”Three decades of evidence have shown that nurse practitioners with full practice authority play a vital role in improving health outcomes, especially in underserved communities, Ramos observed in his remarks. Focusing on the connections between FPA, access to care, and health outcomes, the Dean presented his case to the state’s Joint Legislative Committee on Access to Healthcare and Medicaid Expansion at the North Carolina General Assembly and urged them to pass the SAVE Act to grant full practice authority for NPs providing primary care. Ramos, who is also the vice-chancellor of nursing affairs for Duke, was among eight experts presenting varied views on full practice authority.
“Full practice authority isn’t new. This isn’t innovative. We have 30 years of evidence from 24 states, D.C., and several US territories about the benefit of granting full practice authority to NPs.”
In speaking to the joint committee presided over by Sen. Joyce Krawiec, Ramos addressed the role that nurse practitioners have in transforming health care access and outcomes in North Carolina, including the opportunity to expand care in rural areas that face health care shortages. The joint committee is hearing from experts as they consider passing the SAVE Act, which was first introduced in 2021 to expand full practice authority for primary care NPs in North Carolina. A similar version of the SAVE Act has been introduced in previous legislative sessions, but no action was taken on the legislation.
Role of FPA in Access to Care and Health Outcomes
“Nurse practitioners should be able to practice at the highest level of their competencies, education, and licensing,” Ramos said. “Full practice authority isn’t new. This isn’t innovative. We have 30 years of evidence from 24 states, D.C., and several US territories about the benefit of granting full practice authority to NPs. This improves health outcomes and expands health care to underserved populations and will benefit the people of North Carolina.”
Across the state, 97 of 100 counties face a health professional shortage.
Ramos reflected on his role as dean of the top school of nursing in the state and the second-ranked school in the U.S., and the intense pride he has seeing Duke graduates strengthen their career opportunities with the education they gain at Duke. “The nurse practitioner workforce growth is faster in states with full practice laws than in states with restricted practice,” said Ramos, who is interested in attracting NPs to practice in the state.
Ramos observed that the first states to authorize full NP practice authority began doing so in 1994 — nearly three decades ago — and that, once passed, full NP practice authority has never been repealed. “Full practice authority for primary care NPs improves care access, improves care outcomes, and improves workforce supply,” said Ramos, who also addressed a systematic review of 33 studies that showed no evidence for better NP care outcomes in states with more practice restrictions.
NPs with FPA Increase Efficacy of a State’s Health Workforce
In addressing the critical nursing workforce shortages across the U.S., Ramos notes that NP workforce growth is faster in states with full practice laws compared to states with restricted practice. Across the U.S., during the COVID-19 pandemic, states issued temporary waivers of NP practice restrictions. “This enabled more time-responsive NP practice and care provision as well as a streamlined process for NP orders in the absence of physician signature requirements and an increased capacity of the health care workforce to respond to COVID-19,” Ramos said.
Ramos observes that the reliance of nurses in this manner during a pandemic and health care crisis demonstrates the clinical, scientific, and relational expertise that support nurse influence in improving health outcomes, and it demonstrates the confidence that the health care systems and public have in nurses, who have been considered the most trusted and most ethical profession for more than 20 years.
In conclusion, Ramos pointed out to the committee that:
NP practice restrictions contribute to inadequate care access and primary care workforce shortages, particularly in rural areas.
NP practice restrictions can be a barrier to improving health outcomes and reducing health outcomes and reducing health-related economic costs.
NP practice restrictions requirements can lead to an unsafe and fragile care model, including risks such as the possibility of immediate NP loss of ability to care for patients if a physician can no longer provide supervision for any reason, including moving, retiring, and so on.
NP practice restrictions weaken health workforce responsiveness to emergencies.
Physician supervision agreements can contribute to unnecessary and excessive costs.
The SAVE Act (House Bill 277/Senate Bill 249) did not receive a committee hearing during the 2021 legislative long session. However, following the conclusion of the committee’s work later this spring, the bill could move forward when the legislature returns for the 2022 short session on May 18, 2022.
