CRE Grant Proposal Application FormNCSBN Center for Regulatory Excellence

Send your completed application to:NCSBN Center for Regulatory Excellence

Attention: H. SnyderSubmit as an attached word document to CRE@ncsbn.org

Subject: CRE Grant Proposal

PLEASE TYPE – USE ONLY THE SPACE PROVIDED BELOW

Principal Investigator: Patricia Moulton, PhD

Co-Investigator(s): Rhoda Owens, PhD, RN- Co-Principal Investigator, Thomas Petros, PhD- Co-Investigator

Investigator Contact Information:

Name: Patricia Moulton, PhD

Title: Executive Director

Organization: North Dakota Center for Nursing

Street Address: 3523 45th Street SouthCity, State, Zip: Fargo, ND 58104Country: United States

Telephone: 701-639-6548E-mail: patricia.moulton@ndcenterfornursing.org

Date Submitted: April 5, 2019

Official from Investigator’s Organization to notify if awarded:

Name: Stacey Pfenning, DNP, APRN, FNP, FAANP

Title: President, ND Center for Nursing Board of Directors

Organization: Executive Director, North Dakota Board of Nursing

Street Address: 919 S. 7th Street Suite $504City, State, Zip: Bismarck, ND 58504

Telephone: 701-328-9781E-mail: spfenning@ndbon.org

Organization Type: (Check one)

_X_ Non-profit ___ Public/Government ___ Individual ___Other, please describe

Organization Information:

Legal Name according to the IRS (for U.S.) or IRS-equivalent (non-domestic): North Dakota Center for Nursing

Tax ID Number: 45-2605788

Does the organization have 501(c)(3) status? __X_ Yes ___ No

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Organization’s Scope of Work: Organizational mission, focus, audience served, and geographic reach.

The North Dakota Center for Nursing is a non-profit, 501c3 organization that was developed in 2011 to represent over

20,000 nurses and over 40 nursing organizations across North Dakota. The mission of the North Dakota Center for

Nursing is through collaboration to guide ongoing development of a well-prepared and diverse nursing workforce to

meet health care needs in North Dakota through research, education, recruitment and retention, advocacy and public

policy. 

A key focus is the facilitation of nursing workforce research and the development of new policies and regulations.

Prior to the creation of the Center, Dr. Moulton has conducted research tracking education, supply, and demand trends

since 2002. This started with the North Dakota Nursing Needs Study, a legislatively mandated study, and has continued

with the support of the North Dakota Board of Nursing and through the North Dakota Center for Nursing. The audience

and geographic reach of the North Dakota Center for Nursing is reflected in our mission which is to the meet the health

care needs of the population of North Dakota.

Most recently the ND Center for Nursing has served a key role as co-lead for the ND Governor’s Nursing Shortage

Task Force. This has been a great opportunity to further merge nursing workforce research with state policy and

regulation; the proposed study and the research that the Center has conducted will both serve to inform state workforce

policy.

How did you hear about the Center for Regulatory Excellence? website

Is this application a CRE Grant re-submission? ____ Yes_X___ No

If yes, please provide project number, if known.

Previous Center for Regulatory Excellence Support -

Has your organization received previous support from NCSBN? ____ Yes __X__ No

If yes, please provide project number, if known.

All funded research projects require IRB approval or exemption. Please indicate the date of Institutional Review Board

(IRB) approval or if approval is pending, list “pending” with date of IRB submission.

Date of IRB approval: ___Approved- revision submited____________________

If your proposal is recommended for funding, we expect that you will have IRB approval by the grant start date.

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PROJECT TITLE: INFLUENCE OF PROFESSIONAL QUALITY OF LIFE AND WORK SATISFACTION ON INTENT TO STAY: A MIXED METHODS APPROACH TO INFORM POLICY AND REGULATION

PROJECT OVERVIEW

The proposed study provides the unique opportunity to link state policy/regulation with research. North

Dakota established a Governor’s Nursing Shortage Task Force in 2017 to develop potential solutions for the

state’s nursing shortage. The task force identified a need to learn more about factors that increase the likelihood

that nursing students and nurses will choose to stay in North Dakota and with their current employers. Results

from the proposed study would be used to inform policy and regulation changes. In addition, the Workplace

Culture subcommittee of the Governor’s task force is working to establish a North Dakota-specific workplace

culture designation system. Results from this study will help inform the final system.

The proposed survey phase one will incorporate previously-established instruments to measure Intent to

Stay, Nurse Satisfaction, Professional Quality of Life, Nursing Student Decision-making, and Minimum Data

Set Demographics to provide an innovative, multi-disciplinary examination of predictors. Graduating nursing

students and practicing nurses at all levels will receive surveys. This mixed-methods study will utilize focus

group data in the second phase to further explore policy and regulation options in response to survey findings.

The assembled research team includes individuals with expertise in psychology, public policy, nursing,

psychometrics, advanced statistical methods, and higher education. In addition, the Workplace Culture

Subcommittee provides vast experience and expertise to advise the research team through every step of the

process and on recommendations for policy and regulation changes.

PURPOSE, PROBLEM STATEMENT OR RESEARCH QUESTIONS

The United States is confronting a set of contemporary health and healthcare challenges with numerous

and complex elements. Multilayered health professions education and health care delivery systems face an

array of demands including expectations for responsiveness in meeting current and emerging health care access

and quality needs. Demands placed on the nation’s healthcare infrastructure include caring for culturally

diverse populations with different language and health care customs as well markedly increased numbers of

individuals seeking care for chronic conditions (Greer, 2008; Medicare Payment Advisory Commission, 2008). 3

An aging population also adds expectations for training and deploying a health workforce to older adults-

specific care that is accessible, efficient, and of high quality. Geographic variation in care quality also exists.

Emerging approaches to solving this set of thorny challenges, including driving performance improvement

through structural changes in payment policy, have major implications for both the delivery of health care

services and the preparation of the workforce providing these services (Wakefield & Moulton, 2008). Health

personnel shortages can negatively impact health care quality through reduced health care access, increased

stress on providers, and reliance on under-qualified personnel. Shortages can also contribute to higher costs by

raising compensation levels to attract and retain personnel and by increasing the use of overtime pay and

expensive temporary personnel.

North Dakota is experiencing a nursing shortage much like most states, although there are marked

differences in ND’s nursing workforce shortage. The state has more than the national average of nurses

available, but they tend to live and work in the eastern portion of the state. This is where the biggest cities and

larger health care systems are located. This leaves the other 2/3 of the state with an inadequate supply of

nursing professionals. However, even the large health care systems in urban areas are experiencing recruitment

issues as they continue to expand the size and breadth of healthcare coverage and compete with nearby facilities

in Minnesota that have a marked increase in salaries, which can be partially attributed to differences in

reimbursement.

North Dakota nursing programs produce a steady supply of new nurses. Over the last five years, 90% of

LPN and 84% of RN graduates registered for the NCLEX exam with the intention to practice in North Dakota.

The Statewide Longitudinal Data System indicates that graduates may stay initially; but, that they are also likely

to leave the state 2+ years after graduation and, after seven years post-graduation, the average nurse retention

rate is 49.8% (e.g., less than half of RN graduates that graduated in 2010-2012 are still employed in ND (See

Table 1). Overall, 40% of the 2015 and 2016 North Dakota’s NP program graduates began their practice in

North Dakota health care facilities (Zwilling & Owens, 2017).

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Table 1: North Dakota Employment Rates by Years after Degree Completion by Cohort Year

CohortYear

Cohort Size

1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years

2010 309 73.8% 67.3% 57.6% 55.7% 53.7% 53.1% 49.8%2011 378 68.0% 62.7% 56.1% 52.6% 47.9% 44.2% 2012 415 59.0% 53.0% 48.7% 46.7% 43.4% 2013 456 61.8% 56.8% 51.1% 45.2% 2014 500 58.2% 50.8% 43.2% 2015 520 61.0% 55.6% 2016 562 59.3%

Source: Statewide Longitudinal Data System 2018.

North Dakota also has a higher-than-average number of unemployed nurses; for ND-licensed LPNs that live

in North Dakota, 14% are unemployed (national average = 10.3%) For those ND-Licensed RNs that live in

North Dakota, 8% are unemployed (national average = 5.8%). (Budden, Moulton, Harper, Brunell & Smiley,

2016). ND nurses cite caring for home and family, going to school, and other reasons as causes for

unemployment.

Shortly after being sworn into office, Governor Doug Burgum convened a taskforce comprised of a diverse

group of stakeholders to examine the nursing shortage issue, identify causes, possible solutions, and make

policy recommendations to address this critical shortage. After extensive collection and analysis of education,

supply and demand, and workforce projections, the group developed draft drivers and strategies that were also

vetted with multiple groups in fall of 2017. This resulted in a set of 15 strategies that are currently being

incorporated into the Governor’s Policy Agenda for the 2019 legislative session. The first driver examines

barriers to entry into nursing programs, ways to maximize current program capacity and filling all available

seats across programs. The second driver examines ways to expand program capacity including ensuring there

are adequate faculty, clinical sites and the placement of new program sites in rural areas.

The third driver is to develop policies and strategies for retaining ND nursing program graduates as well as

practicing nurses to meet demand. Policy changes are already drafted and in-process to examine Medicaid

reimbursement to allow for increased salaries, examining nurse licensure and renewal requirements and

processing by the ND Board of Nursing, root cause analysis at individual facilities regarding the utilization of

travel nurses, statewide nurse loan repayment programs, and increasing diversity. One strategy, a mix of policy

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and research, is to examine barriers to retention of graduating nursing students and nurses within healthcare

settings and within North Dakota in general. The purpose of this grant proposal is implementation of this study

on a statewide level, utilizing validated instruments to examine the intent to stay within the context of

demographic factors, professional quality of life, and overall work satisfaction. Results from this study will not

only inform future policy and regulation strategies for the 2021 legislative session but will also be utilized to

develop a North Dakota-based healthcare facility designation system. This would be similar to the concept of

Magnet designation but would be applicable to ND’s rural setting and overall workplace climate. A small grant

has been received from the Blue Cross Blue Shield Caring Foundation to support a retreat to develop draft

criteria for this designation system and the results from the study will be used to finalize the criteria near the end

of 2019 during a final retreat.

The purpose of this proposed study is to explore and identify factors that influence graduating nursing

students’ and practicing nurses’ intent to stay in North Dakota and in their workplaces and to develop policies

that encourage nurses to stay in the state and workplaces. The central problem in North Dakota is a current and

projected widening gap between the number of nurses licensed in ND compared to the statewide need for highly

skilled nurses. Vacancy rates range from 4.97% to 13.44% depending on the type of nurse (ND Governor’s

Nursing Shortage Task Force, 2018). With projected increases in population throughout the state of ND, nursing

positions are expected to continue to grow through 2026, resulting in an increased need for licensed nursing

staff of over 1,200 per year

(Moulton, 2018). To address this

problem, the proposed study is

uniquely designed to address

several key research questions

for graduating nurses (all

levels), LPNs, RNs and

APRNS.

Proposed Research Questions

1. What factors influence graduating nurses’ post-graduation intent to stay in North Dakota?

2. What factors influence practicing nurses’ intent to stay in their workplace and in North Dakota?

3. What policies and best practices influence graduating nurses’ intent to stay in their workplace and in North Dakota?

4. What policies and best practices influence practicing nurses’ intent to stay in their workplace and in North Dakota?

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CONTRIBUTION TO NURSING REGULATION

The proposed study will answer critical questions related to the recruitment and retention of nurses. To

this point, most research in North Dakota on the nursing workforce related to policy and regulation has focused

on determining the number and distribution of nursing personnel. While this is important, other ongoing issues

exist regarding the workplace environment. Ensuring a safe, diverse, accessible, and effective healthcare system

is a central role of nursing regulation. The first goal of the North Dakota Board of Nursing’s Strategic Plan is

Public Protection through Evidence-Based Regulation (ND Board of Nursing, 2017). The importance of

understanding the workforce is also reflected by the National Council of State Boards of Nursing’s (NCSBN)

multiple year National Nursing Workforce Survey, which is a joint effort between NCSBN and the National

Forum of State Nursing Workforce Centers (Budden et al., 2016). A better understanding of the decision-

making process and movement of nurses between states will also be useful to other state boards and centers for

nursing as they work to ensure an adequate nursing workforce in their state. The proposed study is innovative in

its direct connection with state policy-making through the Governor’s Task Force and the utilization of results

to develop a statewide designation system.

