The use of nurse practitioners (NPs) is one way to address the shortage of physician primary care providers. NP training programs and the number of practicing NPs have increased in the past two decades. However, regulations limiting their scope of practice vary greatly by state. We assessed the impact of state regulations on the increase in care provided by NPs in the United States, using a 5 percent national sample of Medicare beneficiaries. We found that between 1998 and 2010 the number of Medicare patients receiving care from NPs increased fifteenfold. By 2010 states with the least restrictive regulations of NP practice had a 2.5-fold greater likelihood of patients’ receiving their primary care from NPs than did the most restrictive states. Relaxing state restrictions on NP practice should increase the use of NPs as primary care providers, which in turn would reduce the current national shortage of primary care providers.

Background Burnout rates amongst nurses have detrimental impact on job satisfaction, teamwork, and patient care. This costs millions of dollars in the healthcare system and challenges nurse leaders to address in order to keep up with the healthcare demands. Furthermore, burnout is especially relevant in our current healthcare climate, as frontline nurses have increased workload and multiple psychosocial stressors during the coronavirus disease (COVID-19) pandemic 62 . Literature also suggests that mindful self-care practices need to be reinforced in order to impact burnout long term. 41 Project7 Mindfulness Pledge© is an accessible and voluntary mindfulness tool that nurses can utilize in their individual practice to reduce burnout and does not require significant time commitment. Objective To evaluate the effectiveness of intentional self-care practices on nurse burnout and workplace environment by measuring job satisfaction and teamwork among nurses. Methods Comparisons between inpatient units on data from the National Database of Nursing Quality Indicators (NDNQI) with the Practice Environment Scale (PES), specifically on job enjoyment and teamwork, were done utilizing ANOVA. Results Results show that nurses in an inpatient unit that implemented Project7 has significantly higher job satisfaction as compared to units that did not implement Project7. Conclusions This suggests that this tool provides an effective and accessible mindfulness framework managers and directors can utilize to improve job satisfaction, teamwork, and thereby reduce burnout to create healthier work environments.

Aim:To examine the experiences of nurses and nursing assistants who participated in a mindfulness project.Background: Increased demands and fewer resources have become the norm in most health care settings. As a result, health care professionals face exceptional stress in their work environments and are vulnerable to burnout and compassion fatigue. Even more distressing, many new nurses are leaving their jobs within the first two years.Methods: Qualitative interviews were conducted with nine participants to discover their experience with the project. Results:The major theme, a process of moving from practice to praxis, is brought forth through in-depth descriptive analysis of nine individual interviews. The process occurred through three themes: fostering self-awareness and compassion; fostering other-awareness and compassion; and compelling transformation in the unit culture. Conclusions:This study develops an evidence base for incorporating and building mindfulness into health care environments at a time when there is a tremendous need for highly functioning practitioners.Implications for Nursing Management: Nurse leaders are encouraged to examine how they can support their staff in moving from practice to praxis as a part of improving professional well-being, retention, quality and safety in health care.

Background and Objectives: School-aged children with chronic conditions require care coordination for health needs at school. Access to the student's accurate, real-time medical information is essential for school nurses to maximize their care of students. We aim to analyze school nurse access to medical records in a hospital-based electronic health record (EHR) and the effect on patient outcomes. We hypothesized that EHR access would decrease emergency department (E.D.) visits and inpatient hospitalizations. Methods: This retrospective secondary data analysis was conducted using EHR data six months pre- and post-school nurse access to students' hospital-based EHR. The main outcome measures were the E.D. visits and inpatient hospitalizations. Results: For the sample of 336 students in the study, there was a 34% decrease in E.D. visits from 190 visits before access to 126 ED visits after access (p<.01). Inpatient hospitalizations decreased by 44% from 176 before access to 99 after access (p<.001). The incident rate of E.D. visits decreased (IRR: 0.66; 95% CI: 0.53-0.83; p= 0.00035), and hospitalizations decreased (IRR: 0.56; 95% CI: 0.44-0.72; p<0.0001) from pre to post access. These findings suggest school nurse access to medical records is a positive factor in improving school-aged patient outcomes. Conclusions: School nurse access to medical records through the hospital-based EHR may be a factor to improve patient outcomes by utilizing health information technology for more efficient and effective communication and care coordination for school-aged children with chronic medical conditions. Keywords- Health Information Exchange; Electronic Health Records; Child; Outcome Assessment, Health Care; School Nursing