Academic Leadership for Advancing Diversity, Equity, and Inclusion.

Academic nursing prepares nurses for the future to deliver, improve, and innovate health care. Moving forward on this imperative requires nurse leaders to support diversity, equity, and inclusion efforts thus partnering with individuals, families, communities, and other sectors to advance health equity, reduce health disparities, and improve care. The purpose of this article is to describe the creation, launch, and evaluation of an Office of Diversity, Equity, and Inclusion (DEI) in an academic nursing institution. Lessons learned are shared to assist others in their own journey to establish a DEI structure within an academic setting, especially one with a robust academic-practice partnership. The ideas shared are easily transferable to nonacademic settings.

Innovations in Academic/Clinical Partnerships During COVID-19 to Prepare a Ready Nursing Workforce.

Management of the COVID-19 pandemic required healthcare leaders and frontline workers to rapidly innovate and adjust to a new reality that has forever transformed nursing education and practice. Throughout the pandemic, key stakeholders in Alabama lobbied for transformations in clinical training practice that ultimately improved students' exposure to clinical environments and alleviated the pressure on practicing nurses and other healthcare workers during pandemic hospitalization surges. The present article highlights the key partners and regulatory innovations that led to these successes in Alabama.

Academic-Practice Partnership Pivot During COVID-19 Pandemic Surge.

Health care systems continue to experience the sequential aftermath of the COVID-19 pandemic, with major care access, quality, safety, financial sustainability, and workforce considerations. Yet, academic-clinical partnership opportunities exist for transformational change, even when efforts to respond to a pandemic seem insurmountable. A nursing partnership between an academic health center nursing school and university health system provided short- and long-term support for the nursing workforce shortage during a COVID-19 surge. An academic-clinical integration framework guided planning, clinical support activities, outcomes achieved, technology innovations, and shared lessons associated with these efforts. The COVID-19 surge response steps included a call to action, preparation for surge support by the academic and clinical partners, and a team approach for clinical service delivery by faculty, students, and staff. Through the 6-week COVID-19 surge response, more than 10 000 hours of hospital nurse staffing were provided by nursing school faculty and students; over 770 worked shifts that provided approximately 30% of the full surge hospital supplemental staffing and approximately 46 000 vaccine encounters. Well-established academic-clinical nursing partnerships allow for quick pivots in the rapidly changing COVID-19 environment that can enhance nursing clinical proficiency and competency, augment clinically immersive learning, and reinforce analytics to measure health outcomes, lower costs, improve access, quality, safety, and workforce conditions.

Academic service-learning nursing partnerships in the Americas: a scoping review.

BACKGROUND: Academic service-learning nursing partnerships (ASLNPs) integrate instruction, reflection, and scholarship with tailored service through enriched learning experiences that teach civic responsibility and strengthen communities, while meeting academic nursing outcomes. OBJECTIVE: This scoping review aimed to identify, appraise, and synthesize evidence of community focused ASLNPs that promote primary health care throughout the Americas region. METHODS: A systematic search of PubMed, CINAHL, Scopus, Google Scholar, and LILACS English-language databases was performed in accordance with PRISMA guidelines. Full-text articles published since 2010 were reviewed using an inductive thematic approach stemming from the "Advancing Healthcare Transformation: a New Era for Academic Nursing Report" and the Pan American Health Organization "Strategic Directions for Nursing." RESULTS: A total of 51 articles were included with the vast majority 47 (92.1 %) representing North America. Structured, established relationships between an academic nursing institution or program and one or more community serving entities resulted in high levels of effectiveness and innovation across settings. Five themes emerged: (a) sustaining educational standards and processes - improving academic outcomes (25.5 %), (b) strengthening capacity for collaborative practice and interprofessional education (13.7 %), (c) preparing nurses of the future (11.8 %), (d) enhancing community services and outcomes (21.6 %), and (e) conceptualizing or implementing innovative academic nursing partnerships (27.4 %). A synthesis of conceptual frameworks and models revealed six focus areas: communities/populations (26.2 %), nursing (26.2 %), pedagogy (19 %), targeted outreach (14.3 %), interprofessional collaboration (11.9 %), and health determinants (9.5 %). A proliferation in US articles, triggered by nursing policy publications, was confirmed. CONCLUSIONS: ASLNPs serve as mechanisms for nurses and faculty to develop and lead change across a wide variety of community settings and healthcare systems, develop scholarship, as well as for students to apply the knowledge and skills learned. Given the lack of geographically broad evidence, successes and challenges across U.S. partnerships should be viewed cautiously. Nevertheless, ASLNPs can play a critical role towards meeting the goal of universal health access and coverage through partnering with the education sector. Further investigation of grey literature as well as Spanish and Portuguese language literature from Latin American and Caribbean countries is highly recommended.