LITERATURE REVIEW

The proposed study is designed to examine multiple factors related to nurses’ intent to stay in their

current workplace and in North Dakota. Intent to stay can be defined as the “degree of positive affect that an

individual has toward the idea of voluntarily leaving the employer or an organization” or “the individual’s

attitude toward staying with their current employer” (Kovner, Brewer, Greene, & Fairchild, 2009, p. 84). Both

intent to stay and intent to leave are terms used in the literature to discuss the factors which lead an individual to

stay or leave a job position at an organization. Studies have described numerous factors impacting newly-

licensed registered nurses’ decision to stay or leave their job positions. Kovner et al. (2009) concluded that

newly licensed registered nurses’ work behavior is a complex process, influenced by their personal

characteristics, attitudes toward their work, job opportunities, and workplace attributes.

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Very few studies have been completed with experienced nurses (including advance practice nurses) and

their intent to stay. Van Osch, Scarborough, Crowe, Wolff, and Reimer-Kirkham (2018) discovered that for

experienced and specialty nurses, a few positive factors such as effective leadership, interprofessional

teamwork, and mentorship may offset the negative features of a practice environment and, in turn, support

nurses’ intent to stay. Feeling valued, respected, and acknowledged by their colleagues, leaders, physicians, and

other interprofessional team members seemed to promote the nurses’ intent to stay. In addition, clinical leaders

who communicate clearly, build teams, and engage and empower their experienced nurses through shared

decision-making influence nurses’ intent to stay. Research has also discovered a strong relationship between

intent to stay in an organization and actual turnover (Brewer, Kovner, Greene, Tukov-Shuser, & Djukic, 2012;

Hayes et al., 2012). Brewer et al. (2012) found that work attributes (voluntary overtime, more than one job for

pay) and work attitudes (intent to stay, job satisfaction, organizational commitment) were negatively related to

turnover, while shocks (work related injuries such as strains and sprains) and working full-time promoted nurse

turnover.

Job satisfaction is a particularly interesting factor in the proposed study as it relates to intent to stay.

Overall, researchers have found a positive relationship between nurses’ intent to stay and job satisfaction

(Kovner et al., 2009; Brewer, Chao, Colder, Kovner, & Chacko, 2015; Jones, 2017; Ross, 2016; Yarbrough,

Martin, Alfred, & McNeil, 2017), and many of the same factors that influence job satisfaction also influence

intent to stay. Nurse job satisfaction in particular has been extensively researched and many factors have been

found to promote satisfaction. Yarbrough et al. (2017) concluded that nurses who were not their sole financial

provider and had assistance with their financial support scored higher on job satisfaction. Other factors that

promote work satisfaction include optimal orientation, support for continuing education, perceptions of fair

workload, supportive nursing administrators, professional values, flexible scheduling, variety, and work group

cohesion and teamwork (Athey et al., 2016; Ross, 2016; Yarbrough et al., 2017). In addition, nurses who have

an assigned mentor or preceptor are more satisfied (Ross, 2016; Jones, 2017). Lastly, nurses who display

positive work attitudes (job involvement, autonomy, distributive justice, less job stress, positive provider-nurse

relationships, chances for promotion, and social support from peers and supervisors), organizational 8

commitment, voluntary overtime (Athey et al. 2016; Brewer et al., 2012), a lack of family-work conflict, and

competitive pay (benefits and compensation) report greater job satisfaction (Kovner et al., 2009; Hayes et al.,

2015).

Researchers discovered several factors that promote rural nurse hiring and retention. Rural nurses prefer

the rural lifestyle and most are born and raised at a rural setting. They chose to live and work in rural

communities due to a rural birthplace, location of family, social relationships, relocation with a spouse, and

proximity to their homes (Molanari, Jaiswal, & Hollinger-Forrest, 2011; Winters & Lee, 2018). Factors that

promote rural nurse job satisfaction and intent to stay include encouragement, support, and communication from

supervisors (Molanari, Jaiswal, & Peterson, 2012). In addition, being able to practice in the nurse generalist role

with autonomy, patient variety, and collaboration with peers (Molanari and Monserud, 2009). Molanari et al.

(2011) discovered that rural nurses are likely to leave their place of employment in the first year because they

felt unprepared to practice at a rural healthcare facility.

Further adding to the research on nurses’ work satisfaction, Athey et al. (2016) found that nurse

practitioners who experienced independent billing practices, collaborative relationships with physicians, and

were engaged in their full scope of practice experienced greater work satisfaction. Owens (2018) discovered

that nurse practitioners perceive greater job satisfaction when they experience successful role transitions from

their registered nurse to nurse practitioner identities. This process was facilitated by experiential learning, their

incentive to learn, and positive interactions with patients and other interprofessional team members. Finally,

Brom, et al. (2016) concluded that there is a positive relationship between nurse practitioners’ work satisfaction

and their intent to stay.

In addition to job satisfaction, the proposed study will also examine the impact of professional quality of

life on intent to stay. This includes compassion satisfaction, burnout and secondary traumatic stress.

Compassion satisfaction (CS), which is boosted through positive emotional valence and an ability to reframe

negative emotions, has been shown to have protective effects on professionals’ wellbeing and job satisfaction

(Li, Early, Mahrer, Klaristenfeld, & Gold, 2014; Samios, Abel, & Rodzik, 2013).

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Burnout, as it pertains to work performance, has been defined as a state of exhaustion,

depersonalization, and lowered sense of accomplishment that can occur due to a mix of heightened work

demands, personal disposition, and accumulation of stress. (Freudenberger, 1974; Maslach & Jackson, 1986;

Schaufeli & Buunk, 1996). This phenomenon has been widely researched and well-documented for over 40

years and applied to a variety of work environments, particularly health professions. As expected, burnout can

negatively affect nurses’ overall wellbeing. Subjective perception of workload, individual attitudes toward work

(highly committed nurses are more sensitive to stressors than others), job satisfaction, level of autonomy, role

conflict and ambiguity, lack of social support, hostile work environment, and low resilience have all shown

strong relationships to burnout development in professionals (Schaufeli & Buunk, 1996).

Secondary traumatic stress (STS) has likewise been shown to impact healthcare professionals’ work

performance. Secondary traumatic stress is a vicarious form of acute stress and post-traumatic stress which

affects people who work closely with trauma sufferers, or people who are required to learn extensively –

through research or readings – about trauma (Ludick & Figley, 2017). The current wealth of research on STS,

spearheaded by Charles Figley in 1982 (he then termed it “secondary victimization”), has focused mainly on

professionals involved in direct work with traumatized or institutionalized persons – in hospitals, nursing or

rehabilitation facilities, or mental health facilities – and for good reason; STS is associated not only with worker

dissatisfaction, stress, and mental health deterioration, but also with self-reported decreases in quality of care

delivery (Luther et al., 2017), which may impact patients’ overall recovery, satisfaction, and wellbeing, though

this sort of transference has not yet been thoroughly examined.

METHODOLOGY

An explanatory mixed-methods design will be used for this proposed study (Creswell & Plano Clark,

2018). Multiple methods of data collection will be utilized for the proposed study including two surveys and a

series of focus groups to further explore factors and policy solutions. It is proposed that the quantitative data

results will provide a general picture of the problem, while the qualitative data and its analysis will refine and

explain those statistical results by exploring the participants’ perceptions and views in greater depth. The

qualitative component will also provide an opportunity to explore potential policy and regulatory changes. 10

The initial concepts that informed the research questions and this study were developed by the ND

Governors Nursing Shortage Task Force Workplace Culture committee. This committee is comprised of 19

stakeholders with diverse backgrounds including hospital administration, state government, private health

foundations, non-profit board leadership, professional associations, university research, and health insurance

(see Table 2). This committee is in the process of developing draft ND-specific designation criteria for healthy

nursing workplace cultures. The results from this study will be utilized to modify criteria and to inform

additional policy and regulation changes. The study was developed to provide a comprehensive examination of

the factors that influence graduating nursing students’ and practicing nurses’ intent to stay in North Dakota and

with their current employers. This study is also unique in that all nursing levels will be included in all phases of

the study; LPN, RN and APRN. This will be accomplished through a model incorporating the impact of primary

factors through the utilization of well-established and validated data collection instruments. These have been

combined to form a graduating nurse survey and a practicing nurse survey.

Table 2: ND Governor’s Nursing Shortage Task Force Workplace Culture Subcommittee

Committee Member Organization City/StatePatricia Moulton- Committee Leader

North Dakota Center for Nursing Fargo, ND

Aleana Goergen North Dakota Chapter of Nursing Association of Directors of Nursing- Long Term Care

Hazen, ND

Andrea Costello Cooperstown Medical Center Cooperstown, ND Bev Davis Brittany Montecuollo Sanford Health System Fargo, NDCarla Hansen North Dakota Center for Nursing

BoardDetroit Lakes, MN

Char Christianson Golden Acres Manor Carrington, ND Darleen Bartz North Dakota Health Department Bismarck, NDDeeAnna Opstedahl North Dakota Organization of

Nurse Executives Dickinson, ND

Delayne Schmidt Cooperstown Medical Center Cooperstown, NDEvelyn Quigley Nurse Consultant Fargo, NDGail Grant Catholic Health Initiatives Fargo, NDJan Kamphuis Sanford Health System Bismarck, NDJanelle Klinke Eventide Fargo, NDJeanna Kujava North Dakota Public Health

Association, Nursing Section Pembina, ND

Jerico Alicante North Dakota Nurses Association Fargo, ND

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Lori Hahn Catholic Health Initiatives Fargo, ND Marcie Schulz North Dakota Critical Access

Hospital Quality NetworkMelodi Krank Sanford Health Fargo, NDNicole Christiansen Essentia Health System, North

Dakota Organization of Nurse Executives

Fargo, ND

Nicole Nestler Catholic Health Initiatives Fargo, NDRhoda Owens University of North Dakota Grand Forks, NDPatricia Peraza Catholic Health Initiatives Fargo, NDRicki Ramlo Jamestown Regional Medical

Center Jamestown, ND

Shelly Peterson North Dakota Long Term Care Association

Bismarck, ND

Sheri Sweere Catholic Health Initiatives Fargo, NDStephanie Deese University of North Dakota Grand Forks, NDSue Heitkamp CHI Home Health and Hospice Fargo, NDSherri Miller North Dakota Nurses Association Bismarck, ND

Susan Elder Former Nurse Montana Pete Seljevold Blue Cross/Blue Shield of ND Fargo, ND

Intent to Stay Instruments

Intent to stay for graduating nurses is defined as the extent to which graduates from North Dakota and

border programs intend to stay and work or continue their nursing education in North Dakota. This will be

measured using components of the North Dakota Nursing Needs Student Survey (NDNNSS) that was

developed and refined over the last 16 years through several studies collecting data from nursing student focus

groups and surveys (Moulton, Lacey, Flynn, Kovner & Brewer, 2009). The NDNNSS survey will help

determine intent to stay decision-making of new nurses in finding employment after graduation, as well as

policies that would assist in encouraging them to stay in North Dakota. This instrument has been reliably

utilized multiple times and results from those studies have been used to inform policy and regulation. Specific

questions from the NDNNS survey that will be utilized in this study to measure intent to stay include post-

graduation plans, reasons for choices and factors that influenced their choice of program and future. Factors for

choice of program and future plans will be measured using a 5-point likert scale. Students will also be asked if

they are already working as nurse since this is a multiple-nurse level study. The scoring will include the average

and frequency distribution for the response to each set of questions. 12

Intent to Stay for nurses is defined as the extent to which employees plan to continue membership with

their employers (Price, 2001). The Intent to Stay instrument will be utilized with practicing nurses and

comprises a unifactorial scale of 4 items measured using a 5-point Likert scale ranging from strongly disagree

(1) to strongly agree (5). The scoring involves computing an overall average for the response to all four

questions. Frequency distributions for each of the 4 items can also be determined (Price, 2001). Measuring

Intent to Stay using this tool has been well established with good reliability and validity within other work force

studies, which determined employee’s Intent to Stay (Price, 2001; Kovner et al., 2009).

Index of Work Satisfaction

The Index of Work Satisfaction (IWS) (Stamps, 1997) survey will be given to all practicing nurses and

will measure the participant’s work satisfaction with his or her present nursing job. The survey has been used

successfully in previous nursing workforce satisfaction studies (Stamps, 1997). The IWS survey contains two

parts. Part A (Paired Comparisons) consists of 15 sets of paired comparisons of six work components (pay,

autonomy, task requirements, organization policies, interaction, and professional status), measuring the relative

importance of each of the six components to the respondent and describes the respondent’s expectations. Part B

(Attitude Questionnaire) of the survey measures satisfaction for each of the same six components and consists

of 44 items with a 7- point Likert scale ranging from strongly agree (1) to strongly disagree (7). Each

component includes a separate mean component score. Frequency distributions for each of the 44 items can also

be determined. Pay includes the dollar remuneration and fringe benefits received for work done. Autonomy

comprises the amount of job-related independence, initiative, and freedom, either permitted or required in daily

work activities. Task requirements involve tasks or activities that must be done as a regular part of the job.

