Scholarly Work for Practice Doctorate Nurse Anesthesia Programs: Current State and Guidance.

The Standards for Accreditation of Nurse Anesthesia Programs: Practice Doctorate was adopted by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) in January 2015. Balancing academic and clinical preparation for doctoral students, preparation for the National Certification Examination, and requirements for scholarly work represents a major challenge for students, faculty, and programs. With most nurse anesthesia programs having transitioned to the practice doctorate, the COA was in a pivotal position to examine the current state of scholarly work and to produce a white paper to guide programs' development of criteria for scholarly work. To inform the guidance contained in the white paper, nurse anesthesia educators provided input via a survey, a focus group at the 2019 Assembly of Didactic and Clinical Educators meeting, and an active discussion and question-and-answer session during the Assembly. A call for comments was also sent to stakeholders for review and comment on the draft white paper. The guidance set forth in the white paper in no way supersedes institutional and/or other accreditor requirements. The aim of this guidance is to aid nurse anesthesia programs in successfully managing scholarly project curriculum. This article provides an overview of the project.

Preeclampsia before 26 weeks of gestation: Obstetrical prognosis for the subsequent pregnancy.

INTRODUCTION: Gestational age at delivery seems to be a risk factor of recurrence of preeclampsia. The objective of this study was to analyze adverse pregnancy outcomes and recurrence of preeclampsia during the subsequent pregnancy in women with a history of pre-eclampsia delivered before 26 weeks of gestation. MATERIAL AND METHOD: We performed a retrospective study in two French tertiary care hospitals between 2000 and 2018. Patients with a history of pre-eclampsia delivered before 26 weeks of gestation were analyzed. Information on the immediate subsequent pregnancy was collected. Adverse composite outcome was defined as recurrent preeclampsia, HELLP syndrome, placental abruption, fetal growth restriction <3rd percentile or <10e percentile with Doppler abnormalities, maternal death and fetal death. RESULTS: Among the 107 patients who met the criteria, 48 were analyzed for a subsequent pregnancy. Seventeen women (35.4 %) developed an adverse composite outcome, occurring for 15 women (31.2 %) before 34 weeks. Ten women (20.8 %) developed a recurrent preeclampsia occurring for 5 women (10.4 %) before 34 weeks. We related 3 HELLP syndromes, 1 placental abruption, 9 fetal growth restrictions, 3 fetal deaths and no maternal death. Compared to baseline normotensive women, chronic hypertension was significantly associated with an increased risk of adverse composite outcome (19.3 vs 58.8 %, p-value 0.014). CONCLUSION: In our population, preeclampsia with delivery before 26 weeks is associated with 35.4 % of adverse composite outcomes and 20.8 % of recurrent preeclampsia during the immediate subsequent pregnancy. These results justify the importance of an ongoing monitoring of these patients during subsequent pregnancy.

Statewide political activism for California academic nursing leaders.

The California Association of Colleges of Nursing (CACN) is a not-for-profit, non-partisan nursing organization whose members are the universities' Schools of Nursing that offer baccalaureate and graduate degree programs in California. The nursing deans and directors are the individuals who attend scheduled statewide meetings and actualize the mission, vision, and governance of this organization. Starting in 2011, CACN began a journey toward greater political activism that was initiated by strategic planning. During the Spring 2017 meeting, forty-four California nursing deans/directors advanced their advocacy by attending prescheduled visits with California legislators. The goals for meetings with California policy makers included: 1. Inform them about CACN as an organization and its sphere of influence and 2. Educate them about CACN's perspective on current bills in the California legislature. This manuscript details a process to assist other state organizations to move toward political activism in support of the nursing profession from the academic nursing leadership perspective.

Academic Leadership Development: A Case Study.

A dean at a private school of nursing implemented a leadership development program for early- to mid-career nursing faculty consisting of one 4-hour evening session per academic quarter for 7 quarters. Eight faculty members who had expressed interest in assuming a leadership role or been recommended by their supervisors as having strong leadership potential were invited to join. Program topics included leadership pathways, legal issues, budgeting and governance, diversity, the political arena, human resources, and student issues. Interviews with participants revealed 6 themes: the support a peer cohort provided, a desire for real-life application, a lack of previous exposure to related content or experiences, new perceptions of themselves as academic nurse leaders, the value of the program as preparation for academic nursing leadership roles, and broad program applicability.

