Research Library

In the early stages of the COVID-19 pandemic, as clinical site restrictions were implemented, education programs leading to licensed practical nurse/licensed vocational nurse (LPN/LVN) degrees increasingly relied on virtual simulation-based experiences to provide clinical training to their students. However, scant evidence exists regarding the extent of this change and the various modalities employed by LPN/LVN programs across the United States.

During the COVID-19 pandemic, nursing regulatory bodies (NRBs) worldwide adopted a variety of measures to bolster the nursing workforce and ensure patient safety. 

In the early stages of the COVID-19 pandemic, strains on the healthcare system forced many U.S. states to revisit long-standing statutory limitations on the care coordinated by advanced practice registered nurses (APRNs). This was done by issuing waivers via executive, legislative, or board of nursing orders.

The COVID-19 pandemic has amplified long-standing issues of burnout and stress among the U.S. nursing workforce, renewing concerns of projected staffing shortages. Understanding how these issues affect nurses’ intent to leave the profession is critical to accurate workforce modeling.

This chapter highlights the current status of transition-to-practice programs, both for RNs and APRNs.

From the Journal of Nursing Regulation July 2020 special supplement issue, NCSBN presents evidence-based regulatory guidelines and quality indicators for nursing programs.

Access to quality primary care is challenging for rural populations and individuals residing in primary care health professional shortage areas (HPSAs). The ability of nurse practitioners (NPs) to provide full care is governed by state scope-of-practice (SOP) regulation, which is classified into three types: full SOP, reduced SOP, and restricted SOP. Understanding how legislative and regulatory decisions can influence supply of NPs in underserved areas can help guide effective health policies to reduce disparities in access to care.

Read about the current status of the regulatory approval of nursing education programs in the United States. What are the challenges and opportunities for the future of program approval?

The findings of this study show a positive return on investment and provide additional evidence to support the business case for implementing a transition to practice (TTP) program in hospitals to decrease new graduate registered nurses (NGRN) turnover. Additionally, the results suggest the immediate investment in a NGRN TTP program has a financial benefit that accrues relatively quickly due to higher nurse retention rates.

Excessive work hours may increase fatigue in registered nurses and reduce performance and fitness to practice. The purpose of this study is to assess the prevalence of excessive work hours among College of Registered Nurses of British Columbia registrants as reported during their licensure renewal as well as the factors associated with excessive hours, including age, sex, Canadian or foreign education, area of specialization, and multiple jobs. The authors found that 6.5% of nurses (2,090 of 32,142) worked more than 2,000 hours during the study year and that 1.4% (466 of 32,142) exceeded 2,500 hours. Males; older nurses; foreign-educated nurses; critical care, operating room, geriatric, administration, education, and research nurses; and nurses with multiple jobs worked excessive hours more frequently than their counterparts. The potential for collaboration between employers and regulators is discussed.

Aims of this study were to identify nurse workarounds during medication administration, to assess changes in the rates of medication events and workarounds after STEP, to assess changes in systems thinking and safety culture after STEP, and to correlate safety culture and systems thinking.

As countries across sub-Saharan Africa work towards universal health coverage and HIV epidemic control, investments seek to bolster the quality and relevance of the health workforce. The African Health Profession Regulatory Collaborative (ARC) partnered with 17 countries across East, Central, and Southern Africa to ensure nurses and midwives were authorized and equipped to provide essential HIV services to pregnant women and children with HIV.

Nurse practitioner (NP) prescribing continues to be a contentious policy issue, and studies systematically examining NP prescribing are lacking. The aim of this study was to conduct a descriptive analysis comparing the prescribing services of NPs with those of primary care physicians (PCPs) in providing care to Medicare beneficiaries.

This study provides empirically derived estimates of the numbers of CNA training hours that yield the best nursing homes resident care outcomes.

Newly licensed RN retention: hospital and nurse characteristics.

This article addresses the issue of how to detect item preknowledge using item response time data in two computer-based large-scale licensure examinations. Item preknowledge is indicated by an unexpected short response time and a correct response. Two samples were used for detecting item preknowledge for each examination. The first sample was from the early stage of the operational test and was used for item calibration. The second sample was from the late stage of the operational test, which may feature item preknowledge. The purpose of this research was to explore whether there was evidence of item preknowledge and compromised items in the second sample using the parameters estimated from the first sample. The results showed that for one nonadaptive operational examination, two items (of 111) were potentially exposed, and two candidates (of 1,172) showed some indications of preknowledge on multiple items. For another licensure examination that featured computerized adaptive testing, there was no indication of item preknowledge or compromised items. Implications for detected aberrant examinees and compromised items are discussed in the article.

