Walden University NURS 6050 Polic

Walden University
NURS 6050 Policy and Advocacy for
Improving Population Health
Module 3
IntroductionResourcesDiscussionAssignmentMy Progress
Tracker
Improving Population Health | Module 3

IntroductionResourcesDiscussionAssignment☰Menu
Walden University
Module 3
Tracker

IntroductionResourcesDiscussionAssignment☰Menu×
NURS 6050 Policy and Advocacy for Improving Population
Health Back to Course Home Course Calendar Syllabus Course
Information Resource List Support, Guidelines, and Policies
Module 1 Module 2 Module 3 Module 4 Module 5 Module 6
Exit and return to the Blackboard App menu to access
other tools, assessments, and content. Pull down, then click the
"X" button at the top left corner of your mobile device.
Photo Credit: Getty Images/iStockphotoModule 3: Regulati on
(Weeks 5-6)
Laureate Education (Producer). (2018). Regulation [Video file].
Baltimore, MD: Author.
Rubic_Print_FormatCourse CodeClass CodeAssignment
TitleTotal PointsLDR-463LDR-463-O501Topic 5 Journal
Entry30.0CriteriaPercentageUnsatisfactory (0.00%)Less Than
Satisfactory (65.00%)Satisfactory (75.00%)Good
(85.00%)Excellent (100.00%)CommentsPoints
EarnedContent100.0%Response to Journal Entry
Prompt80.0%Response to the journal entry prompt is not
present.Response to the journal entry prompt is incomplete or
incorrect.Response to the journal entry prompt is complete but
lacks relevant detail.Response to the journal entry prompt is
thorough and contains substantial supporting details.Response
to the journal entry prompt is complete and contains relevant
supporting details.Mechanics of Writing includes spelling,
punctuation, grammar, and language use.20.0%Frequent and
repetitive mechanical errors distract the reader. Inconsistencies

in language choice (register) or word choice are present.
Sentence structure is correct but not varied.Surface errors are
pervasive enough that they impede communication of meaning.
Inappropriate word choice or sentence construction is
used.Some mechanical errors or typos are present, but they are
not overly distracting to the reader. Correct and varied sentence
structure and audience-appropriate language are employed.Prose
is largely free of mechanical errors, although a few may be
present. The writer uses a variety of effective sentence
structures and figures of speech.Writer is clearly in command of
standard, written, academic English.Total Weightage100%
Walden University
Module 3
Tracker

Walden University
Module 3
Tracker

Photo Credit: Getty Images/iStockphotoModule 3: Regulation
(Weeks 5-6)
Walden University

Module 3
Tracker
Walden University

Module 3
Tracker

Photo Credit: Getty Images/iStockphotoModule 3: Regulation
(Weeks 5-6)
Original Article
Evaluating the Impact of EBP Education:
Development of a Modified Fresno Test for
Acute Care Nursing
Margo A. Halm, PhD, RN, NEA-BC
Keywords
modified Fresno,
EBP education/
competencies,
acute care nursing,
novice-to-expert,
psychometrics
ABSTRACT
Background: Proficiency in evidence-based practice (EBP) is

essential for relevant research find-
ings to be integrated into clinical care when congruent with
patient preferences. Few valid and
reliable tools are available to evaluate the effectiveness of
educational programs in advancing
EBP attitudes, knowledge, skills, or behaviors, and ongoing
competency. The Fresno test is one
objective method to evaluate EBP knowledge and skills;
however, the original and modified
versions were validated with family physicians, physical
therapists, and speech and language
therapists.
Aims: To adapt the Modified Fresno-Acute Care Nursing test
and develop a psychometrically
sound tool for use in academic and practice settings.
Methods: In Phase 1, modified Fresno (Tilson, 2010) items were
adapted for acute care nursing.
In Phase 2, content validity was established with an expert
panel. Content validity indices (I-CVI)
ranged from .75 to 1.0. Scale CVI was .95%. A cross-sectional
convenience sample of acute care
nurses (n = 90) in novice, master, and expert cohorts completed
the Modified Fresno-Acute Care
Nursing test administered electronically via SurveyMonkey.
Findings: Total scores were significantly different between
training levels (p < .0001). Novice
nurses scored significantly lower than master or expert nurses,
but differences were not found
between the latter cohorts. Total score reliability was
acceptable: (interrater [ICC (2, 1)]) =
.88. Cronbach’s alpha was 0.70. Psychometric properties of
most modified items were satis-
factory; however, six require further revision and testing to

meet acceptable standards.
Linking Evidence to Action: The Modified Fresno-Acute Care
Nursing test is a 14-item test for
objectively assessing EBP knowledge and skills of acute care
nurses. While preliminary psycho-
metric properties for this new EBP knowledge measure for acute
care nursing are promising,
further validation of some of the items and scoring rubric is
needed.
INTRODUCTION
Over a decade ago, the Institute of Medicine (Institute of
Medicine [IOM], 2001) recognized evidence-based practice
EBP as a key solution to ensure care delivered has the high-
est clinical effectiveness known to science. To reach the IOM’s
(2007, p. ix) 2020 goal that “90% of clinical decisions will be
supported by accurate, timely and up-to-date clinical informa-
tion that reflects the best available evidence,” nurses need EBP
competencies to guarantee that relevant research findings are
integrated into clinical situations when congruent with patient
preferences (Melnyk, Gallagher-Ford, Long, Long, & Fineout-
Overholt, 2014).
BACKGROUND
A recent evidence synthesis reported 10 studies evaluating
the effectiveness of educational interventions in building EBP
attitudes, knowledge, skills, and behaviors of nurses (Halm,
2014). Interventions were primarily workshop or immersion
programs, but seminars, journal clubs, and EBP and research
councils were also evaluated via: (a) self-reported EBP attitude,
knowledge, and behavior (Chang et al., 2013; Dizon, Somers, &
Kumar, 2012; Edward & Mills, 2013; Leung, Trevana, &
Waters,
2014); (b) PICO questions and activity diaries (Dizon et al.,

