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The nursing profession is engaged in robust national dialogue on how to implement competency-based education. This dialogue often conflates the concept of "competency-based education" with nursing "competence" or "practice readiness." Our aim is to discuss the potential harms of conflating "competency-based education" with "competence" or "practice readiness." This commentary explores the possible risks of issue conflation. Risks include (a) suggesting that nurses who have successfully obtained licensure are not "competent" or "ready to practice," and (b) de-emphasizing the importance of safe and sustainable work environments for new graduate nurses. We discuss the need to separate conversations about "competency-based education" and "practice readiness"; the need to increase the clarity and specificity of discourse surrounding competency-based education; and the need for strategic alignment across academia and practice.

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Preceptors are responsible for departmental specific orientation and shaping the development of the new graduate in the early weeks and months of their nursing career. Turnover of direct care nurses has increased at an alarming rate since the start of the pandemic and new graduate nurses continue to be in high demand, but the diminishing number of qualified preceptors presents a challenge. Innovative approaches are needed to make way for increasing the pace of hiring and onboarding new graduates. A group orientation approach was identified as an opportunity to redesign orientation for newly licensed registered nurses in an employer-based transition to practice nurse residency programs. Findings from the first cohort suggest that leaders, preceptors, direct care nurses, and new graduate orientees were satisfied with a group orientation model. Preparing novice nurses to enter practice requires organizational commitment and resources. Group orientation may be a useful approach to foster new graduate nurses' transition to practice and advance the preceptor role.

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Strong partnerships are essential to lead the innovative change needed to prepare future nurses who demonstrate quality and safety competence. Successful models involve senior leadership, a shared vision, mutual goals, mutual respect, and an access to shared knowledge. The academic-practice partnership between a private university-based school of nursing and its affiliated health care system facilitated the implementation of a new Accelerated Bachelor of Science in Nursing (ABSN) program track to provide a seamless education to practice pathway for graduate nurses educated with quality and safety competencies and to meet the workforce demands of the health care system. The academic-practice model is based on the Guiding Principles outlined by the American Association of Colleges of Nursing-American Organization of Nurse Leaders (AACN-AONL) Task Force on Academic Practice Partnerships. As a result of this partnership, 84% of the program's graduates accepted a position with the health care partner as an advanced medical-surgical nurse, and student outcomes in quality and safety competencies were encouraging.

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BACKGROUND: Workplace incivility is a common problem in nursing, and novice nurses are particularly vulnerable to incivility. METHOD: Cognitive rehearsal training to defend against incivility was presented to resident nurses. RESULTS: Three months after the educational intervention, 55% of nurses reported that they had witnessed incivility in the past month and 45% reported that they had responded to the incivility when it occurred. CONCLUSION: Most of the nurses expressed that the training improved their ability to manage incivility. Responses to open-ended comments revealed that incivility adversely affects the workplace and that leaders also may benefit from education on incivility and cognitive rehearsal. [J Contin Educ Nurs. 2021;52(5):232-239.].

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COVID-19 required innovative approaches to educating health professions students who could no longer attend in-person classes or clinical rotations. Interprofessional education (IPE) activities were similarly impacted. To replace an in-person IPE activity slated for this spring, nursing and medical students with similar levels of clinical experience came together to attend a synchronous virtual session focused on discharge planning. The class objectives focused on the IPEC competencies of Role/Responsibility and Interprofessional Communication. Discussion revolved around the discharge planning process for an elderly patient with multiple medical problems, as this is a time when interprofessional collaboration has a clear benefit to patients. Twenty-eight nursing students and eleven medical students attended a 90 min session via Zoom. Students received pre-readings, the day's agenda, learning objectives, and discussion questions in advance. The session had three sections: introduction/welcome, breakout sessions, and debrief and evaluation. Four faculty leaders and four students who participated in a similar in-person session in the past served as facilitators. They received a supplemental facilitator guide for use if students were not able to sustain their discussions for the allotted time. Materials can be accessed by contacting the corresponding author (BR). Students completed a post-session survey, and qualitative analysis demonstrated that they had addressed the two relevant IPEC competencies in their groups and showed evidence of touching on the additional two IPEC competencies as well. Overall, they enjoyed the experience. This virtual experience made scheduling simpler than planning an in-person session and allowed this activity to occur despite restrictions secondary to the pandemic. This might remain a useful format for similar sessions in the future.

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OBJECTIVE: We explored the perceptions, experience, and meaning of fatigue as a distressing symptom of chronic heart failure (HF). BACKGROUND: Fatigue, a common symptom of HF, may indicate worsening condition. Patients interpret their symptoms to determine the need for assistance. The meaning of fatigue in everyday life for HF patients in the United States is not well understood. METHODS: We performed an interpretive study of in-depth interviews with HF patients (n = 26) who reported fatigue as a symptom, using a thematic analysis of transcripts within an iterative group framework. RESULTS: Fatigue is characterized by patient values related to their self-identity, their body, their experience of time, their environment, and their relationships with others, including the healthcare system. CONCLUSIONS: Fatigue influences perceived proximity to death and how patients try to preserve what they can do. A patient's HF management plan should be tailored and responsive to that patient's experience of fatigue as communicated by the patient.

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In the highly technological environment of critical care, a comprehensive symptom assessment from the patient's perspective is routine. There is a paucity of research related to symptom management in the critical care environment. The lack of understanding of the symptom experience for critical care patients could represent missed opportunities to manage symptoms and minimize suffering. This article discusses the importance of assessing symptoms and symptom clusters in critical care patients and challenges surrounding the assessment of symptom clusters. By understanding symptom clusters, critical care nurses can develop more comprehensive assessments, as well as more tailored intervention strategies.

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