NERI Award Recipients

The Nursing Education Research Initiative (NERI) award was given to 3 group recipients for the 2022-2023 award year. This research initiative focuses on supporting faculty of the College of Nursing and Health Innovation (CONHI) in research endeavors focused on rural health nursing education.

RESEARCH PROJECT #1

Title: “Factors Associated with Academic Success and Retention Among CONHI Undergraduate Prelicensure Students in Rural Communities”

Researchers: Cynthia Koomey, PhD, RN

Deana Furr, PhD, RN

Description of Project: This project will focus on obtaining descriptive data regarding life context factors, such as healthcare employment and hours worked per week in the rural and non-rural student population; comparing study strategies, course resource usage, and exam scores in rural and non-rural nursing students; and following the progression and retention of online and campus-based rural nursing students longitudinally over a period of time. This team will then use the data to design multifaceted academic support strategies suited to the students in their existing contexts. The data will also provide evidence for professors in their selection of course resources to meet student learning needs (textbook, online materials), and will reveal the perceived effect of clinical experiences on exam success.

Project’s Importance: Very little research has been done in the U.S. investigating nursing students from the standpoint of rural vs. non-rural status. This study will provide data to form an understanding of differences and similarities between the two populations regarding study habits, stressors, employment and hours worked, as well as academic success.  This team will collect this data and will follow the students through multiple semesters (from Spring 2022 through Spring 2023).

Through this study this team will accrue data regarding nursing students attending clinicals in rural sites (who may not live in the rural areas). This information will enable clinical instructors who serve in the rural hospitals to address concerns as well as promote the interests of the rural hospitals. For example, in the exam wrapper question asking, “To what extent did clinical/lab contribute to your exam knowledge,” the student response may or may not be influenced by the size and diversity of the hospital patient population.   Students at rural hospitals having a more limited census might benefit from a more proactive simulation experience, and our instructors could be equipped to deliver such an experience (Radford, 2018).

Findings of project:

“We conducted an extensive exam-wrapper study, obtaining input from the undergraduate teaching team and have discovered findings that can be used to improve the program.   Challenges encountered included a drop in response rates after the initial exam wrapper, which was met successfully by providing incentives for students to complete the wrappers.  We used a drawing for high-quality stethoscopes and received significantly better response rates after doing so.”

1. Rural students (there were only 16 in the first three semesters for F2022) worked 21 hours per week on average while the average non-rural student worked 15. This was non statistically significant due to the small number of rural students.  Three rural students were LVNS. This was significant (MWU <.001).  UTA’s online prelicensure BSN program is clearly attractive to LVNs with plans to advance their education, and with already established rural networks in the personal as well as professional settings, the online program may be more likely than other interventions to result in nurses staying in their established rural areas.  
2. Using exam change scores which compare the scores between the first and final exams, we discovered that students who use exam wrappers earn higher exam scores. However, exam wrappers were not related to a positive change score.  Thus, students who used exam wrappers were higher scoring and more diligent students from the beginning, and their use did not help poor performers improve.  
3. Hours worked per week positively correlated with health care experience (Spearman .367, p = <.001). Those students already in health care work more hours.
4. Hours worked per week negatively correlated with hours spent studying, all exam scores, and change scores (p = .001).
5. The table below indicates that schools making an effort to increase the numbers of underrepresented nurses in terms of race/ethnicity would do well to increase scholarships for minority nurses to allow them to work fewer hours and be more successful in nursing school.

Presentations:

American Academy of Colleges of Nursing Conference, December 2022, Podium Presentation

The National League of Nursing Research Conference, March 2023, Podium Presentation

RESEARCH PROJECT #2

Title: “Exploring Well-being in New Graduate Nurses Transitioning to Practice in Rural Settings”

Researchers: Regina Urban, PhD, RN NPD-BC, CNE, ACUE, MA-LPC

Leslie Jennings, MSN/Ed, RN, CNE, ACUE

Marlene Porter, MSN, RN, NPD-BC, CEN, TCRN, CCRN-K

Description of Project: This research team aims to investigate well-being in new graduate nurses (NGNs) in rural settings utilizing a three-phase research project. NGNs participating in the Phase I study will be encouraged to participate in Phase II and III studies, maximizing recruitment efforts.

Phase I will describe the prevalence of and associations among well-being variables in NGNs transitioning to practice in rural settings. For this study, well-being variables include: depression, anxiety, stress, professional well-being, job satisfaction, and resignation ideation.

Phase II will influence rural NGN well-being using a 6-week synchronous instructor-led online well-being intervention. This intervention will include a pre-intervention survey, an online resilience intervention, a post-intervention survey, and a 3-month post-intervention survey.

Phase III will qualitatively explore the lived experiences of NGNs transitioning to practice in rural settings. This will be done in the form of semi-structured online interviews.

