Stress and Short: Creating a Balanced and Innovative Preceptor Model in a Medical Intensive Care Unit.

An innovative preceptor model (IPM) was developed to transition newly graduate nurses (NGNs) to practice. The imbalanced number of experienced nurses to NGNs during COVID-19 demonstrated a need for an "out-of-the-box" solution, one preceptor to two nurse residents, in the medical intensive care unit. The IPM was evaluated through surveys, postclinical immersion debriefs, and feedback sessions with the preceptors and NGNs. The IPM helped preceptors guide NGNs in their journey to independent practice.

Exploring the Association of Metabolic Syndrome with In-Hospital Survival of Older Patients Hospitalized with COVID-19: Beyond Chronological Age.

BACKGROUND: Despite the variability and complexity of geriatric conditions, few COVID-19 reports of clinical characteristic prognostication provide data specific to oldest-old adults (over age 85), and instead generally report broadly as 65 and older. OBJECTIVE: To examine metabolic syndrome criteria in adults across 25 hospitals with variation in chronological age. DESIGN AND PARTICIPANTS: This cohort study examined 39,564 hospitalizations of patients aged 18 or older with COVID-19 who received inpatient care between March 13, 2020, and February 28, 2022. EXPOSURE: ICU admission and/or in-hospital mortality. MAIN MEASURES: Metabolic syndrome criteria and patient demographics were examined as risk factors. The main outcomes were admission to ICU and hospital mortality. KEY RESULTS: Oldest old patients (≥ 85 years) hospitalized with COVID-19 accounted for 7.0% (2758/39,564) of all adult hospitalizations. They had shorter ICU length of stay, similar overall hospitalization duration, and higher rates of discharge destinations providing healthcare services (i.e., home health, skilled nursing facility) compared to independent care. Chronic conditions varied by age group, with lower proportions of diabetes and uncontrolled diabetes in the oldest-old cohort compared with young-old (65-74 years) and middle-old (75-84 years) groups. Evaluations of the effect of metabolic syndrome and patient demographics (i.e., age, sex, race) on ICU admission demonstrate minimal change in the magnitude of effect for metabolic syndrome on ICU admission across the different models. CONCLUSIONS: Metabolic syndrome measures are important individual predictors of COVID-19 outcomes. Building on prior examinations that metabolic syndrome is associated with death and ARDS across all ages, this analysis supports that metabolic syndrome criteria may be more relevant than chronological age as risk factors for poor outcomes attributed to COVID-19.

Effectiveness of the ABCDEF method for developing an institution-specific pain management clinical resource.

Introduction: Comprehensive treatment strategies improve pain management in hospitalized patients, but no conclusive algorithm is currently available. The Audience, Blueprint, Collaborators, Dissemination, Education, Feedback method for pain management resource development (ABCDEF method) has been proposed as an "executable template" for developing clinical resources customized to local practice environments. Methods: The ABCDEF method was used to develop a proposal for a pain management pamphlet. Thereafter, a "Pocket Resource: Evidence-Based Pain Management and Responsible Opioid Prescribing" was developed according to the proposal. Qualitative retrospective analysis was performed to determine executability of the ABCDEF method for developing this institution-specific pain management resource. Results: Twelve elements of the ABCDEF method were analyzed. Ten were completed according to the ABCDEF method instruction sheet. Of those, the expected outcome was different than actual outcome for four elements. All outcomes that were different than expected expanded either the overall impact or the information incorporated into the finished resource. Conclusions: This qualitative retrospective analysis demonstrates executability of the ABCDEF method to successfully develop an institution-specific pain management resource. This template adds to the resources available to create evidence-based care consistency individualized to local practice environments. Study limitations include the retrospective analysis and a lack of generalizability for the results.

Closing the Workforce Staffing Chasm by Breaking Boundaries: Innovative Partnerships and Strategies Between Recruitment and Nursing.

As hospitals are experiencing a nursing shortage, nursing leaders must build innovative partnerships and strategies between nursing and recruitment to close the workforce gap. One large health care system was experiencing a high vacancy rate. To improve recruitment and retention efforts, nursing leaders partnered with the recruitment department and other key stakeholders to develop strategies. Together, they designed a candidate-centric recruiting and hiring process, designed innovative recruitment campaigns including recruiting former employed nurses, recruitment of traveling nurses into employees, increased graduate nurse recruitment efforts, and implementation of a registered nurse (RN) Ambassador program. The team improved work process efficiency for recruiters and candidates. Retention efforts focused on engaging nurses in the work environment, decreasing nurse leader workload to allow a focus on staff relationships, and improving exit processes in an effort to retain the nurse. The actual vacancy rate was as high as 20.9% in July 2021 to 8% in September 2022, indicating the system is closing the vacancy rate and nearing the goal of 5%.

Efficacy of acute care health care providers in cardiopulmonary resuscitation compressions in normal and obese adult simulation manikins.

Annually, over 350,000 persons require cardiopulmonary resuscitation (CPR), either in or outside of the hospital. With obesity a rising health issue in the United States, concerns exist regarding the efficacy of quality compressions for CPR in obese patients. The aims of this study were to determine if the compressions for three adult simulation manikins (normal, obese, and morbidly obese) met quality guidelines; to examine any differences in quality of chest compressions performed by health care providers between the three manikins; and to examine the effect of participant characteristics on the quality of chest compressions in obese and morbidly obese manikins. A randomized controlled design was used. Sixty-one health care providers performed chest compressions on the three simulation manikins. Results showed that performance on the normal-sized manikin was significantly better than that on both obese and morbidly obese manikins. Participant characteristics were significantly associated with quality of chest compressions. The effectiveness of compressions in obese and morbidly obese CPR recipients has yet to be determined.