Seizing opportunity: Diverse early-entry nursing students' perceptions of seeking a PhD.

BACKGROUND: The aging and retirement of the current nursing professoriate and the increasing numbers of nurses pursuing practice doctorates has precipitated decreasing numbers of nurses, specifically diverse nurses pursuing a research doctorate, thus limiting the development of nursing science. PURPOSE: To describe factors influencing decisions about entering a PhD program from the perspectives of early-entry PhD nursing students. METHOD: A qualitative descriptive design using semistructured interviews to explore the perceptions of making the decision to pursue a PhD in nursing of the students who participated in two early-entry mentoring programs. FINDINGS: A model, entitled "Seizing Opportunity" was developed from the findings about the process of students deciding to pursue a PhD. DISCUSSION: Motivators and detractors that can help nursing educators understand how to successfully recruit diverse PhD students were uncovered. Providing knowledge and mentoring for early entry students can increase the numbers of diverse students pursuing a PhD in nursing.

Completion and attrition of nursing PhD students of the 2001 to 2010 matriculating cohorts.

PURPOSE: To examine completion and attrition of students in nursing PhD programs. METHODS: Total 5,391 students who matriculated into nursing PhD programs in 2001 to 2010 were selected from the AACN database. FINDINGS: The completion rate of the students was 74.2% and the attrition rate was 22.7%. On average, it took 5.7 years for the students to graduate and 3.7 years for the students who left without graduating to drop out. The mean age at matriculation and graduation was 42.4 and 47.5, respectively. Male students, part-time students, students of post-baccalaureate programs, students who were not faculty or held a part-time faculty position, students of the 2001 to 2010 matriculation cohorts, and students in PhD programs with 25% or more of the courses taught online were more likely to experience attrition. CONCLUSION: The study findings provide useful information for the nursing education community to better address the issue of nursing PhD shortage.

A study of statistics knowledge among nurse faculty in schools with research doctorate programs.

Statistics knowledge is essential for nursing faculty in both teaching and research roles. In the teaching role when discussing nursing research, nursing faculty are confronted with statistical concepts and statistical methods applications. Knowledge of fundamental statistical concepts is needed so that nursing faculty can understand and critically evaluate the literature. The purpose of this study was to assess nursing faculty knowledge of fundamental statistical concepts. A probability sample with a 7.7% response rate yielded participation from 164 nursing faculty from 26 accredited schools. Results showed that most faculty members (91.5%) read peer-reviewed health-related scientific journal articles. On average, nursing faculty answered 5.1 (SD = 1.6) out of 8 statistical knowledge questions correctly. Problematic concepts included randomization (43.3% correct), and interpreting a confidence interval (42.7%) and odds ratio (33.5%). The results of this study may be used to improve statistics education and training for future nursing faculty and strengthen scholarship for nursing faculty conducting research.

The DNP Degree: Are We Producing the Graduates We Intended?

OBJECTIVE: This study addressed how recently graduated doctor of nursing practice (DNP) nurses describe their current practice, how their supervisors describe the DNP's current practice, and whether nurse and supervisor descriptions of the practices reflect the American Association of Colleges of Nursing (AACN) DNP Essentials and, if so, how? BACKGROUND: Introduced in 2004, the goal of DNP programs was to educate advanced practice RNs for effective leadership in complex healthcare environments. The value of the DNP degree for nurses in healthcare systems is evolving. METHODS: We used conventional content analysis to inductively describe how DNP graduates from 7 different schools and their supervisors described the practice of the recently graduated DNPs. Interviews were reviewed to assess whether the AACN DNP Essentials were enacted in practice. RESULTS: The overarching theme was "becoming more: re-envisioning self as an agent of change." CONCLUSIONS: Results support the claim that DNP education prepares advanced practice nurses for leadership across complex healthcare systems. Evidence of the DNP Essentials is realized when graduates perceive themselves as equal to other leaders and capable of driving change using evidence and effective collaboration.

Does improved postgraduate capacity shift the balance of power for nurse specialists in a low-income country: A mixed methods study.

