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Nurses experience high levels of burnout, and this has become a major factor in recruitment and retention of nurses. Several factors have been associated with burnout, but it is not clear which factors are the most significant predictors. Understanding the most prevalent factors that are associated with burnout will allow for the development and implementation of interventions to ameliorate and/or reduce burnout in the nursing workforce.

Burnout is a condition resulting from chronic workplace stress that has not been effectively managed, described in 3 dimensions: (a) feelings of energy depletion or exhaustion, (b) increased mental distance from one's job, and (c) reduced professional efficacy. Burnout is a widespread problem reaching concerning levels among health care professionals, with more than 50% of physicians and one-third as many as 80% of nurses reporting symptoms. The National Academy of Medicine (NAM) action collaborative on clinician well-being and resilience has prioritized exploring ways to enhance baseline understanding of clinician well-being and promotion of multidisciplinary solutions to burnout.

Health professionals, including nurses, are vulnerable to burnout, which occurs when chronic stress is not managed. COVID-19 led to nurses working in stressful environments, and being required to work mandatory overtime. The result was an increase in burnout. Nurses exhibited physical, psychological, emotional, and behavioral signs of burnout. There are several ways that nurses can mitigate the situation and have more control over burnout. Nurses need to work together to support each other, including supporting the leader. There are several actions, such as mindfulness activities and maintaining a healthy lifestyle that can help prevent burnout.

Despite the strong support for DNP education, we have limited knowledge about completion and attrition of DNP students, which are important measures of achievement of DNP programs.To examine completion and attrition of students in DNP programs.The data were obtained from AACN's Doctoral Student Roster Survey and Annual Survey of Baccalaureate and Graduate Programs in Nursing. 31,320 students who matriculated into DNP programs between 2006 and 2015 were selected. These years were chosen to ensure accurate estimates of graduation and attrition rates. Bivariate and multivariate analyses were used to examine the associations between individual and institutional characteristics and attrition of DNP students.We found that the completion rate of DNP students of the 2006-2015 matriculating cohorts was 77.3% and the attrition rate was 19.3%. On average, after matriculation, it took 3 years for the students to graduate and 1.9 years for students who left without graduating to drop out. The mean age at matriculation was 39.9 and the mean age at graduation was 42.2. Our multivariate analysis found that male students, part-time students, students who were not faculty or held a part-time faculty position, and students in DNP programs with more than 50% of courses taught online were more likely to experience attrition.The study findings provide useful information for DNP programs and nursing schools to better understand academic progression of DNP students.

A healthy work environment is a critical factor in nurse satisfaction, retention, and patient outcomes. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is the most commonly used instrument to measure the nursing practice environment. This study uses meta-analysis to examine the reliability generalization of the PES-NWI. A meta-analysis of 51 studies representing a total of 80,563 subjects was conducted. The mean score reliability for the PES-NWI based on 38 studies ( n = 68,278) was .922 ( p < .05). The Mean Weighted Effect Size was stronger for studies conducted in the United States versus non-U.S. (.946 vs. .907). For studies rated high and moderate quality, the mean score reliability was .911 and .946, respectively. Scores on the PES-NWI are reliable for measuring the nursing practice environment across samples in the United States and non-U.S. countries.

Several interrelated workforce and population trends have intensified the need to increase the number of nurse practitioners (NPs) in primary care. The Advanced Nursing Education Expansion (ANEE) program was created to address health workforce needs by increasing the number of students enrolled full-time in NP and nurse-midwifery programs. Using data from ANEE grant performance measures, we found that nearly 65% of ANEE-supported graduates practice in primary care and 44.8% work in medically underserved communities. Results from this study demonstrate that even short-term federal investments have an impact on the expansion of the primary care health workforce.

The Journal of Excellence in Nursing and Healthcare Practice (JENHP) was created to promote innovations, translation, and dissemination of evidence supporting improved outcomes in the nursing practice environment. The journal welcomes manuscripts focusing on topics such as national and international workforce issues, quality improvement projects, evidenced-based practice initiatives, nursing research studies, interprofessional practice, educational issues, improvements in technology, innovative practice problem solutions, and the impact of social change in society. Although we accept submissions from all types of researchers, both new and experienced, one central purpose of this journal is to provide an outlet for research conducted by students. Hence, individuals from doctoral, master’s, and baccalaureate programs are especially welcomed to submit manuscripts based on scholarly projects or papers completed while in or after graduating from an accredited program.

