A mixed methods study of the work patterns of full-time nurse practitioners in nursing homes.

PubMed

Martin-Misener, Ruth; Donald, Faith; Wickson-Griffiths, Abigail; Akhtar-Danesh, Noori; Ploeg, Jenny; Brazil, Kevin; Kaasalainen, Sharon; McAiney, Carrie; Carter, Nancy; Schindel Martin, Lori; Sangster-Gormley, Esther; Taniguchi, Alan

2015-05-01

The aim of this study was to explore the integration of the nurse practitioner role in Canadian nursing homes to enable its full potential to be realised for resident and family care. The objective was to determine nurse practitioners' patterns of work activities. Nurse practitioners were introduced in Canadian nursing homes a decade ago on a pilot basis. In recent years, government and nursing home sector interest in the role has grown along with the need for data to inform planning efforts. The study used a sequential mixed methods design using a national survey followed by case studies. A national survey of nurse practitioners included demographic items and the EverCare Nurse Practitioner Role and Activity Scale. Following the survey, case studies were conducted in four nursing homes. Data were collected using individual and focus group interviews, document reviews and field notes. Twenty-three of a target population of 26 nurse practitioners responded to the survey, two-thirds of whom provided services in nursing homes with one site and the remainder in nursing homes with as many as four sites. On average, nurse practitioners performed activities in communicator, clinician, care manager/coordinator and coach/educator subscales at least three to four times per week and activities in the collaborator subscale once a week. Of the 43 activities, nurse practitioners performed daily, most were in the clinician and communicator subscales. Case study interviews involved 150 participants. Findings complemented those of the survey and identified additional leadership activities. Nurse practitioners undertake a range of primary health care and advanced practice activities which they adapt to meet the unique needs of nursing homes. Knowledge of work patterns enables nursing homes to implement the full range of nurse practitioner roles and activities to enhance resident and family care. © 2014 John Wiley & Sons Ltd.

Personality Traits of Nurses in Anesthesia and Family Nurse Practitioner Masters Degree Programs

DTIC Science & Technology

1998-02-01

careers by acquiring on advanced clinical skills such as nurse anesthesia, family nurse practitioner or nurse midwifery . Nurses are drawn to specific...disastrous situation. Attempts to alleviate stress often involve alcohol and drugs . Most nurses who abuse alcohol and drugs are the high achievers, the so...alcohol and drug addiction than other medical specialties with the exception of psychiatrists (McAuliffe, 1984). If students do not enjoy working in

The management of advanced practitioner preparation: a work-based challenge.

PubMed

Livesley, Joan; Waters, Karen; Tarbuck, Paul

2009-07-01

This paper explores the collaborative development of a Master's level advanced practice programme in the context of the radical reform and remodelling of the UK's National Health Service. Some of the educational, managerial and practice challenges are discussed. Changes to education and training in response to key strategic reviews undertaken by the Greater Manchester Strategic Health Authority (North West of England) established a need to develop nurses and allied health care practitioners to advanced practitioner level. This paper considers how employers, commissioners and educationalists worked together to produce a Master's level programme to prepare nurses and other health care practitioners for sustainable advanced practice roles. Developing innovative and effective curricula to meet the needs of post graduate students from varied backgrounds preparing to practice in different contexts with different client groups is challenging. However, the development of individual learning pathways and work-based learning ensures that the student's work and intended advanced practice role remains at the centre of their learning. Analysis of each student's knowledge and skill deficits alongside an analysis of the organization's readiness to support them as qualified advanced practitioners (APs) is instrumental in ensuring that organizations are ready to support practitioners in new roles. Work-based learning and collaboration between students, employers and higher education institutions can be used to enable managers and students to unravel the network of factors which affect advanced practice in health and social care. Additionally, collaborative working can help to create opportunities to develop strategies that will facilitate change. Implications for nursing management Sustainable change concerned with the introduction of advanced practitioner roles present a real challenge for managers at a strategic and operational level. Commissioning flexible, collaborative and

Nurse practitioner integration: Qualitative experiences of the change management process.

PubMed

Lowe, Grainne; Plummer, Virginia; Boyd, Leanne

2018-04-30

The aim of this qualitative research was to explore perceptions of organisational change related to the integration of nurse practitioners from key nursing stakeholders. The ongoing delivery of effective and efficient patient services is reliant upon the development and sustainability of nurse practitioner roles. Examination of the factors contributing to the underutilization of nurse practitioner roles is crucial to inform future management policies. A change management theory is used to reveal the complexity involved. Qualitative interviews were undertaken using a purposive sampling strategy of key stakeholders. Thematic analysis was undertaken and key themes were correlated to the theoretical framework. The results confirm the benefits of nurse practitioner roles, but suggest organisational structures and embedded professional cultures present barriers to full role optimization. Complicated policy processes are creating barriers to the integration of nurse practitioner roles. The findings increase understanding of the links between strategic planning, human resource management, professional and organisational cultures, governance and politics in change management. Effective leadership drives the change process through the ability to align key components necessary for success. Sustainability of nurse practitioners relies on recognition of their full potential in the health care team. The results of this study highlight the importance of management and leadership in the promotion of advanced nursing skills and experience to better meet patient outcomes. The findings reinforce the potential of nurse practitioners to deliver patient centred, timely and efficient health care. © 2018 John Wiley & Sons Ltd.

Understanding nurse practitioner autonomy.

PubMed

Weiland, Sandra A

2015-02-01

This Gadamerian hermeneutic study was undertaken to understand the meaning of autonomy as interpreted by nurse practitioners (NPs) through their lived experiences of everyday practice in primary health care. A purposive sample of nine NPs practicing in primary health care was used. Network sampling achieved a broad swath of primary care NPs and practice settings. Data were collected by face-to-face interviews. Because NP autonomy is concerned with gender and marginalization, Gilligan's feminist perspective was utilized during interpretive analysis. Having Genuine NP Practice was the major theme, reflecting the participants' overall meaning of their autonomy. Practicing alone with the patient provided the context within which participants shaped the meaning of Having Genuine NP Practice. Having Genuine NP Practice had four subthemes: relationships, self-reliance, self-empowerment, and defending the NP role. The understanding of Having Genuine NP Practice will enable NPs to articulate their autonomy clearly and better influence healthcare reform. Implications for advanced practice nursing education include integrating findings into classroom discussion to prompt self-reflection of what autonomy means and socialization to the NP role. ©2014 American Association of Nurse Practitioners.

Reliability and validity of the Nurse Practitioners' Roles and Competencies Scale.

PubMed

Lin, Li-Chun; Lee, Sheuan; Ueng, Steve Wen-Neng; Tang, Woung-Ru

2016-01-01

The objective of this study was to test the reliability and construct validity of the Nurse Practitioners' Roles and Competencies Scale. The role of nurse practitioners has attracted international attention. The advanced nursing role played by nurse practitioners varies with national conditions and medical environments. To date, no suitable measurement tool has been available for assessing the roles and competencies of nurse practitioners in Asian countries. Secondary analysis of data from three studies related to nurse practitioners' role competencies. We analysed data from 563 valid questionnaires completed in three studies to identify the factor structure of the Nurse Practitioners' Roles and Competencies Scale. To this end, we performed exploratory factor analysis using principal component analysis extraction with varimax orthogonal rotation. The internal consistency reliabilities of the overall scale and its subscales were examined using Cronbach's alpha coefficient. The scale had six factors: professionalism, direct care, clinical research, practical guidance, medical assistance, as well as leadership and reform. These factors explained 67·5% of the total variance in nurse practitioners' role competencies. Cronbach's alpha coefficient for the overall scale was 0·98, and those of its subscales ranged from 0·83-0·97. The internal consistency reliability and construct validity of the Nurse Practitioners' Roles and Competencies Scale were good. The high internal consistency reliabilities suggest item redundancy, which should be minimised by using item response theory to enhance the applicability of this questionnaire for future academic and clinical studies. The Nurse Practitioners' Roles and Competencies Scale can be used as a tool for assessing the roles and competencies of nurse practitioners in Taiwan. Our findings can also serve as a reference for other Asian countries to develop the nurse practitioner role. © 2015 John Wiley & Sons Ltd.

Delineating advanced practice nursing in New Zealand: a national survey.