Organization policies include management policies and procedures put forward by administration. Interaction

comprises opportunities presented for both formal and informal social and professional contact during working

hours. Lastly, professional status includes the overall importance or significance felt by the participant about his

or her job, both in his or her view and in the view of others (Stamps, 1997). A total weighted score – called the

Index of Work Satisfaction – is derived from the combination of the component weighting coefficient (Part A)

and the mean component score (Part B), and then scaled to represent one summary score. The most current 13

version of the IWS has generally good reliability for each component (pay, α = .83 to .89; autonomy and

interaction, α = .70 to .80; task requirements and organizational policies, α = .67 to .83; and professional status,

α = .63 to .76), and validity has likewise been found to be adequate (Stamps, 1997).

Professional Quality of Life

Stamm’s Professional Quality of Life (ProQOL) instrument is an open-source assessment tool that has

been in use since 1995 and is the most commonly-used measure of the negative and positive effects of being a

caregiver (Stamm, 2005). The ProQOL-5 is the most current version and will be used to measure overall

compassion satisfaction (CS), burnout (BO), and secondary traumatic stress/compassion fatigue (STS/CF)

experienced by nurses (Stamm, 2005). The ProQOL-5 has generally good reliability for each scale (Compassion

Satisfaction, α = .87; Burnout, α = .72; Compassion Fatigue, α = .80) and validity is similarly good with shared

variance between CF and STS at 2%, CS and BO at 5%, and STS/CF and BO at 23% (Stamm, 2005). Its

usefulness in measuring professional rates of turnover intent and intent to stay is emerging and the proposed

study will help contribute to this. In recent years, researchers have used the ProQOL-5 in connection with other

measure to examine nurses’ wellbeing and attitudes toward their work and found that overall ProQOL was

impacted by levels of professionalism in nurses (Jang, Kim, & Kim, 2016), organizational culture, emotional

intelligence (Keesler, 2017), excessive workload, and a sense that the care they provided was ineffective

(Austin, Saylor, & Finley, 2017). Nurses who reported higher CF, STS, and BO more frequently expressed their

intent to leave, and higher CS was associated with less turnover intent (Wells-English, 2018; Yang & Kim,

2016).

National Forum of State Nursing Workforce Centers’ Minimum Dataset

Demographic data will be collected via the National Forum of State Nursing Workforce Centers’ Minimum

Dataset (National Forum of State Nursing Workforce Centers Supply MDS, 2016). In 2008, the National Forum

developed a long-term goal of establishing a national repository of nurse workforce data based on state-level

contributions of data collected from nurses, employers, and nursing education programs. A national repository

of state nurse workforce data would be advantageous for state and national nurse workforce analysts and

planners. Consistently collected state-level data would permit state-to-state and state-to-region comparisons. 14

When aggregated to the national level, such a repository would be the most exhaustive and accurate source of

information ever assembled on the U.S. nursing workforce and would be useful for policy and regulation. With

initial funding from the Center to Champion Nursing in America and in-kind contributions from members, the

National Forum embarked on a year-long process to develop National Nursing Workforce Datasets for supply,

demand and education. This process which is described in detail in two publications (Moulton et al., 2012;

Nooney et al., 2010) included collecting surveys, codebooks and reports from each state and other national

surveys, compiling a list of all of the variables from all states, determining the perceived important of each

variables for forecasting and policy, drafting the initial Minimum Data Set, discussion of draft sets in a day-long

summit, gathering public comment by national entities and workforce data experts, final dataset drafting and

then ratification by the Forum in 2009.

The Forum recently updated the Supply MDS and annually collects information on implementation by state-

based centers for nursing. NDCSBN has also implemented the Supply MDS in the development of its national

supply repository and as the basis for the National Nursing Workforce Study. Dr. Moulton, the Principal

Investigator for the proposed study, was on the original drafting team for the MDS and was a co-lead of the

NCSBN National Nursing Workforce Study. As President of the Forum of State Nursing Workforce Centers she

also testified to the Institute of Medicine Committee evaluating the Future of Nursing report regarding the

utilization of the MDS and the status of implementation across states (Moulton, 2015). She also served as the

lead of a group following the Assessing Progress on the Institute of Medicine Report: The Future of Nursing

(Institute of Medicine, 2015) to work to create a national nursing repository of nursing workforce data with the

Supply MDS as a base.

The proposed study will utilize the 20 variables from the Supply MDS which include demographics,

employment characteristics, educational background, and licensure. These MDS variables will be utilized to

examine relationships between Job Satisfaction and Professional Quality of Life scores and how they serve as

moderators for predicting future intent to stay and thus inform future policy and regulatory practices.

Participants

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The first set of participants will include nursing students (PN, RN and Graduate) nearing graduation in

all ND nursing programs along with border programs in East Grand Forks and Moorhead, Minnesota.

Table 3: ND and Bordering Nursing Education Programs

Nursing Program Campus Location Nursing Programs Offered Bismarck State College Bismarck, ND Certificate PN, ADRNDakota College at Bottineau Bottineau, ND Certificate PN, ADRNLake Region State College Devil’s Lake, ND Certificate PN, ADRNWilliston State College Williston, ND Certificate PN, ADRNDickinson State University Dickinson, ND AASPN, BSRNND State College of Science Wahpeton., ND AASPN, ADRN Sitting Bull College Fort Yates, ND AASPNConcordia College Moorhead, MN BAN, Accelerated 2nd DegreeMinot State University Minot, ND BSRN, RN to BSRNNorth Dakota State University Fargo, ND BSRN, DNP, FNP, LPN to

BSRN, RN to BSRNND State University at Sanford Health Bismarck, ND BSRNUniversity of Jamestown Jamestown, ND BSRNUniversity of Mary Bismarck, ND BAN, BSRN, DNP, MSNUniversity of North Dakota Bismarck, ND BSRN, AGPCNP, DNP, FNP,

MSN, PhD, RN to BSN Rasmussen College Fargo and Moorhead, MN BSRNMayville State University Mayville, ND RN to BSRNMinnesota State University at Moorhead Moorhead, MN RN to BSRN, MSN, DSN/DNPMinnesota State Technical and Community College at Moorhead

Moorhead, MND Certificate PN, ASRN

Northland Community and Technical College

East Grand Forks, MN Certificate PN, ASRN

Graduates will be within their last year of receiving one of several degrees specific to the education

program (Practical Nursing Certificate, Associate Degree, Bachelor of Science Degree, Master’s Degree,

Doctor of Nursing Practice Degree, and Doctor of Philosophy). For the survey, nursing programs will be asked

to pass out flyers with online links to students during their classes. All students will also receive an invitation to

focus groups in their region.

The second set of participants will include ND nurses practicing at all licensure levels (LPNs, RNs,

APNs) as well as nurses licensed in Minnesota, South Dakota and Montana who live in border counties and/or

graduated from a North Dakota nursing education program. The goal will be to include participants from most

of the state’s different practice areas (e.g., hospitals, clinics, out-patient settings, long-term care, education,

16

public health, etc). Mailing addresses from the NDBON and neighboring nursing boards will be accessed and

used to send practicing nurses the postcard to complete the online survey and the invitation to participate in a

focus group. During Phase 2, early in the second year of the study, these participants will be invited to join in

focus groups. These focus groups will also be based out of the 8 larger cities and will include invitations to all

nurses living in the area.

Data Collection

Graduating nursing students in their last year will receive a flyer describing the study including link to

online survey during class, between September-October 2019. A written explanation of the purpose of the study

(and other implied informed consent information) will be included. Instructors will be asked to read the consent

information to the class and encourage students to enter link on their laptop, tablet or smart phone and complete

during class. Instructors will be asked to email the link with consent information to all distance students and

those were not able to attend an in-class session. It is estimated that the survey will be provided to

approximately 1,800 students with an estimated completion rate of 80% (potential sample size=1,440) which is

determined by estimating the number of students that may be absent on the day of class or that don’t fill out the

online link.

A postcard for the online will be sent to all currently practicing nurses utilizing the ND Board of

Nursing Licensure Database. The Licensure database will also be obtained/purchased from the Minnesota State

Board of Nursing, the South Dakota State Board of Nursing and the Montana State Board of Nursing. These

licensure lists will be sorted to include all practicing nurses working in the counties that border North Dakota

and nurses that have graduated from a North Dakota nursing program in the last 10 years. It is estimated that a

1. What factors influence graduating nurses’ post-graduation intent to stay in North Dakota?

2. What factors influence practicing nurses’ intent to stay in their workplace and in North Dakota?

17

total of 20,000 nurses will receive the postcard. Due to the policy-related nature of the study, the research team

plans to collect information from as many practicing nurses as possible. Written consent information on the

purpose of the study will be included with the online survey with completion of the survey confirming

participants’ informed consent to participate in the study. To maximize our response rate to the anticipated 40%

(potential sample size= 8,000), surveys, in addition to postcards will be augmented by online and print

marketing.

In addition to the postcards, nurses will be encouraged to complete the survey through the ND Center for

Nursing e-newsletter that is distributed monthly to all ND nurses, an ad placed in the North Dakota Nurses

Association quarterly mailed publication, and an ad placed in the ND Board of Nursing/SD Board of Nursing

quarterly mailed publication. Information about the survey will also be sent to all ND nursing organizations as

members of the ND Center for Nursing Board of Directors and Leadership team to disseminate to their

members, along with the North Dakota Hospital Association and the North Dakota Long Term Care

Association.

Phase II

Qualitative data collection with focus groups will be used to gather more detailed information about

factors and to further explore policy/regulation options. Focus groups will also be held in the 8 largest ND

cities (see Table 4). In addition to the postcard invitation, invitation will be placed in the North Dakota

Center for Nursing e-newsletter that is distributed to all nurses, and through an invitation distributed to all

nursing organizations that are represented through the ND Center for Nursing Board of Directors and the

Leadership Team. Organizations will be asked to electronically send the invitation to all their members.

Informed consent will be obtained from participants prior to beginning each focus group. Standard

discussion guides will be developed for graduating nurse focus groups and nurse focus groups. Questions

3. What policies and best practices influence graduating nurses’ intent to stay in their workplace and in North Dakota?

4. What policies and best practices influence practicing nurses’ intent to stay in their workplace and in North Dakota?

18

will provide an in-depth examination of questions that are asked on online surveys and will also focus on

emerging policies and best practices that influence nursing students’ and practicing nurses’ intent to stay in

their workplace and in North Dakota. Focus group meetings will be audiotaped and transcribed verbatim.

Focus group participants can provide written feedback along and answer demographic questions to enable

cartelization of focus group participation. Food will be provided at all focus groups.

Table 4: List of Meetings/Locations for Focus Groups

Gradating Nurses Focus Group Locations Practicing Nurse Focus Group Locations

Regional Nursing Student Focus Groups (potential N= 1600)Grand Forks/East Grand ForksDevil’s LakeMinotWillistonDickinsonBismarckJamestownFargo/Moorhead

Regional Practicing Nurse Focus Groups (potential N= 1600)Grand Forks/East Grand ForksDevil’s LakeMinotWillistonDickinsonBismarckJamestownFargo/Moorhead

DATA ANALYSIS

The overall statistical plan involves path analysis designed to determine factors across multiple dimensions

that impact intent to stay in North Dakota and in their current workplace. Two statistical models have been

developed. The first reflects the instruments and variables that will be utilized to determine Intent to Stay for

graduating nurses (see figure 1). The second reflects the instruments and variables that will determine Intent to

Stay for practicing nurses (see Figure 2). All instruments, their variables, subscales and whether they will be

utilized with graduating or practicing nurses are listed in Table 5.

