Policy,Politics,& Nursing Practice

Registered nurse turnover is an important indicator of the nurse job market. Despite its wide use as a measure for health-care system analysis, there is a lack of consistency in the definition of turnover. Some definitions include any nurse leaving an organization; others may include involuntary and voluntary leaving. These inconsistent definitions also result in various turnover rates. The RN Work Project is a 10-year panel study of new nurses. Data were collected from the new nurses, rather than from a specific organization. About 17.5% of new nurses leave their first job within 1 year of starting their jobs. Consistent and accurate measurement of turnover is an important step in addressing organizational work environments and policies about the nursing workforce.

Research has shown that hospitals with better nurse staffing and work environments have better nurse outcomes—less burnout, job dissatisfaction, and intention to leave the job. Many studies, however, have not accounted for wage effects, which may confound findings. By using a secondary analysis with cross-sectional administrative data and a four-state survey of nurses, we investigated how wage, work environment, and staffing were associated with nurse outcomes. Logistic regression models, with and without wage, were used to estimate the effects of work environment and staffing on burnout, job dissatisfaction, and intent to leave. We discovered that wage was associated with job dissatisfaction and intent to leave but had little influence on burnout, while work environment and average patient-to-nurse ratio still have considerable effects on nurse outcomes. Wage is important for good nurse outcomes, but it does not diminish the significant influence of work environment and staffing on nurse outcomes.

Secondhand smoke exposure is a major public health issue, increasing the risk of cardiovascular and respiratory diseases and cancer. Although best practices for adopting smoke-free policy are well understood, there is limited research on the effective implementation of smoke-free policy. This article presents theoretical and practical considerations for smoke-free policy implementation in three Kentucky communities guided by the Institutional Analysis and Development (IAD) Framework. Although both Danville and Lexington-Fayette County, Kentucky have comprehensive smoke-free policies, Danville had more effective implementation, as well as better outcomes. Further study is needed to understand the critical elements of smoke-free policy implementation and their association with population outcomes. The IAD is a promising model to guide the study of both policy adoption and implementation.

Disseminating research to decision makers is difficult. Interaction between researchers and decision makers can identify key messages and processes for dissemination. To gain agreement on the key findings from a synthesis on the integration of advanced practice nurses, we used a modified Delphi process. Nursing decision makers contributed ideas via e-mail, discussed and clarified ideas face to face, and then prioritized statements. Sixteen (89%) participated and 14 (77%) completed the final phase. Priority key messages were around access to care and outcomes. The majority identified “NPs increase access to care” and “NPs and CNSs improve patient and system outcomes” as priority messaging statements. Participants agreed policy makers and the public were target audiences for messages. Consulting with policy makers provided the necessary context to develop tailored policy messages and is a helpful approach for research dissemination.

The objective of this article is to examine the racial and ethnic diversity profile of the nurse workforce over time and by geographic region. We conducted survey analysis using the National Sample Survey of Registered Nurses from 1988 to 2008, and further supplemented our trend analysis using published findings from the 2013 National Workforce Survey of Registered Nurses. The gap in racial/ethnic minority representation between the RN workforce and the population has been persistent and has widened over time. This diversity gap is primarily due to underrepresentation of Hispanics and Blacks in the RN workforce, which varied across states and regions, with the largest gaps occurring for Hispanics in the South and West and for Blacks in the South. Greater levels of sustained and targeted support to increase nurse workforce diversity are needed and should be geared not only to specific underrepresented groups but also to the regions and states with the greatest needs.

Nurses are increasingly encouraged to be active participants in health policy. This article provides an exemplar of how nurse practitioners (NPs) in one state, North Dakota, used strategic policy actions to obtain independent prescriptive privileges. Consistent and clear communication among NPs and with key stakeholders, including legislators, contributed to a positive policy outcome. North Dakota nurse leaders in this initiative have shared their experiences with a variety of audiences including other state boards of nursing and NP organizations in states such as New York, South Dakota, and Louisiana. In addition, a webinar sponsored by the Center to Champion Nursing in America at AARP featured several of the North Dakota NP leaders, who shared their reflections of this experience and the strategies they used. Regulatory environments and public policies will continue to significantly influence the future of all nurses. This case study of one state can be useful to NPs and other nurses seeking meaningful policy change through laws or regulations with regard to scope of practice or other health policy issues.