Building a Practice Ready and Resilient Nursing Workforce.

Nurse leaders depend upon resiliency skills to support their practice. It is important to provide opportunities for nursing students to learn, practice, and observe these skills, which are needed to navigate challenging work environments. This article describes the impact of a resiliency curricular component in a grant-funded BSN elective course, Concepts of Primary Care. Program evaluation was performed using a pre/posttest format and 2 surveys, the Brief Resilience Scale (BRS) and the Brief Resilience Coping Scale (BRCS). Three open-ended questions were administered upon completion of the elective course. A concurrent nested design was utilized with a thematic analysis undertaken to analyze qualitative data. Analysis of quantitative data was performed using descriptive statistics. Undergraduate BSN students showed an overall increase in resiliency (BRS: P = .112; BCRS: P = .064), and responses to open-ended questions supported the ability to apply and analyze most of the resiliency skills presented during the didactic portion of the elective course. This course promoted the development and refinement of undergraduate BSN student resilience skills. Integration of resilience content in the primary care course also supported student professional development. The addition of resiliency concepts and skills into undergraduate nursing curricula is recommended to enhance the ability of novice nurses to address work-related challenges and promote career satisfaction for the future.

Academic Leadership for Advancing Diversity, Equity, and Inclusion.

Academic nursing prepares nurses for the future to deliver, improve, and innovate health care. Moving forward on this imperative requires nurse leaders to support diversity, equity, and inclusion efforts thus partnering with individuals, families, communities, and other sectors to advance health equity, reduce health disparities, and improve care. The purpose of this article is to describe the creation, launch, and evaluation of an Office of Diversity, Equity, and Inclusion (DEI) in an academic nursing institution. Lessons learned are shared to assist others in their own journey to establish a DEI structure within an academic setting, especially one with a robust academic-practice partnership. The ideas shared are easily transferable to nonacademic settings.

Understanding the Impact of Span of Control on Nurse Managers and Hospital Outcomes.

GOAL: Span of control is a multidimensional concept requiring a comprehensive definition that captures the complexities of the nurse manager's role in acute care settings. This concept analysis aimed to identify factors associated with span of control and provide a comprehensive definition outlining the breadth of this concept. METHODS: ProQuest, PubMed, and Scopus databases were used to search peer-reviewed literature addressing the span of control in acute care nurse management. The search produced 185 articles; 177 titles and abstracts were screened for eligibility. Data from 22 articles were included in this analysis. PRINCIPAL FINDINGS: This analysis includes antecedents, attributes, and consequences of expanded nurse manager spans of control. Work-related factors such as staff and manager experience levels, work complexity, and patient acuity are attributes of a nurse manager's span of control. Our findings suggest that expanded spans of control can have negative consequences on nurse managers such as role overload and burnout. Low satisfaction among staff and patients can result from excessive spans of control. PRACTICAL IMPLICATIONS: An awareness of span of control can promote sustainable nursing practices by improving workplace conditions, staff satisfaction, and patient care quality. Our findings may translate across other health disciplines and thus contribute to scientific knowledge that can support changes in job designs and encourage more manageable workloads.

Association between personality and cognitive performance in middle-aged and older adults with human immunodeficiency virus (HIV).

BACKGROUND: Nearly half of adults with human immunodeficiency virus (HIV) experience HIV-Associated Neurocognitive Disorder (HAND), characterized by cognitive impairments in two or more cognitive domains, which can interfere with everyday functioning. Many factors are thought to influence such cognitive impairments in adults with HIV; one factor seldom examined is personality. OBJECTIVE: This study investigated the association between five major dimensions of personality (openness, conscientiousness, extraversion, agreeableness, and neuroticism) and cognitive function in older adults with HIV. METHODS: In this cross-sectional study, a secondary data analysis was conducted on 261 HIV + participants. Participants completed a norm-based cognitive battery covering seven cognitive domains, which yielded the following indices: global cognitive impairment, and global and domain-specific T-scores. The Big Five Inventory was used to assess personality traits. RESULTS: Higher openness, conscientiousness, and agreeableness were associated with better performance on individual cognitive domains while agreeableness and openness were also positively associated with global cognitive T-scores (p < .01). Only openness significantly predicted global cognition when adjusting for covariates (p < .01). DISCUSSION: Openness was associated with better global cognitive function in persons with HIV. This study provides a basis for further investigation of potential mechanisms for the association between personality and cognition in people with HIV in order to ultimately inform intervention strategies.

