The presence and roles of nurse navigators in acute care hospitals.

OBJECTIVE: A survey of hospital-based nurse executives was conducted to determine the extent, approaches, and outcomes of nurse navigator (NN) programs. BACKGROUND: Nurse navigators are distinct from other recognized healthcare roles. Navigators most commonly focus on a single health condition with the goal of improving the provision of specified health services for an individual patient. METHODS: An 11-question Internet-based survey was e-mailed to 580 nurse executives in Texas. RESULTS: Of the respondents, only 24% implemented any type of NN program. Most of the respondents with navigators rated these programs as successful. Most of the NN programs served cancer patients. Sixty percent implemented noncancer NN programs, with most reporting quality improvement as the main outcome measure for patients with conditions such as diabetes, cardiovascular disease, and high-risk obstetrics. CONCLUSIONS: Opportunities exist in demonstrating the value of NN roles. To increase support for the role, nurse executives should develop the programs to meet the clinical, marketing, and financial objectives of the organization and targeted patient populations.

Differentiated essential competencies: a view from practice.

This article describes the results of strategies to elicit views of practicing nurses by the Texas Board of Nursing regarding competencies expected of new graduate licensed vocational nursing/LPN, associate degree/diploma, and baccalaureate nurses. The implications of these perceptions regarding the competencies expected of new graduates in Texas are considered, with questions posed for future exploration.

Evaluating the impact of scenario-based high-fidelity patient simulation on academic metrics of student success.

Despite the ongoing nursing shortage, nurse educators are responsible for preparing students to practice in highly complex health care systems. As nurse educators explore new learning strategies to support an increase in student admissions, they must also evaluate the impact of these strategies on the quality of the educational experience. The study reported here evaluated the impact of scenario-based, high-fidelity patient simulation used to increase student admissions in an associate degree and baccalaureate nursing program in north-central Texas upon students' sense of their own clinical competence, graduating grade point average (GPA), and performance on standardized exit examinations. These are measures commonly used by nurse educators as metrics of success.

Assessing continued competency through simulation: A call for stringent action.

This article proposes that simulation has potential as a method to validate critical and reflective thinking skills and continued competency of registered nurses. The authors recognize the challenges and benefits for using simulation in assessing competency. Furthermore, the authors stress that the potential use of simulation in competency testing cannot be achieved until educators and researchers acquire the specific knowledge and skills to make informed decisions and recommend policy.

Creating tomorrow's leaders today: the Emerging Nurse Leaders Program of the Texas Nurses Association.

The Texas Nurses Association initiated an Emerging Nurse Leaders Program as an approach to engaging new nurses in the leadership of the professional association. This article explains the program's origin, the commitment of the Texas Nurses Association to this process, the implementation of the plan, and the discussions that launched a new way of connecting leaders across generations. Further, it is an approach that any professional organization can use to encourage the involvement of new leaders.

A competency transcript to assess and personalize new graduate competency.

The competence of a new registered nurse (RN) at the time of graduation influences the rapidity with which the RN becomes an effective practitioner. One school of nursing offering a bachelor of science in nursing developed a competency documentation system, a "competency transcript," to better describe the graduate's clinical judgment and psychomotor skill. This transcript was used as a communication tool between a clinical agency and a university school of nursing and was also used to help one hospital personalize orientation based on the learning needs of the graduate, with the goal of decreasing orientation time and cost.

A regional simulation center partnership: collaboration to improve staff and student competency.

This article describes the development of a Regional Simulation Center by a hospital, university, and community college to provide competency education and validation for students, nurses, and other allied health staff. Using high-fidelity patient simulators and scenario-based simulations, bachelor's of science in nursing-prepared laboratory mentors provide realistic opportunities for hospital staff and students to validate their clinical judgment as well as their psychomotor skills. The process of development, as well as the advantages of the partnership for the hospital and the nursing programs, is outlined.

The evolution of simulation and its contribution to competency.