PubMed

Carryer, J; Wilkinson, J; Towers, A; Gardner, G

2018-03-01

A variety of advanced practice nursing roles and titles have proliferated in response to the changing demands of a population characterized by increasing age and chronic illness. Whilst similarly identified as advanced practice roles, they do not share a common practice profile, educational requirements or legislative direction. The lack of clarity limits comparative research that can inform policy and health service planning. To identify advanced practice roles within nursing titles employed in New Zealand and practice differences between advanced practice and other roles. Replicating recent Australian research, 3255 registered nurses/nurse practitioners in New Zealand completed the amended Advanced Practice Delineation survey tool. The mean domain scores of the predominant advanced practice position were compared with those of other positions. Differences between groups were explored using one-way ANOVA and post hoc between group comparisons. Four nursing position bands were identified: nurse practitioner, clinical nurse specialist, domain-specific and registered nurse. Significant differences between the bands were found on many domain scores. The nurse practitioner and clinical nurse specialist bands had the most similar practice profiles, nurse practitioners being more involved in direct care and professional leadership. Similar to the position of clinical nurse consultant in Australia, those practicing as clinical nurse specialists were deemed to reflect the threshold for advanced practice nursing. The results identified different practice patterns for the identified bands and distinguish the advanced practice nursing roles. By replicating the Australian study of Gardener et al. (2016), this NZ paper extends the international data available to support more evidence-based nursing workforce planning and policy development. © 2017 International Council of Nurses.

Nurse Practitioner-Physician Comanagement: A Theoretical Model to Alleviate Primary Care Strain.

PubMed

Norful, Allison A; de Jacq, Krystyna; Carlino, Richard; Poghosyan, Lusine

2018-05-01

Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is comanagement of patients by more than 1 primary care clinician. Comanagement has been investigated in acute care with surgical teams and in outpatient settings with primary care physicians and specialists. Because nurse practitioners are increasingly managing patient care as independent clinicians, our study objective was to propose a model of nurse practitioner-physician comanagement. We conducted a literature search using the following key words: comanagement; primary care; nurse practitioner OR advanced practice nurse. From 156 studies, we extracted information about nurse practitioner-physician comanagement antecedents, attributes, and consequences. A systematic review of the findings helped determine effects of nurse practitioner-physician comanagement on patient care. Then, we performed 26 interviews with nurse practitioners and physicians to obtain their perspectives on nurse practitioner-physician comanagement. Results were compiled to create our conceptual nurse practitioner-physician comanagement model. Our model of nurse practitioner-physician comanagement has 3 elements: effective communication; mutual respect and trust; and clinical alignment/shared philosophy of care. Interviews indicated that successful comanagement can alleviate individual workload, prevent burnout, improve patient care quality, and lead to increased patient access to care. Legal and organizational barriers, however, inhibit the ability of nurse practitioners to practice autonomously or with equal care management resources as primary care physicians. Future research should focus on developing instruments to measure and further assess nurse practitioner-physician comanagement in the primary care practice setting. © 2018 Annals of Family Medicine, Inc.

Pediatric nurse practitioners: influences on career choice.

PubMed

Freed, Gary L; Dunham, Kelly M; Martyn, Kristy; Martin, Jean; Moran, Lauren M; Spera, Laura

2014-01-01

The demand for hiring pediatric nurse practitioners (PNPs) is strong. However, the number of newly educated PNPs has remained relatively flat during the past several years. Understanding the rationale and timing for the decision to pursue this profession is essential to having a positive impact on increasing the future workforce. A mail survey of all new PNPs certified between January 2009 and July 2011 (N = 1040) was conducted. The response rate was 79.9%. Nearly half of all respondents (45%, N = 314) reported that they work in outpatient general pediatrics, 26% (N = 184) in outpatient subspecialty pediatrics, and 22% (N = 152) in inpatient settings. More than one third (36%, N = 253) spend most of their time in a private practice. Forty percent (N = 307) reported that they decided to pursue education as an advanced practice nurse while in practice as a registered nurse (RN), and 38% (N = 289) made the decision before pursuing RN education. Efforts to increase the PNP pipeline will need to be directed both to students during their RN education and to creating opportunities for current RNs to pursue advanced practice nurse education that is focused on children. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Advanced practice nursing role delineation in acute and critical care: application of the strong model of advanced practice.

PubMed

Mick, D J; Ackerman, M H

2000-01-01

This purpose of this study was to differentiate between the roles of clinical nurse specialists and acute care nurse practitioners. Hypothesized blending of the clinical nurse specialist and acute care nurse practitioner roles is thought to result in an acute care clinician who integrates the clinical skills of the nurse practitioner with the systems knowledge, educational commitment, and leadership ability of the clinical nurse specialist. Ideally, this role blending would facilitate excellence in both direct and indirect patient care. The Strong Model of Advanced Practice, which incorporates practice domains of direct comprehensive care, support of systems, education, research, and publication and professional leadership, was tested to search for practical evidence of role blending. This descriptive, exploratory, pilot study included subjects (N = 18) solicited from an academic medical center and from an Internet advanced practice listserv. Questionnaires included self-ranking of expertise in practice domains, as well as valuing of role-related tasks. Content validity was judged by an expert panel of advanced practice nurses. Analyses of descriptive statistics revealed that clinical nurse specialists, who had more experience both as registered nurses and in the advanced practice nurse role, self-ranked their expertise higher in all practice domains. Acute care nurse practitioners placed higher importance on tasks related to direct comprehensive care, including conducting histories and physicals, diagnosing, and performing diagnostic procedures, whereas clinical nurse specialists assigned greater importance to tasks related to education, research, and leadership. Levels of self-assessed clinical expertise as well as valuing of role-related tasks differed among this sample of clinical nurse specialists and acute care nurse practitioners. Groundwork has been laid for continuing exploration into differentiation in advanced practice nursing roles. As the clinical

42 CFR 440.166 - Nurse practitioner services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Nurse practitioner services. 440.166 Section 440... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.166 Nurse practitioner services. (a) Definition of nurse practitioner services. Nurse practitioner services means services that...

42 CFR 440.166 - Nurse practitioner services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Nurse practitioner services. 440.166 Section 440... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.166 Nurse practitioner services. (a) Definition of nurse practitioner services. Nurse practitioner services means services that...

42 CFR 441.22 - Nurse practitioner services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Nurse practitioner services. 441.22 Section 441.22... General Provisions § 441.22 Nurse practitioner services. With respect to nurse practitioner services that... State plan must meet the following requirements: (a) Provide that nurse practitioner services are...

42 CFR 441.22 - Nurse practitioner services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Nurse practitioner services. 441.22 Section 441.22... General Provisions § 441.22 Nurse practitioner services. With respect to nurse practitioner services that... State plan must meet the following requirements: (a) Provide that nurse practitioner services are...

The perceptions of key stakeholders of the roles of specialist and advanced nursing and midwifery practitioners.

PubMed

Casey, Mary; O'Connor, Laserina; Nicholson, Emma; Smith, Rita; O'Brien, Denise; O'Leary, Denise; Fealy, Gerard M; Mcnamara, Martin S; Stokes, Diarmuid; Egan, Claire

2017-12-01

To explore the perceptions of key stakeholders of the roles of specialist and advanced nursing and midwifery practitioners. There is evidence that the contribution of these roles to patient care is poorly understood. This research took place over 2 months in 2015 and is part of a larger study involving a rapid review to inform policy development on the specialist and advanced nursing and midwifery practice in Ireland. As an added value, a qualitative element involving thematic analysis was undertaken with key stakeholders. A phenomenological qualitative study was conducted incorporating semi-structured interviews with key stakeholders (n = 15). Purposive sampling with maximum diversity was used to recruit a wide range of perspectives. Participant's perspectives led to seven themes: Impact of these roles; role preparation, experience and organizational support; specialist and advanced practice roles in an interdisciplinary context; different folks but not such different roles; impact of specialist and advanced practice roles on patient outcomes; barriers and facilitators to enacting specialist and advanced practice roles; future development of these roles. There is acknowledgement of the positive impact of specialist and advanced practitioners; however, the evidence is currently not conclusive. Preparation for these roles needs to reflect changes in the calibre of today's professional applicants, and organizational support is paramount to their successful execution. The contribution of their activity to patient outcome needs to be made visible to enhance these roles and to justify the development of new roles across a variety of healthcare areas. © 2017 John Wiley & Sons Ltd.

Microcomputer Nurse-Practitioner Protocols

PubMed Central

Way, Anthony B.; Rowley, Blair A.; White, Melanie A.

