The important primary care role of neonatal nurse practitioners in the neonatal intensive care unit.

ABSTRACT: Neonatal nurse practitioners (NNPs) are recognized as acute care providers but are actually both acute and primary care providers via education and practice. Neonatal nurse practitioners provide primary care such as anticipatory guidance, care and follow-up of technologically dependent infants, and discharge planning. Numerous interventions and care in the neonatal intensive care unit (NICU) fall under the umbrella of health promotion, an aspect of primary care. In addition, NNPs must also be able to recognize, diagnose, and manage myriad common pediatric illnesses. There is a paucity of data to evaluate how NNP programs are meeting the National Association of Neonatal Nurses educational standards on this topic. A REDCap survey was sent to 31 NNP program directors, with a 100% response rate. All programs provide content addressing primary care management in their curriculum. National recognition of the primary care role, in addition to the acute care role that NNPs practice, should increase opportunities for clinical placement sites, employment opportunities, and grant funding. This article aims to demonstrate both the educational preparation and the delivery of primary care that NNPs provide in the NICU and other areas of practice.

Rethinking Nursing Education and Curriculum Using a Racial Equity Lens.

BACKGROUND: Health educators are called on to dismantle health care inequities as they train future health care clinicians to deliver care that promotes equity, improves access to care, and actively addresses antiracism. METHOD: Through an Advanced Nursing Workforce grant by the Health Resources and Services Administration, a partnership was established with the Institute for Perinatal Quality Improvement to provide training for health care clinicians and students on ways to SPEAK UP against implicit and explicit bias with an emphasis on maternal health. RESULTS: Dismantling racism is a continuous process. Activities included self-reflection, small group meetings, antiracism and bias training, and community engagement. CONCLUSION: Acknowledging that racism and health inequities exist and directly contribute to the rise in maternal and infant mortality is only the beginning. Rethinking nursing education, curriculum, and clinical care to train culturally responsive health care clinicians is required to address systemic and structural racism in health care. [J Nurs Educ. 2022;61(8):493-496.].

Mentoring and Support for Underrepresented Nursing Faculty: An Integrative Research Review.

BACKGROUND: Nursing faculty members may need several mentors to succeed in scholarly productivity, career development, work-life balance, and socialization in the academy. Underrepresented (UR) faculty report additional challenges to success. PURPOSE: The aim of this study was to search the literature for best practices in mentoring UR faculty. METHODS: An integrative review was conducted to identify best and evidence-based practices for mentoring UR faculty, including gender, sexual minority, race, ethnicity, and geographic remoteness (rural). Fifteen articles were rated on evidence and methodological quality. RESULTS: Successful mentorship programs include honest communication, including all stakeholders in forming a mentoring program, goals and activities that come from the mentees, and guaranteed resources. CONCLUSIONS: Underrepresented nursing faculty may benefit from formal mentoring programs, but more research is needed.

STEPP IN: A Multicenter Quality Improvement Collaborative Standardizing Postoperative Handoffs.

OBJECTIVE: To reduce care failures by 30% through implementation of standardized communication processes for postoperative handoff in NICU patients undergoing surgery over 12 months and sustained over 6 months. METHODS: Nineteen Children's Hospitals Neonatal Consortium centers collaborated in a quality improvement initiative to reduce postoperative care failures in a surgical neonatal setting by decreasing respiratory care failures and all other communication failures. Evidence-based clinical practice recommendations and a collaborative framework supported local teams' implementation of standardized postoperative handoff communication. Process measures included compliance with center-defined handoff staff presence, use of center-defined handoff tool, and the proportion of handoffs with interruptions. Participant handoff satisfaction was the balancing measure. Baseline data were collected for 8 months, followed by a 12-month action phase and 7-month sustain phase. RESULTS: On average, 181 postoperative handoffs per month were monitored across sites, and 320 respondents per month assessed the handoff process. Communication failures specific to respiratory care decreased by 73.2% (8.2% to 4.6% and with a second special cause signal to 2.2%). All other communication care failures decreased by 49.4% (17% to 8.6%). Eighty-four percent of participants reported high satisfaction. Compliance with use of the handoff tool and required staff attendance increased whereas interruptions decreased over the project time line. CONCLUSIONS: Team engagement within a quality improvement framework had a positive impact on the perioperative handoff process for high-risk surgical neonates. We improved care as demonstrated by a decrease in postoperative care failures while maintaining high provider satisfaction.