Nurse educators are challenged to implement teaching strategies that promote learners' clinical competency and critical-thinking skills. Additionally, these educators are asked to base their curriculum decisions, teaching practices, and evaluation methods on current research findings. Simulation offers a unique mode for experiential learning and evaluation, but the appropriate use of the spectrum of simulation typology requires strategic planning. Although simulation provides educators with new educational opportunities, the potential use of simulation in competency testing cannot be achieved until educators and researchers acquire the knowledge and skills needed to use this education strategy, develop realistic case scenarios, and design and validate standardized and reliable testing methods. Numerous pressures exist for clinical settings to document the competencies of their employees. Simulation could be used in the practice environment to promote and validate the clinical judgment and competency of nurses.

Conflict management styles in the health professions.

The purpose of the study was to determine prevalent conflict management styles chosen by students in nursing and to contrast these styles with those chosen by students in allied health professions. The associations among the level of professional health care education and the style chosen were also determined. A convenience sample of 126 students in a comprehensive university completed the Thomas-Kilmann Conflict Mode Instrument (TKI), which requires respondents to choose behaviors most characteristic of their response to conflict and classifies these behaviors as one of five styles. There was no significant difference between the prevalent conflict management styles chosen by graduate and undergraduate nursing students and those in allied health. Some of the students were already licensed in their discipline; others had not yet taken a licensing exam. Licensure and educational level were not associated with choice of styles. Women and men had similar preferences. The prevalent style for nursing students was compromise, followed by avoidance. In contrast, avoidance, followed by compromise and accommodation, was the prevalent style for allied health students. When compared to the TKI norms, slightly more than one half of all participants chose two or more conflict management styles, commonly avoidance and accommodation at the 75th percentile or above. Only 9.8% of the participants chose collaboration at that level. Implications for nurse educators, researchers, and administrators are discussed.

An economic analysis of patient simulators clinical training in nursing education.

Patient simulators have become widely used in medical education including increasing use in nursing education. Research suggests their usefulness in developing nursing competence. Little research to date, however, has examined the financial feasibility of the use of patient simulators as an educational tool. The extent to which a simulation lab comprising six Laerdal SimMan high-fidelity patient simulators and a staff of nurse educators is a financially feasible alternative to classroom-based education is examined.

Patient-Perceived Access to Care When Actively Seeking Treatment.

PURPOSE/OBJECTIVES: To examine predictors of perceived access to care and reported barriers to care of patients with cancer actively seeking treatment.
. DESIGN: Retrospective secondary data analysis.
. SETTING: U.S. Medical Expenditure Panel Survey, a national survey with questions about healthcare coverage and access.
. SAMPLE: 1,170 adults with cancer actively seeking treatment.
. METHODS: A retrospective analysis of data. Bivariate tests for significant association between individual characteristics and low perceived access to care were conducted using a chi-square test. 
. MAIN RESEARCH VARIABLES: The dependent variable was perceived access to care. The independent variables included sex, age, race, poverty status, education level, marital status, cancer site, comorbidities, and insurance status.
. FINDINGS: Those with Medicaid insurance or no health insurance had significantly lower perceived access to care compared to those with Medicare. Institutional barriers to treatment, such as financial or insurance, were the most common reported barriers.
. CONCLUSIONS: Most adults with cancer reported adequate access to medical care and medications, but a small yet vulnerable population expressed difficulties in accessing treatment.
. IMPLICATIONS FOR NURSING: To effectively advocate for vulnerable populations with Medicaid or no insurance, nurses may require specialized knowledge beyond the scope of general oncology nursing.

Preparing faculty and students for an international nursing education experience.

As society becomes increasingly globalized, it is imperative to include international educational perspectives in the nursing profession. This article shares experiences of a university and hospital in facilitating education of students of nursing from India. It includes implementing partnerships, student selection process, and transcultural considerations. These considerations include faculty preparation for receiving students from India. In addition, ways to prepare Indian and U.S. students are examined.

Build a framework for conflict assessment.