1982-01-01

We have developed a set of protocols on a microcomputer to assist in the management of a geographically isolated nurse practitioner. If a mid-level practitioner is supervised by a physician, some system is needed to ensure that approved care is being provided. The currently available paper-based protocols do not adequately serve all the needs for training, auditing, and record keeping. Conversely, adequate systems based on large computers are not feasible for small clinics. We have therefore developed a microcomputer-based system of protocols for a small rural nurse-practitioner's clinic. Our programs are designed for direct use by the practitioners while the patient is in the clinic. The user is given immediate feedback about any errors. The supervisor is later provided with a summary of the protocol uses and errors, and a copy of any erroneous records. The system appears to be easy to use by the nurse practitioner. The protocols are quickly learned and auditing is facilitated.

5-years later - have faculty integrated medical genetics into nurse practitioner curriculum?

PubMed

Maradiegue, Ann H; Edwards, Quannetta T; Seibert, Diane

2013-10-31

Abstract Many genetic/genomic educational opportunities are available to assist nursing faculty in their knowledge and understanding of genetic/genomics. This study was conducted to assess advance practice nursing faculty members' current knowledge of medical genetics/genomics, their integration of genetics/genomics content into advance practice nursing curricula, any prior formal training/education in genetics/genomics, and their comfort level in teaching genetics/genomic content. A secondary aim was to conduct a comparative analysis of the 2010 data to a previous study conducted in 2005, to determine changes that have taken place during that time period. During a national nurse practitioner faculty conference, 85 nurse practitioner faculty voluntarily completed surveys. Approximately 70% of the 2010 faculty felt comfortable teaching basic genetic/genomic concepts compared to 50% in 2005. However, there continue to be education gaps in the genetic/genomic content taught to advance practice nursing students. If nurses are going to be a crucial member of the health-care team, they must achieve the requisite competencies to deliver the increasingly complex care patients require.

Nurse Practitioner Pharmacology Education.

ERIC Educational Resources Information Center

Waigandt, Alex; Chang, Jane

A study compared the pharmacology training of nurse practitioner programs with medical and dental programs. Seventy-three schools in 14 states (40 nurse practitioner programs, 19 schools of medicine, and 14 schools of dentistry) were surveyed by mailed questionnaire about the number of hours devoted to the study of pharmacology. The major findings…

Development of the Nurse Practitioner Standards for Practice Australia

PubMed Central

Buckley, Thomas; Donoghue, Judith; Heartfield, Marie; Bryce, Julianne; Cox, Darlene; Waters, Donna; Gosby, Helen; Kelly, John; Dunn, Sandra V.

2015-01-01

This article describes the context and development of the new Nurse Practitioner Standards for Practice in Australia, which went into effect in January 2014. The researchers used a mixed-methods design to engage a broad range of stakeholders who brought both political and practice knowledge to the development of the new standards. Methods included interviews, focus groups, surveys, and work-based observation of nurse practitioner practice. Stakeholders varied in terms of their need for detail in the standards. Nonetheless, they invariably agreed that the standards should be clinically focussed attributes. The pillars common in many advanced practice nursing standards, such as practice, research, education, and leadership, were combined and expressed in a new and unique clinical attribute. PMID:26162455

Developing a neonatal workforce: role evolution and retention of advanced neonatal nurse practitioners

PubMed Central

Smith, S; Hall, M

2003-01-01

Background: Over the past decade more than 120 advanced neonatal nurse practitioners (ANNPs) have graduated from the Southampton based ANNP programme. Objectives: To determine the scope of practice and evolving role of ANNPs and to identify factors that may affect future recruitment and retention. Method: An open ended structured questionnaire on clinical role, working arrangements, retention and attrition, continuing education, and professional development was sent to 95 ANNPs. Results: A response rate of 83% was achieved. There was an attrition rate of 14%, with most ANNPs remaining in their original seconding unit. Factors considered to be important for role satisfaction included a well defined role, working within a team of ANNPs, appropriate remuneration, and evidence of unit support for both role definition and continuing professional development. Conclusions: Although ANNPs are expensive to both train and employ, this evidence suggests that there is a good return on the investment in terms of retention to the unit and the specialty. Their role incorporates many features of advanced nursing practice as well as providing "value added" neonatal care by merging traditional medical and nursing roles and crossing professional boundaries. In 2004 the manpower challenges for neonatal units will be even more acute; these data confirm that there are effective options available but they require long term strategic planning and investment. PMID:12937050

Early predictors of study success in a Dutch advanced nurse practitioner education program: A retrospective cohort study.

PubMed

Bossema, Ercolie R; Meijs, Tineke H J M; Peters, Jeroen W B

2017-10-01

Study delay and attrition are major concerns in higher education. They cost time and effort, and threaten the availability of higher qualified professionals. Knowing early what factors contribute to delay and attrition may help prevent this. The aim of this study was to examine whether student characteristics, including a literature study report grade as a proxy of cognitive abilities, predicted study success in a dual advanced nurse practitioner education program. Retrospective cohort study, including all 214 students who between September 2009 and September 2015 started the two-year program at the HAN University of Applied Sciences in Nijmegen, the Netherlands. Study success was defined as having completed the program within the envisaged period. Variables examined included: age, gender, previous education (bachelor's degree or in-service training in nursing), work setting (general health, mental health, public health, or nursing home care), and literature study report grade (from 1 to 10). A hierarchical logistic regression analysis was performed. Most students were female (80%), had a bachelor's degree in nursing (67%), and were employed in a general healthcare setting (58%). Mean age was 40.5years (SD 9.4). One hundred thirty-seven students (64%) had study success. Being employed in a general healthcare setting (p≤0.004) and a higher literature study report grade (p=0.001) were associated with a higher study success rate. In advanced nurse practitioner education, study success rate seems associated with the student's cognitive abilities and work field. It might be worthwhile to identify students 'at risk of failure' before the start of the program and offer them extra support. Copyright © 2017 Elsevier Ltd. All rights reserved.

Theoretical links supporting the use of problem-based learning in the education of the nurse practitioner.

PubMed

Chikotas, Noreen Elaine

2008-01-01

The need to evaluate current strategies in educating the advanced practice nurse, specifically the nurse practitioner, is becoming more and more imperative due to the ever-changing health care environment. This article addresses the role of problem-based learning (PBL) as an instructional strategy in educating and preparing the nurse practitioner for future practice.Two theoretical frameworks supporting PBL, andragogy and constructivism, are presented as important to the use of PBL in the education of the nurse practitioner.

The development of advanced nursing practice globally.

PubMed

Sheer, Barbara; Wong, Frances Kam Yuet

2008-01-01

To examine the development of advanced nursing practice globally. Data were collected from documentary resources available in the International Nurse Practitioners/Advanced Practice Nurse Network (INP/APNN) of the International Council of Nurses. The areas examined were guided by the "key informant survey on advanced nursing practice self-administered questionnaire." Two core members of the INP/APNN who have rich experience in global advanced nursing development analyzed the data.A total of 14 countries and three regions from five continents were included in the analyses. The development of advanced nursing practice in these areas is facilitated by a need for better access to care in a cost-containment era and the enhancement of nursing education to postgraduate level. The mechanism for regulation of practice is in place in some countries. Confirms the development of advanced practice in nursing is a global trend. APNs can improve global health with points to enhanced education in nursing and regulation of advanced practice.

Expanding collaborative boundaries in nursing education and practice: The nurse practitioner-dentist model for primary care.

PubMed

Dolce, Maria C; Parker, Jessica L; Marshall, Chantelle; Riedy, Christine A; Simon, Lisa E; Barrow, Jane; Ramos, Catherine R; DaSilva, John D

The purpose of this paper is to describe the design and implementation of a novel interprofessional collaborative practice education program for nurse practitioner and dental students, the Nurse Practitioner-Dentist Model for Primary Care (NPD Program). The NPD Program expands collaborative boundaries in advanced practice nursing by integrating primary care within an academic dental practice. The dental practice is located in a large, urban city in the Northeast United States and provides comprehensive dental services to vulnerable and underserved patients across the age spectrum. The NPD Program is a hybrid curriculum comprised of online learning, interprofessional collaborative practice-based leadership and teamwork training, and clinical rotations focused on the oral-systemic health connection. Practice-based learning promotes the development of leadership and team-based competencies. Nurse practitioners emerge with the requisite interprofessional collaborative practice competencies to improve oral and systemic health outcomes. Copyright © 2017. Published by Elsevier Inc.

The NNP/DNP shortage: transforming neonatal nurse practitioners into DNPs.

