reporter...karen andrea, ms, rn, bc subscription to the dna reporter may be purchased for $20 per...

Constituent member of ANA The mission of the Delaware Nurses Association is to advocate for the interest of professional nurses in the state of Delaware. The Delaware Nurses

Association is dedicated to serving its membership by defining, developing, promoting and advancing the profession of nursing as an art and science.Quarterly publication direct mailed to approximately 12,000 RNs and LPNs in Delaware.

Volume 40 • Issue 1 February, March, April 2015

Inside DNA REPORTER

Reporter The Official Publication of the Delaware Nurses Association

Nursing Workforce in the State of Delaware: A Current Look

Pages 5-8

DNA ChaptersI Want to Get Involved!

1

current resident or

Presort StandardUS Postage

PAIDPermit #14

Princeton, MN55371

Guest Editor . . . . . . . . . . . . . . . . . . . . . . . . 1Executive Director’s Column . . . . . . . . . . . . 1 President’s Message . . . . . . . . . . . . . . . . . . 3Keys to Success in Research and Direct Care Nursing: A Roadmap for Research Inquiry in Pediatric Nursing . . . . . . . . . . 4Nursing Workforce in the State of Delaware: A Current Look . . . . . . . . . . . . . . . . . . 5-8

The Role of a Clinical Research Nurse . . . . 9Enhanced Patient and Caregiver Engagement Drive Utilization and Quality Outcomes in an Advanced Practice Nurse-Led Care Transitions Intervention with Super Utilizers . . . . . . 10 Welcome New and Reinstated Members . . 11

Guest Editor Executive Director’s ColumnRuth Mooney, PhD, MN, RN-BC

Dr . Mooney received her BSN from Pennsylvania State University, her MN with specialization in Gerontological Nursing from UCLA, and her PhD in nursing from the University of Florida .

She began her nursing career in the Army Nurse Corps, and was stationed at Valley Forge Army Hospital . Her career included clinical nursing, eduction, and research . She was the administrator for a Practical Nursing Program, and taught on the AD and MSN level . She was a Gerontological Clinical Nurse Specialist and educator for approximately 10 years . Previously held certifications in gerontological nursing and is currently certified in Nursing Professional Development .

Dr . Mooney has been a Nursing Research Facilitator at Christiana Care Health system for the past 6 years, where she has helped clinical nurses become involved research and evidence based practice . She participates in protocol development, data collection and analysis, and dissemination of research . She is an advisor to the Nursing Research Council and the Evidence Based Nursing Practice Council and is actively involved in the Magnet application process at Christiana Care Health System . She performs a key role in the Annual Nursing Research and Evidence Based Conference .

Dr . Mooney is a member of DNA, Sigma Theta Tau International, and the Delaware Valley Geriatrics Society . She may be reached by e-mail at rmooney@christianacare .org or at her office at 302-733-1578 .

WelcomeIt is my pleasure to welcome you to this edition

of the DNA Reporter. The focus of this edition is on Nurses and Research . In this edition you will find three articles written by nurses working in Delaware who will share their unique experiences in research . An article written by Christy L . Poole, RN, BSN, CRNI, CCRC, Research Nurse Supervisor of the Department of Emergency Medicine at Christiana Hospital, describes the role of the nurse in clinical trials . This is very important work that provides for testing of drugs and devices while insuring safety of the individuals participating in the trial . A second article is written by Megan M . Williams, DNP, APRN, FNP-C, and Director of Population Health for Beebe Population Health . She describes her DNP project which she recently completed . Her research addresses health care utilization and describes a study of the impact of an Advanced Practice Nurse led initiative to improve care of patients transitioning from the hospital . The third article is from two nurses, Paula White, BSN, RN, and Jennifer Boyer, BSN, RN, who work in the Post Anesthesia Care Unit (PACU) at Nemours Alfred I . DuPont Hospital for Children Wilmington, Delaware . Their article addresses key elements needed for the support of clinical nurses conducting research in a hospital setting . Lastly, results from the Nursing Workforce Study, a joint research effort between the Delaware Nurses Association and the Delaware Board of Nursing, will provide the basis of a feature article in this edition .

I hope you enjoy this edition of the DNA Reporter and gain new insights into diverse roles nurses have in research .

Sarah J. Carmody, MBA

In November 2014, Pam Zickafoose, Board of Nursing Executive Director and I attended a Future of Nursing: Campaign for Action conference in Phoenix titled Leadership and Legacy: The Future is Now. The conference focused on advancing nursing leadership and discussed strategies to meet the goal of ‘10,000 nurses on boards by 2020 .’ This goal is a direct reflection of the IOM Future of Nursing report recommending nurses assume leadership position at all levels from boards to executive management teams to improve the health of all Americans .

In addition, Johnson & Johnson introduced a new documentary titled “Nurses: Their Vital Role in Transforming Healthcare .” In the documentary, seasoned nurses discuss how fellow nurses can be leaders in transforming today’s health care system for the better . A link to the video can be found on the DNA website .

As we move forward in 2015, envision yourself as a leader! Make it a point to move out of your comfort zone and stretch your abilities and knowledge by answering the call to be a leader . Terri Sterling, MSN, MBA, the COO of Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana

Ruth Mooney

Sarah Carmody

Executive Director continued on page 2

• DNA Reporter February, March, April 2015

Vision: The Delaware Nurses Association is dedicated to serving its membership by defining, developing, promoting and advancing the profession of nursing as an art and science.

Mission: The Delaware Nurses Association advocates for the interest of professional nurses in the state ofDelaware.

Goals: The Delaware Nurses Association will work to:

1. Promote high standards of nursing practice, nursing education, and nursing research.

2. Strengthen the voice of nursing through membership and affiliate organizations.

3. Promote educational opportunities for nurses.

4. Establish collaborative relationships with consumers, health professionals and other advocacy organizations.

5. Safeguard the interests of health care consumers and nurses in the legislative, regulatory, and political arena.

6. Increase consumer understanding of the nursing profession.

7. Serves as an ambassador for the nursing profession.

8. Represent the voice of Delaware nurses in the national arena.

OFFICIAL PUBLICATIONof the

Delaware Nurses Association

4765 Ogletown-Stanton Road, Suite L10Newark, DE 19713

Phone: 302-733-5880Web: http://www.denurses.org

The DNA Reporter, (ISSN-0418-5412) is published quarterly every February, May, August and November by the Arthur L. Davis Publishing Agency, Inc., for the Delaware Nurses Association, a constituent member association of the American Nurses Association.

ExECUTIVE COMMITTEE

President TreasurerKaren Panunto, Victoria Varga, RN Ed.D, RN, APN

SecretaryAlana King, MSN, RN

COMMITTEE CHAIRS

Continuing Education Advanced PracticeTerry Towne, MSN, RN-BC-NE-BC Allen Prettyman, Kathy Davidson, MSN, RN-BC, SDS PhD, FNP-BCCo-Chairs

Committee on Nomination Professional Development Jane Kurz, PhD, RN May Oboryshko, MSN, RNChair

Vacant Legislative Melanie Marshall, RN

Vacant

Environmental Ad-Hoc CommunicationsAnn Darwicki, RN William T. Campbell, Ed.D, RNNursing Healing Our Planet Jennifer Hargreaves, BA, RN(NHOP)

Executive Director


CE Coordiator

Karen Andrea, MS, RN, BC

Subscription to the DNA Reporter may be purchased for $20 per year, $30 per year for foreign addresses.

For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. DNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

Acceptance of advertising does not imply endorsement or approval by the Delaware Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. DNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of DNA or those of the national or local associations.

Managing EditorsWilliam T. Campbell, Ed.D, RNJennifer Hargreaves, BA, RN

The DNA Reporter welcomes unsolicited manuscripts by DNA members. Articles are submitted for the exclusive use of The DNA Reporter. All submitted articles must be original, not having been published before, and not under consideration for publication elsewhere. Submissions will be acknowledged by e-mail or a self-addressed stamped envelope provided by the author. All articles require a cover letter requesting consideration for publication. Articles can be submitted electronically by e-mail to Karen L. Panunto, EdD, RN, APN @ [email protected].

Each article should be prefaced with the title, author(s) names, educational degrees, certification or other licenses, current position, and how the position or personal experiences relate to the topic of the article. Include affiliations. Manuscripts should not exceed five (5) typewritten pages and include APA format. Also include the author’s mailing address, telephone number where messages may be left, and fax number. Authors are responsible for obtaining permission to use any copyrighted material; in the case of an institution, permission must be obtained from the administrator in writing before publication. All articles will be peer-reviewed and edited as necessary for content, style, clarity, grammar and spelling. While student submissions are greatly sought and appreciated, no articles will be accepted for the sole purpose of fulfilling any course requirements. It is the policy of DNA Reporter not to provide monetary compensation for articles.

Reporter

Published by:Arthur L. Davis

Publishing Agency, Inc.

http://www.denurses.org

Did you know the DNA Reporter goes

to all registered nurses in Delaware

for free?

