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Background: Registered nurse (RN) turnover is a recurring phenomenon that accelerated during COVID-19 and heightened concerns about contributing factors., Purpose: Provide baseline RN turnover data to which pandemic and future RN workforce turnover behaviors can be compared., Methods: A cross-sectional, secondary analysis of RN turnover using U.S. National Sample Survey of Registered Nurses 2018 data. Responses from 41,428 RNs (weighted N = 3,092,991) across the United States were analyzed. Sociodemographic, professional, employment, and economic data and weighting techniques were used to model prepandemic RN turnover behaviors., Discussion: About 17% of the sample reported a job turnover, with 6.2% reporting internal and 10.8% reporting external turnover. The factors common across both internal and external turnover experiences included education, employment settings, and years of nursing experience., Conclusions: Baseline RN turnover data can help employers and policymakers understand new and recurring nursing workforce trends and develop targeted actions to reduce nurse turnover., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Critical care nurse shortages and burnout have spurred interest in the adequacy of nursing supply in the United States. Nurses can move between clinical areas without  additional education or licensure., Purpose: To identify transitions that critical care nurses make into non-critical care areas, and examine the prevalence and characteristics associated with those transitions., Methods: Secondary analysis of state licensure data from 2001-2013., Discussion: More than 75% of nurses (n = 8,408) left critical care in the state, with 44% making clinical area transitions within 5 years. Critical care nurses transitioned into emergency, peri-operative, and cardiology areas. Those observed in recession years were less likely to make transitions; female and nurses with masters/doctorate degrees were more likely., Conclusion: This study used state workforce data to examine transitions out of critical care nursing. Findings can inform policies to retain and recruit nurses back into critical care, especially during public health crises., (Published by Elsevier Inc.)

Purpose: Nurse practitioners (NPs) and physicians serve in both usual source of care (USC) and supplement roles to each other in the provision of primary care to patients. Yet little is known about the care that patients receive from providers in these roles. This study examined the care individuals received when NPs and physicians served in USC and supplemental roles., Methods: Pooled data from the Household Component of the Medical Expenditure Panel Survey 2002-2013. Cross-sectional, secondary data analysis using propensity score matching and multinomial logistic regression. Data were collected from a national subsample of households., Findings: Regardless of provider role, patients reported receiving more therapeutic or preventive care from NPs but more diagnostic care and biomedical treatments from physicians. Patients reported having similar diagnoses when seen by NPs and physicians serving in USC roles, but different diagnoses when NPs and physicians served in supplemental roles., Discussion: NPs and physicians providing different care when serving in the same role. Findings can inform policy-makers as they develop policies for serving patients and utilizing the relevant expertise of NPs and physicians., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The role of the Doctor of Nursing Practice-prepared nurse (DNP) outside of academic settings has not been clearly articulated or widely explored, and therefore the value DNP-prepared nurses bring to their practice settings is largely unknown. This study: (1) surveyed existing DNP programs to identify the nonacademic settings in which their DNP graduates were employed and (2) conducted semistructured interviews with employers to identify the role and value of the DNP-prepared nurse in nonacademic settings., Method: Data were collected from January 2016 to August 2016 in two parts: (1) an online survey of the DNP programs and (2) qualitative semistructured telephone interviews with employers. First, we conducted an online survey of program directors (or their equivalent) from 288 DNP programs across the United States to capture descriptive information about current DNP programs (e.g., location, modality, profit status), the types of nonacademic institutions that hire their graduates, percentage of graduates employed by each setting, and the contact information for these employers. Employers were identified either by DNP program directors through the online survey or by a convenience sampling method. Using semistructured telephone interviews, we asked questions to employers in different care settings about the role of the DNP in these settings and how the DNP compares to other nurse leaders and advanced practice nurses (APRN). Employers were asked to describe the role of the DNP-prepared nurse working in direct patient care roles such as APRNs or as leaders, administrators, and managers., Findings: Descriptive thematic analyses were derived from the interviews, to identify the roles DNP-prepared nurses filled and how they compared to other nurse leaders and advanced practice nurses in these settings. A total of 130 DNP program directors responded to the online survey. Twenty-three employers participated in semistructured telephone interviews. The thematic analysis resulted in four main themes regarding the role of the DNP-prepared nurse in non-academic settings: "DNP-Prepared Nurse Positions and Roles," "Perceived Impact of the DNP-Prepared Nurse on Staff, Patient, and Organizational Outcomes," "Comparison of the DNP-Prepared Nurse to Other