The Geographic Distribution of Vascular Surgeons and Trainees by State in 2023.

OBJECTIVE: Approximately 1.4 vascular surgeons/100,000 persons are estimated to fulfill current patient needs in the United States (US), but an ongoing shortage exists. The aims of this study are to provide an updated nationwide state-by-state workforce analysis and compare the distribution of practicing vascular surgeons and training opportunities. METHODS: Vascular surgeons in the US were identified using the National Provider Identifier registry in 2023. Only board-certified and actively licensed vascular surgeons were included. To estimate the number of vascular surgery graduates per year in each state, integrated residency and fellowship-matched positions (trainees) were ascertained from the National Resident Matching Program website. Surgeons and trainees were totaled by state, and densities were calculated using the 2020 US Census Bureau state populations. These two cohorts were also examined together using simple linear regression and geographic mapping. RESULTS: This study included 3399 board-certified vascular surgeons and 228 newly matched trainees. The average densities of vascular surgeons and trainees in the US are 1/100,000 persons and 0.06/100,000 persons, respectively. The five states with the lowest densities of vascular surgeons are AR, ND, NV, OK, and WY, averaging 0.4/100,000 persons. Eight states (AK, ID, KS, ND, NM, NV, RI, WY) had zero training programs offering positions in 2023 and ranked in the lowest quartile for the number of practicing vascular surgeons (Figure 1). Simple linear regression demonstrated a statistically significant correlation between state rates of vascular surgeons and trainees (p < 0.001). CONCLUSION: States with zero training positions also have the fewest vascular surgeons per capita. Statewide attention to expanding vascular surgery training opportunities targeted in these areas could positively impact the current maldistribution and shortage of vascular surgeons.

Practice changes and infant health risks during the 2022 infant formula shortage: Results of a US healthcare provider survey.

BACKGROUND: In February 2022, an infant formula recall and closing of a major manufacturing center exacerbated a nationwide shortage initiated by COVID-19-related supply chain disruptions. The effects were far-reaching, impacting families and healthcare providers across the US. METHODS: A 19-item web survey was developed to better understand how the infant formula shortage impacted healthcare provider practices, resources needed and those already used, and patient health, including malnutrition. Subjective data on providers' experience were also collected. RESULTS: Two hundred forty-one providers responded, primarily registered dietitians (94%) practicing in inpatient/academic hospitals in urban and metropolitan areas. Practice adjustments included increases in patient education (100%), communication with pharmacies/durable medical equipment companies (65%), and visit durations (28%). Feeding adjustments by caregivers included new infant formula (99%), toddler (55%) or homemade (23%) formula, cow's milk (46%) or milk alternatives (32%), formula dilution (41%), and early food introduction (14%). Providers indicated an increase in malnutrition (33%), related diagnoses (including failure to thrive [31%] and deceleration in z score [27%]), and associated symptoms. Of the providers who reported malnutrition and related diagnoses, 93% also reported caregiver feeding practices that are generally not recommended. CONCLUSION: Providers made practice adjustments to mitigate the consequences associated with formula unavailability and misuse yet saw an increase in malnutrition and related diagnoses or symptoms. Subjectively, providers reported frustration that greater workloads did not result in improved outcomes, contributing to burnout. These data underscore the essentiality of supporting healthcare providers as they guide families in safe infant feeding practices.

The Foundation Supporting Future Assessments of Education Program Outcomes Among Providers of Advanced Practice Respiratory Therapy.

There are physician shortages in the United States including the cardiopulmonary specialty. Nonphysician advanced practice providers (NAPP), who are nurse practitioners or physician assistants, have been proposed to meet some more routine patient care needs. A supplementary provider called an Advanced Practice Respiratory Therapist (APRT) has been proposed. Such personnel start as respiratory therapists followed by training in a graduate degree program. The Commission on Accreditation for Respiratory Care (CoARC) has published a set of standards for such an education program, and one program has begun to train APRTs. The CoARC requires each accredited program to publish its outcomes. The respiratory therapy credentialing board, the National Board for Respiratory Care (NBRC), has undertaken stewardship of assessing APRT education program outcomes. The research question asks whether there is national support to develop a standardized assessment of graduates' performances near the end of an APRT education program. Described in the article are methods used during this study of the nascent APRT role, which informed decisions of an advisory committee as they considered what content to assess and how to design the measurement instrument. The study exposed a set of survey-derived metrics about potential content signaling whether there was endorsement among physicians, NAPPs, and APRT graduates. Metrics are described from these and other subgroups plus the committee's decisions are explained about what content to assess and how. Most of the surveyed content was endorsed for being part of the APRT role, so the committee proceeded to make design decisions about the outcome assessment.

