International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Nurses' perceptions of the role of health organisations in building professional commitment: Insights from an israeli cross-sectional study during the COVID-19 pandemic.

AIMS: To reveal the factors associated with nurses' professional commitment during the COVID-19 pandemic. BACKGROUND: During the first wave of the COVID-19 pandemic, the Nursing Division at the Israeli Ministry of Health and partners conducted a study to examine the nurses' perceptions towards a set of personal and professional circumstances that may affect their performance. METHOD: A cross-sectional Web-based study was conducted in Israel. Study' participants included 817 community and hospital nurses. The Occupational Commitment Scale for Health Professionals during pandemic (PanHP-OCS) was used to gather data. Univariate and multivariate analyses explored associations between the PanHP-OCS score and demographic and professional variables. RESULTS: About 40% of 817 respondents reported having managerial roles (n = 320). Those who received specific pandemic-focused training had significantly better PanHP-OCS scores (p < .001). Most respondents expected their organisation to provide them emotional support. Linear regression explored the organisational commitment factor as the greatest contributor to nurses' professional commitment (ß = 0.284, p < .001). CONCLUSION: To enhance the nurses' professional commitment during the COVID-19 pandemic, training and emotional support must be emphasized in all types of nurses' workplaces. IMPLICATIONS FOR NURSING MANAGEMENT: In a pandemic, health organisations must provide dedicated pandemic training, including proactive emotional support for nurses. Special attention should be given to community care.

Nursing and midwifery advocacy to lead the United Nations Sustainable Development Agenda.

The United Nations 2030 Agenda for Sustainable Development was implemented on January 1, 2016 and is composed of 17 Sustainable Development Goals (SDGs) and further delineated by 169 targets. This article offers background information on the 2030 Agenda as it relates to nursing and midwifery, professional organizational initiatives currently advancing the SDGs, the ethos of global citizenship, the urgency to respond to dwindling planetary health, the salience of nursing and midwifery advocacy in SDG attainment, and the myriad opportunities for nurses to lead and collaborate toward realizing these Global Goals. A US-based perspective is employed to underscore the Agenda's relevance to the US nursing workforce and healthcare system. The SDGs, with their holistic bio-psycho-social-environmental approach to health, present enormous opportunities for nurses and midwives. The SDG framework is naturally aligned with the foundational philosophy and purpose of our professions.

Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice.

AIM: To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles. BACKGROUND: Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services. METHOD: A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces. RESULTS: New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads. CONCLUSIONS: The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility.

No health without a workforce, no workforce without nurses.

Judith Shamian, President of the International Council of Nurses, looks back over 2015 and considers how nurses across the world can address the challenges ahead.

The role of nurses and nurse leaders on realizing the clinical, social, and economic return on investment of nursing care.

There is a limited understanding of the significance and the potential contribution that nursing can make through practice, policy, science, and profession to the global health agenda. In this article, we present some of the evidence to demonstrate the clinical, social, and economic returns on investment in nursing. We conclude by addressing the issues that nurse and system leaders need to address in order to achieve these returns on investments, and unless nurses get involved at the leadership level, these returns on investment will not be attained.

Making research integral to home care services.

Home care is the fastest growing segment of the Canadian healthcare system, yet research on patient safety has been conducted predominantly in institutional settings. This is a case example of how Victorian Order of Nurses Canada, a national not-for-profit home and community care provider, embedded a nurse researcher to create an environment in which health services research flourished. This model strategically propelled important issues such as home care safety on to the national research and policy agendas and helped leverage change in multiple levels of the healthcare system. This is a call to action for building partnerships to have a researcher as an integral team member in organizations providing home care services.

Assessing the country-level involvement of nurses in COVID-19 vaccination campaigns: A qualitative study.

BACKGROUND: As each country individually manages the COVID-19 pandemic, mass vaccination campaigns have varied considerably. Implementation campaigns often depend on nurses; however, nurses are not consistently involved in higher-level planning, prioritization, and policy development decisions. This study aimed to examine the involvement and engagement of nurses in country-level COVID-19 mass vaccination policies and practices in 10 Office of Economic Cooperation and Development countries, identify barriers and factors to enhancing the engagement of nurses in the evidence-informed mass vaccination decision-making processes, and suggest areas for improvement. METHODS: A qualitative study using in-depth semi-structured interviews was conducted as a follow-up study to an International Council of Nurses survey. The study sample included a purposeful sample of 14 country-representative nurses from 10 Office of Economic Cooperation and Development countries. Interview questions focused on each country's overall COVID-19 vaccination campaign and policies, participants' perspectives regarding the involvement of nurses in the planning, design, and implementation of the mass vaccination program observed outcomes, and the impact of nursing on the outcomes. Interviews were recorded, transcribed, translated where necessary, coded, and thematically analyzed. RESULTS: Main areas of involvement identified by participants were membership in advising and decision-making committees, operationalization planning, implementation and coordination processes, education efforts, and nurses' interactions with the media. Seven themes emerged among perceived facilitators of nursing involvement: existing systems and infrastructure, nursing profession-related skills and competencies, communication and messaging, multidisciplinary and interagency work, recognition and visibility of nurses and nursing, trust in nurses, and nursing pride. Meanwhile, perceived barriers included lack of a voice, recognition and appreciation for nursing, workforce-related challenges, decentralization of responsibility and authority, supply and access issues, downstream effects of the pandemic, and non-COVID-related nursing barriers. Three main themes emerged among suggestions made by participants for improved involvement of nursing: culture change within nursing and healthcare, opportunities and momentum to build upon, and perceptions of responsible parties. CONCLUSIONS: Nurses play a central role in providing health services but are inconsistently included in the policy, planning, and decision-making processes. Findings highlighted the critical importance of nursing leadership roles and expanded roles for nurses. Nursing should be represented by high-level leaders as part of multidisciplinary decision-making groups, educational initiatives for involvement in health policy should be implemented in nursing schools and continuing education, and advocacy and inclusion efforts should utilize bottom-up and top-down approaches concurrently.

