An Interview With Susan Reinhard.

This column addresses how AARP, a consumer organization, is leading a Center for Health Equity through Nursing. The Center is working to support nursing to mitigate the nursing workforce crisis. Susan C. Reinhard is a senior vice president at AARP, directing its Public Policy Institute (PPI), the focal point for public policy research and analysis at the state, federal, and international levels. She leads PPI's family caregiving initiatives and serves as the chief strategist for the Center to Champion Nursing in America, a national resource center created to ensure that America has the highly skilled nurses it needs to provide care in the future. As a previous deputy commissioner of the New Jersey Department of Health and Senior Services, Reinhard led the development of policies and nationally recognized programs for family caregiving, consumer choice, and community-based care options. She is a fellow of the American Academy of Nursing, the Gerontological Society of America, and Salzburg Global. She holds a master's degree in nursing and a PhD in sociology.

A theoretical framework for Acute Care Nurse Stress Appraisal: Application of the transactional model of stress and coping.

AIM: To develop a framework for understanding the stress appraisal process among acute care nurses during the COVID-19 pandemic. DESIGN: A secondary analysis of open-ended responses from a cross-sectional survey of 3030 frontline, acute care nurses in New Jersey and the effect of burnout during the COVID-19 pandemic. METHODS: Lazarus and Folkman's transactional model of stress and coping guided the study. Thematic analysis was used to analyse 1607 open-ended responses. RESULTS: Nine themes emerged during the secondary appraisal of stress. Five themes contributed to distress and burnout including (1) high patient acuity with scarce resources, (2) constantly changing policies with inconsistent messaging, (3) insufficient PPE, (4) unprepared pandemic planning and (5) feeling undervalued. Four themes led to eustress and contributed to post-traumatic growth including (1) team nursing to ensure sufficient resource allocation, (2) open channels of communication, (3) sense- of-duty and (4) personal strength from new possibilities. CONCLUSION: The COVID-19 pandemic was a traumatic event for patients and the nursing workforce. Internal and external demands placed on acute care nurses increased burnout, however, a subset of nurses with adequate support experienced personal growth. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Beyond mental health interventions for acute care nurses, organizational interventions such as reevaluation of emergency action plans to optimize resource allocation, and work environment strategies such as improved communication and decision-making transparency are necessary. IMPACT: To better understand how frontline acute care nurses experienced stress during COVID-19, a data-informed framework was developed that included a primary and secondary appraisal of stress. Themes contributing to distress and burnout were identified, and themes leading to eustress and post-traumatic growth were also identified. These findings can assist nurse leaders in optimizing strategies to reduce burnout and promote post-traumatic growth in the post-COVID years. REPORTING METHOD: No patient or public contribution.

A call to act: RN volunteers needed in their communities.

OBJECTIVE: Recognizing registered nurses (RNs) as valued, trusted professionals to lead and advocate for healthier communities (Pittman, 2019), the New Jersey Action Coalition (NJAC) developed a model designed to match RN volunteers to community projects. DESIGN: Using a descriptive study design, researchers examined the numbers of RN volunteers and projects across 21 counties in NJ from 2016 to 2018. SAMPLE: The sample consisted of the numbers of volunteers and projects from every county retrieved from the NJAC's website. MEASUREMENTS: In addition to the NJAC data, researchers examined the percentage of RNs living in each county as well as data from County Health Rankings & Roadmaps© (University of Wisconsin Population Health Institute, 2019). The counties were divided into three groups: high, moderate, and low overall health counties. RESULTS: After 2 years of implementing the NJAC model, the data revealed that, at minimum, there was one RN coach per county in the high overall health counties group. In the lower overall health counties group, there were fewer community projects, less RN coaches, and volunteers. CONCLUSION: Engaging RN volunteers requires raising awareness of the needs of the community and the ways in which a RN can take action to promote public health and health equity.

New Jersey PA regulation and the march on Trenton.

New Jersey was the next to the last state to recognize physician assistants (PAs) and pass legislation allowing them to practice. This first-person account supported by interviews with those who were there details the trail to NJ licensure, including the development of a state society, the growth of support from strong leaders in the medical and academic communities, and the grassroots efforts of many PAs aspiring to work in their home state.

School Nurses' Emotional Wellbeing: May the Schwartz Be With you!

The purpose of this article is to introduce Schwartz Rounds as a means for school nurses to foster their personal wellbeing by sharing their experiences. Nurse panelists openly discuss their journeys, followed by facilitated small-group conversations led by mental health professionals. To address the unique challenges of school nurses during the COVID-19 pandemic, the New Jersey Nursing Emotional Well-Being Institute initiated virtual Schwartz Rounds. New Jersey State School Nurses Association leaders joined as panelists to discuss the theme of hope for the upcoming school year. Schwartz Rounds prove highly effective in preserving and enhancing school nurses' mental health and wellbeing, allowing them to maintain their vital work while caring for themselves and their school communities. This approach builds community among school nursing professionals, fostering connections, and providing mutual support to combat isolation.