Project’s Importance: Conducting research that describes well-being and mental health variables of new graduate nurses (NGNs) in Texas (Phase I) is the first step towards understanding these variables in rural NGNs and may provide additional insight that can be used to improve their well-being and / or maximize their retention during the critical first year of nursing practice (Calleja et al., 2019). Offering a six-week resilience intervention to study participants (Phase II) can provide needed education, support, and skills designed to enhance the well-being and mental health of rural NGNs. This is especially important in rural environments where the need for nurses who can function in a generalist role is critical to serve the healthcare needs of rural Texas residents and where support for NGNs’ well-being may be lacking (Fowler et al., 2017). Interviewing rural NGN’s individually (Phase III) will help the research team to gain much needed insight into NGNs’ motivation behind choosing to work in a rural setting, a deeper understanding of their lived experiences, and information about how a pre-licensure program can better assist or prepare them to practice in a rural setting. These three proposed studies have implications for being among the first to explore well-being in NGNs as they transition to practice in rural settings in Texas. According to the National Academies of Sciences, Engineering, and Medicine [NASEM] (2019), studying clinician well-being is important because of its connection to improved patient-clinician relationships, the delivery of high-quality patient care, and increased workforce engagement. Enhancing clinician well-being may help to mitigate anxiety, depression, stress, burnout, and turnover in NGNs (NASEM, 2019).

Findings of project:

Phase I: A cross-sectional, observational study that explored variables associated with professional well-being, resignation ideation, and job satisfaction in newly licensed registered nurses transitioning to practice in rural settings.  Data analysis was completed on this project in the Fall of 2023. This resulted in a publication.

Phase 2: An online 6-week resiliency training program with rural new grads and a research project around this intervention was proposed for study #2.  We had no participants interested in participating in this type of experience.  Summer 2023 it was decided that this team would not be able to conduct this proposed study due to a lack of interest by potential study participants.

Phase 3: Qualitative interviews were conducted with 9 individuals about their lived experiences as they transitioned to practice.  These interviews are ready for data analysis but have not been completed at this time. This study’s low number of participants may make it difficult for this team to find a journal that will publish these findings as a qualitative research study article.

Presentations:

CRHN 2nd Annual Rural Health Conference, October 2023, Poster Presentation

Publications:

Urban, R.W., Porter, M., Jennings, L., & Mester, S (2024). Well-being, job satisfaction, and resignation ideation in Registered Nurses transitioning to practice in rural settings: A pilot study. Online Journal of Rural Nursing and Health Care, 24(2), 74-99. https://doi.org/10.14574/ojrnhc.v24i2.769

RESEARCH PROJECT #3

Title: “Creating Empathetic Connections Between Nursing Undergraduates and Rural Health”

Researchers: Jessica Smith, PhD, MSN, RN, CNE

Jennifer Roye, MSN, RN, CHSE, CNE

Melynda Hutchings, DNP, MSN, RN-BC, CEN

Stephanie Key-Rush, MSN, RN

Description of Project: This project will focus on testing the effectiveness of education interventions. This study will have two interventions included to increase nursing student empathy, knowledge, advocacy, and confidence to care for the health of rural populations: (1) modular online didactic content, and (2) modular online didactic content plus a three-part simulation video vignette. The target population is senior undergraduate nursing students at the University of Texas at Arlington. Modular content will address concepts such as telehealth, demographics, and statistics about rural Texas, social determinants of health, disparities, and Healthy People 2030.

Phase I will include the design and development of the online module and the simulation with pilot testing the intervention. Data will be collected during this phase to improve intervention for phase II.

Phase II will include recruiting for participants, testing interventions, and measuring pre-post intervention empathy.

Phase III will compare the educational intervention effectiveness for increasing empathy and the reporting results.

Project’s Importance: Improving the education of undergraduate nursing students about rural population needs and challenges is an important step in ensuring unique rural population healthcare needs, such as the need for telehealth consultation in some scenarios, is recognized and accommodated. Results will inform effective methods (simulation compared to modules alone) to improve the care of rural populations through nursing, regardless of practice setting.

Findings of project:

How the project went: This project was successful in generating data for presentation and publication, and for informing curriculum changes that have been implemented and kept to this date. The intervention that was created for this project was integrated into the Population and Community Health Nursing On-Campus and AO courses, and students write reflection assignments based on the content created.

Presentations:

NLN Education Summit 2024, September 2024, Podium Presentation

Sigma, Delta Theta Chapter Research Symposium, January 2024, Podium Presentation

Sigma 47th Biennial Convention, November 2023, Podium Presentation

CRHN 2nd Annual Rural Health Conference, October 2024, Podium Presentation

2023 International Rural Nursing Conference, July 2023, Podium Presentation

Publications:

https://rnojournal.binghamton.edu/index.php/RNO/article/view/764