Employers are uniquely situated to assist regulators by monitoring nurses practicing with conditions and restrictions resulting from a discipline order by a regulator. However, attitudes, perceptions, and contextual factors may impact employers’ participation, and their education and training needs must be considered. A quality-improvement study was conducted to target these areas and provide direction to regulators in developing education and outreach efforts for employers.

A survey conducted in 2001, and replicated in 2003 with the same results, found that fewer than 50% of employers thought newly licensed nurses were safe and effective in practice. These findings caused concern for boards of nursing, so in 2002 the National Council of State Boards of Nursing (NCSBN) began to examine transition to practice (TTP) in nursing, developing an evidence-based model program and studying its effectiveness in hospital and nonhospital settings. After completion of the TTP study in hospitals with registered nurses (RNs) published earlier in 2015, a study was conducted in nonhospital facilities with RNs and licensed practical nurses to determine if NCSBN’s TTP program could be used effectively across settings. Sites volunteering to participate, however, faced many challenges while the study was underway. This article presents the TTP program, study design, challenges faced by nonhospital sites trying to implement a TTP program, and limited findings

A key message from the Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health, addresses the need for better health care workforce data collection and information infrastructure, which is a prerequisite for effective workforce planning and policy making. Health care workforce forecasting models provide a mechanism for making future projections, which can be valuable in quantifying supply and demand and identifying the most appropriate strategies to prevent future shortages. Forecasts or predictions about future nursing supply and demand at the state level, although becoming more prevalent, are limited to a minority of states using a variety of methodologies. The Louisiana Multi-Regional Statewide Nursing Workforce Forecasting Model offers a unique and powerful tool to both monitor and forecast changes in the supply of, and demand for nurses at both the state and regional levels relative to specific health care settings. Development of such a model requires collaboration with agencies and/or entities having access to state-level data as well as the support of stakeholders interested in using the model in strategic planning and policy development.

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 Nursing’s 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.

The African Health Profession Regulatory Collaborative (ARC) was launched in 2011 to help countries develop or strengthen nursing regulations to ensure safe and sustainable nurse-initiated and nurse-managed HIV treatment. ARC supports teams of national nursing leaders from 17 countries to engage in rapid regulatory strengthening through regional meetings, regulation improvement grants, and in-country technical assistance. The ARC initiative has awarded 33 regulation improvement grants on topics such as continuing professional development, scopes of practice, nurse practice acts, and entry-to-practice examinations. Progress is measured by a novel tool that captures meaningful advancements in national regulations. The ARC initiative facilitates rapid improvements in professional nursing regulation. The model and evaluation framework are highly transferable to other health care cadres and offer a platform for regulators, policy makers, professional bodies, and educators to collaborate on prioritized regulation issues.

Emerging evidence indicates that harmful nursing home resident outcomes occur because of ineffective collaboration between registered nurses (RNs) and licensed practical nurses (LPNs) during assessment, care planning, delegation, and supervision. This observational, factorial vignette survey related video vignettes of RN–LPN collaboration in nursing home care to RN perceptions of: 1) current practice in their home; and 2) preferred practice in their home (N = 444 rated vignettes of nursing practice).

Medication order discrepancies pose safety risks when nursing home residents transition between health care settings. In nursing homes, both registered nurses (RNs) and licensed practical nurses (LPNs) frequently are assigned to detect medication order discrepancies, using the process of medication reconciliation. This study was undertaken to examine the extent to which licensure (RN, LPN), years of experience performing medication reconciliation, and the perceived Need for Closure were related to differences in the detection of medication order discrepancies. The Multiple Segment Factorial Vignette design was used to explore and compare nursing home nurses’ detection of such discrepancies.

Hospitalizations of nursing home residents are costly and adversely affect the health of already vulnerable residents, and reducing avoidable hospitalizations has been identified as a priority quality and safety outcome by the U.S. government. However, existing interventions to reduce hospitalizations do not account for differences in scopes of practice among licensed nursing staff. This article describes the development of an educational innovation for nursing home staff members to learn to collaborate in ways that differentiate registered nurse and licensed practical/vocational nurse scopes of practice and strengthen connections among licensed and unlicensed nurses to improve detection and management of conditions associated with avoidable hospitalizations. The innovation was developed using situated learning theory and facilitated unfolding case discussions, reflecting the actual care environment. Evaluation data indicated the feasibility of this approach to staff education.

Nursing programs are seeking guidance from boards of nursing about how much simulation can be substituted for traditional clinical practice. To address this question and to assess educational outcomes when simulation is substituted for clinical time, the National Council of State Boards of Nursing (NCSBN) conducted a study using 10 nursing schools across the United States. This article focuses on the faculty development needed to maintain fidelity in the intervention, implementation, and evaluation processes of initiating simulation programs.