PubMed

Pressler, Jana L; Kenner, Carole A

2009-01-01

Neonatal nurse practitioners (NNPs) represent a high-demand specialty practice that is especially targeted for US secondary and tertiary care neonatal intensive care units (NICUs). NNPs make primary decisions about the caregiving of high-risk newborns at the time of admission, throughout hospitalization, at transfer, and at discharge that require an advanced knowledge base in neonatology as well as NICU clinical experience. NNPs prepared at the master's level are currently in very short supply, with some estimates suggesting that for each NNP who graduates, there are 80 positions open across the country. Even with the present shortage, due to the high cost of NNP education, NNP programs are diminishing and those that are remaining are not graduating a sufficient number of new NNPs each year to keep up with the demand. To add to the basic shortage problem, in 2004 the American Association of Colleges of Nursing decided that by 2015, the terminal degree for all nurse practitioners should move from the master's degree to the doctor of nursing practice (DNP) degree. That decision added a minimum of 12 months of full-time education to the advanced education requirements for nurse practitioners. What impact will the decision to require a DNP degree have on NNP specialty practice? Will even more NNP programs close because of faculty shortages of NNPs prepared at the DNP level? If a worse shortage occurs in the number of NNPs prepared to practice in NICUs, will physician assistants or other nonphysician clinicians who meet the need for advanced neonatal care providers replace NNPs? What steps, if any, can nursing take to ensure that NNP specialty practice is still needed and survives after supplementing the DNP requirement to NNP education?

42 CFR 410.75 - Nurse practitioners' services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Nurse practitioners' services. 410.75 Section 410... Nurse practitioners' services. (a) Definition. As used in this section, the term “physician” means a... Medicare Part B coverage of his or her services, a nurse practitioner must be a registered professional...

Mapping the literature of nurse practitioners.

PubMed

Shams, Marie-Lise Antoun

2006-04-01

This study was designed to identify core journals for the nurse practitioner specialty and to determine the extent of their indexing in bibliographic databases. As part of a larger project for mapping the literature of nursing, this study followed a common methodology based on citation analysis. Four journals designated by nurse practitioners as sources for their practice information were selected. All cited references were analyzed to determine format types and publication years. Bradford's Law of Scattering was applied to identify core journals. Nine bibliographic databases were searched to estimate the index coverage of the core titles. The findings indicate that nurse practitioners rely primarily on journals (72.0%) followed by books (20.4%) for their professional knowledge. The majority of the identified core journals belong to non-nursing disciplines. This is reflected in the indexing coverage results: PubMed/MEDLINE more comprehensively indexes the core titles than CINAHL does. Nurse practitioners, as primary care providers, consult medical as well as nursing sources for their information. The implications of the citation analysis findings are significant for collection development librarians and indexing services.

Exploring the potential role of the advanced nurse practitioner within a care path for patients with chronic fatigue syndrome.

PubMed

Ryckeghem, Hannah; Delesie, Liesbeth; Tobback, Els; Lievens, Stefaan; Vogelaers, Dirk; Mariman, An

2017-07-01

To explore the experiences and expectations of patients with chronic fatigue syndrome and general practitioners to develop the potential role of an advanced nurse practitioner at the diagnostic care path of abnormal fatigue developed for regional transmural implementation in the Belgian provinces of East and West Flanders. Patients with chronic fatigue syndrome experience an incapacitating chronic fatigue that is present for at least 6 months. Since many uncertainties exist about the causes and progression of the disease, patients have to cope with disbelief and scepticism. Access to health care may be hampered, which could lead to inappropriate treatments and guidance. Qualitative design. Individual semi-structured interviews were conducted with patients with chronic fatigue syndrome and general practitioners in Belgium. Data were collected over 9 months in 2014-2015. All interviews were audio recorded and transcribed for qualitative analysis using open explorative thematic coding. Fifteen patients and 15 general practitioners were interviewed. Three themes were identified: mixed feelings with the diagnosis, lack of one central intermediator and insufficient coordination. Participants stressed the need for education, knowledge and an intermediator to provide relevant information at the right time and to build up a trust relationship. This qualitative exploration underscores some clear deficiencies in the guidance of patients suffering from chronic fatigue syndrome and abnormal fatigue. An advanced nurse practitioner as a central intermediator in the transmural care of these patients could promote interdisciplinary/multidisciplinary collaboration and effective communication, provide education and ensure a structured and coordinated approach. © 2016 John Wiley & Sons Ltd.

Oncology Advanced Practitioners Bring Advanced Community Oncology Care.

PubMed

Vogel, Wendy H

2016-01-01

Oncology care is becoming increasingly complex. The interprofessional team concept of care is necessary to meet projected oncology professional shortages, as well as to provide superior oncology care. The oncology advanced practitioner (AP) is a licensed health care professional who has completed advanced training in nursing or pharmacy or has completed training as a physician assistant. Oncology APs increase practice productivity and efficiency. Proven to be cost effective, APs may perform varied roles in an oncology practice. Integrating an AP into an oncology practice requires forethought given to the type of collaborative model desired, role expectations, scheduling, training, and mentoring.

The Path to Advanced Practice Licensure for Clinical Nurse Specialists in Washington State.

PubMed

Schoonover, Heather

The aim of this study was to provide a review of the history and process to obtaining advanced practice licensure for clinical nurse specialists in Washington State. Before 2016, Washington State licensed certified nurse practitioners, certified nurse midwives, and certified nurse anesthetists under the designation of an advanced registered nurse practitioner; however, the state did not recognize clinical nurse specialists as advanced practice nurses. The work to drive the rule change began in 2007. The Washington Affiliate of the National Association of Clinical Nurse Specialists used the Power Elite Theory to guide advocacy activities, building coalitions and support for the desired rule changes. On January 8, 2016, the Washington State Nursing Care Quality Assurance Commission voted to amend the state's advanced practice rules, including clinical nurse specialists in the designation of an advanced practice nurse. Since the rule revision, clinical nurse specialists in Washington State have been granted advanced registered nurse practitioner licenses. Driving changes in state regulatory rules requires diligent advocacy, partnership, and a deep understanding of the state's rule-making processes. To be successful in changing rules, clinical nurse specialists must build strong partnerships with key influencers and understand the steps in practice required to make the desired changes.

Orientation program for hospital-based nurse practitioners.

PubMed

Bahouth, Mona N; Esposito-Herr, Mary Beth

2009-01-01

The transition from student to practicing clinician is often a challenging and difficult period for many nurse practitioners. Newly graduated nurse practitioners commonly describe feelings of inadequacy in assuming clinical responsibilities, lack of support by team members, unclear expectations for the orientation period, and role isolation. This article describes the formal nurse practitioner orientation program implemented at the University of Maryland Medical Center, a large urban academic medical center, to facilitate the transition of new nurse practitioners into the workforce. This comprehensive program incorporates streamlined administrative activities, baseline didactic and simulation-based critical care education, ongoing and focused peer support, access to formalized resources, and individualized clinical preceptor programs. This formalized orientation program has proven to be one of the key variables to successful integration of nurse practitioners into our acute care clinical teams.

Developing clinical leaders: the impact of an action learning mentoring programme for advanced practice nurses.

PubMed

Leggat, Sandra G; Balding, Cathy; Schiftan, Dan

2015-06-01

To determine whether a formal mentoring programme assists nurse practitioner candidates to develop competence in the clinical leadership competencies required in their advanced practice roles. Nurse practitioner candidates are required to show evidence of defined clinical leadership competencies when they apply for endorsement within the Australian health care system. Aiming to assist the candidates with the development or enhancement of these leadership skills, 18 nurse practitioner candidates participated in a mentoring programme that matched them with senior nurse mentors. A pre-postlongitudinal intervention study. Eighteen nurse practitioner candidates and 17 senior nurses participated in a voluntary mentoring programme that incorporated coaching and action learning over 18 months in 2012 and 2013. Participants completed a pen and paper questionnaire to document baseline measures of self-reported leadership practices prior to commencement of the programme and again at the end of the programme. The mentors and the nurse practitioner candidates qualitatively evaluated the programme as successful and quantitative data illustrated significant improvement in self-reported leadership practices among the nurse practitioner candidates. In particular, the nurse practitioner candidates reported greater competence in the transformational aspects of leadership, which is directly related to the nurse practitioner candidate clinical leadership standard. A formal, structured mentoring programme based on principles of action learning was successful in assisting Australian advanced practice nurses enhance their clinical leadership skills in preparation for formal endorsement as a nurse practitioner and for success in their advanced practice role. Mentoring can assist nurses to transition to new roles and develop knowledge and skills in clinical leadership essential for advanced practice roles. Nurse managers should make greater use of mentoring programmes to support nurses in

Cooperative m-learning with nurse practitioner students.

