Assessment of nursing faculty retirement projections.

BACKGROUND: Nursing faculty retirement is a critical factor contributing to the nursing faculty shortage. PURPOSE: To assess the accuracy of projections on 2016 to 2025 nursing faculty retirements made in a previous study by Fang and Kesten (2017). METHODS: The 2016 to 2022 full-time nursing faculty data collected by American Association of Colleges of Nursing were used to examine the accuracy of the retirement projections for the same years. DISCUSSION: The study found that the mean age of full-time nursing faculty decreased for the first time; the number of faculty retirees and their age distributions projected by Fang and Kesten (2017) were accurate; there was a larger loss of nursing faculty at senior ranks to retirements than was anticipated; nursing faculty aged 50 to 59 in 2015 have made significant progress in doctoral attainment, senior rank, and graduate-level teaching by 2022, but they were still underrepresented in senior ranks compared to the 2016 to 2022 retirees; and for nursing faculty with a PhD degree, their growth was slower than their loss to retirements. CONCLUSION: The findings demonstrate the usefulness of the specific methods for faculty retirement projections. The decline in the mean age of nursing faculty is a positive sign that there is an increased recruitment of younger nurses into academia. The increase in the number of younger nurses entering academia with Doctor of Nursing Practice (DNP)-degree preparation can be leveraged through PhD-DNP collaboration to prepare practice-ready nursing graduates who contribute to health care improvements. Nursing schools need to implement innovative strategies to mentor younger faculty for their successful succession.

Burnout among academic nursing faculty.

BACKGROUND: Nurse faculty burnout is a growing concern in the United States. There are limited studies exploring the level of burnout in nursing faculty. PURPOSE: To assess the prevalence of burnout among nurse faculty in undergraduate and graduate programs and its relationship with specific demographic and organizational variables. METHODS: A descriptive cross-sectional research design was employed to examine the level of burnout of nursing faculty. An internet-based survey was administered to nursing faculty in over 1000 schools of nursing in the United States. Burnout was measured using the Oldenburg Burnout Inventory. RESULTS: A total of 3556 surveys were returned. Among all participants, most of the sample exhibited moderate levels of burnout, exhaustion, and disengagement. Based on the findings from the OBI, a moderate/high exhaustion level was reported in 85.5 % of participants, while disengagement was moderate/high in 84.9 %, and overall burnout was at moderate/high levels in 85.2 % of the nursing faculty. CONCLUSIONS: The nation's nurse faculty population is experiencing a moderate to high level of burnout, exhaustion, and disengagement. Academic nursing leaders are encouraged to identify ways and take action to reduce faculty burnout and promote faculty wellness and resilience.

Support for Doctoral Nursing Students in PhD Programs in the United States.

BACKGROUND: The number of PhD nursing programs in the U.S. has increased, but the number of nursing students entering and completing these programs remains stagnant. It is crucial to consider innovative approaches to recruit, nurture, and graduate more diverse nursing students. PURPOSE: This article presents the perceptions of PhD nursing students regarding their programs, experiences, and strategies to support their academic success. METHODS: This study used a cross-sectional, descriptive design. Data were obtained from an online 65-question student survey completed between December 2020 and April 2021. RESULTS: A total of 568 students from 53 nursing schools completed the survey. Five themes emerged regarding the barriers students experienced during their programs: Faculty issues, time management and balance, insufficient preparation for dissertation research, financial barriers, and COVID-19 impact. Student recommendations for improving PhD nursing programs were also captured in five themes: Program improvement, coursework improvement, research opportunities, faculty, and dissertation. The low numbers of male, non-binary, Hispanic/Latino, minority, and international survey respondents indicate a need for innovative recruitment and retention strategies to increase diversity of PhD students. CONCLUSION: PhD program leaders should complete a gap analysis based on the recommendations in the new AACN position statement and perceptions of PhD students reported from this survey. By doing so, PhD programs will be better positioned to implement a roadmap for improvement to better prepare the next generation of nurse scientists, leaders, and scholars.

Sustained Implementation of an Evidence-Based Extubation Checklist Reduced Extubation Failure in Trauma Patients.