The aim of this study was to describe newly licensed RN (NLRN) preceptorships and the effects on competency and retention.

Many factors affect quality care in long-term care (LTC) settings. A supportive organizational culture, strong leadership, appropriate staff and staffing, and effective training and professional development of staff members are all fundamental elements necessary for influencing quality care in LTC settings. This article discusses challenging issues confronting LTC settings and provides strategies for managing the complexities of culture change, staffing, and education in LTC.

From December 1, 2010, through May 31, 2013, the South Dakota Board of Nursing conducted a pilot study, “Virtual Nursing Care for Children with Diabetes in the School Setting.” The findings from the study supported the use of the virtual nurse model of care as a safe and effective method of supervising and delegating diabetes nursing care tasks to unlicensed assistive personnel (UAP), including insulin administration. This article provides an update describing the 2014 changes made to the nursing delegation rules, the protocol established for registered nurses using the virtual nurse model of care, and the training program for UAP providing diabetes nursing care.

Despite a growing number of foreign-educated nurses (FENs) joining the health care workforce, scientifically based evidence comparing FENs to U.S.-educated nurses on quality of care, including medication errors, is lacking. Hypotheses tested were related to differences in frequencies and consequences of medication error incidents between FENs and U.S.-educated nurses. The case and control groups were randomly selected from 2006 and 2010 risk management files and medication files at five Southwestern hospitals. The sample included 2,178 observations. In 2006, there were comparable percentages of FENs in the case group (34.7%) and in the control group (31.2%). In 2010, the percentages were again comparable (30.7% of FENs in the case group and 28.6% in the control group). In 2006, FENs were less likely to make medication errors not reaching patients (4.5% for FENs and 13.3% for U.S.-educated nurses), but tended to make errors reaching patients without harm (85.8% for FENs and 75.1% for U.S.-educated nurses); however, the difference disappeared in 2010. The authors’ comparison demonstrates that FENs provide quality of care comparable to that of U.S.-educated nurses with regard to medication errors, which may be attributed to the rigorous registered nurse licensure exam; FENs’ relatively higher educational background; the hospital’s recruitment, mentoring, and training programs; and the implementation of health information systems.

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.

NCSBN's Transition to Practice (TTP) study: implications for educators.

The purpose of this article is to describe differences in nursing home quality outcomes among nurses who are foreign born and foreign educated, nurses who are foreign born and U.S. educated, and nurses who are U.S. born and U.S. educated.

Regulators have been discussing the issue of allowing simulation to replace clinical time for years and are looking for evidence to guide their decision making. In anticipation of the National Council of State Boards of Nursing National Simulation Study results, a descriptive survey was conducted to document the current regulatory environment on simulation and serve as a benchmark for future regulatory comparisons. This article reports the results of the survey. 

The purpose of this study was to explore the relationship between registered nurse (RN)-to-population ratio and population health indices. A cross-sectional secondary analysis of existing national data was conducted, using counties as the unit of analysis. Data based on 1,929,414 RNs in 33 states in 2012 were obtained from the National Council of State Boards of Nursing's Nursys® database, and county health data were obtained from 2,016 counties from the 2012 County Health Rankings database. Regression analysis indicated that the RN-to-population ratio along with nurse education (percentage of RNs with a BSN or higher degree) and experience (number of years since graduation) was significantly associated with the self-rated health (percentage of adults reporting fair or poor health), mammography screening rates, and teenage birth rates. The associations were all positive: Greater numbers of nurses per capita were associated with better population health indices. These results are consistent with the Nurse Dose concept and support the need for enhanced recognition and policy changes regarding the contribution of nurses to the health of the population. Implications for nursing regulation include the need for sustained and coordinated efforts to support the health of the population through the recruitment and maintenance of a well educated and experienced nursing workforce.

Little is known about the extent and types of errors and near misses (ENMs) made by nursing students. In nursing schools, the norm has been a culture of blame in which a student, a faculty member, or both are held accountable for ENMs regardless of the source. However, evidence suggests that a failure to track and trend ENMs and learn from them actually increases the likelihood of more ENMs. To help student nurses become competent nurses, educators need systems and structures that allow trending and analysis of ENMs. Key first steps include creating a mechanism for schools to use in reporting nursingstudent ENMs and creating a transparent and blame-free culture. In addition, it will be critical to establish a national database to reflect the occurrence and types of ENMs. The database will provide a baseline of information that will guide faculty members in designing interventions to reduce ENMs. This article describes the issues and challenges encountered in creating an occurrence reporting tool, testing the tool, and establishing a national database for tracking and trending ENMs encountered by nursing students. In addition, this article presents an adaptation of the tested occurrence reporting tool that schools can use while a national database is established.

