How academia can help to grow-and sustain-a robust nursing workforce.

This panel paper is the second installment in a six-part Nursing Outlook special edition based on the 2022 Emory Business Case for Nursing Summit. The 2022 summit convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises, including the nursing shortage. Each of the summit's four panels authored a paper in the special edition on their respective topic(s), and this panel paper focuses on the topic of nursing workforce growth. It discusses priority areas for academia to help ameliorate nursing shortages, including through changes to nursing curricula and/or programming, greater attention to nursing financial needs (including nursing student loans), and regulatory reforms.

Career development of doctorally prepared nurses.

AIM: To integrate research literature regarding careers, career development and factors influencing the career development of doctorally prepared nurses. DESIGN: An integrative review. DATA SOURCES: Medline, CINAHL and Embase were searched in June 2022 without time restrictions. METHODS: Peer-reviewed empirical publications written in English with different types of study designs were included. Two researchers independently applied eligibility criteria, selected studies and conducted quality appraisals using Joanna Briggs checklists. Data were extracted and analysed using a convergent integrated approach with thematic analysis. Themes were established within three categories based on the research questions: career, career development and factors influencing career development. RESULTS: Twenty-two studies were included. Nine themes were identified. One theme regarding careers describes that doctorally prepared nurses need to prioritize work within different positions. The two themes focusing on career development described the need to determine career goals after the doctorate and further develop competencies. Six themes described factors influencing career development: 'Intrinsic motivation to improve health care and nursing education', 'Available support sources', 'Professional development programmes', 'Work-life balance', 'Organizational infrastructures for career advancement' and 'Competition and hostile treatment among colleagues'. CONCLUSION: Limited knowledge of the careers and career development of doctorally prepared nurses was found. Doctorally prepared nurses need to balance work with various part-time positions. Careers and career development could be supported by the development of structures for career advancement as well as supportive working environments. IMPACT: Doctorally prepared nurses with strong careers are important to health care and nursing as they generate and implement new knowledge into clinical practice and thereby support the improvement of (nursing) care and patient outcomes. This study provides considerations towards strengthening the careers of doctorally prepared nurses. REPORTING METHOD: PRISMA. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Current state and future recommendations for faculty in PhD in nursing programs.

In 2020 the American Association of Colleges of Nursing (AACN) Board of Directors appointed a 9-member task force to revise AACN's 2010 position statement, The Research-Focused Doctoral Program in Nursing: Pathways to Excellence, with the goal of developing a vision for research-focused doctoral programs and graduates. This resulted in 70 recommendations in a new AACN position statement, The Research-Focused Doctoral Program in Nursing: Pathways to Excellence (2022). The new document is based on a review of the literature from 2010 to 2021 and 2 inaugural surveys sent to deans and PhD students in nursing. The new The Research-Focused Doctoral Program in Nursing Pathways to Excellence document focuses on the critical need for nurse scientists who can develop the science, steward the profession, and educate new nurse educators. Several manuscripts have been developed describing various components of the PhD Pathways document focusing on the role of faculty, students and curriculum, resources and post-doctoral education. This article focuses on the recommendations related to explicating the faculty role in PhD education and includes data from the AACN (2020) deans' survey, the current state of the professoriate involved in PhD education and the developmental needs of PhD faculty for the future.

Creating a racial justice plan in a school of nursing: A journey of discovery and learning.

While there are many individuals and instances which illustrate the injustices experienced by people of color at the hands of police in the United States, the video which documented the murder of George Floyd by a law enforcement officer graphically illustrated our long and sad history of racial injustices. This and other events in 2020 forced our society to look at racism and systemic injustices that are embedded so deeply within our policies and practices that differentially advantage or disadvantage certain faculty, students and staff within higher education. This paper will describe the infrastructure and processes used to examine and address individual and systemic racism and white supremacy-based practices and policies at a School of Nursing. We describe the initial phases of racial justice work and infrastructure used to engage and support the efforts of committed faculty, staff and students aspiring to achieve racial equity. We share our challenges as well as immediate outcomes with the hope of stimulating thinking and dialogue in other schools around eliminating racial injustices in nursing education programs so the profession can achieve its' vision of preparing a diverse nursing workforce for the future who will work to improve the health of all.