2012); (c) Edmonton Research Orientation (Gardner, Smyth,
Renison, Cann, & Vicary, 2012) and Clinical Effectiveness or
EBP Questionnaire (Sciarra, 2011; Toole, Stichler, Ecoff, &
Kath, 2013; White-Williams et al., 2013); and (d) interviews
and
focus groups to identify qualitative themes about nurses’ expe-
rience in EBP programs (Balakas, Sparks, Steurer, & Bryant,
2013; Nesbitt, 2013; Wendler, Samuelson, Taft, & Eldridge,
2011). Varied measurement across studies limited estimation
of the effectiveness of EBP training (Dizon et al., 2012).
In a systematic review, Shaneyfelt et al. (2006) rec-
ommended valid and responsive methods to evaluate the
programmatic impact of EBP education and progression in
272 Worldviews on Evidence-Based Nursing, 2018; 15:4, 272–
280.
© 2018 Sigma Theta Tau International
CE
http://crossmark.crossref.org/dialog/?doi=10.1111%2Fwvn.1229
1&domain=pdf&date_stamp=2018-05-14
EBP competencies. As self-report is extremely biased (Lai
& Teng, 2011; Shaneyfelt et al., 2006); objective knowledge
tests that incorporate multiple-choice or short answers with
case-based decision-making like the Berlin Questionnaire
(Fritsche, Greenhalgh, Falck-Ytter, Neumayer, & Kunz, 2002)
or Fresno test were recommended to evaluate EBP knowledge
and skills (Shaneyfelt et al., 2006). The Fresno test, a valid and
reliable method to evaluate EBP knowledge and skills using
a standardized scoring rubric, has been validated with family
physicians (Ramos et al., 2003), physical therapy (Miller,
Cummings, & Tomlinson, 2013; Tilson, 2010), and speech

language (Spek, de Wolf, van Dijk, & Lucas, 2012).
SPECIFIC AIMS
As objective methods for assessing EBP knowledge and skills
of nurses are lacking, the specific aim of this study was to fill a
measurement gap by adapting the modified Fresno test (Tilson,
2010) for acute care nursing. Only with consistent use of psy-
chometrically sound methods can useful evidence be generated
about the effectiveness of various EBP teaching strategies—
new knowledge that can direct effective educational and pro-
fessional development programs for students and practicing
nurses. The specific research question was: Will an adapted
Fresno test discriminate EBP knowledge and skills between
novice, master, and expert acute care nurses?
METHODS
Research Design
A cross-sectional cohort design was used to replicate Tilson’s
(2010) modified Fresno test (Figure 1).
Phase I: Test adaptation. New scenarios on acute care nurs-
ing were developed for items #1–8 that remained unchanged.
Item #9 (clinical expertise) was retained despite removal due to
poor psychometric performance by Tilson (2010). Items #10–13
were modified for acute care although the EBP focus was un-
changed. Item #14 was modified to the best design for studying
the meaning of experience.
Phase 2: Content validity. Content validity was established
with a panel of four masters and doctorally prepared acute care
EBP experts from practice and academic settings. In round
one, panelists rated each item and rubric for clarity, impor -
tance, and comprehensiveness on a 5-point Likert scale. Pan-
elists provided feedback on whether items should be retained,
revised, dropped, or added (Polit & Beck, 2012). In round two,
items #10 (mathematical calculations for sensitivity, positive

predictive value) and #11 (relative and absolute risk reduction)
were replaced because the panel did not believe acute care
nurses would be expected to make these calculations without
a resource. These items were replaced (and reviewed) with
assessing tool reliability/validity and applying qualitative find-
ings. The scoring rubric (Figure S1) was modified to reflect
item
alterations and ensure scoring consistency across subjects and
raters (Jonsson & Svingby, 2007). With a single overall score,
Figure 1. Study flowchart.
a passing score was defined as >50% of available points for in-
dividual items (Tilson, 2010). This passing score was set lower
than that defined as “mastery of material” (Ramos, Schafer, &
Tracz, 2003) to reduce the risk of a floor effect with novices.
A content validity index (I-CVI) was calculated for individ-
ual items by dividing the number of 4–5 ratings by the number
of experts. Mean (M) item ratings were 4.54 (clarity), 4.82 (im-
portance), and 4.75 (comprehensiveness). Only item 12 had an
I-CVI value <0.78 because the panel rated interpreting con-
fidence intervals lower on importance for acute care nurses.
The scale CVI of .95% was calculated by averaging I-CVIs,
exceeding acceptable standards of >.90 (Polit & Beck, 2007;
Table 1).
Phase 3: Validation of modified Fresno. After Institu-
tional Review Board exemption was obtained, invitations were
emailed to three cohorts: (a) novice nurses (less than 2 years of
Worldviews on Evidence-Based Nursing, 2018; 15:4, 272–280.
273

Original Article
Table 1. Modified Fresno Test Items (n = 90)
Scores
Item/EBPstepor
component Topic
Content
validity index
(I-CVI)
Possible
score
Passing
score
Novices
(n = 30)
M (SD)
Masters
(n = 30)
M (SD)
Experts
(n = 30)
M (SD) p value*
1 INQUIRE PICOquestion .92 0–24 >12 13.73 (7.37) 19.47
(3.71) 18.13 (4.55) .001 (N-M,N-E)
2ACQUIRE Sources 1.0 0–24 >12 15.03 (6.53) 20.33 (5.09)

17.53 (6.05) .004 (N-M)
3APPRAISE Treatment
design
1.0 0–24 >12 5.80 (6.77) 10.50 (6.90) 11.90 (5.87) .001 (N-
M,N-E)
4ACQUIRE Search .92 0–24 >12 13.93 (5.06) 16.53 (4.69)
15.10 (4.69) .18
5APPRAISE Relevance .92 0–24 >12 7.47 (6.31) 9.77 (6.83)
12.03 (6.72) .03 (N-E)
6APPRAISE Validity .92 0–24 >12 7.30 (6.75) 10.67 (7.77)
10.23 (7.38) .16
7APPRAISE Significance 1.0 0–24 >12 3.40 (3.94) 9.97 (8.18)
7.70 (7.03) .001 (N-M,N-E)
8PATIENT
PREFERENCES
Patient
preference
1.0 0–16 >8 6.13 (4.36) 8.20 (5.59) 9.00 (4.95) .08
9CLINICAL
EXPERTISE
Clinical
expertise
1.0 0–8 >4 4.80 (3.04) 5.60 (2.49) 6.40 (2.49) .08

10APPLY Tools .92 0–12 >6 3.90 (4.18) 8.50 (3.35) 7.00 (4.12)
.001 (N-M,N-E)
11APPLY Qualitative 1.0 0–16 >8 12.13 (4.75) 10.93 (5.35)
12.53 (6.19) .50
12APPRAISE Confidence
intervals
.75 0–4 >2 .13 (.73) .40 (1.22) 1.07 (1.80) .02 (N-E)
13APPRAISE Design
diagnosis
1.0 0–4 >2 .27 (1.01) .27 (1.01) .27 (1.01) 1.00
14APPRAISE Design
meaning
1.0 0–4 >2 2.13 (2.03) 3.73 (1.01) 3.87 (.73) .001 (N-M,N-E)
Total scores .95ScaleCVI 0–232 >116 96.17 (26.14) 134.87
(30.76) 132.77 (28.94) .001 (N-M,N-E)
*Scheffe post-hoc analysis: N = Novices;M = Masters; E =
Experts.
experience after graduation from a bachelorette program) from
three U.S. Magnet hospitals; (b) master nurses (master’s pre-
pared) recruited via the National Association of Clinical Nurse
Specialists listserv; and (c) expert nurses (doctorally prepared)
recruited via the American Nurses Credentialing Corporation’s
Magnet program director’s listserv and faculty at Bethel Uni -
versity (St. Paul, MN, USA). Nurses in the expert cohort self-
affirmed their EBP expertise and teaching experience. Up to
1 hr (in one sitting) was allowed to complete the test with no

