To be a nurse, one must possess many different skills, with clinical judgment –the ability to think critically and make quick decisions that impact patient outcomes – being one of the most important. Another increasingly important skill is technology literacy, or the ability to use, understand and manage technology. Elsevier’s recent Clinician of the Future report found that 53% of U.S. nurses believe that technology literacy will become their most valuable capability over the next ten years, ranking higher than clinical knowledge.
The report also found that 54% of U.S. nurses predict they will draw on tools utilizing artificial intelligence to inform most of their clinical decisions. However, 69% of U.S.-based nurses report being overwhelmed with the current volume of data available and 84% of nurses in the U.S. predict the widespread use of digital health technologies will represent an even more challenging burden in the future. Despite these concerns, 59% of nurses in the U.S. still agree that the widespread use of digital health technology will enable a positive transformation of healthcare.
While use of technology in the healthcare setting is not without challenges, I believe it has a net positive benefit, particularly providing nurses with tools and information to enable rapid critical thinking and sound clinical judgment in patient care. I propose three ways higher-education institutions and health systems can maximize technology throughout a nurse’s career.
Utilize Education Technology (EdTech) Solutions
A nurse’s career journey begins in the classroom, and it’s during this time they develop the foundation for clinical judgment and critical thinking they will use throughout their careers. New and emerging forms of educational technology solutions, such as simulation-based and virtual-reality (VR) scenarios are providing students with an immersive way to learn skills in a safe and standardized environment. In these realistic patient scenarios that integrate the latest evidence-based research and education content, nurses can build confidence through practice on digital patients in a virtual environment that encourages exploration, adaptation and the development of critical reasoning skills.
Shadow Health, a suite of simulation learning products, features a diverse patient set representing various backgrounds with different health concerns. This conversation-based solution allows students to respond to many patient scenarios, while developing clinical judgment skills and practicing therapeutic communication. These innovative forms of education technology are already having a profound impact on how students absorb information. A recent study on the efficiency of patient care skills for nursing students in programs that use Shadow Health found that 82% of learners showed an increase in overall efficiency and 68% were better equipped to identify the number of correct care plan components.
Make the Transition to Practice Easier
As nurses make the transition from nursing school to practice, they are entering an increasingly demanding and complex environment. In addition to patient care responsibilities and keeping up with evolving care guidelines, nurses must also update electronic health records (EHRs) and handle time-consuming administrative work. These stressors can result in high turnover rates, with some hospitals seeing novice nurse turnover as high as 35%.
Learning how to balance these responsibilities can be overwhelming and may be contributing to more patient-related errors for new nurses. According to research from the National Library of Medicine and The Online Journal of Issues in Nursing, 40% of new graduate nurses reported making medication errors, and 50% reported missing signs of life-threatening conditions. The industry can better support nurses and ensure they are always practice-ready by providing technology solutions.
Providing novice nurses in a hospital setting with simple-to-use tech-based reference and communication tools enables safe, practice-based development of their patient care competency. Nurses can rely on these resources when they have questions or are unsure of procedures, supporting the ongoing development of their critical thinking skills and reducing patient care errors.
Provide Continued Professional Development on Digital Health Technology
While a nurse’s journey begins in the classroom, ongoing education remains critical throughout their career. The Clinician of the Future report found that 79% of U.S. nurses believe that training and ongoing education needs to be overhauled so they can keep pace with technological advancements. While resident nurses may have been exposed to emerging forms of technology during nursing school and are more comfortable with digital solutions, nurses who have been in-practice for decades may not be as comfortable using unfamiliar technologies.
Healthcare leaders must identify where nurses need the most support and provide continued professional development to ensure nurses at all levels are comfortable using digital health technologies. Hospitals, health systems and nursing organizations can provide solutions for nurses throughout their careers to enable technological proficiency and support critical thinking during patient care. These resources ensure nurses have access to the latest guidelines and evidence-based treatment pathways, empowering them to make more informed, confident decisions and driving better patient results.
