October 2022 Innovation Issue

INNOVATION SPECIAL ISSUE

Thank You Magnet

Visit us at the 2022 ANCC Magnet Conference at Booth #2018.

Innovation in Education

By Michele Wojciechowski

Informatics Is for Every Nurse

By Julia Quinn-Szcesuil

Getting Ready for the Next Generation NCLEX

By Louis Pilla

Editor’s Notebook

Innovations in Nursing

As the calendar turns to October, we must focus on the ANCC National Magnet Conference® in Philadelphia, Pennsylvania, October 13–15.

This year’s conference theme is Educate. Innovate. Celebrate.

The vision for the Magnet Recognition Program is to transform healthcare globally by bringing knowledge, skill, innovation, leadership, and compassion to every person, family, and community.

Magnet nurses are pioneers of our future. And innovations in nursing care, care delivery, and the practice environment are the hallmark of Magnet organizations.

Magnet, education, and innovation work hand-in-hand in transforming nursing.

This month, Minority Nurse focuses on Magnet and innovation.

Changes and innovations improve how and what nursing students learn. Michele Wojciechowski profiles innovations in nursing education: technology, simulations, and more.

Innovation and technology in the nursing industry change in a second. Julia QuinnSzcesuil profiles why informatics is one of the most cutting-edge nursing specialties for every nurse.

If you’re a nursing student taking the NCLEX after April 1, 2023, or an educator pre paring students for the test, you’ll be faced with an exam that is very similar to, but in some ways very different from, today’s NCLEX. Louis Pilla looks at changes in the Next Generation NCLEX.

Educate. Innovate. Celebrate! -Reneé Hewitt

Innovation in Education

BY MICHELE WOJCIECHOWSKI

In most educational pro grams, changes and innova tions improve how and what students learn. And nursing school is no different. These innovations can come in vari ous forms: technology, simula tions, and more.

Let’s start with technology. “One advancement is the use of high fidelity. We have always had mannequins. Now we have mannequins that can replicate breathing, bleeding, and a variety of other things,” says Debra J. Barksdale, Ph.D., FNP-BC, CNE, FAANP, ANEF, FAAN, Dean and Professor at the University of North Carolina Greensboro (USCG) School of Nursing.

“We have always had mannequins. Now we have mannequins that can replicate breathing, bleeding, and a variety of other things.”

“Recent advances include facial expressions and emotions. Simulation technology allows us to replicate real-life scenarios safely, whether students are in our BSN program or our DNP Nurse Practitioner or Nurse Anesthesia program. Many programs are also incorporating more VI and AI.” She adds that they have mannequins of all skin colors and male, female, and children.

That’s not all. Kimberly Mau, DNP, MSN, RN, Academic Program Director/Associate Dean at Western Governors University (WGU), says that their school prides itself on staying ahead of the technol ogy curve.

“The biggest development in technology WGU has recently adopted is the Resuscitation Quality Improvement® (RQI®) program which is part of The National League for Nursing (NLN), Laerdal Medical, and the American Heart Association.

This is a game-changing new approach to CPR. It helps give nurses the confidence to resus citate cardiac patients to the best of their ability. Since the introduction of RQI in 2015 in collaboration with the American Heart Association, more than 2,400 hospitals and 2 million nurses have adopted and enrolled in the program, and it is estimated that 20,000 lives have been saved.”

cigarettes near an oxygen tank, hazards in the bathroom, and trip hazards,” she explains.

“That is a great, low-cost teaching, learning simulation exercise. We can also produce other scenarios, such as having a patient decompensate in a hospital-like setting.” As time goes by, courses change as well.

For example, although it has offered competency-based edu cation for 25 years, in 2022, WGU redeveloped its RN to BSN program curriculum. As a result, it has courses that align with the new American Association of Colleges and Nursing The Essentials: Core Competencies for Professional Nursing Education . In addi tion, this updated program aligns with the ten domains of Essentials, competencies, and sub-competencies.

• Diversity, Equity, and Inclusion

• Transgender nursing care

• Value-based care/systembased care

• Global population health

• Direct and indirect hours in field experience in the four spheres of care outlined in The Essentials--preventative, chronic, regenerative/restor ative, and palliative care.

In addition, Mau says, “The program redevelopment focused upon providing RN to BSN graduates with tools to prepare them for career-long learning. Students will com plete six professional develop ment certificates within the program.”