As science advances, new competencies must be integrated into nursing practice to ensure the provision of safe, responsible, and accountable care. This article utilizes a model for integrating a new complex competency into nursing practice, using genomics as the exemplar competency. Nurses working at 23 Magnet® Recognition Program hospitals participated in a 1-year new competency integration effort. The aim of the study was to evaluate nursing workforce attitudes, receptivity, confidence, competency, knowledge, and practices regarding genomics. Results were analyzed using descriptive statistical techniques. Respondents were 7,798 licensed registered nurses. The majority (89%) said it was very or somewhat important for nurses to become more educated in the genetics of common diseases. Overall, the respondents felt genomics was important, but a genomic nursing competency deficit affecting all nurses regardless of academic preparation or role was observed. The study findings provide essential information to help guide the integration of a new competency into nursing practice.

Nurses agree that direct practice with actual patients is vital, but the teaching methodologies and faculty-student relationships that optimize students’ learning in clinical settings have not been documented. This study examined students’ thinking and their interactions with faculty during clinical experiences at three academic nursing programs. Findings suggest that missed opportunities for learning, inadequate measures for clinical progress and learning, and lack of interprofessional practice are failing to optimize student clinical learning experiences.

Access to safe health care when a nurse is not present is a public protection issue facing many boards of nursing. This is especially true in schools where a nurse is not present to provide care for children with diabetes. This study examined the safety and effectiveness of a model of care that linked trained unlicensed school personnel to registered nurses (RNs) via telehealth technology to delegate and supervise diabetes care tasks, including insulin administration. The study took place from December 2010 to May 2013, and 5,568 doses of insulin were administered safely by unlicensed personnel. Surveys taken before and after implementation measured the perceptions of parents and school personnel regarding the safety and efficacy of the model of care. Statistical results showed large degrees of effectiveness. This study provides preliminary evidence supporting regulatory changes for the delegation of insulin administration and other diabetes care tasks by RNs.

The use of unlicensed assistive personnel (UAP) in hospitals has increased over the last 20 years. In lieu of regulation of UAP by boards of nursing, many health care agencies and organizations have developed their own educational standards, role definitions, and scopes of practice for UAP in acute care. The purpose of this study was to explore how UAP are used in acute care settings and how their work is perceived by nurses who work with them and by themselves. The results of this mixed method design study showed many similarities among UAP titling; however, there were substantial variations in educational preparation and use of UAP, especially as they move into advanced or specialty areas. Nevertheless, both registered nurses and UAP perceive the work of UAP to be highly effective. Additional collaborative research by regulatory and health care agencies is recommended. This research should be used to inform the development of regulations for educational preparation and utilization of these providers.

The purpose of this study was to determine whether certain key outcomes differ between preRN licensure students who have a criminal history and those who do not. Outcomes examined were program completion, NCLEX-RN ® passage, subsequent criminal acts, and subsequent professional misconduct. A retrospective descriptive-comparative research design was used. The sample consisted of 3,166 applicants from the 2006 cohort of preRN licensure students in Louisiana who met the criteria for inclusion in the study. Analysis of the data revealed 10% of participants with a criminal history had a subsequent criminal incident, whereas only 3.4% of the noncriminal history group had a subsequent criminal incident. Additionally, 4.5% of the criminal history group had subsequent professional misconduct compared with 1% of the noncriminal history group.

This study aimed to describe state regulatory certified nursing assistant (CNA) oversight in two domains—use of registry or licensing for credentialing and initial CNA training and continuing education (CE) requirements—and to evaluate whether CNA oversight is associated with resident outcomes in nursing homes. This cross-sectional secondary analysis combined 2004 data on state-level regulatory requirements for CNA oversight, training, and CE with nursing home resident outcomes data collected in 2004 from 16,125 U.S. facilities in 49 states. Though 26 states required CNAs to have more initial training hours than the federal requirement of 75 hours, only four states required additional yearly CE hours to maintain CNA certification. The combination of increased initial training and annual CE hours was significantly associated with nursing homes reporting lower antidepressant and antipsychotic use and lower average medication use. Use of a registry or licensing board for credentialing was significantly related to lower catheter use, and CNA licensure was significantly associated with lower odds of falls. Findings suggest that regulatory modifications could be beneficial to improve resident care outcomes in nursing homes.

