Early career nurses and moral distress: An integrative review.

AIM: The purpose of this integrative review was to evaluate and synthesize literature published in peer-reviewed journals within the past 40 years addressing moral distress in early career nurses (graduation to five years of experience). BACKGROUND: Moral distress experienced in nursing education and practice manifests physically and psychologically, leads to workforce burnout and attrition, and compounds the nursing shortage. The transition to practice period is a vulnerable time for student nurses emerging into professional practice. Nurse educators serve a crucial role in the preparation of nurses for the recognition and management of moral distress in their professional nursing practice. A better understanding of the state of the science pertaining to the reports of moral distress in early career nurses is essential. DESIGN: Whittemore and Knafl's Integrative Review method and the PRISMA 2020 Checklist were utilized in this integrative review. METHODS: Five literature databases (CINAHL, ERIC, PsychInfo, PubMed, and Embase) were searched using 'moral distress' and 'new graduate nurses' as keywords. Studies were included for English language; qualitative and quantitative research; moral distress focus; years of nursing practice experience collected and analyzed in results or discussion; and all areas of clinical nursing practice, geographic locations, and nursing education levels. Studies were excluded for non-peer reviewed publications; moral distress in the academic setting; and the absence of analysis of years of nursing practice experience in the results or discussion. RESULTS: Eight primary research reports, published between 2016 and 2022 met eligibility criteria. Research methods were largely quantitative with six countries geographically represented. Acute care healthcare settings had the greatest representation with considerations for the COVID-19 pandemic in two reports. Various formats of four moral distress research instruments were used. Years of nursing practice experience were collected as a mean or category. Inconsistent reports of moral distress in early career nurses were found based on experience, age, or nursing education level. CONCLUSIONS: Research of moral distress prevalence in early career nurses was an identified literature gap. Varied reports of moral distress in early career nurses indicate a need to further understand this topic contextual to academic and clinical education. Nurse educators can prepare students for experiences of moral distress in their professional nursing practice by implementing teaching strategies that draw upon their diverse backgrounds and experiences. A research and education emphasis on moral distress in early career nurses can promote their transition to practice, support their career progression, and uphold nursing occupational commitment. TWEETABLE ABSTRACT: An integrative review of moral distress in early career nurses found inconsistent reports of moral distress in this population and a need for further research.

Assessing the Financial Sustainability of High-Fidelity and Virtual Reality Simulation for Nursing Education: A Retrospective Case Analysis.

To stimulate classroom discussion and collaboration amid the COVID-19 pandemic, increasingly creative pedological methods for nursing education are necessary. Traditionally, high-fidelity simulation has been the standard for nursing education, but the use of virtual reality simulation is increasing. One of the major evaluative measures of simulation clinical training is the cost associated with each modality. In this retrospective case analysis, budget impact analysis methods were employed to compare high-fidelity simulation with virtual reality simulation. The components of each simulation pedagogy were compared in categorized cost buckets. Overall, virtual reality simulation education was determined to require 22% less time than high-fidelity simulation education. The cost associated with the virtual reality simulation was found to be 40% less expensive than the high-fidelity simulation. Our results demonstrate that virtual reality simulation is a financially advantageous, resource conscious pedagogical option for nursing education.

Examining the Impact of Board-Certified Registered Nurses in Skilled Nursing Facilities Using National and State Quality and Clinical Indicators.

A convenience sample of skilled nursing facilities was selected from a sample of graduates of an online training program for RNs who subsequently achieved board certification in gerontological nursing (RN-BC). Facilities that employed one or more RN-BC were pair-matched using 11 organizational characteristics with facilities that did not employ a RN-BC. Facility data were collected at two time points, and differences between time points and between facility type (RN-BC versus non-RN-BC) were analyzed. Findings showed that there were no statistically significant differences between RN-BC and non-RN-BC facilities with respect to quality ratings and nurse sensitive clinical indicators (e.g., restraint use, urinary tract infections, falls, antipsychotic medication use) between the two time periods; however, in the second time period, RN-BC facilities showed greater improvement versus non-RN-BC facilities in seven of nine outcomes, achieving significance in Overall (4.10 vs. 3.55, p < 0.01) and Survey (3.48 vs. 2.86, p < 0.01) 5-Star ratings. [Journal of Gerontological Nursing, 45(11), 39-45.].

Retooling the RN workforce in long-term care: nursing certification as a pathway to quality improvement.

This article describes a project to improve nursing care quality in long-term care (LTC) by retooling registered nurses' (RN) geriatric clinical competence. A continuing education course was developed to prepare LTC RNs (N = 84) for national board certification and improve technological competence. The certification pass-rate was 98.5%. The study used a mixed methods design with retrospective pretests administered to RN participants. Multivariate analysis examined the impact of RN certification on empowerment, job satisfaction, intent to turnover, and clinical competence. Results showed certification significantly improved empowerment, satisfaction, and competence. A fixed effects analysis showed intent to turnover was a function of changes in empowerment, job dissatisfaction, and competency (F = 79.2; p < 0.001). Changes in empowerment (t = 1.63, p = 0.11) and competency (t = -0.04, p = 0.97) did not affect changes in job satisfaction. Findings suggest RN certification can reduce persistently high RN turnover rates that negatively impact patient safety and LTC quality.