Background The Health Resources and Services Administration’s Grants to States to Support Oral Health Workforce Activities, otherwise known as the State Oral Health Workforce Program (SOHWP), help states develop and implement innovations that address the workforce needs of dental Health Professional Shortage Areas in a manner appropriate to the states’ individual needs. Aim This cross-sectional study explores the broad impact of the SOHWP by comparing measures of dental workforce density and access to oral health care in states with multiple years of funding versus states with few or no years of funding. Methods We used data for 2006–2016 SOHWP awardees together with data from the 2016–2017 Area Health Resources Files and the 2016 Behavioral Risk Factor Surveillance System to compare numbers of dentists per 100,000 population and age-adjusted prevalence of annual dental visits among adults for long-term SOHWP-funded states versus states with few or no years of funding. Results Multi-year SOHWP funding is associated with higher workforce density and greater access to oral health care, especially in the Midwest and West. Conclusion Allowing states funding utilization flexibility may result in improved outcomes. This finding can help inform planning and policy about whether and how to scale future training and workforce programs to achieve greater impact.

A National Sample Survey of Nurse Practitioners was conducted in 2012 to provide a national estimate of the nurse practitioner (NP) workforce and new information on services provided by NPs, their specialty areas, and job satisfaction. Data from almost 13,000 respondents show that 76% of NPs in the workforce are trained in primary care and 48% of NPs in patient care provide primary care. There is also evidence of increased proclivity to specialize in primary care among the most recent graduates, indicating that NPs will continue to play a critical role in improving access to primary care.

Objective Inform health planning and policy discussions by describing Health Resources and Services Administration's (HRSA's) Health Workforce Simulation Model (HWSM) and examining the HWSM's 2025 supply and demand projections for primary care physicians, nurse practitioners (NPs), and physician assistants (PAs). Data sources HRSA's recently published projections for primary care providers derive from an integrated microsimulation model that estimates health workforce supply and demand at national, regional, and state levels. Principal findings Thirty-seven states are projected to have shortages of primary care physicians in 2025, and nine states are projected to have shortages of both primary care physicians and PAs. While no state is projected to have a 2025 shortage of primary care NPs, many states are expected to have only a small surplus. Conclusions Primary care physician shortages are projected for all parts of the United States, while primary care PA shortages are generally confined to Midwestern and Southern states. No state is projected to have shortages of all three provider types. Projected shortages must be considered in the context of baseline assumptions regarding current supply, demand, provider-service ratios, and other factors. Still, these findings suggest geographies with possible primary care workforce shortages in 2025 and offer opportunities for targeting efforts to enhance workforce flexibility.

The Health Resources and Services Administration maintains a strong emphasis on increasing the diversity of the health-care workforce through its grant programs. Increasing the diversity of the workforce is important for reducing health disparities in the population caused by socioeconomic, geographic, and race/ethnicity factors because evidence suggests that minority health professionals are more likely to serve in areas with a high proportion of underrepresented racial and ethnic minority groups. The data show success in increasing the diversity of enrollees in five nursing programs.

This article examines the potential benefits of enhanced use of advanced practice registered nurses (APRNs) given health care workforce projections that predict an inadequate supply of certain types of providers. The conclusions of a systematic review comparing the effectiveness of care provided by APRNs with that of physicians alone or teams without APRNs indicate the viability of this approach. Allowing APRNs to assume roles that take full advantage of their educational preparation could mitigate the shortage of primary care physicians and improve care processes. The development of health care policy should be guided by patient-centric evidence rather than how care has been delivered in the past.

The United States Army Nurse Corps (ANC) and the University of Maryland School of Nursing (UMDSON) formed a partnership to address the nursing faculty shortage. Six ANC officers served as full-time faculty at the UMDSON for a 2-year period. Given that the student experience is central to the context of learning, the purpose of this study was to describe the experience of the students who interacted with ANC officers. Using a descriptive phenomenological approach, 14 nursing students participated in open-ended, in-depth, audiotaped interviews. Although the students had preconceived ideas about ANC officers as faculty, following engagement with the officers, the students reported many positive attributes of having ANC officers as clinical instructors and an enlightened understanding of the role of the military in today’s world. The findings of this study indicate that the use of ANC officers is a plausible solution to the ongoing nursing shortage.