Arthur L . Davis Publishing does a great job of contacting advertisers, who support the publication of our newsletter . Without Arthur L . Davis Publishing and advertising support, DNA would not be able to provide the newsletter to all the nurses in Delaware .

Now that you know that, did you know receiving the DNA Reporter does not automatically provide

membership to the Delaware Nurses Association?

DNA needs you! The Delaware Nurses Association works for the nursing profession as a whole in Delaware . Without the financial and volunteer support of our members, our work would not be possible . Even if you cannot give your time, your membership dollars work for you and your profession both at the state and national levels . The DNA works hard to bring the voice of nursing to Legislative Hall, advocate for the profession on regulatory committees, protect the nurse practice act, and provide educational programs that support your required continuing nursing education .

At the national level, the American Nurses Association lobbies, advocates and educates about the nursing profession to national legislators/regulators, supports continuing education and provides a unified nationwide network for the voice of nurses .

Now is the time! Now is the time to join your

state nurses association! Visit www.denurses.org to join or

call (302) 733-5880.

Executive Director continued from page 1

answered the call . She served on many non-profit boards before being recommended and currently serving, as a member of the Board of Directors of the Federal Reserve Bank of Atlanta . Where will you go?

As you move outside of your comfort zone, what was once the unknown and frightening becomes your new normal. ~ Robin S . Sharma

Always Caring. Always Here .

Nanticoke Health Services has a history of offering a progressive and professionally rewarding workplace for its employees. We’re committed to exceeding patients’

expectations and ensuring that our values of excellence and teamwork are shared by all.

With a growing medical staff, innovative programs and technology, in addition to excellent compensation and

benefits packages, Nanticoke continuously strives to be an employer of choice.

We have current openings for experienced ED and ICU RNs, with other opportunities in Med-Surg

and Progressive Care Unit.

For current nursing opportunities, visit us at:

www.nanticoke.org

That research paper isn’t going to write itself.

Visit www.nursingALD.com

to gain access to 600+ issues of official state nurses publications, all to

make your research easier!

February, March, April 2015 DNA Reporter •

Newly Elected Treasurer Bonnie Osgood and incoming President Karen Panunto

Outgoing President Leslie Verucci and Jane Kurz, Nominating Committee Chair

New Reporter Editors William Campbell and Jennifer Hargreaves

President’s Message

Karen L. Panunto

Welcome to the February-March-April edition of the DNA Reporter . I want to thank Dr . Ruth Mooney for her willingness to serve as the current Guest Editor in highlighting several research efforts of nurses in our state . It is inspiring to read articles that demonstrate the use of evidence-based practice in clinical decision making from nurses working in our state . In particular, I am excited to share with you results from the Nursing Workforce study . As nurses are vital components in providing safe and patient focused healthcare, results from this study will provide Delaware leaders with a current picture of what is occurring to the nursing profession in this state, and emphasize the need to make the nursing workforce a priority focus .

On another note, having just returned from participating in the American Nurses Association’s Presidents Immersion Course, I am motivated to begin planning with the DNA Board of Directors for future activities that will align with the organization’s mission . Over the next several months, the Board will be charged to evaluate current operations, resources, and programs for the purpose of short-term and long-term planning . To consider the following questions: “What are we doing that we should be doing more of? What are we doing that we should be doing less of? What are we doing that we should stop doing? What aren’t we doing that we should be doing?” (Centers for Strategic Planning, 2012) . During planning sessions, the Board needs to consider, what are the new directions for the organization to take? Through careful strategic planning, the DNA’s organizational goals will continue to align with the ANA’s strategic goals that are focused on nurses advancing our profession to improve health for all:

2014-2016 ANA Strategic Goals1 . Promote a safe, ethical work environment as

well as the health and wellness of nurses in all settings .

2 . Advance the Quality and safety of patient care in a transforming health care system .

3 . Optimize professional nursing practice and the quality of health care through leadership development and by ensuring full use of the knowledge and skills of RNs and APRNs .

4 . Aggressively grow membership by acquiring, engaging and retaining members; strengthening the membership value proposition and increasing ANA’s capacity to deliver customized experiences .

5 . Strengthen Constituent and State Nurses Associations and the ANA Enterprise through mutual partnerships .

Lastly, the ANA Membership Assembly will be held this year from July 23, 2015 through July 25, 2015 . It is during Membership Assembly when critical issues involving nursing practice and policy are discussed and voted . As the DNA is a constituent member organization (C/SNAs), two elected members are eligible to attend and participate in the voting process . Prior to the Membership Assembly, the DNA will have the opportunity to propose Bylaw changes beginning January 26, 2015 through March 4, 2015 . Any suggestions for proposed Bylaws changes should be directed to Sarah Carmody at the DNA office .

ReferencesAmerican Nurses Association . 2014-2016 Strategic Goals .

Nurses advancing our profession to improve health for all . Retrieved from: http://www .anacalifornia .org/docs/ANAStrategicPlanFlyer_Final_September_2014 .pdf

Reprinted with Permission ©2012 Center for Strategic Planning . Retrieved from: www .centerforstrategic planning .org


Keys to Success in Research and Direct Care Nursing:A Roadmap for Research Inquiry in Pediatric Nursing

Paula White, BSN, RN, CPN

Ms . White has her certification in Pediatric Nursing (CPN) . She has over 30 years of nursing experience in adult and pediatric ED nursing and in Perianesthesia Critical Care Unit (PACU) experience . She is currently a level IV Clinical Nurse in the Perianesthesia Care Unit at Nemours Alfred I . duPont Hospital for Children .

She may be reached at Paula .White@nemours .org

Jennifer Boyer, BSN, RN

Ms . Boyer received her BSN from the University of Connecticut in 1995 . She has spent the majority of her nursing career in emergency nursing caring for adults, but now enjoys working with children . She is currently a Clinical Nurse III in the Perianesthesia Care unit at Nemours Alfred I . duPont Hospital for Children .

She may be reached at Jennifer .Boyer@nemours .org

Paula White, BSN, RN, CPN and Jennifer Boyer, BSN, RN

Navigating the research system as a nurse today requires guidance and support from our nursing leaders . Nurse leader participation is essential to the success of research, and is dependent on collecting information regarding nurse practices and clinical processes (Bolton et al ., 2005) . It is important to find ways to educate and develop our knowledge regarding research . The bedside is the laboratory for direct care nurses . At the bedside, nurses are best equipped to identify the clinical issue, review the literature, develop a research plan, and collect and evaluate data to bring new knowledge into daily practice . Quality improvement is methodical with data –guided activities designed to bring about immediate improvements in health care delivery .

Research is a lengthy process, highly structured, and builds a new knowledge base for typically tradition based nursing practice . Both require review, approval and some degree of oversight by the Institutional Review Board of the organization (Bellin & Neveloff-Dubler, 2001) .

We encourage nurses not to become overwhelmed by the process of research . As we have been mentored and lived the research process, we have become passionate about its importance to direct nursing care . In turn we have become mentors on our unit, encouraging other nurses to ask questions regarding certain practices and participate in research projects on the unit . By doing this, we can empower ourselves through the inquiry process, become national leaders on that subject through conferences, discussions, lectures and presentations . We as nurses will experience strength and take control of our practice . But this may not be enough, as the steps to get there require engagement at the highest levels of the institution .

Importance of Engagement of Institutional Leadership

A health system, and nursing leadership within that system, has a profound influence on how we perceive research and how it affects us as nurses in the health care field . Does the institution support research and evidenced based practice? Do leaders model scholarship by conducting their own scholarly inquiry? Successful collaboration between nursing leadership and direct care nurses may contribute to the efficient use of nursing resources; improve patient outcomes, and ultimately, nurse satisfaction and retention (Lamont, Brunero, Lyons, Foster & Perry, 2014) .

Several systems at Nemours A . I . duPont Hospital for Children are in place to facilitate research by direct care nurses . First, the Shared Governance Model encourages nurses to conduct research to address questions that may occur while in practice . The Shared Governance Model champions and inspires nurses to become leaders and take control of the quality of care that is given to their patients . Second, the Research Committee promotes research through availability of an avenue to review proposed projects, provide mentorship to develop a research study, and assist with expenses through the awarding of a Nightingale grant . The Nightingale fund is available, once a proposed project is reviewed by the Committee and approved for funding, to assist with expenses for pilot studies or quality improvement projects Research is the hallmark of the future in medicine . Third, a strong leader in the area of research, who can inspire, mentor and encourage direct care nurses to participate in research and quality improvement is important . At Nemours, we are fortunate to have Dr . Christina Calamaro, the Director of Research for Nursing,

Continuing Education Courses

http://www.ed2go.com/polytech/ orwww.polytechworks.com

Customized training programs available!

Contact: Jeremy McEntire302-697-4545 or [email protected]

available to the Department of Nursing to assist us in honing our research question, developing the methodology, and navigating the IRB process . Under Dr . Calamaro’s direction, we have been inspired to become research advocates, and have instituted studies on our units as well as act as a resource for other nurses in the PACU who desire to do research .