PubMed

Wyatt, Tami H; Krauskopf, Patricia B; Gaylord, Nan M; Ward, Andrew; Huffstutler-Hawkins, Shelley; Goodwin, Linda

2010-01-01

New technologies give nurse academicians the opportunity to incorporate innovative teaching-learning strategies into the nursing curricula. Mobile technology for learning, or m-learning, has considerable potential for the nursing classroom but lacks sufficient empirical evidence to support its use. Based on Mayer's multimedia learning theory, the effect of using cooperative and interactive m-learning techniques in enhancing classroom and clinical learning was explored. The relationship between m-learning and students' learning styles was determined through a multimethod educational research study involving nurse practitioner students at two mid-Atlantic universities. During the 16-month period, nurse practitioner students and their faculty used personal digital assistants (PDAs) to participate in various m-learning activities. Findings from focus group and survey responses concluded that PDAs, specifically the Pocket PC, are useful reference tools in the clinical setting and that all students, regardless of learning style, benefited from using PDAs. It was also demonstrated that connecting students with classmates and other nurse practitioner students at distant universities created a cooperative learning community providing additional support and knowledge acquisition. The authors concluded that in order to successfully prepare nurse practitioner graduates with the skills necessary to function in the present and future health care system, nurse practitioner faculty must be creative and innovative, incorporating various revolutionary technologies into their nurse practitioner curricula.

Barriers and enablers to advanced practitioners' ability to enact their leadership role: A scoping review.

PubMed

Elliott, Naomi; Begley, Cecily; Sheaf, Greg; Higgins, Agnes

2016-08-01

Advanced roles such as nurse practitioner, nurse consultant and advanced nurse or midwife practitioner are increasing across the world. In most countries, clinical practice, education, leadership and research are the four components that define the advanced practitioner's role. Of these, leadership is perhaps the most important part of the role, but its study has largely been neglected. There is a risk that failure to identify and respond to barriers to enacting the advanced practitioners' leadership role will limit the extent to which they can become strategic leaders for professional development, and jeopardise the long-term sustainability of the role. To identify the barriers and enablers to advanced practitioner's ability to enact their leadership role. A search of the research literature was undertaken in electronic databases (PubMed, CINAHL, PsycINFO, ProQuest Dissertation and Theses, from inception to 4-6th June 2015), unpublished research in seventeen online research repositories and institutes, and hand search of 2 leadership journals (March/April 2010-4th June 2015). Using pre-set inclusion criteria, the 1506 titles found were screened by two authors working independently. The 140 full text reports selected were reviewed by two authors separately and 34 were included, and data extracted and cross-checked. Any disagreements were discussed by the scoping team until consensus was reached. Using content analysis, the barriers and enablers relating to leadership enactment were sorted into themes based on their common characteristics, and using a Structure-Process-Outcome conceptual framework were categorised under the four structural layers: (1) healthcare system-level, (2) organisational-level, (3) team-level, and (4) advanced practitioner-level. Thirteen barriers to, and 11 enablers of, leadership were identified. Of these a majority (n=14) were related to organisational-level factors such as mentoring, support from senior management, opportunity to

Factors influencing advanced practitioners' ability to enact leadership: a case study within Irish healthcare.

PubMed

Higgins, Agnes; Begley, Cecily; Lalor, Joan; Coyne, Imelda; Murphy, Kathy; Elliott, Naomi

2014-10-01

To report the factors that influence clinical specialists' and advanced nurse practitioners' ability to enact their clinical and professional leadership roles; findings from the SCAPE study. The importance of leadership for specialist and advanced practitioners is highlighted in the international literature and is considered an important factor in the provision of improved patient outcomes. Despite many studies identifying the barriers in developing and integrating new specialist/advanced practice roles into health services, little is known about the factors that influence the leadership dimension of their role. A case study design involving 23 clinical specialist/advanced practitioners working in Ireland and multidisciplinary team members working with them, was used. Data were collected using interview, observation and documentary analysis. Four mediating factors influence the specialist/advanced practitioner's ability to perform a leadership role, namely the presence of a framework for the professional development of the role; opportunities to act as leaders; mechanisms for sustaining leadership; and personal attributes of practitioners. Nursing/midwifery leaders and managers at all levels have a key role in supporting leadership potential, through countering the negative impact of professional isolation, expanding opportunities for specialist/advanced practitioners to influence policy and network with wider professional groups. © 2013 John Wiley & Sons Ltd.

42 CFR 405.2414 - Nurse practitioner and physician assistant services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Nurse practitioner and physician assistant services... nurse practitioner, physician assistant, nurse midwife, or specialized nurse practitioner who is... assistant, nurse midwife or specialized nurse practitioner who furnished the service is legally permitted to...

42 CFR 405.2414 - Nurse practitioner and physician assistant services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Nurse practitioner and physician assistant services... nurse practitioner, physician assistant, nurse midwife, or specialized nurse practitioner who is... assistant, nurse midwife or specialized nurse practitioner who furnished the service is legally permitted to...

42 CFR 405.2414 - Nurse practitioner and physician assistant services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Nurse practitioner and physician assistant services... nurse practitioner, physician assistant, nurse midwife, or specialized nurse practitioner who is... assistant, nurse midwife or specialized nurse practitioner who furnished the service is legally permitted to...

Advancing leadership capacity in nursing.

PubMed

Scott, Elaine S; Miles, Jane

2013-01-01

To address the potential shortage of nurse leaders, the profession must evaluate current strategies in both education and practice. While many new graduates dream of becoming a nurse practitioner or nurse anesthetist, few transition into practice with the goal of becoming a nurse leader. To increase the number of nurses capable of leadership, the profession must address 2 critical issues. First, effort must be made to augment faculty and students' conceptualization of nursing such that leadership is seen as a dimension of practice for all nurses, not just those in formal leadership roles. In so doing, leadership identity development would be seen as a part of becoming an expert nurse. Second, a comprehensive conceptual framework for lifelong leadership development of nurses needs to be designed. This framework should allow for baseline leadership capacity building in all nurses and advanced leadership development for those in formal administrative and advanced practice roles. The knowledge and skill requirements for quality improvement and patient safety have been explored and recommendations made for Quality and Safety Education for Nurses, but parallel work needs to be done to outline educational content, objectives, and effective pedagogy for advancing leadership development in nursing students at all levels.

42 CFR 414.56 - Payment for nurse practitioners' and clinical nurse specialists' services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for nurse practitioners' and clinical nurse... HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners' and clinical nurse specialists' services. (a) Rural areas. For services furnished beginning January 1, 1992 and...

42 CFR 414.56 - Payment for nurse practitioners' and clinical nurse specialists' services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... the service. For assistant-at-surgery services, allowed amounts for the services of a nurse... 42 Public Health 3 2014-10-01 2014-10-01 false Payment for nurse practitioners' and clinical nurse... AND OTHER HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners...

42 CFR 414.56 - Payment for nurse practitioners' and clinical nurse specialists' services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... the service. For assistant-at-surgery services, allowed amounts for the services of a nurse... 42 Public Health 3 2012-10-01 2012-10-01 false Payment for nurse practitioners' and clinical nurse... AND OTHER HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners...

42 CFR 414.56 - Payment for nurse practitioners' and clinical nurse specialists' services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the service. For assistant-at-surgery services, allowed amounts for the services of a nurse... 42 Public Health 3 2013-10-01 2013-10-01 false Payment for nurse practitioners' and clinical nurse... AND OTHER HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners...

42 CFR 414.56 - Payment for nurse practitioners' and clinical nurse specialists' services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the service. For assistant-at-surgery services, allowed amounts for the services of a nurse... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for nurse practitioners' and clinical nurse... HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners' and clinical...

42 CFR 405.2414 - Nurse practitioner and physician assistant services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Nurse practitioner and physician assistant services... Clinic and Federally Qualified Health Center Services § 405.2414 Nurse practitioner and physician... nurse practitioner, physician assistant, nurse midwife, or specialized nurse practitioner who is...

The role of the nurse practitioner in psychiatric/mental health nursing: exploring consumer satisfaction.

PubMed

Wortans, J; Happell, B; Johnstone, H

2006-02-01

There is a substantial body of literature pertaining to the role of the nurse practitioner. Research directed towards consumer satisfaction suggests that the care provided by nurse practitioners is perceived as at least equal to that provided by a medical practitioner. However, there is a paucity of literature examining the nurse practitioner role in the psychiatric/mental health field. An evaluation of a Nurse Practitioner demonstration model has recently been undertaken in the Crisis, Assessment and Treatment Team in Victoria, Australia. This article presents the findings of a qualitative, exploratory study. Individual interviews were conducted with consumers (n = 7) who had received care and treatment provided by the nurse practitioner candidate. Data analysis revealed two main themes: the quality of the service provided, and the unique role of the nurse. The findings supported the available literature in articulating the specific aspects of the nurse practitioner role that are favourably perceived by consumers of services. This study contributes to the limited body of knowledge in the psychiatric/mental health nursing field and specifically emphasizes the importance of the relationship between nurse practitioner and consumer in facilitating the provision of effective care and treatment.