At the same time, it is crucial for leaders to be thoughtful about the technologies they are considering deploying and to take the time to understand the benefits of any solution under consideration. A study published in the Western Journal of Nursing Research found that the use of telehealth to manage certain diseases, such as Type 2 diabetes and hypertension actually worsened nurses’ workloads and led to twice as many activities completed by nurses. To gauge the impact new technologies will have on nurses, administrators may want to consider issuing employee surveys or informally gathering feedback, which is also a great way to show nurses that their voices matter in choices being made by the organization.
The last few years have shown us that nurses are invaluable to the healthcare industry, and it’s imperative that we provide them with tools for success throughout their entire career. Technology is going to continue to play a major role in healthcare. Healthcare leaders and educational institutions can use technology to their advantage, but they must provide current and future nurses with development opportunities to enhance their technology skills.
Six years ago, Conville was a gunshot wound victim. The bullet injured the left side of his face, and he was rushed into life-saving surgery.
“I woke up in a lot of pain, in a dark room. I was alone except for my nurse. I couldn’t do anything but cry.”
“I woke up from later that night and realized I was still alive. I was relieved, but at the same time I woke up in a lot of pain, in a dark room. I was alone except for my nurse. I couldn’t do anything but cry,” Conville said. “I was a 21-year-old and supposed to be this big, strong athlete, but I felt weak and powerless. But my nurse stayed there, comforted me during my worst moments. That inspired me to want to do something to help other people.”
Over the next few months, Conville underwent several surgeries and faced a long road to recovery. His initial plans—playing college baseball and attending medical school—were derailed as recovery took a mental and physical toll.
But the support of friends and family and an opportunity at UAB Hospital helped him rediscover his passion.
“It was very difficult for me to take my next steps forward in my education, but the one thing that always spurred me on a little bit, or kept my feet moving, was my nurse that night after surgery,” Conville said. “I can’t remember her name, and I hardly remember her face, but I will always remember what she did for me.”
His nurse’s care led Conville to seek out ways to help others. When a family friend and Senior Director of Emergency Services at UAB Medicine Frankie Wallis, DNP, NP-C, NEA-BC, COI, reached out about a shadowing opportunity in the emergency department, Conville jumped at the chance.
“I knew Cade wanted to help people and make a difference, and I said that if he wanted to be in health care, UAB was the place to be,” Wallis said.
“It was very difficult for me to take my next steps forward in my education, but the one thing that always spurred me on a little bit, or kept my feet moving, was my nurse that night after surgery.”
After shadowing in the emergency department, Conville knew it was the right next step.
“UAB is such a big, bustling hospital. I recognized all of our patients in need, but there is also an excitement because there was so much we could do at once,” Conville said. “It brought me back to this team atmosphere, where I could be part of a group that cared about something, where everyone pulled in the same direction. That spoke to me—I put my resume in the same night.”
Conville took a job as a patient care technician and thrived in the experience, but eventually, he felt compelled to return to school and further his education. Through the support of his family and Wallis, he applied to nursing school.
“I looked up to the nurses I worked with, and it brought back the memory of the young woman who helped me that night,” Conville said. “I thought that if I could do the same thing for someone else, it would make all the hours of extra work worthwhile.”
After consulting with mentors, including Wallis, and doing research of his own, Conville decided the Accelerated Masters of Nursing Pathway at the UAB School of Nursing was the best step forward. The program is designed for students with a bachelor’s degree or higher in another field and creates an accelerated track toward licensure and a master’s in nursing.
“I knew the program was for me. I already had a degree under my belt, but it also felt like I had the time management skills to take on such a rigorous program,” said Conville, who also has a Bachelor of Science in molecular biology.
“I’ve had several other staff members who have come through the AMNP program,” Wallis said. “It’s a great program, and when I talked to Cade about it, I had every bit of belief he could do it. I talked to him about pursuing this degree, while cautioning him about the tough road ahead. But at the end of the road there is a reward.”
When Conville started the AMNP program in fall 2020, he found another team in pursuit of helping others. Faculty offered continuous support and encouragement throughout challenges, he said, and provided the tools necessary to move forward.
“I looked up to the nurses I worked with, and it brought back the memory of the young woman who helped me that night. I thought that if I could do the same thing for someone else, it would make all the hours of extra work worthwhile.”