Leadership and Mentorship of Nurses on the Research Process

“The secret of good leadership is the ability to inspire others with faith in their own high potential” (Walters, 1993, p . 53) . Dr . Calamaro has taught us that each nurse has her finger on the pulse of practice, and through research and quality improvement can make important contributions . As direct care nurses in the PACU, we see this value and through our leadership roles, we believe we can impact others by demonstrating the significant difference each can make in their everyday practice through testing a hypothesis or improving delivery of care by a quality improvement project . Additionally, mentorship involves networking with nurses on other units to determine what they are doing to improve care, collaborate or share experiences .

For my department, I (Paula White) am the unit representative for the Research committee . This has afforded me the opportunity to collaborate with other nurses in an effort to move our practice forward and continue to maintain excellence in the standard of care in our institution . Both of us encourage nurses to become involved in a study either through quality improvement, or a research study in order to meet this goal . Changes in nursing practice often reflect rapid changes in the health care environment . With these changes, the direct care nurse may have questions regarding clinical practice that require exploration . Therefore, it is important for the direct care nurse to be in an environment that continually supports inquiry about practice . This provides a real opportunity for the nurse to change standards of practice that are realized to be not operating effectively . The investigation is the means to implementing research . At Nemours A .I duPont Hospital for Children, nursing leadership views nursing research as a priority and encourages the nursing staff to question practice as a mechanism to improve care .

As nursing professionals we have the responsibility to question our practice in order to achieve excellence in the delivery of care to our patients . The most significant source of empowerment is knowledge . Nurses need to tap into their expertise and do research or quality improvement at the bedside . Using the bedside as our laboratory allows us to gather information to implement research studies . Research scholarship is an essential part of our career that promotes leadership and mentorship, and helps to establish nursing care as critical to improving the health and wellness of patients in the healthcare system .

ReferencesBellin, E ., & Neveloff –Dubler, N . (2001) . The quality

improvement–research divide and the need for external oversight . American Journal of Public Health, 91(9) . 1512–1517 .

Bolton, L .B ., Shihady, I .R ., Bennett, C ., Broussard, P ., Fridman, M ., Fink, A ., … Gregory, KD . (2005) . Engaging nurse leaders in health services research . Journal of Nursing Administration, 35(5) . 238-43 .

Lamont, S ., Brunero, S ., Lyons, S ., Foster, K ., & Perry, L . (2014) . Collaboration amongst clinical nursing leadership teams: a mixed-methods sequential explanatory study . Journal of Nursing Management, Nov 5 . doi: 10 .1111/jonm .12267

Walters, D . (1993) . The Secret of Leadership. Nevada City, Nevada: Crystal Clarity Publishers .

Start your future here!Find the perfect nursing job that meets your needs at

nursingALD.com


Karen L. Panunto, EdD, MSN, RN, APN and Sarah Carmody, MBA

Karen L. Panunto, EdD, MSN, RN, APN

Dr . Karen L . Panunto earned her ADN and MSN from Wesley College and her EdD from Wilmington University . Her MSN is in Community Health Nursing, Health Promotion and Wellness, and her doctorate is in Educational Leadership with a concentration i n O r g a n i z a t i o n a l Leadership . Dr . Panunto is currently licensed as an Advanced Practice Nurse in health promotion and wellness . She is an Associate Professor of Nursing at Wesley College and is the BSN Program Director . Dr . Panunto has been an active member of the Delaware Nurses Association for over 17 years and currently serves as President of the organization . She can be reached at Karen .Panunto@wesley .edu or by phone at (302)736-2511 .


Sarah Carmody earned Bachelor of Arts degree in marketing and economics from Saint Martin’s University in Lacey, Washington . Her Master of Business Administration was earned from Goldey B e a c o m C o l l e g e i n Wilmington, Delaware . Ms . Carmody is the Executive Director of the Delaware Nurses Association and is also an adjunct instructor at Goldey Beacom College .

Abstract

Purpose: Nursing is the largest health care profession in the country, providing care in underserved areas, hospitals, walk-in clinics, schools, prisons, and in the home . A nursing workforce shortage would prove to be detrimental to the health care industry and communities . Recognizing the need to have a sufficient number of registered nurses to meet the health care needs of the population, the Delaware Nurses Association (DNA) and the Delaware Board of Nursing partnered in a joint research effort to examine the current composition of registered nurses licensed and practicing in the state of Delaware .

Methods: For the purpose of this study, the Delaware Board of Nursing sent an email to 14,750 registered nurses licensed in the state of Delaware with a link to an electronic survey questionnaire for voluntary completion . A total of 4,265 (29 .98%) registered nurses completed the online survey questionnaire from January 17, 2014 through March 15, 2014 . Data were gathered on the age, race, gender, educational level, employment status and location, practice area, wages/salaries, and workplaces of the registered nurses .

Results: Of the registered nurses that responded, 77 .07% were practicing in the State of Delaware . Of the respondents (74 .78%) reported to being > 40 years of age with 53 .26% of that group being > 50 years of age . The following are selected highlights of the study: 33 .93% hold a Bachelor of Science in Nursing Degree; 75 .43% have been practicing for 11 years or greater, and 44 .64% reportedly practice in a hospital setting .

Conclusion: With the current aging nursing workforce, results from this study support the need

Nursing Workforce in the State of Delaware:A Current Look

for Delaware leaders to recognize that the priority focus for the future of healthcare in Delaware must be placed on ensuring a sufficient nursing workforce . Efforts should be placed on providing additional education funding opportunities as support for future nurses and nursing education programs, as well as encouraging hospitals and other employers to hire new nurses in order to maintain adequate staffing levels . In addition, financial assistance should be provided for further research endeavors on the nursing workforce supply .

The issue of whether or not there will be a sufficient number of registered nurses to meet the future health care needs of the population is of particular concern for the health care industry . According to the American Nurses Association (2014), by the year 2020 there will be a need for over 1 .1 million new registered nurses to ensure a sufficient nursing workforce . McMenamin (2014) agreed and added that “by 2020 total employment of RNs and APRNs will increase by 574,400 jobs . In fact, with RN retirements also in the mix, the nation will need to have produced 1 .13 million new RNs by 2020 to fill those jobs” (p . 8) . Auerbach, Staiger, Muench, and Buerhaus (2012) pointed out that there are several factors which will contribute to the demand for health care over the next two decades, such as an aging baby boomer generation, an increase in the overall population, and an increase in the number of people living with chronic health issues . McMenamin (2014) emphasized that the demand will escalate as the Medicare program is stressed by the addition of “two to three million people” (Surviving the Transition, para . 6) every year through the end of this century . In addition, Auerbach et al . (2012) noted that another factor to the increased demand for health care is the millions of Americans to be covered under the Affordable Care Act .

To further complicate the issue of whether there will be a sufficient nursing workforce in the future is the aging population of registered nurses . Buerhaus, Auerbach, Staiger, and Muench (2013) pointed out that “nationally, approximately 850,000 RNs are between the ages of 50-64 (a third of the RN workforce)” (pp . 13-14) . As many of these nurses begin to retire by the year 2020, it is essential that they be replaced . In addition, it is not only imperative to replace those retiring, but there will be additional RNs needed to meet the growing population, or as suggested by Dolan (2010) “…a crisis may be looming” (p . 9) .

Buerhaus (2012) discussed several large scale endeavors initiated over the past decade in an attempt to draw attention to the nursing profession . Publicity focused on the Johnson & Johnson Campaign for Nursing’s Future, the Robert Wood Johnson Foundation, and the Gordon & Betty Moore Foundation have been successful in increasing the number of individuals who have entered the nursing profession . Buerhaus (2012) pointed out that “in fact, the number of young people becoming nurses is so large that it rivals the number of baby boomers who entered the nursing profession back in the 1960s and 1970s” (p . 10) .

In addition to strategies focused on increasing the RN population, the recession has also played a part in bringing registered nurses either back into the workforce, or has led them to change from being part-time employees to full-time employees (Singleton, 2010; Buerhaus, 2012) . Indeed, Beurhaus pointed out that during the recession that started in December 2007 and ended in June 2009 there was a rise in health care related jobs . Beurhaus explained that “in 2007 and 2008, RN employment increased by an estimated 243,000, the largest employment increase during any 2 year period in the past four decades” (2012, p . 11) . Singleton (2010) shared that “the 2014 Bureau of Labor Statistics (BLS) places registered nursing as the occupation with the most robust growth compared to other occupations for 2008-2018 . Projected growth of 22%, or more than 580,000 employment opportunities is expected for RNs” (p . 209) . McMenamin (2014) explained that the economic recovery affecting market changes as well as employer changes and care coordination

Nursing Workforce continued on page 6

will also contribute to the demand . Currently, the concern being raised is that with an improvement in the economy, there will be a large number of nurses leaving the workforce . Beurhaus (2012) concurred that, “while the surge in young people entering nursing is very promising and welcome news, the big question remains: will it be enough?” (Buerhaus, 2012, p . 11) .