Nurses With Advanced Training," and "Challenges Experienced by Nurses With DNP Degrees., Discussion: The role of the DNP-prepared nurse in nonacademic settings is unclear. These DNP-prepared nurses typically function as APRNs in clinical care or as health care system leaders. While there is a low number of DNPs in clinical practice settings, the number is expected to grow as more graduate and enter practice. Thus, knowledge of the roles, value, and outcomes of the DNP-prepared nurse can guide practice setting leaders on how to best use DNP-prepared nurses in their setting., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Previous studies reported that primary care nurse practitioners working in primary care settings may earn less than those working in specialty care settings. However, few studies have examined why such wage difference exists., Purpose: This study used human capital theory to determine the degree to which the wage differences between dingsPCNPs working in primary care versus specialty care settings is driven by the differences in PCNPs' characteristics. Feasible generalized least squares regression was used to examine the wage differences for PCNPs working in primary care and specialty care settings., Methods: A cross-sectional, secondary data analysis was conducted using the restricted file of 2012 National Sample Survey of Nurse Practitioners., Findings: Oaxaca-Blinder decomposition technique was used to explore the factors contributing to wage differences.The results suggested that hourly wages of PCNPs working in primary care settings were, on average, 7.1% lower than PCNPs working in specialty care settings, holding PCNPs' socio-demographic, human capital, and employment characteristics constant. Approximately 4% of this wage difference was explained by PCNPs' characteristics; but 96% of these differences were due to unexplained factors., Discussion: A large, unexplained wage difference exists between PCNPs working in primary care and specialty care settings., (Copyright © 2018. Published by Elsevier Inc.)

Background: A more diverse registered nurse (RN) workforce is needed to provide health care in North Carolina (NC) and nationally. Studies describing licensed practical nurse (LPN) career transitions to RNs are lacking., Purpose: To characterize the occurrence of LPN-to-RN professional transitions; compare key characteristics of LPNs who do and do not make such a transition; and compare key characteristics of LPNs who do transition in the years prior to and following their transition., Methods: A retrospective design was conducted using licensure data on LPNs from 2001 to 2013. Cohorts were constructed based on year of graduation., Findings: Of 39,398 LPNs in NC between 2001 and 2013, there were 3,161 LPNs (8.0%) who had a LPN-to-RN career transition between 2001 and 2013. LPNs were more likely to transition to RN if they were male; from Asian, American Indian, or other racial groups; held an associate or baccalaureate degree in their last year as an LPN (or their last year in the study if they did not transition); worked in a hospital inpatient setting; worked in the medical-surgical nursing specialty; and were from a rural area., Discussion: Our findings indicate that the odds of an LPN-to-RN transition were greater if LPNs were: male; from all other racial groups except white; of a younger age at their first LPN licensure; working in a hospital setting; working in the specialty of medical-surgical nursing; employed part-time; or working in a rural setting during the last year as an LPN., Conclusion: This study fills an important gap in our knowledge of LPN-to-RN transitions. Policy efforts are needed to incentivize: LPNs to make a LPN-to-RN transition; educational entities to create and communicate curricular pathways; and employers to support LPNs in making the transition., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: A number of factors in the health care environment, including a change in regulatory policy, may affect a country's nursing workforce and nurse migration and mobility., Purpose: This study compared the characteristics of Canadian-educated nurses who had migrated to the United States to work with their colleagues in the United States and Canada in anticipation of a change in Canada's RN entry to practice requirements in 2015., Methods: We conducted a retrospective comparative study of nurses in Canada and the U.S. using 2008 data from the US National Sample Survey of Registered Nurses and the Canadian Institute of Health Information., Discussion: There was little change in the number of Canadian-educated nurses working in the United States in 2008 compared with 2004. We found differences between U.S. nurses and Canadian-educated nurses working in the United States in educational level, work status, work location, and age. No differences were found between Canadian-educated nurses working in the United States and those working in Canada., Conclusions: This research highlights the value of international comparisons of the nursing workforce, especially in the context of anticipated regulatory changes, which may affect a country's nursing health human resources., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Despite the importance of the internationally educated nurse (IEN) workforce, there has been little research on the employment settings of IENs and other aspects of their employment. We analyzed data from the 2008 National Sample Survey of Registered Nurses to characterize IENs in the United States using descriptive statistics and multivariate ordinary least squares regression. We find notable differences in the decade of immigration, current age, and highest nursing education across the countries in which IENs were educated. IENs are more likely to be employed in nursing and to work full-time. They receive higher total annual earnings and earn higher average hourly wages. However, when demographic, human capital, and employment characteristics are held constant, IENs from every country except Canada earn no more than U.S.