U.S. Primary Care Provider Needs: An Analysis of Workforce Projections and Policy Implications.

The primary care (PC) physician workforce has consistently been projected as requiring additional numbers to meet the needs of the U.S. The Health Resources and Service Administration (HRSA) has reported the PC nurse practitioner (NP) workforce to be 90,000 NPs more than required to meet the PC needs of the U.S. With both clinician types contributing to the PC workforce in the country, it is difficult to understand such an oversupply of NPs with continued deficit in PC physicians. The purpose of this study was to investigate results and methods used for HRSAs current PC workforce projections and compare those with the same used for Bureau of Labor Statistics (BLS) and American Association of Medical Colleges (AAMC) projections. Methods included a review of technical documents, dashboards, and published reports. Interviews with subject matter experts were also completed. Projections were found to differ significantly, as did data and assumptions. Two of the three projections modeled physicians as the sole provider of PC. An integrated model gives the most comprehensive and accurate picture of PC workforce needs. The utilization of NPs as PC providers has been demonstrated to be safe and effective, with the potential to alleviate predicted shortages, improve patient care outcomes, reduce cost, and address PC inequities. Implications include improving workforce data, creating projections that mirror clinical integration in PC, adjusting workforce preparation funding, incentivizing interprofessional collaboration in research, addressing barriers to practice among non-physician providers, and leveraging growth in the NP workforce.

The Role of Technology in Health Professions Education During the COVID-19 Pandemic.

The COVID-19 pandemic has sparked radical shifts in the ways that both health care and health professions education are delivered. Before the pandemic, some degree programs were offered fully online or in a hybrid format, but in-person learning was considered essential to the education and training of health professionals. Similarly, even as the use of telehealth was slowly expanding, most health care visits were conducted in-person. The need to maintain a safe physical distance during the pandemic rapidly increased the online provision of health care and health professions education, accelerating technology adoption in both academic and professional health care settings. Many health care professionals, educators, and patients have had to adapt to new communication modalities, often with little or no preparation. Before the pandemic, the need for cost-effective, robust methodologies to enable teaching across distances electronically was recognized. During the pandemic, online learning and simulation became essential and were often the only means available for continuity of education and clinical training. This paper reviews the transition to online health professions education and delivery during the COVID-19 pandemic and provides recommendations for moving forward.

Hospital-Based Nursing Research: Clinical and Economic Outcomes.

We surveyed 181 nursing research leaders from Magnet® hospitals, using mixed methods with the online Hospital-Based Nursing Research Clinical and Economic Outcomes survey, to describe the clinical and economic outcomes of nursing research conducted in hospital settings. We used descriptive statistics to analyze the quantitative findings and a qualitative descriptive approach to study the open-ended responses. Most respondents reported that findings from their hospital-based studies were implemented on their units (88.2%), improved health care processes (88.2%), and reduced hospital costs (79%). Over 50% reported positive impacts on core quality measures, including improving patient/family satisfaction (76.8%), nurse satisfaction (65%), length of stay (59.1%), and infection rates (56.5%). Four themes were identified: study evaluation, improvements in care delivery/clinical outcomes, economic impact, and intrinsic and extrinsic rewards. Much of the research reported by respondents focused on quality measures with findings that resulted in improved clinical and economic outcomes.

Interprofessional care of people with multiple chronic conditions: An open-access resource for nursing educators.

Nurses, nurse practitioners, and other healthcare professionals must be prepared to care for the growing population of patients with multiple chronic conditions, to promote patient engagement, patient self-management, and for interprofessional collaboration. Interprofessional Care of Individuals with Multiple Chronic Conditions is an open-access eLearning course designed to prepare students with these skills. The course features multimedia presentations, interactive exercises, and an immersive "day in the life of a patient-centered medical home" in which learners make decisions, receive feedback, and experience consequences in the context of real-world video scenarios. Three hundred thirty-four nurse practitioner students participated in the educational program. To evaluate the program, we conducted a paired-samples t-test to compare scores on pre and posttest evaluation surveys. There was a significant difference in the scores for applying the Chronic Care Model t (df) = 15.99; p < 0.001, coaching for self-management t (df) = 11.04; p < 0.001 and interprofessional collaboration t (df) = 3.86; p < 0.00. The majority of students were satisfied or very satisfied with the modules. Students found the immersive video scenarios to be the best feature of the course. The course is available to assist students in gaining the ability to care for patients with chronic illnesses within interprofessional practice settings.