Influence of Primary Care Provider Type on Chronic Pain Management Among Veterans.

Background: Chronic pain disproportionately impacts veterans and is often treated in primary care, where physician shortages in the Veterans Health Administration (VHA) healthcare system are well documented. Nurse practitioners (NPs) may represent a solution to the care shortage; however, concerns of NP opioid overprescribing have led to NP practice and prescribing restrictions in individual VHA facilities and at the state level. Little is known regarding the prescribing patterns of NPs and physician assistants (PAs) for veterans with chronic pain in the VHA. Purpose: The purpose of this study was to compare opioid and non-opioid prescribing patterns of physicians, NPs, and PAs for chronic pain patients at VHA centers. Methods: We used data from the U.S. Department of Veterans Affairs Survey of Healthcare Experience of Patients and Corporate Data Warehouse from October 2015 to September 2016. Patient medical records for the year were analyzed by provider type (physician, NP, or PA) for differences in providers' rates of prescribing opioid and non-opioid medications, as well as characteristics of the opioid prescriptions (e.g., high daily morphine milligram equivalent [90 MME/day] dose, long-term opioid therapy [90 days]). Results: Medical records of a total of 39,936 patients were included. In FY 2016, 55% of patients received one opioid prescription, whereas 83.8% received one non-opioid prescription. Compared to patients of NPs and PAs, patients of physicians had higher odds of receiving opioid (vs. NPs: OR = 1.13, p < 0.01; vs. PAs: OR = 1.16, p < 0.01) and non-opioid prescriptions (vs. NPs: OR=1.08, p = 0.02; vs. PAs: OR=1.20, p < 0.01) after adjusting for patient characteristics. There were no differences in high MME/day dose (p = 0.59) or long-term opioid therapy (p = 0.99). Conclusion: In a national sample of veterans with chronic pain, NPs and PAs did not have higher odds of opioid prescribing. Concerns of NP or PA opioid overprescribing may be addressed by considering evidence that patients of these providers are not at higher odds of receiving an opioid prescription.

Patient demographics and clinical characteristics influence opioid and nonopioid pain management prescriptions of primary care NPs, PAs, and physicians.

BACKGROUND: Evidence exists on racial and gender disparities in chronic pain management among veterans. Most literature has described physicians' disparate opioid prescribing patterns, although it is unknown if prescribing disparities exist among nurse practitioners (NPs) and physician assistants (PAs) or among prescription of nonopioid analgesic strategies. PURPOSE: To identify patient characteristics associated with opioid and nonopioid prescriptions among Veterans Affairs (VA) chronic pain patients by primary care physicians, NPs, and PAs. METHODOLOGY: We used data from the VA's Survey of Health care Experience of Patients and Corporate Data Warehouse from October 2015 to September 2016. Outcomes included opioid and nonopioid analgesic prescriptions. Patient characteristics included race/ethnicity, gender, education level, age, and clinical characteristics (comorbidities, self-reported health, and self-reported mental health). Logistic regression was performed to test for associations of patient characteristics with outcomes. RESULTS: Patients who were White, male, age 41-64 years, and with no postsecondary education had higher odds of receiving an opioid prescription (all p -values ≤ .01), whereas patients who were Black, female, and <65 years old had higher odds of a nonopioid prescription (all p -values < .01). Having 5+ comorbidities and fair/poor self-reported health increased the odds of opioid and nonopioid prescriptions (all p -values < .01). CONCLUSIONS: Disparities in race, gender, and educational level significantly affect how primary care NPs, PAs, and physicians manage chronic pain. IMPLICATIONS: NPs and other primary care providers should pursue training opportunities to identify and mitigate potential biases that may affect their practice. Future research should take an intersectional lens in examining the source of chronic pain disparities.

Inclusive leadership to guide nursing's response to improving health equity.