Approximately 8% of nurses in the United States were educated abroad, and in Florida and California, foreign-educated nurses (FENs) represent large percentages of the nurse labor force. It is important to know whether these nurses are prepared to care for patients who have complex needs; communicate successfully with other nurses, physicians, patients, and families; adapt to high technology in today's acute-care settings; and successfully transition to practice in the United States. It has been noted there is no comparative outcomes research on FENs and U.S.-educated nurses. The purpose of this study was to examine the effects of hospitals' proportions of FENs on nurse outcomes, hospital quality of care, perceptions of work environment, and patient-safety incidences.

Over the past 3 decades the Health Resources and Services Administration has reported on the supply of registered nurses (RNs) through theNational Sample Survey of Registered Nurses (NSSRN). Data collection from the most recent, and final, NSSRN was completed in 2008; hence, there is no current data on the nationwide supply of RNs. This current project was conducted by the National Council of State Boards of Nursing and the Forum of State Nursing Workforce Centers to fill this ongoing need and is titled, The National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers 2013 National Workforce Survey of RNs. This article presents the highlights of the study and its results.

For RNs to participate effectively in hospital Quality Improvement, they must have adequate QI knowledge and skills. This descriptive study assessed employer-sponsored QI education and RNs' preparedness across a wide range of QI steps and processes. RNs from 15 US states who were employed in hospitals and were initially licensed to practice in 2007 to 2008 were surveyed. Findings revealed the QI education offered by employers to RNs could be substantially improved. Nurse educators play a critical role in making these improvements.

This article provides a summary of social media and privacy laws, discusses the legal issues health care organizations and workers face when a breach of patient privacy occurs, and offers best practices for avoiding privacy violations.     

Currently, boards of nursing (BONs) use seven different models for approving nursing programs, and nursing education rules and regulations in BONs are not consistent across jurisdictions.  In 2010, the National Council of State Boards of Nursing’s (NCSBN) Board of Directors convened a committee to assess the state of prelicensure nursing program approval in BONs and to make recommendations to the NCSBN’s board based on current and future needs.  This article describes the committee’s collaborative engagement with national accreditors and the recommendations that resulted.

In increasing numbers, pediatric nurse practitioner (PNP) students seek educational programs that prepare them for dual certification in acute care and primary care. In 2008, an AFPNP research team of faculty experts was convened to examine areas of commonality and distinction between acute-care and primary-care PNP programs. Based on the results of surveys and interviews, an AFPNP task force created guidelines for combined educational programs that prepare students for dual certification as acute-care and primary-care PNPs.

A valid, reliable practice assessment is needed to support intervention on the public's behalf when the pattern of a nurse's performance results in or is likely to result in patient harm. A collaborative multiagency research team developed and tested a criterion-referenced competency assessment process, using high-fidelity clinical simulation based on the Taxonomy of Error Root Cause Analysis and Practice Responsibility and the Clinical Competency Assessment of Newly Licensed Nurses. The 41-item instrument includes nine competency categories essential for safe practice. The instrument used with high-fidelity simulation testing shows promise as a reliable, valid method for identifying unsafe nursing practice.

A mailed survey of licensed practical nurses (LPNs) employed in nursing homes in Minnesota and North Carolina examined their role and responsibilities as well as barriers to and facilitators for working within their scope of practice. The study focused on the nursing practice domains of assessment, care planning, evaluation, delegation, and supervision. BONs are encouraged to provide guidance to nurses and their nursing home employers who interpret RN and LPN scopes of practice as a means of promoting accountable, safe, quality care for nursing home residents.

Efforts to increase the number of accredited programs for practical nursing and associate-degree nursing and efforts to improve the BON rules for approving education programs led to a requirement that all programs in Minnesota must obtain national accreditation. This article describes the two distinct processes that produced this significant change.

Hospital-based research links higher proportions of nurses with BSN degrees to lower patient mortality rates, but it does not explain the mechanism. This study explored mechanisms related to individuals and work groups that could explain the association between nurses' education and patient outcomes. Our findings suggest the need for a broadened regulatory focus that considers not only nurses' education but also the contribution of the work environment and interdisciplinary teams to the coproduction of high-quality safe care.

The purpose of this article is to report additional data gathered during the NCSBN 2010 nationwide simulation survey of 1,729 nursing programs in the US. It serves as a companion article to the initial survey data reported by Hayden in 2010.

This study aimed to determine possible risk factors associated with error events or practice breakdowns for nurses that were reported to boards of nursing (BONs). We evaluated 861 cases submitted by BONs to the NCSBN’s Taxonomy of Error, Root Cause Analysis, and Practice-Responsibility database. Standard statistical analysis was used. A high percentage of nurses involved in practice breakdowns that were reported to BONs have a negative job history (discipline or termination for practice issues by their employers). Among the 725 nurses with complete job histories available, 60% (n = 437) had been disciplined or terminated by their employers in the past. A nurse's job history may serve as a useful index to identify a small group of nurses with a risk of being involved in a practice breakdown. In addition to conventional disciplinary actions, a tailored remediation program should be considered to prevent additional practice breakdowns.