The ANA (2014) suggested that in order to ensure a sufficient number of registered nurses, strategies need to focus on providing resources, such as federal funding to support future nurses and nursing education programs, as well as addressing employer hiring practices . According to the ANA, federal funding has decreased an average of 2 percent over the past several years . This is a concern with the future demands that will be placed on the nursing profession . The ANA has proposed an increase of 12 percent in Title VIII federal funding for the year 2015 . The ANA reported that in 2012, there were roughly 80,000 applicants turned away from nursing education programs due largely to an insufficient number of faculty . Lack of sufficient faculty and clinical training experiences has a negative impact on the future RN workforce . Unfortunately, this is not a new trend . In 2006, Dienno pointed out that schools were limiting student admissions into nursing programs to compensate for an insufficient number of qualified nursing faculty . Further, with many faculty leaving the academic environment due to stressors from overwork or reaching retirement age, existing faculty are left to carry on the burden of meeting additional curricular demands; this compounds an already unhealthy, stressful environment (Dienno, 2006) . Also, results from a 2013 survey indicated that a majority (72%) of faculty who teach in nursing education programs are over 50 years of age (ANA, 2014) . McMenacin (2014) pointed out that this could be detrimental to the nursing profession with such a large number of nursing faculty on the verge of retirement and contends that by 2022 there will be a need for over 30,000 new nursing faculty .

Over the next two decades, the health care industry will be challenged as an aging population of registered nurses progress to retirement . As pointed out by the ANA (2014), nurses are pivotal members of the health care team and strategies to maintain an adequate nursing workforce need to be a priority focus for the future . Emphasis should be placed on ensuring adequate funding for nursing education programs in efforts to provide potential students with the opportunity to pursue a nursing degree as well as provide continued support for nursing faculty to teach the next generation of RNs . Hospitals and other health care agencies need to recognize their role in ensuring an adequate nursing workforce by embracing the concept of hiring new graduates to work alongside experienced RNs currently in the workplace .

Methodology

The purpose of this study was to examine the current composition of registered nurses licensed in the state of Delaware . This study was conducted in partnership between the Delaware Nurses Association and the Delaware Board of Nursing . The researchers conducted a non-experimental study . The tool utilized for the study was an online survey questionnaire with categories that included demographics, education, employment (status and location), practice area, wages/salaries, and workplace . The questionnaire took approximately 5 minutes to complete .

The Delaware Board of Nursing sent an email with a link to the electronic survey questionnaire to 14,750 registered nurses in Delaware . Of those emails sent, 523 were returned undeliverable . The email included an explanation of the purpose of the study, that answers were optional, and that all responses were anonymous . Delaware registered nurses were informed of the workforce study via the DNA website and Listserve, Facebook, and the DNA quarterly publication, The Reporter. The first email was sent January 17, 2014 with a reminder


email sent on February 19, 2014 . The deadline for participating in the study was March 15, 2014 .

Participants were not asked identifying information such as their names or places of employment . Implied consent was given by the voluntary completion of the questionnaire . Data was analyzed using the online survey software, SurveyMonkey .

Results

There were 4,265 completed questionnaire responses to the online survey questionnaire . The population sample size for this study represented a 29 .98% response rate of registered nurses licensed in the state of Delaware . Data were analyzed using the online survey software, SurveyMonkey .

Demographics

The sample of registered nurses for this study yielded the following demographic information:

• 3,867(91.83%)females

• 344(8.17%)male

(54 participants did not respond to this question)

The ages of the registered nurses ranged from 20-29 years through 70 years and older with the largest responses (32 .87%) from nurses between the ages of 50-59 years . The second largest responses (21 .52%) were between 40-49 years old, and the third largest (18 .11%) were 60-69 years of age . (See Table I, Age of Registered Nurses)

Table I: Age of Registered Nurses

Age 20-29 years

30-39 years

40-49 years

50-59 years

60-69 years

70 and over

Total

Percentage 9 .65% 15 .56% 21 .52% 32 .87% 18 .11% 2 .28%

Response N= 410 661 914 1,396 769 97 4,247

Missing: N=18

Race/ethnicity was also collected for this study . The largest group, 86 .65% of participants were White . The second largest (7 .56%) were African American, and the third largest (2 .01%) were Asian/Pacific Highlander . (See Table II, Race/Ethnic Group)

Table II: Race/Ethnic Group

Demographics

American Indian/Alaska Native

Asian/Pacific Islander

African American, not of Hispanic Origin

HispanicMulti-racial

White, not of Hispanic origin

Other Total

Percentage 0 .21% 2 .01% 7 .56% 1 .23% 1 .23% 86 .65% 1 .11%

Response N= 9 85 320 52 52 3,667 47 4,232

Missing: N=33

The largest group of participants (46 .61%) reported residing in New Castle County . The second largest group (20 .3%) reported residing in Sussex County, and (13 .76%) Kent County . A total of 781 respondents (19 .33%) indicated not residing in Delaware . (See Table III, State/County of Residency)

Table III: County/State of Residency

New CastleCounty

Kent County

Sussex County

MarylandNew Jersey

Pennsylvania Total

Percentage 46 .61% 13 .76% 20 .30% 1 .29% 3 .71% 14 .33%

Response N= 1,883 556 820 52 150 579 4,040

Missing N= 225

Education

The largest proportion of participants (33 .93%) hold a Baccalaureate degree in nursing, the second highest (22 .74%) hold an Associate degree, and (20 .88%) have an earned Master’s Degree in Nursing . A small percentage of respondents (3 .17%) hold a doctoral degree, and 1 .67% hold a doctoral degree in nursing . (See Table IV, Highest Level of Education) . A majority of respondents (60 .95%) reported that they are certified .

Slightly more than fourteen percent of participants were currently enrolled in a nursing education program . When asked how participants were continuing their education, 52 .77% specified a traditional program and 18 .95% indicated an online program . A large majority (80 .26%) reported nursing as a first career choice .

Table IV: Highest level of Education

VocationalPractical certificate

DiplomaAssociateDegree

Bachelor’sDegree-Nursing

Bachelor’sDegree-Other

Master’sDegree-Nursing

Master’sDegree-other

DoctoralDegree-Nursing

DoctoralDegree- other

Total

0 .05% 8 .77% 22 .74% 33 .93% 4 .94% 20 .88% 5 .53% 1 .67% 1 .50%

N=2 N=373 N=967 N=1,443 N=210 N=888 N=235 N=71 N=64 4,253

Missing N=12

Practice/Employment Status

The greatest number of registered nurses (24 .57%) have practiced less than 10 years . The second largest (23 .51%) between 31-40 years, and the third largest (21 .57%) between 21-30 years . (See Table V, Years of Practice)

Table V: Years of Practice

Less than 10 11-20 21-30 31-40 More than 40 Total

24 .57% 21 .17% 21 .57% 23 .51% 9 .18%

N=1,039 N=895 N=912 N=994 N=388 4,228

Missing N=37

Participants were asked how long they plan to continue the practice of nursing . The average response was 27 .8% for those who anticipated practicing nursing between 11-20 years and 27 .79% for greater than 20 years . . Of the remaining participants, 26 .38% reportedly plan to practice 5-10 more years, 15 .08% less than 5 years, and 2 .93% for less than a year . (See Table VI, Continued Practice)

Table VI: Continued Practice

<1 year <5 years 5-10 years 11-20 years >20 years Total

2 .93% 15 .08% 26 .38% 27 .82% 27 .79%

N=120 N=618 N=1,081 N=1,140 N=1,139 4,098

Missing N= 167

The largest percentage of registered nurses (91 .12%) were employed in nursing, 2 .95% were seeking employment, 1 .75% were neither working nor seeking employment, and 2 .53% were retired and do not plan to return to the workforce . A small percentage (1 .65%) of participants worked in a field other than nursing . For those participants who were unemployed, 5 .57% were having difficulty finding a position, 2 .75% were taking care of home and family, 1 .49% were disabled, and 0 .16% indicated that it was due to inadequate salary .

Employment Location

The majority of registered nurses (49 .43%) were employed in New Castle County . The second largest group (15 .05%) were employed in Sussex County, followed by 12 .59% who were employed in Kent County . A total of 13 .68% of participants indicated they were not employed in Delaware . Of those participants, 7 .48% worked in Pennsylvania, 1 .43% in New Jersey, and 4 .92% in Maryland .

Nursing Workforce continued from page 5


Learn more about aging and disability resources and decide what services best meet your

needs.

ADRC provides easy access to aging and disability information

and resources in Delaware.