external resources; only notepaper and calculators were per -
mitted. Reminder e-mails were sent at 2 and 4 weeks. A $10
gift certificate incentive was offered upon completion. Some
participants did not answer all the items on the exam; these
participants were not included in the sample for each cohort.
Only participants who had a complete exam were included in
the analysis. Data were collected in 2015.
Two doctorally prepared nurses with expertise teaching EBP
served as raters after an orientation to the test items and scor -
ing rubric. Raters practiced scoring three pilot tests from the
three cohorts and resolved discrepancies that could threaten in-
terrater reliability (IRR; e.g., halo effect, leniency or
stringency,
central tendency errors; Castorr et al., 1990; before scoring
commenced. A midway refresher session allowed raters to re-
view scores, reducing the threat of rater drift (Castorr et al.,
1990). Data were analyzed with SPSS Version 23.0 (IBM Corp.,
Armonk, NY, USA).
RESULTS
Descriptive Statistics
The total sample of 90 nurses included cohort (a) new grad-
uates (n = 30); (b) master’s prepared CNSs (n = 30); and
(c) doctorally prepared nurses (n = 30). Seventy-six percent
completed the test within 60 min (83% novices, 70% mas-
ters, 73% experts). Mean min for test completion were 56.43
274
Development of a Modifi ed Fresno Test for Acute Care Nursing

Table 2. Psychometric Properties of Individual Items (n = 90)
%Passedbycohort
Item# Topic ICC IDI ITC
All
(n = 90)
Novices
(n = 30)
Masters
(n = 30)
Experts
(n = 30) χ2 p-value
1 PICOquestion .78 .43 .53 85.6 63.3 100.0 93.3 18.52 .0001
2 Sources .78 .35 .53 84.4 73.3 93.3 86.7 4.74 .09
3 Treatmentdesign .86 .61 .56 44.4 26.7 50.0 56.7 6.03 .05
4 Search .72 .26 .48 80.0 76.7 86.7 76.7 1.25 .54
5 Relevance .48 .65 .63 35.6 26.7 33.3 46.7 2.72 .26
6 Validity .47 .43 .50 32.2 20.0 43.3 33.3 3.76 .15
7 Significance .74 .52 .57 26.7 6.7 40.0 33.3 9.55 .01
8 Patient
preference

.55 .52 .39 52.2 36.7 50.0 70.0 6.77 .03
9 Clinical expertise .23 .22 .40 88.9 80.0 93.3 93.3 3.60 .17
10 Tools .76 .74 .68 68.9 40.0 90.0 76.7 18.77 <.0001
11 Qualitative .68 .17 .31 88.9 93.3 90.0 83.3 1.58 .46
12 Confidence
intervals
.90 .04 .12 13.3 3.3 10.0 26.7 7.50 .02
13 Designdiagnosis .61 .13 .12 6.7 6.7 6.7 6.7 .00 1.0000
14 Designmeaning .89 .35 .37 81.1 53.3 93.3 96.7 22.77 <.0001
Total score .88 N/A N/A .0001
(standard deviation [SD] 38.21) for novices; 57.20 (SD 42.54)
for masters; and 43.21 (SD 26.33) for experts.
Reliability Statistics
IRR was calculated using intraclass correlation coefficients
(ICC) for total score and individual items (Table 2). Total score
reliability was high at .88. Of the 14 items, 3 had excellent
reliability (>.80), 7 had moderate reliability (.60–.79), and 4
had questionable reliability (<.60). Items with questionable
IRR focused on relevance (#5), validity (#6), patient preference
(#8), and clinical expertise (#9). A Cronbach’s alpha coefficient
of .70 was obtained for internal consistency of the modified
exam.
Item discrimination index (IDI) was calculated for each item
by separating total scores into quartiles and subtracting the pro-
portion of nurses in the bottom quartile who passed that item

(>50% points per item was passing) from the proportion in the
top quartile who passed the same item. The 50% threshold has
been defined as “mastery of material” (Ramos et al., 2003) and
used in similar validation studies (Tilson, 2010). IDI ranges
from –1.0 to 1.0, representing the difference in passing rate
between nurses with high (top 25%) and low (bottom 25%)
overall scores. Eleven of the 14 items had acceptable IDIs >.2
(Table 2). Correlation between item and total score and cor-
rected item-total correlation (ITC) was assessed using Pearson
correlation coefficients. Twelve of the 14 items had acceptable
ITCs >.3 (Table 2). Low IDI and ITC items focused on con-
fidence intervals (#12) and design for diagnostic tests (#13).
Qualitative findings (#11) also had a low IDI.
Total Score Analysis
No floor or ceiling effect was apparent, indicating the test is ap-
plicable from novice to expert (Figure 2). As shown in Table 1,
total mean scores for novices (M 96.17, SD 26.14) revealed
that a passing score of 116 was not achieved in this cohort as
with the master (M 134.87, SD 30.76) and expert (M 132.71,
SD 28.94) cohorts. One-way analysis of variance (ANOVA)
demonstrated that overall mean scores were significantly dif-
ferent, F (2, 89) = 17.58, p < .0001, between cohorts. A post-
hoc Scheffe comparison showed novice total mean scores (M
96.17, SD 26.14) differed significantly from master (M 134.87,
SD 30.07, d = 1.36) and expert nurses (M 132.77, SD 28.94,
d = 1.33). Cohen’s d is an effect size measure that is used
to explain the standardized difference between two means,
275