“Simulation technology allows us to replicate real-life scenarios safely.

This is a game-changing new approach to CPR.

It helps give nurses the confidence to resuscitate cardiac patients to the best of their ability.

“The development of the course material provided for input from practice partners to create courses that are innovative, timely, and reflective of the advancing integrated systems of healthcare.”

Another project at UNCG is LEAD: Leadership, Education, and Diversity (LEAD) in Maternal Child Health. “This project offers a traineeship to some of our students, so they are better prepared to posi tively impact the health of mothers, babies, and children,” says Barksdale. “Priority in the program is given to those stu dents who self-identify as cul turally diverse, underserved, and/or underrepresented backgrounds.”

Simulation takes another step forward at USCG. In addition to the varied mannequins, Barksdale says they have a simulated apartment, which enables students to learn to care for patients in their homes.

“I love the exercise where fac ulty members create all poten tial hazards in the simulated apartment that students need to recognize and address. These potential hazards include fake

“As recommended in The Essentials, the academic-prac tice partnership model used in the development of the course material provided for input from practice partners to cre ate courses that are innova tive, timely, and reflective of the advancing integrated sys tems of healthcare,” says Mau. Strengthening opportunities integrated within the new pro gram version include:

www.minoritynurse.com www.dailynurse.com

Michele Wojciechowski is a national award-winning free lance writer based in Baltimore, Maryland. She loves writing about the nursing field but comes close to fainting when she sees blood. She’s also the author of the humor book, Next Time I Move, They’ll Carry Me Out in a Box.

Informatics Is for Every Nurse

BY JULIA QUINN-SZCESUIL

If nurses know anything about innovation and technology in the nursing industry, they know this: it changes in a second.

Of all the nursing specialties, nursing informatics, which combines the knowledge and practices of nursing and tech nology, is one of the most cut ting-edge areas. Most nurses work with something related to informatics or technology, and that’s why nurses in the specialty are needed.

Nurses who use the sys tems and technologies with patients are best positioned to help innovate, design, and recommend improvements for everything from tools using artificial intelligence to medi cation scanning. Their history of using technology in a realworld clinical setting offers a perspective that others don’t have. As advances progress rap idly, they will be the ones using it with patients in real-time.

consultant with Vanderbilt University Medical Center.

“Informatics does that, and then it gets all the data out to make predictions and improve

in academic or work settings, so nurses are prepared to use any technology to its full advantage.

He says that nearly threefourths of healthcare execu tives trust artificial intelligence tools. Still, in his research, Alexander says nurses who

says, is the telehealth work that increased dramatically during the COVID-19 pandemic—con necting with patients remotely reduced the opportunities for the virus to spread while also allowing patients to receive the care they needed. Virtual appointments and tools also greatly expanded access to and

Their history of using technology in a realworld clinical setting offers a perspective that others don’t have.

Nursing’s Technology Future

“Nurses will tell you they are given a piece of technol ogy, and they try to use it, and they say, ‘Who designed this?’ Someone has to get into a nurse’s head and under stand how a nurse thinks,” says Patricia Sengstack, DNP, RN-BC, FAAN, FACMI, senior associate dean for informat ics and a professor biomedi cal informatics at Vanderbilt University School of Nursing, and a nursing informatics

ments in care.”

Whether nurses feel fluent with technology and infor matics, they are adept at the systems they use in their work processes, which is essential.

“In today’s world, if you go into a hospital, an ambulatory setting, or a long-term care facility, there are few aspects of care delivery that don’t have some aspect of technology,” says Sengstack. Nurses work with technology constantly, from electronic health records to pulse oximeters. They proba bly are, even if they don’t con sider themselves especially tech literate. “If you have to plug it in or it needs a battery, that’s technology,” she says.

Training Makes a Difference

Nurses frequently learn equipment as they are working with it, so they have a different perspective of its efficacy, says Gregory Alexander, Ph.D., RN, FAAN, FACMI, and a professor of nursing at the Columbia University School of Nursing

It can be frustrating for nurses to learn on the fly, but that can be helped if nurse informatics experts work to close the knowledge gap. For example, they can introduce AI in simulations or elec tronic health records training

work with the clinical systems are more wary of AI.