Extubation failure remains a challenge in the perioperative setting. The aim of this intervention was to decrease the rate of perioperative extubation failure through the utilization of an extubation checklist. A five-item evidence-based extubation readiness checklist was implemented at a level I trauma center on all patients who were electively extubated in the operating room (OR). Extubation failure rates before and after implementation of the checklist were compared. Of 26,867 trauma patients extubated in the OR after the intervention, 84 cases (0.31%) failed extubation in the immediate postoperative period. A significant and sustained decrease in extubation failure rate per case performed was observed between the pre- and post-checklist period (OR, 0.33; 95% CI, 0.19, 0.56; P < 0.001). Partial (vs full) checklist completion, higher ASA physical status score, advanced age, and longer case length were independently associated with increased odds of extubation failure in the postintervention period.

Research focused doctoral nursing education in the 21st century: Curriculum, evaluation, and postdoctoral considerations.

The AACN position statement on The Research-Focused Doctoral Program in Nursing: Pathways to Excellence was revised in 2022 by an AACN Task Force charged with creating a new vision for the PhD and similar programs in nursing. This document, which was informed by hundreds of academic nursing stakeholders, yields expectations and recommendations for PhD program curriculum, program evaluation, post-doctoral competencies, and resources. Results of an AACN 2021 survey indicated increased enrollment in PhD programs 2017-2000. Fifteen percent of students were enrolled in BSN-PhD, programs, 70 % of schools reported external review, and overall average time to degree completion was 5 years. Considerations for the education for the research doctorate include development of curriculum that fosters the scholarship of discovery and scientific inquiry and implements systematic evaluation of program outcomes while advancing postdoctoral competencies and resources, including the post-doctoral fellowship. Comprehensive assessment of the PhD program promotes ongoing program analysis and quality. Postdoctoral fellowships advance the science of nursing via the creation of a culture and workforce for nursing research. Successful postdoctoral programs have mentors, resources, and infrastructure to adequately enable the fellow to progress in their line of inquiry and develop as an investigator.

Anesthesia-Related Malpractice Claims in Maryland 1994-2017.

This article presents data on anesthesia cases filed with the Maryland Health Claims Alternative Dispute Office between 1994 and 2017, a publicly available resource that includes all anesthesia-related claims filed in Maryland, regardless of whether they were reported to any national claims repository. Analysis of anesthesia malpractice claims offers critical information that can both decrease legal liability and improve patient outcomes for those receiving anesthesia. A total of 276 claims were filed. Variables under investigation included venue, types of surgery, legal cause of action, trends, and outcomes. Types of anesthesia-related claims included the administration of general anesthesia (59.8%), monitored anesthesia care (14.9%), pain management (10.9%), epidural/spinal anesthesia (9%), nerve blocks (2.9%), and local anesthesia infiltration (2.6%). Most cases (39.5%) involved failure to adequately monitor the patient. Inadequate perioperative care was alleged as the cause of action in 68.8% of cases. Major adverse patient outcomes were death (38.8%), brain damage (21%), and permanent nerve damage (14.9%). Understanding the events that lead to legal action can assist anesthesia providers to focus on ways to improve their practice.

Systematic Review of Burnout in US Nurses.

Nurses experience high levels of burnout, and this has become a major factor in recruitment and retention of nurses. Several factors have been associated with burnout, but it is not clear which factors are the most significant predictors. Understanding the most prevalent factors that are associated with burnout will allow for the development and implementation of interventions to ameliorate and/or reduce burnout in the nursing workforce.

Comparison of Factors Associated with Physician and Nurse Burnout.

Burnout is a condition resulting from chronic workplace stress that has not been effectively managed, described in 3 dimensions: (a) feelings of energy depletion or exhaustion, (b) increased mental distance from one's job, and (c) reduced professional efficacy. Burnout is a widespread problem reaching concerning levels among health care professionals, with more than 50% of physicians and one-third as many as 80% of nurses reporting symptoms. The National Academy of Medicine (NAM) action collaborative on clinician well-being and resilience has prioritized exploring ways to enhance baseline understanding of clinician well-being and promotion of multidisciplinary solutions to burnout.