AIM: To explore nurse specialists' experiences of change and influence on practice two years after graduating with a postgraduate degree. BACKGROUND: In the absence of further study opportunities for nurses in their own country, a master's degree was introduced to train the first group of nurse specialists in Mozambique. DESIGN: Within a hybrid evaluation framework an exploratory, sequential mixed methods design was followed. METHODS: Qualitative data from focus group interviews with nurse specialists (N = 12) led to five thematic data sets from which survey questions were formulated for the sequential quantitative component. FINDINGS: "Change expectations", "Ambiguous practice environments", "Feeling powerless", "Having some influence" and "Workplace support" were emergent themes from interview data. Areas of positive change occurred in research (100%) and the use of evidence (88.9%) and involvement in decision-making (77.8%). For some change did not happen as anticipated-reasons included lack of nurse mentors to support new graduates (55.6%); lesser respect compared with doctors (44.4%) and poor understanding of the value of a master's degree (44.4%). Improvements in service quality and elevating the status of nursing were areas of greatest influence (77.8%). CONCLUSION: Several enabling and limiting factors were identified in the experiences of change and influence on practice of newly qualified nurse specialists. Tacit change with respect to the value of the degree in improving the status of nursing seems not to have affected nurse specialists' own ability and power to influence practice. Improved postgraduate capacity on its own does not empower nurses in their role as specialists. IMPACT: The findings point to a two-tiered strategy to be developed to dismantle barriers to the empowerment and advancement of nurse specialists. The identification of designated nurse mentors is essential to induct and sustain newly graduated nurse specialists. A clear research policy should be developed that supports the conduct of relevant research and the use of evidence in specialist practice.

The role of Doctor of Nursing Practice-prepared nurses in practice settings.

BACKGROUND: The role of the Doctor of Nursing Practice-prepared nurse (DNP) outside of academic settings has not been clearly articulated or widely explored, and therefore the value DNP-prepared nurses bring to their practice settings is largely unknown. This study: (1) surveyed existing DNP programs to identify the nonacademic settings in which their DNP graduates were employed and (2) conducted semistructured interviews with employers to identify the role and value of the DNP-prepared nurse in nonacademic settings. METHOD: Data were collected from January 2016 to August 2016 in two parts: (1) an online survey of the DNP programs and (2) qualitative semistructured telephone interviews with employers. First, we conducted an online survey of program directors (or their equivalent) from 288 DNP programs across the United States to capture descriptive information about current DNP programs (e.g., location, modality, profit status), the types of nonacademic institutions that hire their graduates, percentage of graduates employed by each setting, and the contact information for these employers. Employers were identified either by DNP program directors through the online survey or by a convenience sampling method. Using semistructured telephone interviews, we asked questions to employers in different care settings about the role of the DNP in these settings and how the DNP compares to other nurse leaders and advanced practice nurses (APRN). Employers were asked to describe the role of the DNP-prepared nurse working in direct patient care roles such as APRNs or as leaders, administrators, and managers. FINDINGS: Descriptive thematic analyses were derived from the interviews, to identify the roles DNP-prepared nurses filled and how they compared to other nurse leaders and advanced practice nurses in these settings. A total of 130 DNP program directors responded to the online survey. Twenty-three employers participated in semistructured telephone interviews. The thematic analysis resulted in four main themes regarding the role of the DNP-prepared nurse in non-academic settings: "DNP-Prepared Nurse Positions and Roles," "Perceived Impact of the DNP-Prepared Nurse on Staff, Patient, and Organizational Outcomes," "Comparison of the DNP-Prepared Nurse to Other Nurses With Advanced Training," and "Challenges Experienced by Nurses With DNP Degrees. DISCUSSION: The role of the DNP-prepared nurse in nonacademic settings is unclear. These DNP-prepared nurses typically function as APRNs in clinical care or as health care system leaders. While there is a low number of DNPs in clinical practice settings, the number is expected to grow as more graduate and enter practice. Thus, knowledge of the roles, value, and outcomes of the DNP-prepared nurse can guide practice setting leaders on how to best use DNP-prepared nurses in their setting.

Reports of three organizations' members about doctor of nursing practice project experiences and outcomes.