Informatics and technology bring advances at the patient bedside and also in adminis tration. For example, nursing executives’ advances in infor matics are a boon. “Healthcare executives can use the data to make different decisions about their institutions,” says Alexander.

But if nurses learn to approach new tech tools, how they approach their work tasks helps reframe it all. “In nurs ing, we assess, diagnose, plan, implement, and evaluate,” says Sengstack. “That’s the nurs ing process.” Informatics, she says, follows the same pattern. “One of my teachers in grad school said that any electronic system can be managed using the nursing process: you ana lyze, plan, implement, and evaluate.”

“The beauty of this field is that it’s always evolving,” says Sengstack, noting that’s one of the reasons she is so happy with her career choice in informatics. “It’s not the same, and there are always new advancements.” The most evident recent example, she

continuation of necessary athome and mental healthcare.”

Improving Equity with Informatics

As organizations begin to use informatics to assess patients, Alexander says equity will be improved because technology often improves the accuracy of a diagnosis. But until that hap pens, disparities will continue.

In addition, organizations will need to catch up as sys tems become more sophisti cated and widely used. “You have to think about the set tings,” says Alexander. “Most nursing homes staff are not ready for that kind of tech nology, and there’s not the infrastructure in that setting to support it.”

In the future, Sengstack sees technology becoming more complex.

As artificial intelligence evolves with, for example, more exact language process ing and voice recognition, she envisions virtual nurses delivering data-gathering and data-entering tasks or eventu ally capturing audio and visual interactions to translate into

“Informatics does that, and then it gets all the data out to make predic tions and improvements in care.”

“The beauty of this field is that it’s always evolv ing,” says Sengstack.

“Healthcare executives can use the data to make different decisions about their institutions.”

medical records and document it in the patient’s chart.

Alexander agrees, noting that educating and training nurses on any new technology, technical process, or equip ment is essential. “Otherwise, you’re just winging it,” he says, and it will impact a nurse’s workflow and patient care. Using equipment in real-time is also vastly different from using it with a patient, so tech nology must enhance that patient-centered relationship, not degrade it, says Alexander.

Nurses who can fill these roles are not super techy

coders and programmers, says Sengstack; they can even be nurses who use equipment, understand its value, and have ideas on how it can be

improved. So even if a nurse has no plans to change careers, the nurse’s expertise in specific systems is invaluable.

Nurses interested in the career should begin by shad owing an informatics nurse to see what they do and how that would match particular interests. If there’s an informat ics department in the hospital where you work, that’s a great way to get your foot in the door, says Sengstack. As you’re already with the organization and the systems and technol ogy being used, your transition

will be smoother than starting with all unknowns.

“It’s all exciting, but it won’t happen overnight,” says Sengstack. “We need nurse informaticists because we don’t have enough nurses at the design, planning, and implementation table. With nurse informaticists, the tech nology is much more effective and successful at meeting the desired needs.”

Julia Quinn-Szcesuil is a free lance writer based in Bolton, Massachusetts.

Nurses interested in the career should begin by shadowing an informat ics nurse to see what they do and how that would match particular interests.

Life changing is... being a positive force “At UPMC, Life Changing Medicine means advocating for my patients and making a difference in their lives any way I can.”

- Tess, BSN, RN

nurses

UPMC.com/Nursing

Getting Ready for the Next Generation NCLEX

BY LOUIS PILLA

If you’re a student who will take the NCLEX after April 1, 2023, or an educator preparing stu dents for the test, you’ll be faced with an exam that is very simi lar to, but in some ways very different from, today’s NCLEX.

The Next Generation NCLEX (NGN) will include a signifi cant emphasis on clinical judgment and changes in item types and scoring. In this arti cle, we’ll take a look at some of the major changes.

Focus on Clinical Judgment

With the advent of the NGN, “we’re introducing the

other NCSBN exams since 2010. “That is what we found was the most effective way to measure clinical judgment. These case studies will look very different from today’s NCLEX.”

“The case study is a brand new element com ing to the exam,” says Schwartz.

For the trend item, a ques tion will provide information about a situation that changes over time. For instance, notes Schwartz, the question might provide information about vital signs at noon, 2 pm, and 4 pm, and ask a question related to the different measurements.

are doing at the RN and PN levels. According to Schwartz, the practice analysis measures not only what the nurses are doing but also the frequency and criticality of those tasks.