Medication aides are unlicensed assistive personnel who administer medications. A survey was developed to provide insights into medication aide education, supervision, and work role. Items were derived by reviewing the literature and regulations. Data were analyzed by calculating percentages over all respondents, followed by breaking out data by type of work setting. In some cases, state regulations were incorporated to determine the percentage of responders who were performing tasks that regulations stated they should not perform. Study implications are discussed.

There is evidence linking improved patient care to standardized transition to practice programs in the areas of safety, competence, and retention.  This chapter explores that evidence, presents a standardized model as a solution, and gives examples of transition program models, as well as an overview of NCSBN’s Transition to Practice model.

This article provides the results of a nonexperimental, descriptive study conducted to explore the frequency and importance of activities performed by certified, entry level MAs. More than 1,800 MAs provided valid responses.

Social media can be a very effective way of communicating in nursing, but guidelines for appropriate use by healthcare providers are essential. This article briefly introduces the phenomenon of social media and introduces three actual scenarios where nurses unintentionally violated appropriate use of social media in healthcare. The scenarios are discussed related to social media, career, concerns, and nursing regulation. Incorporating these and other examples with data from board of nursing cases, the nature of complaints against nurses is explored as well as common myths and misunderstandings about using social media platforms. Guidelines for appropriate use by nurses and available resources to inform policy are highlighted. Next steps in social media in nursing should include development of organizational level policies and educational programs on the use of social media.

Social media offers many opportunities to promote student engagement and interactivity; however, student nurses must be instructed in the appropriate use of this tool.  It is important for nursing programs to develop sound policies related to social media.  This article suggests social media policy guidelines and presents several tools for nurse educators to utilize while implementing their own policies.

In this article a program that takes an innovative, alternative approach to transitioning RNs into practice developed and implemented by nurse leaders in the Memorial Hermann Healthcare System in Houston, Texas, is described and discussed.

In British Columbia, the regulatory body recognizes that providing support so nurses can meet the Standards of Practice helps protect the public and promote the goal of competent, ethical care. This article describes the mechanisms through which practice support is provided and some tools that help RNs apply standards and meet expectations for professional practice.

The authors introduce the Staircase Model for Professional Development as a framework for nurses’ growth as nurse professionals.   

Calls for innovation in nursing education have been prevalent in recent years.  In 2009, the Innovations in Education Regulation Committee, convened by the National Council of State Boards of Nursing (NCSBN), worked collaboratively with other stakeholders to identify perceived and real barriers to innovation in nursing education and proposed model rules and statute language that boards of nursing could adapt to foster innovations in their state’s nursing programs.  The model language was unanimously adopted by NCSBN’s Member Boards.  Since then, NCSBN has conducted three surveys to determine the impact of NCSBN’s initiative as well as the state of innovations in nursing education.  Following a review of the committee’s work, this article presents survey data on innovation in nursing education over the last 3 years.

Nurse Practitioners (NPs) are certified within a population-focused specialty area, practice in a variety of settings, and treat a wide range of patients. Little is known about what agreement exists between certification obtained and actual site of practice. The purpose of this study was to examine NP practice sites as compared with their certification and examine additional education they received after employment.

This article discusses the importance of developing a national, standardized program, implemented through regulation, for transitioning all newly licensed nursing graduates to practice. The background for establishing this evidence-based model in the context of today’s health-care arena is presented. A model for transition and the supporting evidence are described.

The Massachusetts Board of Registration in Nursing and the University of Massachusetts Medical School Center for Health Policy and Research convened the Massachusetts Medication Safety Alliance, a 15-member collaborative of regulatory agencies and long-term care providers, to develop the Nurse-Employer Medication Safety Partnership Model to cultivate a safety culture in Massachusetts nursing homes that supports voluntary medication-event recognition and disclosure by nurses. To guide the model's development, the Alliance assessed the perceptions of 1,286 nurses working in 109 Massachusetts nursing homes, finding more than half rated their practice environment as punitive and identified fears of blame, disciplinary action, and lawsuits as barriers to medication-event reporting.

During 2009 and 2010, a survey was administered to hospital, home health, and nursing home nurse employers in the US to capture insights into the professional and practice issues affecting nursing. These key issues were identified: workforce, educational preparation, transition, and patient safety. The implications for regulators, researchers, educators, and employers are discussed.

