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                                                                                                           Potential Sources of Funding

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                                                                                                           Potential Sources of Funding

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As a member of the American Association of Critical Care Nurses (AACN), there is a potential to obtain funding through the AACN Impact Research Grant. This grant awards up to $50,000 annually for clinicians and researchers to propose projects that support inquiry and systematic research that generates knowledge (AACN, 2017). This grant is designed to ensure a vital source of clinically relevant research for creating evidence -based resources that influence high acuity critical care nursing. As a result of this dissertation, novice nurses who enter the world of critical care will benefit from the focus on improving care and improving outcomes in the intensive care areas. A second source of potential funding can be obtained from the National League of Nursing (NLN). The principal investigator must be a NLN member who will contribute to the development of the science of nursing education (NLN, 2017). Three to five $25,000 grants will be awarded based on nursing research priorities that can potentially be impacted by the dissertation topics: improving quality of life by managing symptoms of acute and chronic illness; and by enhancing health promotion and disease prevention (NLN, 2017). As a result of this dissertation, the revision and implementation of novice nurse educational and orientation programs will change to hopefully build strong foundations in critical thinking/reasoning outcomes.

American Association of Critical Care Nurses. (2017). AACN Grants: Driving Change in Nursing  through Research. Retrieved from http://www.aacn.org/nursing-excellence/grants

National League of Nursing. (2017).  NLN Nursing Education Research Grants Guidelines. Retrieved from http://www.nln.org/professional-development-programs/grants-and-scholarships/nursing-education-research-grants/nln-nursing-education-research-grants-proposal-guidelines

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                                                                                                         Current Advocacy Efforts

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                                                                                                         Current Advocacy Efforts

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The American Nurses Association supports a legislative model empowering nursing to create staffing plans specific to their unit (American Nurses Association, 2017).This approach facilitates the creation of staffing levels that are flexible and adaptable for changes; changing patient acuity , the number of admissions, discharges and transfers during a shift, level of experience of nursing staff, layout of the unit, and availability of resources  (American Nurses Association 2017).  There are several nursing organizations that are supportive of staffing ratio plans that help foster a safer environment that include but not limited to: Department for Professional Employees (DPE); American Nurses Association (ANA); and American Association of Critical-Care Nurses, AACN.
American Association of College and Nursing supports the concept of employers to foster practice environments that embrace lifelong learning and offer incentives for registered nurses  seeking to advance their education to the baccalaureate and higher degree levels (American Association of College and Nursing, 2017). This concept is consistent with developing the critical thinking/reasoning in novice nurses to develop an environment of safety and quality focused care.

American Nurses Association (2017).  Nurse Staffing. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/State-StaffingPlansRatios

American Association of College and Nursing (2017). The impact of education on nursing practice. Retrieved by http://www.aacn.nche.edu/media-relations/fact-sheets/impact-of-education

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                                      Current Political Policies

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                                      Current Political Policies

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There are currently two national  safe patient ratio bills, one in the Senate S. 864 (Boxer) and the House HR 1602 (Schakowsky) (National Nurses United, 2017).  The National Nursing Shortage Reform and Patient Advocacy Act  establishes requirements for acute-care facilities to provide registered nurse staff based on the acuity of patients provided that minimum nurse-to-patient ratios for each unit are met at all times. Registered nurses shall also have the obligation to act in the exclusive interest of their patients, and the right to be patient advocates (National Nurses United, 2017).  Safe Nurse Staffing for Patient Safety and Quality Care Act - HR 1602 (Schakowsky) is a bill focused on improving patient quality of care by establishing a requirement for nurse-to-patient ratios that put patient safety first. These bills will help novice nurses concentrate on cementing skills and critical thinking abilities while caring for an appropriate patient load.
National Nurses United. (2017). National Campaign for Safe RN-to-Patient Staffing Ratios.  Retrieved from http://www.nationalnursesunited.org/issues/entry/ratios

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                                                                                                               Research Method

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                                                                                                               Research Method

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The research method of this dissertation will be quantitative. There will be an initial analysis of the level of critical thinking at 0 months, 6 months and 12 months using measurement tools:  California Critical Thinking Skills Test (CCTST) and the Collegiate Learning Assessment (CLA). The CCTST evaluates the new graduate nurse’s abilities to solve programs and make decisions using reasoned judgments; measures skills in six subscales (analysis, inference, explanation, interpretation, self-regulation, and evaluation) and overall score for critical thinking (Bers, Chun, Daly, Harrington, Tobolowsky & Associates, 2015).   CLA is a test used for performance-based tasks to measure students’ critical thinking with formatting for baccalaureate institutions and for community colleges ((Bers, Chun, Daly, Harrington, Tobolowsky & Associates, 2015). The research method will also require an evaluation of safety related concerns indicated by hospital based occurrence systems. This will allow an inverse examination of increasing critical thinking levels to decreasing occurrences of safety related concerns in the novice nurse population. The population of interest for this study will be novice nurses. This nursing population will be limited to nurses that have not begun their clinical orientation, plan on working in an inpatient unit for at least 12 months and possess a willingness to complete critical thinking testing at time intervals previously stated.
Bers, T., Cuhn, M., Daly, W.T., Harrington, C., Tobolowsky, B.F., & associates (2015).   Foundations for Critical Thinking. National Resource Center

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                          Impact of Policy Initiatives

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                          Impact of Policy Initiatives

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This topic can be impacted or influenced by policy driven concepts. The creation of policy initiatives that limit staffing patient ratio of nurses will allow novice nurses the opportunity to focus on tasks and experiences that build critical reasoning abilities. Limiting staffing ratios also contributes to the retention of practicing nurses resulting in tenured staff that practice with a higher quality of care. The increased focus of policies based on value based care will also be impactful. As healthcare outcomes are being examined for breaches in quality, insurance companies and governing bodies will hold institutions to a higher standard of care. Therefore, by reducing the impact of safety concerning novice nurse practice through nurse residency programs, mentorship programs and simulation exercises the caliber of practice will improve resulting in a positive return on investment for value based care.

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                                                                                                             Topic Description

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                                                                                                             Topic Description

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The occurrence of safety related concerns in health care is a growing epidemic.  There are many preventable means to foster a safer patient environment and the nursing profession is at the center of it.  According to Smith & Crawford (2002), novice nurse safety concerns make up 53% of these occurrences including but not limited to: medication errors; failure to recognize; and failure to respond.  Benner describes new graduate nurses as being limited to aspects of care situations that they can see and understand (Forneris & Peden-McAlpine, 2007).  During the first year of practice, novice nurses struggle to accomplish all tasks required for safe patient care but at what time during this year does the quality of practice change and based on what factors.
The initial building blocks of critical thinking/reasoning of novice nurses has been inferred as a potential link to safety related concerns. With investigating this link, the hope is to correlate the critical thinking/reasoning abilities of novice nurse with safety related concerns during their first year of clinical practice.
Forneris, S.G., & Peden-McAlpine, C. (2007). Evaluation of a reflective learning intervention to  improve critical thinking in novice nurses. Journal of Advanced Nursing, 57(4), 410-421. doi: 10.1111/j.1365-2648.2006.04120.x

Smith J., & Crawford, L. (2002). Report of findings from the 2001 employers survey. National Council of State Boards of Nursing, Chicago.

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        Does Critical Thinking in New Graduate nurses affect safety?

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        Does Critical Thinking in New Graduate nurses affect safety?