Empowering nurses with evidence-based practice environments: surveying Magnet®, Pathway to Excellence®, and non-magnet facilities in one healthcare system.

BACKGROUND: Nurses have an essential role in implementing evidence-based practices (EBP) that contribute to high-quality outcomes. It remains unknown how healthcare facilities can increase nurse engagement in EBP. PURPOSE: To determine whether individual or organizational qualities could be identified that were related to registered nurses' (RNs') readiness for EBP as measured by their reported EBP barriers, ability, desire, and frequency of behaviors. METHODS: A descriptive cross-sectional survey was used in which a convenience sample of 2,441 nurses within one United States healthcare system completed a modified version of the Information Literacy for Evidence-Based Nursing questionnaire. Descriptive statistics, t tests, one-way ANOVA, and regression modeling were used to analyze the data. RESULTS: RNs employed by facilities designated by the American Nurses Credentialing Center (ANCC) as Magnet® or Pathway to Excellence® reported significantly fewer barriers to EBP than those RNs employed by non designated facilities. RNs in Magnet organizations had higher desire for EBP than Pathway to Excellence or non designated facilities. RNs educated at the baccalaureate level or higher reported significantly fewer barriers to EBP than nurses with less education; they also had higher EBP ability, desire, and frequency of behaviors. A predictive model found higher EBP readiness scores among RNs who participated in research, had specialty certifications, and engaged in a clinical career development program. LINKING EVIDENCE TO ACTION: Education, research, and certification standards promoted by the Magnet program may provide a nursing workforce that is better prepared for EBP. Organizations should continue structural supports that increase professional development and research opportunities so nurses are empowered to practice at their full capacity.

A Comparison of the 1918 and 2019 Pandemics in the United States.

ABSTRACT: There are eerie similarities between the 1918 Spanish influenza and 2019 COVID-19 pandemics that are somewhat surprising and disheartening, given that the time interval between the 2 pandemics is more than 100 years. This article covers the national response, etiology and pathophysiology, disease course and treatments, nursing shortages, healthcare responses, sequelae following infections, and economic and social impacts of both pandemics. Understanding the development and course of both pandemics will inform clinical nurse specialists about the changes that need to be made to be better prepared to recognize the changes that need to be made to prepare for the next pandemic.

An Exploration of New Graduate Nurses' Transition to Specialty Practice.

New graduates' adjustment to high-acuity specialty areas was evaluated using qualitative methods in a hospital system that uses the Versant New Graduate Residency Program. Subjects were interviewed at baseline in person, answered interview questions at 6 months via computer, and were interviewed at 12 months in person. Twelve themes emerged from the interviews, reflecting intrinsic and extrinsic factors affecting new graduate nurse adjustment. Study results were used to evaluate the program and improve the program implementation.

National validation of the NACNS clinical nurse specialist core competencies.

PURPOSE: To validate the 75 core National Association of Clinical Nurse Specialists' (NACNS) clinical nurse specialist (CNS) competencies among practicing CNSs. Specific aims were to (a) determine the extent to which 75 core CNS competencies were used in current CNS practice, (b) determine the importance of those competencies to practicing CNSs, and (c) identify gaps between CNS core competencies and role expectations in current practice. DESIGN: A survey design was used with both paper-and-pencil and online instruments. The survey included 150 items and three open-ended questions. METHODS: A convenience sampling method was used, which targeted practicing CNSs. FINDINGS: Respondents (N=505) were practicing CNSs who entered the field as RNs between 1956 and 2006. The survey had a high degree of internal consistency reliability (0.967%) between the subscales. The 75 NACNS core competencies were found to be useful and important for CNSs. A few gaps were identified between CNS core competencies and CNS role expectations in current practice. CONCLUSIONS: No one method for validating competencies will be satisfactory for all situations; however, the processes and methods used in this study were well suited to accomplish the goal of validating CNS core competencies. The process described here may be instructive to leaders of other national and international professional organizations interested in developing and evaluating competencies. Core competencies are useful and important to currently practicing CNSs. CLINICAL RELEVANCE: The CNS role is growing internationally. Core CNS competencies can be a framework for CNS role development, education, and practice. As described here, a competency validation survey is one way to assure that CNSs are meeting healthcare needs.

Improving the Patient Experience and Decreasing Patient Anxiety With Nursing Bedside Report.

PURPOSE: The study's purpose was to explore the patient experience in an intervention group participating in nursing bedside report and the control group not participating. DESIGN: This descriptive, observational study had 3 objectives: (1) to measure baseline anxiety on admission to the hospital using the Beck Anxiety Inventory, (2) to describe patient self-reported anxiety and patient experiences during hospitalization, and (3) to evaluate the opinions by the intervention group about participating in nursing bedside report. METHODS: This mixed-methods study included quantitative and qualitative data. Three data collection tools were used: a demographic data tool, the Beck Anxiety Inventory, and daily journal entries. Quantitative data were analyzed using SPSS, and qualitative data using content analysis. RESULTS: There were no differences in baseline anxiety scores between patient groups. Anxiety levels decreased during hospitalization. About 73% of patients completed their journals. Themes that emerged were patients' perceptions of care, patient engagement, communication, and teamwork. CONCLUSIONS: Journal responses showed communication played a significant role in patients' perceptions of their patient experience. Because patients exhibited different baseline anxiety levels, assessing anxiety level on admission may help nurses develop plans of care that improve the patient experience. Further study is needed about the patient experience.