Academic-Practice Partnerships for Unemployed New Graduates in California.

In California, academic-practice partnerships offer innovative transition programs to new registered nurse (RN) graduates who have not yet found positions in nursing. This report describes the formation of 4 partnerships between 1 or more schools of nursing and clinical practice sites that included hospitals and nonacute care settings, such as hospice, clinics, school districts, and skilled nursing facilities. Factors facilitating the partnerships included relationships established as nurse leaders from practice and academia came together to address previous workforce issues, positive interpersonal experiences, an independent convening and coordinating organization, a shared understanding of the employment challenge faced by new RN graduates, and a shared vision for its solution. Partnerships face continuing challenges that include sustaining engagement, resource constraints, and insufficient nursing leadership succession planning. Partnership benefits include improved relationships between academia and practice, a forum to address contemporary issues in nursing education and practice advances, and stimulation of a reassessment of how to integrate ambulatory, transitional, and community-based nursing into prelicensure education.

Preceptor and Self-Evaluation Competencies Among New RN Graduates.

Four transition-to-practice programs for new RN graduates who had not yet found employment in nursing were based on the Quality and Safety Education for Nurses (QSEN) competencies of knowledge, skills, and attitudes (KSAs). To support consistent evaluation of participants by preceptors, a 35-item tool was developed that used a 4-point scale to assess selected behaviors. This article describes the initial reliability and validity testing of the tool, which had good internal consistency, with a Cronbach's alpha of 0.92 for preceptor evaluation of participants and 0.82 when used as a self-evaluation tool. Six content experts evaluated the tool's face validity; it successfully discriminated between junior-level baccalaureate nursing students and nursing faculty. Although the tool does not exhaustively reflect the QSEN KSAs, it provides a way to assess competencies among new nurse graduates.

Economic aspects of community-based academic-practice transition programs for unemployed new nursing graduates.

Four partnerships between schools of nursing and practice sites provided grant-funded 12- to 16-week transition programs to increase confidence, competence, and employability among new RN graduates who had not yet found employment in nursing. Per capita program costs were $2,721. Eighty-four percent of participants completing a postprogram employment survey became employed within 3 months; 55% of participants became employed at their program practice site. Staff development educators may find this model a useful adjunct to in-house nurse residency programs for new RN graduates.

Preparing new nurse graduates for practice in multiple settings: a community-based academic-practice partnership model.

Responding to local and national concerns about the nursing workforce, the California Institute for Nursing and Health Care worked with private and public funders and community health care partners to establish community-based transition-to-practice programs for new RN graduates unable to secure nursing positions in the San Francisco Bay Area. The goals were to retain new RN graduates in nursing and further develop their skills and competencies to increase their employability. Leaders from academic and inpatient, ambulatory, and community-based practice settings, as well as additional community partners, collaboratively provided four 12- to 16-week pilot transition programs in 2010-2011. A total of 345 unemployed new nurse graduates enrolled. Eighty-four percent of 188 respondents to a post-program survey were employed in inpatient and community settings 3 months after completion. Participants and clinical preceptors also reported increases in confidence and competence.

Collaborative academic-practice transition program for new graduate RNs in community settings: lessons learned.

In 2010-2011, leaders from California academic and practice settings and additional community partners collaboratively developed four 12- to 16-week transition programs for 345 new registered nurse (RN) graduates who had not yet found employment as nurses. Program goals were to increase participants' confidence, competence, and employability and expand the employment landscape to nontraditional new graduate settings. One program focused exclusively on community-based settings and was completed by 40 participants at clinics and school sites; all participants secured RN jobs. Key lessons learned go beyond the impact for participants and relate to changing the nursing culture about career path models for new graduates, troubleshooting regulatory issues, the potential for new graduates to help transform nursing, and advancing academic-practice partnerships and supporting practice sites. The community-based transition program continues to provide opportunities for new RN graduates and model an approach for transforming nursing practice.

Competence gaps among unemployed new nursing graduates entering a community-based transition-to-practice program.

Multiple reports document competence gaps among employed new RN graduates. Less is known about the competence and confidence of new RN graduates who have not yet found employment in nursing. As part of an academic/practice partnership model, 4 collaboratives provided transition-to-practice programs for newly graduated and licensed, but unemployed, RNs. The authors describe the new nurses' characteristics on program entry and discuss implications for nursing education and practice.