More than 40% of patients have experienced a “longer than reasonable” wait for healthcare, with 26% of those patients waiting more than two months for healthcare, according to a new national survey of U.S. adults released by the American Association of Nurse Practitioners (AANP).
As a result, nearly half of those who experienced unreasonable wait times gave up seeking an appointment and did not receive care. This includes patients seeking critical mental health services, according to the survey conducted in April 2023.
“These results are an eye-opening look at the state of access to care in our healthcare system,” says AANP President Stephen Ferrara, DNP. “A lack of timely access to care, particularly primary and preventive care, can lead to chronic conditions that put patients’ lives in danger and increase costs. Delayed or deferred care can put an individual’s health at greater risk for complications, which may also lead to a negative impact on mental health and lost wages for those patients. A decline in productivity for employers may also occur.”
Among those surveyed, 26% reported waiting more than two months to gain access to a healthcare provider. This situation extends across all major demographics, including age, gender, and education, and it impacts access to care in all geographic areas, including rural, suburban, and urban settings. Those most likely to give up on seeing a provider after a lengthy wait include younger adults, people living in urban areas, and respondents who reported their ethnicity as Hispanic.
“As a nation, we can solve the growing crisis in access to care by modernizing the outdated policies that sideline NPs from delivering care they are educated and clinically prepared to provide,” says AANP Chief Executive Officer Jon Fanning MS, CAE, CNED. “We can help shorten wait times and give patients timely access to the care they need by removing barriers to America’s 355,000 NPs.”
AANP supports modernizing policies to ensure people across the nation have full and direct access to the high-quality healthcare NPs provide. Giving patients the freedom to choose their healthcare provider is the first step in ensuring that, as a nation, we improve access to care and increase positive health outcomes for all.
Expectations are high for acute care nurse practitioners (ACNPs), and novice ACNPs may benefit from additional support as they transition into advanced practice roles.
The U.S. has more than 300,000 licensed NPs, with over 36,000 completing their academic programs between 2019 and 2020. They may practice in various clinical settings, each with competencies, procedures, and patient populations.
ACNPs working in cardiothoracic intensive care units (CTICUs) are highly trained to care for critically ill patients with complex conditions and specialized needs. They must know various procedures, such as coronary artery bypass, cardiac valve replacement or repair, and heart or lung transplants.
“Clinical knowledge alone is not sufficient to prepare a novice ACNP to enter an already- complex healthcare system amid a pandemic,” says Lidia Hernandez, DNP, RN, AGACNP-BC, CCRN-CSC, and lead author. “Mentors can help them navigate into a new role with confidence and help them evolve as clinicians and grow into leadership roles.”
The article notes the differences between mentorship and preceptorship, often occurring during orientation and focusing on acquiring specific knowledge or skills. On the other hand, a mentor may provide emotional support, guidance, and personal feedback to help with anxiety and imposter syndrome, as well as other issues that may impact effectiveness in a new role.
It also discusses how the mentor helped the novice ACNP develop solutions to challenges with the new role, such as improving organization, preparedness, and access to resources.
Many organizations, events, concepts, and theoretical frameworks drive innovation and advancement in nursing. With our profession currently reeling from the impact of the COVID-19 pandemic, there couldn’t be a better time for nurses to gather together and envision the future. The annual Magnet Conference is one such event that allows nurses to convene for a moment of mutual understanding and forward thinking.
Forward Movement in Nursing
To strive for excellence in nursing, whether in leadership, clinical research, patient care, entrepreneurship, or any virtually limitless career avenues for curious nurses.
Evidence-based practices are central to Magnet. Unfortunately, without focusing on the emerging evidence, we would rely on eight very dangerous words: “But that’s the way we’ve always done it.”
Conferences like Magnet attract nurses interested in forwarding movement, not the status quo. Nurses don’t attend conferences to learn how everything should remain the same. Instead, nurses are drawn to asking what can be done better, more efficiently, and more safely.
Gatherings of nurses interested in momentum, innovation, and camaraderie are like a proverbial shot in the arm that many crave. This is why Magnet is a gathering so many greatly anticipate.
Healing and Growing
The pandemic has taken a toll on nursing, just as on every other sector of a global society. Even now, it seems like the entire world is understaffed and on backorder, and healthcare is no stranger to this phenomenon.
