Maryann Alexander

Transition to Practice Study in Hospital Settings

This multisite study of transition to practice included 105 hospitals in three states. Hospitals volunteered to participate and were randomly assigned to either the study group or the control group, and all new graduate registered nurses hired between July 1 and September 30, 2011, were invited to participate. The study hospitals adopted the National Council of State Boards of Nursings Transition to Practice model program; control hospitals continued using their existing onboarding programs, which ranged from simple orientation procedures to structured transition programs with preceptorships. The new graduate nurses who volunteered for the transition to practice study ( n = 1,088) filled out surveys at baseline, 6, 9, and 12 months after beginning their first nursing position. Competence was reported by both the new nurses and their preceptors. New nurse self-reported data included the number of errors, safety practices, work stress, and job satisfaction. The hospitals provided retention data on the all the new graduates hired during the study period. Though the results showed few statistically significant differences between the two groups, when the hospitals in the control group were categorized as having established or limited programs, differences were detected. Hospitals using established programs had higher retention rates, and the nurses in these programs reported fewer patient care errors, employed fewer negative safety practices, and had higher competency levels, lower stress levels, and better job satisfaction. Structured transition programs that included at least six of the following elements were found to provide better support for newly graduated RNs: patient-centered care, communication and teamwork, quality improvement, evidence-based practice, informatics, safety, clinical reasoning, feedback, reflection, and specialty knowledge in an area of practice.

NCSBN Simulation Guidelines for Prelicensure Nursing Programs

The National Council of State Boards of Nursing (NCSBN) published the results of the largest, most comprehensive study to date concerning the use of simulation as a substitute for traditional clinical experience. Results of the study, which were published in 2014, demonstrated that high-quality simulation experiences could be substituted for up to 50% of traditional clinical hours across the prelicensure nursing curriculum. An expert panel convened by NCSBN evaluated the data gathered through this study, examined previous research and the International Nursing Association for Clinical Simulation and Learning Standards of Best Practice: SimulationSM, and used their collective knowledge to develop national simulation guidelines for prelicensure nursing programs. This article presents those guidelines, evidence to support the use of simulation, and information for faculty and program directors on preparation and planning for using simulation successfully in their nursing programs.

The Journal of Nursing Regulation at Age 6: A Bibliographic Analysis

Introduction Bibliometric analysis is a technique that can be used to understand the structure and content of a scientific domain. Aim The aim of this study is to analyze the scientific content of the articles contained in the first 6 years of the Journal of Nursing Regulation. Method Data were extracted using Scopus to identify the bibliographic information related to all peer-reviewed articles. The articles were then imported into VOSviewer where a co-word analysis was completed. Results Six themes were identified: conduct, simulation, delegation and supervision, public protection, transition to practice, and patient safety and regulatory culture. Nine other areas were suggested for further work. North American authors dominated the articles, and several articles were identified as being highly cited. Conclusions A bibliometric analysis of the content provided valuable insights into the issues addressed, the popularity of certain topics, and the success of a number of authors. The analysis also identified areas for further study.

National Guidelines for Nursing Delegation

Health care is continuously changing and this includes the roles and responsibilities of licensed health care providers and assistive personnel. The number of licensed nurses (i.e., advanced practice registered nurses [APRNs], registered nurses [RNs], or licensed practical nurse/ vocational nurses [LPN/VNs]) may be limited in certain regions and/or institutions. Therefore, care may need to extend beyond the traditional role and assignments of RNs, LPN/VNs, and unlicensed assistive personnel (UAP). When certain aspects of nursing care need to be delegated beyond the traditional role and assignments of a care provider, it is imperative that the delegation process and the state nurse practice act (NPA) be clearly understood so that it is safely and effectively carried out. The delegation process is multifaceted. It begins with decisions made at the administrative level of the organization and extends to the staff responsible for delegating, overseeing the process, and performing the responsibilities. It involves effective communication, empowering staff to make decisions based on their judgment and support from all levels of the health care setting. The employer/nurse leader, individual licensed nurse, and delegatee all have specific responsibilities within the delegation process. (See Figure 1.) It is crucial to understand that states/jurisdictions have different laws and rules/regulations about delegation, and it is the responsibility of all licensed nurses to know what is permitted in their state NPA, rules/regulations, and policies. In early 2015, the National Council of State Boards of Nursing (NCSBN) convened two panels of experts representing education, research, and practice to discuss the literature and key issues, and evaluate findings from delegation research funded through NCSBN’s Center for Regulatory Excellence Grant Program. The goal was the development of national guidelines to facilitate and standardize the nursing delegation process. They build on previous work by NCSBN and the American Nurses Association, and provide clarification on the responsibilities associated with delegation. Additionally, these guidelines are meant to address delegation with respect to the various levels of nursing licensure (i.e., APRN, RN, and LPN/VN, where the state NPA allows).

Guidelines for Assessing Candidates with Criminal Histories

Biometric state and federal criminal background checks provide the most comprehensive information available for determining whether a nurse applying for a license has a history of criminal activity. In some cases of past criminal behavior, it will be clear that licensure should be denied and in other cases, it will be clear that the potential licensee should be considered. However, in many cases, the decision is not clear, which makes the task of risk assessment so crucial. Was the violation of the law an indiscriminate act or does the individual have deficiencies in his or her personality or moral integrity? Does the individual exhibit criminal thinking? In 2012, National Council of State Boards of Nursing convened a task force to develop a method that would assist boards of nursing (BONs) in the interpretation of a criminal conviction history. The guidelines developed by this task force are presented here.

A Review of Criminal Convictions Among Nurses 2012–2013

Introduction Nurses with criminal convictions accounted for approximately 10% of the disciplinary actions taken by state boards of nursing (BONs) between 2003 and 2013. The purpose of this study was to better understand the types of crimes for which nurses are convicted and what actions BONs are taking to protect the public. Methods The records of nurses and nurse applicants who received disciplinary actions in the years 2012 and 2013 for a criminal conviction were extracted from the Nursys® database. Information on demographic and licensure characteristics, the type of crime committed, and the actions issued by the BON were coded and analyzed. Results 4,260 nurses and 559 nurse applicants received a board action in 2012 and 2013 due to a criminal conviction. Male nurses and licensed practical nurse/vocational nurses were overrepresented as compared to their proportion in the national nursing workforce. Driving under the influence, violation of the Controlled Substances Act, and theft were the most common crimes; probation and suspension of license were the most common BON actions. Board actions for egregious crimes and crimes involving patients were more severe. Among all nurses and applicants in this group, 18% failed to disclose a previous criminal conviction. Conclusion Overall, the vast majority of nurses are safe practitioners. The majority of crimes reported to BONs are not patient-related. This study provides evidence that BONs diligently address criminal convictions and evaluate whether the conviction is an indication that the individual is capable of practicing nursing safely.

Scope of Nursing Practice Decision-Making Framework

In early 2015, the Tri-Council for Nursing, consisting of the American Association of Colleges of Nursing (AACN), the American Nurses Association (ANA), the American Organization of Nurse Executives (AONE), and the National League for Nursing (NLN), in collaboration with the National Council of State Boards of Nursing (NCSBN) determined that a uniform tool (scope of practice decision-tree) was needed. Representatives from the ANA, NLN, and Boards of Nursing, along with NCSBN staff, hat would assist nurses and their employers in determining the responsibilities a nurse can safely perform. Upon examination of these existing algorithms and identification of essential elements, a uniform scope of practice decision-making framework was developed.