-educated nurses. Future research should seek to identify the causes of these employment and earnings differences to understand the role and impact of the IEN workforce., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Nurses are known to migrate from rural to urban areas, which may cause geographic imbalances in the workforce., Purpose: The aim of this study was to compare new graduate nurse retention based on the type of geographic area (capital, metropolitan, and nonmetropolitan) of their first job and their job satisfaction by geographic location., Methods: The sample included 533 nursing graduates working full-time as registered nurses in hospitals or clinics. Survival analysis was conducted to compare nurse retention in three geographic locations., Results: Survival curves for nurses in capital and nonmetropolitan areas were significantly different. The 1-, 2-, and 3-year survival probabilities of nurses in the capital were .923, .881, and .872, respectively, whereas those in nonmetropolitan areas were .887, .776, and .672, respectively. Nurses in nonmetropolitan areas were more dissatisfied with pay (odd ratio [OR] = 1.820, p = .009), fringe benefits (OR =1.893, p = .015), employment security (OR =2.640, p = .033), and personal growth (OR =1.626, p = .045) than those in the capital., Conclusions: Nurses employed in nonmetropolitan areas were more mobile and less satisfied with their jobs than those in the capital., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The "globalization" of health care creates an increasingly interconnected workforce spanning international boundaries, systems, structures, and processes to provide care to and improve the health of peoples around the world. Because nurses comprise a large sector of the global health workforce, they are called upon to provide a significant portion of nursing and health care and thus play an integral role in the global health care economy. To meet global health care needs, nurses often move within and among countries, creating challenges and opportunities for the profession, health care organizations, communities, and nations. Researchers, policy makers, and industry and academic leaders must, in turn, grapple with the impacts of globalization on the nursing and health care workforce. Through this special issue, several key areas for discussion are raised. Although far from exhaustive, our intent is to expand and stimulate intra- and interprofessional conversations raising awareness of the issues, uncover unanticipated consequences, and offer solutions for shaping the nursing and health care workforce of the future., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Since the 1980s, U.S. policy makers have used immigration policy to influence the supply of nurses by allowing or restricting the entry of internationally educated nurses (IENs) into the U.S. workforce. The methods pursued have shifted over time from temporary visa categories in the 1980s and 1990s to permanent immigrant visas in the 2000s. The impact of policy measures adopted during nursing shortages has often been blunted by political and economic events, but the number and representation of IENs in the U.S. nursing workforce has increased substantially since the 1980s. Even as the United States seeks to increase domestic production of nurses, it remains a desirable destination for IENs and a target market for nurse-producing source countries. Hiring organizations and nurse leaders play a critical role in ensuring that the hiring and integration of IENs into U.S. health care organizations is constructive for nurses, source countries, and the U.S. health care system., (Copyright © 2014 Elsevier Inc. All rights reserved.)

A chart review of 20 patients who sustained acute proximal humeral fractures and who were treated by surgical stabilization with locked antegrade humeral intramedullary nails (Polarus nails) was undertaken. The clinical outcome measurements were fracture healing, infection, and neurologic injury. Radiologic outcome measurements included fracture alignment, loosening, fixation and hardware failure, and malunion and nonunion. Of 20 fractures, 11 healed without complications. The mean immediate postoperative and final radiographic valgus neck/shaft angulation measured 131 degrees. Of the 20 implants, 3 had proximal fixation screw loosening. Of the 20 implants, 2 underwent revision surgery for proximal fixation failure. With certain fracture types, the Polarus intramedullary humeral nail can be an effective implant. In fracture cases involving an unstable or comminuted lateral metaphyseal fracture, if the starting point extends into the greater tuberosity, fixation failure or fracture displacement may result.

Despite the successes of the US health care system, problems associated with access, affordability, and quality of care remain to be solved. Health services research (HSR) has the potential to aid nurses in addressing these issues; yet the importance of its inclusion in the academic preparation of nurse researchers has not been consistently recognized. This article discusses the relevance of HSR to nursing, provides a brief review of the history of HSR and its imperatives, and presents rationale for nursing's involvement in HSR. Problems identified by the Re-envisioning PhD project conducted by the University of Washington are assessed for relevance to HSR and nursing doctoral preparation. Recommendations are included for integrating HSR into nursing doctoral programs and meeting HSR capacity building needs for the future.