“One day I sat down with [AMNP Pathway Director] Michael Mosley, MSN, CRNP, ANP-BC (MSN 2012) and we talked about why he pushes us so hard to get the right answer and to understand why we got that answer,” Conville said. “He said that when you’re working with a patient, you’re not just checking boxes. And while you can make two or three mistakes on a test and still get a 96, if you make two or three mistakes with a person, you can really hurt them. That told me a lot about him as a person—he truly cares about us and wants us to be the best nurses possible.”
Conville also made an impact on his peers in his AMNP cohort. They selected him as the fall 2021 recipient of the Florence Nightingale Award, a recognition of his passion for quality of nursing care and pursuit of excellence. It was also the reason he stood up to speak about resilience at the Senior Recognition Ceremony.
“This award reiterates Cade’s personal characteristics and his commitment to nursing,” Wallis said. “It shows his dedication and how well he works within a team, how he incorporates team theory to develop relationships with his peers and colleagues. He is a great young man with great potential, great abilities and he will move forward to do great things in the future of health care.”
Conville finished the AMNP program in fall 2021 and accepted a job at UAB Hospital in spring 2022. He wants to further his education and work toward a career in nursing management.
Conville continues that refrain of resilience, for his future and the future of nursing.
“I know the state of nursing isn’t perfect right now, that a lot of us who are graduating and going into the workforce have a difficult road ahead of us,” Conville said. “We’re joining health care in one of the most difficult times to be a health care professional, and we just have to be as diligent as we possibly can. We need to understand that our patients need us, and we need each other. We’re going to get through this together. While there are a lot of tough times going on, it’s still a great time to be a nurse.”
Evidence-based practice is at the heart of nursing—and most of that evidence is based on quantitative research. For nurses who are merely competent in math, though, interpreting the numbers can be a challenge. And if your own facility with statistics is middling, trying to mentor semi-numerate DNP students may leave you feeling helpless at times.
Help is on the way. On May 19, data analysis expert James Lani, Ph.D., MS is hosting a free webinar specifically aimed at faculty members who mentor graduate students for dissertation, thesis, or scholarly projects and are seeking to take their command of statistics to the next level to better guide those students.
Dr. Lani, the CEO of Intellectus Statistics, has been helping faculty and graduate students with their quantitative research for over two decades.
In his upcoming webinar session, Dr. Lani will use mock data to work through faculty and students’ research questions, prepare and graph data, select and conduct the correct statistical analyses, and demonstrate how to appropriately present results. He will also cover sample size and power analysis, data management, and visualization techniques, and at the end of the presentation, he can even provide faculty with project-specific help.
James Lani holds a Ph.D. in Clinical Psychology from Miami University in Oxford, Ohio, an MS in Psychology with an emphasis in Experimental Methods from California State University Long Beach, a Bachelor of Science in Electrical Engineering, and minors in Mathematics and Human Services from California State University, Fullerton.
Who can attend: Faculty members in nursing, social work, counseling, public health, psychology, and health administration at any stage of their research or faculty who mentor students’ research as they pursue their degree (i.e., Dissertations, DNP Project for Nurses, Fieldwork and Supervision for Behavior Analysts, etc.)
The famous biblical verse, “To whom much is given, much will be required” (Luke 12:48) is more than a quote for Constance Smith Hendricks, PhD, RN, FAAN. For the influential University of Alabama at Birmingham School of Nursing alumna (BSN 1974, MSN 1981), it is a mantra to live by.
With more than 40 years of trailblazing experience educating, mentoring and inspiring students who want to fulfill their dreams and become leaders in nursing and health care, Hendricks has blazed a trail on another front as the first African American to establish an endowed scholarship in the UAB School of Nursing.
“I had the privilege of doors being open for me growing up,” Hendricks said. “I want to give students a chance to reach their full potential and have access to higher education, much like I have.”
Hendricks has been a “first” and “only” at almost every step of her career. After earning her BSN and MSN from the UAB School of Nursing, she was hired by Auburn University’s School of Nursing as an instructor in community health nursing, where she was the only African American faculty member. She then followed that up with a milestone only she can say she’s accomplished.