Contact the ADRC at:Phone:

1-800-223-9074

E-mail: [email protected]

Web: www.DelawareADRC.com


Practice Setting

The largest number of registered nurses (44 .64%) were employed in a hospital setting . The ambulatory care setting was the second highest (9 .03%), and nursing homes were the third highest setting (6 .65%) . (See Table VII, Practice Setting of Registered Nurses)

Nursing Practice

The largest number of registered nurses (71 .50%) reported providing direct care to patients . The majority of the participants (41 .65%) noted their practice role as being staff/general duty nurses with the second highest roles (12 .46%) as Nurse Practitioners/Certified Nurse Midwife/Certified Nurse Specialist/Nurse Anesthetist . (See Table VIII Nursing Practice)

Table VIII: Nursing Practice

My nursing role is best described as

Department Administrator/Supervisor

DischargePlanner/Case Manager

Educator Faculty

Nurse Practitioner/certified Nurse MidwifeCNS/Nurse Anesthetist

Quality Assurance/Infection Control

Researcher/Consultant

Staff/GeneralDuty Nurse

Total

6 .75% 3 .66% 5 .53% 2 .11% 12 .46% 1 .48% 1 .87% 41 .65%

N=282 N=153 N=231 N=88 N=521 N=62 N=78 N=1741 3156

Missing N=1,109

Workplace

This portion of the study attempted to identify the perception Delaware nurses had of their workplace and the support they received from employers . The range for responses was 0-5 with 5 being the highest and 0 being the least . A majority (33 .39%) gave their employers the highest ranking in feeling appreciated in the workplace with almost the same percentage (32 .25%) who experienced a positive environment working with other nurses . When asked about employer support 20 .51%, ranked employers the highest in the area of workload support and 18 .60% ranked their employers the highest in staffing ratios . In both areas, a relatively high percentage (21 .0% and 21 .72% respectively) indicated a neutral position . (See Table IX, Workplace Environment)

Table IX: Workplace Environment

0Low

1 2 3 45High

N/A Total

Do you feel valued/respected/appreciatedin the workplace?

3 .29%N=138

4 .91%N=206

8 .11%N=340

18 .03%N=756

28 .64%N=1,201

33 .39%N=1,400

3 .79%N=159

4,193

Missing N=72

Do you feel the RN to RNtreatment in your workplace is positive?

1 .48%N=62

3 .06%N=128

5 .55%N=232

17 .51%N=732

31 .41%N=1,313

32 .25%N=1,348

9 .09%N=380

4,180

Missing N= 85

How would you rank employer support with respect to workload?

6 .44%N=269

7 .75%N=324

11 .78%N=492

20 .99%N=877

27 .64%N=1,155

20 .51%N=857

5 .19%N=217

4,178

Missing N=87

How would you rank staffing ratios in your place of employment?

5 .32%N=222

7 .00%N=292

10 .02%N=418

21 .71%N=906

26 .82%N=1,119

18 .60%N=776

11 .36%N=474

4,173

Missing N=92

Discussion

Age

The predominate age range of 50-59 represented 32 .87% of responding registered nurses in the state of Delaware with the majority of respondents (74 .78%) who were 40 years or greater . Registered nurses of 29 years of age or less represented 9 .65% of responses . These finding were consistent with the national age of the nursing workforce which demonstrated a distribution to be highest over the age of 46 years (Nooney et al ., 2013), and reflected a third of the nursing workforce or approximately 850,000 nurses (ages 50-64) nearing retirement age with many expected to retire by 2020 (Buerhaus, 2013) . According to a 2013 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 53% of the RN workforce were age 50 or older (Budden, Zhong, Moulton, & Cimiotti, 2013) . Future projections have indicated that more than 1 million registered nurses will reach retirement age within the next 10 to 15 years (Health Resource and Service Administration [HRSA], 2013) .

Race/Ethnicity

Delaware data related to Race/Ethnicity of registered nurses were compared with national statistics obtained from Minority Nurse (2014) . A large proportion (86 .65%) of Delaware registered nurses identified as being White (not of Hispanic origin) which was higher than the national percentage (75 .45%) of registered nurses who reported being White . Delaware registered nurses (7 .56%) identified as African American (not of Hispanic origin) was slightly lower than the national statistic (9 .9%) . In Delaware, 2 .01% of registered nurses identified themselves as Asian/Pacific Islander which was significantly lower than the national percentage of 8 .3% . The Hispanic population of registered nurses in Delaware was reported to be 1 .23% which was significantly lower than the national number of 4 .8% . American Indian, Alaska Native, and Multi-racial ethnic groups represented 1 .44% of registered nurses in Delaware . Nationally, 0 .4% of registered nurses were reportedly American Indian or Alaskan Native, and 1 .3% categorized themselves as two or more races .

Gender

Of those registered nurses who responded to the survey, 91 .83% were female and 8 .17% were male . This was fairly consistent with national numbers in that 9 .1% of registered nurses were reportedly male (Minority Nurse, 2014) . Overall, the population of registered nurses who are male has significantly increased as in 2008 the percentage was reported to be at 6 .6% having demonstrated an upward trend in the RN male population (U .S . Department of Health and Human Services, Health and Resource Service Administration [HRSA], 2010) .

Education

Data for the educational level of registered nurses in Delaware was compared with data reported by the Health and Resource Service Administration [HRSA] report in 2013 based on the 2008-2010 American Community Survey (ACS) .

The number of Diploma graduates reported in Delaware was 8 .77%, which was greater than the national average of 6 .9% . There were reportedly 22 .74% of registered nurses working in Delaware educated at the Associate Degree level compared to the national average of 37 .9% . Reportedly 33 .93% of registered nurses in Delaware who were educated with a Baccalaureate in Nursing Degree compared with 44 .6% nationally . Of the total Delaware respondents, 20 .88% hold a Master’s Degree in Nursing, and 1 .67% hold a Doctorate in Nursing . Nationally, 10 .3% of registered nurses hold a Master’s Degree in Nursing, and 0 .4% hold a Doctorate degree in nursing .

A total of 14 .17% of registered nurses in Delaware reported being enrolled in a nursing educational program with 52 .77% enrolled in a traditional program and 18 .95% who participated in online classes . This is fairly consistent with findings from the 2008 National Sample Survey of Registered Nurses (HRSA, 2010) which reported that slightly over 15% of registered nurses pursuing a higher degree were enrolled in a distance education program .

Nursing Practice

Current to this study, the majority of registered nurses in Delaware (44 .64%) reported working in a hospital setting . This number was significantly lower than the national number which was reported to be 63 .2% (HRSA, 2013) . The second ranking category for employment in Delaware was ambulatory care (9 .03%) which was slightly lower than the national reported number reported at 10 .5% (HRSA, 2010) . Nursing home/extended care was the third ranked employment location at 6 .65% for Delaware registered nursing which was slightly lower than the national average of 7 .4% (HRSA, 2013) . A small percentage (4 .1%) of registered nurses in Delaware responded that they work in an Academic setting . Nationally it is reported that 0 .6% of registered nurses were employed in colleges/university (HRSA, 2013) . Employment in Home Health was reported by 3 .81% of Delaware respondents . This was significantly lower than nationally where 6% responded as practicing in Home Health (Bureau of Labor Statistics, 2014) . Working in the Community Health setting was 2 .57% of Delaware respondents . Nationally, 7 .8% of registered nurses in 2008 were employed in the public health setting to include school and occupational health (HRSA, 2010) .



Table VII: Practice Setting of Registered Nurses

Practice Setting Percentage Response N=

Academic Setting 4 .10% 172

Ambulatory Setting 9 .03% 379

Assistant Living 0 .62% 26

Community Health 2 .57% 108

Correctional Health 0 .60% 25

Home Health 3 .81% 160

Hospice 1 .67% 70

Hospital 44 .64% 1,874

Insurance claims/Benefits 2 .83% 119

Nursing home/extended care 6 .65% 279

Occupational Health 1 .07% 45

Total N=3,257

Missing N=1,008


Practice Area

Of the total respondents, 6 .75% of Delaware registered nurses reported practicing as a department administrator/supervisor . This is significantly lower than the national average which was reported to be at 12 .5% (HRSA, 2010) . A small number (5 .53%) of registered nurses reported practicing in the role of an educator with 2 .11% that reported being in a faculty role . Nationally, 3 .38% of registered nurses were identified as practicing in an academic education setting (HRSA, 2010) . Current to this study, 41 .65% of registered nurses in Delaware reported practicing as a staff/general duty nurse . This is significantly lower than the national average where 63 .2% of nurses reported practicing in this area (HRSA, 2013) .

Continuing to Practice

A majority of Delaware registered nurses anticipated practicing eleven or more years (27 .82% for 11-20 years and 27 .79% more than 20 years) . The second highest response (26 .38%) was from those who anticipated practicing five to 10 years . Those registered nurses who reportedly plan to work less than five years were 15 .08%, and 2 .93% plan to work one year or less . As reported in the Health Resources Service Administration report [HRSA] 2013, it is predicted that over the next two decades one million registered nurses will leave the workforce due to advancing age . As these nurses leave the workforce there will be a “loss of experiential knowledge and leadership brought to the workforce by seasoned RNs” (HRSA, 2013, p . 22) .

Limitations

The researchers recognized two limitations to this study . First, the response rate of registered nurses in the state of Delaware was lower than expected . The use of an online survey questionnaire may have contributed to the small representation of the sample due to a shortened time period available for response to the study . The researchers have discussed providing a longer period for registered nurses to respond to the survey questionnaire during future data collection .

Second, although data was collected related to wages/salary of nurses in the state of Delaware, there appeared to be a large number of participants who made a double entry in that focus area . Registered nurses holding an advanced practice nursing license were instructed to respond to a separate set of questions related to wages/salary than the general RN population . For this reason, wages/salary of nurses was not included with the results or discussion . The researchers have discussed the possibility of emailing a separate survey questionnaire to those nurses holding an advance practice nursing license for future studies .