Transition to Practice Experiences of New Graduate Nurses From an Accelerated Bachelor of Science in Nursing Program: Implications for Academic and Clinical Partners.

BACKGROUND: This study explored the transition to practice experiences of new graduate nurses and the effects of their education on their readiness to practice. METHOD: This phenomenological study used two focus groups to gain an in-depth understanding of the lived experiences of these graduate nurses during their first year of practice, their perceptions of the effectiveness of their academic experience in preparing them for professional nursing practice, and clinical agency support. RESULTS: Three themes emerged from the focus group analysis: Practice Readiness, Work-Related Environmental Influences, and Being a Nurse. CONCLUSION: This study provides insight into the key issues surrounding the transition process experienced by new nurses and suggests ways to educate and successfully transition them into professional practice. Information gained from this study provides a beginning evidence base for other educators in both the academic and clinical settings interested in supporting successful transition to practice for new graduate nurses. [J Contin Educ Nurs. 2020;51(9):433-440.].

A call to action: Building evidence for use of simulation in nurse practitioner education.

Leaders from national nursing organizations, nursing schools, and health care simulation vendors convened in early 2019 to discuss simulation in nurse practitioner (NP) education. Nurse practitioner clinical education needs a more standardized, efficient, and sustainable model to prepare NPs to provide quality care in complex health care systems. Currently, a major shortage of clinical sites and preceptors to educate students creates challenges for NP programs and nursing faculty. One strategy used by nursing programs to overcome this challenge is using simulation to provide clinical training for NP students in a safe, controlled environment. There remains, however, a lack of evidence linking these simulation experiences with clinical skills acquisition and program outcomes. Implementing competency-based education through standardized simulations has the potential to demonstrate quality, safety, and accountability across NP education programs. Ultimately, the expansion and acceptance of simulation hours in NP education is dependent on strong and favorable evidence from rigorous, high-quality studies.

National Study of Nursing Research Characteristics at Magnet®-Designated Hospitals.

OBJECTIVE: To describe the research infrastructure, culture, and characteristics of building a nursing research program in Magnet®-designated hospitals. BACKGROUND: Magnet recognition requires hospitals to conduct research and implement evidence-based practice (EBP). Yet, the essential characteristics of productive nursing research programs are not well described. METHODS: We surveyed 181 nursing research leaders at Magnet-designated hospitals to assess the characteristics in their hospitals associated with research infrastructure, research culture, and building a nursing research program. RESULTS: Magnet hospitals provide most of the needed research infrastructure and have a culture that support nursing research. Higher scores for the 3 categories were found when hospitals had a nursing research director, a research department, and more than 10 nurse-led research studies in the past 5 years. CONCLUSIONS: While some respondents indicated their nurse executives and leaders support the enculturation of EBP and research, there continue to be barriers to full implementation of these characteristics in practice.

Systems Thinking and Systems-Based Practice Across the Health Professions: An Inquiry Into Definitions, Teaching Practices, and Assessment.

Phenomenon: Systems thinking is the cornerstone of systems-based practice (SBP) and a core competency in medicine and health sciences. Literature regarding how to teach or apply systems thinking in practice is limited. This study aimed to understand how educators in medicine, physical therapy, physician assistant, nursing, and speech-language pathology education programs teach and assess systems thinking and SBP. APPROACH: Twenty-six educators from seven different degree programs across the five professions were interviewed and program descriptions and relevant course syllabi were reviewed. Qualitative analysis was iterative and incorporated inductive and deductive methods as well as a constant comparison of units of data to identify patterns and themes. FINDINGS: Six themes were identified: 1) participants described systems thinking as ranging across four major levels of healthcare (i.e., patient, care team, organization, and external environment); 2) participants associated systems thinking with a wide range of activities across the curriculum including quality improvement, Inter-professional education (IPE), error mitigation, and advocacy; 3) the need for healthcare professionals to understand systems thinking was primarily externally driven; 4) participants perceived that learning systems thinking occurred mainly informally and experientially rather than through formal didactic instruction; 5) participants characterized systems thinking content as interspersed across the curriculum and described a variety of strategies for teaching and assessing it; 6) participants indicated a structured framework and inter-professional approach may enhance teaching and assessment of systems thinking. Insights: Systems thinking means different things to different health professionals. Teaching and assessing systems thinking across the health professions will require further training and practice. Tools, techniques, taxonomies and expertise outside of healthcare may be used to enhance the teaching, assessment, and application of systems thinking and SBP to clinical practice; however, these would need to be adapted and refined for use in healthcare.