The purpose of this manuscript is to examine traditional models of leadership in nursing, and to provide a roadmap and specific recommendations for nurses at all levels to lead our profession through the next decade in achieving health equity. We examine current leadership frameworks in nursing and discuss ways to contemporize these frameworks to more explicitly center the expertise of clinicians and communities from historically marginalized backgrounds. Next, we examine the racial, gender, and able-bodied biases that impact nurses, and call upon nurses to examine and dismantle these biases. We discuss the roles of health systems and academic organizations in developing inclusive leaders, including through community engagement and true service-learning partnerships. Finally, we provide a set of recommendations for all nursing leaders across career stages to embrace inclusivity as they work to improve health equity.

Promoting Strategies to Increase HPV Vaccination in the Pediatric Primary Care Setting.

INTRODUCTION: Evaluation of a quality improvement project designed to improve HPV vaccine uptake in a pediatric primary care setting for young adolescents. METHOD: Three strategies were implemented in one private pediatric practice to promote HPV vaccine uptake for 11- and 12-year-old adolescents. 1) a standardized vaccine policy change was made to include HPV vaccine with other adolescent vaccines, 2) a pre-visit email was sent to parents of teens to provide factual vaccine information in preparation for the visit, and 3) a provider communication initiative was implemented to ensure all providers communicated consistent messages and delivered an effective cancer prevention recommendation for HPV vaccination. A pre/post design was used to compare vaccine rates. Data was obtained via the electronic health records. RESULTS: The post-intervention group demonstrated HPV vaccine rates increased substantially from 17.8% to 63.6%. DISCUSSION: Strategically implementing standardized clinical vaccine policies and presumprive provider communication practices has implications for significantly increasing HPV vaccine uptake among teens and may be key to preventing cancer among future generations.

Influence of provider type on chronic pain prescribing patterns A systematic review.

BACKGROUND: Chronic pain affects 100 million Americans and is most often treated in primary care, where the health care provider shortage remains a challenge. Nurse practitioners (NPs) represent a growing solution, yet their patterns of chronic pain management are understudied. Additionally, prescriptive authority limitations in many states limit NPs from prescribing opioids and often exist due to concerns of NP-driven opioid overprescribing. Little evidence on NP pain management prescribing patterns exists to address these issues. OBJECTIVE: Systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, to examine opioid and nonopioid prescribing patterns of physicians, NPs, and physician assistants (PAs) in primary care. Eligible studies scored ≥60% on the Joanna Briggs Institute Critical Appraisal checklist. DATA SOURCES: Searches within PubMed, Embase, CINAHL, and Web of Science. CONCLUSIONS: Three themes were elucidated: 1) opioid prescribing in primary care, 2) similarities and differences in opioid prescribing by provider type, and 3) nonopioid pain management strategies. All provider groups had similar opioid prescribing patterns, although NPs and PAs may be slightly less likely to prescribe opioids than physicians. Although some studies suggested that NPs/PAs had higher opioid prescribing rates compared with physicians, methodological flaws may undermine these conclusions. Evidence is also lacking on nonopioid prescribing patterns across disciplines. IMPLICATIONS FOR PRACTICE: Nurse practitioner/PA prescriptive authority limitations may not be as effective of a solution for addressing opioid overprescribing as transdisciplinary interventions targeting the highest subset of opioid prescribers. Future research should examine prescribing patterns of nonopioid, including nonpharmacologic, therapies.

Publishing in Predatory Journals: Guidelines for Nursing Faculty in Promotion and Tenure Policies.

PURPOSE: The purpose of this study was to assess the extent to which academic promotion and tenure (APT) criteria and guidelines in schools of nursing recognize predatory publishing. This assessment included an analysis of APT documents looking specifically for guidance about predatory publications by faculty in schools of nursing. DESIGN: This study used a cross-sectional, descriptive design and was conducted in 2020. METHODS: A mixed methods approach was used to collect data from two sources. Data were extracted from APT documents for 92 research-intensive universities found online and specifically focused on documents for universities and for schools of nursing in the United States. Interviews were conducted with a subsample of academic administrators (n = 10) from selected schools. FINDINGS: The majority (57%; n = 50) of APT documents reviewed addressed quality of the journals in which faculty publish. However, very nonspecific terms, such as "high quality" or "peer reviewed" were used. None of the documents reviewed (n = 88) included any reference to predatory journals. Deans who were interviewed validated the analysis of the APT documents. While most deans reported faculty were aware of predatory journals and the risks of publishing in them, formal guidelines for consequences for publishing in predatory journals were not developed or available. CONCLUSION: This study examined how schools of nursing in research-intensive universities address the issue of predatory journals. APT criteria do not provide guidance to faculty and promotion and tenure committees about issues related to predatory publications as low-quality publication outlets. Recommendations for APT committees, mentors, and faculty are provided. CLINICAL RELEVANCE: Clinicians rely on researchers, many of whom are faculty, to publish rigorous studies that produce evidence they can translate into practice. One measure of the quality of a study's findings is where the paper is published and reflects the level of peer review it has been through. Faculty who publish in predatory journals may not have had their work reviewed by experts; evidence produced may or may not be adequate for translation to guide nursing practice.