Implementation of a Registered Nurse Primary Care Clinical Mentoring Academy.

Registered nurses (RNs) are pivotal team members for improving the quality of care in communities; however, they are underutilized in primary care. Two schools of nursing in Alabama partnered to develop and implement a project to build a resilient primary care RN workforce. A major component of this project is the Primary Care Clinical Mentoring Academy (PCCMA), which was designed to prepare RN clinical mentors to implement positive student learning experiences in the primary care setting. The PCCMA follows a comprehensive curriculum implementing both didactic instruction and interactive activities related to primary care competencies; interprofessional education and collaborative practice; and primary care RN mentor roles and responsibilities. Participants reported that the PCCMA was effective and useful, and they perceived that it would improve their overall job performance as a clinical mentor. The PCCMA is an effective way to produce confident and capable RN mentors in primary care. [J Contin Educ Nurs. 2022;53(7):312-320.].

Leading Multisector Partnerships to Address Social Determinants of Health and Advance Health Equity for an Underresourced Heart Failure Patient Population.

Addressing the social determinants of health (SDoH) to advance health equity for persons with heart failure is a complex endeavor. Best results are achieved in partnership with multiple sectors beyond just the health care industry. We describe the evolution of an academic-practice-community partnership addressing the SDoH to advance health equity for a population of underresourced heart failure patients. Using a bundled approach to care delivery within a nurse-led interprofessional collaborative practice model and cultivating multisector partnerships, we initiated a systematic approach to addressing the SDoH within a heart failure clinic in the southeastern United States. Through our SDoH program, our clinic has improved access to care, medications, and food for our patients, thus advancing health equity and reducing hospital readmissions. Our multisector partnerships to address SDoH and advance health equity provide a foundation to improve population health outcomes for underresourced persons with heart failure. An SDoH program such as ours would not have been possible without strong leadership and collaboration of colleagues from multiple disciplines and sectors. In keeping with the Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report, we showcase our actions consistent with the report's recommendations.

Curricular and Clinical Innovation Engaging Undergraduate Nursing Students to Build a Resilient Primary Care Workforce.

BACKGROUND: Primary care health settings provide access to services for underserved populations, yet baccalaureate (BSN)-prepared nurses are currently underutilized on the primary care health care team. PROBLEM: BSN curricula often focus on acute care settings for clinical experiences, and students may not be aware of the scope and impact the RN has in a primary care setting. This gap in experiences may lead to overlooking primary care employment opportunities. PURPOSE: The purpose of this article is to describe the development, implementation, and evaluation of an innovative course that builds the primary care nurse workforce capacity. APPROACH: An undergraduate elective course focusing on primary care didactic and clinical experiences was created. OUTCOMES: Qualitative student feedback regarding the course was positive, while quantitative data revealed an above-average course outcome rating. CONCLUSIONS: An effective intervention to increase workforce capacity in primary care settings is to immerse students in primary care concepts and experiences in a formal, combined didactic and clinical course.

Academic-Practice Partnership Pivot During COVID-19 Pandemic Surge.

