Angela M. Gerolamo

Workload and the nurse faculty shortage: Implications for policy and research

Although it is hypothesized that workload is a causative factor of the nurse faculty shortage and that nurse faculty workload is not equitable with that of faculty from other academic disciplines, it is not known whether evidence supports this assertion. This paper has three objectives: (1) to identify what is known about nurse faculty workload and its relationship to the nurse faculty shortage, (2) to determine whether evidence supports the assertion that nurse faculty workload is not equitable with faculty workload in other disciplines, and (3) to discuss policy and research implications for addressing workload and the nurse faculty shortage. Science Direct, medline, CINAHL, HealthSTAR databases, and the web were searched using combinations of nurse faculty, workload, academia, and equity. Findings suggest that the majority of research on nurse faculty workload has been limited to a single institution or region. Further, the literature lacks a comparison of nurse faculty workload with that of faculty from other disciplines. A study comparing workload across disciplines would shed light on the workload inequity hypothesis. More importantly, a systematic analysis of nurse faculty workload would facilitate the prioritization of strategies to address the shortage.

Profiling the Hospital-Based Psychiatric Registered Nurse Workforce

BACKGROUND: Registered nursing is a core profession staffing psychiatric hospitals. However, strategic planning to address a critical national workforce shortage of registered nurses has not included psychiatric registered nurses. The lack of information thwarts policy decisions to adequately staff registered nurses for safe and effective psychiatric inpatient environments. OBJECTIVE: This study describes and compares demographic, educational, and employment characteristics of hospital-based psychiatric nurses with nonpsychiatric nurses at the national level. It is hypothesized that significant differences between psychiatric and nonpsychiatric nurses exist, requiring special planning for recruitment and retention of psychiatric registered nurses. DESIGN: A weighted sample of 1,113,277 hospital-based registered nurses was identified from the 2000 National Sample Survey of Registered Nurses. Of these, 33,891 hospital-based psychiatric nurses were identified. RESULTS: Hospital-based psychiatric nurses are older, with a significantly lower proportion of younger entrants into the field. They are more diverse in race, education, gender, and marital status than nonpsychiatric nurses. Psychiatric nurses are also more likely than nonpsychiatric nurses to have an associate degree in nursing with a previous bachelor’s degree in another field. They have a higher rate of job turnover than nonpsychiatric nurses and have a slightly lower gross annual salary. CONCLUSION: Evidence suggests that psychiatric nurses will age out of the workforce faster than nonpsychiatric nurses. It is imperative that resources for the recruitment and retention of registered nurses be directed toward the psychiatric nurse workforce.

Who will educate our nurses? A strategy to address the nurse faculty shortage in New Jersey

BACKGROUND The nurse faculty shortage hampers the capacity of the nursing workforce to respond to the demands of the evolving health care system. As a strategy to address the shortage in New Jersey, the Robert Wood Johnson Foundation implemented the New Jersey Nursing Initiative Faculty Preparation Program to prepare nurses for the faculty role. This article highlights program implementation successes and challenges, scholar and faculty perceptions of the program, and provides recommendations for others interested in preparing nurse faculty. METHODS This evaluation uses data from scholar surveys and focus groups, interviews with grantees, and grantee reports. RESULTS Findings suggest that a program that includes generous monetary support, socialization to the nurse faculty role, and formal education courses produces graduates who readily assume a faculty position and are committed to at least a part-time career in nursing education. CONCLUSIONS This evaluation emphasizes the need to carefully design programs that integrate faculty preparation and advanced clinical training.

State of the Science: Women and the Nonpharmacological Treatment of Substance Abuse:

BACKGROUND: Substance abuse affects men and women differently, and as a result, treatment programs should be designed specific to their unique needs. The nonpharmacological treatment of substance abuse among women has been largely neglected in the literature. OBJECTIVE: The purpose of this review was to analyze critically the existing literature related to the nonpharmacological treatment of substance abuse among women. The methodological rigor of existing research was critiqued and gaps in knowledge identified. DESIGN : The databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Sociological Abstracts, and MEDLINE were searched using the key words women and substance abuse treatment. Studies included in the review were those that were published between 1975 and 2003 and were related to the nonpharmacological treatment of substance abuse for women. RESULTS: Forty-three articles were reviewed. Evidence suggests that there are gender and cultural differences related to substance abuse. There is a dearth of research related to the effectiveness of treatment interventions designed specifically for women who abuse substances. The research that exists is limited in its theoretical foundation and methodological rigor. CONCLUSIONS : Few treatment programs reflect gender and cultural differences, leaving gaps in substance abuse treatment among women. Furthermore, existing research related to women and substance abuse treatment lacks a robust scientific foundation. Future research should be theoretically based and methodologically sound to advance the evidence base of substance abuse treatment for women.