19

Table 5: Variables/Subscales in Proposed Study

Instrument/Variables GRADUATING

PRACTICING

Instrument/Variable GRADUATING

PRACTICING

Forum Supply MDS Price Intent to StayGender X X Leave Employer/ND XEthnicity X X Leave Employer/ND ASAP XRace X X Stay with Employer/ND XYear of Birth X X Will not leave Employer/ND XEntry Level Education X X NDNNS Student Intent to Stay Highest Level of Education X X Post-Graduation Plans XHighest Level in another field X X Post-Graduation Further Education Plans XLicense Type X X Intended work location XYear of Initial Licensure X X NDNNS Availability of Nursing

Jobs/Workplace CharacteristicsCountry of Initial RN/LPN License X X Factors in choosing where to work XLicense Status X X Factors in choosing to work in ND XAPRN License/Certification X X Factors in choosing to work outside ND XEmployment Status X X Plan to work part or full time XReason for being unemployed X X Reasons plan to work part time XNumber of positions employed in X X ProQol-5 Factors Hours worked per week X X Compassion Satisfaction Subscale X XEmployers State and Zip Code X X Burnout Subscale X XEmployment Setting X X Secondary Traumatic Stress Subscale X XEmployment Position X X Stamp Nurse Satisfaction Index Employment Specialty X X Interaction Subscale XAdditional Demographic Factors Organizational Policies Subscale XType of shift worked X X Pay Subscale XMarital Status X X Professional Status Subscale XChildren and children under 6 X X Task Requirements Subscale XOverall Health Status X X Opinions of Others- NDNNSEnglish as First Language X X Factors in Choosing Career XNursing Program enrolled in X Factors in Choosing Nursing Program XSalary X Factors in choosing ND nursing program XSocial Support Factors- NDNNS Policy Related Factors- Governors CommitteeAvailability of Friends in work location X X Policy related incentives to work in ND X XOpinion of friends regarding work location X X Policy related incentives to attend school in ND X XOpinion of nursing friends about work location X X

20

Figure 1: Statistical Analysis Model for Graduating Nurses

Figure 2: Statistical Analysis Model for Practicing Nurses

Intent to StayNDNNS

Compassion

Satisfaction

ProQol

Opinions of

OthersNDNN

S

DemographicsForum MDS

BurnoutProQol

Secondary

Traumatic StressProQol

Forum MDS

Additional

Demographi

c Factor

s

Policy Related Factors

Governors

Committee

Availability of

Nursing Jobs &

Workplace

Characteristics

Social Support NDNNS

Intent to StayPrice

Social Support NDNNS

Policy Related Factors

Governors

Committee

Compassion

Satisfaction

ProQol

BurnoutProQol

Secondary

Traumatic StressProQol

Forum MDS

DemographicsForum MDS

Additional

Demographi

c Factor

s

Interaction- NSIStamp

Professional

Status- NSI

Stamp

Pay- NSIStamp

Organizational

Policies- NSI

Stamp

Autonomy- NSIStamp

Task Requirements-

NSIStamp

SalaryNDNN

S

Availability

of Contin

ued Educat

ion

21

After data collection, data will be cleaned. This will include running frequency analyses on all variables to

determine whether there is missing or inaccurately coded data. The research team will also dummy code data as

needed to provide for data analysis.

A path analysis will be conducted using the three subscales from the ProQol, 5 scales created for this study

and a set of demographic variables. Each of the scales are measurements regarding the factors that would

determine where the student will go to work. Once the initial path coefficients are established, covariances

among the predictors will be examined to improve the model and examine the factorial composition of the

predictors.

After data collection is complete, the data will be cleaned. This will include running frequency analyses on all

variables to determine whether there is missing or inaccurately coded data. The research team will also dummy

code data as needed to provide for data analysis.

When the data set is finalized, a nonresponse bias will be conducted to check for the need to weight the data

to best reflect the population. Although response rates are a valuable indicator of survey quality, they may not

be a good measure of response bias. An analysis of basic demographic data (i.e., gender, age, race/ethnicity,

2. What factors influence practicing nurses’ intent to stay in their workplace and in North Dakota?

1. Compassion satisfaction (ProQol)2. Burnout (ProQol)3. Secondary Trauma (ProQol)4. Opinion of Others (family, teacher/counselor, someone in health care) (NDNNS)5. Availability of nursing jobs and workplace characteristics (where I live, where I will move to)

(NDNNS)6. Salary (where I live, where I will move to) (NDNNS)7. Availability of continued education (where I live, where I will move to) (NDNNS)8. Availability of social support (where I live, where I will move to) (NDNNS)9. Demographics (Forum MDS)10. Social Support (NDNNS) 11. Policy Related Factors (Governor’s Committee)

Graduating Nurse Predictor Sets

1. What factors influence graduating nurses’ intent to stay in their workplace and in North Dakota?

22

number of years since graduation, number of years since first licensed) for all LPN, RN and APRN licensees

that completed the survey will be compared with available data from Board of Nursing licensure databases (ND,

MN, SD, MT) to determine the representativeness of the survey participants.

If a nonresponse bias is found, the data will be weighted. For example, if a nonresponse bias is found for

Age and Gender as was found on the national survey, the survey response rates for the age variables will be

compared using 5-year group intervals and combined with gender variable response categories to produce

AgeGender categories. The weight would then be calculated using the response rate for each new AgeGender

category. The resulting weights in the proposed study will simply adjust the distribution across those

demographic variables with a nonresponse bias. They will be applied when analyzing relationships between

variables without the effect of artificially increasing the degrees of freedom and thereby affecting significance

tests.

A path analysis will be conducted using the three subscales from the Professional Quality of Life Factors, 6

scales obtained from The Index of Work Satisfaction and a number of demographic variables. Once the initial

path coefficients are established, covariances among the predictors will be examined to improve the model and

examine the factorial composition of the predictors.

1. Compassion satisfaction (ProQol)2. Burnout (ProQol)3. Secondary Trauma (ProQol)4. Pay (Stamp NSI)5. Autonomy (Stamp NSI)6. Task requirements (Stamp NSI)7. Organizational Policies (Stamp NSI)8. Interaction (Stamp NSI)9. Professional Status (Stamp NSI)10. Demographics (Forum MDS)11. Social Support (NDNNS) 12. Policy Related Factors (Governor’s Committee)

Practicing Nurse Predictor Sets

3. What policies and best practices influence graduating nurses’ intent to stay in their workplace and in North Dakota?

4. What policies and best practices influence practicing nurses’ intent to stay in their workplace and in North Dakota?

23

Focus group data from both the student groups and the nurse groups will be transcribed. The file will

then be checked for missing words which will be completed using contextual references. After focus group

tapes are transcribed, thematic analysis of focus group verbatim transcripts will use the approach by Braun and

Clarke (2006). This process involves: (1) familiarization with the data, (2) generating initial codes, (3) searching

for themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the report (Braun &

Clark, 2006). The focus group data will be independently read and re-read by two researchers separately to

become familiar with the data, make initial notes, and find patterns of meaning. Initial codes will be developed

and categorized into themes as they emerge. The researchers will first complete data analysis separately before

meeting as a group to complete further discussions. Themes will be reviewed again by checking with the coding

extracts and across the entire data set until there is consensus amongst the two researchers. Focus group

transcripts from the graduating nursing students and practicing nurses will be analyzed separately. Potential

regulatory and policy changes will be compiled and weighted according to frequency and strength of support of

participants. Finally, the quantitative and qualitative results will together be interpreted and summarized.

Analysis will determine to what extent and in what ways the qualitative results help to explain the quantitative

results (Creswell & Plano Clark, 2018). Focus group results will also be presented to the Governor’s Nursing

Shortage Task Force Workplace Culture group in order to prioritize and implement policy and regulation

recommendations that arise from the findings.

Limitations

One potential limitation of the proposed study includes self-response error on the graduating nursing student

and practicing nurse surveys. Information on the surveys will not be validated by a secondary source. This can

be especially problematic for demographic, education background and employment setting data. We will work

to minimize this limitation by ensuring the questions and intended answer categories are as clear as possible by

using the most current Supply MDS.

A second potential limitation of the proposed study is a nonresponse bias for the practicing nurse survey as it

will be mailed to all nurses in North Dakota and a sample of nurses in Minnesota, South Dakota, and Montana,

which will result in an anticipated 40% response rate. The 2015 National Nursing Workforce Survey (Budden et 24

al., 2016) found a nonresponse bias indicating certain groups of nurses may have been slightly overrepresented.

These included White/Caucasian participants, female participants, and those age 60 or older. For the proposed

study, a formal nonresponse bias analysis will be conducted as described in the Data Analysis section and data

will be weighted if a bias is found.

The third potential limitation of the proposed study is the utilization of purposive sampling of participants

rather than random sampling. To maximize the amount of potential input for our focus group questions, we will

be hosting focus groups at conferences and meetings and hosting regionally-based groups. As this is the

qualitative phase of the proposed study, it is important to ensure that “information-rich” cases are included to

ensure the best qualitative data possible (Patton, 1990). The proposed study will minimize potential differences

between focus groups by utilizing a standard focus group discussion guide with specific prompts and

encouraging participants to provide additional feedback in written form to the same set of questions.

25

Project Timetable

Start Date: July 1, 2019

End Date: June 30, 2020

Research Question 1: What factors influence graduating nurse's post-graduation intent to stay in ND?

Major Steps Activities/Key Tasks Responsible Entities Year One Quarter1 2 3 4

Finalize survey logistics and arrangements with nursing programs.

Finalize policy/regulation related survey questions with Workplace Culture Committee.

Research Team/Workplace Culture Committee

Finalize online survey instrument and consent flyer.

Research Team

Hold conference call with nursing program contacts to explain research project and finalize distribution dates.

Research Team

Print flyers and launch online survey. MoultonCollect survey data from graduating nursing students.

Distribute consent flyers to nursing programs. MoultonEmail a reminder to nursing instructors half-way through collection period.

Moulton

Track survey completion and call schools who have not had students complete the survey.

Moulton

Data cleaning and analysis.

Data is cleaned and dummy coded as needed for analysis.

Moulton

Data analysis as detailed in grant is completed.

Petros, Research Consultant

Supporting tables and graphs are developed. Petros, Research ConsultantPublication of results. Results are incorporated into a presentation

for the Governors Workplace Culture group including recommendations for policy and regulation changes related to workplace culture.

Research Team

Results are incorporated into a draft journal article and submitted to a peer-review journal for publication. Results are also presented at a state or regional conference.

Research Team

Research Question 2: What factors influence practicing nurse’s intent to stay in their workplace and in ND?

Finalize survey and logistics.

Finalize policy/regulation related survey questions with Workplace Culture Committee.

Research Team/Workplace Culture Committee

Finalize online survey and postcards. Research Team

Obtain mailing list from Boards of Nursing, develop cleaned mailing lists.

Moulton

Collect survey data from practicing nurses.

Distribute postcards and launch online survey. Moulton

ND Center for Nursing places reminders to complete surveys online and in newsletter and purchase ads in NDBON and NDNA quarterly publications.

Moulton

Data cleaning and analysis.

Data is cleaned and dummy coded as needed for analysis.

Moulton

Nonresponse bias analysis is completed and Petros, Moulton

26

weighted as needed. Data analysis as detailed in grant is run. Petros, Research Consultant

Supporting tables and graphs are developed. Petros, Research Consultant

Publication of results. Results are incorporated into a presentation for the Governors Workplace Culture group including recommendations for workplace culture designation system.

Research Team

Results are incorporated into a draft journal article and submitted to a peer-review journal for publication. Results are also presented at a state or regional conference.

Research Team

Research Question 3: What policies and best practices influence graduating nurses’ intent to stay in their workplace and in ND?

Finalize graduating nurses focus group materials and logistics.

Develop final focus group questions including policy/regulation questions, discussion guides and feedback form with Workplace Culture Committee.

Owens, Moulton

Hold conference call with nursing program contacts to explain research project and finalize distribution dates.

Owens, Moulton

Conduct Focus Groups.

Schedule focus groups with nursing programs.

Owens

Print materials for focus groups and order food for participants.

Moulton

Hold focus groups, audio tape discussions and distribute written feedback forms.

Owens, Moulton

Focus Group data transcription and analysis.

Have focus group tapes transcribed. Clean transcriptions by filling in missing words as needed.

Owens, Moulton

Analyze qualitative data from focus groups and feedback form as detailed in grant including inter-rate reliability.

Owens, Moulton

Develop summary information, graphs and tables as needed.

Owens, Moulton

Publication of results from focus groups.

Results are incorporated into a presentation for the Governors Workplace Culture group including recommendations for workplace culture designation system. Draft policy/regulation changes are developed.

Research Team

Results are incorporated into a journal article and submitted to a peer-review journal for publication. Results are also presented at a state or regional conference.

Research Team

Research Question 4: What policies and best practices influence practicing nurses’ intent to stay in their workplace and in ND?

Finalize practicing nurses focus group materials and logistics.

Develop final focus group questions including policy/regulation questions, discussion guides and feedback form with Workplace Culture Committee.

Owens, Moulton

Determine locations for practicing nurse focus groups and make arrangements.

Owens, Moulton

Conduct Focus Groups.

Solicit volunteers for focus groups. ND Center for Nursing places ad online and in newsletter and purchased ads in NDBON and NDNA quarterly publication.

Moulton

27

Print materials for focus groups and order food for participants.

Moulton

Hold focus groups, audio tape discussions and distribute written feedback forms.

Owens, Moulton

Focus Group data transcription and analysis.

Have focus group tapes transcribed. Clean transcriptions by filling in missing words as needed.

Owens, Moulton

Analyze qualitative data from focus groups and feedback form as detailed in grant including inter-rate reliability.

Owens, Moulton

Develop summary information, graphs and tables as needed.

Owens, Moulton

Publication of results from focus groups.