Association of rurality and health professional shortages with the clinicopathologic characteristics of melanoma in North Carolina.

PURPOSE: To assess rural-urban and health professional shortage area (HPSA)-related influences on the characteristics of melanoma in North Carolina. METHODS: We conducted a single-center retrospective cohort study of patients living in North Carolina with an available pathology report for invasive cutaneous melanoma seen in the Duke University Health System from 01/01/2014 to 12/31/2020. Multivariable logistic regression models were employed to compare patient and tumor characteristics between rural versus urban county residence as well between melanoma thicknesses dichotomized into thin (≤1.0 mm) and thicker (>1.0 mm) tumors. FINDINGS: The cohort included 807 patients, and rural patients accounted for 177 (21.9%) of invasive cutaneous melanomas. Rural patients had significantly higher odds of having thicker tumors than urban patients (odds ratio [OR] = 1.78, 95% confidence interval [CI]: 1.17-2.71; P = .008). Rural patients were significantly more likely to be female (OR = 1.59, 95% CI: 1.10-2.28; P = .013) and located in a population-based (OR = 2.66, 95% CI: 1.84-3.84; P<.001) or geographic-based (OR = 8.21, 95% CI: 3.33-20.22; P<.001) HPSA. Living in a medium- or high-shortage population-based HPSA was associated with higher odds of thicker tumors (OR = 2.65, 95% CI: 1.85-3.80; P<.001). CONCLUSIONS: Patients living in rural North Carolina counties were more likely than those in urban counties to be diagnosed with melanomas >1.0 mm in thickness, a clinically significant difference with important prognostic implications. Interventions at the county- and state-level to address this disparity may include improving access to skin cancer screening and teledermatology programs, increasing partnerships with primary care providers, and targeting interventions to counties with health professional shortages.

Elevated concentrations of soil carbon dioxide with partial root-zone drying enhance drought tolerance and agro-physiological characteristics by regulating the expression of genes related to aquaporin and stress response in cucumber plants.

Water scarcity and soil carbon dioxide elevation in arid regions are considered the most serious factors affecting crop growth and productivity. This study aimed to investigate the impacts of elevated CO2 levels (eCO2 at rates of 700 and 1000 ppm) on agro-physiological attributes to induce drought tolerance in cucumbers by activating the expression of genes related to aquaporin and stress response, which improved the yield of cucumber under two levels of irrigation water conditions [75% and 100% crop evapotranspiration (ETc)]. Therefore, two field experiments were conducted in a greenhouse with controlled internal climate conditions, at the Mohamed Naguib sector of the national company for protected agriculture, during the winter seasons of 2021-2022 and 2022-2023. The treatments included eCO2 in soil under normal and partial root zoon drying (PRD, 100% ETc Full irrigations, and 75% ETc). All the applied treatments were organized as a randomized complete block design (RCBD) and each treatment was replicated six times. Untreated plants were designed as control treatment (CO2 concentration was 400 ppm). The results of this study showed that elevating CO2 at 700 and 1000 ppm in soil significantly increased plant growth parameters, photosynthesis measurements, and phytohormones [indole acetic acid (IAA) and gibberellic acid (GA3)], under partial root-zone drying (75% ETc) and full irrigation conditions (100% ETc). Under PRD condition, eCO2 at 700 ppm significantly improved plant height (13.68%), number of shoots (19.88%), Leaf greenness index (SPAD value, 16.60%), root length (24.88%), fresh weight (64.77%) and dry weight (61.25%) of cucumber plant, when compared to untreated plants. The pervious treatment also increased photosynthesis rate, stomatal conductance, and intercellular CO2 concentration by 50.65%, 15.30% and 12.18%; respectively, compared to the control treatment. Similar findings were observed in nutrient concentration, carbohydrate content, Proline, total antioxidants in the leaf, and nutrients. In contrast, eCO2 at 700 ppm in the soil reduced the values of transpiration rate (6.33%) and Abscisic acid (ABA, 34.03%) content in cucumber leaves compared to untreated plants under both water levels. Furthermore, the results revealed that the gene transcript levels of the aquaporin-related genes (CsPIP1-2 and CsTIP4) significantly increased compared with a well-watered condition. The transcript levels of CsPIP improved the contribution rate of cell water transportation (intermediated by aquaporin's genes) and root or leaf hydraulic conductivity. The quantitative real-time PCR expression results revealed the upregulation of CsAGO1 stress-response genes in plants exposed to 700 ppm CO2. In conclusion, elevating CO2 at 700 ppm in the soil might be a promising technique to enhance the growth and productivity of cucumber plants in addition to alleviating the adverse effects of drought stresses.

