Policy, Politics, & Nursing Practice recent issues

In This Issue

Keepnews, D. M. — Thu, 24 Sep 2009 21:38:13 PDT

U.S. Health Reform: A Continuing Imperative

Keepnews, D. M. — Thu, 24 Sep 2009 21:38:14 PDT

A new political climate in the United States has raised renewed hope for achieving much needed reform of the U.S. health care system. Opposition to reform raises old arguments, however, including warnings against "big government," currently focused on proposals to include a public plan option in health reform. But greater government involvement in health care is needed to achieve comprehensive reform. Further substantial delay in achieving reform is unthinkable; success will require continued and expanded support efforts. Although a strong public plan option would represent a significant step forward, continued advocacy by proponents of single-payer health care can help strengthen broader efforts to achieve public accountability. Supporters of meaningful health reform will need to continue their efforts long past the passage of reform legislation.

Massachusetts Nurse Practitioners Step Up as One Solution to the Primary Care Access Problem: A Political Success Story

Craven, G., Ober, S. — Thu, 24 Sep 2009 21:38:14 PDT

Massachusetts’ political experience with efforts to insure all citizens provided a unique opportunity for nurse practitioners to address the growing need for access to primary care. Passage of a new statute to recognize nurse practitioners as primary care providers that health plan beneficiaries could choose was accomplished through strategic planning and political savvy. The results of a focused effort using the expertise of a professional lobbying team along with organizational support resulted in a groundbreaking new law that is a component of a reform model being examined by the nation as a whole, looking to address accessible, quality, and affordable health care. This article chronicles that journey and its accomplishment.

Predicting Nursing Human Resources: An Exploratory Study

Squires, A., Beltran-Sanchez, H. — Thu, 24 Sep 2009 21:38:14 PDT

The nurse-to-population ratio (NPOP) is a standard indicator used to indicate a country’s health care human resources capacity for responding to its disease burden. This study sought to explore if socioeconomic development indicators could predict the NPOP in a country. Mexico served as the case example for this exploratory study, with the final five variables selected based on findings from a qualitative study analyzing the development of nursing human resources in the country. Multiple linear regression showed that two variables proved significant predictors of the NPOP and the model itself explained 70% of the variance (r² = .7; p = .0000). The findings have multiple implications for nursing human resources policy in Mexico and at a global level as governments attempt to build human capital to respond to population health needs.

Social Responsibility of Nursing: A Global Perspective

Thu, 24 Sep 2009 21:38:14 PDT

This study addresses social responsibility in the discipline of nursing and implications for global health. The concept of social responsibility is explicated and its relevance for nursing is examined, grounded in the American Nurses Association Code of Ethics and the International Council of Nurses Code of Ethics. Social justice, human rights, nurse migration, and approaches to nursing education are discussed within the framework of nursing’s social responsibility. Strategies for addressing nursing workforce issues and education within a framework of social responsibility are explored.

Nurse Working Conditions and Nursing Unit Costs

Mark, B. A., Lindley, L., Jones, C. B. — Thu, 24 Sep 2009 21:38:14 PDT

The authors examined the relationship between nurse working conditions and nursing unit costs in 210 general medical, general surgical, and general medical surgical units in 112 randomly selected U.S. hospitals. Data were collected from registered nurses (N = 3,747 and 2,878), patients (N = 2,100), study coordinators, and secondary data sources. After controlling for relevant hospital, nursing unit, and patient characteristics, the authors found that good working conditions did not increase nursing unit costs. Teaching status was associated with higher costs, whereas larger unit size was associated with lower costs. Higher proportions of registered nurses and licensed practical nurse staffing were also associated with higher costs. Patient variables were not significantly related to costs. We suggest a variety of strategies that managers may use to improve working conditions.

Preconception Care: Practice and Policy Implications for Nurses

Sanders, L. B. — Thu, 24 Sep 2009 21:38:14 PDT

Statistical reports describe a troubling portrait of infant mortality in the United States today. This rate, an indicator of the health of a nation, has not declined in the past 5 years and is marked by enormous disparities among racial and ethnic groups. Although the overall infant mortality rate in the United States is 6.86 per 1,000 live births, the rate for non-Hispanic Black infants is 13.63 deaths per 1,000 live births. Among developed nations, the United States now ranks 29th in infant mortality. It is believed that lack of preconception care and late entry into prenatal care are contributing factors to infant mortality. Preconception care, although not a new concept, has not been universally adopted into the health care setting. This article examines the potential barriers to developing and using preconception care and policy implications related to nursing practice.