An Exemplar Interprofessional Academic Emergency Nurse Practitioner Program: A Blueprint for Success.

PubMed

Evans, Dian Dowling; Ashooh, Meredith Pollock; Kimble, Laura P; Heilpern, Katherine L

Emergency department census rates and manpower gaps have continued to rise over the past decade, creating a demand for well-prepared emergency nurse practitioners (ENPs). The implementation of the consensus model for advanced practice nurses has brought acknowledgment by leading health care, physician, and nursing organizations of the ENP specialty as critical to building a high-quality emergency care workforce. Recognition of the ENP's unique skill set, and therefore need of specialty certification, has led to a growing interest in the expansion of nurse practitioner curricula in emergency care. This article describes a novel approach for ENP education based on an interprofessional training model, with an in-depth discussion of curriculum development and clinical placement, as well as program outcomes and implications.

Outsourcing issues for nurse practitioner practices.

PubMed

Mackey, Thomas A; McNiel, Nancy O; Klingensmith, Kenneth

2004-01-01

Nurse practitioner managed practices face multiple business and clinical processes. While most practice managers are prepared as clinicians, they are not well prepared to deal with the daily multiple business infrastructure issues they face. To provide for increased efficiency and effectiveness, nurse practitioner practices should consider outsourcing context business functions.

The business management preceptorship within the nurse practitioner program.

PubMed

Wing, D M

1998-01-01

Changes in health care reimbursement practices have affected the way in which primary health care is provided. To be successful, nurse practitioners must have a proficient understanding of basic business functions, including accounting, finance, economics, marketing, and reimbursement practices. Yet, many graduates of nurse practitioner programs are not adequately prepared to make fundamental business decisions. Therefore, it is essential that nurse practitioner faculty provide learning experiences on primary practice business. Because the preceptor experience is an integral aspect of nurse practitioner education, a business preceptorship provides students with pragmatic knowledge of the clinical practice within a business framework. The University of Indianapolis School of Nursing offers a nurse practitioner business preceptorship. The implementation, challenges, and positive outcomes of the course are discussed in this article.

Nurse practitioner job satisfaction: looking for successful outcomes.

PubMed

Pasarón, Raquel

2013-09-01

To examine overall job satisfaction and its association with extrinsic and intrinsic characteristics of job satisfaction among nurse practitioners at the chosen practice site. The objectives were to identify relevant retention and recruitment strategies, from the nurse practitioners perspective, by examining (1) what role aspects are most satisfying, and (2) approaches for successful, professional development and integration in the role. Supportive professional practice environments are particularly important to nurses' satisfaction with their work and the quality of patient care provided. Hence, research that examines nurse practitioners practice implications and barriers in today's healthcare system is essential. A descriptive-correlational design using survey methodology. A nonprobability sample of convenience was used. The outcome measures were: The Misener Nurse Practitioner Job Satisfaction Scale and two investigator-developed surveys. Participants expressed dissatisfaction with professional and monetary recognition, assertive influence, administrative support and collegial relationships. Interaction of subscale factors on overall job satisfaction and demographic survey findings has important implications for health administrators and nurse practitioners in similar organisations. Stakeholders in healthcare milieus need to be fully engaged in the redesign of the American healthcare system heeding the recommendations of the Institute of Medicine to provide safer health systems to the public. By doing this, issues related to frustration by nurse practitioners related to job satisfaction will be addressed. The need for cooperation, participation, collaboration and instrumental communication are essential in the delivery of safe, quality patient care. A better understanding of intrinsic professional rewards needs to be learned by nurse practitioners who want to seek professional satisfaction and engage in the survival and growth of the profession. Nurse

42 CFR 405.2415 - Services and supplies incident to nurse practitioner, physician assistant, certified nurse...

Code of Federal Regulations, 2014 CFR

2014-10-01

... practitioner, physician assistant, certified nurse midwife, clinical psychologist, or clinical social worker... nurse practitioner, physician assistant, certified nurse midwife, clinical psychologist, or clinical social worker services. (a) Services and supplies incident to a nurse practitioner, physician assistant...

The role and experiences of advanced nurse practitioners working in out of hours urgent care services in a primary care setting.

PubMed

Yuill, Jacci

2018-05-30

GPs' workload has increased significantly in recent years affecting their ability to provide high-quality services, and consequently there is increasing focus on nurses to provide a solution. There is little evidence of how advanced nurse practitioners (ANPs) experience their role in out of hours (OOH) services, and it is important to understand their perceptions of this and the challenges they may face in supporting service development and improvement. This article evaluates the role and experiences of ANPs working in an OOH urgent primary care service and identifies important factors that affect their roles. Positive factors enable job satisfaction, but challenges associated with knowledge base, perceptions, role definitions and isolation must be considered for quality and governance purposes. The article describes how supportive systems must be in place to enable mentorship, supervision programmes and development of this group of advanced practitioners. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Critical Thinking Disposition of Nurse Practitioners in Taiwan.

PubMed

Hsu, Hsiu-Ying; Chang, Shu-Chen; Chang, Ai-Ling; Chen, Shiah-Lian

2017-09-01

Critical thinking disposition (CTD) is crucial for nurse practitioners who face complex patient care scenarios. This study explored the CTD of nurse practitioners and related factors. The study was a cross-sectional descriptive design. A purposive sample was recruited from a medical center and its hospital branches in central Taiwan. A structured questionnaire was used to collect data from 210 nurse practitioners. The participants obtained the highest average score on systematicity and analyticity. CTD had a significant positive correlation with fundamental knowledge readiness, professional knowledge readiness, and confidence in making clinical decisions. Professional knowledge readiness, education level, and on-the-job training predicted the score of the participants on overall CTD. On-the-job training and education level may influence the CTD of nurse practitioners. Providing formal or on-the-job continuing education training to nurse practitioners may help enhance their CTD. J Contin Educ Nurs. 2017;48(9):425-430. Copyright 2017, SLACK Incorporated.

Clinical productivity of primary care nurse practitioners in ambulatory settings.

PubMed

Xue, Ying; Tuttle, Jane

Nurse practitioners are increasingly being integrated into primary care delivery to help meet the growing demand for primary care. It is therefore important to understand nurse practitioners' productivity in primary care practice. We examined nurse practitioners' clinical productivity in regard to number of patients seen per week, whether they had a patient panel, and patient panel size. We further investigated practice characteristics associated with their clinical productivity. We conducted cross-sectional analysis of the 2012 National Sample Survey of Nurse Practitioners. The sample included full-time primary care nurse practitioners in ambulatory settings. Multivariable survey regression analyses were performed to examine the relationship between practice characteristics and nurse practitioners' clinical productivity. Primary care nurse practitioners in ambulatory settings saw an average of 80 patients per week (95% confidence interval [CI]: 79-82), and 64% of them had their own patient panel. The average patient panel size was 567 (95% CI: 522-612). Nurse practitioners who had their own patient panel spent a similar percent of time on patient care and documentation as those who did not. However, those with a patient panel were more likely to provide a range of clinical services to most patients. Nurse practitioners' clinical productivity was associated with several modifiable practice characteristics such as practice autonomy and billing and payment policies. The estimated number of patients seen in a typical week by nurse practitioners is comparable to that by primary care physicians reported in the literature. However, they had a significantly smaller patient panel. Nurse practitioners' clinical productivity can be further improved. Copyright © 2016 Elsevier Inc. All rights reserved.

Promoting the nurse practitioner by using a marketing approach.

PubMed

Gallagher, S M

1996-03-01

Being good at what you do is not enough. Despite strong evidence that the nurse practitioner delivers cost-efficient and outcome-based care, few consumers really understand the nurse practitioner's scope of practice. With the current rapidly changing status of health care, the nurse practitioner is presented with many opportunities. Strategies that ensure survival and growth are critical to longevity. Marketing strategies can offer solutions to these challenges. The 4 P's of marketing are discussed as an approach to promote the role of the nurse practitioner.

State-granted practice authority: do nurse practitioners vote with their feet?