Eight Ways Nurses Can Manage a Burnt-Out Leader.

Health professionals, including nurses, are vulnerable to burnout, which occurs when chronic stress is not managed. COVID-19 led to nurses working in stressful environments, and being required to work mandatory overtime. The result was an increase in burnout. Nurses exhibited physical, psychological, emotional, and behavioral signs of burnout. There are several ways that nurses can mitigate the situation and have more control over burnout. Nurses need to work together to support each other, including supporting the leader. There are several actions, such as mindfulness activities and maintaining a healthy lifestyle that can help prevent burnout.

Completion and attrition of DNP students of the 2006-2015 matriculating cohorts.

BACKGROUND: Despite the strong support for DNP education, we have limited knowledge about completion and attrition of DNP students, which are important measures of achievement of DNP programs. PURPOSE: To examine completion and attrition of students in DNP programs. METHODS: The data were obtained from AACN's Doctoral Student Roster Survey and Annual Survey of Baccalaureate and Graduate Programs in Nursing. 31,320 students who matriculated into DNP programs between 2006 and 2015 were selected. These years were chosen to ensure accurate estimates of graduation and attrition rates. Bivariate and multivariate analyses were used to examine the associations between individual and institutional characteristics and attrition of DNP students. FINDINGS: We found that the completion rate of DNP students of the 2006-2015 matriculating cohorts was 77.3% and the attrition rate was 19.3%. On average, after matriculation, it took 3 years for the students to graduate and 1.9 years for students who left without graduating to drop out. The mean age at matriculation was 39.9 and the mean age at graduation was 42.2. Our multivariate analysis found that male students, part-time students, students who were not faculty or held a part-time faculty position, and students in DNP programs with more than 50% of courses taught online were more likely to experience attrition. DISCUSSION: The study findings provide useful information for DNP programs and nursing schools to better understand academic progression of DNP students.

Impact of the Health Resources and Services Administration's state oral health workforce grant program on dental workforce density and access to oral health care.

BACKGROUND: The Health Resources and Services Administration's Grants to States to Support Oral Health Workforce Activities, otherwise known as the State Oral Health Workforce Program (SOHWP), help states develop and implement innovations that address the workforce needs of dental Health Professional Shortage Areas in a manner appropriate to the states' individual needs. AIM: This cross-sectional study explores the broad impact of the SOHWP by comparing measures of dental workforce density and access to oral health care in states with multiple years of funding versus states with few or no years of funding. METHODS: We used data for 2006-2016 SOHWP awardees together with data from the 2016-2017 Area Health Resources Files and the 2016 Behavioral Risk Factor Surveillance System to compare numbers of dentists per 100,000 population and age-adjusted prevalence of annual dental visits among adults for long-term SOHWP-funded states versus states with few or no years of funding. RESULTS: Multi-year SOHWP funding is associated with higher workforce density and greater access to oral health care, especially in the Midwest and West. CONCLUSION: Allowing states funding utilization flexibility may result in improved outcomes. This finding can help inform planning and policy about whether and how to scale future training and workforce programs to achieve greater impact.

Practice Environment Scale of the Nursing Work Index: A Reliability Generalization Meta-Analysis.

A healthy work environment is a critical factor in nurse satisfaction, retention, and patient outcomes. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is the most commonly used instrument to measure the nursing practice environment. This study uses meta-analysis to examine the reliability generalization of the PES-NWI. A meta-analysis of 51 studies representing a total of 80,563 subjects was conducted. The mean score reliability for the PES-NWI based on 38 studies (n = 68,278) was .922 (p < .05). The Mean Weighted Effect Size was stronger for studies conducted in the United States versus non-U.S. (.946 vs. .907). For studies rated high and moderate quality, the mean score reliability was .911 and .946, respectively. Scores on the PES-NWI are reliable for measuring the nursing practice environment across samples in the United States and non-U.S. countries.

Trends in racial and ethnic demographics of the nursing workforce: 2000 to 2015.