Interprofessional Collaborative Practice Model to Advance Population Health.

The purpose of this paper is to describe the development, implementation, and lessons learned associated with an interprofessional collaborative practice (IPCP) care delivery model initiated at the University of Alabama at Birmingham (UAB). The model emphasizes transitional care coordination in chronic disease management for underserved and vulnerable populations. The model operates within a clinic environment with care providers from a variety of disciplines who integrate individual case management and actualize leadership taken by the appropriate discipline based on the needs of each patient. Two clinics will be discussed - Providing Access to Healthcare (PATH) and Heart Failure Transitional Care Services for Adults (HRTSA) - both of which leverage the resources of an existing academic-practice partnership between the UAB School of Nursing and UAB Hospital (UABH) and Health System. Clinic target patient populations are uninsured adults with diabetes (PATH Clinic) and uninsured or underinsured adults with heart failure (HRTSA Clinic) who are discharged from UABH with no source for ongoing care. The model uses a nurse-led, team-based approach that involves multiple professions working together to provide care for high-need, high-cost patients. Clinics use 4 simultaneous bundles of care that include evidence-based treatment guidelines, transitional care coordination activities, patient activation strategies, and behavioral health integration. Engaged patients indicate very high levels of satisfaction with care and improved physical and mental health outcomes resulting in significant cost savings for the health system. Finally, IPCP team members report joy in their work within the clinics.

Academic/clinical nursing integration in academic health systems.

BACKGROUND: Sustained partnerships that strengthen and expand nursing's contribution to the integration of academic nursing into clinical practice holds the promise of improving Academic Health Systems (AHS). PURPOSE: The purpose of this paper is to propose a framework whereby academic/clinical integration can be achieved within the AHS to enhance relationships between academe and clinical nursing entities. METHODS: Nursing deans and chief nurse officers/vice presidents from top ranked AHS offer perspectives to advance the integration of nursing leadership into the governance of high functioning AHS. FINDINGS: Academic and clinical nursing entities within the AHS governance calls for a shared framework to promote an integrated approach to full engagement of academic and clinical nursing. DISCUSSION: The collaborative benefits of aligning nursing's academic/clinical missions within AHS are described. The challenges and opportunities inherent in the way forward must build on intentionality and commitment for academic and clinical nursing entities to transform the AHS and improve outcomes.

An Innovative Approach for Graduate Education for Psychiatric Nurse Practitioners.

A major transformation in nurse practitioner (NP) education is the emergence of post graduate residencies; their foci include (a) educating NPs in population health; (b) increasing clinical proficiency; and (c) incorporating quality and safety into practice. We describe a psychiatric NP residency program supported by an academic-practice partnership, known as the Veterans Affairs Nursing Academic Partnership for Graduate Education (VANAP-GE) between the Birmingham Veterans Administration Medical Center (BVAMC) and the University of Alabama at Birmingham (UAB) School of Nursing (SON) for a population of Veterans with complex mental and physical health needs. Topics which are covered include risks of suicide among Veterans, post-traumatic stress disorder, depressive and anxiety disorders, and substance use disorders. During this one-year traineeship during the first year after NP certification, residents engage in development of crucial skills for improving the future of U.S. health care. All residents are newly licensed PMHNPs, but some are also pursuing DNP degrees. For residents who are simultaneously enrolled in BSN to DNP programs, the additional clinical training afforded by NP residency education provides a natural laboratory for their projects with foci of quality and safety, leadership, and clinical scholarship. Reduction in NP turnover as well as cost savings of orientation and recruitment are significant benefits for the practice partner with zero vacancies since the partnership's inception. These multiple successes predict increased establishment of residencies as viable post graduate pathways for NPs.

Sustainability of an Interprofessional Collaborative Practice Model for Population Health.

Sustainability is an important concept in implementation science, yet little about sustainability is published in leadership journals. Leaders are charged on a daily basis with initiating programs that make a difference; however, they are often not well prepared to design effective strategies to sustain their efforts. In a value-based health care industry where facilitating access to care, enhancing the patient experience, improving health outcomes, and reducing the cost of care are imperative, creating sustainability strategies that achieve these results is key. In this article, we describe the successful efforts within an academic-practice partnership to implement a sustainable interprofessional collaborative practice model emphasizing transitional care coordination in chronic disease management for advancing population health with underserved populations. A sustainability framework is presented along with lessons learned.