BACKGROUND: Holders of the Doctor of Nursing Practice (DNP) degree were envisioned to improve health and health care outcomes by implementing quality improvement initiatives, applying evidence-based practice changes (EBP), and influencing policy. Little is known about the nature of the DNP project experience and its relationship with subsequent experiences of graduates. Filling these knowledge gaps is important because of the investment of time, faculty and student effort, expense, and the projects' potential long-term effects on the organizations in which they were conducted. PURPOSE: (1) Describe the impetus for foci, outcomes and activities of DNP projects and (2) determine the extent to which project foci are a part of post-graduation experiences. METHODS: A cross-sectional descriptive survey design was used and a via mailed paper and online version was sent with return options to graduates of Doctor of Nursing Practice program. The sampling technique was designed to maximize the capture of DNP graduates. Three mailings were sent to 5,830 nurse members of three national organizations with memberships that included advanced practice registered nurses, nurse administrators and nurse educators. The 1,308 DNP prepared respondents were demographically and geographically representative of organizational members. FINDINGS: Most (65.2%) reported the topic of the project was their own idea and they sought out an organization in which to conduct it. Twenty-five percent indicated not all aspects of the reorganization/initiative/policy change were completed by graduation. Five project foci emerged with the majority reporting an EBP initiative or an EBP project involving reorganization in the setting (57.7%) There was also a wide variation in the number, types and combinations of activities reported to be a part of the project. There was wide variation in the relationship of project foci and activities with reports of post-graduation experience by position title. DISCUSSION/CONCLUSION: Findings suggest potential avenues for innovations during the DNP project experience innovations. Long term effects of projects on organizations in which they were conducted and the relationship of project activities with post-graduation roles should be considered.

Variation in academic preparation and progression of nurses across the continuum of care.

BACKGROUND: Changing health care needs are driving new models of care that emphasize care coordination, health promotion, and disease management by registered nurses (RNs). A skill-mix favoring professional (baccalaureate or above) over technical (less than baccalaureate) education is promoted by national initiatives. PURPOSE: To examine the academic preparation and progression of general practice RNs in practice settings across the care continuum. METHOD: Secondary analyses of data from the Texas Board of Nurses RN Licensure databases in 2008 and 2014. FINDINGS: Overall the professional skill-mix for general practice RNs improved from 47.1% to 50.2%. Disparities were identified in home health (31.6%), long-term care (27.8%) and nonmetropolitan areas (31.7%). Role change was the strongest correlate of academic progression. DISCUSSION: Non-hospital and rural practice settings may be vulnerable to the effects of an undereducated RN workforce. More effective reimbursement policies and employer incentives are needed to drive academic progression and address disparities across practice settings.

Exploring the Doctor of Nursing Practice project facilitator/mentor role.

BACKGROUND: The Doctor of Nursing Practice (DNP) facilitator/mentor is a collaborative member of the project team, yet little has been reported about this role. This qualitative study explored the experiences of DNP project facilitators. METHODS: Focus groups were conducted using a purposeful sample of project facilitators. Focus group questions were developed using Gitlin, Lyons, and Kolodner's five-stage model of collaboration. Data were transcribed and content analyzed using Kruger and Casey methods. RESULTS: Three focus groups included 21 facilitators who were affiliated with an academic health system. Six themes emerged: (a) exploring student interest, (b) establishing a collaborative fit, (c) connecting with key stakeholders, (d) overcoming barriers, (e) role clarity, and (f) interaction. CONCLUSION: DNP project facilitators have an important role not only in students' formation, but also in contributing to the academic-practice partnership. The importance of the facilitator role as the student progresses through their DNP project cannot be overstated.

Characterization of didactic and pedagogical training in Brazilian stricto sensu Postgraduate Programs in Nursing.

OBJECTIVE: To characterize the didactic and pedagogical training offered in Brazilian stricto sensu Postgraduate Programs in Nursing. METHOD: Descriptive, documentary research, based on data from 30 postgraduate programs that offer an academic master's degree and a PhD degree. We collected the course projects and teaching plans of the disciplines related to didactic and pedagogical training, accessed through the Sucupira Platform or the institutional website. The variables were analyzed by descriptive statistics, through calculations of relative and absolute frequency. RESULTS: Regarding the lines of research of the programs, it was evidenced that 17.4% (n=20) were related to didactic and pedagogical training, 9.4% (n=3) followed this approach and, regarding compulsory didactic and pedagogical disciplines, it was observed that they were expressed differently in the curricula of masters and PhD courses, since part of the masters courses (56.6%, n=17) and of the PhD courses (76.6%, n=23) did not have this requirement. CONCLUSION: There should be a Brazilian guideline to promote the didactic and pedagogical training of university professors.

Dissemination of scholarship across eight cohorts of doctor of nursing practice graduates.