Results are incorporated into a presentation for the Governors Workplace Culture group including recommendations for workplace culture designation system. Draft policy/regulation changes are developed.

Research Team

Results are incorporated into a journal article and submitted to a peer-review journal for publication. Results are also presented at a state or regional conference.

Research Team

28

Collaborating Organizations: Other organizations you are working with on the project and the role of each:

Organization Name Role

1. University of North Dakota College of Nursing

and Professional

Oversee reports to the University of North Dakota Institutional Review Board. Assist with data collection, data analysis and publication development. Oversee Nurse Job Satisfaction scoring. Supervise qualitative data transcription and analysis.

2. University of North Dakota Department of

Psychology

Supervise overall quantitative data analysis, nonresponse bias analysis and weighting.

3.

4.

Amount of Funding Request (USD): $118,348

Other Funding Sources: N/A

Organization Name Type of Support Amount

1.

2.

DETAILED BUDGET FOR PROJECT PERIODDIRECT COSTS ONLY

(Budget Justification on next page)

FROM07/01/19

THROUGH06/30/2020

PERSONNEL (Applicant organization only) DOLLAR AMOUNT REQUESTED

NAMEROLE ON PROJECT

BASE SALARY % effort SALARY

REQUESTED

FRINGE BENEFITS TOTAL

Patricia Moulton, PhDND Center for Nursing

Principal Investigator

116,307 25% 29,077 10,177 39,254

Rhoda Owens, PhD, BSRNUniversity of North Dakota

Co-Principal Investigator

110,934 20% 22,187 5,990 28,177

Thomas Petros, PhDUniversity of North Dakota

Co-Investigator Statistician

128,544 10% 12,854 3,471 16,325

$64,118 19,638 83,756

CONSULTANT COSTS (Not to exceed $250/day)

Stephanie Deese- consultant $200/day X 80 days= $16,000

16,000

TRAVEL RELATED TO DISSEMINATION OF RESULTS (Limit $1,500)

Travel to state/regional conferences to present

1,500

DATA COLLECTION, PROCESSING, STATISTICAL ANALYSIS COSTS

Focus group travel to sites, food and materials for participants $6,000

Focus group transcription $2,250.00

8,250

REPRODUCTION/DISTRIBUTION OF SURVEYS OR OTHER TOOLS COSTS

Printing out and mailing of one survey reminder postcard, mailing of survey information to nursing programs and return of

surveys

5,000

OTHER EXPENSES DIRECTLY RELATED TO THE RESEARCH PROCESS

Purchase of Minnesota, Montana and South Dakota licensure databases= $642

Purchase of SPSS Statistical Software= $2,200

Marketing costs to place ads in state nursing publications to encourage completion of surveys and focus groups= $1,000

3,842

SUBTOTALS SUBTOTALS $34,592

TOTAL DIRECT COSTS FOR PROJECT PERIOD $118,348

BUDGET JUSTIFICATIONPERSONNEL North Dakota Center for Nursing

Patricia Moulton, PhD, (Effort 25%).  Dr. Moulton will serve as Principal Investigator on the proposed study. Dr. Moulton will serve as a liaison with the National Council of State Boards of Nursing including development of grant reports. Dr. Moulton will administer the subcontract to the University of North Dakota and the consultant. Dr. Moulton will supervise the overall research team, collection of data, data analysis and publication development. Dr. Moulton will be responsible for connecting with nursing education programs for graduating nursing students and obtaining/cleaning of licensure board data. Dr. Moulton will oversee data collection of the Supply MDS. Dr. Moulton will also serve as a liaison to the ND Governors Nursing Shortage Task Force Workplace Culture Committee for which she is the chair. This committee will be responsible for development and implementation of policy and regulation changes in response to study findings. The remaining .75 FTE of Moulton’s position is allocated to other administrative and research duties at the North Dakota Center for Nursing. 

Fringe Benefits are based on actual and anticipated cost of benefits estimated at 35% of salary. Actual costs will be charged to the grant.  This includes worker’s compensation, retirement, health insurance, dental insurance, social security and federal taxes and unemployment compensation.  

North Dakota Center for Nursing Salary and Fringe Benefits Total = $39,254

University of North Dakota Rhoda Owens, PhD, BSRN (Effort 20%). Dr. Owens will serve as the Co-Principal Investigator. Dr.

Owens will serve as the liaison for the University of North Dakota subcontract. Dr. Owens will oversee reports to the University of North Dakota Institutional Review Board. Dr. Owens will assist with data collection, data analysis and publication development. Dr. Owens will oversee Nurse Job Satisfaction scoring. Dr. Owens will supervise qualitative data transcription and analysis. The remaining .80 FTE of Owens’s position is allocated to other duties at the University of North Dakota College of Nursing and Health Professions. 

Thomas Petros, PhD (Effort 10%) Dr. Petros will serve as a Co-Investigator and Statistician on the proposed study. Dr. Petros will assist with data collection, data analysis and publication development. Dr. Petros will supervise overall quantitative data analysis, nonresponse bias and weighting. The remaining .80 FTE of Petros’s position is allocated to other duties at the University of North Dakota Psychology Department.

Fringe Benefits are based on actual and anticipated cost of benefits estimated at 27% of salary. Actual costs will be charged to the grant.  This includes worker’s compensation, retirement, health insurance, dental insurance, social security and federal taxes and unemployment compensation.  

University of North Dakota Salary and Fringe Benefits Total = $44,502  

OPERATING EXPENSES 

All operating expenses will be administered by the North Dakota Center for Nursing.

CONSULTANT COSTS Stephanie Deese will serve as a consultant on the proposed research project. Ms. Deese has special

expertise in the application of the Professional Quality of Life instrument scoring and utilization with the nursing workforce. Ms. Deese will provide up to 80 hours of consultant services at $200 and hour for a maximum of $16,000 during the research project. The ND Center for Nursing will administer the contract with Ms. Deese.

TRAVEL RELATED TO DISSEMINATION OF RESULTS Travel to state/regional conferences to present as funding allows. Travel reimbursement will include

mileage reimbursement using the standard IRS reimbursement rate which for 2018 is 54.5 cents/mile. Hotel reservation costs and per diem reimbursement will also follow IRS guidelines. Conference registration and poster development as applicable will be reimbursed.

Travel Total= $1,500

DATA COLLECTION, PROCESSING, STATISTICAL ANALYSIS COSTS Focus group travel for research team to sites (including mileage, per diem, hotel and meeting costs as

applicable using the same standards as dissemination travel), food and materials for participants $6,000 Focus group transcription through VerbaLink Transcript estimated at $2.50/minute X 22 focus groups X

45 minutes = $2,250. Data Collection Total = $8,250

REPRODUCTION/DISTRIBUTION OF SURVEYS OR OTHER TOOLS COSTS Printing out and mailing of one survey reminder postcard, mailing of survey information to nursing

programs and return postage for surveys $5,000 Survey Distribution Costs = $5,000

OTHER EXPENSES DIRECTLY RELATED TO THE RESEARCH PROCESS Purchase of Neighboring State Board of Nursing Licensure Data= $642

o Minnesota State Board of Nursing licensure data= $90o South Dakota State Board of Nursing Licensure data= $50o Montana State Board of Nursing Licensure data= $502

Purchase of SPSS Statistical Analysis Software at the ND Center for Nursing= $2,200 Marketing costs to place ads in state nursing publications to encourage completion of surveys and

participation in focus groups = $1,000Other Expenses Total = $3,842

TOTAL OPERATING EXPENSES= $34,592 TOTAL DIRECT COSTS= $118,348

TOTAL INDIRECT COSTS = $0

Due to NCSBN's status as a 501(c)(3) not-for-profit organization, indirect costs cannot be funded by the Center for Regulatory Excellence. See website at https://www.ncsbn.org/691.htm for more information.

BIOGRAPHICAL SKETCH

NAME

Moulton, Patricia L.POSITION TITLE

Executive Director

EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)

INSTITUTION AND LOCATION DEGREE(if applicable) YEAR(s) FIELD OF STUDY

University of North Dakota Grand Forks, ND

B.S. 1997 Psychology

University of North Dakota Grand Forks, ND

M.A. 1999 General Psychology

University of North Dakota Grand Forks, ND

Ph.D. 2002 Experimental Psychology

Positions and EmploymentNorth Dakota Center for Nursing Jul 2011- Present

Executive DirectorJob duties: Overall non-profit corporation management, strategic planning, program planning, development and assessment, marketing including website and social media development, fundraising, grant writing, lobbying and advocating, board support and coordination, volunteer recruitment and management, financial and risk and facilities management, community and public relations and research analysis and dissemination.

University of Jamestown Jul 2017-PresentAdjunct FacultyJob Duties: Instructor for Grant Writing class and Public Policy classes for Master of Arts in Leadership Program.

Impact Foundation Aug 2014-PresentGrant Writing ConsultantJob Duties: Provide grant writing advice and assistance to small and large non-profits developing foundation and federal grant applications. Develop training materials and workshops on grant writing.

University of North Dakota, Grand Forks, ND Jul 2011Associate Professor / Center for Rural Health, School of Medicine and Health Sciences

University of North Dakota, Grand Forks, ND Jan 2010- Jun 2011Assistant Professor / Department of Family and Community Medicine, School of MedicineJob Duties: Grant writing, data collection, analysis and dissemination, program development and administration, supervise project staff and graduate student assistants, program evaluation, teaching and university and state service.

University of North Dakota, Grand Forks, ND Jun 2002- Jun 2011Assistant Professor / Center for Rural Health, School of Medicine and Health SciencesJob Duties: Grant writing, data collection, analysis and dissemination, program development and administration, staff management, program evaluation, teaching and university and state service.

University of North Dakota, Grand Forks, ND Jan. 2006- Jun 2011Adjunct Assistant Professor / Psychology DepartmentJob Duties: Provide support to graduate level psychology students. Teach federal grant writing to graduate students.

University of North Dakota, Grand Forks, ND Spring, 2003Lecturer/ Psychology Department

Job Duties: Serve as primarily instructor for large 200 student introduction to psychology class. Supervise graduate teaching assistants.

University of North Dakota, Grand Forks, ND Spring 2000-2002Undergraduate Director’s Assistant/ Psychology Department

Job Duties: Founding Directors Assistant developed job duties, provided undergraduate advising, website development and other services.

University of North Dakota, Grand Forks, ND Fall, 2000Lecturer/ Introduction to Psychology

Job Duties: Serve as primarily instructor for large 200 student introduction to psychology class. Supervise graduate teaching assistants.

University of North Dakota, Grand Forks, ND Summer, 2000Graduate Service Assistant: Registrar's Office/Institutional Research

Job Duties: Analyzed institutional data and created reports. U.S.D.A. Human Nutrition Research Center, Grand Forks, ND Summer, 1999

Psychology Summer Research InternJob Duties: Carried out animal research studies and analyzed data.

University of North Dakota, Grand Forks, ND Spring, 1999Lecturer, Introduction to Psychology

Job Duties: Serve as primarily instructor for large 200 student introduction to psychology class. Supervise graduate teaching assistants.

University of North Dakota, Grand Forks, ND Fall,1997- Spring, 2001Graduate Teaching Assistant, Psychology

Job Duties: Assist faculty in multiple classes including statistics, introduction to psychology and research methods.

Research Expertise Dr. Moulton has conducted health workforce research for the past 16 years. This includes a ten-year, statewide longitudinal nursing supply, education, and demand study that was mandated by the ND State Legislature. Dr. Moulton has also served on the research team for two national supply surveys with the National Council of State Boards of Nursing and the National Forum of State Nursing Workforce Centers (Forum). These surveys utilized the Forum’s Nursing Supply Minimum Data Set, the development of which Dr. Moulton assisted as a co-lead, and she authored two articles describing the development of the data sets. Dr. Moulton’s research was also used in a national nursing shortage designation study conducted by SUNY New York and funded by HRSA. As the President of the Forum, Dr. Moulton testified before the Institute of Medicine as a part of their evaluation of the status of the Future of Nursing recommendation implementations. Dr. Moulton currently co-leads a Governor’s Nursing Shortage Task Force and has served as the Executive Director of the ND Center for Nursing for the last eight years. Dr. Moulton has served in a leadership role of over $11 million in federal, state and local/foundation grants. Dr. Moulton is also an adjunct faculty at University of Jamestown where she teaches Grant Writing and Public Policy to students in the Master’s in Leadership program.