Obesity as a Social Problem in the United States: Application of the Public Arenas Model

Smith, M. C. — Thu, 24 Sep 2009 21:38:14 PDT

Obesity rates in the United States have been rising over the past 35 years, resulting in a subsequent increase in nutrition-related chronic disease morbidity and mortality and significant burdens to families, communities, and health care systems. In working to formulate effective public health policy solutions that address the obesity epidemic, it is important to analyze how obesity has been defined and accepted as a social problem. This article applies Hilgartner and Bosk’s public arenas model to examine how obesity is defined in the public arena, how competition plays a role in "framing" the obesity issue, and how operatives influence the ways in which obesity is viewed and understood. Implications for nurses and policy makers are addressed in the context of using the public arenas model as a tool to analyze the social problem of obesity.

Patient Satisfaction of Young Adults in Rural Clinics: Policy Implications for Nurse Practitioner Practice

Lemley, K. B., Marks, B. — Thu, 24 Sep 2009 21:38:14 PDT

In an effort to increase primary care services to Medicare and Medicaid patients, the Rural Health Clinics Services Act of 1977 required collaborative practices to include mid-level providers such as nurse practitioners (NPs). As a result, NPs have increased access to primary care in many rural and underserved areas. Now, in an effort to improve quality of health care, the Centers for Medicare and Medicaid Services (CMS) initiated public reporting of health care quality indicators. Although patient satisfaction is recognized as a quality indicator, few researchers have investigated patient satisfaction with NPs in rural family practice. A patient satisfaction survey (PSS) was distributed to a convenience sample of 213 young adult patients seen by five nurse practitioners in two rural family practice clinics. Survey results are analyzed and discussed within the framework of current CMS policy initiatives such as performance measures, pay for performance (P4P), transparency, and public reporting.

The Politics of Nursing Care: Correcting Deviance in Accordance with the Social Contract

O'Byrne, P., Holmes, D. — Thu, 24 Sep 2009 21:38:14 PDT

Despite numerous theories, models, and philosophies describing what nurses are and what they do, nursing care is often presented as an apolitical process which primarily focuses on patient needs and priorities. However, it is our position that nursing practice—in all regards—is political. To support this argument, we have drawn on works describing of soft/hard power, pastoral power, stigma, deviance, and governmentality, in addition to explaining our institutional social contract conceptualization of politics. In using these concepts, our political perspective reframes nursing practice as a means by which an individual’s potential or actual deviance (meaning a deviation from social norms) can be identified and then corrected.

Predominant Discourses in Swedish Nursing

Dahlborg-Lyckhage, E., Pilhammar-Anderson, E. — Thu, 24 Sep 2009 21:38:14 PDT

The aim of this study was to elucidate the predominant discourse in the field of Swedish nursing in 2000, 25 years after nursing was introduced as an academic discipline in Sweden. The method used was content analysis and deconstructive analysis of discourses. Laws, statutes, regulations, and examination requirements, including official reports, recruitment campaigns, and media coverage, were analyzed. The findings uncovered competing discourses striving to gain hegemony. In the public sector, official requirements competed against the media fixation on gender stereotypes and the realities of local recruitment campaigns. Media has a major role in disseminating prevailing conceptions and conventions pertaining to the nursing profession. As a result, decision makers, students, patients, and family members could get lower expectations of the professional competence of nursing practitioners than would otherwise have been the case in the absence of media exposure.