Developing clinical nurse specialist practice competencies.

BACKGROUND: In 1998, the National Association of Clinical Nurse Specialist (NACNS) developed the first ever core competencies for clinical nurse specialist (CNS) practice. PURPOSE: This article describes the method used to develop, validate, and revise CNS core practice competencies. METHODS: The stepwise method of identifying core CNS competencies included content analysis of CNS position/job descriptions, extensive literature review, development by role experts, first-tier corroboration, second-tier corroboration encompassing stakeholder review, final review/editing, approval by the board of directors, and dissemination. DISCUSSION: The process used by professional organizations to develop competencies and standards varies; however, it should be transparent and consist of adequate review and validation for accuracy and applicability by members of the representative group for whom the standards and competencies apply. CONCLUSIONS: The stepwise method used by the National Association of Clinical Nurse Specialist generated valid CNS core competencies and may be instructive to professional organizations interested in developing competencies and standards.

A Nurse-Directed Model for Nitrous Oxide Use During Labor.

BACKGROUND: Nitrous oxide has a long history of use and has been well documented in the literature as a safe, effective, and inexpensive option for pain management in labor in other countries, but it is underused in the United States. LOCAL PROBLEM: Pain relief options for laboring women in rural community hospitals with a small perinatal service are limited due to lack of availability of in-house anesthesia coverage. METHOD: This quality improvement project involved development and implementation of a nurse-driven, self-administered, demand-flow nitrous oxide program as an option for pain relief for laboring women in a rural community hospital. INTERVENTION: Women's Services registered nurses developed the project using an interdisciplinary team approach based on an extensive literature review and consultation with experts across the country. The hospital is part of a large healthcare system; approval was sought and obtained by the system as part of the project. Cost analysis and patient satisfaction data were evaluated. Outcomes were monitored. RESULTS: Approximately one half of the patients who have given birth at the hospital since initiation of the project have used nitrous oxide during labor. The majority of women who participated in a survey after birth found it helpful during mild-to-moderate labor pain. No adverse effects have noted in either the mother or the baby following nitrous oxide use. CLINICAL IMPLICATIONS: Initiation and management of nitrous oxide by registered nurses is a safe and cost-effective option for labor pain. It may be especially beneficial in hospitals that do not have 24/7 in-house anesthesia coverage.

Integrating Retired Registered Nurses Into a New Graduate Orientation Program.

PURPOSE: The project goal of was to decrease new graduate nurse (NGN) attrition during the first year of employment by improving communication skills and providing additional mentoring for NGNs employed in a community hospital located in a rural area. DESCRIPTION OF PROJECT: All NGNs participate in the Versant Residency Program. Even with this standardized residency program, exit interviews of NGNs who resigned during their first year of employment revealed 2 major issues: communication problems with patients and staff and perceived lack of support/mentoring from unit staff. A clinical nurse specialist-led nursing team developed an innovative program integrating retired nurses, Volunteer Nurse Ambassadors (VNAs), into the Versant Residency Program to address both of those issues. OUTCOME: All NGNs mentored by a retired nurse remain employed in the hospital (100% retention). Before the VNA program, the retention rate was 37.5%. Both the NGNs and VNAs saw value in their mentor-mentee relationship. There have been no critical incidences or failure to rescue events involving NGNs mentored by a VNA. CONCLUSION: Use of VNAs to support NGNs as they adjust to the staff nurse role can prevent attrition during their first year of nursing practice by providing additional support to the NGN.

Increasing nursing faculty in rural Texas through online education.

To increase RN production, there must be a cadre of qualified faculty. Faculty shortages abound across the United States and are particularly acute in rural areas. Our innovation provides one answer to increasing rural faculty resources through online education.

Development and implementation of an online CNS program.

PURPOSE/OBJECTIVES: Online educational programs are rapidly increasing in all fields. This article describes a private university's online clinical nurse specialist graduate program that included supervised clinical practicum experiences. METHODS: The program was designed using the 1998 National Association of Clinical Nurse Specialists (NACNS) Statement on Clinical Nurse Specialist Practice and Education as a curriculum guide. Issues that occur with online program development/design, implementation, and evaluation are described and solutions are presented. CONCLUSIONS: The online education program for clinical nurse specialists faced challenges; however, faculty and students agreed that this innovative program is a success.

Developing a rural transitional care community case management program using clinical nurse specialists.