BACKGROUND: The case for a more diverse nursing workforce has never been stronger given the rapidly changing demographics of the United States (U.S.) and the underrepresentation of certain racial and ethnic groups in nursing. PURPOSE: The purpose of this paper is to examine how representation of ethnic and racial minority groups in the nursing workforce has changed over a 15-year period (2000-2015). METHODS: The American Community Survey (ACS) data files were used to examine patterns in ethnicity/race and education level in the registered nurse (RN) workforce. Data were analyzed using descriptive statistics and chi-square. FINDINGS: In the nursing workforce, minority groups are reaching higher levels of education. There has been a sharp increase in the number of baccalaureate graduates and a leveling-off of associate degree nurses. DISCUSSION: Nursing leaders are working collaboratively to increase the ethnic and racial diversity of the nursing workforce that is growing at a rate faster than that of the U.S. population as a whole.

Perspectives: Using Results from HRSA's Health Workforce Simulation Model to Examine the Geography of Primary Care.

OBJECTIVE: Inform health planning and policy discussions by describing Health Resources and Services Administration's (HRSA's) Health Workforce Simulation Model (HWSM) and examining the HWSM's 2025 supply and demand projections for primary care physicians, nurse practitioners (NPs), and physician assistants (PAs). DATA SOURCES: HRSA's recently published projections for primary care providers derive from an integrated microsimulation model that estimates health workforce supply and demand at national, regional, and state levels. PRINCIPAL FINDINGS: Thirty-seven states are projected to have shortages of primary care physicians in 2025, and nine states are projected to have shortages of both primary care physicians and PAs. While no state is projected to have a 2025 shortage of primary care NPs, many states are expected to have only a small surplus. CONCLUSIONS: Primary care physician shortages are projected for all parts of the United States, while primary care PA shortages are generally confined to Midwestern and Southern states. No state is projected to have shortages of all three provider types. Projected shortages must be considered in the context of baseline assumptions regarding current supply, demand, provider-service ratios, and other factors. Still, these findings suggest geographies with possible primary care workforce shortages in 2025 and offer opportunities for targeting efforts to enhance workforce flexibility.

Diversifying the Health-Care Workforce Begins at the Pipeline: A 5-Year Synthesis of Processes and Outputs of the Scholarships for Disadvantaged Students Program.

The case for a more diverse health-care workforce has never been stronger given the rapidly changing demographics of the United States and the continued underrepresentation of certain racial and ethnic groups across the health professions. To date, progress toward diversifying the health-care workforce has been and continues to be deterred by a mix of factors at the societal, institutional, and individual levels. Since the 1970s, the Federal government has invested resources in initiatives that support the training and development of the existing workforce as well increase the supply of new health professionals-particularly those from underrepresented minority groups and/or from disadvantaged backgrounds. However, limited studies have been published detailing the processes, outputs and, where available, outcomes of such investments across multiple years. This article describes how the Health Resources and Services Administration's Bureau of Health Workforce used retrospective case study methodology to evaluate processes and outputs associated with the Scholarships for Disadvantaged Students program-an over US$40 million annual Federal investment aimed at offsetting tuition costs for health professions students from disadvantaged backgrounds-over a 5-year period. Lessons learned and recommendations for strengthening the program's design and requirements are provided.

Where do physicians train? Investigating public and private institutional pipelines.

Where a physician is educated-in a public or a private institution-affects his or her practice choices, including the likelihood of choosing a career in primary care. It is important to monitor the educational pipeline for physicians to ensure that a robust cadre of professionals is entering the health care workforce from public-sector institutions to meet the growing demand for primary care providers.

The Health Resources and Services Administration diversity data collection.

The Health Resources and Services Administration maintains a strong emphasis on increasing the diversity of the health-care workforce through its grant programs. Increasing the diversity of the workforce is important for reducing health disparities in the population caused by socioeconomic, geographic, and race/ethnicity factors because evidence suggests that minority health professionals are more likely to serve in areas with a high proportion of underrepresented racial and ethnic minority groups. The data show success in increasing the diversity of enrollees in five nursing programs.