In 2030, when baby boomers reach 65 years of age and represent 18% of the population, it is anticipated that 67 million adults will have a diagnosis of arthritis increasing the demand for total hip and knee arthroplasty. With the growing emphasis on patient- and family-centered care, the aim of this project was to assess the patient experience of patients and families throughout the entire spectrum of the total joint replacement service line care at a university regional trauma hospital. A shadowing methodology as defined by the Institute for Health Improvement was utilized. Eight patient/family groups undergoing total joint replacements were shadowed. The mapped care experience included time, caregiver, activity, shadower observations, and impressions. Findings revealed inconsistencies in the delivery of patient- and family-centered care. Communication and interactions were predominantly provider-centric, with a focus on care routines versus the patient and family, and anticipation that care would be medically directed.

Addiction rates in nurses are higher than in the general population. The relationship between stress, coping, and adaptation in nurses (N = 82) enrolled in a recovery and monitoring program in the state of New Jersey was examined. Social support, a variable tested as a mediator of this relationship, was also examined. Participants completed the Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, and Psychological General Well-Being Index. Negative relationships were found between stress and social support and stress and well-being, and a positive relationship was found between social support and well-being (all ps < .05). The direct relationship between stress and well-being was decreased in the presence of social support. The findings of this research suggest that, to assist nurses, an increased awareness of stress and its injurious effects on overall well-being must be identified so proactive measures can be implemented to prevent potential untoward consequences. Ultimately, methods to strengthen social support and social networks will enhance the probability of sustained recovery, relapse prevention, and safe reentry into nursing practice. Implications for behavioral health providers and health care practitioners are discussed.

Not alone: One network' s approach to pandemic nurse staffing N urse leaders faced an unprecedented staffing crisis during the height of the COVID-19 pandemic. As COVID-19 spread throughout New Jersey, acute care hospitals quickly had to shift from treating patients with various medical conditions to treating those with COVID-19 or persons under investigation (PUI). With the surge of COVID-19 patients needing ICU care, nurse leaders didn't have a blueprint for the emergency staffing response required to handle this crisis. Despite disaster experiences, such as 9/11 and Hurricane Sandy, nurse leaders needed resiliency, innovation, and creative decision-making as they faced this new challenge. 1 Hackensack Meridian Health (HMH) is one of the largest healthcare systems in New Jersey, employing over 8,000 nurses. Despite the impressive staffing numbers of this clinically integrated network, HMH's nurse leaders struggled to meet the clinical demands of caring for more than 13,000 patients with COVID-19. Turning to the literature for evidence-based staffing guidance, minimal evidence was found regarding staffing ratios, options, and models and how to successfully implement a staffing model during a pandemic. Thus, at the beginning of the COVID-19 pandemic, there was a gap in the literature relative to staffing in hospitals during pandemics, epidemics, or illness outbreaks.

The COVID-19 pandemic presented staffing challenges in providing care during the surge of critically ill patients. This qualitative descriptive study was conducted to obtain an understanding of clinical nurses' perspective of staffing in units during the first wave of the pandemic. Eighteen focus groups were conducted with registered nurses who worked on intensive care, telemetry, or medical-surgical units at 9 acute care hospitals. The focus group transcripts were thematically analyzed to identify codes and themes. The overarching theme was staffing, a bit of a mess, which sums up the general perception of nurses during the initial phase of the pandemic. The following additional themes underscore the overarching theme: challenging physical work environment; supplementing the frontline: buddies, helpers, runners, agency, and travel nurses; nurses do everything; getting through as a team; and emotional toll. Nurse leaders can utilize these findings to guide staffing decisions today and in the future, such as ensuring nurses are oriented to their deployed unit, keeping team members together when reassigned, and striving for consistency with staffing. Learning from the experience of clinical nurses who worked during this unprecedented time will assist in improving nurse and patient outcomes.