The American Association of Colleges of Nursing (AACN) is embarking on an initiative focused on building leadership capacity in new nurses with a special emphasis on developing essential skills in resilience, self-care, and well-being. The two-year project, titled A Competency-Based Approach to Leadership Development and Resilience for Student Nurses, was launched with funding from the Johnson & Johnson Foundation in partnership with the Johnson & Johnson Center for Health Worker Innovation.
“As we move beyond the pandemic and consider the future of health care, we arrive at a pivotal time in nursing when new ideas and energy are driving us toward a new way of preparing nurses for contemporary practice,” said Dr. Deborah Trautman, AACN President and Chief Executive Officer. “We applaud Johnson & Johnson for helping us develop the next generation of nurse leaders with the skills needed to adapt work environments to prioritize self-care, healthy behaviors, and well-being.”
A New Standard for Nursing Education
In April 2021, member schools affiliated with AACN voted to endorse The Essentials: Core Competencies for Professional Nursing Education, which outlines a new model and framework for professional nursing education using a competency-based approach. Moving to implement the new Essentials presents a unique opportunity for schools of nursing to infuse innovation into nursing curriculum to better prepare nurses to thrive across practice settings. The new standards call for preparing nurses with specific competencies related to leadership development, professionalism, emotional intelligence, and developing wellness and resilience for themselves and others.
Through this new initiative, AACN will convene an expert advisory group to develop new learning strategies and assessment measures related to personal, professional, and leadership development, including activities and self-reflection that foster health, resilience, and well-being. Once developed, AACN will pilot test the new content at 10 schools of nursing, assess the impact on student competency, disseminate results to all nursing schools, and offer faculty development opportunities to assist with new content integration into curriculum.
“Academic nursing leaders recognize that developing leadership and resilience capacity among new nurses is essential to effective nursing practice,” said Dr. Trautman. “We are excited to have this opportunity to elevate nursing’s role in leading innovation while sustaining provider well-being and impact.”
Expert Advisory Group Formed
To guide this new initiative, AACN has convened an expert group of nurse faculty and content specialists to develop new curriculum and learning strategies for building competencies essential to leadership and fostering resilience, wellness, and self-care. This work entails designing innovative clinical learning experiences where students can practice these new skills. Outcomes will include the identification of effective learning assessment measures consistent with the competency-based approach to learning advanced in the new Essentials. Members of this expert group include:
Michael Ackerman, DNS, RN, FCCM, FNAP, FAANP, FAAN
Professor of Clinical Nursing and Director of Master of Healthcare Innovation Program
The Ohio State University College of Nursing
Adejoke Bolanle Ayoola, PhD, RN, FAAN
Department Chair and Professor
Calvin University
Sherry S. Chesak, PhD, MS, RN
Assistant Professor of Nursing
Mayo Clinic
Janie Heath, PhD, APRN-BC, FNAP, FAANP, FAAN
Dean and Warwick Professor of Nursing
University of Kentucky College of Nursing
Teri Pipe, PhD, RN
Professor and Dean Emerita
Founding Director, ASU Center for Mindfulness, Compassion and Resilience
Edson College of Nursing and Health Innovation Arizona State University
Allison P. Squires, PhD, RN, FAAN
Associate Professor and Director, Florence S. Downs PhD Program in Nursing Research and Theory Development
New York University Rory Meyers College of Nursing
Deborah Stamps, EdD, MBA, MS, RN, GNP, NE-BC
Executive Vice President Chief Nursing Education and Diversity Officer
Rochester Regional Health
Cheryl Woods Giscombe, PhD, PMHNP-BC, FAAN
LeVine Family Distinguished Scholar of Quality of Life, Health Promotion, and Wellness and Associate Dean, PhD Division & Program
The University of North Carolina at Chapel Hill School of Nursing
AACN will provide regular updates on this initiative to the academic nursing community as the work moves forward. For more information, please contact Kathy McGuinn, AACN’s Director of Interprofessional Education and Practice Partnerships, at [email protected].
