%) reported feeling confident dealing with ethical practice situations and 75% indicated interest in further education and training in this domain. Findings from this survey support the need to explore avenues to facilitate education, discussion and reflective practice in relation to ethical mental health nursing practice.

Statutory and regulatory recognition for clinical nurse specialists in Oregon.

Clinical nurse specialists (CNSs) in Oregon initiated the process of achieving statutory and regulatory recognition several years ago. Throughout this process, specific phases of activity and events helped CNSs to identify what was required to achieve this goal. The resulting lessons learned are shared in this report. Statutory recognition of CNSs in Oregon occurred in 1999, and the administrative rules for CNS practice were published in 2001. These administrative rules delineate the CNS scope of practice and other aspects of CNS practice consistent with national standards.