Health care systems continue to experience the sequential aftermath of the COVID-19 pandemic, with major care access, quality, safety, financial sustainability, and workforce considerations. Yet, academic-clinical partnership opportunities exist for transformational change, even when efforts to respond to a pandemic seem insurmountable. A nursing partnership between an academic health center nursing school and university health system provided short- and long-term support for the nursing workforce shortage during a COVID-19 surge. An academic-clinical integration framework guided planning, clinical support activities, outcomes achieved, technology innovations, and shared lessons associated with these efforts. The COVID-19 surge response steps included a call to action, preparation for surge support by the academic and clinical partners, and a team approach for clinical service delivery by faculty, students, and staff. Through the 6-week COVID-19 surge response, more than 10 000 hours of hospital nurse staffing were provided by nursing school faculty and students; over 770 worked shifts that provided approximately 30% of the full surge hospital supplemental staffing and approximately 46 000 vaccine encounters. Well-established academic-clinical nursing partnerships allow for quick pivots in the rapidly changing COVID-19 environment that can enhance nursing clinical proficiency and competency, augment clinically immersive learning, and reinforce analytics to measure health outcomes, lower costs, improve access, quality, safety, and workforce conditions.

COVID-19 Telehealth Fair Partnership for Capacity Building in Primary Care Nursing.

Telehealth in health care delivery grew exponentially throughout the COVID-19 pandemic. This growth occurred because of necessity, yet requires capacity building to maximize the technology's use. In this article, we discuss the development, implementation, and evaluation of a telehealth fair to build capacity in the use of telehealth technology within primary care nursing. The telehealth fair consisted of didactic and simulation components. Undergraduate and graduate nursing students completed the telehealth fair supported by a team of 12 nursing faculty and 6 clinical partner sites. Findings suggest statistically significant increases in student self-assessment of knowledge in telehealth, self-confidence in the use of telehealth, and readiness in the use of telehealth technology. Participant satisfaction following completion of the telehealth fair was high, with average scores of 4.2 to 4.58 (out of 5) for the didactic and 4.57 to 4.86 for the simulation components. The telehealth fair provided an invaluable opportunity for participants to enhance their learning relative to telehealth within primary care nursing. The experience also provided an opportunity for students to gain clinical hours during a pandemic when clinical placements in the community were limited. The experience also enhanced telehealth practice readiness of nursing students entering the workforce.

The Association of COVID-19 on Organizational Attitudes in Primary Care Among Interprofessional Practice Clinics.

This article describes the association of COVID-19 on organizational attributes in primary care among 2 academic-practice partnership interprofessional collaborative practice (IPCP) clinics. Our team used a concurrent, triangulation repeated-measures study design to examine responses to the Survey of Organizational Attitudes of Primary Care (SOAP-C) instrument between January and December 2020. Analysis revealed statistically nonsignificant change over 12 months across all 4 subscales. Study results suggest that IPCP teams can function effectively through adversity. The IPCP model seemed to bolster resilience making it a viable model for ambulatory practices caring for vulnerable populations.

Clinical Team Training and a Structured Handoff Tool to Improve Teamwork, Communication, and Patient Safety.

BACKGROUND: Effective communication among healthcare teams is essential for ensuring handoff-related safety and quality care outcomes. PURPOSE: The aim of this project was to improve patient safety through the reduction of communication-related errors on an acute hemodialysis unit (AHU) in an academic medical center. A target was set to reduce by 50 percent the communication-related errors using strategies to improve teamwork and communication. METHODS: Acute hemodialysis unit team members attended Clinical Team Training (CTT) informational sessions on teamwork and communication. A structured handoff tool was implemented in the AHU to improve nurse communication and reduce communication-related patient safety events. Descriptive statistics and comparison of means were conducted to assess the differences between preimplementation and postimplementation audit and safety event data. RESULTS: There was a statistically significant difference between the preintervention and postintervention groups of handoff tool usage and completion as well as a consistent decrease in handoff-related safety events after implementation. CONCLUSIONS/IMPLICATIONS: Findings suggest that CTT and a structured handoff tool used to guide nurse-to-nurse care transitions lead to a reduction in communication-related safety events during handoffs in an AHU.

Academic service-learning nursing partnerships in the Americas: a scoping review.

