Elsevier

Nursing Outlook

Volume 66, Issue 3, May–June 2018, Pages 244-253
Nursing Outlook

Hospital nursing leadership-led interventions increased genomic awareness and educational intent in Magnet settings

https://doi.org/10.1016/j.outlook.2017.10.010Get rights and content

Highlights

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    Receptivity was high with most nurses thinking genomics was important.

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    The MINC study targeted nursing; however, most dyads engaged interprofessionally.

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    Genomic knowledge deficits persisted, indicating the intervention was insufficient.

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    Genomics as a complex competency lacking observability limited learning capacity.

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    Leaders' involvement increased nurses learning and genomic application in practice.

Abstract

Background

The Precision Medicine Initiative will accelerate genomic discoveries that improve health care, necessitating a genomic competent workforce.

Purpose

This study assessed leadership team (administrator/educator) year-long interventions to improve registered nurses' (RNs) capacity to integrate genomics into practice.

Methods

We examined genomic competency outcomes in 8,150 RNs.

Findings

Awareness and intention to learn more increased compared with controls. Findings suggest achieving genomic competency requires a longer intervention and support strategies such as infrastructure and policies. Leadership played a role in mobilizing staff, resources, and supporting infrastructure to sustain a large-scale competency effort on an institutional basis.

Discussion

Results demonstrate genomic workforce competency can be attained with leadership support and sufficient time. Our study provides evidence of the critical role health-care leaders play in facilitating genomic integration into health care to improve patient outcomes. Genomics' impact on quality, safety, and cost indicate a leader-initiated national competency effort is achievable and warranted.

Section snippets

Background

The primary aim of genomic clinical applications is improved health outcomes (Rehm, 2017). Evidence of potential cost savings associated with the appropriate use of genomic information and technology is emerging, a priority in the current fiscal climate (Anderson et al, 2006, Bock et al, 2014, Gallego et al, 2015, Plevritis et al, 2006). Advances having significant ethical and safety challenges motivate nursing schools to integrate genomic content into curricula. However, the ability to

Study Design and Sample

This was a 1-year longitudinal study of RNs employed at 23 American Nurses Credentialing Center-designated Magnet hospitals conducted from 2012 to 2013. Two groups were assessed pre and post interventions; group one consisted of 21 intervention Magnet hospitals and group two consisted of 2 Magnet hospitals serving as control. Intervention hospitals underwent a competitive application to participate whereas the control hospitals were recruited by the study team from a pool of institutions that

Enrollment

Of the 21 intervention hospitals, one institution withdrew from the study, citing competing demands and inability to adhere to an institution-wide initiative. Their data are not included in this analysis. A second institution had a participation gap of 4 months due to staffing challenges, resulting in the inability to meet the study demands during this period. That facility's survey data were included in the analysis.

Participants

The 20 intervention hospitals that completed the study represented 14 states

Complex Competency

Despite awareness changes resulting from the year-long intervention, competency deficits persisted with minimal changes in knowledge and adoption domains. This was influenced by the dyads time required for achieving personal genomic competency and institutional leadership endorsement. This finding is not surprising given genomics is a science that many health-care providers, including nurses, have limited foundational knowledge from which to build upon. This differs considerably from other

Conclusions

The nursing profession is a cornerstone of health-care delivery and an essential bridge between genomic discoveries with clinical utility and their adoption into practice to advance health (Calzone et al., 2010). Genomics is a central science for health-care practitioners, including nurses. The Precision Medicine Initiative is poised to accelerate genomic discoveries relevant to practice (Collins & Varmus, 2015). Assuring the genomic awareness of nurses in the workforce is an essential step to

Acknowledgments

Akron Children's Hospital, Avera McKennan Behavioral Health Hospital, Baptist Hospital of Miami, Baptist Hospitals of Southeast Texas, Beaumont Hospital, Beaumont Health System.

Central DuPage Hospital, Children's National Medical Center, Duke University Hospital, Fox Chase Cancer Center, Hunterdon Healthcare System, Jersey City Medical Center, Martha Jefferson, Michael E. DeBakey VA Medical Center, Northwestern Memorial Hospital, OSF Saint Anthony Medical Center, Providence St. Vincent Medical

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    Funding: This research was funded through a grant from the National Council of State Boards of Nursing, (R41003) and supported by West Virginia University (10015559) and the Intramural Research Programs of the National Institutes of Health, National Cancer Institute, and National Human Genome Research Institute, Division of Policy, Communications, and Education.

    Conflict of Interest: All authors reported no conflicts of interest.

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