Development of an academic practice partnership to improve maternal child health.

This manuscript describes one nursing school's innovative community-based partnership with community organizations and Nurse-Family Partnership (NFP), an established nurse home visiting program for first-time, low income mothers and infants. The aim of this academic nursing endeavor with the community and NFP is to improve the health and well-being of low-income, first time mothers and their children while also providing comprehensive, population-based nursing experiences for students and service leadership and scholarship opportunities for faculty. The academic-practice community partnership described here makes a case for utilizing the expertise and capacity of a nursing school to implement and administer an NFP program and serves as an exemplar for the recommendations described in the New Era for Academic Nursing report (AACN, 2016). The value of forming partnerships between a public health department, the philanthropic community and an academic nursing institution is highlighted. In this case, the three organizations partnering together around a common purpose of improving birth outcomes enabled the partnership to accomplish more than any individual organization could have accomplished alone.

Essential global health competencies for baccalaureate nursing students in the United States: A mixed methods Delphi study.

AIMS: To reach consensus among experts on global health competencies for baccalaureate nursing students in the USA. DESIGN: A three-round modified Delphi study using a mixed methods research approach. METHODS: In the first round, the original list of competencies (Wilson et al., 2012, Journal of Professional Nursing, 28, 213-222) was revised based on prior research, a review of literature and the Nursing Global Health Competencies Framework developed by the fist author. Nine global health domains and 52 competencies were identified in Round One. In Round Two, two surveys were conducted for validation of the revised list of global health competencies using a group of six nurses with expertise in global health and baccalaureate nursing education, which produced modifications in the competencies used for the third phase of the study. In Round Three, 41 participants completed a survey to rate the extent to which they thought the competencies obtained in Round Two were essential for baccalaureate nursing education in the United States. Data collection took place from May 2017 - January 2018. RESULTS: A group of experts in global health and baccalaureate nursing education from the United States achieved consensus that 40 global health competencies were essential for baccalaureate nursing education in the United States. CONCLUSION AND IMPACT: The domains and competencies derived in this study can be used to guide undergraduate nursing curriculum development in global health and provide a framework for both clinical instruction and evaluation of global health student experiences.

Psychiatric Nurse Practitioner Residents Improve Quality and Mental Health Outcomes for Veterans Through Measurement-Based Care.

INTRODUCTION: Measurement-based care (MBC) is commonly used to manage medical illness, whereas only about 20% of psychiatric care providers use MBC. One aim of the partnership between the Birmingham Veterans Affairs Medical Center (BVAMC) and the University of Alabama at Birmingham School of Nursing (UAB SON) is to provide MBC to Veterans. The goal is to describe the efficacy of MBC in the treatment of Veterans by psychiatric-mental health nurse practitioner (PMHNP) residents. PURPOSE: By teaching PMHNP residents evidence-based assessment, they gain tools to shorten time to remission of depression, anxiety, and posttraumatic stress disorder. METHODS: Residents administered the Patient Stress Questionnaire (PSQ), an MBC tool that assesses depression, anxiety, trauma-related symptoms, and alcohol use, to patients of the Residency Continuity Clinic (RCC). Patient Stress Questionnaire scores from March 2016 to May 2018 were analyzed using paired t tests. RESULTS: Analysis revealed a downward trend in PSQ scores over time, suggesting improvement in psychiatric symptoms. Depressive and anxiety symptoms decreased significantly. CONCLUSIONS/IMPLICATIONS: This quality project highlights the utility of MBC by PMHNP residents in an RCC. Measurement-based care tools can be quickly and easily administered with little impact on workflow. Use of validated screening tools can enhance care, engage patients, and improve patient outcomes.

Meeting Health Care Needs in Rural Alabama: The Power of Partnerships.

Recruiting and retaining rural primary care providers is challenging. The Graduate Nursing Education Primary Care Scholars (GNEPCS) is a partnership between a philanthropic organization and a school of nursing to recruit, educate, train, and retain primary care advanced practice registered nurses (APRNs) for practice in rural Alabama with a focus on improving the state's health outcomes. In its initial four years, the GNEPCS partnership has been successful in identifying 60 registered nurses interested in becoming rural primary care APRNs. These students have received mentoring, individualized content on rural health, preceptorships with rural providers, and opportunities for professional and leadership development. Pilot philanthropic funding has allowed us to develop sustainable curricula, attract additional complementary federal funds, and create a critical mass of practice-ready APRNs who are improving primary care access for some of the state's most rural and underserved populations.