With changing staffing structures and persistent quality concerns in nursing homes, registered nurses are challenged to ensure that appropriate care is delivered. We describe differences in the nurse practice acts and related administrative code for all 50 states and DC for LPN delegation and supervision. Next, we explore relationships between these differences and quality measures from CMS for US nursing homes, using 2007 data. Findings indicate that how BONs regulate LPN scope of practice is directly related to care quality.

A cross-sectional secondary data analysis was conducted linking nursing work environment data from a 2004 survey of 633 nurses in 71 hospitals in North Carolina and Illinois to hospital-level patient outcomes data based on the Agency for Healthcare Research and Quality inpatient quality indicators and patient safety indicators. Nurses' job demands and schedules are associated with selected patient outcomes and should be considered as modifiable working conditions, along with staffing, to improve patient care.

The primary purpose of boards of nursing is public protection, but few boards have conducted research with the public's input. This article provides results of a study conducted by the Alabama Board of Nursing regarding the views of 600 consumers on advanced practice registered nurses (APRNs). Less than 20% of participants knew the agency responsible for regulating APRNs, but the expectations for public safety were explicit regarding preparation for practice and competence.

This study represents an initial attempt at exploring the characteristics of graduate programs in nursing for non-nurses (GPNNNs), their students, and real and potential regulatory concerns. The variability in the required number of credits alone is a prompt for educators to examine the most efficient path to a graduate degree for non-nurses. Further, those involved in the design, implementation, and regulation of these programs and the students need to consider the actual and potential regulatory issues that can surface when students without a nursing degree are permitted or required to take the NCLEX after completing pregraduate nursing courses.

This chapter gives an overview of NCSBN’s Transition to Practice model.

This article provides an overview of nursing regulation during public health emergencies. Many nurses are quick to volunteer during an emergency; being prepared in advance will help the overall response effort.

This article explores nursing internship programs not associated with nursing courses or curricula but are stand-alone programs used to recruit nurses. Issues discussed are the nurse interns’ liability and misunderstanding of the licensure requirement and the health-care systems' promotion of practice without a license.

This article describes the professional, ethical, and legal implications of using social media inappropriately and provides guidelines from the National Council of State Boards of Nursing for using them appropriately.     

The purposes of this article are to provide an overview of medication errors in nursing homes, an understanding of the challenges nursing homes face in ensuring safe medication processes, and the role delegation can play in safe medication administration.

A survey was developed with the goal of providing insight into the work settings, education, supervision, and work roles of medication aides. Results of the survey and study implications are discussed.

A review of the literature on medication error rates among medication aides is presented, followed by an exploration of medication-aide regulations regarding oversight, applicant requirements, training, testing, continuing education, work setting and supervision, and role limitations. The results show the wide variability in the roles and regulations of medication aides. The issue of more uniformity in the regulation of medication aides is discussed.

Madison, M. & Staggers, N. (2011). Electronic Health Records and the Implications for Nursing Practice. Journal of Nursing Regulation, 1 (4), 54-60.

How do newly licensed RNs transition from an educational environment to practice to assure safe patient care?  This article examines a case study that highlights this issue, and discusses indicators that support a standardized transition to practice program for all newly licensed nurses.

More than 2,000 practice anecdotes emailed by new nurses during their first 5 years of practice were analyzed to describe nurses’ definitions of competence and how it developed over time. Nurses defined competence as efficient care amid complex priorities; rapid response to subtle changes in patients’ conditions; seeing the big picture and working the system on patients’ behalf; interpersonal warmth, respect, and authority; and a committed desire to learn and improve. Support for development of these qualities may promote nursing care quality in high-acuity practice environments.

Speak for Success was a research study designed to test the effectiveness of an evidence-based, comprehensive communication training program for international nurses. This study indicated that a short-term linguistic intervention was effective in reducing phonologic errors of international nurses regardless of gender, age, country of origin, or length of residency in the US. Despite a tendency of improvement for some communication variables, differences in between-group and within-group comparisons were not significant.

The Missouri Just Culture Collaborative brought together health-care providers, regulators, and other key stakeholders to learn and implement the principles of Just Culture. Under the leadership of the Missouri Center for Patient Safety, 67 health-care providers and regulatory agencies worked together to implement aspects of Just Culture. The collaborative led to an improved understanding between providers and regulators about barriers to implementing true Just Culture and how regulators can support provider efforts to improve the safety culture.

Promoting clear communication and information sharing among nurse regulatory bodies is an essential step toward protecting patients worldwide. The research described in this article was intended to enhance global information sharing among nurse regulators, aid the development of a system that efficiently validates nurses' eligibility, and thus manage risk associated with increasing nurse migration, and allow recognition of best practices.

This multisite study examines the impact of multiple-patient simulation experiences on the development of students' abilities to make clinical judgments in evolving situations and the correlation between the design of the simulation and student outcome achievement in the final semester of their prelicensure nursing program.

