Project was launched to help nursing schools create environments where students, faculty, and staff feel a sense of belonging and are encouraged to thrive.

A Kentucky nursing school that has worked to provide diversity in healthcare for more than a decade is one of 50 U.S. nursing schools selected for a national initiative to foster inclusive learning environments and build a more diverse nursing workforce.

Frontier Nursing University (FNU) in Versailles, Kentucky, is among the schools of nursing chosen by the American Association of Colleges of Nursing (AACN) to participate in the project Building a Culture of Belonging in Academic Nursing. AACN launched this initiative to help nursing schools create environments where students, faculty, and staff possess a strong sense of belonging and are encouraged to thrive.

“Creating a learning culture where all individuals are able to develop and do their best work is critical to achieving academic nursing’s goals related to diversity, equity, and inclusion,” said Dr. Deborah Trautman, AACN president and CEO. “AACN is pleased to join with 50 member schools to pilot test a new tool that will help to evolve how nurse educators approach teaching, learning, and professional engagement.”

To support this project, AACN developed a digital platform to administer its Leading Across Multidimensional Perspectives (LAMP®) Culture and Climate Survey.

This instrument collects data on student, faculty, and staff perceptions of their college classrooms as communities in five areas: fair treatment and observations of discrimination; belongingness; value of diversity and inclusion; campus services; and clinical training.

Using data collected from LAMP, AACN will provide assessments and action reports to the participating schools related to developing inclusive academic environments. This tool provides administrators with a better understanding of how their campus climate influences student experiences and achievement so they can initiate change, target areas of growth, and improve student outcomes.

AACN will also use aggregate data collected from participating schools to identify best practices and success strategies that can be deployed at institutions nationwide.

Diversity, equity, and inclusion (DEI) has been an intentional component of Frontier Nursing University’s goals, initiatives, and planning since 2010, when the university launched PRIDE (Promoting Recruitment and Retention to Increase Diversity in Nurse-Midwifery and Nurse Practitioner Education). Now known as the Diversity Impact Program, PRIDE was specifically intended to raise the level of diversity in student enrollment.

In 2010, the enrollment of students of color was 9%. Today, that number has risen to more than 27%, and FNU’s DEI efforts have expanded exponentially to include all members and aspects of the FNU community, including faculty and staff diversity, curriculum content, recruitment, and retention. 

“We are honored to have been selected to participate in this important initiative,” said FNU Interim Chief Diversity and Inclusion Officer Paula Alexander-Delpech, Ph.D., PMHNP-BC, APRN.

Schools selected to participate in this pilot study are geographically diverse and represent a range of institutional types—public and private institutions; small and large schools; rural and urban-serving programs, etc.

Pilot testing of the LAMP survey will be completed in spring 2023. AACN will disseminate aggregate findings to all schools of nursing next year.

Related:  How Frontier Nursing University Has Pioneered a More Diverse Healthcare System

Pittsburgh-based agency paid 218 workers straight time when the law required it to pay overtime rates and tried to hide the wage theft.

Everest Home Care LLC, a Pittsburgh-based home care agency, and owner Bhuwan Acharya must pay 218 employees more than $1.4 million in back wages and damages for not paying overtime wages. The company then manipulated records to hide the wage theft, according to the U.S. Department of Labor.

The department’s Wage and Hour Division in Pittsburgh investigated and determined the employer paid workers a straight-time hourly rate instead of one-and-one-half their required rate for hours over 40 in a workweek, according to a department press release.

The investigation also revealed that Everest Home Care, which provides personal assistance, home- and community-based services, and long-term living assistance, attempted to mask the wage discrepancy by representing straight-time pay as overtime when overtime wages were required. Everest also failed to include recruitment commissions and hourly coronavirus hazard pay in employees’ required rates of pay when calculating overtime.

All these actions violate the Fair Labor Standards Act.

“Home health care workers provide vital services to people in need and their families,” said Jessica Looman, principal deputy Wage and Hour Division administrator. “The U.S. Department of Labor is committed to enforcing worker protections and holding accountable employers who defy the law and deny workers the hard-earned wages on which they depend to care for themselves and their families.”

Entered in the U.S. District Court for the Western District of Pennsylvania on Friday, the consent judgement—a decision reached by a court upon the agreement of all parties involved—requires Everest Home Care and Acharya to pay $719,962 in back wages and an equal amount in liquidated damages.