Conclusions and Recommendations for Future Study

This study was conducted in order to provide the state of Delaware with current data related to the workforce supply of Delaware registered nurses at this point in time . The literature indicates that over the next two decades the health care industry will be stressed as it strives to meet the health care needs of the population . Factors such as a growing population, an aging generation of baby boomers, an increased number of people living with chronic health conditions, and a large number of people covered by the Affordable Care Act will all contribute to the demands placed on the health care industry . Of particular concern will be the large number of nurses leaving the profession over the next two decades due to retirement . As nursing is the largest health care profession in the country, a nursing workforce shortage could prove to be detrimental to the safety and quality of US healthcare .

With 44 .39% of registered nurses who participated in this study reporting that they plan to continue working ten years or less, Delaware leaders must recognize that providing the state with an adequate supply of registered nurses is essential in meeting future health care needs . Efforts should be placed on providing additional funding opportunities that will provide support for future nurses, nursing education programs, as well as encouraging hospitals and other employers to hire new nurses in order to maintain adequate staffing levels .

The researchers who conducted this study feel that future studies are needed to examine the age of

Delaware registered nurses and their practice settings . This will provide the state with trended data on the nursing workforce supply in key areas of need in order to plan for future nursing deficits .

ReferencesAmerican Nurses Association (2014) . News Release

(9/2/2014) . Increased investment needed to produce 1.1 million RNs, head off nursing shortage. NursingWorld . Retrieved from: http://nursingworld .org/FunctionalMenuCategories/MediaResources/PressReleases/2014-PR

Auerbach, D ., Staiger, D .O ., Muench, U ., & Buerhaus, P .I . (2012) . The nursing workforce: A comparison of three national surveys . Nursing Economics/September-October 2012/vol. 30/No.5.

Budden, J . S ., Zhong, E . H ., Moulton, P ., & Cimiotti, J . P . (2013) . Highlights of the national workforce survey of registered nurses . Journal of Nursing Regulations, 4(2) . 5-14 .

Buerhaus, P .I . (2012) . What will happen to the nursing workforce in the years ahead? Tar Heel Nurse. 74(3), 10-11 . ( Nurse, July/August, September 2012) .

Buerhaus, P .I ., Auerbach, D .I ., Staiger, D .O ., & Muench, U . (2013) . Projections of the long-term growth of the registered nurse workforce: A regional analysis . Nursing Economic$/January-February 2013 vol. 31/No. 1.

Dienno, M . (2006) . Patient safety and the nursing shortage: a national concern . Plastic Surgical Nursing, 26(3), 113-115 .

Dolan, T . (2011) . Has the nursing shortage come to an end? ONS Connect. 2011 Aug: 26 (8), 8-12.

McMenamin, P . (2014) . RN retirement: Tsunami warning! American Nurses Association. NurseSpace. NursingWorld . Retrieved from: ht t p://w w w .a na nu rsespace .org/b logsma i n/blogviewer/?BlogKey=398c2049-1b0d-405e-b065-0b0cea4eec59&ssopc=1

Minority Nurse .com (2014) . Nursing Statistics. Springer Publishing Company, LLC. Retrieved from: http://www .minoritynurse .com/minority-nursing-statistics

National Council of State Boards of Nursing . (2013) . The National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers 2013 National Workforce Survey of RNs . Journal of Nursing Regulation, 4(Suppl .), S1–S72 .

Nooney, J ., Cleary, B ., Moulton, P ., Wiebusch, P ., Murray, J ., Yore, M ., & Brunell, M . (2010) . Towards standardization (part 1) . Assessment of state and national nursing workforce data sources . Policy, Politics, and Nursing Practice, 11, 173-183 .

Singleton, K . (2010) . No nursing shortage: Being in the know . MEDSURG Nursing, July/August 2010 Vol 19/ No. 4 p. 209.

U .S . Bureau of Labor Statistics . (2014) . Occupational Outlook Handbook. Retrieved from http://www .bls .gov/ooh/healthcare/registered-nurses .htm

U . S . Department of Health and Human Services, Health Resources and Services Administration (2010) . The Registered Nurse Population: Initial Findings from the 2008 National Sample Survey of Registered Nurses. Retrieved from http://bhpr .hrsa .gov/healthworkforce/rnsurveys/rnsurveyinitial2008 .pdf

U . S . Department of Health and Human Services, Health Resources and Service Administration (October, 2013) . The U.S. Nursing Workforce, Trends in Supply and Education.

Retrieved from http://bhpr .hrsa .gov/healthworkforce/supplydemand/nursing/nursingworkforce/nursingwo rkforcefullreport .pdf


Doctor of

Nursing PracticeEarn Your DNP at Georgetown University!•Preparing nurses to be systems-level leaders in complex health

care environments•Executive format ideal for APRNs working full-time nationally• Join us for an online information session (see website for

details) or call to set up an individual meeting

APPLY NOW for Fall 2015 EnrollmentVisit nhs.georgetown.edu/nursing/dnp or call (202) 687-3203

• Adult-Gerontology Primary

Care Nurse Practitioner

• For more information, contact 610-361-5208 or [email protected]

Nursing

aston, Pennsylvania • www.neumann.edu

MASTER’S DEGREE AND CERTIFICATES


The Role of a Clinical Research NurseChristy L. Poole, RN, BSN, CRNI, CCRC

Ms . Poole is currently a R e s e a r c h N u r s e S u p e r v i s o r i n t h e Department of Emergency Medicine at Christiana Care Health System . She also is a member of the System-w ide Nursing Research Council .

Ms . Poole earned her BSN from Widener University in Chester, PA . She is a certified Clinical Research Coordinator (CCRC) and a Certified Registered Nurse Infusion (CRNI) .

She worked as a staff nurse in the Emergency Department at Riddle Memorial Hospital for about 10 years and has also been on the vascular access teams at both Christiana Care Health System (5 years) and Riddle Hospital for 10 years . She also recently served on the Clinical Research Nurse Council .

Ms . Poole can be reached by email at cpoole@christianacare .org or at her office at (302) 733-1643 .

Most bedside or direct care nurses have heard of evidenced-based nursing research perhaps while they were in school or when working on a project for their nursing unit . Evidenced based-nursing is the practice of nursing in which the nurse makes clinical decisions on the basis of the best available current evidence, his or her own clinical expertise, and the needs and preferences of the patient to improve outcomes (Melnyk & Fineout-Overholt, 2011, p . 575 .)

On the other hand, clinical research nursing may not be so well known . Clinical trials show us what works (and what doesn’t) in medicine and health care (American Cancer Society, 2014) . They are designed to answer two questions; does the new treatment work in humans and is the new treatment safe? (American Cancer Society, 2014) . Clinical research nursing is nursing practice with a specialty focus on the care of the research participants (National Institute of Health Clinical Center (NIH CC), “Building the Foundation,” 2009) . In addition to providing and coordinating clinical care, clinical research nurses have a central role in assuring participant safety, ongoing maintenance of informed consent, integrity of protocol implementation, accuracy of data collection, data recording and follow up (NIH CC, “Building the Foundation,” 2009) .

A clinical trial can take many years to complete . A drug trial, for instance a new cancer drug, may be studied for 6 years in the developmental stages before reaching the clinical trial stages of human subject research (American Cancer Society, 2014) . Once a trial reaches human subject research, it can take an additional 6-8 years to complete (American Cancer Society, 2014) . Clinical trials can have varying lengths of participation as well . For instance, a trial for mild ischemic stroke or TIA may require follow-up for participants up to and including 90 days following enrollment, or, some sepsis trials may require follow-up for up to a year . Cardiovascular trials can require follow up for 5 years . This can be challenging for clinical research nurses to maintain their relationships with participants to ensure complete data collection for the study .

Direct care nurses and clinical research nurses frequently work together, sometimes on a daily basis . My role as a clinical research nurse in the emergency department includes working together with nurses and physicians to identify and enroll potential research participants . Educating the nurses and physicians with regards to our studies develops relationships and involves direct care nurses in research . The nurses in the emergency department perform their standard of care duties such as obtaining vital signs and recording pertinent medical history . Accurate documentation within the medical record is important not only for documenting clinical care but the data that is in the medical record may become data collected for a clinical trial if the patient becomes a research participant .

During the screening process in which we identify potential participants, we will review medical records . Why are we permitted to review a particular patient’s medical record? All clinical research which involves screening and recruitment of human subjects requires Institutional Review Board (IRB) approval . Under FDA regulations, an IRB is an appropriately constituted group, with at least five members, with varying backgrounds, that has been formally designated to review and monitor biomedical research involving human subjects (Department of Health and Human Services [USDHHS], “Institutional Review Boards,” 2014) . In accordance with FDA regulations, the IRB has the authority to approve, require modifications in (to secure approval), or disapprove research (USDHHS, “Institutional Review Boards,” 2014) . This group review serves an important role in the protection of the rights and welfare of human research subjects (USDHHS, “Institutional Review Boards,” 2014) . Before a trial begins screening and enrollment the process of acquiring IRB approval can take weeks or months depending on the type of research and modifications that may need to occur prior to approval . The clinical research nurse also contributes and or coordinates the IRB process and can be primarily responsible for submission to the IRB .