In This Issue

Keepnews, D. M. — Mon, 20 Apr 2009 21:44:02 PDT

Welcome News in the Sentosa Nurses Case

Keepnews, D. M. — Mon, 20 Apr 2009 21:44:02 PDT

Unifying Nursing's Policy Voice

Kurtzman, E. T. — Mon, 20 Apr 2009 21:44:02 PDT

Developing Alliances: How Advanced Practice Nurses Became Part of the Prescription for Pennsylvania

Hansen-Turton, T., Ritter, A., Valdez, B. — Mon, 20 Apr 2009 21:44:02 PDT

The authors describe how advanced practice nurses in Pennsylvania were able to successfully advocate for nursing-related legislative reforms through Governor Edward G. Rendell's signature health care reform plan (the "Prescription for Pennsylvania"). In addition to discussing advocacy efforts related to a series of nursing-related bills considered by the Pennsylvania Assembly in 2007, the article also describes years of hard work and foundational advocacy conducted by a broad coalition of nurses, which paved the way for the Prescription for Pennsylvania's reforms. By examining the successful tactics of Pennsylvania's nurse advocates, the authors conclude that policy makers' current interest in solving the health care crisis presents a tremendous opportunity for nurses to reform legislation. To seize this opportunity, nurses must learn to speak with a unified voice and build strong relationships with a broad range of bipartisan policy makers, funders, civic leaders, business leaders, and legislative advocates.

A Descriptive Analysis of Health Care Coverage and Concerns in West Central Wisconsin

Jamelske, E. M., Johs-Artisensi, J. L., Taft, L. B., German, K. A. — Mon, 20 Apr 2009 21:44:02 PDT

This study examines the level of health care coverage and health care concerns among a sample of 222 West Central Wisconsin residents. More than 68% of respondents felt that Wisconsin health care has at least major problems, and only 2.7% felt that there were no problems. Approximately 60% were extremely or very worried about not being able to afford health care services, whereas more than 70% were extremely or very worried that insurance companies care more about profits than patient care. These concerns translate into a desire for reform, with more than 90% of respondents saying it is extremely or very important for Wisconsin to make health care more affordable and accessible for all residents. Despite some differences between the insured and uninsured, the call for action to expand access and control costs was significant among both groups. These results can help guide the current policy debate on health care reform.

Toward a New Method for Identifying Facilities and Communities With Critical Shortages of Nurses

Wing, P., McGinnis, S. L., Moore, J. M. — Mon, 20 Apr 2009 21:44:02 PDT

This article summarizes the key findings of a study designed to evaluate the effectiveness of different methods for assessing the severity of nursing shortages in four types of health care facilities in the United States (hospitals, long-term care facilities, home health agencies, and public health agencies). The study involves testing several statistical models using currently available data to assess their accuracy and ease of use as possible bases for estimating and predicting the severity of nursing shortages in individual health care facilities. The assessments are based on criteria developed with the advice of panels of experts knowledgeable about each of the four types of facilities. The results of a "preferred method" for rating the severity of nursing shortages in counties in the United States are presented, along with key findings based on a variety of other models and analyses. Although it requires some refinement and a systematic validation, this method holds promise as a possible basis for targeting federal resources to alleviate the most critical nursing shortages across the country.

The Effect of Patients' Race on Provider Treatment Choices in Coronary Care: A Literature Review for Model Development

Greene Jackson, D., Hamilton, P., Hutchinson, S., Huber, J. — Mon, 20 Apr 2009 21:44:02 PDT

This selective literature review provides insight into the depth and breadth of the problem of unequal medical treatment of Blacks compared with Whites, with particular focus on coronary heart disease. Poor health outcomes among Blacks, when compared with Whites, are well documented, and these disparities are linked to lower quality of and less aggressive medical treatment. It is not clear why these disparities in treatment occur. This review provides theoretical frameworks that attempt to explain the effect of race on treatment and presents an analysis of the quality and strength of existing evidence of racial disparity related to coronary care. Based on the review, implications for policy makers and providers are identified.

Expanding the Knowledge Base of Resident and Facility Outcomes of Care Delivered by Advanced Practice Nurses in Long-Term Care: Expert Panel Recommendations

Mon, 20 Apr 2009 21:44:02 PDT

In 2003, a panel of nationally recognized experts in geriatric practice, education, research, public policy, and long-term care convened to examine and make recommendations about care quality and safety issues related to advanced practice nurses (APNs) in nursing home practice. This article reports on the panel recommendation that addressed expanding the evidence base of resident and facility outcomes of APN nursing home practice. A review of the small but important body of research related to nursing home APN practice suggests a positive impact on resident care and facility outcomes. Recommendations are made for critically needed research in four key areas: (a) APN nursing home practice, (b) relative value unit coding, (c) outcomes related to geropsychiatric and mental health nursing services, and (d) outcomes related to geriatric specialization. The APN role could be significantly enhanced and executed if its specific contribution to resident and facility outcomes was more clearly delineated through the recommended rigorous research.