Clinical residency training: Is it essential to the Doctor of Nursing Practice for nurse practitioner preparation?

BACKGROUND: The Doctor of Nursing Practice (DNP) degree positions nurse practitioners (NPs) and other advanced practice registered nurses, with clinical competencies similar to other disciplines requiring doctoral education (medicine, physical therapy, psychology, and pharmacy). In addition, all these disciplines also offer residencies. However, nursing is the only discipline that does not require a doctoral degree and/or have a systematic approach to residency training for advanced practice roles. The authors posit that there are critical policy issues to resolve within the nursing profession to clarify the role that clinical residencies should play in transition to DNP practice specifically related to NPs. PURPOSE: The purpose of this article was to (a) describe the context of NP residency models within NP curricula that strengthen the DNP Essentials with an emphasis on Essential VIII and a focus on distinctive clinical specialization, (b) describe the history and policy implications of NP residency programs as well as existing programs that assist transition to practice, and (c) recommend policies for consideration related to DNP NP residencies. METHODS: Literature on nurse practitioner residencies was reviewed. DISCUSSION: While nurse practitioner residencies continue to grow, research is needed regarding outcomes of job satisfaction, clinical competencies, and patient satisfaction. CONCLUSION: The first year of practice for nurse practitioners is a critical period of professional development. It is important to further clarify the need, direction, and program standards. Academically affiliated residencies will facilitate the development and standardization of curricula and competencies to enhance clinical rigor. The partnership between academic units and clinical agencies will pool resources and strengthen nursing in both settings.

Transforming veterans health care through academic-practice partnerships.

The Veterans Health Affairs Office of Academic Affiliations (OAA) has invested in the creation of academic-practice partnerships to transform the care of veterans and their families. This article details how a long-standing relationship between the University of Alabama at Birmingham School of Nursing and the Birmingham Veterans Affairs Medical Center grew into such a partnership. The three programs that now exist within the Birmingham Veterans Affairs Nursing Academic Partnership (VANAP) umbrella are described, including an undergraduate VA nurse scholars program that has sustained beyond OAA funding, a VANAP graduate education program for psychiatric mental health nurse practitioners (NPs), and a Mental Health NP Residency. Key features of the programs are noted as are outcomes and lessons learned for building mutual goals and a sustainable academic-practice partnership. With the recent passage of the Veterans Choice Program, the importance of educating all nurses about veterans and veterans' health is stressed.

Caring for America's Veterans: The Power of Academic-Practice Partnership.

Veterans receive care across the entire health system. Therefore, the workforce needs knowledge and awareness of whether patients are Veterans and the impact of their military service on their physical and mental health. Recent reports of limitations in access for Veterans seeking health care have highlighted this need across all health care settings. Academic-practice partnerships are one mechanism to align the need for improved health care services within the Veteran population while advancing nursing practice in the Veterans Health Administration and surrounding communities. The key to strong partnerships and sustained collaboration is shared goals, mutual trust and respect, the development of formal relationships, and support of senior leadership that fosters the joint vision and mission to improve nursing care for Veterans. This article describes the evolving partnership between one Veterans Health Administration Medical Center and a School of Nursing, which aligned strategic goals across both organizations to increase the capacity and capability of services provided to Veterans.

Partnership to improve quality care for veterans: the VA Nursing Academy.

More than 22 million living veterans reside in the United States. In fact, understanding military culture and the experiences of these veterans is important to their ongoing health care and the unique challenges faced by many. The Veterans Affairs (VA) Nursing Academy began in 2007 to fund pilot partnerships between schools of nursing and local VA health care facilities to better serve our veteran population. Fifteen academic/service partnerships were selected for funding between 2007 and 2009 with the goals of expanding faculty and professional development, increasing nursing student enrollment, providing opportunities for educational and practice innovations, and increasing the recruitment and retention of VA nurses. This article details critical components of the partnership developed between the Birmingham VA Medical Center and the University of Alabama at Birmingham School of Nursing, a VA Nursing Academy partnership funded in the 2009 cohort. Site-specific goals of the partnership are described along with a discussion of the framework used to develop the Birmingham VA Nursing Academy, which includes relationship building, engagement, governance, evaluation of outcomes, and sustainability. The logic model developed for the partnership is included, and the interim outputs and outcomes of this practice-academic partnership are detailed, a number of which can be replicated by VAs and schools of nursing across the country.