Once we have identified a potential research participant, we review inclusion and exclusion criteria for the particular study . In a clinical trial, the investigators must specify inclusion and exclusion criteria . This is a list of criteria defining the eligibility of a participant and may include an age range, a type and stage of a particular disease (i .e . stroke, sepsis, cancer) as well as the presence or absence of a particular medical condition or medication (USDHHS, “Glossary of Terms,” n .d .) .

When a participant is determined to be eligible, we move forward and approach the patient for possible participation . This process includes informed consent . Informed consent is more than just a signature on a form; it is a process of information exchange that may include, in addition to reading and signing the informed consent document, verbal instructions, question and answer sessions and measures of their understanding (USDHHS, “A Guide to Informed Consent,” 2014) . This also gives us the ability to educate the patient and their families about their disease process as well as be an advocate in their care . Offering research opportunities provides additional options for patients, in addition to their standard of care . We are responsible for ensuring that informed consent is obtained from each research participant before they participate in research . This process can take some time to ensure that the patient and/or family member fully understand the trial and its risks and benefits as well as give them ample time to read the consent and ask questions . In the emergency department many of our trials are time sensitive and it is crucial to be sure that even though our time line may be shorter we must still provide an adequate period of time for this information exchange to take place . And even after a participant agrees to participate and signs the consent form, they are free to withdraw from the study at any time, their participation is voluntary .

If the patient agrees to participate its GO time! Each trial is different and includes its own protocol . In addition to stating the trial goals and objectives along with background information, the investigator for the trial has outlined the study design and methodology (World Health Organization [WHO], n .d .) . The methodology is the most important . It describes the intervention, procedure and observations required and a timeline when those components should be completed, similar to following a recipe . Accompanying the protocol is the case report form (CRF) . A CRF is a paper and/or electronic data collection tool . This document is used to record the data needed in order to determine if their intervention or new drug is safe and effective . Clinical research nurses along with the physician investigators are responsible for adhering to the protocol as well as monitoring participant safety and accurate data collection .

As a clinical research nurse who cares for the research participant, coordinates and manages clinical trials and investigator initiated research, (research created and implemented with our own physicians), working with direct care nurses is an important component of our everyday function . It is essential to include the direct care nurse in the

education and roll out of our studies . Fostering that relationship promotes participant safety as well as engages direct care nurses in research . Working together we can accomplish great things in both clinical research and evidenced-based research .

ReferencesAmerican Cancer Society . (2014, October) . Why do we need

clinical trials? Retrieved from http://www .cancer .org/treatment/treatmentsandsideeffects/clinicaltrials/whatyouneedtoknowaboutclinicaltrials/clinical-trials-what-you-need-to-know-why-do-we-need-clin-trials

CFR - Code of Federal Regulations Title 21 . (2014, April) . Retrieved from http://www .accessdata .fda .gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch .cfm?fr=56 .107

CRN 2010 Domain of Practice Committee 2009, Building the Foundation for Clinical Research Nursing: Domain of Practice for the Specialty of Clinical Research Nursing . 2009 . National Institute of Health Clinical Center, Nursing and Patient Care Services . Available at http://www .cc .nih .gov/nursing/crn/DOP document .pdf

U .S . Department of Health and Human Services . (n .d .) . AHRQ Effective Health Care Program . Glossary of Terms . Retrieved from http://effectivehealthcare .ahrq .gov/glossary-of-terms/?filterletter=i

U .S . Department of Health and Human Services . (2014, June) . Regulatory Information: Institutional Review Boards Frequently Asked Questions - Information Sheet . Retrieved from http://www .fda .gov/RegulatoryInformation/Guidances/ucm126420 .htm

U . S . Department of Health and Human Services . (2014, June) . U .S . Food and Drug Administration: Protecting and Promoting Your Health . A Guide to Informed Consent – Information Sheet . Retrieved from http://www .fda .gov/regulatory information/guidances/ucm126431 .htm

Melnyk, B . M ., & Fineout-Overholt, E . (Eds .) . (2011) . Evidence-based practice in nursing & healthcare: A guide to best practice . Philadelphia: Lippincott Williams & Wilkins .

World Health Organization . (n .d .) . Research Policy: Recommended format for a Research Protocol . Retrieved from http://www .who .int/rpc/research_ethics/format_rp/en/

2015—Get Started on Advancing Your Degree In Nursing

• RN to BSN • RN to MSN • MSN

• PhD in Nursing

Learn more about the Alumni Network and Open Faculty Positions at www.udel.edu/nursing


Megan M. Williams, DNP, APRN, FNP-C

As the Director of Population Health, Dr . Williams is responsible for providing leadership, m a n a g e m e n t , a n d coordination for Beebe P o p u l a t i o n H e a l t h programs and directing B e e b e ’s C o m mu n i t y Outreach screening teams responsible for Health Promotion and Disease Prevention Education . In 2011, Dr . Williams began to develop and implement Beebe’s first population care management program, with a focus on the care of high utilizer patients across the Beebe healthcare system . Through this program the department has developed the capacity to provide robust care management to the most challenging patients, and demonstrated sustainable reduction in healthcare utilization with associated cost savings and improved transition skills and quality of life among program participants . Dr . Williams oversees the team of care coordinators who are responsible for the work carried out through the clinically integrated organization, the Delmarva Health Network (DHN) . The DHN aims to provide accountable care with a focus on optimizing quality outcomes and reducing the cost of care across a wide variety of populations and care settings .

Dr . Williams earned a BA in Anthropology and BS in Nursing from University of Delaware in 1999, completed MSN with concentration in Community Oriented Primary Care and Family Nurse Practitioner certification at University of North Carolina- Chapel Hill in 2005, and finished her Doctorate in Nursing Practice (DNP) at Thomas Jefferson University in 2014 . She holds ANCC certification in the John Hopkins Guided Care Nurse program and received certification in Advanced Population Health from Thomas Jefferson University in 2012 .

Over the course of her nursing career has worked in a variety of patient care settings, from acute in-patient care to private family practice, and was responsible for leading a team of providers in achievement of meaningful use and accreditation as a patient centered medical home . She is the Delaware State Representative for the American Association of Nurse Practitioners and a founding member of the Delaware Coalition of Nurse Practitioners .

As the Director of Population Health at Beebe Healthcare, Dr . Williams is responsible for providing leadership, management, and coordination for Beebe Population Health programs and directing Beebe’s Community Outreach screening teams responsible for Health Promotion and Disease Prevention Education . The research presented here is the result of doctoral work with Thomas Jefferson University, focused on the care of high risk patients transitioning out of the acute care setting .

AbstractThe purpose of this project, Beebe CAREs, was to

incorporate health coaching and a multidisciplinary approach into traditional Advanced Practice Nurse-led transitional care . The CAREs intervention (Care coordination, Access to care, Referral to community based resources and Empowerment of patients and caregivers) aimed to achieve a sustainable impact on participants, resulting in reduced hospitalization, and improved transition skills and quality of life . APRNs possess the clinical and interpersonal skills, in-depth knowledge of systems and how to work within them to affect positive patient outcomes and keep patients well during vulnerable transitions in care . As the health care industry moves forward in pursuit of the best way to provide care for patients across the entire continuum of care, the focus should be on optimizing both utilization and quality of life for the most vulnerable populations through the provision of Advanced Practice Nurse- led transitional care emphasizing health coaching and patient and caregiver engagement .

BackgroundBy 2020, over 157 million Americans will be

living with one or more chronic diseases, leading to greater risk for hospitalization, emergency room visits and expanding healthcare costs (Gillespie, Mollica, Horvath, & Williams, 2005) . APRNs possess a unique and powerful skill set that is particularly well suited to providing comprehensive care for complex patients such as those transitioning out of the hospital setting (Naylor, Brooten, Campbell, Maislin, McCauley, & Schwartz, 2004) . The APRN holistic and patient-centric approach facilitates identification of vulnerable patients and development of high acuity interventions that encompass both clinical and social components of care which is central to the successful transition of patients across the health care continuum (Brooten et al ., 2002) .

MethodsIn January 2013, this quasi-experimental, pre-

test post-test design study was launched . The study was carried out by the CAREs team, consisting of a nurse practitioner, registered nurse and social

worker, working to provide transitional care to our highest utilizers in the healthcare system . In this study, the team enrolled high risk patients at the time of hospital discharge, conducted a full bio-psychosocial assessment, and developed a plan of care based upon patient-defined goals . Program eligibility was based upon recent inpatient hospitalization at the site hospital two or more times in the previous six months and the presence of five or more readmission risk factors based on the adapted 8P BOOST Target Tool (Project BOOST Team, 2008) . The plan was carried out over the course of 90 days as the team worked in collaboration with the progression of care rounds group, outpatient providers, skilled nursing care providers and the patients and their caregivers . The ultimate outcomes that the CAREs team and patients strove to achieve were reduced healthcare utilization (re-admissions and length of stay) and improved transition skills and quality of life for all program participants . The dependent variables measured for each participant in the study were healthcare utilization, transitions skills and quality of life- based upon the following validated tools: Care Transitions Measure -15 (CTM-15) (Coleman, Mahoney & Parry, 2005), CDC Health related Quality of Life (Center for Disease Control and Prevention, 1993), and utilization .