Patterns of Community-Based End-of-Life Care in Rural Areas of the United States

Madigan, E. A., Wiencek, C. A., Vander Schrier, A. L. — Mon, 20 Apr 2009 21:44:02 PDT

There is relatively little empirical data on the supply of community-based end-of-life (EOL) providers especially in rural areas despite projections for growth. This study examined the availability of community-based EOL providers in eight states using mapping techniques and statistical approaches. Analysis of variance and geographic information system approaches were used to compare the availability of community-based EOL providers at the county level by degree of rurality. Examining numbers of rural counties by provider, it was found that hospices were the least available community-based EOL providers in rural counties with 62% to 92% of rural counties not having hospice providers (exception: Vermont). When examining the number of providers by population older than 65 years, few differences were found. It is concluded that there are substantially fewer hospice providers in the most rural areas, raising issues of access to care. Examination of both unadjusted and adjusted numbers of providers is important to understand community-based EOL provider supply.

Delivery of Nursing Care in Alabama Public Schools

Terry, A. J. — Mon, 20 Apr 2009 21:44:02 PDT

Many states, including Alabama, allow registered nurses (RNs) in school settings to delegate procedures such as assistance with medication to unlicensed assistive personnel. In Alabama, the Board of Nursing(the Board) is accountable for enforcing the regulations that allow for this action. The Alabama Board of Nursing Administrative Code addresses delegation by school nurses and lists specific tasks that cannot be delegated because they require nursing judgment. As a result of this reporting requirement, Alabama's Center for Nursing, a division of the Board of Nursing, implemented an annual survey of school nurses to determine how nursing care is delivered to students in Alabama public schools. This study investigates the results of this survey and its implications for school nursing both in Alabama and in other states.

In This Issue

Keepnews, D. M. — Mon, 02 Mar 2009 21:05:12 PST

An Important Step Toward Ethical International Recruitment

Keepnews, D. M. — Mon, 02 Mar 2009 21:05:12 PST

Unit Characteristics and Patient Satisfaction: A Multilevel Model

Seago, J. A. — Mon, 02 Mar 2009 21:05:12 PST

The purpose of this study was to discover if there was relationship between nurse perception of autonomy, control over practice, or relationships with physicians and patient satisfaction with care related to pain management, teaching, or physical care on medical surgical units. The study design was correlational, descriptive, and cross-sectional. The hospital sample was a purposive convenience sample of acute care hospitals in California, with a total of 21 hospitals, 60 medical surgical nursing units, 314 nurses, and 470 patients. Findings indicated that higher patient functional status and having a doctor in the hospital 24 hours/day were related to patient satisfaction with pain management. Lower nurse perception of autonomy, having a doctor in the hospital 24 hours/day, and higher number of patient years of education were related to higher patient satisfaction with teaching. Lower total hours worked by the nurses was related to higher patient satisfaction with physical care.

Insurers' Contracting Policies on Nurse Practitioners as Primary Care Providers: Two Years Later

Hansen-Turton, T., Ritter, A., Torgan, R. — Mon, 02 Mar 2009 21:05:12 PST

A national survey showed that nearly half of all major managed care organizations in the United States refuse to credential nurse practitioners as primary care providers. In nurse-managed health centers throughout the country, nurse practitioners provide primary care to underserved populations with similar outcomes to primary care physicians. Insurers' prohibitive credentialing and reimbursement policies reduce these centers' capacity for growth and, in turn, threaten the long-term sustainability of a key component of the health care safety net. Two years after conducting a national survey of insurers' credentialing and reimbursement policies regarding primary care nurse practitioners, researchers returned to the subject matter and found that many of the same financial barriers to nurse-managed health center sustainability still exist. Although some progress had been made since 2005, this progress did not appear to be attributable to regulatory changes or renewed enforcement of existing laws.