BACKGROUND: Academic service-learning nursing partnerships (ASLNPs) integrate instruction, reflection, and scholarship with tailored service through enriched learning experiences that teach civic responsibility and strengthen communities, while meeting academic nursing outcomes. OBJECTIVE: This scoping review aimed to identify, appraise, and synthesize evidence of community focused ASLNPs that promote primary health care throughout the Americas region. METHODS: A systematic search of PubMed, CINAHL, Scopus, Google Scholar, and LILACS English-language databases was performed in accordance with PRISMA guidelines. Full-text articles published since 2010 were reviewed using an inductive thematic approach stemming from the "Advancing Healthcare Transformation: a New Era for Academic Nursing Report" and the Pan American Health Organization "Strategic Directions for Nursing." RESULTS: A total of 51 articles were included with the vast majority 47 (92.1 %) representing North America. Structured, established relationships between an academic nursing institution or program and one or more community serving entities resulted in high levels of effectiveness and innovation across settings. Five themes emerged: (a) sustaining educational standards and processes - improving academic outcomes (25.5 %), (b) strengthening capacity for collaborative practice and interprofessional education (13.7 %), (c) preparing nurses of the future (11.8 %), (d) enhancing community services and outcomes (21.6 %), and (e) conceptualizing or implementing innovative academic nursing partnerships (27.4 %). A synthesis of conceptual frameworks and models revealed six focus areas: communities/populations (26.2 %), nursing (26.2 %), pedagogy (19 %), targeted outreach (14.3 %), interprofessional collaboration (11.9 %), and health determinants (9.5 %). A proliferation in US articles, triggered by nursing policy publications, was confirmed. CONCLUSIONS: ASLNPs serve as mechanisms for nurses and faculty to develop and lead change across a wide variety of community settings and healthcare systems, develop scholarship, as well as for students to apply the knowledge and skills learned. Given the lack of geographically broad evidence, successes and challenges across U.S. partnerships should be viewed cautiously. Nevertheless, ASLNPs can play a critical role towards meeting the goal of universal health access and coverage through partnering with the education sector. Further investigation of grey literature as well as Spanish and Portuguese language literature from Latin American and Caribbean countries is highly recommended.

Perceived Racial Discrimination in the Pregnant African American Population: A Concept Analysis.

African American women experience higher lifetime exposure to chronic stressors, such as perceived racial discrimination. Clearly defining perceived racial discrimination in the pregnant African American population has the potential to better explain the phenomenon and how it relates to adverse birth outcomes such as preterm birth. The purpose of this concept analysis is to more clearly define perceived racial discrimination in the pregnant African American population using Rodgers' evolutionary method. Defining the concept of interest has the potential to uncover modifiers that may help close the gap in the Black-White infant mortality rates in the United States.

Interprofessional Collaborative Practice Model to Advance Population Health.

The purpose of this paper is to describe the development, implementation, and lessons learned associated with an interprofessional collaborative practice (IPCP) care delivery model initiated at the University of Alabama at Birmingham (UAB). The model emphasizes transitional care coordination in chronic disease management for underserved and vulnerable populations. The model operates within a clinic environment with care providers from a variety of disciplines who integrate individual case management and actualize leadership taken by the appropriate discipline based on the needs of each patient. Two clinics will be discussed - Providing Access to Healthcare (PATH) and Heart Failure Transitional Care Services for Adults (HRTSA) - both of which leverage the resources of an existing academic-practice partnership between the UAB School of Nursing and UAB Hospital (UABH) and Health System. Clinic target patient populations are uninsured adults with diabetes (PATH Clinic) and uninsured or underinsured adults with heart failure (HRTSA Clinic) who are discharged from UABH with no source for ongoing care. The model uses a nurse-led, team-based approach that involves multiple professions working together to provide care for high-need, high-cost patients. Clinics use 4 simultaneous bundles of care that include evidence-based treatment guidelines, transitional care coordination activities, patient activation strategies, and behavioral health integration. Engaged patients indicate very high levels of satisfaction with care and improved physical and mental health outcomes resulting in significant cost savings for the health system. Finally, IPCP team members report joy in their work within the clinics.