“Exploring the Birth Stories of Women on the Autism Spectrum” has earned Laura Foran Lewis, Ph.D., RN the 2022 Best of The Journal of Obstetric, Gynecologic, & Neonatal Nursing (JOGNN) award. Dr. Lewis, an assistant professor at the University of Vermont (UVM) College of Nursing and Health Sciences will receive the award in June at the 2022 Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) Convention for herself and her co-authors, UVM and UVM nursing graduates Hannah Schirling, Emma Beaudoin, Hannah Scheibner, and Alexa Cestrone.
Lewis and her team explored birth stories of autistic women to understand how they make sense of the experience of childbirth. Accounts of poor communication, untreated pain, and sensory overload dominated the birth narratives, as study participants expressed feelings that their concerns were minimized, their wishes were ignored, and they were left out of critical communication and education during the birth process. Participants also emphasized the struggle they experienced when their own autistic traits, such as sensory sensitivities, were out of balance with the birth environment, impairing their ability to communicate with providers and participate in the birth.
The study concluded that nurses could help improve the birth experiences of autistic women by providing thorough and nonjudgmental education about the birth process; trusting women’s reports of pain and anxiety; and making environmental adjustments to help minimize sensory overload.
The study results pose a new challenge to conclusions of previous research documenting delayed bonding between autistic mothers and their babies, Lewis adds.
“In the past, we’ve just assumed that these early parenting outcomes are directly related to autism, but our study sheds new light on the severe trauma many of these women face during childbirth that may lead to detachment and postpartum depression,” said Lewis.
Lewis’s research contributes important evidence to the practice of inclusive health care, said Nursing Department Chair Rosemary Dale, Ed.D., APRN.
“Professional nurses care for a full spectrum of pregnant individuals. The more we are able to highlight the similarities and the unique needs of groups, then we are able to tailor our care and maximize inclusivity,” said Dale.
Lewis will receive the award at the 2022 Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) Convention in June.
Nursing educators challenged with incorporating nursing informatics into their curriculum in accordance with the new AACN Core Competencies for Professional Nursing Education can get a jump start at a three-day conference offered by Vanderbilt University School of Nursing this summer.
The Vanderbilt Informatics Summer Teaching Academy (VISTA) will be July 20-22, 2022, at Vanderbilt’s park-like campus in Nashville, TN. This informatics immersion for educators will be led by nursing informatics experts who will use the new AACN informatics essentials (No. 8) as a framework to provide attendees with concrete ways to embed informatics into their curricula.
“The AACN Core Competencies call for the incorporation of essential informatics and communications technologies into nursing curricula within a few years,” said Patricia Sengstack, DNP, RN-BC, FAAN, FACMI, Senior Associate Dean for Nursing Informatics at Vanderbilt School of Nursing. “The nursing faculty across the nation responsible for making this happen need knowledge on how to do that. Informatics can be confusing. This conference will give nursing faculty and curriculum developers the knowledge they need to bridge that gap for their students and their schools.”
Conference attendees will identify teaching strategies, develop content and create assessment measures to help their schools of nursing transition programs to meet the new AACN informatics-focused competencies. The academy format will include case examples, use of hands-on technology and breakout sessions focused on ideas, innovation and transformation. Attendees will return to their home institutions equipped with new knowledge, applicable strategies and realistic plans to add informatics concepts to their schools’ courses and programs.
“With the pervasiveness of technology in health care today, and the need for robust analytics, informatics concepts are no longer optional in nursing education,” Sengstack said. “They are now essential components to understand in the delivery of transformational care.”
VISTA instructors include Sengstack, a former president of the American Nursing Informatics Association who has also served as chief of clinical informatics at the National Institutes of Health, Clinical Center, and as chief nursing informatics officer for the Bon Secours Health System.