Psychiatric Nurses' Attitudes Toward Consumer and Carer Participation in Care: Part 2--Barriers to Participation

Goodwin, V., Happell, B. — Mon, 02 Mar 2009 21:05:12 PST

Australian government policy has effectively mandated consumer and carer participation. However, the limited relevant literature suggests there are significant barriers to implementing participation in mental health services. Nurses have been identified as a professional group with an important role in creating the culture changes necessary for successful implementation, yet their views about consumer and carer participation have not been extensively explored. This article presents Part 2 of the findings of a qualitative study using focus group interviews with 30 nurses to explore opinions on the topic of consumer and carer participation. Data were analyzed using a content analysis approach, assisted by the software package NVivo. The themes explicated were systemic barriers and education, an essential ingredient. These findings emphasize the barriers and provide some sense of how educational techniques might assist with making some constructive inroads.

The Other Nursing Shortage: A Regional Collaboration to Address the Shortage of Nursing Faculty

Mon, 02 Mar 2009 21:05:12 PST

A regional collaborative of one major hospital system and nine schools of nursing has addressed the critical shortage of nursing faculty in Northeast Ohio. This model of institutional collaboration is preparing expert nurse clinicians from the hospital nursing staff to assume clinical faculty roles in regional schools of nursing while maintaining their primary role as clinical staff. The model included the development of a recruitment campaign, a uniform application process, an online database, faculty orientation programs, and continuing faculty development opportunities. Currently, more than 240 clinical nursing staff have applied for the program. Two faculty orientation sessions were attended by more than 100 prospective faculty. Additionally, the first continuing faculty development workshop was attended by more than 170 current and prospective nursing faculty. Now in its third year of implementation, the project is expanding its scope to include a broader base of regional partners and to address the issue of sustainability.

Governing Masses: Routine HIV Testing as a Counteroffensive in the War Against HIV-AIDS

Gagnon, M., Holmes, D. — Mon, 02 Mar 2009 21:05:12 PST

The aim of this article is to critically discuss routine HIV testing policy in the United States by locating its origins within health promotion efforts to govern masses and the neoliberal construction of the individual as free, autonomous, responsible, and empowered. Basing our approach on the work of the late French philosopher Michel Foucault, we describe routine HIV testing as a bio-political intervention that redefines the norms and social practices pertaining to HIV testing with the goal of regulating the population's health. From a neoliberalist perspective, routine HIV testing is also introduced as a practice of self-care that should be undertaken by any rational person who performs good health practices around HIV/AIDS. The objective of this article is to situate routine HIV testing policy in relation to nursing practice and, most important, to demonstrate how this policy should not be considered in isolation from the political context in which it was created.

What Are the Sources of Health Policy That Influence Nursing Practice?

Taft, S. H., Nanna, K. M. — Mon, 02 Mar 2009 21:05:12 PST

This article seeks to fill a gap in the existing nursing literature by answering the question, "Where does health policy come from?" Nursing leaders agree that nurses should be involved in developing health policy, yet most nurses are not engaged. Many factors contribute to nurses' low rates of involvement, but the primary drivers is that nurses believe they lack the knowledge and skills to influence policy formulation. This article proposes a framework of the sources of health policy. We classify health policy sources as public, organizational, or professional, and provide examples. Nurses with a deeper understanding of the varied sources of health policy can enhance their political competence and more readily act in the policy domain.

Evidence-Based Policy: Implications for Nursing and Policy Involvement

Hewison, A. — Mon, 02 Mar 2009 21:05:12 PST

Evidence-based policy making is espoused as a central feature of government in the United Kingdom. However, an expectation that this will improve the quality of policy produced and provide a path to increased involvement of nurses in the policy process is misplaced. The purpose of this article is to demonstrate that the emphasis on evidence-based policy is problematic and cannot be regarded as a "new model" of policy making. Also, it could deflect attention from more practical approaches to policy involvement on the part of nurses. Policy development activities, acquisition of skills in policy analysis, and other forms of involvement are needed if nurses are to move along the continuum from policy literacy, through policy acumen, to policy competence. This involves taking a critical stance on the notion of evidence-based policy.