“We’re putting a direct focus on clinical judgment as a new construct on the exam that we’re very interested in measuring based on its importance to safe and effective care.”

Each case study will pres ent a real-world nursing scenario followed by six ques tions. “Our Clinical Judgment Measurement Model essentially breaks clinical judgment down into a sequence of six testable components, each of which becomes a focus of an item in the case study,” according to Schwartz.

The bow-tie item involves a drag-and-drop technology, where the test taker moves things from one place to another. The response area where items are dragged and dropped looks like a bow tie.

Not Radically Different

What’s more, the exam normally changes based on changes in practice, such as phasing out questions about procedures or practices that are no longer performed.

One Passing Standard

biggest change to the exam since going to computers,” says Jason Schwartz, MS, director of outreach at the National Council of State Boards of Nursing (NCSBN). When the new test plans come out for the RN and PN exam in April 2023, “we’re putting a direct focus on clinical judgment as a new construct on the exam that we’re very interested in mea suring based on its importance to safe and effective care.”

To measure clinical judg ment, the NCSBN had to go beyond the multiple-choice items the exam contained and include new item types and case studies. “The case study is a brand new element coming to the exam,” says Schwartz, who has worked on the NCLEX and

Every test taker, says Schwartz, will see three case studies that count toward the score. A graduate might see more than three case studies, but any additional case studies are simply part of the normal data collection that goes on for the NCLEX and do not count toward the pass-fail result.

New Item Types

Besides the case studies, test takers will see several new item types on the NGN, including two specifically designed to measure clinical judgment. They are a trend item and a “bow-tie” item.

Although the NGN will feature significant changes, Schwartz cautions against thinking that the NGN is a radically different test from today’s NCLEX. In the NGN, “the overwhelming majority of questions that graduates see will be identical to what they would see today on the test,” he says.

Schwartz uses the analogy of a pizza. “If today’s NCLEX is a cheese pizza, the NGN will be a pepperoni pizza,” he says. “It’s today’s test with some toppings or extras.”

The NGN will have one passing standard for both the traditional and the clinical judgment items in the exam. “What we were able to find in our studies is that we could keep a single threshold for the exam,” Schwartz says. “In other words, your work on the clinical judgment and every thing else blend into a single ability estimate, and we can maintain a passing standard or pass-fail cut-off. If your abil ity estimate is at or above that cut-off, you pass; if it’s below, you don’t pass.”

Test takers will see sev eral new item types on the NGN, including two specifically designed to measure clinical judgment.

“If today’s NCLEX is a cheese pizza, the NGN will be a pepperoni pizza. It’s today’s test with some toppings or extras.”

The NGN will have one passing standard for both the traditional and the clinical judgment items in the exam.

Still Five Hours

The NCLEX typically changes incrementally every three years, based on a practice analysis, notes Schwartz. That practice analysis is a scientific study designed to tell NCSBN exactly what entry-level nurses

Like today’s NCLEX, the NGN’s maximum exam time is five hours. However, today’s NCLEX is 75 to 145 items, and the next genera tion NCLEX will be 85 to 150 items. Those extra questions, notes Schwartz, allow for the measurement of clinical judg ment. “Keep in mind that the length of today’s NCLEX,

as a computerized adaptive test, can vary, depending on who takes the exam,” notes Schwartz.

“Ultimately, when we’re looking at the time limit, what we’re looking at is will the overwhelming majority of candidates have time to finish? Therefore, five hours remain sufficient even though ‘maximum length’ testing candidates will now receive five additional items,” says Schwartz.

Partial Scoring

For the first time, notes Schwartz, test takers will earn partial credit for getting some, but not all, parts of a question correct. “At the item level, par tial credit is a major change to the scoring,” Schwartz says.

Test takers will earn partial credit for getting some, but not all, parts of a question correct.

For instance, imagine a “select all that apply” question that asks about the signs and symptoms of COVID, and three out of the five responses in the query are correct. In the past, a test taker had to get all three responses right to get credit for the question. Otherwise, they would get zero credit. Now, if they answer two of the three, the test taker will get partial credit for that question.

As nursing classes start this fall, students and educators

need to keep these changes to the NGN in mind.

Louis Pilla is a seasoned pub lishing expert with over 20 years of experience providing content and digital products to healthcare audiences.