Original Article
Figure 2. Box plots for sum scores.
commonly reported with ANOVAs or t tests. There were no
significant differences between the master and expert cohorts.
Item Score Comparison
Post-hoc Scheffe analysis also revealed significant cohort dif-
ferences in eight items (Table 1). Novice nurses scored sig-
nificantly lower than master and expert nurses on PICO (#1),
sources (#2), treatment design (#3), relevance (#5), significance
(#7), tools (#10), confidence intervals (#12), and design mean-
ing (#14). On the other hand, the mean scores for four items
increased progressively across cohorts from novice to master,
and then from master to expert. These items were treatment
design (#3), relevance (#5), patient preference (#8), and con-
fidence intervals (#12). While not all items performed in this
manner, these items demonstrated mastery of EBP material
across cohorts.
Item Difficulty
Item difficulty (IDI) was calculated via the proportion of nurses
who achieved a passing score for each item (Table 2). Of the
14 items, none were easy (IDI > .8). Ten items (71%) were
moderate (IDI > .3), and 4 (29%) were difficult (IDI < .3;
Janda, 1998; Nunnally & Bernstein, 1994). In testing individual
items, all three cohorts scored below the passing cutoff for five
items: Treatment design (#3), validity (#6), significance (#7),
confidence intervals (#12), and diagnosis design (#13). Novice
and master nurses did not achieve a passing score for relevance
(#5), while novices did not pass patient preferences (#8) and
tools (#10).
Using chi-square analysis, seven items showed significant

differences in the proportion of passing scores between cohorts
(Table 2). Masters scored highest on PICO (#1), significance
(#7), and tools (#10). Experts performed best on treatment de-
sign (#3), design meaning (#14), patient preferences (#8), and
confidence intervals (#12).
In examining item discrimination based on the propor-
tion of nurses who passed the test (Table 2), some significant
items did not discriminate well between masters and experts:
(a) PICO (#1); (b) treatment design (#3); (c) significance (#7);
and (d) design meaning (#14). Items on sources (#3), search
(#4), relevance (#5), validity (#6), and expertise (#9) discrim-
inated on the IDI but did not assess unique EBP knowledge
and skills among the three cohorts (p > .05).
DISCUSSION
The Modified Fresno-Acute Care Nursing test is a 14-item test
for assessing EBP knowledge and skills. While the original
test assessed core principles of EBP steps, this replication val -
idated patient preferences and clinical expertise to fully assess
all EBP domains. The test has excellent content validity with
I-CVIs ranging from .75 to 1.0. Overall scale CVI was .95. In-
ternal consistency was acceptable at .70. Table 3 compares the
psychometric properties of the Modified Fresno-Acute Care
Nursing test with the original and modified tests.
Total scale reliability for the two independent raters was
excellent (.88). IRR for individual items was good to excellent
for 10 of 14 items (71%). One reason IRR may have been lower
for relevance (#5) and validity (#6) was the rubric complexity
that required raters to consider responses for both items when
scoring. Like Tilson (2010), IRR was less than desirable for pa -
tient preference (#8) and clinical expertise (#9). Some leniency
in scoring may have occurred with #8 when a nurse offered a
phrase that could elicit patient preferences, rather than stating
it as a question as specified in the rubric. As recommended by

Tilson (2010), clinical expertise should be retained as it covers
an essential EBP domain, but further revision and validation is
needed.
Item difficulty was moderate to high. Two items retained
from Tilson’s (2010) version had low IDI and ITC: Confidence
intervals (#12) and design for diagnosis (#13). These items were
difficult across cohorts and did not discriminate. Of the new
items, tools (#10) had acceptable psychometrics across ICC,
IDI, and ITC. The second qualitative item (#11) had accept-
able ICC and ITC but low IDI and did not discriminate across
cohorts. This finding may demonstrate that qualitative find-
ings have a rich tradition of emphasis across levels of nursing
education and practice.
While some items did not perform ideally, these items re-
main valuable to the larger research goal of developing an
objective and responsive method to evaluate EBP knowledge
and skills. Reasons for poor item performance may include
item characteristics, unknown sample characteristics, scoring
concerns, or a combination of these factors. Six items (#5, #6,
#9, #11, #12, and #13) need to be revised and retested before
be-
ing removed. Although Tilson (2010) dropped clinical expertise
(#9), it covers an important EBP domain that other researchers
recognized as essential for measurement (Miller et al., 2013).
A range in item difficulty is best so that the high and low
range of ability can be evaluated. For item #12 (confidence
276

Table 3. Comparison of Reliability and Validity of Fresno Tests
Performance
Measure/acceptable
results
Original Fresno (Ramos
et al., 2003)
DutchadaptedFresno
(Speket al., 2012)
ModifiedFresno-physical
therapy (Tilson, 2010)
ModifiedFresno-AcuteCare
Nursing test (Halm, 2018
current study)
Population � Familyphysicians � Speech
language, clinical
epidemiology
students
� Physical therapy � Acute care nurses
Total score/# items � 212/12 � 212/12 � 224/13 � 232/14
Content validity
� ScaleCVI/>.90 � Not reported � .92 � Not reported � .95

Interrater reliability
� Interrater
correlation/
�
>.60
� Items: .72–.96
� Total score: .97
� Not reported
� Items: .41–.99
� Items: .23–.90
Internal reliability
� Cronbach’s/>.70
� Item-total
correlation
(ITCs)/>.30
� .88
� .47–.75 (items)
� .83
� .31–.76
� .78
� .20–.66

� .70
� .12–.68
Itemdiscrimination
� Item
discrimination
index (IDI)/>.20
� .41–.86; no items
hadweakor
negative
discrimination
� Not reported � .25–.68; no items
hadweakor
negative
discrimination
� .04–.74; 3 itemshad
weakdiscrimination
Construct validity
� Comparisonof
meancohort
scores
� Novice = 95.6+
� Expert = 147.5;
morepassedall
items (p < .05)
� Year 1 students
= 26.3*

� Year 2 students
= 69.3*
� Year 3 students
= 89.1*
� Masters students
= 154.2*
� Novice = 92.8
� Trained = 118.5
� Expert = 149.0++;
morepassed 11
items
(p < .03–.01)
� Novices = 96.17++
� Masters = 134.87;
morepassed3 items
(p < .01–.0001)
� Experts = 132.77;
morepassed4 items
(p < .01–.0001)
*p < .05; +p < .001; ++ p < .0001.
intervals), the IDI was low, most likely due to the low base
success rate; however, it did discriminate the high end of EBP
knowledge among cohorts. This item replaced a mathemati-
cal calculation and should be retained because of the growing
importance of understanding confidence intervals, although it
may need to be revised. Similarly, item #13 (design diagnosis)
was difficult. This item should be retained but reworded to in-
crease clarity that it is referring to selection and interpretation

of diagnostic tests.
Item #14 (design meaning) may have been too easy. This
item should be retained but reworded, so it is more difficult.
Since item #11 was labeled qualitative, it may have primed
nurses, and so item #14 (design meaning) should be moved
earlier in the test. Based on ITC performance, the rubric for
item #11 (qualitative) needs to be more difficult, requiring
more specific or unusually helpful or insightful advice to better
differentiate between a best possible (16 points) answer versus
a more limited (8 points) answer.
No floor or ceiling effects were evident, indicating that EBP
knowledge and skills, and not clinical experience, influenced
mean score differences (Tilson, 2010). Mastery of EBP material
was evident from novice to expert nurses on four items. The
277
Original Article
Table 4. Uses of the Modified Fresno-Acute Care Nursing Test
Self-assessment Pre–post assessment
Academic settings 1. Students could use individual itemsand
scoring rubric asaguidewhen learningeach
EBPstep/component
2. Educators couldperiodically take the test
before andafter teachingEBPcourses to