We may have been called “heroes” ad nauseum throughout the worst months of this global debacle (although I would greatly prefer the word “warriors”), but we can’t rest on our laurels and consider a job well done — there’s far too much to accomplish.
The nursing shortage continues to rear its ugly head, and nurse attrition from the profession is high. A shortfall of more than 400,000 nurses in the near future isn’t just a nightmare — it may be our reality. And even if it’s only partially accurate that as many as two-thirds of nurses are considering leaving the profession in the next two years, that’s an unsustainable loss.
This point in the pandemic has given us a few moments to assess the damage, pick up the pieces, and dust ourselves off, but we also acknowledge that there’s much work still to be done once we’ve licked our collective wounds.
Healing those wounds takes a community. Growing our ranks by creating safe and healthy workplaces where nurses feel valued, honored, and recognized can go a long way toward stemming the hemorrhage of talent poised to leave nursing behind.
Perhaps one way to honor, value, and recognize nurses in the context of community is to bring us together at events where we can look one another in the eye, see how we need to grow and where we need to heal, and then roll up our sleeves for the task at hand.
Magnet Celebrates the Power of Connection
When we connect deeply and take the time to acknowledge those who’ve made sacrifices for the good of the whole, contributed to the body of literature, advanced the profession, suffered moral or physical injury, or perhaps even given their lives, we empower one another to be the kinds of nurses who stand up for our beloved profession and the patients we serve.
Some nurses have been beaten down over the last few years; still, others have managed to thrive amid the chaos, confusion, and difficulties. The nursing profession is at a turning point, and we must take stock of where we are to move ahead.
The power of connection can occur over a video call. Still, there’s nothing like meeting with like-minded colleagues who can capture the imagination and empower creative forward-thinking. Inspiration from others can empower us to take ownership of our own professional story — and when we’re in charge of our own story, we feel better about the road we’re on. As a result, we can contribute much more to the collective good.
Scores of nurses will attend Magnet this year, and many will return to their workplaces inspired, reinvigorated, and ready to tackle the challenges ahead. Nursing may sometimes be down, but there are assuredly still thousands of nurses ready to see our profession through to a brighter day. Are you?
Daily Nurse is thrilled to welcome Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
UCI Sue & Bill Gross School of Nursing Assistant Professor Nakia Best doesn’t tend to exaggerate: When she makes a statement, she has the data to back it up and says kids are healthier when school nurses are in the building.
A self-confessed data nerd with a nursing Ph.D. from the University of North Carolina — Chapel Hill and a post-master’s degree from Johns Hopkins University in health informatics, she is passionate about translating the story that the data-based evidence tells.
“The goal is for kids to have medical access to a nurse every day. Unfortunately, that’s not the case in the United States, where 25% of schools have no nurse,” she says.
An Unexpected Discovery about School Nurses
Best neither expected nor planned to find herself an expert on the relationship between school nurses’ availability and students’ educational outcomes.
This area of research came to her by chance when she was introduced to an exceptionally rich trove of data relating to school nursing in North Carolina, where she grew up and spent two decades of her career.
Best’s practice had been as an ICU nurse in cardiothoracic surgery, but, she says, “I’ve always been interested in how we’re using tech to improve healthcare.”
She had already left ICU nursing for teaching and research when, after her post-master’s, her question became, “Was there a way to marry informatics with critical care?” The initial focus of her Ph.D. was to do with ways to improve nursing information capture in electronic health records.
An Opportunity to Mine ‘Mesmerizing’ Data
Best’s mentor, however, introduced her to North Carolina’s supervisor for school nursing, who had come to a healthcare community meeting looking for help. The state’s Department for Health & Human Sciences had been painstakingly collecting data about school nursing since the 1990s, and no one had ever put it to good use.
Best laughs about her reaction when her mentor first put her forward as a possible candidate: “I knew nothing about school nursing. I hadn’t worked with kids, never worked in paediatrics, and I don’t have kids. My parents said that even when I was a kid, I was a little adult!”
Nonetheless, she recalls, “I left that meeting thinking, ‘I’ve got to do this!’ The data was mesmerizing.”
What that data told Best about school nursing in North Carolina became the subject of her Ph.D.