PubMed

Perry, John J

2012-01-01

Nurse practitioners have become an increasingly important part of the US medical workforce as they have gained greater practice authority through state-level regulatory changes. This study investigates one labor market impact of this large change in nurse practitioner regulation. Using data from the National Sample Survey of Registered Nurses and a dataset of state-level nurse practitioner prescribing authority, a multivariate estimation is performed analysing the impact of greater practice authority on the probability of a nurse practitioner moving from a state. The empirical results indicate that nurse practitioners in states that grant expanded practice are less likely to move from the state than nurse practitioners in states that have not granted expanded practice authority. The estimated effect is robust and is statistically and economically meaningful. This finding is in concert with and strengthens the wider literature which finds states that grant expanded practice authority to nurse practitioners tend to have larger nurse practitioner populations.

Nursing service innovation: A case study examining emergency nurse practitioner service sustainability.

PubMed

Fox, Amanda; Gardner, Glenn; Osborne, Sonya

2018-02-01

This research aimed to explore factors that influence sustainability of health service innovation, specifically emergency nurse practitioner service. Planning for cost effective provision of healthcare services is a concern globally. Reform initiatives are implemented often incorporating expanding scope of practice for health professionals and innovative service delivery models. Introducing new models is costly in both human and financial resources and therefore understanding factors influencing sustainability is imperative to viable service provision. This research used case study methodology (Yin, ). Data were collected during 2014 from emergency nurse practitioners, emergency department multidisciplinary team members and documents related to nurse practitioner services. Collection methods included telephone and semi-structured interviews, survey and document analysis. Pattern matching techniques were used to compare findings with study propositions. In this study, emergency nurse practitioner services did not meet factors that support health service sustainability. Multidisciplinary team members were confident that emergency nurse practitioner services were safe and helped to meet population health needs. Organizational support for integration of nurse practitioner services was marginal and led to poor understanding of service capability and underuse. This research provides evidence informing sustainability of nursing service models but more importantly raises questions about this little explored field. The findings highlight poor organizational support, excessive restrictions and underuse of the service. This is in direct contrast to contemporary expanding practice reform initiatives. Organizational support for integration is imperative to future service sustainability. © 2017 John Wiley & Sons Ltd.

Education of advanced practice nurses in Canada.

PubMed

Martin-Misener, Ruth; Bryant-Lukosius, Denise; Harbman, Patricia; Donald, Faith; Kaasalainen, Sharon; Carter, Nancy; Kilpatrick, Kelley; DiCenso, Alba

2010-12-01

In Canada, education programs for the clinical nurse specialist (CNS) and nurse practitioner (NP) roles began 40 years ago. NP programs are offered in almost all provinces. Education for the CNS role has occurred through graduate nursing programs generically defined as providing preparation for advanced nursing practice. For this paper, we drew on pertinent sections of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing to describe the following: (1) history of advanced practice nursing education in Canada, (2) current status of advanced practice nursing education in Canada, (3) curriculum issues, (4) interprofessional education, (5) resources for education and (6) continuing education. Although national frameworks defining advanced nursing practice and NP competencies provide some direction for education programs, Canada does not have countrywide standards of education for either the NP or CNS role. Inconsistency in the educational requirements for primary healthcare NPs continues to cause significant problems and interferes with inter-jurisdictional licensing portability. For both CNSs and NPs, there can be a mismatch between a generalized education and specialized practice. The value of interprofessional education in facilitating effective teamwork is emphasized. Recommendations for future directions for advanced practice nursing education are offered.

Challenges and leadership strategies for managers of nurse practitioners.

PubMed

Reay, Trish; Golden-Biddle, Karen; Germann, Kathy

2003-11-01

The aim of this paper is to report on the findings from our research into the recent introduction of nurse practitioners in Alberta, Canada. Through an organizational research perspective, we identify the critical role of health care managers in developing a sustainable nurse practitioner role. Previous literature has focused on nurse practitioners themselves as the key factor in their integration into the health care system. Although they are qualified and organizationally well placed, managers of nurse practitioners have been overlooked as a critical part of implementation strategies. We interviewed 25 nurse practitioners and seven of their managers. Through our data analysis we identified three major challenges for managers: (1) clarifying the reallocation of tasks; (2) managing altered working relationships within the team; (3) continuing to manage the team in an evolving situation. Associated with these challenges, we propose leadership strategies that managers may find useful as they work through the consequences of introducing the nurse practitioner role. These strategies are: * encourage all team members to sort out 'who does what'; * ensure that task reallocation preserves job motivating properties; * give consideration to how tasks have been allocated when issues identified as 'personal conflict' arise; * pay attention to all perspectives of the working relationships within the team; * facilitate positive relationships between team members; * lead from a 'balcony' perspective; * work with the team to develop goals that are not over focused on the nurse practitioner; * regularly share with other managers the experiences and lessons learned in introducing nurse practitioners. For managers to be most effective, they need to address three challenges that are of a managerial, not clinical, nature. By implementing specific leadership strategies, managers of nurse practitioners can facilitate the introduction of the new role and improve its sustainability in

Factors influencing the decision to use nurse practitioners in the emergency department.

PubMed

McGee, Laurie A; Kaplan, Louise

2007-10-01

Emergency department overcrowding is a serious problem nationwide. Of an estimated 14 million visits to hospital emergency departments, only 12.9% are considered emergent. Many emergency departments, however, employ only physicians despite the fact that nurse practitioners have a proven record of providing high quality, cost-effective care in the emergency department. The purpose of the study was to determine factors that influence the decision to use nurse practitioners in the emergency department. Interviews were conducted with ED managers in hospitals that both employ and do not employ nurse practitioners in the emergency department. In this study, the primary reason that nurse practitioners were not employed by emergency departments was that physician groups with whom the hospitals contract refuse to use nurse practitioners. Emergency department managers of facilities with nurse practitioners reported high levels of satisfaction with the nurse practitioners performance. The 2 ED managers without nurse practitioners in their facility were highly supportive of having nurse practitioners in the emergency department and have advocated for hiring nurse practitioners. Education needs to occur with emergency departments regarding the value of the nurse practitioner's role to the facility. Research is needed to investigate why emergency department physician groups resist hiring nurse practitioners. Increased staffing with nurse practitioners in the emergency department can serve to reduce overcrowding, reduce waiting times, and increase patient satisfaction.

Challenges of assessing critical thinking and clinical judgment in nurse practitioner students.

PubMed

Gorton, Karen L; Hayes, Janice

2014-03-01

The purpose of this study was to determine whether there was a relationship between critical thinking skills and clinical judgment in nurse practitioner students. The study used a convenience, nonprobability sampling technique, engaging participants from across the United States. Correlational analysis demonstrated no statistically significant relationship between critical thinking skills and examination-style questions, critical thinking skills and scores on the evaluation and reevaluation of consequences subscale of the Clinical Decision Making in Nursing Scale, and critical thinking skills and the preceptor evaluation tool. The study found no statistically significant relationships between critical thinking skills and clinical judgment. Educators and practitioners could consider further research in these areas to gain insight into how critical thinking is and could be measured, to gain insight into the clinical decision making skills of nurse practitioner students, and to gain insight into the development and measurement of critical thinking skills in advanced practice educational programs. Copyright 2014, SLACK Incorporated.

On the night shift: advanced nurse practice in emergency medicine.

PubMed

Jenkins, Jennifer

2016-05-01

Advanced nurse practitioners in the author's emergency department (ED) work autonomously and as part of a team to assess, diagnose and treat patients with unexplained and undiagnosed illnesses and injuries over a 24-hour cycle of care. The complexity of the role in EDs is often not fully understood, and expectations can vary between trusts and between different clinical areas within trusts. This article describes one night shift in the author's ED to explain the complexity of advanced nurse practitioners' roles in this environment. The article focuses on autonomous decision-making skills and the use of advanced clinical skills in the context of evidence-based practice.

Healthcare Provider Views on Transitioning From Task Shifting to Advanced Practice Nursing in Tanzania.

PubMed

Mboineki, Joanes Faustine; Zhang, Weihong

The Tanzanian health sector suffers from shortages of healthcare workers as well as uneven distribution of healthcare workers in urban and rural areas. Task shifting-delegation of tasks from professionals to other healthcare team members with less training, such as medical attendants-is practiced, compromising quality of care. Advanced practice nursing is underutilized. The purpose of this study was to explore the views of nurses and physicians on current responses to shortages of healthcare workers and the potential for utilization of advanced practice nurses. A descriptive, qualitative design was used. Purposeful sampling was used to select 20 participants. An in-depth interview guide was used to obtain information. Interviews were conducted in Swahili or English. Content analysis was used to identify themes. Shortage of human resources in rural primary healthcare facilities was identified as a major rationale for implementation of the advanced practice nurse practitioner role because the current health providers in rural health facilities are less trained and doctors are not ready to work in these settings. Opposition from physicians is expected during the course of implementing the nurse practitioner role. Professional bodies and government should reach consensus before the implementation of this role in such a way that they should agree on scope and standards of practice of nurse practitioners in Tanzania. Shortage of human resources for health is greater in rural primary healthcare facilities. Task shifting in Tanzania is neither effective nor legally recognized. Transition to advanced practice nursing roles-particularly the nurse practitioner role-can facilitate provision of optimal care. Nurse practitioners should be prepared to work in rural primary healthcare facilities.