AIMS AND OBJECTIVES: To evaluate the publication record across eight cohorts of post-master's Doctor of Nursing Practice graduates. BACKGROUND: Dissemination of findings from evidence-based practice is described in the American Association of the Colleges of Nursing, Doctor of Nursing Practice Essential III. Students in Doctor of Nursing Practice programmes are expected to generate deliverables (e.g., a manuscript) of evidence to improve practice or patient outcomes. DESIGN: A descriptive study was conducted to determine whether two key manuscripts (i.e., integrative review and an evidence-based quality improvement project) were disseminated in peer-reviewed journals, and if so, the length of time from graduation to publication. Co-authorship with faculty advisors and contributors was also examined. RESULTS: The number of evidence-based quality improvement publications outpaces the number of integrative reviews over this span of time. Time to publication from graduation has decreased in recent years. CONCLUSIONS: Expecting, rather than encouraging a publishable-ready manuscript as a course deliverable would further student's motivation to disseminate their scholarship. Focused attention on faculty co-authorship may help increase the number of successful student publications for both integrative reviews and evidence-based quality improvement projects and decrease the time from graduation for those publications. RELEVANCE TO CLINICAL PRACTICE: Dissemination of academic scholarly work is an expected outcome for Doctor of Nursing Practice graduates who impact clinical, operational and financial outcomes in complex healthcare delivery systems.

Retirements and succession of nursing faculty in 2016-2025.

BACKGROUND: Faculty retirement has been a growing concern for the nursing education community given the impact it may have on preparing the future nursing workforce. PURPOSE: To estimate faculty retirements in 2016-2015 and to assess the impact of retirements on the faculty workforce. METHOD: The Least-Squares Regression and the Cohort Component Methods were used to project retirements. DISCUSSION: The study projected that total retirements in 2016-2025 would equal one third of faculty in 2015. Retirees are likely to come from current faculty aged 60 or older, and faculty aged 50-59 are likely to be their replacements. The impact of the retiring faculty on the faculty workforce will be huge given their overrepresentation in doctoral attainment, senior rank, and ability for graduate-level teaching. CONCLUSION: The findings suggest a sense of urgency for the nursing education community to address the impending exodus of senior faculty and to develop younger faculty for their successful succession.

Junior research track faculty in U.S. schools of nursing: Resources and expectations.

BACKGROUND: Concerns about U.S. nursing research workforce preparation and success in the research arena require information about support mechanisms and readiness because the first research position is key to researcher retention and success. PURPOSE: The purpose was to describe the state of junior nursing research faculty recruitment terms, nursing programs' support during the first 2 years of employment, and administrators' views about strengths and weaknesses of the junior nursing research faculty pool and adequacy of the support provided. METHODS: Survey administrators in all U.S. nursing programs offering research doctorates (n = 125; response rate: 52%). DISCUSSION: Resource availability varied widely across institutions. Most respondents reported resources were adequate regardless of the actual level provided. Administrators' teaching and research expectations of these faculty also varied widely. Administrators identified readiness to perform as an issue of concern. CONCLUSION: As consumers of nursing research program graduates and as administrators responsible for the nursing research enterprise, deans need to take collective as well as individual actions.

Evidence-Based Practice Beliefs and Implementation in Doctor of Nursing Practice Students.

BACKGROUND: Doctors of Nursing Practice focus on leadership in evidence-based practice (EBP). EBP is influenced by one's beliefs in and implementation of EBP. Little is known to date about the EBP beliefs and implementation of Doctor of Nursing Practice students and outcomes of Doctor of Nursing Practice education. AIMS: Guided by the Advancing Research and Clinical practice through close Collaboration (ARCC) Model, the Evidence-Based Practice Beliefs (EBPB) and Implementation (EBPI) tools were used to assess the impact of EBP as a program pillar, curricular thread, and content area on EBPB and EBPI of Doctor of Nursing Practice-Family Nurse Practitioner students. METHODS: Five cohorts who completed the same curriculum were studied. Fifty-four of the 89 students across the five cohorts began and completed the study. RESULTS: Paired t-test for group effects showed statistical significance from pre- to post-measure in students overall EBPB, t = 4.4 (52), p < .001, and EBPI, t = 8.4 (52), p < .001. A large effect size of .75 standard deviation (SD) gain above the mean for EBPB, and a very large effect size of 1 SD gain above the mean for EBPI were observed. Repeated measures ANOVA showed that all cohorts made gains across the curriculum. Effect sizes for EBPB ranged from .25 to 1 SD above the mean, and .75 to 1.5 for EBPI. LINKING EVIDENCE TO ACTION: DNP students who are educated to be EBP leaders must have a curriculum that supports them in the knowledge and skill-set needed to translate evidence into practice. The ARCC Model can guide faculty in EBP curriculum development. EBPB and EBPI are valid and reliable measures to assess for gains across a curriculum. Through educational outcomes, educators can assess desired student outcomes for EBP across a curriculum and can build an evidence base for ongoing curriculum development.