Reexamining Transplant Outcomes in Acute Kidney Injury Kidneys Through Machine Learning.

BACKGROUND: Despite many people awaiting kidney transplant, kidney allografts from acute kidney injury (AKI) donors continue to be underutilized. We aimed to cluster kidney transplant recipients of AKI kidney allografts using an unsupervised machine learning (ML) approach. METHODS: Using Organ Procurement and Transplantation Network-United Network for Organ Sharing (OPTN/UNOS) data, a consensus clustering cohort analysis was performed in 12 356 deceased donor kidney transplant recipients between 2015 and 2019 in whom donors had a terminal serum creatinine ≥1.5 mg/dL. Significant cluster characteristics were determined, and outcomes were compared. RESULTS: The median donor terminal creatinine was 2.2 (interquartile range [IQR] 1.7-3.3) mg/dL. Cluster analysis was performed on 12 356 AKI kidney recipients, and three clinically distinct clusters were identified. Young, sensitized kidney re-transplant patients characterized Cluster 1. Cluster 2 was characterized by first-time kidney transplant patients with hypertensive and diabetic kidney diseases. Older diabetic recipients characterized Cluster 3. Clusters 1 and 2 donors were young and met standard kidney donor profile index (KDPI) criteria; Cluster 3 donors were older, more likely to have hypertension or diabetes, and meet high KDPI criteria. Cluster 1 had a higher risk of acute rejection, 3-year patient death, and graft failure. Cluster 3 had a higher risk of death-censored graft failure, patient death, and graft failure at 1 and 3 years. Cluster 2 had the best patient-, graft-, and death-censored graft survival at 1 and 3 years. Compared to non-AKI kidney recipients, the AKI clusters showed a higher incidence of delayed graft function (DGF, AKI: 43.2%, 41.7%, 45.3% vs. non-AKI: 25.5%); however, there were comparable long-term outcomes specific to death-censored graft survival (AKI: 93.6%, 93.4%, 90.4% vs. non-AKI: 92.3%), patient survival (AKI: 89.1%, 93.2%, 84.2% vs. non-AKI: 91.2%), and overall graft survival (AKI: 84.7%, 88.2%, 79.0% vs. non-AKI: 86.0%). CONCLUSIONS: In this unsupervised ML approach study, AKI recipient clusters demonstrated differing, but good clinical outcomes, suggesting opportunities for transplant centers to incrementally increase kidney utilization from AKI donors.

Addressing Shortages in Nursing with Male Representation: A Literature Review.

The nursing shortage in the US and all over the world continues to skyrocket. An untapped channel of recruitment that some are considering is men in the nursing profession. Currently a large disparity exists in the representation of men in nursing causing issues with quality of care, diversity, and staffing. Research suggests that nursing recruitment should occur before licensure in order to better address gender stereotypes and prejudice. Early exposure is revealed as a defining factor in enticing men into the profession. Further research reveals that issues related to nurse educator staffing must first be considered to include more men into the profession. Without nurse educators, schools are unable to increase class sizes and admit more men into programs.

How general practitioners in France are coping with increased healthcare demand and physician shortages. A panel data survey and hierarchical clustering.