“Going to Boston College in 1989 and being the first African American to graduate from their prestigious PhD program in 1992 was a tremendous honor and a life-changing event for me,” Hendricks said. “I hope my continued efforts have inspired the next generation of students and show them that with hard work and dedication, anything is possible.”
Hendricks has devoted her career to developing quality nursing programs at universities across the southeast and even in her hometown of Selma, Alabama. She was dean of the School of Nursing and Allied Health at Tuskegee University, a professor (now emerita) and the Charles W. Barkley Endowed Professor at Auburn University, dean of the Hampton University School of Nursing, developed the DNP Program at Kentucky State University, implemented the first Doctor of Philosophy nursing program in the state of Louisiana at Southern University and A&M College and founding dean of Nursing and Allied Health at Concordia College Alabama in Selma.
Recently Hendricks, along with her friends, have been working on a book, “Alabama’s Notable Nurses,” that recognizes notable nurses in the state of Alabama.
“We are shining a light on nurses who have been in the field for at least 35 years or more and may not necessarily get the recognition they deserve because they are in a smaller county in Alabama,” said Hendricks.
Achieving a 100% pass rate on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) was a goal that seemed impossible, especially in 2021. Nursing schools were in the midst of a national pandemic and learning how to teach nursing in both face-to-face and virtual settings. If past performance rates on the NCLEX-RN were an indication of things to come, the University of West Alabama Division of Nursing (DON) could have expected a disastrous 2021 year. In 2013, the program’s NCLEX-RN pass rate fell to 74%. While it rebounded during 2014-2017 (82.4, 85, 88, and 81.6%, respectively), the nursing faculty realized there was a pattern in NCLEX-RN rates that directly correlated to their student population. Scores declined again in 2018 (77.3%).
A multi-pronged approach had to be used to help the UWA DON prepare its students for success, not only during a pandemic, but post-pandemic. In 2013, one nursing faculty member was enrolled in a doctor of education program, while the other six faculty held a Master’s degree in nursing. A focus on faculty development for young faculty was crucial, but faculty development in education was also beneficial to those who lacked the tools to understand curriculum development, test-item development, and test-taking strategies. Currently, six faculty members hold doctorate degrees with an emphasis in nursing education, while one is enrolled in a doctoral program. As faculty members were earning degrees, they were learning to use research practices and methodologies to understand and predict the habits of their students.
Located in the Blackbelt region of west Alabama, the University of West Alabama serves some of the poorest counties in the nation. Students come from educationally and economically disadvantaged backgrounds, adding a layer of complexity to a curriculum fraught with rigor and time constraints.
Students are expected to attend class, skills labs, simulation labs, and clinical labs Monday through Friday. For those who have to work to make ends meet, have children or older relatives to care for, or who are ill-equipped for the study and time demands of a nursing curriculum, the first and second semester of the nursing program may prove too much to endure. To determine student learning needs and implement initiatives to support progression and graduation from the nursing program, the faculty assessed the needs of the program’s student population and diagnosed the issues hindering progression, program completion, and passing the NCLEX-RN. They could then plan interventions that would lead to better student outcomes, implement the plan promptly, and evaluate the plan for areas of strength, weakness, and opportunities.
Program assessment was key to the process. Students were having difficulty in the third semester of the nursing program. Retention of content appeared to be an issue for the fourth-semester nursing students. Foundational principles of basic care and comfort were troublesome, as were the dreaded multiple-answer questions, also known as “select all that apply” (SATA). Students in the first and second semesters appeared to have trouble understanding what the question was asking them to determine. It was evident that reading comprehension was an issue for some students.
For others, a review of ACT scores on file revealed students were not very good standardized test-takers and needed intentional practice to improve test-taking skills, not merely testing for content knowledge. If a student was repeating the nursing program, they were less likely to pass the NCLEX-RN exam on the first attempt than students who completed the program in five semesters. Finally, students needed help with goal-setting, time-management, and study skills that would allow them to progress and graduate on time. With this information on board, it was time to implement strategies to help the associate in science nursing students reach their full potential and successfully graduate from the nursing program while preparing them to successfully pass the national licensure exam.
