Leveraging nursing strengths, listening to nursing needs: A keynote paper from the 2022 Emory University Business Case for Nursing Summit.

This keynote paper is the first installment in the six-part Nursing Outlook special edition based on the 2022 Emory University Business Case for Nursing Summit. The summit, which took place in March 2022, was led by Emory School of Nursing in partnership with Emory School of Business. It convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises. Each of the summit's panels authored a paper in this special edition on their respective topic(s). Those topics included the growth, distribution, resilience, and value of the nursing workforce. As on the day of the event, the keynote frames the panelists' discussions by sharing nursing workforce trends, expert workforce insights, and data-informed questions to help promote dialogue in this series and beyond.

2022 Emory Business Case for Nursing Summit: What has changed in the past year.

This commentary paper concludes the Business Case for Nursing special edition. The special edition covered major areas of dialogue from the 2022 Emory Business Case for Nursing Summit. The 2022 summit, led by Emory School of Nursing in partnership with Emory School of Business, convened national nursing, health care, and business leaders. Its aim was to explore possible solutions to nursing workforce crises, including nursing shortages. Each of the summit's four panels authored a paper in this special edition on their respective topic(s) of discussion. This paper is written by the summit's hosting deans and closing speaker in response to those discussions. It shares major policy and regulatory reforms that have taken place since the summit and highlights workforce needs that will require continued attention in 2023 and beyond. Topics include issues driving nurse turnover and workforce distribution, the relationship(s) between working conditions and nursing retention, the importance of competitive nursing salaries, and the need for systems to protect resilience in nursing.

Design health care systems to protect resilience in nursing.

This panel paper is the fourth installment in a six-part Nursing Outlook special edition based on the 2022 Emory Business Case for Nursing Summit. The 2022 summit was led by Emory School of Nursing in partnership with Emory School of Business. It convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises, including the nursing shortage. Each of the summit's four panels authored a paper in this special edition on their respective topic(s) of discussion, and this panel paper is focused on resilience in nursing. It addresses the importance of organizational culture in nursing retention, the role of leadership in reducing nurse turnover, and strategies for how to build resilience systems that counteract or eliminate sources of moral distress. Cost rationales are discussed as part of 'the busienss case' for investing in resilience systems.

Strategies to expand the distribution of nursing talent in the United States.

This panel paper is the third installment in a six-part Nursing Outlook special edition based on the 2022 Emory Business Case for Nursing Summit. The 2022 summit was led by Emory School of Nursing in partnership with Emory School of Business. It convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises, including the nursing shortage. Each of the summit's four panels authored a paper in this special edition on their respective topic(s). This panel paper focuses on strategies to optimally distribute nursing talent in rural and underserved areas. It discusses the role of nursing talent distribution in ensuring equity in access to care for U.S. populations. Topics covered include the need for expanded and standardized advanced practice registered nurse (APRN) scope of practice, an expanded nurse licensure compact, reimbursement reforms, and competitive nursing salaries.

Maximizing the potential value of the nursing workforce.

This panel paper is the fifth installment in a six-part Nursing Outlook special edition based on the 2022 Emory Business Case for Nursing Summit. The 2022 summit convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises, including the nursing shortage. Each of the summit's four panels authored a paper in this special edition on their respective topic, and this panel paper focuses on maximizing the potential value of the nursing workforce. It addresses topics including the need to create a nursing-inclusive federal health care billing system improve nursing salaries by designing/testing nurse-informed compensation models, and strengthen nursing's national professional infrastructure.

How academia can help to grow-and sustain-a robust nursing workforce.

This panel paper is the second installment in a six-part Nursing Outlook special edition based on the 2022 Emory Business Case for Nursing Summit. The 2022 summit convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises, including the nursing shortage. Each of the summit's four panels authored a paper in the special edition on their respective topic(s), and this panel paper focuses on the topic of nursing workforce growth. It discusses priority areas for academia to help ameliorate nursing shortages, including through changes to nursing curricula and/or programming, greater attention to nursing financial needs (including nursing student loans), and regulatory reforms.

Reject the "Practice Readiness Myth": Ask if systems are ready for nursing graduates instead.

The nursing profession is engaged in robust national dialogue on how to implement competency-based education. This dialogue often conflates the concept of "competency-based education" with nursing "competence" or "practice readiness." Our aim is to discuss the potential harms of conflating "competency-based education" with "competence" or "practice readiness." This commentary explores the possible risks of issue conflation. Risks include (a) suggesting that nurses who have successfully obtained licensure are not "competent" or "ready to practice," and (b) de-emphasizing the importance of safe and sustainable work environments for new graduate nurses. We discuss the need to separate conversations about "competency-based education" and "practice readiness"; the need to increase the clarity and specificity of discourse surrounding competency-based education; and the need for strategic alignment across academia and practice.