The Value of Nurse Leaders on Federal Advisory Panels: Experience With the Agency for Healthcare Research and Quality

Najar, B. E., Hubbard, H. — Mon, 02 Mar 2009 21:05:12 PST

This article focuses on interviews with six nationally known nurse leaders who have been, or currently are, members of National Advisory Committee for the Healthcare Research and Quality (NAC). The nurse leaders are either deans and/or professors of schools of nursing. They discuss how their participation on the NAC serves the Federal Government and what they view as the benefits they now offer the nursing profession from being on the NAC such as an increased focus on evidence-based research. These nurse leaders also discuss what they bring to the table in terms of helping to influence public policy vis a vis health care quality, safety, and scientific evidence and their bearing on health care systems and services. They also talk about the myriad Federal opportunities that exist beyond this influential panel for nurse leaders to help continue shaping the future of health care.

Introduction: Building Global Alliances IV: Global Health Challenges in a World Divided by Health Inequities

Nichols, B. L. — Mon, 02 Mar 2009 21:05:12 PST

The five papers following this introduction are based on presentations delivered at Building Global Alliances IV, Global Health Challenges in a World Divided by Health Inequities , sponsored by CGFNS International on December 3-4, 2007, in Philadelphia. Building Global Alliances IV provided opportunities to generate greater understanding of the local, national, and global ramifications of health inequities; the United Nations Millennium Development Goals (MDGs); the effect of migration on the distribution of health professionals (particularly the issues posted by international nurse migration); and the impact of these issues on health care delivery systems.

Building Global Alliances in a World of Health Care Inequities

Lewis, S. — Mon, 02 Mar 2009 21:05:12 PST

Nurses are at the heart of any effective response to the ongoing HIV/AIDS pandemic in Africa and internationally. Without nurses, we will be unable to provide treatment for the growing numbers of people with HIV/AIDS and victims of violence, famine, and poverty. As countries such as the United States and Canada face nursing shortages, they are looking elsewhere to find nurses. But poaching nurses from other countries, especially those from countries that are struggling for survival, is reprehensible and immoral. If we put our resources in the appropriate places, we can sustain the professional disciplines in the country where they are trained. We need to take an advocacy stance to demand rational policies that will support sustainable health systems.

Addressing Global Health and Health Financing Disparities: The Role of Donor Agencies

Vujicic, M. — Mon, 02 Mar 2009 21:05:12 PST

This article is based on a presentation to a symposium on Building Global Alliances in a World of Healthcare Inequities, sponsored by CGFNS International and held in Philadelphia, Pennsylvania in December 2007. The presentation focuses on four areas related to the symposium's theme of "Global Health Challenges in a World Divided by Health Inequities: Global Health Disparities, Health Financing Disparities, Donor Assistance for Health, and Human Resources."

The Impact of Global Inequities on Health Professional Migration

Roberts, J. H. — Mon, 02 Mar 2009 21:05:12 PST

Health determinants and how they are distributed have an important impact on health systems around the world. Nurses can play a significant role in mediating the effects of many of these determinants both inside the health care system and outside. Yet the areas that have the greatest health inequities and heaviest disease burdens have the fewest health workers. A number of efforts are underway to understand and manage health care worker migration. Intersectoral collaboration is key, as are other factors necessary to build strong health systems, including research for development, capacity-building, integrated health systems, evidence-based decision-making, a strong and vibrant civil society and accountability and transparency in the public and private sectors.

Nurse Migration and the Global Health Care Economy

Kingma, M. — Mon, 02 Mar 2009 21:05:12 PST

Health care services represent one of the most rapidly growing sectors in the world economy. Today's health sector labor market and workforce are international, fast becoming global. Migration on a massive scale offers countless business opportunities, not only for the private sector but also for the public sector. The migration pathway is often filled with a significant number of obligatory stops. Many people and circumstances along the way will either facilitate or prevent progress. There will be a need for certain services and a series of goods to complete the migration. These will be provided by a wide range of agencies, institutions, entrepreneurs, regulatory bodies, and businesses. This article looks at the current global workforce and explores the commercialization or the business of nurse migration and its impact.