PURPOSE: This quality improvement project developed a community nursing case management program to decrease preventable readmissions to the hospital and emergency department by providing telephonic case management and, if needed, onsite assessment and treatment by a clinical nurse specialist (CNS) with prescriptive authority. BACKGROUND: As more people reach Medicare age, the number of individuals with worsening chronic diseases with dramatically increases unless appropriate disease management programs are developed. RATIONALE: Care transitions can result in breakdown in continuity of care, resulting in increased preventable readmissions, particularly for indigent patients. The CNS is uniquely educated to managing care transitions and coordination of community resources to prevent readmissions. DESCRIPTION: After a thorough SWOT (strengths, weaknesses, opportunities, and threats) analysis, we developed and implemented a cost-avoidance model to prevent readmissions in our uninsured and underinsured patients. OUTCOMES: The project CNS used a wide array of interventions to decrease readmissions. In the last 2 years, there have been a total of 22 less than 30-day readmissions to the emergency department or hospital in 13 patients, a significant decrease from readmissions in these patients prior to the program. Three of them required transfer to a larger hospital for a higher level of care. CONCLUSION: Using advanced practice nurses in transitional care can prevent readmissions, resulting in cost avoidance. The coordination of community resources during transition from hospital to home is a job best suited to CNSs, because they are educated to work within organizations/systems. IMPLICATIONS: The money we saved with this project more than justified the cost of hiring a CNS to lead it. More research is needed into this technology. Guidelines for this intervention need to be developed. Replicating our cost-avoidance transitional care model can help other facilities limit that loss.

Redefining "charge nurse" within the front line.

Don't overlook the importance of charge nurses. Learn how one organization redefined the role and strengthened these leaders, increasing patient and staff satisfaction.

Elder case management by registered nurses.

PURPOSE/OBJECTIVES: Before integrating advanced practice registered nurse (APRN) case management, we compared managed Medicare clients' hospital admissions for 12 months prior to and 12 months after registered nurse (RN) or social worker case management. PRIMARY PRACTICE SETTING(S): Our clients are cared for by a multispecialty physician group and five local hospitals. FINDINGS/CONCLUSIONS: The 12-month admissions dropped from 351 to 101. There was a 75.5% reduction for Level 1 clients, a 72% reduction for Level 2 clients, and a 25% reduction for Level 3 clients. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: (1) RNs, APRNs, and social workers are educated to holistically manage care for elders with chronic disease who require physiological, psychosocial, spiritual, and environmental interventions, not just disease treatment. (2) The complex interaction between aging and chronic disease in elders necessitates RN, social worker, and/or APRN case management. (3) Although RNs, social workers, and APRNs can work independently, dyads may be more effective.

A comparison of coagulation study results between heparinized peripherally inserted central catheters and venipunctures.

PURPOSE/OBJECTIVE: The purpose of this study was to test an evidence-based procedure of drawing blood samples for coagulation testing from heparinized peripherally inserted central catheter (PICC) by comparing results with blood drawn from venipuncture (VP). DESIGN: A prospective, quasi-experimental design using purposive sampling was used. SETTING: The setting was a 230-bed community hospital located in the Southwest. The hospital is part of a 15-hospital system. SAMPLE: : The sample was composed of 30 hospitalized patients with heparinized PICCs. METHODS: Informed consent was obtained. Using aseptic technique, samples of blood were drawn via VP and from the PICC using the evidence-based procedure. Data were analyzed using Pearson product moment correlations and Bland-Altman analysis. FINDINGS: For 5 coagulation tests studied, correlations between PICC values and VP values ranged from 0.990 to 0.998, indicating almost perfect correlations. In Bland-Altman analyses, mean biases and SDs were small to moderate for prothrombin time, 0.13 seconds (-0.55 to 0.81 seconds) (P = 0.0484); international normalized ratio, 0.010 (-0.050 to 0.070) (P = 0.085); partial thromboplastin time, 2.16 seconds (-5.10 to 9.43 seconds) (P = 0.0033); and fibrinogen, -18.2 mg (-70.4 to 34.1 mg) (P = 0.0033) and 0.52 (-0.73 to 1.77) seconds (P = 0.0003). Correlations of absolute difference versus average ranged from 0.18 to 0.49. Only the paired international normalized ratio samples had P values suggesting nonagreement. CONCLUSIONS: Drawing blood samples from heparinized PICCs for coagulation tests using the evidence-based procedure developed for this study resulted in accurate coagulation test results in 4 of the 5 tests: prothrombin time, partial thromboplastin time, and fibrinogen in seconds and in milligrams.

Incidence and prevalence of pressure ulcers in children.

OBJECTIVE: To determine the incidence and prevalence of pressure ulcers in children. DESIGN: National survey mailed to 234 members of 4 pediatric-specific health care databases. PARTICIPANTS: A total of 55 questionnaires were returned (25% return rate). Fifty-one of the questionnaires were suitable for obtaining prevalence data and 40 were suitable for obtaining incidence data. RESULTS: The pressure ulcer incidence rate was 0.29% and the prevalence rate for 1998 was 0.47%. Many of the contributing factors cited by participants mirrored those seen in adult patients with pressure ulcers. CONCLUSION: Under the National Institutes of Health guidelines, children can be excluded from pressure ulcer studies that include subjects above age 21 because of the rarity of pressure ulcer development in the pediatric population. However, separate pediatric pressure ulcer studies should be conducted to determine best-practice models for children with pressure ulcers.