identify areas for continual learning to
advance levels of EBPexpertise
1. Faculty could usepre–post scores to evaluate EBP
education in academicprograms (BSN,MSN,DNP,
PhD). Test scores could assist curriculum
design/redesign, andassessment of thequality/
rigor of course content, teaching styles, and
methods
2. Objective test scores could showhowstudent
outcomesare improving, data that canbeused for
accreditationpurposes
Acute care settings 1. Clinical/advancedpractice nurses canuse
individual itemsand scoring rubric as a
guide for learning eachEBP
step/component
2. Clinical nurses could take the test to assess
EBPstrengths andareas for improvement
before attendingEBPeducational activities
(Ramoset al., 2003)
1. Acute care educators and researchers could use
pre–post scores to evaluate EBPeducation for
clinical nurses
� Identifiedgapswould informneeds for
orientation/ongoing staff development
opportunities that advanceEBPcompetencies
2. Scores could be tracked tomonitor EBP
knowledge/skill progressionof nurses in attaining
higher levels of EBPcompetency. A 10%change is
meaningful in evaluating improvement in EBPskills
over time (McCluskey&Bishop, 2009)

� EBPknowledge/skills could beassessed for new
hires, existing nurses, aswell asmembers of
journal clubs, EBP/researchandpolicy/
procedure committees responsible for revising
policies/procedures/protocols/guidelines based
onbest available evidence
ability of the test to differentiate between novice nurses and
masters or experts was high but not across all three cohorts.
Historical threats to validity may be one explanation. As an
evolving concept, some nurses may not have had similar ex-
posure to EBP in doctoral education. Interestingly, acute care
nurses had longer times to completion (M 56.43, SD 38.21 for
novices; M 57.20, SD 42.54 for masters; M 43.21, SD 26.33
for experts) than those reported by Tilson (M 33.2, SD 8.7 for
novices; M 34.8, SD 10.0 for masters; M 40.5, SD 15.5 for ex-
perts). These differences may be due to the sample or changes
in the Fresno test.
EVIDENCE TO ACTION
The findings from this sample suggest EBP topics need re-
inforcement with acute care nurses in academic and practice
settings. Acute care nurses at all levels would benefi t from
more education on appropriateness of designs for different
research questions, as well as assessment of validity, clinical
and statistical significance, and confidence intervals. Novice
nurses need more guidance in assessing patient preferences
and applicability of tools for practice. Both novice and master
nurses need more education on assessing study relevance. Ar -
eas for EBP education or reinstruction should align with the
national EBP competencies developed by Melnyk et al. (2014)
for clinical and advanced practice nurses. These competencies
provide the road map for expected levels of EBP in the clinical
setting.

Scores derived from the Modified Fresno-Acute Care Nurs-
ing test have many uses in both the academic and prac-
tice setting. As described in Table 4, the test and scoring
rubric can be used as self-study and assessment guides. While
test scores could be used in a pre–post fashion to docu-
ment the impact of educational programs in advancing EBP
knowledge and skills and competencies of acute care nurses,
the Modified Fresno-Acute Care Nursing test needs to un-
dergo further validation before such use occurs in practice or
academia.
LIMITATIONS
The first limitation is the lack of demographic information
for this small U.S. sample. Length of time since graduation
and years of EBP experience were not captured and may have
278
influenced performance in the test. The sample of doctorally
prepared nurses who were recruited as EBP experts is a further
limitation because the test did not differentiate well between
experts and masters. Experts spent on average 13 min less time
to complete the test and thus, may not have thoroughly docu-
mented their EBP knowledge. The scores obtained in these
sample cohorts are not generalizable globally to acute care
nurses because the emphasis and amount of EBP education
may differ in general and across levels of nursing education in
developing or developed countries (Ciliska, 2005; Deng, 2015;
Holland & Magama, 2017).

Secondly, the scoring rubric is complex. Raters need EBP
experience and training to ensure reliable use of the rubric.
Pilot testing with opportunities to clarify scoring procedures is
essential for IRR. At least 10–15 min per test should be
allocated
(Ramos et al., 2003; Tilson, 2010). This scoring time could be
a limitation if an educator or researcher desires an easy assess -
ment to evaluate competency or effectiveness of EBP education.
The manual grading also increases rater burden, especially if
large volumes of nurses or students will be assessed. Another
limitation was that the raters were not blinded to the cohorts
during scoring. Intrarater reliability was also not performed as
done by Tilson (2010).
RECOMMENDATIONS FOR RESEARCH
The Modified Fresno-Acute Care Nursing test needs further
revision and testing. The Delphi method could be used to en-
gage numerous EBP experts on how to revise items with poor
psychometric performance. These items could then be tested
with larger samples of novice, master, and expert acute care
nurses.
Once validated, test administration should include self-
assessment of EBP expertise because educational level alone
cannot predict level of EBP expertise. Future research should
utilize the test to evaluate the effectiveness of face-to-face ver-
sus online EBP education and to compare teaching pedagogies,
such as didactic versus case study methodologies. Ramos et al.
(2003) suggested other reliable methods be developed to as -
sess application of EBP knowledge and skills in real clinical
scenarios through simulation. Such simulation methods could
be compared with the Modified Fresno-Acute Care Nursing
test to establish further validity.
CONCLUSIONS

Total scores differed significantly across training levels
(p < .0001). Novices scored significantly lower than master
or expert nurses, but differences were not found between the
latter. Total score reliability was acceptable (interrater [ICC
(2, 1)]) = .88. Cronbach’s alpha was 0.70. Psychometric prop-
erties of most modified items were acceptable; however, six
require further revision and testing to meet acceptable stan-
dards. While preliminary psychometric properties for this new
EBP knowledge measure are promising, further validation of
some of the items and scoring rubric is needed. WVN
LINKING EVIDENCE TO ACTION
� Educators in practice and academic settings can
reinforce a variety of EBP topics
� NOVICES: Assessing patient prefer-
ences; evaluating applicability of tools for
practice
� NOVICES & MASTERS: Assessing rel-
evance of studies for PICO question of
interest
� ALL NURSES: Researching designs for
various types of questions; assessing va-
lidity of studies; understanding clinical
versus statistical significance; interpret-
ing confidence intervals
� Align evidence-based education with national EBP
competencies for clinical nurses and advanced
practice nurses (Melnyk et al., 2014)
� Acute care nurses at all levels can use the Modified
Fresno-Acute Care Nursing test as a self-study and

assessment guide.
Author information
Margo A. Halm, Associate Chief Nurse Executive, Nursing Re-
search & Evidence-Based Practice, VA Portland Health Care
System, 3710 SW, Veterans Hospital Road, Portland, OR
Dr. Margo A. Halm, Associate Chief Nurse Executive, Nursing
Research & Evidence-Based Practice, VA Portland Health Care
System, Portland OR. At the time this work was completed, Dr.
Halm served as the Director, Nursing Research, Professional
Practice & Magnet, Salem Health, Salem, OR. The contents of
this article do not represent the views of the US Department of
Veterans Affairs or the US Government.
Address correspondence to Dr. Margo A. Halm, Associate
Chief Nurse Executive, Nursing Research & Evidence-Based
Practice, VA Portland Health Care System, 3710 SW Veterans
Hospital Road, Portland OR; [email protected]
Accepted 12 February 2017
Copyright C© 2018, Sigma Theta Tau International
References
Balakas, K., Sparks, L., Steurer, L., & Bryant, T. (2013). An
out-
come of evidence-based practice education: Sustained clinical
decision-making among bedside nurses. Journal of Pediatric
Nursing, 28, 479–485.
Castorr, A., Thompson, K., Ryan, J., Phillips, C., Prescott, P.,
&
Soeken, K. (1990). The process of rater training for
observational

