Critical Care Nursing: A Key Constraint to COVID-19 Response and Healthcare Now and in the Future.

This article discusses the crucial role and dearth of critical care nurses in the United States highlighted during the COVID-19 pandemic. This challenge of sufficient critical care nursing resources existed before the pandemic, but now concern is heightened by the need for such crucial healthcare providers now and in the future. We present strategies to address the gap, as well as challenges inherent in the suggested approaches. The discussion is relevant as nurse leaders adapt to COVID-19 and other novel challenges in the future.

Teamwork in the time of COVID-19.

Strong and effective clinical teamwork has been shown to improve medical outcomes and reduce medical errors. Incorporating didactic and clinical activities into undergraduate medical education in which students work in teams will develop skills to prepare them to work in clinical teams as they advance through their education and careers. At the Yale School of Medicine, we foster the development of team skills in the classroom through team-based learning (TBL) and in clinical settings with the Interprofessional Longitudinal Clinical Experience (ILCE). Both TBL and ILCE require students work in close physical proximity. The COVID-19 pandemic forced us to immediately adapt our in-person activities to an online format and then develop clinical and interprofessional experiences that adhere to social distancing guidelines. Here we describe our approaches to solving these problems and the experiences of our students and faculty.

Burnout Among Beginning First-Year Students from Three Health Professional Training Programs.

The study objective was to learn about burnout prevalence among beginning first-year students from three health professional programs-Advance Practice Registered Nursing (APRN), Medicine, and Physician Associate (PA) training. All first-year students were invited to anonymously complete a survey measuring burnout. Subscales for exhaustion and disengagement together accounted for burnout. Means and frequencies were derived for categorical variables (gender, program, and direct entry from college). Subscales were summarized with means and standard deviations. Analysis of variance and post hoc t-tests compared unadjusted differences in means. Based on results, multivariable linear regressions for total burnout and exhaustion examined associations for the independent variables. With a 97% response rate, 70% were female (the APRN program is predominantly female), and 32% began training directly after college. Female students had significantly higher average total burnout and exhaustion than males. APRN and PA students had significantly higher total burnout and exhaustion than MD students. There were no other significant associations. In multivariable linear regressions, APRN students had significantly higher, and PA students had not quite significantly higher, burnout and exhaustion compared with medical students, with no moderation by any other variables. Burnout among first-year students in all three programs was more prevalent than anticipated. Consistent with previous literature, the programs with students who experienced higher burnout used more competitive, multi-tiered grading systems and introduced clinical expectations earlier in training. The implication is that educational leaders should consider effects of competitive grading and early clinical exposure on burnout among beginning health professional students.

Interprofessional education development: not for the faint of heart.

Interprofessional education (IPE) has the potential to improve communication, collaboration and coordination of care, leading to improved health care outcomes. Promoting IPE has become an aim for many professional schools. However, there are challenges to implementing meaningful curricula that involve multiple health care professional schools. In this study, we outline 12 lessons learned when designing and implementing an Interprofessional Longitudinal Clinical Experience (ILCE) for 247 students from a School of Nursing, Medicine and Physician Associate Program in New England. Lessons learned over 4 years include pilot, evaluate and refine projects; create a formal interprofessional organizational structure; involve faculty who are passionate ambassadors for IPE; procure and maintain financial support; recognize power struggles and bias; overcome logistical conundrums to realize common goals, secure clinical sites and prepare IPE coaches; expect there will always be another hurdle; do not go it alone; recruit experts; recognize role differentiation and similarities; be aware of fragility of students and faculty and collect data to assess, evaluate, improve and gain buy-in. We were able to successfully implement a large program for students from three different health care professional schools that takes place in the clinical setting with faculty coaches, patients and their families. We hope that the lessons learned can be instructive to those considering a similar effort.

Looking Is Not Seeing and Listening Is Not Hearing: A Replication Study With Accelerated BSN Students.

Development of perceptual aptitude is a critical yet complex skill that requires the effective organization and interpretation of data using visual and auditory clinical observation. Educators face challenges in creating pedagogy that consistently demonstrates reliability and validity in fostering clinical skills. We have dependably used the arts as a means to improve students' auditory and visual skills, and this article will describe replication of our work with accelerated nursing students in a bachelor's program in their last semester of nursing school (n=23). Our results reveal that auscultative and observational abilities of soon-to-be registered nurses are in need of improvement. The use of art in a museum improves observational and assessment abilities, and music training increases auscultative interpretive skills significantly.

Readiness for interprofessional learning among healthcare professional students.

OBJECTIVE: The purpose of this study was to investigate attitudes toward interprofessional learning among first year medical, nursing, and physician associate students at an American university at the start of their training. METHODS: First year medical (n=101), nursing (n=81), and physician associate (n=35) students were invited to complete an anonymous online survey which included items related to demographic information and the Readiness for Interprofessional Learning Scale. Scores were compared by the general linear model and Duncan's multiple range test while controlling for demographic differences. RESULTS: All three groups scored in the high range, indicating readiness for shared learning. Female students, those with advanced degrees, and those with healthcare experience prior to enrolment in health professional school had significantly higher scores than their counterparts. After controlling for differences in demographic factors, nursing students scored significantly higher than physician associate and medical students (F = 6.22, 0.0025). CONCLUSIONS: Health professions students demonstrated readiness for interprofessional learning early in their academic programs, however important differences in baseline readiness emerged. These findings suggest that educators consider baseline attitudes of students when designing interprofessional education curricula, and use caution when extrapolating data from other geographies or cultures.

Nurses' Perspectives on Clinical Alarms.

BACKGROUND: Alarm hazards are a critical issue in patient safety. Of all health care providers, nurses are the ones most directly affected by the multitude of clinical alarms. OBJECTIVES: To qualitatively explore nurses' experiences with clinical alarms. METHODS: The Krippendorff method for content analysis was used to analyze comments provided by 406 nurses in a national survey on perceptions of clinical alarms. RESULTS: Six interrelated themes emerged: dissonance and desensitization; pollution, panic, and pathology; calling for accountability; calling for authority of nurses; clinical alarm management is crucial but not a panacea; and hope for the future. CONCLUSIONS: Nurses are concerned about the impact of alarm fatigue on nurses and patients, recognize the importance of nurses' role in reducing noise pollution, and offer valuable insight into strategies that can mitigate alarm hazards.