Transitioning a bachelor of science in nursing program to blended learning: Successes, challenges & outcomes.

To help address the challenges of providing undergraduate nursing education in an accelerated time frame, the Teaching and Transforming through Technology (T3) project was funded to transition a second-degree ABSN program to a blended learning format. The project has explored the use of blended learning to: enable flexible solutions to support teaching goals and address course challenges; provide students with new types of independent learning activities outside of the traditional classroom; increase opportunities for active learning in the classroom; and improve students' digital literacy and lifelong learning skills. Program evaluation included quality reviews of the redesigned courses, surveys of student perceptions, pre- and post-program assessment of students' digital literacy and interviews with faculty about their experiences with the new teaching methods. Adopting an established quality framework to guide course design and evaluation for quality contributed to the efficient and effective development of a high-quality undergraduate blended nursing program. Program outcomes and lessons learned are presented to inform future teaching innovation and research related to blended learning in undergraduate nursing education.

Strategic Planning and Doctor Of Nursing Practice Education: Developing Today's and Tomorrow's Leaders.

Strategic planning and thinking skills are essential for today's nurse leaders. Doctor of nursing practice (DNP) programs provide an opportunity for developing effective nurse strategists. A well-designed strategy course can stimulate intellectual growth at all levels of Bloom's Taxonomy. Discussion forums in online education provide new opportunities for rich interaction among peers en route to development of well-informed strategic plans. An interprofessional perspective adds a rich and vital aspect to doctoral nursing education and it serves to inform strategic plan development. A roadmap for teaching strategic planning to current and future nursing leaders will guide the integration of essential content into DNP programs.

Using preappraised evidence sources to guide practice decisions.

PURPOSE: The purpose of this article is two-fold. The first is to describe preappraised evidence sources or a top-down approach to obtaining the best available evidence. The second purpose of the article is to describe how to incorporate preappraised evidence into clinical decision making with the Best Practice Decision Guide. DATA SOURCES: The Best Practice Decision Guide begins with a query of preappraised and filtered electronic sources to obtain recommended evidence summaries, or a so-called "top-down" approach to obtaining the best available evidence. CONCLUSIONS: Information on the major issues and dilemmas encountered at each step is presented, including evaluation of clinical practice guidelines and the consideration of relevant studies to particular patients or subpopulations. IMPLICATIONS FOR PRACTICE: Recommendations for other resources to use in the appraisal process and in making final practice decision are also described in the article.

Integrating executive coaching and simulation to promote interprofessional education of health care students.

This study used executive coaching and simulation to enhance interprofessional teamwork by promoting collaboration and leadership capacity in health professional students attending undergraduate programs. A mixed methods approach to program evaluation was used. A statistically significant (p<0.05) increase was noted pre- and post-program on the Team Assessment Inventory. Qualitative analysis of reflective essays and focus group interviews revealed that students participated as a career-building opportunity and because they wanted to gain a better appreciation for the roles and contributions of other health care providers. The themes that emerged related to aspects of the process students found helpful, lessons learned about professional roles, and the meaning of leadership in the context of interprofessional teams. Students also provided recommendations for future studies. Findings suggest that integrating executive coaching and simulation in interprofessional education may have the potential to create meaningful experiences for health professional students. While more empirical research is needed to investigate this potential, in terms of how executive coaching and simulation may increase professional collaborative care and improve the quality of health care delivery, the initial insights seem promising.

Preparing students for graduate study: an eLearning approach.

This paper describes the development and preliminary evaluation of an eLearning program intended to provide incoming nursing students with the basic knowledge, skills and abilities needed to succeed in graduate-level, online coursework. Using Mayer's principles (2008) for the effective design of multimedia instruction, an open-access, self-directed, online program was developed. The Graduate School Boot Camp includes five online modules focused on learning strategies and time management, academic writing, technology, research, and library skills. To motivate and engage learners, the program integrates a fun, graphical sports theme with audiovisual presentations, examples, demonstrations and practice exercises. Learners begin with a self-assessment based on the Motivated Strategies for Learning Questionnaire or MSLQ (Pintrich et al., 1993). To assess change in knowledge levels before and after completing the program, learners take a pre-test and post-test. Preliminary findings indicate that the students found the information relevant and useful. They enjoyed the self-paced, multimedia format, and liked the option to return to specific content later. This innovative program offers a way to prepare students proactively, and may prove useful in identifying students at risk and connecting them with the appropriate resources to facilitate successful program completion.