Leadership lessons in global nursing and health from the Nightingale Letter Collection at the University of Alabama at Birmingham.

This article analyzes the components of Florence Nightingale's visionary leadership for global health and nursing within the historical context of Great Britain's colonization of India. The descriptive study used the qualitative approach of narrative analysis to analyze selected letters in the Nightingale Letter Collection at the University of Alabama at Birmingham that Nightingale wrote to or about Dr. Thomas Gillham Hewlett, a physician and health officer in Bombay, India. The authors sought to increase understanding of Nightingale's visionary leadership for global nursing and health through a study of the form and content of the letters analyzed as temporally contextualized data, focusing on how the narratives are composed and what is conveyed. Several recurring themes central to Nightingale's leadership on global nursing and health emerge throughout these letters, including health and sanitation reform, collaborative partnerships, data-driven policy development, and advocacy for public health. These themes are illustrated through her letters to and testimony about Dr. Thomas Gillham Hewlett in her vivid descriptions of health education and promotion, data-driven policy documents, public health and sanitation advice, and collaboration with citizens, medicine, policy makers, and governments to improve the health and welfare of the people of India. The focus on leadership in nursing as a global construct highlights the lessons learned from University of Alabama at Birmingham's Nightingale Letter Collection that has relevance for the future of nursing and health care, particularly Nightingale's collaboration with policy leaders, her analysis of data to set policy agendas, and public health reform centered on improving the health and well-being of underserved populations.

Global health competencies for nurses in the Americas.

This article reports the findings from an online survey of nursing faculty from the United States, Canada, Latin America, and Caribbean countries to identify their perceptions about global health competencies for undergraduate nursing students. A list of global health competencies for medical students developed by the Association of Faculties of Medicine of Canada Resource Group on Global Health and the Global Health Education Consortium was adapted for nurses and translated from English to Spanish and Portuguese. The competencies were divided into six subscales, and respondents rated each competency on a 4-point Likert scale, with high scores reflecting strong agreement that the competency was essential for undergraduate nursing students. E-mail invitations and links to the online survey were distributed using a nonprobability convenience sampling strategy. This article reports findings only from the respondents to the English and Spanish surveys. The final sample included 542 responses to the English survey and 51 responses to the Spanish survey. Cronbach's alpha reliability coefficients for the subscales ranged from .78 to .96. The mean values for all 6 subscales and for each of the 30 items were greater than 3.0 for the respondents to the Spanish survey, and the mean values for 27 of the items were greater than 3.0 for the respondents to the English survey. These findings suggest that respondents perceived the competencies as essential global health competencies for undergraduate nursing students in the Americas. Narrative comments written by respondents indicate additional competencies and specific concerns about adding additional content to an already full curricula. Results of this study can be used to guide faculty deliberations about global health competencies that should be incorporated in the nursing curricula.

Quality improvement learning collaboratives.

PURPOSE: To identify and synthesize characteristics of successful data-driven Quality improvement learning collaboratives (QILCs) in the United States and Europe, and to extend previously discussed and newly identified guidelines for developing successful data-driven QILCs across health care settings and systems. METHODS: An interview guide of open-ended questions was developed and posed to 18 key informants of various disciplines involved in the development and implementation of successful QILCs across 10 organizations in 3 countries. Aspects of successful QILCs were analyzed to identify patterns emerging from structure-process interactions between complex health care systems. RESULTS: Shared patterns of successful collaboratives included cultivating trust, attendance to the human dimension, nonlinear development, attendance to organizational culture, integrated philosophy of quality improvement, and a focus on process and outcome measurement to drive change. This study extends the knowledge base through synthesis of findings from previous quality improvement research with the findings from this study to develop guidelines for establishing and developing successful QILCs. CONCLUSIONS: The core characteristics identified in this study were critical to successful collaboration when these approaches were used in the contexts identified. The intrinsic complexity of QILCs requires that effectiveness studies employ qualitative as well as quantitative methodologies.

Can nurse practitioners and physicians beat parochialism into plowshares?

Nurse practitioners have evolved into a large and flexible workforce. Far too often, nurse practitioner and physician professional organizations do not work together but rather expend considerable effort jousting in policy arenas. Turf battles interfere with joint advocacy for needed health system change and delay development of interdisciplinary teams that could help patients. A combined, consistent effort is urgently needed for studying, training, and deploying a collaborative, integrated workforce aimed at improving the health care system of tomorrow. The country can ill afford doctors and nurses who ignore one another's capabilities and fail to maximize each other's contributions cost-effectively.