Nursing: not the problem, but leading solutions.

One of the major themes uncovered by Graham and Sibbald in their analysis of the 50-year-old issues of Hospital Administration in Canada (HAC) is the evolution of nursing. However, the HAC approach 50 years ago was that nursing was a problem to be solved, not a resource for health, the health system and the public, and that image would stay with nursing in Canada for many years to come. The recent commissioning by the Canadian Nurses Association of a National Expert Commission to examine sustainability of health and the healthcare system, and the resultant report, The Health of Our Nation, the Future of Our Health System: A Nursing Call to Action, released in June 2012, reflect a significantly different expectation about nurses and the nursing profession - they are not problems to be addressed, but are leading the solutions to better health, better care and better value. And patients are not passive recipients of care decided on by professionals alone, but central team members - "CEOs of their own healthcare" - in an inter-professional patient-/family-focused team that collectively supports people in their health journey. A number of examples of potential articles about and from nursing, based on the findings of the National Expert Commission, are included to illustrate how nursing should be reflected in an issue of HAC in 2012.

Wink, wink, nudge, nudge... maybe we need more than incentives to get us moving.

In the lead essay, Oliver differentiates between utilizing incentives to motivate single simple behaviour changes (e.g., getting immunizations, undergoing screening tests) and using them to motivate sustained behaviour changes (e.g., losing weight, quitting smoking). This commentary focuses on the latter. Here, the authors talk about four main points related to the lead article: (1) governmental intervention, (2) understanding why people do not change their behaviour, (3) contemplating motivational "nudges" other than money and (4) other policy considerations.

Who doesn't deserve excellent care?

Discussion on implementation of the Excellent Care for all Act, 2010 (ECFA Act), Bill 46, has focused on the hospital sector in Ontario, but it also has relevance outside the hospital setting. As primary healthcare, long-term care and home care all receive public funding, these sectors should be expected to be compliant with Bill 46. But does the act also govern government-funded (i.e., by other than the Ministry of Health and Long-Term Care) community-based programs such as adult day programs, meals-on-wheels, nutrition programs for children, and more? We propose that we cannot exclude any of these essential programs. We also consider the non-hospital sector and health organizations that do not receive public funding. The healthcare system will be well served if we consider whether the EFCA Act's key elements should be implemented across the system both vertically and horizontally. Vertical implementation in the hospital sector could be followed by primary care, home and community care, long-term care, and the rest of the vertical silos within the healthcare system. But by taking the horizontal approach, all sectors within and outside of what we traditionally think of health would be integrated using an evidence-informed and outcome-based approach and methodology.

How we move beyond a policy prescription to action.

In response to "Evidence-Based Policy Prescription for an Aging Population," by Chappell and Hollander, this paper proposes that efforts be made to execute strategies to build the political momentum and public support necessary for concrete action toward achieving the recommended policies. It also suggests the implementation of knowledge translation strategies to assist in disseminating and integrating existing successful programs across the wider health system. Finally, this paper proposes a concerted and robust mobilization of forces in order to move from evidence-based agenda setting into active policy implementation. A key element of this transition involves placing greater emphasis on interest group activation and public policy deliberation. Such a focus would enable consensus between policy makers, decision-makers, interest groups and the public, garnering the political traction necessary to allow for the implementation of healthy public policy that best serves the needs of an aging population.

Impact and determinants of nurse turnover: a pan-Canadian study.

AIM: As part of a large study of nursing turnover in Canadian hospitals, the present study focuses on the impact and key determinants of nurse turnover and implications for management strategies in nursing units. BACKGROUND: Nursing turnover is an issue of ever-increasing priority as work-related stress and job dissatisfaction are influencing nurses' intention to leave their positions. METHODS: Data sources included the nurse survey, unit managers, medical records and human resources databases. A broad sample of hospitals was represented with nine different types of nursing units included. RESULTS: Nurses turnover is a major problem in Canadian hospitals with a mean turnover rate of 19.9%. Higher levels of role ambiguity and role conflict were associated with higher turnover rates. Increased role conflict and higher turnover rates were associated with deteriorated mental health. Higher turnover rates were associated with lower job satisfaction. Higher turnover rate and higher level of role ambiguity were associated with an increased likelihood of medical error. CONCLUSION: Managing turnover within nursing units is critical to high-quality patient care. A supportive practice setting in which role responsibilities are understood by all members of the caregiver team would promote nurse retention. IMPLICATIONS FOR NURSING MANAGEMENT: Stable nurse staffing and adequate managerial support are essential to promote job satisfaction and high-quality patient care.