The Link Between School Nurses and Children’s Success
Looking specifically at children with chronic health conditions of asthma and diabetes, she found that “the presence of the school nurse reduced the number of days missed; it increased children’s ability to manage their own conditions. There’s also evidence of how much of the principal’s and teachers’ time is saved when there’s a nurse around.”
She says, “Schools are charged with providing a safe environment for kids, and nurses help do this.”
Kids missed less school not just because they were less ill but because parents could trust that the school was a safe place for their child to be.
After completing her Ph.D., Best still had questions about school nurses’ experiences and their impact on communities. But changing topic midway through her Ph.D. meant that she’d spent six years researching and writing, and she was exhausted and needed a chance to recharge. So she returned to teaching at the University of North Carolina Greensboro, where she had earned her initial master’s degree in Nursing Education.
UCI Sue & Bill Gross School of Nursing Assistant Professor Nakia Best
Always Ready to Try Something New
“I always liked teaching new nurses,” she says, recalling a childhood trait. “My parents told me, ‘You love teaching!’ So when I was a kid, I would literally sit my sister down, get a blackboard, and teach her math from my grade. She’d be doing fifth-grade math when she was in first grade!”
For someone born educator, researcher, and, increasingly, a leader in her field, Best’s account of her career is full of self-deprecating humor and frequent attributions of her progress to happenstance rather than her own skills and talent.
She’s often frank about the difficulties of retaining confidence and motivation and is quick to credit others — her mentors, colleagues, and family — for her successes.
“I’ll try anything,” she says, “because my parents always said, ‘Try it! If it doesn’t work out, you can always come home and regroup.'” Yet, demonstrably, it is indeed her ability, her approach, and the quality of her output that have created widening demand for her work.
Going to UCI
She wasn’t looking for a new job when Founding Dean and Distinguished Professor Adey Nyamathi, founding dean of the Sue & Bill Gross School of Nursing, contacted her to see if she would be willing to interview for UCI. The Dean was seeking faculty with Best’s specific skills.
“I still don’t know how she found me,” Best recounts.
“It was Sunday, and I was with my family. We’d been to church and were having breakfast when I flipped through my emails. I thought her message was spam! But we’d heard of UCI because of their basketball team. So I looked up Dean Nyamathi and saw what a scientist she is. I thought: I want to do what she’s doing! And I always wanted to go to California.
School Nurses and Pandemic Response
Best took up her position at UCI in 2019, just weeks before COVID-19 — began to make its way across the globe.
“Dr. Dan Cooper, a professor of pediatrics who holds several senior roles at UCI, got in touch,” she says. “He said, ‘We have to help Orange County get ready. No one knows what’s happening, and everything changes daily. The community needs our help. How do we help schools prepare?’ I knew that school nurses needed to be involved.”
Along with “this ragtag group of scientists” who were her colleagues, Best plunged into the emergency, “…trying to help figure out who needed to stay home, how, ultimately we could get the kids back in school. Vulnerable kids. Kids in multi-generational households who have vulnerable older people at home. I was pulling together every piece of research I could find and reading, reading, reading…”
What impressed her most was how “…school nurses never stop nursing. They said, ‘The schools may be closing, but I’ve still got my kids!’ And I thought, ‘I’ve got to tell their story.'”
More than two years into the pandemic, Best is now immersed in that work. “COVID was bad,” she says, “but it was much worse for some people. What I want to look at next [in relation to school nursing data] is overlaying the social determinants of health. Every child has a right to go to school, even with a health condition. Sometimes school nurses are the only access to a child’s healthcare — and nurses can connect them to other resources.”
Harnessing Parent Power to Raise Awareness
She also analyzed qualitative data about school nurses’ experiences during school closures. “People talk about moral distress, moral injury,” she explains. “When you think, ‘I know what needs to be done, I know the right thing to do, but something is stopping me from being able to do that.’ I want to share what it’s been like for school nurses. I want people to know what they’ve been doing.”
In Orange County, school nursing is coordinated under the Department of Education rather than under the Department of Health & Human Sciences as it is in North Carolina; in both instances, as elsewhere across America, funding for school nurses is typically provided by individual school districts.