The nursing program functions from a multi-tiered approach to engage students and monitor progress throughout the semester. Each approach is needed to provide a comprehensive and inclusive model to facilitate a culture of success in the nursing program.
A faculty-student mentoring program was important to understand the academic and non-academic challenges that nursing students would face as individuals. Individualized action plans could be created for each student to assist in program progression. The faculty-student mentoring program requires all students entering the nursing program to be assigned to a faculty mentor. Students meet with their mentors two weeks into the semester and at regular intervals during the semester to monitor academic progress and discuss issues that may deter progression or strategies that will foster success.
Retention and Progression Methodologies
Once students have been admitted to the nursing program, student progression and retention become the focal point. Students enter the program with a multitude of life affairs – children, work, bills that need to be paid.
For these reasons and others, the nursing curriculum was infused with ways to integrate positive study habits, reiterate test-taking skills, and repeat information deemed “need-to-know.” While Faculty-Student Mentors introduce students to these habits and reinforce them as necessary, a Retention Specialist (RS) would be assigned to students who were at-risk of failing the nursing program due to class performance. Student grades were monitored closely and referrals were made to the RS when needed. Some students are assigned to a RS at the outset of the nursing program and are required to meet with the RS before the first exam to review the importance of class attendance, note-taking, study habits, and test-taking strategies.
The use of repetition throughout the program has proven to be very useful. Students are encouraged to use practice test items to prepare for examinations. Students are also encouraged to create peer study groups of no more than four students to study before the exam. Students need to understand that nursing content is to be learned and not memorized for test purposes only. Convincing students to change their study habits and teaching them how to study plays an important role in progression.
Students who graduated from the nursing program were not always successful at passing their licensure examination on the first attempt. For some, a second attempt was needed. Finding a solution to prevent this second attempt was important to the nursing program due to the financial burden that it can place on graduates, and the real and perceived negative burden placed on nursing programs by accrediting bodies. The first-time pass rate continues to be a program outcome standard that nursing programs are measured by, in spite of the increased test anxiety seen in students today.
In 2019, the Division of Nursing found a game-changer to its preparation for licensure. The introduction of UWorld NCLEX-RN QBank as a means to create practice exams for the licensure exam was one of the most significant changes made in improving licensure scores. Initially, faculty implemented the prep system without a policy to guide student behavior. Minimal gains were noted. With the introduction of a formal policy on UWorld QBank, the nursing program’s graduates were able to earn a 100% first-time pass rate on the NCLEX-RN in 2021. The UWorld policy is housed in the NS 204: Advanced Adult Health and Critical Care course taken in the final semester. Students must complete a minimum of 2000 questions in the UWorld QBank and achieve a minimum score of 65% correctly answered questions. To achieve this goal, most students have to answer in excess of 3,000 questions.
In addition to prepping, students also needed to understand the time-sensitive nature of learned content and test-taking strategies. The nursing program fully believes that its graduates are prepared to care for patients as advanced beginners as bedside nurses. But there is an awareness that test-taking behaviors and learned content will begin to fade over time. As graduates begin to practice, their new behavior will replace learned behavior. The second critical step to licensure prep for our students was testing in a timely manner. Nursing graduates were encouraged to take the NCLEX-RN by June 15th, a date that generally falls six weeks post-graduation. Students have had their NCLEX-RN review, they have completed the prep question set as stated in the course syllabus, and they have completed a predictor on NCLEX performance. The six weeks give them more time to prepare if needed, but most are ready to take the exam when a test date is available.
In 2020, the Division of Nursing was awarded a grant through Health Resources and Services Administration (HRSA) to support students from disadvantaged backgrounds. Project EARN (Educating Alabama’s Rural Nurses), in the amount of $2.4 million, is dedicated exclusively to scholarships. Nursing programs add costs to college students with the purchase of uniforms, assessment tools, NCLEX preparation, and travel to and from clinical sites. Many UWA students are nontraditional and/or from disadvantaged backgrounds. Alleviating the financial stress of getting a college degree has allowed students to focus on studying and graduation.
For the UWA DON, a multifaceted approach to program progression and completion has always been necessary. The mystery lay in passing the NCLEX-RN on the first attempt. The addition of a prep tool for licensure has proven to be a game-changer for nursing students. As 2022 nursing students gear up for the licensure exam, the policy is in place and UWA nursing faculty are anxious to learn if they have found the key to NCLEX success for their program.
