BACKGROUND: Since the COVID-19 pandemic, the turnover rate among U.S. nurses has remained elevated, and now stands at 16.4%, costing the average hospital organization more than $3 million annually. The U.S. military face...BACKGROUND: Since the COVID-19 pandemic, the turnover rate among U.S. nurses has remained elevated, and now stands at 16.4%, costing the average hospital organization more than $3 million annually. The U.S. military faces similar challenges in its nursing workforce, with rising resignations and increasing job demands resulting in a shortage of more than 1,300 active-duty nurses. Without sufficient military nurses, service members, their families, and our national defense may be negatively impacted. We therefore felt it was important to examine how military nurses' experiences influence retention. PURPOSE: This interpretive, descriptive, qualitative study aimed to explore the unique experiences of active-duty U.S. Army nurses to determine the concepts that influence retention in the military. METHODS: Twenty-four active-duty Army nurses with varying levels of nursing experience were recruited via social media. Semistructured interviews were conducted via Zoom. A six-phase cyclic process of reflexive thematic analysis was used to generate the findings. RESULTS: The concepts that influence the retention of active-duty Army nurses are multifactorial. The main themes identified were (1) "It's the people," consisting of leaders, mentors, the Army nurse community, and military care recipients, and (2) "I'm not only a nurse," capturing the dual professional roles of nurses, who are also military officers, while also considering their nonprofessional roles as individuals and family members. CONCLUSIONS: Our findings suggest that positive interpersonal relationships and the ability to balance multiple professional and nonprofessional roles contribute to retention among active-duty Army nurses. Future retention efforts should include fostering relationship-based leadership styles, enhancing mentorship opportunities, uniting the military nursing community, and instituting a clinical career track so nurses can remain focused on their patient population and the nursing profession.
Predatory conferences employ deceptive tactics to attract attendees for the purpose of making money from large registration and publication fees. Protecting oneself and others from predatory conferences requires vigilanc...Predatory conferences employ deceptive tactics to attract attendees for the purpose of making money from large registration and publication fees. Protecting oneself and others from predatory conferences requires vigilance and collective action. This article aims to inform people who may not be aware of the growing incidence and increasing savviness of predatory conferences and provides recommendations and resources to help nurses protect themselves.
Health professionals and health care organizations globally are beginning to recognize that climate change significantly threatens patient health and the sustainability of health care systems. To address these issues, he...Health professionals and health care organizations globally are beginning to recognize that climate change significantly threatens patient health and the sustainability of health care systems. To address these issues, health care professionals can use three approaches-mitigation, adaptation, and advocacy-to promote climate action, decarbonize the health care system, transform health care practice, and develop policies that protect the public. In this article, we discuss advocacy, focusing on the ways nurses can use their professional and personal voices to address climate change.
BACKGROUND: Children with autism spectrum disorder (ASD) may experience heightened fear and distress when accessing health care services, which can result in noncompliance with procedures. Management of needle pain and f...BACKGROUND: Children with autism spectrum disorder (ASD) may experience heightened fear and distress when accessing health care services, which can result in noncompliance with procedures. Management of needle pain and fear is particularly important for children with ASD given their higher utilization of health care services, neurodiversity, and limited coping skills. PURPOSE: The purpose of this quality improvement project was to implement and evaluate evidence-based interventions to improve procedural care processes and challenging behaviors in children with ASD undergoing venipuncture. METHODS: The Iowa Model was used to guide evidence-based practice (EBP) improvement in the care of children with ASD undergoing venipuncture at a pediatric procedure and imaging suite of a children's hospital at an academic medical center. Based on evidence from the literature, patient and family preferences, and clinician input, a practice change that included individualized care, patient and family preparation, clinician preparation, and system design was implemented. RESULTS: Sixteen clinicians, including RNs, medical assistants, and nursing assistants, demonstrated increased knowledge and comfort in caring for children with ASD, improved availability of resources, improved utilization of procedure support cues and workflows, and improved outcomes. Similarly, 20 parents of children with ASD demonstrated improved preparedness, staff comfort, appointment flow, supportive environment, and awareness of individual needs and communication. Process measures were used to identify opportunities for improvement, select implementation strategies, and design the practice change. CONCLUSIONS: Improvement in individualized care, patient and family preparation, clinician preparation, and system design can optimize care of children with ASD undergoing venipuncture procedures. An EBP process model and multiple targeted implementation strategies may facilitate the adoption of interventions to support these children.
Sickle cell disease (SCD) is an inherited red blood cell disorder that affects an estimated 70,000 to 100,000 people in the United States, most of whom are of African descent. SCD causes acute and chronic pain and widesp...Sickle cell disease (SCD) is an inherited red blood cell disorder that affects an estimated 70,000 to 100,000 people in the United States, most of whom are of African descent. SCD causes acute and chronic pain and widespread end-organ damage, resulting in acute and chronic complications, high morbidity, and early death. Advances in research and treatment have improved patient outcomes for people living with SCD. Over the past 10 years, several new medications and curative therapies have been approved by the U.S. Food and Drug Administration for people with SCD, and more medications are in the pipeline. This review includes historical perspectives, current treatment options, and future directions for this population. With the ongoing rapid changes in SCD care, nurses are well positioned to play a role in patient education, research, advocacy, and the implementation of these emerging therapies to advance the care of those affected by SCD.
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an immunologic, potentially fatal complication resulting from exposure to heparin, an anticoagulant. This complication may be treated with argatroban, a thrombin inhi...BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an immunologic, potentially fatal complication resulting from exposure to heparin, an anticoagulant. This complication may be treated with argatroban, a thrombin inhibitor. But dosing errors with argatroban predispose patients to further complications, including thrombosis and bleeding. PURPOSE: The purpose of this study was to assess the safety and efficacy of a standardized electronic argatroban dosing nomogram and electronic clinical decision support (e-CDS) tools used to achieve therapeutic activated partial thromboplastin time (aPTT) values in patients with confirmed or suspected HIT. METHODS: This pre- and postimplementation retrospective study was conducted in nine hospitals across a large health care system in the northeastern United States. The primary outcome of interest was the percentage of patients with two consecutive therapeutic aPTT values within the first 24 hours of therapy. Secondary outcomes included the percentage of patients with two consecutive therapeutic aPTT values within the first 48 hours of therapy, time to the second consecutive therapeutic aPTT value, bleeding events, and nurse nomogram compliance during the 48 hours after initiation of therapy. Data were compiled through retrospective chart review. RESULTS: The pre- and postimplementation groups comprised 34 and 36 patients, respectively. The percentage of patients achieving two consecutive therapeutic aPTT values within 24 hours of argatroban initiation was comparable between the pre- and postimplementation groups, at 70.6% and 63.9%, respectively. Twelve patients in the preimplementation group (35.3%) experienced bleeding events, compared to five patients in the postimplementation group (13.9%), a significant difference (P = 0.04). Nurse nomogram compliance increased significantly from 44.1% in the preimplementation group to 75% in the postimplementation group (P = 0.01). CONCLUSIONS: The implementation of a standardized electronic argatroban dosing nomogram and e-CDS tools did not impact time to reach therapeutic aPTT values but was associated with improved nurse nomogram compliance and a reduction in bleeding events.