These are complex times for regulators on nursing boards, particularly in three areas.  First, they must stay abreast of emerging practice issues emanating from technological advances, systems thinking, a more diverse patient population living longer with multiple chronic illnesses, and a national focus on patient safety and error prevention.  Second, there has been a national call for the transformation of nursing education, and nursing boards are seeing increasing numbers of substandard or fraudulent nursing education programs.  This adds to the boards’ workload.  Third, disciplinary activity involving nurses has increased during the last 10 years, forcing regulations to stay on their toes regarding disciplinary action and investigation.  In this challenging climate, the time is ripe to focus on evidence-based regulation as a strategy for making quality decisions related to regulation.

This article discusses the importance of developing a national, standardized program, implemented through regulation, for transitioning all newly licensed nursing graduates to practice.

While simulation in nursing programs continues to increase, it is important to understand the prevalence of this new technology in nursing education, how this technology is utilized, and how educators are preparing to teach with this educational tool.  This article reports on the results of a survey conducted by the National Council of State Boards of Nursing of 11,060 pre-licensure nursing programs in the United States as a means of describing use of simulation.  

This chapter examines the evidence that a standardized transition program for new graduate nurses has a positive impact on patient safety.

The NCSBN Board of Directors charged an NCSBN committee with reviewing and presenting recommendations for future faculty qualifications and roles.

This chapter takes the reader through the inception and process of professional regulation, highlighting distinctions and overlap between accreditation and approval.  Rationale and preparation for site visits are detailed, along with the recently written Model Nursing Practice Act.

This article discusses the factors that inspired a call for an evidence-based regulatory model for transitioning new nurses to practice, and gives an overview of the Transition to Practice model being developed by NCSBN.

The book addresses the importance of interprofessional collaboration, while this chapter presents interprofessional collaboration from a nursing standpoint.  While this may seem counterintuitive, it is understood that each discipline approaches collaboration from its own perspective, and understanding these perspectives is crucial to the success of interprofessional collaboration.

Because of the complexities in nursing and healthcare delivery and a national focus on patient safety, there has been a call across nursing organizations and healthcare organizations for more innovation in nursing and healthcare education.  The National Council of State Boards of Nursing held an invitational roundtable, involving representatives from nursing education organizations, boards of nursing, the American Nurses Association, and the Robert Wood Johnson Foundation.  Topics of discussion included the meaning and implications of innovation in nursing education, perceived barriers to innovation, and the future of innovation.  This article summarizes the outcomes of the roundtable’s discussion.

This chapter explores in detail the regulatory perspective on clinical education in nursing and why boards of nursing take the position that nursing programs need to provide supervised clinical experiences for their students.  Some of the myths about regulatory barriers are dispelled, and some of the differences among boards are discussed.  Current issues, such as the regulatory perspective on simulation in prelicensure programs and the use of exit exams are also explored.  The importance of the collaboration between education, practice and regulation is integrated throughout.

The National Council State Boards of Nursing took the position in their 2004 Model Nursing Practice Act and Model Administrative Rules, Article XVIII, Chapter 18, that if jurisdictions use medication assistants, they should be regulated by Boards of Nursing.

NCSBN data show that most employers reported that new graduates were not prepared to provide safe and effective care. Although educators may argue that employers are expecting too much from new graduates, this evidence supports that the gap between education and practice still exists.

A significant role for most state boards of nursing, whose mission is to protect the public, is the approval of nursing education programs in their state. As part of this process, many of the state boards review their schools’ annual pass rates of first-time NCLEX-RN candidates and compare these percentages to state regulations. Schools whose pass rates fall below the state standard risk losing the approval of their state board of nursing.

Evidence-based health care (EBHC) and its approach to the practice of medicine has gained considerable acceptance among health care professionals. The Association of American Medical Colleges (AAMC) advocates integration of the principles of evidence-based medicine (EBM) into undergraduate training. Promoted as a tool to further learning by inquiry, to steer clear of opinion-based medicine (Sackett et al., 2000), and to help students at all levels of training to assess conscientiously the current best evidence, an increasing number of medical schools in the United States have incorporated it into their curriculum.

Since Boards of Nursing are mandated to approve nursing programs, the boards are interested in knowing the evidence-based elements of nursing education that are essential for preparing new nurses for safe entry-level practice.

The process of providing health services in hospitals is inherently interdisciplinary; many of the challenges to enhancing quality and safety involve the human aspects of this interdisciplinary system. Each of the major disciplines—physicians, nurses, allied health providers, and health administrators—represent qualitatively distinct sets of goals and professional values, influencing not only current behavior but also who chooses these roles in the first place.