Results and ConclusionAs a result of the CAREs program, participants

experienced a 40% reduction in hospitalization, two fold improvements in quality of life and nearly six fold increase in their transition skills . The cost savings and associated reduction in utilization demonstrated by the implementation of this one program in a relatively small healthcare system in southern Delaware have now served as a springboard for scaling care coordination and accountable care across the entire region . The changes associated with health care reform as laid out in the Affordable Care Act (2010), are daunting to most and still quite vague in a number of areas, however, we have noted a change in the culture, patient-centered approach to care, and outcomes with the implementation of the CAREs program . It has enabled the health care system to re-design care and demonstrate sound cost savings and improve the quality of life for patients . Now a multitude of initiatives across the entire health care system have emerged and this has inspired confidence in our ability to effectively embrace the changes associated with healthcare reform led by APRNs .

ReferencesBrooten, D ., Naylor, M ., York, R ., Brown, L ., Munro, B .,

Hollingsworth, A . & Youngblut, J . (2002) . Lessons learned from testing the quality cost model of advanced practice nursing (APN) transitional care . Journal of Nursing Scholarship, 34(4), 369-375 .

Center for Disease Control and Prevention (1993) . Health Related Quality of Life (HRQOL-4) . National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health .

Coleman, E ., Mahoney, E ., & Parry, C . (2005) . Assessing the Quality of Preparation for Post-Hospital Care from the Patient’s Perspective: The Care Transitions Measure . Medical Care, 43(3), 246-255 .

Gillespie, J ., Mollica, R ., Horvath, J ., & Williams, C . (May, 2005) . Coordinating care in the fee-for-service system for Medicaid beneficiaries with chronic conditions (Contract No . HHS-100-03-0025) . Washington, DC: US . Department of Health and Human Services .

Naylor, M ., Brooten, D ., Campbell, R ., Maislin, G ., McCauley, K ., & Schwartz, J . (2004) . Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial . Journal of the American Geriatrics Society, 52(5), 675-684 . doi: 10 .1111/j .1532-5414 .2004 .52202 .x

Patient Protection and Affordable Care Act, Pub . L . No . 111-148, §2702, 124 Stat . 119, 318-319 (2010) .

Project BOOST Team (2008) . The Society of Hospital Medicine Care Transitions Implementation Guide: Project BOOST: Better Outcomes for Older adults through Safe Transitions . Society of Hospital Medicine website, Care Transitions Quality Improvement Resource Room . Retrieved from http://www .hospitalmedicine .org

Enhanced Patient and Caregiver Engagement Drive Utilization and Quality Outcomes in an Advanced Practice Nurse-Led Care

Transitions Intervention with Super Utilizers


Welcome New & Returning

Members!Juliana Adeleye New Castle, DEAnne Anyanga New Castle, DEGabrielle Archangelo Wilmington, DESuzanne Ariza Chadds Ford, PABernadette Baker Townsend, DECatherine Barber Milton, DEBernadette Clagg Wilmington, DETanya Clarke Wilmington, DEIvelisses Collazo New Castle, DEChelsea Connor Middletown, DEKimlynn Cordero Wilmington, DELinda Darling Lincoln, DEHallie-Katrina Dennison Middletown, DEVictoria Dunbar Hockessin, DEAnnamarie Flick Wilmington, DECarolina Flores-Gopez Bear, DECheryl Flowers Camden, DEJenni Glick Dover, DEJane Govatos Lewes, DEAmy Hudson Georgetown, DELisa Hughes Wilmington, DEFonda Kauffman Greenwood, DEEvgenia Khodukina Frankford, DEDanielle LeGates Lewes, DEDanene Lucas Dover, DEDebra Lynch Newark, DESharon McBride-Howard Camden Wyoming, DEMary McKeever Newark, DECarol Minor Milford, DEKhaira Mitchell New Castle, DEJanet Moore New Castle, DELiann Nolan Claymont, DEJill Petrone Lewes, DEElizabeth Richardson Lewes, DEShauntey Singletary Seaford, DEStacie Smith Wilmington, DEFrances Spivak Hockessin, DEJessica Thompson Felton, DEPatricia Thornton Rehoboth Beach, DETina Torres Milford, DE

Terminology Change for Planners of

Nursing Continuing Education

Karen C. Andrea, MS, RN, BCDNA Continuing Education Coordinator

Beginning January 1, 2015, there is a change in terminology from “Co-Provider/ship” to “Joint Provider/ship .” This change reflects ongoing efforts to help nurses, physicians, pharmacists and all other healthcare continuing education providers and regulatory agencies to standardize terms and create a common language . This change will also assist in collaboratively planning and implementing interprofessional continuing education . Two or more organizations may “jointly provide” (previously “co-provide”) an educational activity provided neither is a commercial interest . Joint Providership requires a written agreement signed by all parties to the joint providership . Further details are available on the DNA website under the Education tab .

DNA ChaptersI Want to Get

Involved!Are you interested in nursing education?

Research? Peer support? Are you a new graduate nurse that would like to connect with other new nurses?

Whatever your nursing passion may be, the Delaware Nurses Association (DNA) can help you connect with your peers locally and across the state . Becoming involved in your professional association is the first step towards creating your personal career satisfaction and connecting with your peers . Now, DNA has made it easy for you to become involved according to your own preferences .

Through the DNA new member-driven chapter structure, you can join multiple chapters and also create your own chapter based on shared interests where you can reap the benefits of energizing experiences, empowering insight and essential resources . For more information, visit the DNA website at www .denurses .org

DOCTOR of NURSING PRACTICESalisbury University

Take the First Step ... Explore Your Options!

PROGRAM HIGHLIGHTSn Full-time study allows for quick career

advancementn Courses delivered in distance-accessible

format through interactive online learningn One-on-one faculty interactions with a small

cohort of studentsn Competitively priced tuition and fees;

scholarships available

New Tracks:n Post-Bachelor’s to D.N.P. – 80 credits

for doctorate and eligibility for FamilyNurse Practitioner certification

n Post-Master’s to D.N.P. – 68 creditsfor doctorate and eligibility for F.N.P.certification

n Post-Master’s to D.N.P. – 38 creditsfor doctorate with leadership focus

Apply now for fall or spring start!Information: 410-543-6420 or [email protected]/nursing

Westminster VillageAs we enjoy our season with changes, Let us remember those we serve. We are so blessed to have this opportunity, and should you want to be part of our team, please contact us at:

Westminster Village1175 McKee Rd

Dover, DE 19904(302) [email protected]

CAMP NURSERNs needed for a NY Performing Arts Camp located in Hancock, 2½ hours from NYC. Available for 3, 6, or 9 weeks and include room and board. Families are accommodated.

For info call (800) 634-1703 or go to: www.frenchwoods.com

NEW CASTLE COUNTYVOCATIONAL TECHNICAL SCHOOL DISTRICT

Real Learning forReal Life

Teach the next generation of Medical Assistants and Nursing Techs!

An unencumbered and active RN license is required.

For career opportunities visit our website: nccvotech.comContact: Mr. Gerald Allen, 1417 Newport Rd,

Wilmington, DE [email protected]

EOE


Find more information on these jobs as well as additional career opportunities on our website . . .

www.delawarestatejobs.com

Delaware Health and Social ServicesDivision of Public Health

Nurse Consultant• ThomasCollinsBuilding,Dover DHSS/Public Health - Health Promotion &

Disease Prevention •WalnutStreetBuilding,Milford

(Anticipated) DHSS/Public Health - Child Development

Watch

AdvancedPracticeNurse• PorterStateServiceCenter,

Wilmington DHSS/Public Health - Sexual &

Reproductive Health Clinic

• UniversityPlaza,Newark DHSS/Public Health – Child Development

Watch

• PyleStateServiceCenter,Frankford(Anticipated Feb 2015)

DHSS/Public Health - Sexual & Reproductive Health Clinic

Registered Nurse II-III • PorterStateServiceCenter,

Wilmington DHSS/Public Health - Sexual &

Reproductive Health Clinic

• HudsonStateServiceCenter,Newark DHSS/Public Health – TB Clinic

• UniversityPlaza,Newark DHSS/Public Health – Home Visiting

• UniversityPlaza,Newark DHSS/Public Health - Regulatory

Compliance

• AdamsStateServiceCenter,Georgetown

DHSS/Public Health – TB Clinic & Home Visiting (Anticipated)

Nursing Opportunities

AA/EEO

reporter...karen andrea, ms, rn, bc subscription to the dna reporter may be purchased for $20 per...

Documents