Best is well aware of the complexities involved in bringing about change, given that “There’s always a nurse shortage! You’ve got to train and hire them…what are the budgets for that?”
“Parents are powerful in getting school boards to make decisions,” she argues. “More affluent schools have a better nursing cover, but they need it less. Do you know if a nurse is in your child’s school building? I’d rather you knew before a tragedy occurred.”
Nurse-leader and health informatics expert Nakia Best doesn’t tend to exaggerate. So perhaps school districts across America should take note — and increasingly, as her work continues, they will.
“The future of nursing and health care is unknown, and the COVID-19 pandemic has brought a newfound urgency for us to work together to find solutions to both long-standing issues and new challenges,” said Bettencourt. “Starting now, we step forward with a renewed sense of purpose, a commitment to action and a focus on a better tomorrow.”
Bettencourt is an assistant professor in Penn Nursing’s Department of Family and Community Health. As an educator, researcher and pediatric clinical nurse specialist, her focus is on achieving the best possible outcomes for acutely and critically ill children. Her current research involves evaluating factors influencing the research-to-practice gap in critical care settings and testing implementation strategies targeting the interprofessional team to improve evidence-based care. She was recently a postdoctoral fellow at the University of Michigan, where she was appointed to the National Clinician Scholars Program and received advanced training in implementation science. Previously, she was responsible for ensuring high-quality nursing care and optimal outcomes for burn, trauma and pediatric patients as a clinical nurse specialist at Regions Hospital in St. Paul, Minnesota, and at UF Health Shands Children’s Hospital in Gainesville, Florida.
Bettencourt’s extensive volunteer service with AACN includes board liaison, NTI Program Planning Committee (2021), AACN – AACN Certification Corporation Nominating Committee, (2020-2021), community moderator, online AACN Peer Support Community Development Team (2020) and board liaison, Chapter Advisory Team (2019-2020).
Her additional affiliations include the American Burn Association and Sigma. In addition to presenting at the National Teaching Institute & Critical Care Exposition (NTI), she has led sessions at several other conferences, including the American Burn Association’s annual meeting. Bettencourt’s publications are in the areas of implementation science, nursing and patient safety, nurse staffing and work environments, burn critical care and pediatric delirium.
Bettencourt earned a Bachelor of Science in exercise science from the University of Florida, an accelerated Bachelor of Science in Nursing from the University of North Carolina at Chapel Hill, and a Master of Science in Nursing from Johns Hopkins University, Baltimore. She earned a PhD from the University of Pennsylvania and a Master of Science in health care research at the University of Michigan.
Before she assumed the role as president, Bettencourt served a one-year term as president-elect. Before that, she completed a three-year term as a director from July 1, 2018, through June 30, 2021, and a one-year term as treasurer from July 1, 2019, through June 30, 2020.
For more than 50 years, the AACN has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 130,000 members and over 200 chapters in the United States.
The Black Hawk helicopter lands in a field behind the FBI Academy, its main rotor sending up a massive plume of dust and grit.
A handful of Uniformed Services University (USU) Graduate School of Nursing (GSN) Registered Nurse Anesthesia students hunker down over the litter they’re carrying to protect themselves and their “patient” from the helicopter’s powerful downwash.
Given the “all-clear” signal, the team gets up and moves to the Black Hawk, staying low under the awesome power of the blades as they evacuate their casualty. The students, using hand gestures to communicate, then work with Navy Cmdr. Ken Radford, USU’s Nurse Anesthesia program director, to intubate the training mannequin, their simulated patient. The first student is successful; Radford offers them a fist bump, and it’s time for the next student to step up and give it a try.
These GSN students are taking part in the Trauma Culmex training exercise held in conjunction with the FBI’s elite Hostage Rescue Team in Quantico, Va., just days before their graduation from USU.
Radford says GSN faculty have provided training for the Hostage Rescue Team medical personnel in the past, which helped to open the door for the nurse anesthesia students to receive their own educational opportunity on the FBI Academy grounds.
“This is the first time that we’ve held this simulated trauma experience so this is an incredible opportunity for them to round out their training,” Radford says.
The event was conceptualized by Dr. Matthew Welder, special assistant to the USU President for operational medicine and Radford, and executed by Air Force Lt. Col. Janet Sims, director for Simulation and Navy Lt. Cmdr. Lauren Suszan, director of Clinical Education, for the RNA program at USU.