Preparing the health workforce in Ethiopia: A Cross-sectional study of competence of anesthesia graduating students.

BACKGROUND: Efforts to address shortages of health workers in low-resource settings have focused on rapidly increasing the number of higher education programs for health workers. This study examines selected competencies achieved by graduating Bachelor of Science and nurse anesthetist students in Ethiopia, a country facing a critical shortage of anesthesia professionals. METHODS: The study, conducted in June and July 2013, assessed skills and knowledge of 122 students graduating from anesthetist training programs at six public universities and colleges in Ethiopia; these students comprise 80% of graduates from these institutions in the 2013 academic year. Data was collected from direct observations of student performance, using an objective structured clinical examination approach, and from structured interviews regarding the adequacy of the learning environment. RESULTS: Student performance varied, with mean percentage scores highest for spinal anesthesia (80%), neonatal resuscitation (74%), endotracheal intubation (73%), and laryngeal mask airway insertion check (71%). Average scores were lowest for routine anesthesia machine check (37%) and preoperative screening assessment (48%). Male graduates outscored female graduates (63.2% versus 56.9%, P = 0.014), and university graduates outscored regional health science college graduates (64.5% versus 55.5%, P = 0.023). Multivariate linear regression found that competence was associated with being male and attending a university training program. Less than 10% of the students believed that skills labs had adequate staff and resources, and only 57.4% had performed at least 200 endotracheal intubations at clinical practicum sites, as required by national standards. DISCUSSION: Ethiopia has successfully expanded higher education for anesthetists, but a focus on quality of training and assessment of learners is required to ensure that graduates have mastered basic skills and are able to offer safe services.

PhD programs in nursing in the United States: visibility of American Association of Colleges of Nursing core curricular elements and emerging areas of science.

Preparing nursing doctoral students with knowledge and skills for developing science, stewarding the discipline, and educating future researchers is critical. This study examined the content of 120 U.S. PhD programs in nursing as communicated on program websites in 2012. Most programs included theory, research design, and statistics courses. Nursing inquiry courses were evidenced on only half the websites. Course work or research experiences in informatics were mentioned on 22.5% of the websites; biophysical measurement and genetics/genomics were mentioned on fewer than 8% of program websites. Required research experiences and instruction in scientific integrity/research ethics were more common when programs had Institutional Training Award funding (National Institutes of Health T32 mechanism) or were located at a university with a Clinical and Translational Science Award. Changes in education for the next generation of PhD students are critically needed to support advancement of nursing science.

Process Improvement: Addressing Attrition from the Uniformed Services University of the Health Sciences Nurse Anesthesia Program.

This retrospective cohort study examined the Uniformed Services University of the Health Sciences Registered Nurse Anesthesia program to identify reasons for high attrition rates. Relevant data were examined for 180 students enrolled in classes from 2005 through 2011. During that period, 40 students were dismissed or disenrolled, with the highest attrition rate (35%) occurring in the class of 2010. Evidence from this investigation indicates students who completed the program were younger, earned higher grade point averages while completing their undergraduate bachelor of science in nursing, and achieved higher analytic and total Graduate Record Examination scores than did students who withdrew or were dismissed. Gender differences were noted, as a greater proportion of women completed the program compared with men. Personal, family, and other issues frequently overlapped, with academic performance problems leading to attrition. Based on these findings, a number of important changes were made in the admission process to the USUHS RNA program and in the nonacademic mentoring and assistance offered to students.

Unveiling the Truth about Nurses' Personal Preparedness for Disaster Response: A Pilot Study.

Although nurses are essential caregivers in disaster response, many are not prepared personally to report to the workplace during disaster situations. An online disaster preparedness education intervention to support personal readiness is described in this pilot study.

The Rapid Growth of Graduates From Associate, Baccalaureate, And Graduate Programs in Nursing.

Growth in the number of RN graduates from 2002-2012 has been dramatic and broad based, occurring between both associate and baccalaureate programs, and has included people from all racial and eth- nic backgrounds. This growth has occurred in all types of public, private not-for- profit, and proprietary institu- tions. The growth of RNs with gradu- ate degrees has also increased, particularly since 2004. Given the rapid production of nursing graduates, leaders in academic nursing education are urged to focus on the quality of nursing graduates, take steps to assure that graduates are well prepared for growth in nonhospital settings, ensure graduates are aware of the many challenges they will confront, and are well prepared to seize opportunities that will unfold during an era of health reform.