BACKGROUND: General practitioners (GPs) face quantitative and qualitative changes in patient demand and doctor shortages. OBJECTIVES: To investigate how GPs cope with doctor shortage issues. MATERIALS AND METHODS: Two cross-sectional surveys of a representative panel of 1530 GPs in 2019 and 2022 about their perceptions of physician shortages, working hours worked (WHW), and adaptive behaviors. Hierarchical clustering enabled identification of profiles with different adaptation patterns. Multiple Poisson or logistic regression models studied associations between GPs' profiles and professional characteristics. RESULTS: 87.4 % of GPs applied at least one adaptation to control patients' healthcare demand. 24 % adopted task-shifting while their average WHW decreased by 3.6 h between 2019 and 2022. Four GP profiles were identified. "Low adapters/low workload" and "Low adapters/high workload" (25 % of the sample each) reported 2.4 adaptive measures: 75.5 % refused to be new patients' preferred doctor in the former group (vs 5.1 %). "High adapters/unchanged consultations" (30.7 %) and "High adapters/shortened consultations" (18.9 %) reported 4.8 and 6.1 adaptations, respectively. They were more likely to practice in medically underserved areas. CONCLUSION: These results call into question GPs' gatekeeper role in the French healthcare system. Moreover, the marked reduction in WHW in underserved areas is likely to exacerbate their uneven distribution nationwide. Encouraging vertical integration between HCPs while enhancing cooperation and task-shifting is probably a pathway toward improving the relative GP shortage.

HELLO: a protocol for a cluster randomized controlled trial to enhance interpersonal relationships and team cohesion among ICU healthcare professionals.

BACKGROUND: Mental health symptoms among healthcare professionals (HCP) in intensive care units (ICUs) are a significant concern affecting both HCP well-being and patient care outcomes. Cross-sectional studies among members of the European Society of Intensive Care Medicine (ESICM) report up to 50% burnout rates. Determinants of burnout include communication, team cohesion, psychological support, and well-being promotion. We designed the 'Hello Bundle' intervention to mitigate burnout among ICU-HCPs by fostering positive social interactions and a supportive work environment. This justification synthesizes evidence from social psychology, positive psychology, and healthcare communication research to support the intervention. The 'Hello Bundle' aims to enhance interpersonal relationships, improve team cohesion, and reduce burnout rates. The six components include: Hello campaign posters, email reminders, integrating greetings in morning huddles, hello jars, lead-by-example initiatives, and a daily updated hello board in each ICU. This protocol describes a cluster randomized controlled trial to evaluate the effectiveness of the intervention. METHODS: This protocol describes a cluster randomized controlled trial (RCT) conducted among ESICM-affiliated ICUs, consisting of at least 73 clusters with in average of 50 respondents per cluster, totaling approximately 7300 participants. Intervention clusters will implement the 6-component Hello Bundle between October 14 and November 10, 2024, while control clusters will be wait-listed to receive the intervention in January 2025 after the RCT concludes. Clusters will be matched based on ICU size (fewer or more than 20 beds), region, and average 2023 mortality. The primary outcome is the proportion of HCPs with burnout between intervention and control clusters at the end of the intervention. Secondary outcomes include comparing the following between clusters: (1) number of HCPs with high emotional exhaustion; (2) number with high depersonalization; (3) number with loss of accomplishment; (4) perception of ethical climate (5) satisfaction at work (VAS); (6) professional conflicts; (7) intention to leave the ICU (VAS); (8) patient-centered care rating; (9) family-centered care rating. The last secondary outcome is the comparison of burnout rates before and after the intervention in the intervention cluster. Outcomes will be based on HCP reports collected within four weeks before and after the intervention. DISCUSSION: This is the first large trial of healthcare communication, social, and positive psychology intervention among ICU-HCPs. It holds the potential to provide valuable insights into effective strategies for addressing burnout in ICU settings, ultimately benefiting both HCPs and patients. TRIAL REGISTRATION: This trial was registered on ClinicalTrials.Gov on June 18, 2024. REGISTRATION: NCT06453616.

Whether medicine supply is really meeting primary health care needs: a mixed-methods study in Shandong Province, China.