Background Advanced practice nurses (APNs) in the United States could expand access to high-quality health care, particularly for underserved populations. Yet, there has been limited synthesis of the evidence related to their effectiveness as compared with other providers. The study reported here, part of a larger study that examined all four types of APNs, compares the labor and delivery care outcomes of certified nurse-midwives (CNMs) and physicians. Data Sources PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Proquest (for dissertations), were searched for the years 1990 through 2008. Study Eligibility Criteria Only those articles where processes or outcomes of care were quantitatively compared between CNMs and physicians were included. For all APNs, 27,993 citations were reviewed. For CNMs, 21 articles representing 18 unique studies reported either infant or maternal outcomes. Methods The systematic review followed established procedures (replicable search of relevant databases, sequential review to identify eligible studies, abstraction by two reviewers, assessment of quality, and grading of evidence). Results For measures that relate to the processes of care (e.g., epidural, labor induction, episiotomy), lower use was found for CNMs. For many of the infant outcomes (e.g., low Apgar, low birth weight, neonatal intensive care unit admission), there were no differences between physicians and CNMs. Perineal lacerations were lower and breastfeeding was higher among women cared for by CNMs compared with physicians. Limitations The review addressed only CNMs practicing in the United States and outcomes measured during labor and delivery. The majority of study designs were observational and the models of care ranged from independent to shared, limiting the control for bias. Moreover, all reviewers were nurses. Conclusion Differences in practice between CNMs and MDs seem to be well documented, particularly in the use of technology. Yet, the findings provide evidence that care by CNMs is safe and effective. CNMs should be better utilized to address the projected health care workforce shortages.

The case for a more diverse health-care workforce has never been stronger given the rapidly changing demographics of the United States and the continued underrepresentation of certain racial and ethnic groups across the health professions. To date, progress toward diversifying the health-care workforce has been and continues to be deterred by a mix of factors at the societal, institutional, and individual levels. Since the 1970s, the Federal government has invested resources in initiatives that support the training and development of the existing workforce as well increase the supply of new health professionals—particularly those from underrepresented minority groups and/or from disadvantaged backgrounds. However, limited studies have been published detailing the processes, outputs and, where available, outcomes of such investments across multiple years. This article describes how the Health Resources and Services Administration’s Bureau of Health Workforce used retrospective case study methodology to evaluate processes and outputs associated with the Scholarships for Disadvantaged Students program—an over US$40 million annual Federal investment aimed at offsetting tuition costs for health professions students from disadvantaged backgrounds—over a 5-year period. Lessons learned and recommendations for strengthening the program’s design and requirements are provided.

Barlow K.M. & Zangaro G.A. (2010) Journal of Nursing Management18, 862–873 Meta-analysis of the reliability and validity of the Anticipated Turnover Scale across studies of registered nurses in the United States Background Globally, there are serious human and financial costs associated with registered nurse (RN) turnover. Anticipating turnover before turnover occurs is important to prevent costly and unnecessary turnover. Using a reliable and valid measure of anticipated turnover is essential to credible healthcare research on which nursing policy decisions are based. This meta-analysis provides a systematic way to determine the legitimacy of the use of the Anticipated Turnover Scale (ATS) in RN workforce research. Aims The aims of this meta-analysis were to determine the consistency of reliability estimates and evidence of construct validity of ATS scores across studies of RNs in the US. A secondary purpose was to evaluate variability in reliability and validity according to study quality, century within which studies were conducted and whether studies were published or unpublished. Methods Search strategies included accessing computerized databases, emailing researchers, consulting experts, footnote-chasing and accessing unpublished reports. Two independent reviewers examined studies according to inclusion criteria and quality. Consensus was reached on selected studies and quality ratings. Results Overall mean weighted effect size (MWES) of reliability from 12 studies was 0.89. Overall MWES of validity correlating the ATS and four job satisfaction measures for seven studies was −0.53. There was variability in reliability according to quality of studies. Conclusion The ATS demonstrated excellent reliability and construct validity across studies of RNs in the US. Implications for nursing management Nursing management should consider the ATS in research on prevention of RN turnover.