STEPP IN: Working Together to Keep Infants Warm in the Perioperative Period.

OBJECTIVES: Reduce postoperative hypothermia by up to 50% over a 12-month period in children's hospital NICUs and identify specific clinical practices that impact success. METHODS: Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for maintaining perioperative euthermia that included the following: established euthermia before transport to the operating room (OR), standardized practice for maintaining euthermia on transport to and from the OR, and standardized practice to prevent intraoperative heat loss. Process measures were focused on maintaining euthermia during these time points. The outcome measure was the proportion of patients with postoperative hypothermia (temperature ≤36°C within 30 minutes of a return to the NICU or at the completion of a procedure in the NICU). Balancing measures were the proportion of patients with postoperative temperature >38°C or the presence of thermal burns. Multivariable logistic regression was used to identify key practices that improved outcome. RESULTS: Postoperative hypothermia decreased by 48%, from a baseline of 20.3% (January 2011 to September 2013) to 10.5% by June 2015. Strategies associated with decreased hypothermia include >90% compliance with patient euthermia (36.1-37.9°C) at times of OR arrival (odds ratio: 0.58; 95% confidence interval [CI]: 0.43-0.79; P < .001) and OR departure (odds ratio: 0.0.73; 95% CI: 0.56-0.95; P = .017) and prewarming the OR ambient temperature to >74°F (odds ratio: 0.78; 95% CI: 0.62-0.999; P = .05). Hyperthermia increased from a baseline of 1.1% to 2.2% during the project. No thermal burns were reported. CONCLUSIONS: Reducing postoperative hypothermia is possible. Key practices include prewarming the OR and compliance with strategies to maintain euthermia at select time points throughout the perioperative period.

Commentary on Potential Crisis in Nurse Practitioner Preparation in the United States.

Nurse practitioner preparation and education, while evolving, still remains at a crossroads. In a recent article by Mundinger and Carter, a timeline and analysis of the number of Doctor of Nursing Practice (DNP) programs in the United States clearly demonstrated that since inception of the DNP degree, 85% of DNP programs are nonclinical. Many of the nonclinical programs in leadership and administration do not require additional clinical preparation beyond the bachelor's or master's degree in nursing. Thus, registered nurses and advanced practice registered nurses (APRNs) may obtain a DNP degree without additional clinical skill preparation beyond a baccalaureate or master's degree, respectively. Several aspects of the nonclinical DNP are concerning. Among the most challenging issues that nonclinical DNPs present is confusion on the part of other health care providers and the public. The relatively low number of clinically focused DNP programs is also problematic. If we do not prepare APRNs at the clinical doctoral level, then other providers such as physician assistants will meet the health care needs of the community. The future of APRNs could be threatened, especially in primary care.

Primer on the practice doctorate for neonatal nurse practitioners.

Recent advances in technology, research, and knowledge have amplified the need for longer and more in-depth education for neonatal nurse practitioners (NNPs). In this article we will briefly review the history of NNP's role and education, define the Doctor of Nursing Practice (DNP), and propose that the practice doctorate is the primary mechanism to meet that need and thus is the future of our profession. Doctor of Nursing Practice programs are designed to prepare the practitioner as an expert clinical NNP. Graduates obtain the highest level of practice expertise integrated with the ability to translate scientific knowledge into complex clinical interventions tailored to meet individual, family, and community health and illness needs. Doctor of Nursing Practice education also expands the scientific basis for practice and clinical practice education, and provides organization and system management and leadership, quality improvement, analytic methods to evaluate practice and apply evidence to practice, enhanced skills in information technology, health policy development, and interdisciplinary collaboration for enhanced patient outcomes.