Selected Peer-reviewed Publications and Manuscripts in Press 1. Budden, J., Moulton, P., Harper, K. & Brunell, M. (2016). 2015 National Nursing Workforce Study. Journal of Nursing Regulation 7(1). Supplement.2. Moulton, P. (2015). Report to the Committee for the Evaluation of the Impact of the Institute of Medicine Report: The Future of Nursing: Leading Change, Advancing Health. National Academy of Science. 3.. Budden, J., Zhong, E., Moulton, P. & Cimiotti, J. (2013). The National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers 2013 National Workforce Survey of RNs. Journal of Nursing Regulation 4(2) 4. Moulton, P., Wiebusch, PL., Cleary, BL., Brunell, ML, Napier, DF, Bienemy, C., LeVasseur, SA., Cimiotti, JP. (2012). Towards Standardization (Part 2): Status of Implementation of

National Nursing Workforce Minimum Data Sets. Policy, Politics and Nursing Practice, 13 (3), 162-9.5. Shanta, L.L., Kalanek, C.B., Moulton, P.L., Lang, T. (2011). Evidence for policy and regulation: A model to address development of under-qualified faculty. Policy, Politics and Nursing Practice, 12 (4) 224-35. 6. Yang, C.C., Su, Y.Y. & Moulton, P. Evidence-based investigation for determining the characteristics of knowledge management on organizational innovation within Taiwanese teaching hospitals. In Press at IBuisness7. Nooney, J., Cleary, B., Moulton, P., Wiebusch, P., Murray, J., Yore, M., Brunell, M. (2010). Towards Standardization (Part 1): Assessment of State and National Nursing Workforce Data Sources. Policy, Politics and Nursing Practice, 11(3) 173-183.8. Rudel, R., Moulton, P. and Arneson, K. (2009) The Shortage Tsunami and High School Guidance Counselors’ Perspectives on Future Nurse Recruitment. MEDSURG Nursing18 (6). 369-384.9. Moulton, P., Lacey, L., Flynn, L., Kovner, C. & Brewer, C. (2009). Addressing the complexities of survey research. In Dickson, G. & Flynn, L eds. The Research-to-Policy Connection: Nurses and their Work. Springer: New York. 10. Rudel, R. & Moulton, P. (2009). Nursing’s long-term pipeline: A study of high school Students using a unique data collection method. In Dickson, G. & Flynn, L eds. The Research-to-Policy Connection: Nurses and their Work. Springer: New York.11. McDonald, LR, Ludtke, RL, Moulton, P, Muus, K, Knudson, AD, Wakefield, M. (2009). Health Policy and Program Implications That Will Enhance the Way Rural Native Americans Will Age in the Twenty-First Century. In Stanford, E. Percil & Nelson, Thomas C. eds. Diversity and Aging in the 21st Century: Let the Dialogue Begin. AARP.12. Wakefield, M. & Moulton, P. (2008). Enhancing Health Care for Rural Populations through Interdisciplinary training and quality improvement. Submitted to the Advisory committee on Interdisciplinary Community-Based Linkages, Division of Diversity and Interdisciplinary Education, Bureau of Health Professions, Health Resources and Services Administration. 13. Amundson, M., Moulton, P., Zimmerman, S. & Johnson, B. (2008) An Innovative Approach to Student Internships on American Indian Reservations. Journal of Interprofessional Care 22, 93-101.14. Muus, K, McDonald, L, Ludtke, R, Allery, A, Knudson, A, & Moulton, P. (2007). Arthritis among American Indian and Alaska Native Elders: Prevalence, Demographic Patterns, and Comorbidities. Journal of Native Aging and Health, 2. 5-13.15. Moulton, P., Miller, M., Offutt, S. & Gibbens, B. (Winter 2006/2007) Identifying Rural Health Care Needs Using Community Dialogues. Journal of Rural Health Vol. 23.16. Moulton, P., Petros, T., Apostal, K., Park, R., Ronning, B., King, B., & Penland J. (2005). Alcohol-Induced Impairment and Enhancement of Memory: A Test of the Interference Theory. Physiology and Behavior, 85. 240-245.17. Moulton, P., McDonald, L., Muus, K., Knudson, A. & Ludtke, R. (2005). Chronic Disease in American Indian/Alaskan Native Elders. IHS Primary Care Provider, 5. 120-123. 18. Petros, T., Bridewell, J., Jensen, W., Ferraro, F.R., Bates, J., Moulton, P., Turnwall, S., Rawley, D. & Howe, T. (2003). Post-Intoxication effects of alcohol on flight performance after moderate and high blood alcohol levels. International Journal of Aviation Psychology, 13. 287-300.19. Moulton, P. (2002). Impact of Chronic Corticosterone Exposure and Zinc-Deprivation on Hippocampal Degeneration and Memory in Rats. Doctoral Dissertation, University of North Dakota Experimental Psychology PhD Program. 20. Moulton, P., Boyko, L., Fitzpatrick, J., and Petros, T. (2001). Effect of five-day dosage of ginkgo biloba on memory in healthy male volunteers. Physiology & Behavior, 73. 659-665.

Research Support2017-2018 Development of a High School Recruitment Program

Otto Bremer Trust:Role: Principal Investigator $15,000

2012-Present North Dakota Board of Nursing North Dakota Center for NursingRole: Executive Director $1,056,221

2002- 2012 Nursing Needs Study: North Dakota Board of Nursing. Role: Project Director (2002) Principal Investigator (2003-2012) $702,000

2011-2012 North Dakota Center for Nursing Infrastructure GrantOtto Bremer FoundationRole: Executive Director $38,000

2011-2012 A Qualitative Study Examining Care Coordination between Rural and Urban HospitalsUND Faculty Seed Grant Role: Principal Investigator $16,766

2010-2011 North Dakota State Workforce Planning GrantACA State Health Workforce Planning GrantsHRSARole: Co- Principal Investigator $184,937

2010-2011 Mobile Interdisciplinary Simulation Team SkillsARRA Equipment to Enhance Training for Health Professionals Area Health Education Center Infrastructure Development AwardsHRSARole: Principal Investigator $249,835

2008-2011 Health Workforce Assistance CenterDHHS, Health Resources and Services AdministrationRole: Workforce Expert $3,750,000

2008-2011 Area Health Education Center ProgramHealth Resources and Services AdministrationRole: Associate Program Director $1,984,332

2006-2011 Rural Research to Diverse AudiencesU.S. Department of Health and Human Services, HRSA, Office of Rural Health Policy. Role: Deputy PI (2006-2008) Principal Investigator (2009-2013) $774,000

2009-2010 Health Workforce Pipeline ProjectND State AppropriationsRole: Lead Investigator: Health Professions Workforce Assessment $60,000

2009-2010 North Dakota Nursing Education ConsortiumND State LegislatureRole: Program Evaluator $500,000

2008-2009 North Dakota Environmental ScanDakota Medical FoundationRole: Co-Investigator $30,000

2007-2009 Nurse Faculty Intern Pilot StudyNational Council of State Boards of NursingRole: Co-Investigator/Statistician $117,571

2007 Nurse Faculty Recruitment and Retention ProjectDakota Medical FoundationRole: Principal Investigator $35,000

2006- 2009 Building Research Infrastructure and Capacity (BRIC).

Agency for Healthcare Research and QualityGreat Plains Institute for Rural Health Services ResearchRole: Co-Investigator $500,000

2006-2008 Northern Plains Center for Behavioral Research TranslationInstitutional Clinical and Translational Science Award (CTSA) R20 planning grant. National Center for Research Resources, National Institutes of Health. Role: Chair of Community Engagement and Dissemination Core $149,783

2005-2007 Pesticide Impact on Neurological Diseases- Reducing RisksCenters for Disease Control and PreventionRole: Co-Principal Investigator $500,00

2004-2007 Impact of Pesticide Exposure on Cognition in Children Academic Research Enhancement AwardNational Institute of Environmental Health SciencesRole: Co-Principal Investigator. $140,050

2004-2007 National Health Service Corp Student Research Experienceand Rotations in Community Health Program. Department of Health and Human Services. Role: Evaluator $320,611

2005-2006 Utilization of Medication Assistants in North DakotaNorth Dakota Board of Nursing. Role: Principal Investigator $10,000

2005 Quentin N. Burdick Rural Interdisciplinary Training GrantDepartment of Health and Human Services. Role: Evaluator $200,000

2004-2005 Comparison of Health, Nutrition and Cognitive Status in Young and Older Adults

University of North Dakota Seed GrantRole: Principal Investigator $25,000

2004-2005 North Dakota Health Providers' Self-Assessment of Knowledge,Skills and Preparedness for Treating Pesticide-Contaminated Patients University of North Dakota Seed Grant. Role: Co-Investigator. $39,850

2004 Assessment of the North Dakota Department of Health’s Internal Organizational Climate North Dakota Department of Health Role: Principal Investigator $10,129

2003-2004 Prevalence of Chronic Disease and the Degree of Rurality of American Indian Elders Grant Program for Policy-Oriented Rural Health Services Research (R04)Office of Rural Health Policy, HHSRole: Principal Investigator $150,000

BIOGRAPHICAL SKETCHNAMEOwens, Rhoda A.

POSITION TITLE

Assistant Professor

EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)

INSTITUTION AND LOCATIONDEGREE

(if applicable)

YEAR(s) FIELD OF STUDY

Minot State University - Minot, ND B.S. 1985 NursingUniversity of North Dakota - Grand Forks, ND M.S. 2006 NursingUniversity of North Dakota - Grand Forks, ND Ph.D. 2015 Teaching and Learning

Higher Education

Positions and EmploymentUniversity of North Dakota – College of Nursing and Professional Disciplines 2015-PresentGrand Forks, ND

Assistant ProfessorJob Duties: Instructor for undergraduate Medical-Surgical courses, RN-BSN Professional Role Development and Interprofessional Care courses, Nursing Theory and Concepts and Foundations of Nursing Science courses for Master of Science and PhD Nursing Students, teach both face-to-face and online courses; Dissertation Committees for PhD Nursing Students

Williston State College, Minot, ND 2009-2015Assistant Professor/Site ManagerJob Duties: Managed the distant site; Instructor for Medical-Surgical courses at the RN and LPN in both the RN and LPN education programs, clinical instructor for both RN and LPN students, andProfessional Role Development course for the RN students

Trinity Health System, Minot, ND 2010-PresentRegistered NurseJob Duties: Part-time/Casual position in the First Care Clinic

Trinity Health System, Minot, ND 1986-2009Registered NurseJob Duties: Worked as staff nurse and charge nurse in Medical and Pediatric patient care units,hospital evening supervisor, case manager home health/hospice, hospice coordinator, staff development department

Mercy Hospital, Williston, ND 1985-1986Registered NurseJob Duties: Staff and charge nurse on surgical unit

Research ExpertiseRhoda Owens PhD, RN has a PhD in Teaching and Learning/Higher Education and has 8 years of research experience utilizing both qualitative and quantitative data collection and analysis. Dr. Owens’ research interests include nursing workforce issues, nurses’ role transition and professional identity development in rural healthcare settings. She has recently published completed studies on nursing faculty and family nurse practitioners and completed papers on North Dakota’s Nurse Practitioner Workforce. In addition, she is a member on the North Dakota Governor’s Nursing Shortage Task Force, and the University of North Dakota’s College of Nursing and Professional Disciplines Research and Scholarship committee.

Selected Peer-reviewed Publications and Manuscripts in Press1. Owens, R.A. (2018). Transition experiences of new rural nurse practitioners. The Journal for Nurse Practitioners. 14(8), 605 – 612. doi: 10.1016/j.nurpra.2018.05.0092. Owens, R.A. (2018). Nurse practitioner role transition and identity development in rural healthcare settings:

A scoping review. Nursing Education Perspectives. (Accepted for publication 2/21/18) NEP-2018-001R13. Owens, R.A. (2018). Two-year institution part-time nursing faculty experiences during their role transition

and identity development: A phenomenological study. Nursing Education Perspectives. 39(1), 10-15. doi: 10.1097/01.NEP.0000000000000250

4. Owens, R.A. (2017). Part-time nursing faculty perceptions of their learning needs during their role transition

experiences. Teaching and Learning in Nursing. 12(1), 12-16. doi: dx.doi.org/10.1016/j.teln.2016.10.002 5. Owens, R.A. (2012). Transcultural nursing course in Tanzania, Africa. Home Healthcare Nurse, 30(6), 347-

352. doi: 10.1097/NHH.0b013e318257569a. 6. Owens, R. A. (2012). Chapters 32, 34, 35, 36 and 37 of the Gastrointestinal System Unit. In L. White, G. Duncan, & W. Baumle (Eds.), Medical-Surgical nursing an integrated approach (3rd

ed.). (pp. 651-667; 690-763). New York: Delmar Cengage Learning. 7. Owens, R.A. (2008). Teaming up to improve the quality of surgical care. American Nurse Today, 3(5), 25-

26. 8. Owens, R.A. (2006). The caring behaviors of the home health nurse and influence on

medication adherence. Home Healthcare Nurse, 24(8), 517-526.