The purpose of this study was to identify factors that contribute to the retention of United States Navy Nurse Corps reservists called to duty in 2003. Data were collected by questionnaires based on Price and Mueller's causal model of voluntary turnover and were analyzed via descriptive statistics, multiple regression analysis, exploratory factor analysis, and structural equation modeling. The data indicate that the model fits the data well, with job satisfaction having the strongest influence on one's intent to stay in the Reserve. The data analyses did not support the concern that a negative experience with a recall could make a reservist resign his/her commission. The results may prove useful to any nation that relies on a volunteer reserve force to augment its day-to-day nursing capabilities.

Where a physician is educated-in a public or a private institution-affects his or her practice choices, including the likelihood of choosing a career in primary care. It is important to monitor the educational pipeline for physicians to ensure that a robust cadre of professionals is entering the health care workforce from public-sector institutions to meet the growing demand for primary care providers.

The purpose of this study was to survey Army, Navy and Air Force nurses between the ranks of 01 to 06 to explore factors influencing their decisions to remain on active duty. A descriptive correlation design using an electronic survey was used to collect the data on nurse retention. A pilot study was conducted to test the instrument and ensure all wording was clearly understood by the participants. Upon completion of the pilot study, an electronic survey was administered to all Army, Navy and Air Force nurses serving on active duty. Sample: The total sample size for analysis purposes was 2,574 (Army = 996; Navy = 590; Air Force = 988). The overall response rate was 30%, which is acceptable for a study this size. The response rates for each service were as follows: Army 35%; Navy 22%; and Air Force 33%. Statistical analysis was completed using descriptives and structural equation modeling. The most significant predictor of job satisfaction and intent to stay on active duty across all 3 services was promotional opportunity (positive relationship, the more promotional opportunities available the more satisfied and likely to stay). Relocation of families was also a significant predictor across all 3 services, the fewer times a family was relocated the more likely they are to stay in the military. Nurses were asking to be able to remain in one geographical area for longer periods of time provided this would not impact their promotional opportunity. Overall, deployments were not a significant factor in determining job satisfaction or intent to stay. Most service members were happy to deploy and saw this as part of their mission and patriotic duty. Additionally, single military members felt that they were expected to be more flexible with relocations and deployments.

Job satisfaction is an extremely important concept that influences a nurse's decision to stay in an organization, as well as the cost of turnover and the nursing shortage. The purpose of this review is to identify published research studies that have assessed job satisfaction and retention (intent to stay) in military nurses serving in the Army, Navy, or Air Force. The available literature was searched from 1980 to 2010 and the review resulted in 21 studies. The majority of the studies used a descriptive correlational design and was specific to one particular service. The researchers reported several satisfiers such as strong sense of teamwork, favorable work environments, pay and benefits, promotional opportunities, leadership and management experiences offered to junior officers. One of the major dissatisfiers was the lack of support from leadership. Nurse researchers must expand the retention science with robust longitudinal interventional studies. Nurse researchers are well positioned to provide military nurse leaders with the best possible evidence to address issues and make decisions regarding nurse retention.

Purpose: To explore the experiences of Army Nurse Corps (ANC) officers who were assigned as faculty at the University of Maryland Baltimore, School of Nursing (UMBSON), as well as explore the experiences of students being taught by ANC faculty. A secondary purpose was to identify factors that influence an undergraduate student's decision-making process about pursuing a military career. Design: This study used a mixed methods approach. In phase one, qualitative interviews were conducted with ANC faculty utilizing a phenomenological approach. In phase two, the Career Decision Making Inventory was administered to students and students were recruited for qualitative interviews which explored their experiences with ANC faculty. Methods: Data were collected using open-ended questions in interviews lasting 45 to 60 minutes. A career decision-making questionnaire was administered to students. Sample: There were six ANC faculty and 14 students interviewed. There were 251 usable surveys returned. Analysis: Qualitative data were analyzed using Colaizzi's method and quantitative data were analyzed using SPSS software. Descriptive, bivariate, and t-tests were used in the analysis. Findings: The Army nurses (n=6) experiences had three themes: transitioning from an Army environment to an academic environment; transforming faculty attitudes about the military; and realizing great personal rewards. The student interviews (n=14) yielded six themes: strict, structured and disciplined; the context of military life; a higher calling; understanding the military uniform; performing as competent instructors; and the person behind the uniform. A response rate of 73% resulted in a sample of 251 students. The findings indicated that exposure to ANC faculty did influence students perceptions of nursing in general and of military nursing. Implications for Military Nursing: This has been an extremely successful partnership between the ANC and the UMDSON.