The Trauma Culmex was developed to fulfill the registered nurse anesthesia student trauma simulation curriculum requirement in their last semester of clinical education. Students take part in training and exercises focused on providing care in austere environments for both injured service members and military working dogs.
Radford says providing his students with a chance to close out their training with the event helps to get them in the right mindset for an operational deployment.
“Our mission is to train anesthesia providers that can provide anesthesia care in austere settings and this was a way for us to round out their education as they approached graduation,” Radford says. “It’s really incredible.”
Inside one building, its walls still spattered with the bright paint of simulated training ammunition used to mimic live bullets during exercises, USU students work on crisis actors made up to look like they have a host of traumatic wounds. Instructors analyze the decisions of the soon-to-be-graduates as they manage the series of injuries their patients experience.
Sims checks in on one group, making sure all of the many moving parts of the trauma culmination exercise are running smoothly before heading back outside. There, a team of four load their patient onto a military ambulance, climbing on and providing care as the vehicle drives off. Sims says their mission with the exercise is to prepare independent military anesthesia providers to give care in any operational and austere environment. She adds that partnering with the FBI and the Hostage Rescue Team was a natural choice to help meet this mission.
“USU students are well-prepared to provide medical care in fixed medical facilities with adequate staff and equipment,” Sims says. “However, operational readiness courses (like this) help prepare them for anesthesia care in the field.”
As students go from one exercise scenario to another, flash bangs go off, the rattle of gunfire echoes nearby, and FBI teams train only feet away in the next room.
“(The students) are taking care of patients with minimal equipment in a building of opportunity, transporting patients and dealing with all that comes along with that — lack of supplies, lots of noise, flash-bangs going off, gunfire, helicopters taking off and landing,” Sims says. “We also have to take care of the military working dogs as CRNAs (certified registered nurse anesthetists) when we’re deployed because they are one of the team and if they get hit, we take care of them until we can transfer them to a higher level of care.”
At another location students are being introduced to a retired military working dog and a half dozen “wounded” canine mannequins. The real dog waits patiently as the new group files in to learn about working with an injured military canine in the field.
“The experience has been great,” says Army student Maj. Andre Brown, adding that he and the others didn’t initially know what to expect before arriving for the exercise. “They hadn’t really given us any information before we got here. It was ‘hey, get a hotel at Quantico, meet at this place and these are the times we’re going to start.’ Then we get out there and it’s like ‘here’s your scenario, go — how would you react?’”
Brown says one of the day’s impactful lessons was learning about how to give care to an injured military working dog.
“I knew enough to get the dogs from point A to point B but here we’re learning more effective care, and a more effective means of how to do things,” Brown says. “… Everybody has been super knowledgeable with helpful tips that I hadn’t even thought about.”
Sims says this year’s collaboration with the FBI and the Hostage Rescue Team is essentially a test run for future trauma culmination exercises. She says the university currently has the “Gunpowder” exercise which helps expose USU students to a variety of challenges they may come across in the field, training them on tactical field care, tactical combat casualty care, prolonged casualty care, and forward resuscitative care.
“Unfortunately, the timeframe (for Gunpowder) does not align with most of our nurse anesthesia students as they attend a 21-month clinical rotation at various locations throughout the country” Sims says. “We’ll see how this exercise goes and obtain feedback from the faculty cadre and students and add or remove content to make it most beneficial to train and assess their trauma anesthesia skills.”
Navy student Lt. Cmdr. Joseph Dimarucut says taking part in the Trauma Culmex has been an amazing experience. Particularly, he says working to intubate a patient from within the confined space of a helicopter stands out to him as a valuable lesson that couldn’t be practiced in a hospital.
“It’s a good culmination of everything that we’ve learned put into practice and what we’ll expect to see in the field,” Dimarucut added.
Hurrying past FBI agents rappelling down a wall, the next group of USU graduate nursing students carries a litter holding a simulated patient, an instructor following closely behind. They arrive at an open field and soon the sounds of a helicopter’s rotor chopping through the day’s warm air once again grows louder. The dust hits them, they get up and hurry for its open doors and the training begins all over again.