Yes We Can!: Eliminating Health Disparities as Part of the Core Business of Nursing on a Global Level

Villeneuve, M. J. — Mon, 02 Mar 2009 21:05:12 PST

Nurses in the 21st century are being called to rise to new levels of practice, including a more influential leadership at senior levels of policy development. Decades of research, good will, and a revolutionary civil rights movement have not resolved the world's staggering health outcome disparities. Nursing has a solution: Many of the most troubling disparities are amenable to effective intervention by the world's nurses through their clinical and policy work. The author challenges nurses to imagine the impact on global health if the elimination of disparities is the core goal of nursing for the 21st century. Moving from individuals and communities to systems levels, nurses must be versed in a range of system-level vital signs that affect policy development including economics, demographics, and access to care. Setting our sights on the elimination of health disparities offers a rallying point around which nursing can coalesce and set human health on a new and more equitable course.

Call for Papers: Policy, Politics, & Nursing Practice

Keepnews, D. M. — Mon, 02 Mar 2009 21:05:12 PST

Calln for Reviewers: Policy, Politics, & Nursing Practice

Keepnews, D. M. — Mon, 02 Mar 2009 21:05:12 PST

In This Issue

Keepnews, D. M. — Tue, 30 Sep 2008 23:10:58 PDT

Rereading Ratios

Keepnews, D. M. — Tue, 30 Sep 2008 23:10:58 PDT

Nurses Working Outside of Nursing: Societal Trend or Workplace Crisis?

Black, L., Spetz, J., Harrington, C. — Tue, 30 Sep 2008 23:10:58 PDT

The phenomenon of career inactivity in professional nursing has been historically portrayed in the literature as a major cause of disequilibrium in the registered nurse labor market. However, there remains a general lack of understanding of the diverse forces that shape the inactive nurse pool and the likelihood that this population will return to nursing. The purpose of this study was to examine the population of registered nurses who are active in the labor market but work in nonnursing employment. Specifically, this study sought to determine the relative importance of nonworkplace- and workplace-related reasons for working outside of nursing. The results demonstrate that dissatisfaction with the nursing workplace is the key reason cited by actively licensed nurses for working outside of nursing employment. These findings suggest that policy and employer remedies are needed to improve the nursing workplace.

Factors Associated With Hospital Retention of RNs in the New York City Metropolitan Area: An Analysis of the 1996, 2000, and 2004 National Sample Survey of Registered Nurses

Rosenfeld, P., Adams, R. E. — Tue, 30 Sep 2008 23:10:58 PDT

The nursing shortage is well documented, and government estimates indicate that shortfalls will worsen in the future. As the largest employer of registered nurses (RNs), hospitals are the most seriously affected by shortages, as they compete with other employment settings for limited nursing resources. Recruitment remains the primary avenue for ensuring staffing levels, but retention is increasingly important as applicant pools shrink because of demographic and employment trends. Effective retention strategies must address the factors that contribute to exodus of RNs from hospitals, as well as isolating the factors that enable RNs to remain in hospital employment. This secondary analysis of the 1996, 2000, and 2004 National Sample Survey of Registered Nurses examines the demographic, employment, and educational factors associated with working in hospitals, having full-time status, and holding patient care positions. The findings suggest that hospitals must address nonwork issues to retain nursing personnel. Relevant policy issues are examined and strategies for effective retention are offered.

The Emerging Role of Faith Community Nurses in Prevention and Management of Chronic Disease

McGinnis, S. L., Zoske, F. M. — Tue, 30 Sep 2008 23:10:58 PDT

Faith community nursing, formerly known as parish nursing, is one model of care that relies heavily on older registered nurses (RNs) to provide population-based and other nonclinical services in community settings. Faith community nursing provides services not commonly available in the traditional health care system (e.g., community case management, community advocacy, community health education). With appropriate support, this model of nursing could be expanded into other settings within the community and has the potential to draw on the skills of experienced RNs to provide communities with services that address unmet health care needs.

The Current State of Nursing Performance Measurement, Public Reporting, and Value-Based Purchasing

Kurtzman, E. T., Dawson, E. M., Johnson, J. E. — Tue, 30 Sep 2008 23:10:58 PDT

Over the last decade, there has been a substantial investment in holding health care providers accountable for the quality of care provided in hospitals and other settings of care. This investment has been realized through the proliferation of national policies that address performance measurement, public reporting, and value-based purchasing. Although nurses represent the largest segment of the health care workforce and despite their acknowledged role in patient safety and health care outcomes, they have been largely absent from policy setting in these areas. This article provides an analysis of current nursing performance measurement and public reporting initiatives and presents a summary of emerging trends in value-based purchasing, with an emphasis on activities in the United States. The article synthesizes issues of relevance to advancing the current climate for nursing quality and concludes with key issues for future policy setting.