Manuscripts Under Review for Peer-reviewed Publications1. Owens, R.A. Accelerated baccalaureate student perceptions of their learning in a hybrid course: A pilot

study. Nursing Education Perspectives. (submitted 9-15-18)

Research Support

2018-Present Exploring Rural Nurse Pracitioners’ First Year Experiences Horter Endowment Award $2000

Role: Principle Investigator

2016-2017 Exploring the Transition Experiences of Registered Nurses to Nurse Practitioners in Rural Healthcare Settings University of North Dakota/College of Nursing and Professional Disciplines Faculty Seed Grant $3000 Role: Principle Investigator

BIOGRAPHICAL SKETCH

NAMEThomas V. Petros, Ph.D.

POSITION TITLE

Professor of PsychologyeRA COMMONS USER NAME (credential, e.g., agency login)EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, include postdoctoral training and residency training if applicable.)

INSTITUTION AND LOCATIONDEGREE

(if applicable)

MM/YY FIELD OF STUDY

Kent State University, Kent Ohio BA 1975 Secondary Education Kent State University, Kent Ohio MA 1978 Developmental PsychKent State University, Kent Ohio Ph.D. 1981 Cognitive Psychology

Positions and Employment

1977-1980 Teaching Fellow, Kent State University1980-1981 Instructor, University of North Dakota1981-1985 Assistant Professor, University of North Dakota1985-1991 Associate Professor, University of North Dakota1991-present Full Professor, University of North Dakota

Research Expertise

Dr. Petros for the last several years has conducted research in psychological assessment, especially with Native Americans. He and his colleagues have examined the validity of common psychological assessment tools (e.g., Beck Depression Inventory, Beck Anxiety Inventory, Substance Abuse Subtle Screening Inventory) with Native Americans. In addition, they have examined the role of environmental factors along with cultural factors that influence response of Native Americans on the MMPI-2 and on the WISC-III). In addition, he has conducted work in human factors and cognition, especially in aviation-related issues. Most recent work used physiological measures (EEG, EOG, ECG) to measure fatigue and task engagement in air traffic controllers during periods of high and low workload. Other work has examined the impact of nutritional intake, high altitude and alcohol hangover on aviation performance.

Earlier work has examined the impact of various pharmacologic agents on cognition and performance. For example, he and his colleagues have studied the impact of common drugs such as alcohol, caffeine, and nicotine on cognition and performance. In addition, they have examined the impact of several factors that moderate the impact of these drugs such as time of day, along with endogenous levels of estrogen and testosterone. Further, they have examined the impact of a dietary supplement (Gingko Biloba), a hormone (cortisol), and a neuropeptide (Vasopressin) on cognition and performance.

Dr. Petros has extensive experience providing statistical consultation for the Department of Psychology and many other departments at the University of North Dakota. Dr. Petros teaches and consults on a variety of statistical topics to graduate students in several disciplines at the University of North Dakota. The topics include analyses of variance of all types, multiple regression analysis of all types, mediational analysis, and modeling techniques.

Selected Peer-reviewed Publications & Presentations

Gray, J.S., Brionez, J., Petros, T., and Gonzaga, K.T. (2018). Psychometric evaluation of depression measures with Northern Plains Indians. Journal of American Indian and Alaska Native Mental Health Research. American Journal of Orthopsychiatry, In Press.

Bernhardt, K., Jorgenson, T., Carson, C., Dreschsel, P., Iseminger, C., Poltavski, D., Ferraro, F.R., & Petros, T. (2017). Tracking Workload and Engagement in Air Traffic Control Students Using Electroencephalography Cognitive State Metrics. Paper presented at the Aviation Psychology Conference, Dayton, April 2017.

Bernhardt, K., Solomon, K.A., Ferraro, F.R., Crockett, R.J., Terrell, H., Petros, T., and Vacek, J. Individual Differences in Dynamic Multitasking Performance. Proceedings of the Human Factors and Ergonomics Society 2016 Annual Meeting

Gray, J.S., McCullagh, J.A, and Petros, T. (2016). Assessment of anxiety among Northern Plains Indians. American Journal of Orthopsychiatry. 86(2), 186-193.

Lindseth,G. and Petros, T. (2016). Neurobehavioral Effects of Consuming Dietary Fatty Acids. Biological Research for Nursing, 18, 573-581

Vandal, R., Kagan, C., Petros, T., and Gray, J.S. Differences Between Native Americans and Caucasians in Responding to Scale 7 of the MMPI-2 Center for Rural Health, Seven Generations Center of Excellence in Native Behavioral Health, School of Medicine and Health Sciences, University of North Dakota. Paper presented at APA, 2016.

Yawakie, B.E., Wheeler, M.J., Gray, J.S. and Petros, T. SASSI-3 Sensitivity to Detect Substance Dependence in Northern Plains American Indians Center for Rural Health, Seven Generations Center of Excellence in Native Behavioral Health, School of Medicine and Health Sciences, University of North Dakota. Paper presented at APA, 2016.

Young, A., Kagan, C., Petros, T., and Gray, J.S. Differences in Responding to the Depression Scale on the MMPI-2: Native Americans and Caucasians Center for Rural Health, Seven Generations Center of Excellence in Native Behavioral Health, School of Medicine and Health Sciences, University of North Dakota. Paper presented at APA, 2016.

Lindseth, G., Coolahan, S., Petros, T., Lindseth, P.  (2014). “Neurobehavioral Effects of AspartameConsumption, Research in Nursing and Health. 37(3), 185-193.

Lindseth, P.D., Lindseth, G.N., Petros, T.V., Jensen, W.C., & Caspers, J. (2013). Effects of Hydration on Cognitive Functions of Pilots. Military Medicine, 178, 792-798.

Lindseth,G., Lindseth, P., Jensen, W., Petros, T., Helland, B., & Fossum, D. (2011). Dietary Effects on Cognition and Pilots’ Flight Performance. International Journal of Aviation Psychology, 21(3), 269-282.

Robertson, C., Ayers, F., French, J., Connolly, T., Blickensderfer, E., Petros, T., Summers, M., Weber, R. (2005). The Impact of Scenario Based Training, Traditional Training and Familiarization on Transfer from Analog gauge to TAA Aircraft. Paper presented at the 13th Biannual Symposium on Aviation Psychology, Oklahoma City, Oklahoma.

Petros, T., Bridewell, J., Jensen, W., Ferraro, F.R., Bates, J., Moulton, P., Turnwell, S., Rawley, D., Howe, T., & Gorder, D. (2003). Postintoxication Effects of Alcohol on Flight Performance After Moderate and High Blood Alcohol Levels. The International Journal of Aviation Psychology, 13, 287-300.

Jensen, W., Petros, T., Moulton, P., Boehle, J., & O’Keefe, S. The Influence of Circadian Variations and Moderate Levels of Simulated Altitude on Sustained Cognitive Performance. Paper presented at the 12th International Symposium on Aviation Psychology, Dayton, Ohio, 2003.

Bartholomew, C.J., Jensen, W., Petros, T.V., Ferraro, F.R., Fire, K., Biberdorf, D., Fraley, E., Schalk, J., & Blumkin, D. (1999). The effect of moderate levels of simulated altitude on sustained cognitive performance. International Journal of Aviation Psychology, 9, 351-359.

Poltavski, D. V., Petros, T. V & Holm, J. E. (2012). Lower but not higher doses of transdermal nicotinefacilitate cognitive performance in smokers on gender non-preferred tasks. Pharmacology, Biochemistry and Behavior, 102, 423-433.

Poltavski, D. & Petros, T. (2006). Effects of transdermal nicotine on attention in adult non-smokers with and

without attentional deficits. Physiology & Behavior, 87, 614-624Poltavski, D. & Petros, T. (2005). Effects of Transdermal Nicotine on Prose Memory and Attention in Smokers

and Non-Smoker. Physiology & Behavior, 83, 833-843Krebs, S., Petros, T., & Beckwith, B. (1994). The Effects of Smoking on Memory for Prose. Physiology and

Behavior, 56, 723-727.Poltavski, D. V., Marino, J., Guido, J., Kulland, A., & Petros, T. (2011). Effects of Acute Alcohol Intoxication

on Verbal Memory in Young Men as a Function of Time of Day. Physiology and Behavior, 102, 91-95.Moulton, P.L., Petros, T.V., Apostal, K.J., Park, R.V., Ronning, E.E., King, B.M., & Penland, J.G.(2005).

Alcohol-Induced Impairment and Enhancement of Memory: A Test of the Interference Theory. Physiology & Behavior, 85, 240-245.

Haut, J. S., Beckwith, B. E., & Petros, T. V. (1990). Acute ethanol intoxication, gender differences, and prose processing. Pharmacology,Biochemistry, and Behavior, 36, 439-440.

Lamberty, G., Beckwith, B. E., Petros, T. V., & Ross, A. (1990). Post-Trial Treatment with Ethanol Enhances Recall of Prose Narratives. Physiology & Behavior, 48, 653-658.

Haut, J. S., Beckwith, B. E., Petros, T. V., and Russell, S. (1989). Gender differences in retrieval from long-term memory following acute intoxication with ethanol. Physiology and Behavior, 45, 1161-1165.

Petros, T. V., Kerbel, N., Beckwith, B. E., Sacks, G., & Sarafolean, M. (1985). The Effects of Alcohol on Prose Memory. Physiology &Behavior, 35, 43-46.

MacPherson, J., Sternhagen, S., Miller, T., Devitt, M., Petros, T. V., & Beckwith, B. (1996). The Effect of Caffeine, Impulsivity, and Gender on the Components of Text Processing and Recall. Experimental and Clinical Psychopharmacology, 4, 438-446.

Arnold, M. E., Petros, T., Beckwith, B. E., Coons, G., & Gorman, N. (1987). The Effects of Caffeine, Impulsivity, and Sex on Memory for Word Lists. Physiology & Behavior, 41, 25-30.

Erickson, G., Hager, L. B., Houseworth, C., Dungan, J., Petros, T. V., & Beckwith, B. E. (1985). The Effects of Caffeine on Memory for Word Lists. Physiology & Behavior, 35, 47-51.

Beckwith, B. E., Petros, T.V., Bergloff, P. J., & Swenson, R. R. (1995). Failure of Posttrial Administration of Vasopressin Analogue (DDAVP) to Influence Memory in Healthy, Young, Male Volunteers. Peptides, 16, 1327-1328.

Beckwith, B. E., Petros, and Swenson, R. R. (1991). Do vasopressin-like neuropeptides influence human memory? In Biological Psychiatry, Vol 2 edited by G. Racagni, N. Brunello, & T. Fukuda. The Netherlands:Elsevier, pp 531-533.

Beckwith, B. E., Petros, T. V., & Knutson, K. (1990). Effects of DDAVP on Gender Specific Verbal and Visuospatial Tasks in healthy Young Adults. Peptides, 11, 1313-1315.

Beckwith, B. E., Petros, T. V., Couk, D. I., & Tinius, T. P. (1990). The Effects of Vasopressin in Healthy Young Adult Male Volunteers: Theoretical and Methodological Issues. In the Annals of the NewYorkAcademy of Science, 579, 215-226.

Beckwith BE, Petros TV, Bergloff, PJ, Staebler RJ. Vasopressin analogue (DDAVP) facilitates recall of narrative prose. Behav Neurosci. 1987 Jun;101(3):429-32. PubMed PMID: 3606814.

Beckwith, B. E., Petros, T., Beckwith, S. K., Couk, D. I., Haug, R. J., & Ryan, C. (1982). Vasopressin analog (DDAVP) facilitates concept Learning in human males. Peptides, 3, 627-630

Beckwith BE, Petros TV, Scaglione C, Nelson J. Dose-dependent effects of hydrocortisone on memory in human males. Physiol Behav. 1986;36(2):283-6. PubMed PMID: 3961002.

Selected Research Support

The UND Psychological Department Study Management System (co-authored with Mark Grabe and Bruce Sawler). This was a $100,000 grant of computer hardware and software from the Digital Equipment Corporation to develop computer assisted study management programs, 1985.

Carry-over Effect of Ethanol on Pilot Performance. Thomas V. Petros, PI, Warren C. Jensen, Co-PI, John B. Bridewell, Co-PI, F. R. Ferraro, Co-PI (6/97-5/98 extended until 5/99). Alcoholic Beverage Medical Research Foundation. Direct Costs, $33,000.

Impact of Pesticide Exposure on Cognition in Children. (2003-2005). Funded by the National Institute of Environmental and Health Sciences. Academic Research Enhancement Award, $100,000.

Co-PI on a grant entitled Northern Plains Center for Behavioral Research with Dr. Glenda Lindseth of the Nursing College a the PI. The grant was funded for $4,000,000 to construct a new building for reseach.