279
Original Article
instruments: Implications for interrater reliability. Research in
Nursing & Health, 13, 311–318.
Chang, S., Huang, C., Chen, S., Liao, Y., Lin, C., & Wang, H.
(2013). Evaluation of a critical appraisal program for clinical
nurses: A controlled before-and-after study. Journal of
Continuing
Education in Nursing, 44(1), 43–48.
Ciliska, D. (2005). Educating for evidence-based practice.
Journal
of Professional Nursing, 21(6), 345–350.
Deng, F. (2015). Comparison of nursing education among
different
countries. Chinese Nursing Research, 2, 96–98.
Dizon, J., Somers, K., & Kumar, S. (2012). Current evidence on
evidence-based practice training in allied health: A systematic
review of the literature. International Journal of Evidence-
Based
Healthcare, 10, 347–360.
Edward, K., & Mills, C. (2013). A hospital nursing research en-
hancement model. Journal of Continuing Education in Nursing,
44(10), 447–454.
Fritsche, L., Greenhalgh, T., Falck-Ytter, Y., Neumayer, H., &
Kunz,

R. (2002). Do short courses in evidence-based medicine
improve
knowledge and skills? Validation of Berlin questionnaire and
before and after study of courses in evidence based medicine.
BMJ, 325, 1338–1341.
Gardner, A., Smyth, W., Renison, B., Cann, T., & Vicary, M.
(2012).
Supporting rural and remote area nurses to utilise and conduct
research: An intervention study. Collegian, 19, 97–105.
Halm, M. (2014). Science-driven care: Can education alone get
us
there by 2020? American Journal of Critical Care, 23(4), 339–
343.
Holland, S., & Magama, M. (2017). Evidence based practice
trans-
lated through global nurse partnerships. Nurse Education in
Practice, 22, 80–82.
Institute of Medicine. (2001). Crossing the quality chasm: A
new
health system for the 21st century. Washington, DC: National
Academies Press.
Institute of Medicine. (2007). Roundtable on evidence-based
medicine: The learning healthcare system: Workshop summary.
In
L. Olsen, D. Aisner & J. McGinnis (Eds.). Washington, DC:
National Academies Press. Retrieved from www.ncbi.nlm.nih.
gov/books/NBK53483
Janda, L. (1998). Psychological testing: Theory and
applications. Need-
ham Heights, MA: Allyn & Bacon.

Jonsson, A., & Svingby, G. (2007). The use of scoring rubrics:
Reliability, validity and educational consequences. Educational
Research Review, 2, 130–144.
Lai, N., & Teng, C. (2011). Self-perceived competence
correlates
poorly with objectively measured competence in evidence based
medicine among medical students. BMC Medical Education,
11(1), 1. https://doi.org/10.1186/1472-6920-11-25
Leung, K., Trevana, L., & Waters, D. (2014). Systematic review
of
instruments for measuring nurses’ knowledge, skills and atti -
tudes for evidence-based practice. Journal of Advanced
Nursing,
70(10), 2181–2195.
McCluskey, A., & Bishop, B. (2009). The adapted Fresno test of
competence in evidence-based practice. Journal of Continuing
Education in the Health Professions, 29(2), 119–126.
Melnyk, B., Gallagher-Ford, L., Long, E., Long, L., & Fineout-
Overholt, E. (2014). The establishment of evidence-based prac-
tice competencies for practicing registered nurses and advanced
practice nurses in real-world clinical settings: Proficiencies to
improve healthcare quality, reliability, patient outcomes, and
cost. Worldviews on Evidence-Based Nursing, 11(1), 5–15.
Miller, A., Cummings, N., & Tomlinson, J. (2013).
Measurement
error and detectable change for the modified Fresno test in
first-year entry-level physical therapy students. Journal of
Allied
Health, 42(1), 169–174.

Nesbitt, J. (2013). Journal clubs: A two-site case study of
nurses’
continuing professional development. Nurse Education Today,
33, 896–900.
Nunnally, J., & Bernstein, I. (1994). Psychometric theory. New
York,
NY: McGraw-Hill.
Polit, D., & Beck, C. (2007). The content validity index: Are
you
sure you know what’s being reported? Research in Nursing &
Health, 29, 489–497.
Polit, D., & Beck, C. (2012). Nursing research: Generating and
assess-
ing evidence for nursing practice. Philadelphia, PA: Lippincott.
Ramos, K., Schafer, S., & Tracz, C. (2003). Validation of the
Fresno
test of competence in evidence based medicine. BMJ, 326, 319–
321.
Sciarra, E. (2011). Impacting practice through evidence-based
edu-
cation. Dimensions of Critical Care Nursing, 30(5), 269–275.
Shaneyfelt, T., Baum, K., Bell, D., Feldstein, D., Houston, T.,
Kaatz,
S., . . . Green, M. (2006). Instruments for evaluating education
in evidence-based practice. Journal of the American Medical
Asso-
ciation, 296, 1116–1127.
Spek, B., de Wolf, G., van Dijk, N., & Lucas, C. (2012).
Develop-

ment and validation of an assessment instrument for teaching
evidence-based practice to students in allied health care: The
Dutch modified Fresno. Journal of Allied Health, 41(2), 77–82.
Tilson, J. (2010). Validation of the modified Fresno test:
Assess-
ing physical therapists’ evidence based practice knowledge and
skills. BMC Medical Education, 10, 1–9.
Toole, B., Stichler, J., Ecoff, L., & Kath, L. (2013). Promoting
nurses’
knowledge in evidence-based practice. Journal for Nurses in
Pro-
fessional Development, 29(4), 173–181.
Wendler, M., Samuelson, S., Taft, L., & Eldridge, K. (2011).
Re-
flecting on research: Sharpening nurses’ focus through engaged
learning. Journal of Continuing Education in Nursing, 42(11),
487–
493.
White-Williams, C., Patrician, P., Fazell, P., Degges, M.,
Graham,
S., Andison, M., . . . McCaleb, A. (2013). Use, knowledge, and
attitudes toward evidence-based practice among nursing staff.
Journal of Continuing Education in Nursing, 44(6), 246–254.
doi 10.1111/wvn.12291
WVN 2018;15:272–280
SUPPORTING INFORMATION
Additional supporting information may be found online in the
Supporting Information section at the end of the article.
Figure S1. MODIFIED FRESNO TEST – ACUTE CARE