Making Sense of Competing Nursing Shortage Concepts

Goldfarb, M. G., Goldfarb, R. S., Long, M. C. — Tue, 30 Sep 2008 23:10:58 PDT

Widespread and continuing discussions of nursing shortages frequently involve divergent concepts of shortage that can have differing policy implications. This article explains the shortage concepts used by economists, hospital administrators, and government policy makers. It discusses measurement problems and suggests possible improvements. It then sets forth the divergent policy implications of competing shortage concepts. The article's aim is to promote greater clarity in analyses of nursing shortages and more fruitful conversations among participants who use different notions of shortages.

The Oregon Consortium for Nursing Education: A Response to the Nursing Shortage

Tanner, C. A., Gubrud-Howe, P., Shores, L. — Tue, 30 Sep 2008 23:10:58 PDT

The Oregon Consortium for Nursing Education (OCNE) is a statewide coalition designed as a long-term solution to the nursing shortage and in response to the need for a new kind of nurse to care for Oregon's aging and increasingly diverse population. It is an effort to increase capacity in schools of nursing by making the best use of scarce faculty, classrooms, and clinical training resources in the delivery of a standard curriculum on 13 campuses, including 8 community colleges and the 5 campuses of the OHSU School of Nursing. This article describes the development of OCNE, including infrastructure development, creation of the shared curriculum, redesign of clinical education, faculty development, and plans for evaluation. If OCNE is successful in achieving its goals, it holds substantial policy implications for the development of nursing education systems, design of curricula, use of simulation as a component of clinical education, and delivery of clinical education.

A Statewide Strategy for Nursing Workforce Development Through Partnerships in Texas

Kishi, A., Green, A. — Tue, 30 Sep 2008 23:10:58 PDT

Statewide efforts and partnerships were used for nursing workforce development to address the nursing shortage in Texas. A statewide strategic action plan was developed where partnerships and collaboration were the key components. One of the most important outcomes of these statewide partnerships was the passage of the Nursing Shortage Reduction Act 2001. Through this legislation, the Texas Center for Nursing Workforce Studies and its advisory committee were established. This article describes how a statewide infrastructure for nursing workforce policy and legislative and regulatory processes were further developed. An overview is provided on the contributions made by the organizations involved with these strategic partnerships. The ingredients for establishing successful, strategic partnerships are also identified. It is hoped that nursing and health care leaders striving to address the nursing shortage could consider statewide efforts such as those used in Texas to develop nursing workforce policy and legislation.

The North Carolina Evidence-Based Transition-to-Practice Initiative

Wolf Roth, J. — Tue, 30 Sep 2008 23:10:58 PDT

Successful transition of newly licensed nurses into practice is essential for safe nursing practice. North Carolina has begun an initiative to implement an evidence-based formal transition-to-practice requirement for all newly licensed entry-level nurses in the state by 2015. Phase I of this collaborative project uses a longitudinal design to study new nurse—preceptor dyads. Resulting data will describe competence and confidence development in newly licensed North Carolina RNs practicing in acute care hospitals. Longitudinal data about practice errors and risk for practice breakdown in the first 6 months of the newly licensed nurse's employment will also be collected. The study will provide data to determine the essential components of this evidence-based transition requirement and will contribute to the evidence base for best practices related to transition experiences for newly licensed RNs.

Book Review: Adams, E., & Kennedy, A. (2006). Positive Practice Environments: Key Considerations for the Development of a Framework to Support the Integration of International Nurses. Geneva, Switzerland: International Centre on Nurse Migration

Zizzo, K., Yu Xu, — Tue, 30 Sep 2008 23:10:58 PDT

Policy, Politics, & Nursing Practice

Keepnews, D. M. — Tue, 30 Sep 2008 23:10:58 PDT

Call For Reviewers

Keepnews, D. M. — Tue, 30 Sep 2008 23:10:58 PDT