Northern Plains Center for Research Translation: Bridging Research and Practice 1P20 RR 023489-01 Co-Collaborator DHHS 9/06-9/07 Direct Costs: $149,783

Center of Excellence for Unmanned Aerial Vehicle (UAV) and Simulation Applications Co-Investigator ND Dept. Commerce 6/06-6/08 Direct Costs: $1,000,000

Petros, T., Ferraro, R., Lindseth, P., Jensen, W., & Higgins, J. Factors that Moderate Age-Related Changes in Pilot Performance and Decision Making. Grant submitted to the Airline Owner’s and Pilot Association. Funded $368,519.00 Beginning and End Dates: 1/1/08 to 12/31/09

Kenville, K., Higins, J., Jensen, W., Petros, T., McBride, R. Airposrt and Air Carrier Resource Manuel: Employees Coping with Traumatic Events. Grant submitted to the Airport Cooperative Research Program of the Transportation Research Board. Funded $299,416. 9/07 to 10/8.

Automated Terminal Airspace Technologies. Department of Defense Grant to Northrup Gruman who subcontracted with UND. The subcontract to UND was to Petros, T. & Kroeber, S. Petros was the PI for the subcontract to UND. The duration of the grant was 11/16/16 to 11/11/17. The amount for UND was $50,000.

Optomizing Human-Automation Team Workload through a Non-Invasive Detection System. Defense Advanced Research Projects Agency Phase 1 Grant to Sonalysts,Inc and to UND. The contract to UND was to Petros, T. & Poltavski, D. Petros was the PI for the contract to UND. The duration of the grant was 3/1/2017 to 2/28/2018. The amount for UND was $60,000.

REFERENCES

Athey, E.K., Leslie, M.S., Briggs, L. A., Park, J., Falk, N. L., Pericak, A., El-Banna, M. M., Greene, J (2016).

How important are autonomy and work setting to nurse practitioners’ job satisfaction? Journal

of the American Association of Nurse Practitioners, 28(6), 320 – 326. doi: 10.1002/2327-6924.12292

Austin, C.L., Saylor, R., & Finley, P.J. (2017). Moral distress in physicians and nurses: Impact on professional

quality of life and turnover, Psychological Trauma: Theory, Research, Practice, and Policy,9(4),

399-406.

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology,

3(2), 77-101. doi: 10.1191/1478088706qp063oa

Brewer, C.S., Chao, Y., Colder, C.R., Kovner, C.T., & Chacko, T.P. (2015). A structural equation model of

turnover for a longitudinal survey among early career registered nurses. International Journal of

Nursing Studies. 52, 1735-1745. doi:10.1016/j.ijnurstu.2015.06.017

Brewer, C. S., Kovner, C. T., Greene, W., Tukov-Shuser, M., & Djukic, M. (2012). Predictors of actual

turnover in a national sample of newly licensed registered nurses employed in hospitals. Journal

of Advanced Nursing, 68(3), 521-538. doi: 10.1111/j.1365-2648.2011.05753.x

Brom, H.M., Melnyk, B.M., Szalacha, L.A., Graham, M. (2016). Nurse practitioners’ role perception, stress,

satisfaction, and intent to stay at a Midwestern academic medical center. Journal of the

American Association of Nurse Practitioners, 28(5), 269-276. doi: 10.1002/2327-6924.12278

Budden, J., Moulton, P., Harper, K., Brunell, M. & Smiley, R. (2016). The 2015 National Nursing Workforce

Survey. Journal of Nursing Regulation, 7(1), Supplement S4-S92.

Budden, J., Zhong, E., Moulton, P. & Cimiotti, J. (2013). The National Council of State Boards of Nursing and

The Forum of State Nursing Workforce Centers 2013 National Workforce Survey of RNs.

Journal of Nursing Regulation, 4(2), 5-14.

Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research. (3rd ed.).

Thousand Oaks, CA: SAGE publications.

Freudenberger, H. J. (1974). Staff burnout. Journal of Social Issues, 30, 159-165.

Greer, A. (2008, June). Embracing accountability: Physician leadership, public reporting, and teamwork in the

Wisconsin Collaborative for Healthcare Quality. Commonwealth Fund, Pub.1142. New York,

NY: www.commonwealthfund.org

Hayes, L. J., O’Brien-Pallas, L., Duffield, C., Shamian, J., Buchanan, J., Hughes F., Laschinger, H. K. S.,

North, N. (2012). Nurse turnover: A literature review update. International Journal of Nursing

Studies, 49, 887-905. doi:10.1016/j.ijnurstu.2011.10.001

Institute of Medicine (2015). Assessing Progress on the Institute of Medicine Report: The Future of Nursing.

Available online at http://www.nationalacademies.org/hmd/Reports/2015/Assessing-Progress-

on-the-IOM-Report-The-Future-of-Nursing.aspx Last accessed 9/13/2018.

Jang, I., Kim, Y., & Kim, K. (2016). Professionalism and professional quality of life for oncology nurses,

Journal of Clinical Nursing. doi:10.1111/jocn.13330

Jones, S. J. (2017). Establishing a nurse mentor program to improve nurse satisfaction and intent to stay.

Journal for Nurses in Professional Development, 33(2), 76-78. doi:

10.1097/NND.0000000000000335

Keesler, J.M. (2017). An evaluation of individual and organizational factors in predicting professional quality of

life among direct support professionals in intellectual/developmental disability services,

Dissertation Abstracts International Section A: Humanities and Social Sciences, 78(4-A)

Kovner, C. T., Brewer, C. S., Greene, W., & Fairchild, S. (2009). Understanding new registered nurses’ intent

to stay at their jobs. Nursing Economics, 27(2), 81-98.

Li, A., Early, S.F., Mahrer, N.E., Klaristenfeld, J.L., & Gold, J.I. (2014). Group Cohesion and Organizational

Commitment: Protective Factors for Nurse Residents' Job Satisfaction, Compassion Fatigue,

Compassion Satisfaction, and Burnout, Journal of Professional Nursing, 30(1), 89-99.

doi:10.1016/j.profnurs.2013.04.004

Ludick, M., & Figley, C. R. (2017). Toward a mechanism for secondary trauma induction and reduction:

Reimagining a theory of secondary traumatic stress. Traumatology, 23(1), 112-123.

doi:10.1037/trm0000096

Luther, L., Gearhart, T., Fukui, S., Morse, G., Rollins, A. L., & Salyers, M. P. (2017). Working overtime in

community mental health: Associations with clinician burnout and perceived quality of care.

Psychiatric Rehabilitation Journal, 40(2), 252-259. doi:10.1037/prj0000234

Maslach, C., & Jackson, S. E. (1986). MBI: Maslach Burnout Inventory; Manual Research Edition. University

of California, Consulting Psychologists Press, Palo Alto, CA.

Medicare Payment Advisory Commission. (2008). Report to the Congress: Reforming the delivery system.

Washington, DC.

Molanari, D. L., Jaiswal, A., & Hollinger-Forrest. (2011). Rural nurses: Lifestyle preferences and education

perceptions. Online Journal of Rural Nursing and Health Care, 11(2), 16-26.

doi.org/10.14574/ojrnhc.v11i2.27

Molanari, D.L., Jaiswal, A., & Peterson, T. (2012). Rural nurses perceptions of organizational culture and the

intent to move. In D. Molinari & A. Bushy (Eds.), The rural nurse: Transition to practice

(pp. 61-70). New York: Spring Publishing Company.

Moulton, P. (2015). Testimony to the Committee for Evaluation of the Impact of the Institute of Medicine

Report: The Future of Nursing: Leading Change, Advancing Health. Nursing Education and

Workforce Data Panel. National Academy of Sciences Building July 27, 2015. Washington D.C.

Last accessed online on 9/13/2018 at

http://www.nationalacademies.org/hmd/Activities/Workforce/FutureofNursingImpact.aspx

Moulton, P. (2018). 2018 Supply and Demand Projections Technical Report. North Dakota Center for Nursing

Research Publication #12. Last accessed online on 9/13/2018 at

https://www.ndcenterfornursing.org/wp-content/uploads/2018/09/FInal-Nurse-Supply-and-

Demand-Projections-2018-Technical-Document.pdf

Moulton, P., Lacey, L., Flynn, L., Kovner, C., & Brewer, C. (2009). Addressing the Complexities of Survey

Research. Nursing Policy Research: Turning Evidence-based Research into Health Policy.

NewYork: Springer Publishing Company.

Moulton, P., Wiebusch, PL., Cleary, BL., Brunell, ML, Napier, DF, Bienemy, C., LeVasseur, SA., Cimiotti, JP.

(2012). Towards Standardization (Part 2): Status of Implementation of National Nursing

Workforce Minimum Data Sets. Policy, Politics and Nursing Practice, 13(3), 162-169.

National Forum of State Nursing Workforce Centers (2016) Minimum Nurse Supply Dataset Last Accessed on

09/25/2018 at http://nursingworkforcecenters.org/wp-content/uploads/2016/11/National-Forum-

Supply-Minimum-Dataset_September-2016.pdf

Nooney, J., Cleary, B., Moulton, P., Wiebusch, P., Murray, J., Yore, M., Brunell, M. (2010). Towards

Standardization (Part 1): Assessment of State and National Nursing Workforce Data Sources.

Policy, Politics and Nursing Practice, 11(3), 173-183.

North Dakota Board of Nursing (2017). State of North Dakota Board of Nursing Annual Report. Last accessed

on 09/13/2018 at https://www.ndbon.org/download_resource.asp?id=692.

North Dakota Governor’s Nursing Shortage Taskforce (2018). North Dakota’s Nursing Shortage: A Rport of

Recommendations to Address the Nursing Shortage in North Dakota. Available upon request.

Owens, R.A. (2018). Transition experiences of new rural nurse practitioners. The Journal for Nurse

Practitioners, 14(8), 605 - 612. doi: 10.1016/j.nurpra.2018.05.009

Patton, M. (1990). Qualitative evaluation and research methods. Newbury Park, CA. Sage Publications.

Price, J. L. (2001). Reflections on the determinants of voluntary turnover. International Journal of

Manpower. 22(7), 600-624.

Ross, J. (2016). Organizational support, workload, and intent to stay: Work environment perceptions in

perianesthesia nursing units. Journal of Perianesthesia Nursing, 32(4), 287-294.doi:

10.1016/j.jopan.2015.07.001

Samios, C., Abel, L.M., & Rodzik, A.K. (2013) The protective role of compassion satisfaction for therapists

who work with sexual violence survivors: an application of the broaden-and-build theory of

positive emotions. Anxiety, Stress & Coping, 26(6), 610- 623. 

doi:10.1080/10615806.2013.784278

Schaufeli, W. B., & Buunk, B. P. (1996). Professional burnout. Handbook of Work and Health Psychology,

311-346.

Stamm, B. H. (2005) The ProQOL Manual. Idaho: Sidran Press.

Stamps, P. L. (1997). Nurses and work satisfaction: An index for measurement. (2nd ed.). Chicago, IL: Health

Administration Press.

Van Osch, M., Scarborough, K., Crowe, S., Wolff, A. C., & Reimer-Kirkham, S. (2018). Understanding the

factors which promote registered nurses’ intent to stay in emergency and critical care areas.

Journal of Clinical Nursing, 27, 1209-1215. doi:10.1111/jocn.14167

Wakefield, M. & Moulton, P. (2008). Enhancing Health Care for Rural Populations through

Interdisciplinary training and quality improvement. Submitted to the Advisory committee on

Interdisciplinary Community-Based Linkages, Division of Diversity and Interdisciplinary

Education, Bureau of Health Professions, Health Resources and Services Administration. Last

accessed on 9/25/2018 at

https://www.hrsa.gov/advisorycommittees/bhpradvisory/acicbl/Reports/eighthreport.pdf

Wells-English, D. (2018). Compassion fatigue as it relates to nurse turnover in oncology nurses at an urban

hospital, DNP Scholarly Projects, 7.

Winters, C.A., & Lee, H.J. (2018. Rural nursing: Concepts, theory, and practice. (5th ed.). New York: Springer

Publishing Company.

Yang, Y.H. & Kim, J.K. (2016). Factors influencing turnover intention in clinical nurses: Compassion fatigue,

coping, social support, and job satisfaction. Korean Academy of Nursing Administration, 22(5),

562-569. doi:10.11111/jkana.2016.22.5.562 

Yarbrough, S., Martin, P., Alfred, D., & McNeil, C. (2017). Professional values, job satisfaction, career

development, and intent to stay. Nursing Ethics. 24(6), 675-685.

doi:10.1177/0969733015623098

Zwilling, J., & Owens, R. A. (2017). North Dakota Nurse Practitioners 2017: Understanding the workforce.

Grand Forks, ND: University of North Dakota, College of Nursing and Professional Disciplines.