Innovations in Ph.D. education to prepare nurse scientists for the future.

The University of Pennsylvania sponsored a PhD summit in October 2019 to bring together faculty and leaders in PhD education as well as professional associations in nursing to discuss the state of PhD education. Participants were divided into groups and asked to address specific questions. This paper presents the discussion points and recommendations from the group focusing on innovation in PhD education. Innovations such as team mentoring models, design thinking courses, and structures that support students to progress from BSN through PhD programs are discussed. Recommendations include a need to intentionally structure faculty development earlier in their professorial careers, develop team models of advisement and longitudinal follow-up of alumni graduates form Ph.D. programs to examine the effectiveness of innovations.

An innovative DNP post-doctorate program to improve quality improvement and implementation science skills.

BACKGROUND: Doctor of Nursing Practice programs prepare nurse leaders for unique roles to address healthcare needs across the quality spectrum. However, additional mentoring and training in implementation science and analytical skills is needed to effectively lead system-wide quality initiatives. PURPOSE: The purpose of this article is to describe the planning, implementation, and evaluation of an innovative post-doctoral DNP Quality Implementation Scholars Program developed through an academic-practice partnership to address this need. PROJECT METHOD: Throughout the one year post-doctoral program, we evaluated student experiences qualitatively using focus groups and quantitatively using standardized course and instructor surveys to assess overall programmatic goals. Program outcomes were evaluated from the perspective of the academic-practice partnership planning committee through a Qualtrics© survey. FINDINGS: Strengths of the program included the in-depth mentoring by faculty and relationships built across the larger health system. Both scholars and the planning team noted that the system-wide project implemented by the scholars was relevant, timely, and quality-focused. CONCLUSIONS: This innovative DNP post-doctoral program leveraged the skill-sets of DNP-prepared nurse leaders to lead system-wide quality improvement initiatives tailored specifically to healthcare organizations.

Assessing Practice Patterns and Influential Factors for Nurse Practitioners Who Manage Chronic Pain.

INTRODUCTION: Challenges exist in caring for chronic pain patients, such as preventing opioid-related adverse events, a lack of available non-pharmacologic alternatives, and limitations in prescriptive authority. Nurse practitioners are well-suited to manage chronic pain due to their holistic approach to care and growing numbers in primary care. Yet little is known about the chronic pain care given by NPs. As such, the purpose of this study was to understand the experiences of NPs who manage chronic pain, and to examine how these experiences impact NP prescribing patterns in chronic pain management. METHODS: We developed the 31-item NP Chronic Pain Prescribing Practices survey. We collected data from N = 128 NPs at the American Association of Nurse Practitioners (AANP) conference. Pearson chi-square and Fisher's exact tests were utilized for statistical analysis. RESULTS: NPs reported high levels of agreement with nearly all the presented challenges. MSN-prepared NPs were more likely than DNP-prepared NPs to report difficulty in managing pain (x 2 = 4.2, p = .04). There were no differences in prescription of chronic pain therapies between NPs of varying practice authority statuses. NPs in specialty care settings were more likely to utilize opioids (x 2 = 13.6, p < .01), while primary care NPs were significantly more likely to use NSAIDs (x 2 = 13.5, p < .01) and Tylenol (x 2 = 3.9, p = .05). CONCLUSIONS: Our findings demonstrate significant challenges NPs face in chronic pain management. More research is needed to better understand the complexities associated with chronic pain care given by NPs in order to effectively manage chronic pain while still preventing opioid-related adverse events.