Before you officially become a nurse, you must graduate from nursing school, become licensed as a registered nurse (RN), and apply for your first job. Once you are hired, you will attend your first nursing orientation at your hospital or clinic. A nursing orientation is a course or set of courses designed to educate new employees about the facility’s procedures and policies. New nurses will also learn standards, codes of conduct, and the proper way to document patient information.
During orientation, employees will discover a wealth of information, including more about their work responsibilities. While these are some of the basics, your employer may also instruct you on other items that are specific to the hospital or clinic. Orientation topics may include how to stay safe and protect patients, as well as what color scrubs or what kind of nursing shoes to wear. You may also find out if you need to supply your own protective gear or stethoscope.
Since you must follow the facility’s policies at all times, it is important to pay close attention to the contents of your orientation session. The following tips will help you to ensure you retain everything you learn during your online sessions or in-person classes. Reading through these pointers before you attend your nursing orientation will help you to retain more information while you attend. A periodic review of the rules and standard operating procedures will help you to be successful at your career.
1. Arrive Early
As a new nursing employee, it is always important to be on time. Be sure to check the start time for your first day of orientation and then plan to arrive at least a few minutes early. It is especially important to be prompt if you are visiting a new building or entering a new facility. Consider that it may take longer than expected for you to find a place to park or walk to the meeting site. By arriving early, you will show your supervisor that you take your role seriously and that you are ready to get started.
If your instructor or supervisor arrives before orientation starts, introduce yourself. A formal introduction helps to make a good first impression, especially as a new professional in the nursing field. It is also helpful to make a connection just in case you have questions or need advice in the future. The relationship with your boss may also be the first one you make at your new clinic or hospital, which is why it is essential to begin promptly and positively.
2. Be Prepared with the Right Nursing Supplies
Check your orientation checklist as soon as you get it. You may need nursing supplies to get started. Sometimes, the best items and nursing gear are found online. A few days’ notice can help to ensure you get everything you need. In most cases, you will need to wear your scrub uniform and nursing shoes. You will also need a stethoscope, as well as a medical bag to carry your devices and documents.
Additional helpful items include a penlight and a storage clipboard. You may also benefit from a nursing watch with a second hand. Other popular nursing supplies that you should consider buying before orientation include a badge holder or lanyard, protective gear like eyewear and a few scrub caps.
3. Take Notes
As you go through orientation, you may have questions about the rules or policies the facility has for the nursing staff. You may also want to clarify reporting procedures or who to contact if you need something in the future. Take notes regarding each of your questions and then plan to follow up after the orientation session. Your notes may include contact information, like your orientation leader’s email or your supervisor’s office number.
Many hospitals will require nurses to take a test or quiz after the orientation session. This helps supervisors ensure that their employees understand how to do their job, document important information, and learn how to care for patients. Taking careful notes and highlighting sections of text will help you to remember key information before the exam.
4. Stay Organized
Being on time, taking notes and having the right office supplies will help you to stay organized. A folder, briefcase or storage bag can help you to keep your writing utensils, notebooks or orientation papers in the right spot. Keep these items away from your personal gear, such as your smartphone, wallet, or snacks. This will help you to locate the right items easier and faster.
If your sessions last for more than one day, double-check that you are to arrive the same time the next day. You should also find out if you will be in the same room for the rest of your sessions. Write down any changes on your smartphone or in your nurse’s notebook. If your orientation is at a different time than your typical nursing shift, be sure to let loved ones know about the changes as soon as you can.
Make the Most of Your Nursing Orientation
Nursing orientation will be full of information, but it is also an essential part of getting used to your new role. Since every hospital and practice is different, it is an excellent idea to pay close attention to your supervisor’s lectures or the facility’s learning videos. While you are sure to have a lot of questions, this is normal. It may take a little time to remember all of the rules and policies of the facility. If you arrive on time and stay focused throughout your orientation, your supervisor will be glad to help you through your first few weeks. Soon, you will be a pro at your workplace’s software and patient procedures.