Additionally, the division assessed $85,075 in civil money penalties given the willful nature of the employers’ FLSA violations.

In fiscal year 2021, the division recovered more than $13.8 million for more than 17,000 healthcare industry workers, according to the department.

“Wage theft is an all-too-common concern in the healthcare industry, and we are determined to use our resources to hold employers who violate federal labor laws accountable to the fullest extent,” said Solicitor of Labor Seema Nanda. “By recovering wages and liquidated damages, when appropriate, for workers we send a clear message to employers in all industries that consequences can be costly for employers who flout the law.” 

The pandemic necessitated virtual simulation learning for nursing students; now, it remains an essential part of their education.

New technology is enabling nursing students to learn hands-on care through virtual reality programs that present situations practically as real as if they were in a clinical setting.

When the COVID-19 pandemic hit and nursing students were unable to do in-person clinicals in hospitals, Wayne State University College of Nursing in Detroit, like other nursing schools, had to rely on simulation to provide students with the education they needed. And although nursing students are returning to in-person clinical rotations, simulation labs remain in important part of their education.

HealthLeaders spoke with Erik Carter, PhD, MS, APRN, CNS, CCRN-A, PHN, director of undergraduate programs for Wayne State’s College of Nursing, about how virtual simulation is used and how effective it is.

This transcript has been lightly edited for brevity and clarity.

HealthLeaders: How increasingly is virtual simulation being used in nursing education?

Erik Carter: We’ve been using it especially since the pandemic started. We had to do a pivot because, as I’m sure you know, some affiliates during the peak of the pandemic were not allowing clinicals to occur in their institutions. So, we as faculty had to think of ways to provide students with a very sound experience that was centric or related to some kind of clinical experience, so we start utilizing simulation. And when I say simulation, there’s a huge breadth but I’m talking about virtual simulation and specifically the vSim® application that is provided through Wolters Kluwer’s platform.

Other simulations are used here as well. We have a simulation lab where our own homegrown simulations are utilized for students.

When the NCSBN [National Council of State Boards of Nursing] provided guidelines for us to use simulation to evaluate our students’ clinical performance, they allowed us to use simulation as a clinical substitute for these experiences. So that's one thing that we did to give students the opportunity to have a safe, realistic type of clinical experience that was not in the acute-care setting, in the primary care setting, or in a long-term care facility.

HL: Did Wayne State have a simulation lab prior to the pandemic?

Carter: Yes, we had a fully functional high-fidelity simulation lab prior to the pandemic. We utilize that with all of our clinical courses. We provided students the opportunity to have a simulation experience; it was just building to part of their overall overarching development. But when the pandemic hit, we had to pivot away from that in-person type of experience for the students and we had to think of ways to provide an online experience.

Our simulation techs and faculty put together these online experiences through simulation for the students in our simulation lab, but we also utilized other tools that we had at our disposal. The vSim platform is one that we use in several of our undergraduate clinical courses, such as med surg, maternity, pediatrics, and the fundamentals. It was nice that we had that ability to do that because again, we were perplexed: “How do we provide this for students? We have permission through the NCSBN to do this, but how?” And so we had to think outside the box and think of ways to provide students these rich opportunities to have some form of clinical engagement that wasn't always centric to them being in the hospital or in a clinical facility.

With the vSim, the student goes in and does pre-reading, and then we do a formative assessment of their understanding of the reading so they are well-prepared before they start the simulation. Once they’re in the simulation, they follow the cues based on their understanding of how they should perform. The best part about that is it provides a formative assessment; it tells them if they were on point with their interventions or their assessments regarding the patient or if they were off somewhat. It then gives clues as to what they can do next time they go back in or when they come back in to perform the simulation again.

We also have some homegrown simulations that we have put together with our faculty, but we have just started using one tool called UbiSim, which is very immersive and a little different than vSim. It’s a headset that puts students into a 3D platform where they're actually doing things within the simulation; they’re part of the simulation.

HL: Can you explain how that works from the student’s perspective?

Carter: Depending on the clinical situation, the patient is seen in bed. They approach and talk to the patient, and the patient, who is a faculty member who has the headset on as well, responds back.