NURSING (14-item), with Scoring Rubric
280
Continuing Education Worldviews on Evidence-Based Nursing
is pleased to offer readers the opportunity to earn
credit for its continuing education articles. Learn more here:
https://www.sigmamarketplace.org/journaleducation
Regulation for
Nursing Practice Staff
Development Meeting
Objectives
professional nurse association.
c distribution, academic credentials,
practice positions, and licensure status of members of the
board for your specific region/area.
l

nurse scope of practice.
Practice Registered Nurses (APRNs).
Differences between a Board of Nursing
and a Professional Nurse Association
BOARD OF NURSING (BON)
g for each state is a
jurisdictional government agency. They are
responsible for the regulation of nursing
practice for each 50 sates.
health and welfare by overseeing and
ensuring the safe practice of nursing.
standards for safe nursing care and issuing
licenses to practice nursing.
monitoring licensees' compliance to
jurisdictional laws and taking action against
the licenses of those nurses who have
exhibited unsafe nursing practice.
Professional Nurse Association
League for Nursing (NLN) have a broad focus,
encompassing the entire nursing profession.

re more than 100 Nursing Organizations, like the
ANA.
professional association) is a private organization whose
members must pay dues to enjoy the benefits of
membership. One of the primary functions of a nursing
association is to represent its members in legislative,
political, and practice matters. It provides a central voice
for its nurse membership
Governor for the interests of its members and the
profession of nursing. A nursing association provides a
united voice that can speak out on the issues important
to a specific area of nursing practice and/or to the
nursing profession as a whole. In addition, a nursing
association provides leadership in other areas such as
improving working conditions and benefits for nurses. A
nursing association also may lead the way in developing
public health policies.
practice positions, and licensure status of members of the
board for your specific region/area.
Professor of a Vocational
Nursing Program, Consultant, Vice President of Nursing for
Surgical/Procedural Services

for a Doctors Hospital, Quality Management, Interim Dean of
Health and Human
Services/Director of Nursing for an associate degree nursing
program, Director of
Public Policy, Quality Assurance hospital nurse, Lead faculty
for a bachelor of science
program, Pediatric Nurse with Cook Children’s Medical, Vice
President at First
Community Bank in Corpus Christi. A chairman of the Port
Aransas Recreational
Development Corporation, and Licensed Vocational Nurse in
the Primary Care
Outpatient Clinic at West Texas Veteran’s Health
Administration.
Texas,
with the exception of the two BA’s on the board.
Distribution, Credentials, & Licensure
status
-
Lubbock
- Representing LVN Education
BA-Consumer Member
-Representing RN Practice
-Representing RN Practice – Helotes
Education – Pearland
–
Dallas

athy Leader-Horn, LVN-Represents LVN Practice –
Granbury
-Edwards, DrPH, MS, RN, CNE-Representing
BSN Education Bellaire
-Representing LVN Practice – Granbury
– Port Aransas
erly “Kim” Wright, LVN- Representing LVN Practice –
Big Spring
The Board
of the board if the
person or the person's spouse:
regulatory agency in the field of
health care;
business entity or other
organization that:
equipment; or
percent interest in a business
entity or other organization that:
actures, or distributes health care supplies or
equipment; or

services, or funds from the
board, other than compensation or reimbursement authorized by
law for board membership,
attendance, or expenses.
Becoming a Board Member
reduction program.
to healthcare (e.g.,
CMS, OSHA, and EPA)?
patients and send them home
healthy. Readmissions occur when complications require a
patient to return to the
hospital for further treatment. The readmissions reduction
program was recently
established by the CMS “to encourage hospitals to manage their
patients in a fashion
that reduces and/or eliminates readmissions to inpatient hospital
care,” VanFleet says.
hospitals
with low readmissions
rates and penalize those with high readmissions rates. “The data
allows CMS and
hospitals to tie outcomes to staffing,” says Young. That means
you’ll be directly helping
your hospital and yourself if you pay careful attention to patient

outcomes.
Federal Regulation
years?
Explain.
Secretary of the Department of Health
and Human Services (HHS) to establish HRRP and reduce
payments to Inpatient Prospective
Payment System (IPPS) hospitals for excess readmissions
beginning October 1, 2012
performance for each of the six
conditions/procedures in the program:
• Acute Myocardial Infarction (AMI)
• Chronic Obstructive Pulmonary Disease (COPD)
• Heart Failure (HF)
• Pneumonia
• Coronary Artery Bypass Graft (CABG) Surgery
• Elective Primary Total Hip Arthroplasty and/or Total Knee
Arthroplasty.
Federal Regulation
continued
policies:

planned readmissions to the
readmissions measures.
with the FY
2015 program to include: (1) patients
admitted for an acute exacerbation of chronic obstructive
pulmonary disease (COPD); and (2)
patients admitted for elective total hip arthroplasty (THA) and
total knee arthroplasty (TKA).
5 IPPS final rule, CMS finalized the following
policies
2017 program to include patients
admitted for coronary artery bypass graft (CABG) surgery.
the following
policies:
policy allowing hospitals that
experience an extraordinary circumstance (such as a hurricane
or flood) to request an exception.
by expanding
the measure cohort to include
additional pneumonia diagnoses: (i) patients with aspiration
pneumonia; and (ii) sepsis patients
coded with pneumonia present on admission (but not including
severe sepsis) beginning with
the FY 2017 program.
Federal Regulation

changes
policy:
readmission ratio on the
Hospital Compare website to allow for the posting of data as
soon as possible
following the review period.
policy:
adjustment factor in
accordance with the 21st Century Cures Act to assess penalties
based on a
hospital’s performance relative to other hospitals treating a
similar proportion of
Medicare patients who are also eligible for full Medicaid
benefits (i.e. dual eligible)
beginning with the FY 2019 program.
lities or hospitals to
submit a form signed by
the facility or hospital’s CEO or designated personnel and to
allow CMS to grant
ECEs due to CMS data system issues which affect data
submission.
Federal Regulation
changes