Other presenters are Kelly Aldrich, DNP, MS, RN-BC, FHIMSS, director of innovation, and Brenda Kulhanek, PhD, RN-BC, NPD-BC, NE-BC, director of Vanderbilt’s Nursing Informatics specialty. Aldrich was the first chief nursing informatics officer for HCA Healthcare and is the former chief clinical transformation officer for the Center for Medical Interoperability, a nonprofit led by health systems to simplify and advance data sharing among medical technologies and systems.
Kulhanek has served as division vice president of clinical education for TriStar Health, corporate associate vice president of clinical education for HCA Healthcare, and corporate director of informatics at Adventist Health; she is a past president of the American Nursing Informatics Association. As educators, the three have approximately a century of combined education experience.
“We’re using a train the trainer model to equip faculty to serve as informatics subject matter experts in their own schools. It’s our hope that nursing school deans and department heads encourage their faculty to attend and then return to share with their colleagues,” Sengstack said.
“Nurses of the future need to be educated on informatics concepts and foundations as part of their nursing education. Clinical practice cannot be separated from the technology used in health care,” she said. “It’s a vital and ever-evolving part of patient care.”
For 30 years, E. Alison Holman, Ph.D., professor of nursing at the University of California Irvine Bill and Sue Gross School of Nursing, has focused her research on collective trauma stemming from such climate-related disasters as wildfires and hurricanes, global events like the pandemic and wars, and other human-caused tragedies such as terrorist attacks, mass shootings and bombings. “I’ve always been interested in large-scale events,” she says. “As healthcare professionals, we need to understand how people’s mental health responses impact their physical health in the moment and long-term.”
“Collective trauma” refers to an event that is shared by an entire community, not just an individual. Media – both traditional and social – has expanded community borders beyond a specific geographic location to encompass anyone anywhere in the world who consumes coverage of the crisis. “The role that media plays in the link between mental and physical health following collective trauma is a critical part of my work,” Holman says.
“The healthcare profession has grown to understand that people’s mental health responses to acute stressors are linked to physical health – particularly cardiovascular ailments – down the road. My research has also identified the role that media can play in perpetuating long-term symptomology.”
Her understanding of that is personal as well as professional. The 9/11 terrorist attacks on the U.S. occurred while she was in Nigeria with her family, including two young children. News of this reverberated around the world, and during the six days they waited to return to the States, they experienced the event through media coverage. “I wasn’t there; I didn’t know anyone who was there. And yet it affected me personally, wondering what our country was in for and what it meant for my kids,” Holman says.
Media matters
Back in the U.S., she was a co-principal investigator on the UCI research team that conducted a large, nationally representative study funded by the National Science Foundation on how early reactions to 9/11 (e.g., psychological responses and media exposure) affected participants’ mental and physical health for three years following the attacks. Says Holman: “Because it was such a big event, people were watching it over and over and over, and that was linked to a lot of distress and health problems over time. We realized that we needed to find a way to prevent overconsumption of media.”
Her research into the 2013 Boston Marathon bombings revealed, surprisingly, that media exposure was a more powerful predictor of acute stress symptoms than being at the site of the blasts. “We found that people who were watching hours and hours of media coverage were more distressed soon after the attack than those who had actually experienced the event in person,” she says. “This was a very unusual discovery then.”
After the 2016 Pulse nightclub shooting in Orlando, Florida, Holman was involved in a follow-up survey of participants from the Boston Marathon study, which identified the cumulative effects of repeated exposure. “A cycle of distress can be created over time in which media consumption heightens distress, increases worries about future terrorism, and promotes further media consumption that is again tied to heightened distress,” she says. “We encourage people to limit the amount of exposure they have to traditional and social media after these collective events.”
Providers and personal biases
Over the last 20 years, the healthcare profession has increasingly recognized the link between mental health responses to acute stressors and long-term physical health effects.
“When faced with a traumatized patient, it’s really important that we understand how their trauma may have affected them both mentally and physically. That awareness, particularly with marginalized and underserved populations that generally experience higher rates of trauma, is going to help us be more compassionate and provide more effective care,” Holman says.