Nursing practice leaders' perspectives on continuing challenges related to the Doctor of Nursing Practice Degree.

In 2020, deans from top-ranked nursing schools authored a Nursing Outlook article titled, "Doctor of Nursing Practice (DNP) Degree in the United States: Reflecting, Readjusting, and Getting Back on Track." In 2022, the American Association of Colleges of Nursing published the report, "State of the Doctor of Nursing Practice Education."- Both have been critical to advancing national discussions on the implementation of a universal DNP practiceentry standard in nursing. This paper, written by Chief Nursing Officers from top-ranked academic medical centers, reports on perspectives from practice settings/employers regarding issues raised by educators and deans in those documents. Barriers to acceptance of the DNP degree in practice include a lack of degree standardization, a need for DNP outcomes data, and a desire for a clearer return on investment for the DNP degree among graduates and employers.

Diversity in nursing and challenges with the NCLEX-RN.

High-stakes, standardized testing has historically impeded education/career attainment for members of underrepresented minority groups and people needing testing accommodations. This study was to understand how high-stakes, standardized testing, particularly the NCLEX-RN, impacts diversity, equity, and inclusion (DEI) in nursing. This study explored the history, context, perspectives surrounding standardized testing, with a focus on the NCLEX-RN. The authors consider content, form, and delivery of testing, including accommodations. They identify available data and data collection gaps relevant to DEI and the NCLEX-RN. No nursing organization published the national data necessary to evaluate/refine the NCLEX-RN from a DEI perspective. Preliminary nursing studies and data from other professions indicated disparities in testing outcomes. Nursing must determine if prospective nurses are experiencing disparities in testing outcomes. The authors highlight opportunities to advance DEI through improved data collection, reformed licensure processes, and the reframing of standardized testing as one of many tools to determine competency.

From Florence to fossil fuels: Nursing has always been about environmental health.

BACKGROUND: Since its founding, professional nursing has applied an environmental lens to healing. METHODS: This CANS 2020 Keynote article describes the history of nursing environmental science and nurses important contributions to the US Environmental Justice Movement. Starting with Florence Nightingale's Notes on Nursing, which established Environmental Theory, the paper introduces key figures throughout nursing history who have studied and advocated for environmental health and justice. FINDINGS: The paper emphasizes that nursing has always been about environmental health and that, regardless of specialty or practice setting, all nurses are called to incorporate environmental science and translation into their research and practice. CONCLUSION: This call to action is especially critical today in the context of urgent issues like climate change, environmental racism and racial health disparities, emerging infectious diseases like COVID-19, and chemical exposures in the home and workplace (among others).

Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track.

BACKGROUND: In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs) and transition to doctor of nursing practice (DNP) preparation only by 2015. Today, five years after the AACN's deadline, nursing has not yet adopted a universal DNP standard for APRN practice entry. PURPOSE: The purpose of this paper is to examine the factors influencing the ability of nursing schools to implement a universal DNP standard for APRNs. METHODS: Deans from top-ranked nursing schools explore the current state of the DNP degree in the US. The authors draw upon their collective experience as national leaders in academic nursing, long-time influencers on this debate, and heads of DNP programs themselves. This insight is combined with a synthesis of the literature and analysis of previously unpublished data from the AACN on trends in nursing doctoral education. FINDINGS: This paper highlights issues such as the long history of inconsistency (in messaging, curricula, etc.) surrounding the DNP, certification and accreditation challenges, cost barriers, and more. The authors apply COVID-19 as a case study to help place DNP graduates within a real-world context for health system stakeholders whose buy-in is essential for the success of this professional transition. DISCUSSION: This paper describes the DNP's standing in today's professional environment and advances the conversation on key barriers to its adoption. Insights are shared regarding critical next steps to ensure national acceptance of the DNP as nursing's terminal practice degree.

Strategies to Evaluate and Enhance Accelerated Second-Degree Nursing Pathways.

BACKGROUND: Health systems are facing historic staffing crises, and they require efficient pipelines of qualified students into practice. Accelerated second-degree students are helping to address pressing health care market needs. PROBLEM: Few publications have assessed the second-degree program landscape or offered comparisons of second-degree pathways. APPROACH: This article discusses the second-degree program landscape, including challenges in second-degree education; compares graduate-level second-degree entry against other pathway options; and presents strategies to optimize and sustain second-degree student pipelines based on these insights. FINDINGS: The second-degree program landscape is characterized by variability. Challenges include inconsistent program nomenclature and limited national data collection. Graduate-level second-degree pathways offer financial and career advantages compared with other pathways. CONCLUSION: Nursing education should standardize second-degree nomenclature, refine national data capture mechanisms, standardize program scope and requirements, and encourage second-degree pathways at the graduate level or above.