BACKGROUND: With the aging population, the increasing prevalence of chronic non-communicable diseases, and the diversified needs for primary health care (PHC) medicines, it is necessary to rethink the functional role of the supply of PHC medicines. This study aims to evaluate the supply of PHC medicines and the status of meeting PHC medicine needs. METHODS: The mixed-methods study was conducted to evaluate the supply of PHC medicines in Shandong Province. In the quantitative study, survey questionnaires were distributed to county hospitals, township hospitals, and patients, and a prescription review was performed in township hospitals. In the qualitative study, semi-structured interviews were conducted with the pharmacy managers, physicians, and patients in county hospitals, township hospitals, and village clinics. A senior pharmacist from a tertiary hospital who has rich experience on the indications for medicine use, accompanied us on a visit to inspect the PHC pharmacies to survey medicine equipment with a professional perspective. RESULTS: Quantitative analysis revealed that 211 county hospitals and 1,581 township hospitals participated in the survey, revealing the median annual frequency of medicine shortages of 5.0 times for county hospitals and 2.0 times for township hospitals. Of the 6,323 patient medication surveys, after excluding 152 patients not involved in medication use, 945 (15.3%) indicated medicine shortages, with half of these attributable to institutions lacking required medicines (52.8%). On average, the prescription qualified rate of 37 township hospitals was 72.2%. Four final themes emerged during the qualitative data analysis: (1) Supply of PHC medicines; (2) Solutions to the shortage of off-list medicines; (3) Appropriateness of PHC medicines list; (4) Pharmacist workforce development and pharmacy services. CONCLUSIONS: The discrepancy between patients' need for PHC medicine and present medicine supply is noteworthy. It is suggested that governments should optimize the existing lists to adequately meet patient medicine needs and prioritize medicines for chronic diseases, which is also particularly important for developing countries. Integrated health care may be a novel strategy to establish unified medicines list and achieve uniform pharmaceutical services in PHC.

Benzathine Penicillin G Shortage and Secondary Syphilis.

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. This disease is characterized by four different stages, each presenting with a variety of manifestations or asymptomatic disease. These stages can be further broken down into early-stage syphilis, which includes primary and secondary syphilis, and late-stage syphilis, which includes tertiary syphilis. It is crucial to recognize and treat syphilis early because the later stages of the disease are marked by irreversible damage to the central nervous system (CNS) and cardiovascular system, and can even increase mortality risk. The primary recommended treatment for early-stage syphilis is intramuscular (IM) benzathine penicillin G (BPG). In this case report, we present a patient with secondary syphilis who exhibited red papules and nonspecific skin eruptions. Due to the unavailability of BPG, the patient initially received doxycycline as an alternative treatment. After eight days of searching multiple facilities and pharmacies, a dose of BPG was finally located and administered to the patient. We highlight crucial information about the BPG shortage, including supply and demand challenges, infrastructure issues, and the broader impact on numerous other antimicrobials. We emphasize the importance of recognizing this issue and provide alternatives for managing the disease in resource-limited settings.

Factors Influencing Drug Shortages and Their Resolution in South Korean Community Pharmacies.

Purpose: Drug shortages directly affect the final stage in the pharmaceutical supply chain, prescription fulfillment in community pharmacies (CPs). This study investigated the current state of drug shortages, their resolution, and influencing factors within CPs. Methods: A cross-sectional online survey was conducted among pharmacists working at pharmacies in Seoul between 7 and 31 October 2022. The survey gathered data on pharmacies and pharmacists' characteristics, drug distribution, information, communication, and administrative practices. Logistic regression was used to identify the factors influencing these rates. Regression results are presented as odds ratios (OR) and 95% confidence intervals (CIs). Results: Of the 1200 pharmacists approached, 713 participated, yielding a response rate of 59.4%. After excluding incomplete responses, data from 671 respondents were analyzed. Pharmacies with higher prescription drug sales demonstrated a lower OR for drug shortages (OR=0.66, 95% CI=0.60-0.72) compared to those with lower sales volumes. Resolution rates were significantly higher when pharmacies were located near clinics (OR=3.30, 95% CI=2.3-4.74) and general hospitals (OR=3.45, 95% CI=2.35-5.07) compared to those without nearby medical facilities. Additionally, good communication with prescribers increased the resolution rates (OR=1.46, 95% CI=1.26-1.69). Conclusion: This study examines the influence of pharmacy purchasing power on drug shortages, identifying proximity to healthcare facilities and communication with prescribers as factors affecting the resolution rates. These findings provide valuable insights for pharmacists, policymakers, and future researchers to optimize drug supply chain management and mitigate shortages in community settings.

