Kathleen M. White

Evidence-based practice: a practical approach to implementation.

Organizations often do not have processes in place to support nurses through a systematic approach for developing and evaluating nursing interventions, protocols, critical pathways, and policies that are derived from scientific evidence. The development of a framework to guide inquiry will have a positive impact on patients. This process may foster a higher level of professional engagement by nurses that may, in the long-term, help improve nurse retention and recruitment. The authors discuss a nursing evidence-based practice model and guidelines that were developed by a team of hospital and academic nurse leaders and is practical and easy to use. This model has been successfully implemented across the department of nursing as a strategic initiative. Results of the implementation have shown that staff nurses can effectively use this model with the help of knowledgeable mentors.

Comparison of Labor and Delivery Care Provided by Certified Nurse-Midwives and Physicians: A Systematic Review, 1990 to 2008

BACKGROUND Advanced practice nurses (APNs) in the United States could expand access to high-quality health care, particularly for underserved populations. Yet, there has been limited synthesis of the evidence related to their effectiveness as compared with other providers. The study reported here, part of a larger study that examined all four types of APNs, compares the labor and delivery care outcomes of certified nurse-midwives (CNMs) and physicians. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Proquest (for dissertations), were searched for the years 1990 through 2008. STUDY ELIGIBILITY CRITERIA Only those articles where processes or outcomes of care were quantitatively compared between CNMs and physicians were included. For all APNs, 27,993 citations were reviewed. For CNMs, 21 articles representing 18 unique studies reported either infant or maternal outcomes. METHODS The systematic review followed established procedures (replicable search of relevant databases, sequential review to identify eligible studies, abstraction by two reviewers, assessment of quality, and grading of evidence). RESULTS For measures that relate to the processes of care (e.g., epidural, labor induction, episiotomy), lower use was found for CNMs. For many of the infant outcomes (e.g., low Apgar, low birth weight, neonatal intensive care unit admission), there were no differences between physicians and CNMs. Perineal lacerations were lower and breastfeeding was higher among women cared for by CNMs compared with physicians. LIMITATIONS The review addressed only CNMs practicing in the United States and outcomes measured during labor and delivery. The majority of study designs were observational and the models of care ranged from independent to shared, limiting the control for bias. Moreover, all reviewers were nurses. CONCLUSION Differences in practice between CNMs and MDs seem to be well documented, particularly in the use of technology. Yet, the findings provide evidence that care by CNMs is safe and effective. CNMs should be better utilized to address the projected health care workforce shortages.

Policy Implications for Optimizing Advanced Practice Registered Nurse Use Nationally

This article examines the potential benefits of enhanced use of advanced practice registered nurses (APRNs) given health care workforce projections that predict an inadequate supply of certain types of providers. The conclusions of a systematic review comparing the effectiveness of care provided by APRNs with that of physicians alone or teams without APRNs indicate the viability of this approach. Allowing APRNs to assume roles that take full advantage of their educational preparation could mitigate the shortage of primary care physicians and improve care processes. The development of health care policy should be guided by patient-centric evidence rather than how care has been delivered in the past.

Adapting standards of care under extreme conditions.

The filing of criminal charges against a group of clinicians in New Orleans for failure to meet expected standards of care following the hurricanes of 2005 made the growing concern among health professionals about care provided during extreme emergencies or disasters all too real. Questions about what may lead to censure, penalties from licensing boards, or lawsuits have come from nurses, physicians, and many other licensed health professionals. A panel convened by the American Nurses Association that included representatives of medical, public health, hospital, and government agencies considered the ethical, professional, and practical aspects of meeting standards of care in such circumstances. Clinicians are reminded that in emergencies, it is only the circumstances that change (perhaps radically); neither the individuals professional competency nor the basic professional standard of care is different. In making prioritized decisions under such circumstances, the individuals ethical framework is utilitarian, and there are 3 areas for action, even when some routine tasks are set aside: maintain worker and patient safety; maintain airway, breathing, and circulation; and establish or maintain infection control. Policy recommendations such as state legislation for the adoption of comprehensive immunity for volunteer health care workers, and the establishment of a medical review panel as arbitration board are also suggested. The resulting white paper summarizes the issues and provides guidance to individual professionals, institutions in which they work, and emergency planners.

Educational strategies to develop evidence-based practice mentors

Basing practice decisions on sound scientific research and best available evidence is an optimal approach for making practice changes. A five-member team of nursing leaders formed an evidence-based practice (EBP) steering committee and developed an EBP model and process. This article describes the educational approaches and the development of mentors used to provide the staff nurse with the necessary knowledge and skills to use EBP successfully.

Guiding implementation: frameworks and resources for evidence translation.

In this department, Dr Newhouse highlights hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, identifying measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. In this article, the authors discuss the need for knowledge translation to leverage improvements in healthcare quality and describe 3 frameworks that can be used to plan and implement translation of evidence to practice.

The new CMS payment system: Too much, too soon?

rofessional nursing advancement programs are multifaceted structures that convey the vision of the individual organization, recognize and elevate the status of the professional nurse, and facilitate nurse recruitment and retention. Since the early 1970s, the goals of advancement programs have been to recognize nurses who work at the bedside and promote clinical excellence.1 The Clinical Nurse Advancement System (CNAS) at Rochester General Hospital (RGH) has evolved By Zara R. Brenner, APRN,BC, MS, Lori Dambaugh, RN,BC, PCCN, BSN, Edie Hill, RN, MPA, CNOR, BSN, Cynthia Roberts, RN, MS, and Dawn Vollers, APRN,BC, MSN

Medical malpractice: a crisis in cost and access.

Examine the medical malpractice crisis and methods of stopping it.

A New and Very Real Nursing Shortage

Current demographics of the nursing shortage are presented and discussed. Issues of this particular nursing crisis are explored relative to past nursing shortages. State and organizational responses to the current crisis are listed relative to the following key areas of nursing concern: mandatory overtime, whistleblower protection, reporting of nursing-sensitive quality data, and patient classification systems.

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.