The effect of an educational programme on attitudes of nurses and medical residents towards the benefits of positive communication and collaboration.

AIMS: This article is a report of a study to determine the effect of an educational programme and to follow up weekly meetings on nurses and medical resident's attitudes towards positive communication and collaboration. BACKGROUND: Clear and appropriate communication and interdisciplinary collaboration is critical to the delivery of quality care. Collaborative practice among all healthcare professionals creates a positive work environment, decreases costs, improves job satisfaction among nurses and improves patient care, as well as decreasing patient morbidity and mortality. Poor communication and lack of teamwork or collaboration have been cited as persistent problems in healthcare. METHOD: The study was conducted in 2008 - 2009 at a hospital where a new medical residency programme was beginning and nurses had no prior experience working with medical residents. A quasi-experimental pre test, post-test design was used. The Jefferson Scale of Attitudes towards Physician-Nurse Collaboration and the Communication, Collaboration and Critical Thinking for Quality Patient Outcomes Survey tool measured the attitudes of 68 nurses and 47 medical residents in the areas of positive communication and collaboration. RESULTS/FINDINGS: The study demonstrates that a formal educational programme and follow-up discussions improved the attitudes of both nurses and medical residents on the Jefferson scale (medical residents t = 4·68, P = 0·001, nurses t = 4·37, P = 0·001) and on the communication scale (medical residents t = 4·23, P = 0·001, nurses t = 4·13, P = 0·001). CONCLUSION: Continuing education for nurses, medical residents and other healthcare providers may assist in developing positive communication styles and promote collegiality and team work.

A Guide to Academic Crisis Response: Strategies for Nursing Schools During COVID-19 and Beyond.

BACKGROUND: COVID-19 has tested the capacity of every nursing school, but its impact has varied according to the size, location, and baseline infrastructure of each school. This makes the pandemic an important lens through which to study crisis management principles, such as flexibility and scalability (the ability to expand and reduce efforts based on situational demands). PURPOSE: This article provides a roadmap for academic crisis management, modeled on the National Incident Management System (NIMS). It is tailored to the unique needs of nursing schools and applies COVID-19 as a case study. METHODS: The authors explore the elements of the NIMS that were deployed within 1 top-ranked school of nursing during COVID-19. RESULTS AND CONCLUSIONS: The article includes best practices, tips, and resources to help academic nurse leaders and educators navigate large-scale or unprecedented crises, such as COVID-19.

The Emory-Addis Ababa PhD in Nursing Program: A sustainable model for strengthening nursing research capacity in Ethiopia.

In 2015, Ethiopia's first PhD in nursing program was established in collaboration between the Addis Ababa University (AAU) and Emory University Schools of Nursing. Eleven students have entered the program since its inception, six have successfully defended their proposals, one has graduated, and two have received Fogarty Global Health Fellowships. This paper describes the evolution of this international partnership and the innovative processes and mechanisms involved in program implementation; the authors address the description of the program, central implementation challenges, notable outcomes, and student achievements. One key implementation challenge has been that, although nursing is one of the largest healthcare workforces in Ethiopia, nurses remain underutilized and undervalued in the workplace. This treatment is due, in part, to limited professional regulations, leading some of the PhD students to apply their leadership skills to advocate for national practice reform. According to students, the PhD program has been a means not only to improve nursing research capacity and education in Ethiopia, but also to generate the regulations necessary for graduates to practice according to their degree. While the opportunity to generate knowledge is vitally important, students also value the chance to transform the profession of nursing.

A quality improvement initiative to implement the eat, sleep, console neonatal opioid withdrawal syndrome care tool in Massachusetts' PNQIN collaborative.

OBJECTIVE: To support hospitals in the Massachusetts PNQIN collaborative with adoption of the ESC Neonatal Opioid Withdrawal Syndrome (NOWS) Care Tool© and assess NOWS hospitalization outcomes. STUDY DESIGN: Statewide QI study where 11 hospitals adopted the ESC NOWS Care Tool©. Outcomes of pharmacotherapy and length of hospital stay (LOS) and were compared in Pre- and Post-ESC implementation cohorts. Statistical Process Control (SPC) charts were used to examine changes over time. RESULTS: The Post-ESC group had lower rates of pharmacotherapy (OR 0.35, 95% CI 0.26, 0.46) with shorter LOS (RR 0.79, 95% CI 0.76, 0.82). The 30-day NOWS readmission rate was 1.2% in the Pre- and 0.4% in the Post-ESC cohort. SPC charts indicate a shift in pharmacotherapy from 54.8 to 35.0% and LOS from 14.2 to 10.9 days Post-ESC. CONCLUSIONS: The ESC NOWS Care Tool was successfully implemented across a state collaborative with improvement in NOWS outcomes without short-term adverse effects.