Globally, there are serious human and financial costs associated with registered nurse (RN) turnover. Anticipating turnover before turnover occurs is important to prevent costly and unnecessary turnover. Using a reliable and valid measure of anticipated turnover is essential to credible healthcare research on which nursing policy decisions are based. This meta-analysis provides a systematic way to determine the legitimacy of the use of the Anticipated Turnover Scale (ATS) in RN workforce research.The aims of this meta-analysis were to determine the consistency of reliability estimates and evidence of construct validity of ATS scores across studies of RNs in the US. A secondary purpose was to evaluate variability in reliability and validity according to study quality, century within which studies were conducted and whether studies were published or unpublished.Search strategies included accessing computerized databases, emailing researchers, consulting experts, footnote-chasing and accessing unpublished reports. Two independent reviewers examined studies according to inclusion criteria and quality. Consensus was reached on selected studies and quality ratings.Overall mean weighted effect size (MWES) of reliability from 12 studies was 0.89. Overall MWES of validity correlating the ATS and four job satisfaction measures for seven studies was -0.53. There was variability in reliability according to quality of studies.The ATS demonstrated excellent reliability and construct validity across studies of RNs in the US. Nursing management should consider the ATS in research on prevention of RN turnover.

Because of the increasing use of civilian registered nurses to supplement the nursing staff at U.S. Navy hospitals, it is imperative to understand the factors that influence satisfaction in both Navy and civilian nurses in military hospitals. This study sought to expand knowledge of satisfaction in hospital-based active duty Navy registered nurses and federal civilian nurses. Respondents completed a survey with a response rate of 42% (N=496). The survey was designed using well-known satisfaction models and included measures of work attitudes, work setting, and demographic characteristics. Linear regression models explained 51% of the variance in job satisfaction for Navy nurses and 55% for civilian nurses. Routinization had the strongest significant negative association with job satisfaction for Navy and civilian nurses. Supervisor support was significantly associated with satisfaction for Navy nurses although coworker support was a significant factor for civilians. These findings have implications for nurse administrators and health care executives who desire to retain nurse employees.

Although several variables have been correlated with nursing job satisfaction, the findings are not uniform across studies. Three commonly noted variables from the nursing literature are: autonomy, job stress, and nurse-physician collaboration. This meta-analysis examined the strength of the relationships between job satisfaction and autonomy, job stress, and nurse-physician collaboration among registered nurses working in staff positions. A meta-analysis of 31 studies representing a total of 14,567 subjects was performed. Job satisfaction was most strongly correlated with job stress (ES = -.43), followed by nurse-physician collaboration (ES = .37), and autonomy (ES = .30). These findings have implications for the importance of improving the work environment to increase nurses' job satisfaction.

Diabetic neuropathy, which affects 60% to 70% of those with diabetes mellitus, is one of the most troubling complications for persons with diabetes, often leading to foot ulcers and potentially to lower limb amputations, both of which are preventable. The physiologic, structural, and functional changes associated with diabetic neuropathy and foot ulcers are discussed. Advanced practice nurses are in a unique position to implement strategies for the prevention of serious and debilitating complications from diabetic neuropathy, including foot assessment, education, and specialist referrals. Research evidence is given to support the use of the Semmes-Weinstein monofilaments to evaluate decreased plantar sensation, a common precursor to ulceration. Ongoing patient and family education can emphasize the importance of preventive self-care measures. Referrals for specialist care and therapeutic footwear can be made by advanced practice nurses. If begun early, these interventions can prevent foot ulcers from diabetic neuropathy, thereby improving the quality of life and reducing healthcare costs for this chronic disease.

Evidence regarding the impact of nurse practitioners (NPs) compared to physicians (MDs) on health care quality, safety, and effectiveness was systematically reviewed. Data from 37 of 27,993 articles published from 1990-2009 were summarized into 11 aggregated outcomes. Outcomes for NPs compared to MDs (or teams without NPs) are comparable or better for all 11 outcomes reviewed. A high level of evidence indicated better serum lipid levels in patients cared for by NPs in primary care settings. A high level of evidence also indicated that patient outcomes on satisfaction with care, health status, functional status, number of emergency department visits and hospitalizations, blood glucose, blood pressure, and mortality are similar for NPs and MDs.