ing in Texas are required to “know
and comply” with the Nursing
Practice Act (NPA) and Board Rules. 22 TAC §217.11(1)(B)
requires the nurse to “promote a
safe environment for clients and others.” This standard
establishes the nurse’s duty to the
patient/client, which supersedes any physician order or any
facility policy. This “duty” to
the patient requires the nurse to use informed professional
judgment when choosing to
assist or engage in a given procedure.
ole in many ways. One
way is that as nurses', we are
always told to follow through with a physician’s order.
However, a professional nurse must
act as a prudent nurse. This means that if an order is given for a
medication, procedure,
etc. that the nurse may deem unsafe or cause harm to the
patient, that nurse has the
obligation and duty to be the advocate for the patient and if
need be, can refuse to
administer a medication or perform the procedure ordered,
despite what the physician
says or how they react.
healthcare in so many ways.
If the nurse is in a situation in which they refuse to administer a
medication that they
deem inappropriate for a patient could possibly avoid a patient
going to the hospital,
which reduces the cost of healthcare, and provides the patient
with a overall better

outcome. The delivery of care is affected in which one has to
question why a prudent
nurse would have to question a physicians order. A nurse takes
an oath to provide care for
a patient by using their own professional judgement and this
must always be followed to
the fullest extent to ensure quality outcomes.
State Regulation
. Authority to Order and Prescribe
Controlled Substances (ADOPTED 11/9/18)
This rule was amended by the BON to implement Prescription
Monitoring Program rules, as required by
legislation from the 85th Session. The rules state that an APRN
must check the PMP, and document that
check, prior to prescribing opioids, benzodiazepines,
barbiturates, or carisoprodol, unless the patient is
receiving hospice care or is diagnosed with cancer. An APRN is
not subject to discipline if the APRN
makes a good faith attempt to review the PMP but is unable to,
and documents that attempt. The APRN
Alliance submitted comments, arguing that the BON should not
discipline for failing to document, that
they should clarify the meaning of a “prescription record,” as
used in the amendment, and that they
should include an effective date, which by law is September 1,
2019. In its adoption, the BON provided
clarifications on the second point and accepted the third.
their scope of practice. Of course RN’s do

not having prescribing medication abilities. Also, with so much
focus on the opioid epidemic right now,
APRN’s must be very diligent in ensuring they have met the
proper guidelines prior to prescribing
medications.
healthcare in so many ways. Having APRNs with
the ability to prescribe medications and treat patients is a game
changer in healthcare itself. This can
and has shown to significantly lower the cost of healthcare as
opposed to patients being restricted to
only being seen by a physician, especially in rural areas. On the
other hand, there must still be policies in
place to ensure that APRN’s are followed closely by a
physician. Physicians in Texas are still required to
sign off on all APRN’s treatment orders. This is a safety issue
as physicians have more extensive training
than APRN’s
State Regulations for APRN
Professional Development: Scope
and Standards of Practice. Silver Spring, Maryland: Nurses
Books.org.
2019, from
https://www.ncsbn.org/
State advocacy. Retrieved from
https://www.aanp.org/advocacy/state/state-practice-environment

July 2, 2019, from https://
www.bon.texas.gov/laws_and_rules_nursing_practice_act.asp
n.d.). Retrieved July 5, 2019,
from National Council of
State Boards of Nursing: https://www.ncsbn.org/about-boards-
of-nursing.htm
-Reduction-Program. (2019, January 16).
Retrieved from https://
www.cms.gov/medicare/medicare-fee-for-service-
payment/acuteinpatientpps/readmissio
ns-reduction-program.html
http://www.aarc.org/advocacy/federal-policies-affecting-
rts/hospital-readmissions/
References
https://www.bon.texas.gov/laws_and_rules_nursing_practice_ac
t.asp
https://www.bon.texas.gov/laws_and_rules_nursing_practice_ac
t.asp
https://www.ncsbn.org/about-boards-of-nursing.htm
https://www.ncsbn.org/about-boards-of-nursing.htm
https://www.cms.gov/medicare/medicare-fee-for-service-
payment/acuteinpatientpps/readmissions-reduction-
program.html
program.html

program.html
rts/hospital-readmissions/
rts/hospital-readmissions/Regulation for Nursing Practice Staff
Development MeetingObjectivesSlide 3Distribution,
Credentials, & Licensure statusThe BoardBecoming a Board
MemberFederal RegulationFederal Regulation continuedFe deral
Regulation changesFederal Regulation changesState
RegulationState Regulations for APRNReferences
Module 3 Week6
Assignment: Regulation for Nursing Practice Staff Development
Meeting
Nursing is a very highly regulated profession. There are over
100 boards of nursing and national nursing associations
throughout the United States and its territories. Their existence
helps regulate, inform, and promote the nursing profession.
With such numbers, it can be difficult to distinguish between
BONs and nursing associations, and overwhelming to consider
various benefits and options offered by each.
Both boards of nursing and national nursing associations have
significant impacts on the nurse practitioner profession and
scope of practice. Understanding these differences helps lend
credence to your expertise as a professional. In this Assignment,
you will practice the application of such expertise by
communicating a comparison of boards of nursing and
professional nurse associations. You will also share an analysis
of your state board of nursing.
To Prepare:
1. Assume that you are leading a staff development meeting on
regulation for nursing practice at your healthcare organization
or agency.

2. Review the NCSBN and ANA websites to prepare for your
presentation
The Assignment: ( 9-slide PowerPoint presentation)
Develop a 9-slide PowerPoint Presentation that addresses the
following:
1. Describe the differences between a board of nursing and a
professional nurse association.
2. Describe the board for your specific region/area.
a.) Who is on the board?
b.) How does one become a member of the board?
3. Describe at least one state regulation related to general nurse
scope of practice.
a.) How does this regulation influence the nurse’s role?
b.) How does this regulation influence delivery, cost, and access
to healthcare?
4. Describe at least one state regulation related to Advanced
Practice Registered Nurses (APRNs).
a.) How does this regulation influence the nurse’s role?
b.) How does this regulation influence delivery, cost, and access
to healthcare?
5. Include Speaker Notes on Each Slide (except on the title page
and reference page)
Resources-6
Use at least 3 resources and 2 more outside resources total of 5
resources to be sited
1. http://www.nursingworld.org/
2. https://doi.org/10.1016/j.outlook.2017.10.002
3.
https://class.content.laureate.net/bd32a596c6788477bb47689648
70b3e8.pdf
4. https://www.ncsbn.org/index.htm
5. https://doi.org/10.1016/j.outlook.2018.03.001

6.https://ezp.waldenulibrary.org/login?url=https://sear ch.ebscoh
ost.com/login.aspx?direct=true&db=mnh&AN=26720310&site=
eds-live&scope=site

Walden University NURS 6050 Polic

Recommended

Recommended

More Related Content

Similar to Walden University NURS 6050 Polic

Similar to Walden University NURS 6050 Polic (20)

More from MoseStaton39

More from MoseStaton39 (20)

Recently uploaded

Recently uploaded (20)

Walden University NURS 6050 Polic