Comparison of COVID-19 Symptoms in Correctional Health Care Workers During the Initial and Omicron Surges.

There is a dearth of medical literature that characterizes the experience of correctional health care workers (HCWs) during the COVID-19 pandemic. We performed a retrospective chart review of the results of an ongoing universal SARS-CoV-2 testing program for New Jersey correctional system HCWs and describe their presenting symptoms, perceived exposure, and demographic characteristics during the initial (March 15, 2020, to August 31, 2020) and Omicron (March 1, 2022, to August 31, 2022) COVID-19 surges. Analysis included 123 eligible records. In both surges, nurses had a high proportion of infections and cough was the most commonly reported symptom. Fever was more than twice as commonly reported in the initial surge. During the Omicron surge, nasal symptoms predominated (39.5% [95% CI: 28.4-51.4]) compared with the initial surge (8.5% [95% CI: 2.4-20.4]). Perceived exposure source was predominantly work related during the initial surge and multiple other sources of exposure were identified during the Omicron surge. Ninety-six percent of HCWs received a COVID-19 booster shot by February 2022. The reinfection rate was less than 10% for our initial cohort. Presenting symptoms correlated with the circulating variant. Mass vaccination of staff, the lower virulence of the Omicron variant, and possibly prior infection likely contributed to the milder illness experienced during the Omicron surge.

Affordable Health Insurance Options for Small Business and Low-Wage Workers Remains Elusive: Experience With New Health Reimbursement Arrangements in New Jersey.

Low-wage workers and those employed by small businesses are least likely to be offered health insurance coverage and they are over-represented among the uninsured. Two new forms of health reimbursement arrangements (HRAs) that allow employers to help fund individual market coverage for workers have been touted as breakthrough strategies to help fill this gap. Despite several years of experience and low adoption, little is known about employer understanding of or views about these HRA options. Consistent with other evidence, only 11.8% of New Jersey employers we surveyed offer or plan to offer either of the HRA options. Few respondents (18.5%) report familiarity with either option. Even among businesses that offer or plan to offer this form of HRA, under half (47.6%) say that they are familiar with them. Other reasons cited for not offering these options include broker advice and complexity. While more investigation is needed, these findings suggest that new strategies should be explored to fill the gap in health insurance for low-wage and small business employees.

Engaging staff with team-based performance sharing.

Team-based performance sharing (TPS) is a tool that hospitals can use to achieve higher levels of performance by tapping into innovative thinking within a unit's staff regarding opportunities to improve performance. In a recent pilot implementation of TPS, employees were able to share in the financial gains from recommended and approved improvements, as long as patient satisfaction remained above a certain specified threshold. Proposals for improvements were vetted by a dedicated crossfunctional team composed of unit staff, who had to be in full agreement regarding the merits of a proposal for it to be accepted.

Practice Patterns, Work Environments, and Job Outcomes of Rural and Urban Primary Care Nurse Practitioners.

As nurse practitioners (NPs) are increasingly relied on to deliver primary care in rural communities, it is critical to understand the contexts in which they work and whether they are characterized by work environments and infrastructures that facilitate the provision of high-quality patient care. This study compares urban and rural NPs using data from a survey of 1,244 primary care NPs in Arizona, California, New Jersey, Pennsylvania, Texas, and Washington. While rural and urban NPs have a number of similarities in terms of demographic characteristics, practice patterns, and job outcomes, they also have noteworthy differences. Rural NPs report higher levels of independent practice, fewer structural capabilities that facilitate quality care, and poorer relationships with physicians. Health care organizations in rural communities may need to invest in work environments and infrastructures that facilitate high-quality care and autonomous practice for NPs.

NJ EMS Line of Duty Deaths: A Trend Analysis.

INTRODUCTION: As early as 2002, researchers were calling the occupational fatalities in Emergency Medical Service (EMS), a hidden crisis. Little consideration has been given to the needs for a safer working environment. METHODS: This is a secondary data analysis of Line of Duty Death (LODD) data of NJ EMS workers from 1912 to 2020. RESULTS: There were 81 reported LODDs. LODDs were greater for the 2000s period than the 1900s period and the results were the same when outliers were excluded. CONCLUSIONS: Efforts are needed to study the plethora of threats to EMS providers in order to target mitigation measures to implement a safety environment within a hot zone of potential threats. These threats are not novel, but it is time for novel solutions to mirror the efforts afforded to fire and police personnel, ensuring a fully safe and resilient public safety sector.

Patient Load per RN Decreases in New Jersey Over Seven-Year Period.

Decrease coincides with national trends and public reporting of nurse staffing levels.