Impact of donor expanded criteria kidney transplantation on clinical outcomes and survival: A single-center experience.

INTRODUCTION: The scarcity of suitable donor organs has led to the inclusion of Expanded Criteria Donor (ECD) kidneys to augment the donor pool, despite potential concerns regarding post-transplant outcomes. METHODS: This retrospective study analyzed the clinical outcomes of a cohort of 317 kidney transplant recipients from deceased donors at a single center between 2008 and 2018. Patients were categorized into ECD and Standard Criteria Donor (SCD) groups, with primary nonfunctioning grafts excluded. Comprehensive laboratory evaluations were conducted, including HLA typing and serum creatinine levels. Immunosuppressive regimens were standardized, and statistical analyses were performed using the SPSS program. RESULTS: The sample consisted of 83 (26.18%) patients who received kidney transplants from ECDs and 234 (73.82%) from SCDs. The ECD group showed a longer cold ischemia time (p = 0.019) and a higher rate of delayed graft function (DGF) compared with the SCD group. No significant differences were observed in graft survival (p = 0.370) or patient survival (p = 0.993) between the ECD and SCD groups. However, differences in graft survival were noted between the groups when stratified by DGF status: ECD with DGF vs. ECD without DGF (p = 0.029), ECD with DGF vs. SCD with DGF (p = 0.188), ECD with DGF vs. SCD without DGF (p = 0.022), ECD without DGF vs. SCD with DGF (p = 0.014), ECD without DGF vs. SCD without DGF (p = 0.340), and SCD with DGF vs. SCD without DGF (p = 0.195). No differences in patient survival rates were observed among these groups for all pairwise comparisons (p > 0.05) when stratified by donor criteria and DGF status. CONCLUSIONS: Graft and patient survival rates were comparable between ECD and SCD kidney transplant recipients.

Prescription for crisis: the compounding effect of community drug shortages on Lebanon's healthcare system.

The multifaceted crises that Lebanon is facing have led to a shortage of medications in the country's community pharmacies. This shortage has triggered a cascade of adverse effects, rippling throughout the nation's healthcare system. In this report, we examine the causes, which range from economic turmoil to inadequate resource distribution, along with the profound impacts on public health, such as increased length of hospital stays and compromised patient care. The paper also proposes a suite of solutions aimed at mitigating the immediate challenges and paving the way for a more resilient healthcare framework.

The growth and development of a novel distance accelerated bachelor of science in nursing program.

Severe nursing shortages threaten the sustainability of US health systems. Rural and underserved communities are disproportionately affected by staffing crises and associated facility closures, as well as health disparities. A major factor contributing to geographic gaps in care is the absence of nursing schools, nursing faculty, and locations for clinical rotations in many rural and underserved areas. Emory School of Nursing is helping to solve for these issues through the Distance Accelerated Bachelor of Science in Nursing (DABSN) program. The DABSN is establishing accelerated pipelines of nursing students into practice in locations where nursing education has historically been difficult or impossible to access. This innovative nursing education model allows students to enroll in a top-ranked nursing school while remaining in their home communities. Students complete synchronous didactic coursework with peers in every US time zone while performing clinical rotations in local healthcare facilities. This paper details the growth and development of the DABSN. It describes the challenges and opportunities we have navigated in implementing the program, along with information about its pedagogy, clinical placement practices, and student/faculty characteristics. We share program outcomes and conclude with recommendations for the future.

Collaborative nursing education between advanced practice registered nurses.

The surge in healthcare demands due to the explosion of growth in the aging adult population demands that academic institutions address enhanced education of Advanced Practice Registered Nurses (APRNs). This is particularly challenging amidst nurse faculty shortages in specialty areas, stemming from factors such as lack of pay competitiveness with clinical positions, and doctoral-prepared nurses seeking faculty positions. Despite efforts to address the shortages, recruitment challenges persist, necessitating innovative approaches. This article explores the interprofessional collaborative teaching between Nurse Anesthesia (NA) and Adult Gerontology Nurse Practitioner (NP) programs, focusing on airway management, sedation techniques, chest X-ray interpretation, and ultrasound skills. To date, this collaboration between NA and NP faculty has proven effective. Both synchronous and online asynchronous teaching have received overwhelmingly positive student feedback. Ongoing communication and collaborations between NA and NP faculty facilitate teaching and educational strategies across programs, sharing faculty expertise, and mitigating reduced faculty numbers. This innovative model benefits faculty and students and provides a platform for firsthand interprofessional collaboration, fostering mutual respect and preparing students for effective interdisciplinary healthcare teamwork.