An Innovative Approach for Graduate Education for Psychiatric Nurse Practitioners.

A major transformation in nurse practitioner (NP) education is the emergence of post graduate residencies; their foci include (a) educating NPs in population health; (b) increasing clinical proficiency; and (c) incorporating quality and safety into practice. We describe a psychiatric NP residency program supported by an academic-practice partnership, known as the Veterans Affairs Nursing Academic Partnership for Graduate Education (VANAP-GE) between the Birmingham Veterans Administration Medical Center (BVAMC) and the University of Alabama at Birmingham (UAB) School of Nursing (SON) for a population of Veterans with complex mental and physical health needs. Topics which are covered include risks of suicide among Veterans, post-traumatic stress disorder, depressive and anxiety disorders, and substance use disorders. During this one-year traineeship during the first year after NP certification, residents engage in development of crucial skills for improving the future of U.S. health care. All residents are newly licensed PMHNPs, but some are also pursuing DNP degrees. For residents who are simultaneously enrolled in BSN to DNP programs, the additional clinical training afforded by NP residency education provides a natural laboratory for their projects with foci of quality and safety, leadership, and clinical scholarship. Reduction in NP turnover as well as cost savings of orientation and recruitment are significant benefits for the practice partner with zero vacancies since the partnership's inception. These multiple successes predict increased establishment of residencies as viable post graduate pathways for NPs.

Sustainability of an Interprofessional Collaborative Practice Model for Population Health.

Sustainability is an important concept in implementation science, yet little about sustainability is published in leadership journals. Leaders are charged on a daily basis with initiating programs that make a difference; however, they are often not well prepared to design effective strategies to sustain their efforts. In a value-based health care industry where facilitating access to care, enhancing the patient experience, improving health outcomes, and reducing the cost of care are imperative, creating sustainability strategies that achieve these results is key. In this article, we describe the successful efforts within an academic-practice partnership to implement a sustainable interprofessional collaborative practice model emphasizing transitional care coordination in chronic disease management for advancing population health with underserved populations. A sustainability framework is presented along with lessons learned.

Transitional Care Home Visits Among Underserved Patients With Heart Failure.

Heart failure (HF), a global public health problem affecting 26 million people worldwide, significantly impacts quality of life. The prevalence of depression associated with HF is 3 times higher than that of the general population. Evidence, though, supports the use of transitional care as a method to enhance functional status and improve rates of depression in patients with HF. This article discusses the findings of a quality improvement project that evaluated health outcomes in underserved patients with HF who participated in a transitional care home visitation program. The visitation program exemplifies the role of leadership in facilitating transitions across the health care continuum. The 2-year retrospective review included 79 participants with HF. Comparisons of outcomes were made over 6 months. Although not statistically significant, clinically significant differences in health outcomes were observed in participants who received a home visit >14 days compared with ≤14 days after hospital discharge. A home visitation program for underserved patients with HF offers opportunities to enhance care across the continuum. Ongoing evaluation of the existing home visitation program is indicated over time with the goal of offering leaders data to enhance patient and family-centered transitional care coordination.

A model operationalizing sustainability in global nursing.

BACKGROUND: The concept of sustainability has received growing attention since the adoption of the United Nations' (UN) Sustainable Development agenda. Yet, in the context of sweeping changes regarding the status and profile of global nursing, sustainability has not been fully conceptualized. PURPOSE: To explore the concept of sustainability in global nursing in order to develop an operational definition and model. METHODS: Concept analysis using Rodger's Evolutionary method to explicate the term "sustainability" in a global nursing context. FINDINGS: Key features of sustainability were described. Existing models of global nursing focus on partnerships and lack a clear conceptualization and integration of sustainability. An operational definition and model of sustainability in global nursing were developed. DISCUSSION: Evolutionary review and analysis led to clarity in operationalizing sustainability in global nursing. The definition and model compliment existing models and provide a road map for global nursing to contribute toward the UN Sustainable Development agenda.