The student would say, “Hello, my name is [student’s name] and I’m here to do a focused assessment on your respiratory system, so I’m going to listen to your lungs. Can you tell me your name and date of birth?” And then the faculty member who is playing the role of the patient would respond accordingly.

The students have a med card and they have the ability to start an IV, start fluids—there's a plethora of different things that you can do within that immersive environment with UbiSim. That’s one way we provide a clinical mimicry of a situation where students, if they're not in clinical, can actually have these experiences here in the college in the simulation lab.

HL: How do the students feel about using virtual simulation technology?

Carter: Once they get a handle on how to utilize, say, the vSim platform, they see how it makes sense. They see that it's something that can test the boundaries of their knowledge. There’s no worry because we tell them, “This is a safe environment; you have the ability to make a mistake and you're not going to harm anyone.”

That is a huge driver to have students think outside the box and try things and know that it’s not going to cause harm.

HL: From an educator’s perspective, how effective is virtual simulation in nursing education?

Carter: From my faculty perspective, it’s very effective. When I think about some of the studies that have been done surrounding the use of simulation, one that comes to mind is the NCSBN national stimulation study. That showed that the clinical experience that students normally would have could be replaced with simulation and they were just as effective as a student being in the clinical setting with a clinical instructor.

There's another one that comes to mind where they did a longitudinal study about how unique experiences and skills that students have, as well as knowledge, were increased, based on the simulation. I think that the utility of simulation is going to get bigger and going to explode. I’m a huge fan of these platforms and I see its utility in nursing education for sure.

HL: How well does virtual simulation prepare nurses for the real world of nursing?

Carter: It provides a safe and realistic environment for students to practice their clinical reasoning and their clinical judgment, and I tell the students all the time, “This is where you want to make a mistake.” Can you imagine if you're at a clinical site and you gave a drug inappropriately to a patient? The anxieties surrounding that error exponentially pushes their anxiety over the edge, making them almost unfunctional in the clinical realm on that day. So, I tell students that when they’re in vSim to go ahead and make a mistake and see what happens and see what the system tells you, so you think about this before you move forward.

It provides the students a safe haven for practice, and it prepares them for true clinical practice in the clinical setting once they are in the hospital or the clinic or wherever they're going to do their practicing. It really does prepare them to be a practice-ready, generalist in the clinical setting, for sure.

Course trains healthcare providers on identifying at-risk patients and how to intervene based on that risk.

The University of California, Davis is offering a free online continuing education course to help clinicians and other healthcare providers prevent firearm injury.

Training is provided by the BulletPoints Project at UC Davis, a program that teaches clinicians how to discuss the risks of firearm access with their patients and to intervene when someone is at increased risk.

The course explains how to have conversations with patients who have access to firearms and may be at risk of interpersonal violence, unintentional injury, or suicide, or unintentional injury, according to UC Davis. It also teaches clinicians how to intervene based on the type and level of risk of firearm violence.

"Clinicians play an important role in shaping public perceptions about safety and injury prevention," said Amy Barnhorst, director of the BulletPoints Project, and vice chair for clinical services at the UC Davis Department of Psychiatry.

"The same way a healthcare provider might ask a patient about smoking cigarettes, or a pediatrician might ask about car seats, they can also talk to their patients about firearms in a nonpartisan, nonjudgmental way," Barnhorst said.

The online course, Preventing Firearm Injury: What Clinicians Can Do, takes about an hour and features scenarios where a patient may be at risk of firearm violence, including suicide, intimate partner violence, mass shooting, and unintentional shooting.

The course walks clinicians through each scenario and provides intervention resource options, such as safe gun storage, temporary transfer of firearms, civil protective orders—also known as "red flag laws" or gun violence restraining orders—and mental health holds, known as 5150.

Clinicians also learn how to talk about the risks and interventions in culturally and politically neutral ways, according to UC Davis.

In 2020, the most recent year for which complete data is available, 45,222 people died from gun-related injuries in the U.S., according to the Pew Research Center. That same year, 79% of all homicides and 53% of all suicides involved firearms.

"The solution to our epidemic of gun violence is multifaceted and complex, and will take changes in policy, education, healthcare, school, and media," Barnhorst said. "Educating healthcare providers is an important piece of the puzzle."

Healthcare providers who complete the course can receive one hour of Continuing Medical Education (CME) through the California Medical Association or Continuing Education (CE) credits through the American Psychological Association.