Review a framework for assessing organizational conflict in a case study format that illustrates implementation strategies.

Impact of managed care on oncology.

OBJECTIVE: To review the general principles of managed care, including purpose, concept of risk, insurance mechanisms, and types of reimbursement. DATA SOURCES: Textbooks and journal articles. CONCLUSIONS: At times, managed health care may restrict the options available to the consumer and the provider of care and can lead to ethical and legal issues. IMPLICATIONS FOR NURSING PRACTICE: Practitioners caring for cancer patients must continue to monitor and participate in outcomes research to clarify the impact of managed care on cancer treatment.

Institutional collaboration not competition: preparing family nurse practitioners to serve rural areas.

In response to the need for an increased number of family nurse practitioners in rural Texas, The University of Texas at Tyler, Texas Tech University Health Sciences Center, and Midwestern State University entered into a collaborative arrangement to provide advanced education to nurses in outlying areas of the state. The catchment area for the project encompassed 72 counties, representing half the land mass in Texas. This article presents the development of the collaborative model, strategies used for implementation, and evaluation of this collaborative effort. The collaborative family nurse practitioner program is based on collegiality rather than competition to better meet the needs of students and communities in a cost-effective manner. Communication between the institutions and faculty has been a key factor in the success of the program. The addition of nurse practitioners from this project has the potential to greatly increase access to health care in large, underserved populations.

Transitioning associate degree in nursing students to the Bachelor of Science in nursing and beyond: a mandate for academic partnerships.

The Institute of Medicine recommendation for 80% of nurses to achieve a baccalaureate degree in nursing by 2020 becomes a major challenge in Texas with only 37.3% of nurses holding this degree in 2010 (Institute of Medicine, 2011). The challenge requires a 42.7% increase in the percentage of baccalaureate-prepared nurses. Regionally, nurse educators together with nurse practice partners are seeking solutions to this challenge. One region in west Texas approached this challenge by first developing and launching a needs assessment for current associate degree nurses, nursing students, faculty, and nurse managers. The results of this needs assessment are presented in this article. Following institutional review board approval, three surveys were developed to capture the perceptions of students enrolled in Texas associate degree nursing (ADN) programs and their faculty regarding enrollment in a bachelor of science in nursing program. A similar survey was developed for chief nursing officers in acute care settings in west Texas. Respondents in all categories suggested that time, financial constraints, and perceived difficulty in completing needed prerequisite general education courses were barriers to RNs continuing their education. Because most of the respondents hoped to return to school within 5 years, recruiting ADN graduates who have been out of school 5 years or less seems to be where schools of nursing should invest their recruitment efforts.

West Texas nursing education portal project: developing a regional centralized application system.

Because of the nursing shortage and a demand for maximum enrollment, a group of five baccalaureate and seven associate degree nursing programs in West Texas first met in 2007 to form the West Texas Nursing Education Consortium (WTNEC). To emphasize the importance of scale and distance, the West Texas region is larger than all of the northeastern states combined. The founding group agreed that the first mission of WTNEC should be to pool resources in order to increase admission and graduation rates for WTNEC schools. Two years later, this mission is being accomplished by the implementation of a plan designed to increase participating schools' admissions, retention, and graduation rates. A grant proposal was written and funded to develop a central regionalization of the application process for entry into WTNEC generic programs (associates degree in nursing and bachelor of science in nursing), with the goal of decreasing and possibly eliminating student vacancy rates in member schools and perhaps reducing the resources needed by each school for the admission process. The implemented centralized application system allowed prospective students to apply online to the centralized admission portal. Students maintained the freedom to choose the nursing program(s) they wanted to attend, but they were also made aware of possible openings in other participating schools. The admission portal also saved potential students time and money by submitting one centralized application, resulting in consolidation of the nursing school application process. Eleven of the 12 consortium schools participated in the centralized application system.

Competency education and validation in the United States: what should nurses know?

This article provides an overview of the progress in the past decade toward effectively documenting the initial and continuing competence of registered nurses.