Leased clinical faculty model: Bridging gaps in nursing education.

In response to the critical Registered Nursing (RN) shortage, John Carroll University, a not-for-profit, private, faith-based university in the Midwest, has developed an academic-practice partnership to bolster its new Bachelor of Science in Nursing (BSN) program. This initiative addresses the challenge of limited clinical faculty. Central to this strategy is a "leased employee agreement" with healthcare partners, which allows the university to employ practicing RNs as part-time clinical instructors. Formulated in collaboration with healthcare Chief Nurse Executives (CNEs), this model enables the seamless integration of hospital-employed RNs into the academic framework as clinical faculty. This model streamlines the onboarding process and enriches student learning experiences by leveraging the practical expertise of active nurses. Initial feedback following its launch in August 2023 has been positive, with students and clinical faculty reporting high levels of satisfaction and quality educational experiences. This approach presents a viable strategy to mitigate faculty shortages in nursing education and underscores the importance of inventive academic-practice partnerships in adapting to the dynamic demands of healthcare training.

State Policy Strategies for the Workforce Emergency in Behavioral Health.

The United States is experiencing a behavioral health workforce emergency of unparalleled magnitude. After decades of inaction, selected states have launched significant efforts to strengthen the mental health and substance use disorder workforce. Seven state policy strategies in frequent use for addressing the current emergency are described, with examples for each. Links to more than 140 additional examples are also provided. States can draw on these strategies as they consider actions to strengthen their behavioral health workforce. There is a compelling need to act quickly while executive and legislative branches have a strong interest in solving this problem and federal support to the states is abundant.

The Role of Negative Age Stereotypes and Sociodemographic Factors in the Intention to Leave Among German University Hospital Nursing Staff.

Staff shortages are a global problem in the nursing profession. Negative beliefs about older workers may have detrimental effects on the development and performance capacity of an aging workforce. To date, little is known about the impact of age stereotypes and potential factors on nurses' intent to leave (ITL). Therefore, the aim of our study was to assess intention to leave and potential predictors (eg, sociodemographic characteristics and age stereotypes) in a large representative sample of nurses in a German university hospital setting. A total of 423 nurses at the University Hospital of Heidelberg participated in a cross-sectional questionnaire study assessing sociodemographic data, age stereotypes using the "Beliefs About Older Workers" questionnaire, and participants' intentions to leave and give up their profession. Questionnaires were returned by 423 nurses (13.7% response rate). The results revealed that negative age stereotypes were highly prevalent. Significant correlations between age and negative age stereotypes were found, indicating that the younger the nurses were, the more negative their age stereotypes were. Most nurses with negative age stereotypes had no intention to leave their profession; however, the majority of nurses could not imagine working in the profession until they retired. Despite the low response rate, the results of the current study suggest that organizational and societal measures to reduce age stereotypes should be directed at newcomers and young nurses to retain them in the profession in the long term.

Using an Academic-Practice Partnership to Address the Perioperative Nursing Shortage.

The nursing shortage continues to affect perioperative nursing negatively. Multiple factors, including a lack of exposure to the perioperative nursing specialty during baccalaureate nursing programs, influence the number of applicants for open perioperative positions. In 2018, we formed a collaborative academic-practice partnership to address this critical gap at our facility. We created an interactive learning program that included a scenario in a fully equipped OR simulation suite to provide nursing students with exposure to the perioperative setting. Students who participated in the experience reported that they appreciated exposure to an OR environment and engaging with perioperative personnel. Additionally, there was an increase in the number of nurse externship applications and students who were interested in completing their capstone experience in perioperative settings at our health care system. These positive outcomes illustrate that an effective collaboration between academic and clinical practice leaders can increase nursing students' interest in perioperative nursing.