“We also need to reflect on our own biases and think about how they may impact our interactions with traumatized patients and, hence, their well-being. We need to learn how to overcome our biases and to support each other as we learn how to change our behavior. None of this is easy, but it’s critical for building a more equitable and effective healthcare system.”
Three Duke University School of Nursing researchers and their collaborators were recently awarded new funding for pilot projects — all centered around reducing health inequities and improving patient care.
This year’s pilot program required that faculty members submit proposals that incorporate at least one of the following racial justice themes:
Dismantling structures that perpetuate racism;
Advancing solutions that ensure health equity in marginalized populations;
Multilevel approaches to addressing social contributors to health;
Methods that improve the participant experience and address racial equity in data collection, analysis, and reporting.
The School’s Center for Nursing Research (CNR) is pleased to announce this year’s grants address the clinical context of sickle cell disease (SCD) management and associated health disparities for adults in Sierra Leone; improve our understanding of the pediatric urobiome, particularly in underserved populations; and acquire large datasets that will allow Duke researchers access to variables needed to improve understanding of health disparities.
Since 2017, the pilot program has encouraged researchers to investigate relevant and innovative ideas that promote health equity and address the School’s Research Areas of Excellence: data science, health innovation, population health and precision health. The goal of the program is to encourage team science and endorse scientific inquiry that positions investigators to be competitive for extramural research funding. The program is administered by the CNR and funded through a generous award from A. Eugene Washington, M.D., M.P.H., M.Sc., chancellor for health affairs, Duke University, and president and CEO, Duke University Health System.
“It was important for the CNR to invest in pilot research that addresses health equity and racial justice so that we are well-positioned to contribute to the future of nursing science,” said Christin Daniels, assistant dean for research development. “This year’s topics tackle a wide variety of pressing challenges – locally and globally, and we’re thrilled to support our researchers’ endeavors toward solving big problems. This pilot program is made possible by our volunteer reviewers, and we’d like to thank them for their collegiality and service. We’d also like to thank Chancellor Washington for the generous award that allows us to offer this program.”
Extending SCD Management: Adapting Management Recommendations to Sierra Leonean Context
Ibemere serves as the principal investigator for her study entitled “Extending Sickle Cell Disease (SCD) Management: Adapting Management Recommendations to Sierra Leonean Context.” She is collaborating with Paula Tanabe, PhD, MSN, MPH, RN, FAEN, FAAN, vice dean, research, and Laurel Chadwick Professor of Nursing, Nirmish Shah, MD, associate professor of medicine, and Cheedy Jaja, PhD, assistant dean for global engagement, University of South Florida.
Evidence-based guidelines exist for sickle cell management, but they do not currently account for the unique perspectives of sub-Saharan populations, who have the greatest prevalence of SCD. Approximately 75 percent of those born with SCD are born in sub-Saharan Africa, and 50 to 90 percent will die before the age of 5. The estimated life expectancy for adults with SCD in Sierra Leone is 20 to 30 years shorter than in high-resourced settings. To reduce the inequitable access to a clinical model for SCD management, the project team will assess clinician and community member knowledge of the National Heart, Lung, and Blood Institute SCD recommendations and evaluate existing SCD management algorithms (e.g. SCD toolbox) for the clinical context in Sierra Leone.
The chasms between SCD outcomes in low-income settings contrasted with those in high-resource settings are linked to systematic decisions and structural barriers which impede workforce development and patient access to care. If left unaddressed, researchers expect continued poor health outcomes for individuals living with SCD in sub-Saharan Africa. Guided by the culture-centered approach, this study will engage Sierra Leonean colleagues, elevating the voices of historically marginalized and minoritized populations while investing in the clinical improvement of SCD disease management within this specific cultural context.
These findings will inform the development of a SCD care management model rooted in evidence-based practice for providers, and the preliminary data will help inform the development of a future NIH R21 submission.
