Evaluation of a Redesigned Canadian Undergraduate Nursing Program: A Prospective Cohort Study.

BACKGROUND: The objective of this study was to determine the degree to which the educational outcomes of the accelerated, redesigned bachelor of science in nursing (BSN) program at The British Columbia Institute of Technology are similar to those of its previous program. METHOD: A prospective cohort study compared outcomes for the first two classes of students in the redesigned program with those of the final class of students in the original program. Data were gathered from administrative records, focus group discussions, and online surveys for BSN students (later, graduates), faculty, and staff, a focus group discussion with Specialty Nursing faculty, and interviews with program leadership and representatives of provincial health authorities. RESULTS: No differences were found between the two programs for most outcomes. CONCLUSION: Although hindered by some low response levels, the evaluation data indicate that the British Columbia Institute of Technology's redesigned BSN program's educational outcomes are largely similar to those of its predecessor. [J Nurs Educ. 2017;56(8):484-489.].

Development and Psychometric Assessment of the Nursing Competence Self-Efficacy Scale.

BACKGROUND: The study aim was to develop and psychometrically assess an instrument to measure baccalaureate nursing students' self-efficacy for practice competence. Social cognitive theory includes the construct of self-efficacy and supports this study. METHOD: Before the Nursing Competence Self-Efficacy Scale (NCSES) was administered to senior nursing students (N = 252), nursing experts in research, practice, instrument development, and psychometrics participated in a two-step validation process consisting of two reviews. Construct validity assessments included content, face, contrasting groups, criterion, and exploratory factor analysis (EFA). The chosen EFA solution consisted of 22 items, each moderately or highly loaded by one of four factors deemed to be interpretable and parsimonious. RESULTS: The initial psychometric assessment of the NCSES supported construct validity, internal consistency reliability (.919), and test-retest stability reliability (r = .831). CONCLUSION: With further psychometric assessment, the NCSES can be useful to evaluate new curriculum interventions aimed at increasing students' self-efficacy for comprehensive practice competence.

Service-based health human resources planning for older adults.

OBJECTIVES: To test a service-based health human resources (HHR) planning approach for older adults in the context of home and long term care (LTC); to create a practical template/tools for use in various jurisdictions and/or health care settings. DESIGN: The most serious health needs of seniors in 2 Canadian jurisdictions were identified and linked to the specific services and associated competencies required of health care providers (HCPs) to address those needs. The amounts of each service required were quantified and compared against the capacity of HCPs to perform the services, measured using a self-assessment survey, by using a previously developed analytical framework. SETTING: Home and LTC sectors in Nova Scotia and Nunavut, Canada. PARTICIPANTS: Regulated and nonregulated HCPs were invited to complete either an online or paper-based competency self-assessment survey. RESULTS: Survey response rates in Nova Scotia and Nunavut were 11% (160 responses) and 20% (22 responses), respectively. Comparisons of the estimated number of seniors likely to need each service with the number who can be served by the workforces in each jurisdiction indicated that the workforces in both jurisdictions are sufficiently numerous, active, productive, and competent to provide most of the services likely to be required. However, significant gaps were identified in pharmacy services, ongoing client assessment, client/family education and involvement, and client/family functional and social supports. CONCLUSION: Service-based HHR planning is feasible for identifying gaps in services required by older adults, and can guide policy makers in planning hiring/recruitment, professional development, and provider education curricula. Implementation will require commitment of policy makers and other stakeholders, as well as ongoing evaluation of its effectiveness. More broadly, the ongoing effectiveness of the approach will depend on workforce planning being conducted in an iterative way, driven by regular reevaluation of population health needs and HHR effectiveness.

The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments.

OBJECTIVE: We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs). METHODS: We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status. RESULTS: Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3-2.1, p < 0.05) and 2.1 (95% CI 1.6-2.8, p < 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%-39.0%, p < 0.01) and 48.8% (95% CI 35.0%-62.7%, p < 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%-63%, p < 0.01) and 71% (95% CI 53%-96%, p < 0.05), respectively. CONCLUSION: The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.

The application of change management principles to facilitate the introduction of nurse practitioners and physician assistants into six Ontario emergency departments.

In a project funded by the Ontario Ministry of Health and Long-Term Care, MedEmerg facilitated the introduction of three new providers into six emergency departments. A managed change process that included team development was carried out. Increased team awareness and a higher acceptance of the provider roles were some of the key successes. Challenges included role confusion and the learning curve for the new providers. While overall the project was a success, lessons learned included the need for physician buy-in, communication, planning for unintended consequences and management of expectations. The project emphasized the importance of a managed process, including team development, in the implementation of change.

An applied simulation model for estimating the supply of and requirements for registered nurses based on population health needs.

Aging populations, limited budgets, changing public expectations, new technologies, and the emergence of new diseases create challenges for health care systems as ways to meet needs and protect, promote, and restore health are considered. Traditional planning methods for the professionals required to provide these services have given little consideration to changes in the needs of the populations they serve or to changes in the amount/types of services offered and the way they are delivered. In the absence of dynamic planning models that simulate alternative policies and test policy mixes for their relative effectiveness, planners have tended to rely on projecting prevailing or arbitrarily determined target provider-population ratios. A simulation model has been developed that addresses each of these shortcomings by simultaneously estimating the supply of and requirements for registered nurses based on the identification and interaction of the determinants. The model's use is illustrated using data for Nova Scotia, Canada.