Implementation of a Reverse Colocation Model: Lessons from Two Community Behavioral Health Agencies in Rural Pennsylvania

This qualitative study examined the implementation of a reverse colocation pilot program that sought to integrate medical care in two community behavioral health agencies. To accomplish this, each agency hired a registered nurse, provided training for its staff to function as wellness coaches, and implemented a web-based tool for tracking consumer outcomes. The findings from two rounds of stakeholder discussions and consumer focus groups suggested that agencies successfully trained their staffs in wellness coaching, integrated nurses into agency functions, developed integrated care planning processes, and increased awareness of wellness among staff and consumers. Similar to other complex interventions, the agencies experienced challenges including difficulty establishing new procedures and communication protocols, discomfort among staff in addressing physical health concerns, difficulty building collaborative relationships with primary care providers, and modest uptake of the web-based tool. The study offers insights into the practical aspects of integrating care and makes recommendations for future efforts.

Development and preliminary validation of a scale to measure patient uncertainty: The “Uncertainty Scale”:

Research suggests that patient uncertainty related to experiencing symptoms may drive decisions to seek care. The only validated measure of patient uncertainty assesses uncertainty related to defined illness. In prior work, we engaged patients to describe uncertainty related to symptoms and used findings to develop the ‘U-Scale’ scale. In this work, we present results from preliminary scale reliability and validity testing. Psychometric testing demonstrated content validity, high internal consistency, and evidence for concurrent validity. Next steps include administration in diverse populations for continued refinement and validation, and exploration of the potential contribution of uncertainty to healthcare utilization.

Use of Group Concept Mapping to Identify Patient Domains of Uncertainty That Contribute to Emergency Department Use

Introduction Prior research suggests that uncertainty related to symptoms is a driver of emergency department (ED) use, and that patients often leave the ED with uncertainty not being addressed. Our objective was to engage patients to identify domains that contribute to feelings of uncertainty and decisions to use the ED. Methods We used Group Concept Mapping, a quasi‐qualitative/quasi‐quantitative method, to elicit patients’ views on how uncertainty related to experiencing symptoms contributes to decisions to access the ED. Purposive sampling was used to recruit participants who either sought treatment at the ED twice within a 30‐day period, or visited both the ED and a primary care provider at least once within the past year. Results Thirty‐four participants engaged in two rounds of Group Concept Mapping during which participants participated in structured brainstorming of ideas, followed by ranking and clustering of ideas into domains. The first round generated 47 idea statements reflecting uncertainty about consequences, severity, emergency room services, primary care options, finances, and psychologic concerns. The second round generated 52 idea statements reflecting uncertainty about self‐management, causation, diagnosis and treatment plan, trust in the provider and institution, accessibility, and alternative care options. Discussion Factors that contribute to uncertainty and decision‐making about ED use are both intrinsic (ie, cause, symptom severity) and extrinsic (ie, finances, accessibility). These domains can inform approaches to measure the uncertainty that patients experience, and to design and test interventions for nurses and other providers to help manage patient uncertainty during acute illness.

Patient-Identified Needs Related to Seeking a Diagnosis in the Emergency Department

Study objective: Although diagnosis is a valuable tool for health care providers, and often the reason patients say they are seeking care, it may not serve the same needs for patients as for providers. The objective of this study is to explore what patients specifically want addressed when seeking a diagnosis at their emergency department (ED) visit. We propose that understanding these needs will facilitate a more patient‐centered approach to acute care delivery. Methods: This qualitative study uses semistructured telephone interviews with participants recently discharged from the ED of a large urban academic teaching hospital to explore their expectations of their ED visit and postdischarge experiences. Results: Thirty interviews were analyzed. Many participants reported wanting a diagnosis as a primary reason for seeking emergency care. When further asked to identify the functions of a diagnosis, they described wanting an explanation for their symptoms, treatment and guidance for symptoms, and clear communication about testing, treatment, and diagnosis. For many, a diagnosis was viewed as a necessary step toward achieving these goals. Conclusion: Although diagnosis may not be a feasible outcome of every acute care visit, addressing the needs associated with seeking a diagnosis may be achievable. Reframing acute care encounters to focus on addressing specific patient needs, and not just identifying a diagnosis, may lead to more effective transitions home and improved patient outcomes.

Long-term outcomes of the New Jersey nurse faculty preparation program scholars

BACKGROUND Rising concerns over the capacity of nursing education to prepare enough nurses to meet population demand have received national attention. The Robert Wood Johnson Foundation implemented the New Jersey Nursing Initiative Faculty Preparation Program to address nursing workforce issues in New Jersey. PURPOSE This paper describes program and scholar outcomes and provides recommendations for nurse faculty development. METHODS This descriptive study uses data from scholar surveys and interviews with grantees. DISCUSSION Findings suggest that a faculty preparation program that targets doctoral students and includes financial support, socialization to the faculty role, and formal education courses produces graduates who maintain a career in nursing education for up to three years after program completion. However, most masters-level students who also received formal preparation in nursing education were employed in clinical practice. CONCLUSIONS Program developers must carefully consider the design of programs that integrate faculty preparation and advanced clinical training for masters-level students.