Stability of the Pediatric Urinary Microbiome
Principal investigator Kelly will lead the study entitled “Stability of the Pediatric Urinary Microbiome” along with her collaborators Lisa Karstens, PhD, assistant professor, Oregon Health and Science University, and Tatyana Sysoeva, PhD, assistant professor of microbiology, The University of Alabama in Huntsville.
Urinary tract infections (UTIs) are the most common outpatient infections in the U.S. and are among the most serious bacterial infections encountered by pediatricians. In children, UTIs can result in life-long health consequences including renal scarring, hypertension, renal insufficiency, and pregnancy complications, such as preeclampsia and preterm birth. Antimicrobial resistance of urinary pathogens that cause UTIs is increasing, yet antibiotics remain the standard treatment for UTIs in children. Antibiotic use increases resistance and may change the child’s microbiome. There is a pressing need to develop non-antibiotic therapeutics for UTI treatment, especially in children.
UTIs are more common in Latinx and white children. Inability to make frequent trips to a clinic for urine collection presents a barrier to care that is exacerbated in marginalized populations. At-home urine collection and storage would improve adherence and enhance the quality of the urobiome data.
This pilot study will utilize urine samples in children taken over the course of two months to determine the stability of the urinary microbiome in children and determine if at-home collection is viable, particularly in the Latinx population. The team will translate their study materials into Spanish and work with a community advisory board to ensure the Latinx community helps guide the research. The long-term goal of this study is to develop a predictive test that can identify children at increased risk of UTIs as well as a non-antibiotic intervention strategy. Kelly and team anticipate using the study data towards a future R01 grant submission.
National Representative Databases for Clinical Research
Myers will serve as the principal investigator of the study entitled “National Representative Databases for Clinical Research.” The research team includes Michael Cary, PhD, RN, Elizabeth C. Clipp Term Chair in Nursing and associate professor and Nancy Crego, PhD, RN, CCRN, CHSE, assistant professor, and Michael J. Smith, MD, professor of pediatrics, Bradley Hammill, DrPH, associate professor, and Gina-Maria Pomann, PhD, assistant professor, with the School of Medicine.
National administrative databases are rich sources of clinical information that may serve as the basis for a multitude of research projects. The School of Nursing and overall Duke community have limited access to such databases. In addition, the databases are not in formats that allow untrained analysts to perform appropriate analyses. This pilot project seeks to purchase the following data sources and convert data into user-friendly formats for Duke research utilization:
Kid’s Inpatient Database from Healthcare Cost and Utilization Project (HCUP)
National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Surveys
National Immunization Survey
National Inpatient Survey
National Emergency Department Sample Census Data and Area Health Resources Files
Myers and team will use this data to build the School of Nursing’s first data warehouse, Health e-Data. The data contained within the warehouse will significantly enhance our ability to access and study large-scale, national clinical data.
The warehouse will also advance our ability to address racial equity in data collection, analysis, and reporting. Incomplete race data is a serious and persistent problem that hampers progress. Fortunately, the HCUP databases have created multiple procedures to address this issue. They have identified standardized categories for race and ethnicity, developed novel imputation methods to reduce the impact of existing missing data on disparities research, and linked zip code-level information (e.g., racial distribution, income, education, and poverty level) from the U.S. Census to address socioeconomic status data. They now also include data examining social determinants of health . As such, the creation of the Health e-Data warehouse will allow researchers to examine racial disparities more robustly and rigorously.
In April 2021, member schools affiliated with AACN voted to endorse 
Ibemere serves as the principal investigator for her study entitled “Extending Sickle Cell Disease (SCD) Management: Adapting Management Recommendations to Sierra Leonean Context.” She is collaborating with 
Principal investigator Kelly will lead the study entitled “Stability of the Pediatric Urinary Microbiome” along with her collaborators Lisa Karstens, PhD, assistant professor, Oregon Health and Science University, and Tatyana Sysoeva, PhD, assistant professor of microbiology, The University of 
Myers will serve as the principal investigator of the study entitled “National Representative Databases for Clinical Research.” The research team includes