Paediatric nurse practitioner managed cardiology clinics: patient satisfaction and appointment access.

AIM: This article summarizes a comparative study of patient/family satisfaction and appointment wait times in physician managed vs. paediatric nurse practitioner managed cardiology clinics. BACKGROUND: Appointment wait times exceeded 40 days in the outpatient cardiology department at a children's hospital. To address the gap in available appointments, paediatric nurse practitioner managed cardiology clinics were implemented. METHODS: A sample of 128 patients who presented concurrently in physician or paediatric nurse practitioner managed cardiology clinics from December 2009 through February 2010 was recruited for participation. The hospital's ambulatory patient satisfaction survey was utilized to measure level of patient satisfaction with care. Survey responses were evaluated using Fisher's exact test. Appointment wait times were compared pre and post implementation of paediatric nurse practitioner managed clinics. RESULTS: Sixty-five physician families and 63 paediatric nurse practitioner families completed the satisfaction survey. There was no statistically significant difference in patient satisfaction between clinic types. Appointment wait time decreased from 46 to 43 days, which was not statistically significant. Paediatric nurse practitioner clinics included a statistically higher percentage total of urgent appointments compared to that in physician clinics. CONCLUSIONS: Paediatric nurse practitioner managed cardiology clinics are a strategic solution for improving patient access and facilitating high quality patient care while earning high levels of patient satisfaction. This healthcare delivery model illustrates the potential for expanded utilization of advanced practice nurses.

Behavior changes in patients with diabetes and hypertension after experiencing shared medical appointments.

PURPOSE: This project examined recently implemented shared medical appointments (SMAs) at a free clinic for patients with diabetes and/or hypertension. Changes in patients' self-managing behaviors, specifically exercise and goal-setting activity, were explored after participating in SMAs for 4 months. DATA SOURCES: The study employed a pretest-posttest quasi-experimental design. Participants completed a questionnaire of their self-managing behaviors and a behavioral action plan at each SMA. The SMAs were facilitated in English, Spanish, and bilingually (English and Spanish) with a total of 37 participants. CONCLUSIONS: Descriptive analysis showed a significant increase in exercise time with a mean increase of 86 min per week at post-SMA (p= .002, 95% confidence interval [CI]). Each participant identified a measurable goal, and 97% of participants reported achieving or almost achieving their goals. Males reported a significantly (p= .002, 95% CI) larger increase in exercise time than women. Variance of self-managing behaviors among the English, Spanish, and bilingual SMAs was statistically not significant. IMPLICATIONS FOR PRACTICE: Though much evidence exists demonstrating that SMAs provide effective quality care, literature is lacking in examining patients' self-managing behaviors after participation in language-specific SMAs. Understanding patients' response to programs that address the needs of the individual leads to more effective programs.

Online teaching strategies to improve collaboration among nursing students.

Collaborative problem-solving is an essential competency for nurses and all health professionals. This paper compares the design characteristics and educational benefits of three online-teaching strategies that nurse educators can use to build the critical thinking and social skills needed for effective collaboration: computer supported collaborative learning, case-based facilitated discussion, and cognitive flexibility hypermedia. These strategies support a critical instructional outcome required for effective collaboration: the ability to examine, assess, and synthesize multiple perspectives to resolve illstructured problems (i.e., problems for which there is no clear-cut solution). Descriptions, examples, and guidelines for implementing each strategy are provided. By integrating these strategies into their online courses, nurse educators can prepare nurses to work effectively with others to solve complex problems in clinical practice and the broader health-care system.

Online teaching strategies to improve collaboration among nursing students.

Collaborative problem-solving is an essential competency for nurses and all health professionals. This paper compares the design characteristics and educational benefits of three online-teaching strategies that nurse educators can use to build the critical thinking and social skills needed for effective collaboration: computer supported collaborative learning, case-based facilitated discussion, and cognitive flexibility hypermedia. These strategies support a critical instructional outcome required for effective collaboration: the ability to examine, assess, and synthesize multiple perspectives to resolve illstructured problems (i.e., problems for which there is no clear-cut solution). Descriptions, examples, and guidelines for implementing each strategy are provided. By integrating these strategies into their online courses, nurse educators can prepare nurses to work effectively with others to solve complex problems in clinical practice and the broader health-care system.