Expanding the role of the nurse practitioner in the deployed setting.

PubMed

Dargis, Julie; Horne, Theresa; Tillman-Ortiz, Sophie; Scherr, Diane; Yackel, Edward E

2006-08-01

Today's military is experiencing rapid advances in technology and in manpower utilization. The Army Medical Department is redesigning the structure and function of deployable hospital systems as part of this effort. The transformation of deployable hospital systems requires that a critical analysis of manpower utilization be undertaken to optimize the employment of soldier-medics. The objective of this article was to describe the use of nurse practitioners as primary care providers during deployment. The lived experiences of five nurse practitioners deployed to Operation Iraqi Freedom are presented. Data gathered during the deployment and an analysis of the literature clearly support expanded and legitimized roles for these health care professionals in future conflicts and peacekeeping operations.

A focus group study of the use of video-recorded simulated objective structured clinical examinations in nurse practitioner education.

PubMed

Barratt, Julian

2010-05-01

The objective structured clinical examination (OSCE) is a common method of clinical skills assessment used for advanced nurse practitioner students across the United Kingdom. The purpose of an advanced nursing OSCE is to assess a nurse practitioner student's competence and safety in the performance of commonly used advanced clinical practice skills. Students often feel nervous when preparing for and participating in an OSCE. Consideration of these identified anxieties led to the development of an alternative method of meeting students' OSCE learning and preparation needs; namely video-recorded simulated OSCEs. Video-recording was appealing for the following reasons: it provides a flexible usage of staff resources and time; OSCE performance mistakes can be rectified; it is possible to use the same video-recordings with multiple cohorts of students, and the recordings can be made conveniently available for students with video streaming on internet-based video-sharing sites or virtual learning environments. The aim of the study was to explore the value of using such recordings amongst nurse practitioner students, via online and face-to-face focus groups, to see if they are a suitable OSCE educational preparation technique. The study findings indicate that simulated OSCE video-recordings are an effective method for supporting nurse practitioner educational development. Copyright 2009 Elsevier Ltd. All rights reserved.

Hiring appropriate providers for different populations: acute care nurse practitioners.

PubMed

Haut, Cathy; Madden, Maureen

2015-06-01

Acute care nurse practitioners, prepared as providers for a variety of populations of patients, continue to make substantial contributions to health care. Evidence indicates shorter stays, higher satisfaction among patients, increased work efficiency, and higher quality outcomes when acute care nurse practitioners are part of unit- or service-based provider teams. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education outlines detailed guidelines for matching nurse practitioners' education with certification and practice by using a population-focused algorithm. Despite national support for the model, nurse practitioners and employers continue to struggle with finding the right fit. Nurse practitioners often use their interest and previous nursing experience to apply for an available position, and hospitals may not understand preparation or regulations related to matching the appropriate provider to the work environment. Evidence and regulatory guidelines indicate appropriate providers for population-focused positions. This article presents history and recommendations for hiring acute care nurse practitioners as providers for different populations of patients. ©2015 American Association of Critical-Care Nurses.

42 CFR 405.2414 - Nurse practitioner, physician assistant, and certified nurse midwife services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Nurse practitioner, physician assistant, and... practitioner, physician assistant, and certified nurse midwife services. (a) Professional services are payable..., physician assistant, or certified nurse midwife who is employed by, or receives compensation from, the RHC...

Gender differences in nurse practitioner salaries.

PubMed

Greene, Jessica; El-Banna, Majeda M; Briggs, Linda A; Park, Jeongyoung

2017-11-01

While male nurses have been shown to earn considerably more than female nurses, there is less evidence on gender disparities in salary among nurse practitioners (NPs). This study examines whether the gender gap in NP salaries persists after controlling for differences in work setting and demographic factors. We analyzed the relationship between gender and salary (2011 pretax earnings) among 6591 NPs working as NPs at least 35 h per week, using the 2012 National Sample Survey of Nurse Practitioners. We first conducted bivariate regression analyses examining the relationship between gender and earnings, and then developed a multivariate model that controlled for individual differences in demographic and work characteristics. Male NPs earned $12,859 more than female NPs, after adjusting for individual differences in demographics and work characteristics. The gender gap was $7405 for recent NP graduates, and grew over time. Male NPs earned significantly more than female NPs across all clinical specialty areas. The gender disparities in NP salaries documented here regardless of professional seniority or clinical area should spark healthcare organizations to conduct pay equity assessments of their employees' salaries to identify and ameliorate pay inequality. ©2017 American Association of Nurse Practitioners.

Nurse practitioners' perceptions and participation in pharmaceutical marketing.

PubMed

Crigger, Nancy; Barnes, Kristen; Junko, Autumn; Rahal, Sarah; Sheek, Casey

2009-03-01

This paper reports on a study conducted to describe family nurse practitioners' perceptions towards and participation in pharmaceutical marketing and to explore the relationships among related variables. The pharmaceutical industry's intense global marketing strategies have resulted in widespread concern in healthcare professionals and professional groups, sectors of the public in many countries, and in the World Health Organization. Research on healthcare providers' participation in pharmaceutical marketing indicates that these relationships are conflicts of interests and compromise healthcare providers' prescribing practices and trust. Nursing, as a discipline, appears to be slow to address the impact of pharmaceutical marketing on nursing practice. Questionnaires about perceptions and participation in pharmaceutical marketing were completed by a random sample of 84 licensed family nurse practitioners in the United States of America in 2007. Family nurse practitioners viewed pharmaceutical company marketing uncritically as educational and beneficial. They also perceived other providers but not themselves as influenced by pharmaceutical marketing. The findings supported those found in previous research with nurses and physicians. Lack of education, participation in marketing and psychological and social responses may impede family nurse practitioners' ability to respond critically and appropriately to marketing strategies and the conflict of interest it creates.

Developing family planning nurse practitioner protocols.

PubMed

Hawkins, J W; Roberto, D

1984-01-01

This article focuses on the process of development of protocols for family planning nurse practitioners. A rationale for the use of protocols, a definition of the types and examples, and the pros and cons of practice with protocols are presented. A how-to description for the development process follows, including methods and a suggested tool for critique and evaluation. The aim of the article is to assist nurse practitioners in developing protocols for their practice.

Blending technology in teaching advanced health assessment in a family nurse practitioner program: using personal digital assistants in a simulation laboratory.

PubMed

Elliott, Lydia; DeCristofaro, Claire; Carpenter, Alesia

2012-09-01

This article describes the development and implementation of integrated use of personal handheld devices (personal digital assistants, PDAs) and high-fidelity simulation in an advanced health assessment course in a graduate family nurse practitioner (NP) program. A teaching tool was developed that can be utilized as a template for clinical case scenarios blending these separate technologies. Review of the evidence-based literature, including peer-reviewed articles and reviews. Blending the technologies of high-fidelity simulation and handheld devices (PDAs) provided a positive learning experience for graduate NP students in a teaching laboratory setting. Combining both technologies in clinical case scenarios offered a more real-world learning experience, with a focus on point-of-care service and integration of interview and physical assessment skills with existing standards of care and external clinical resources. Faculty modeling and advance training with PDA technology was crucial to success. Faculty developed a general template tool and systems-based clinical scenarios integrating PDA and high-fidelity simulation. Faculty observations, the general template tool, and one scenario example are included in this article. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.

Impact of postgraduate education on advanced practice nurse activity - a national survey.

PubMed

Wilkinson, J; Carryer, J; Budge, C

2018-03-22

There is a wealth of international evidence concerning the contribution post-registration master's level education makes to advancing the discipline of nursing. There are approximately 277 nurse practitioners registered in NZ, but they account for only a small portion of nurses who have undertaken master's level education. The additional contribution these nurses make to the work environment through advanced practice activities has not, hitherto, been documented. To report the extent of advanced practice nurse activity associated with various levels of nursing education in a sample of nurses working in clinical practice in New Zealand. A replication of recent Australian research was done via a national cross-sectional survey of 3255 registered nurses and nurse practitioners in New Zealand using an online questionnaire to collect responses to the amended Advanced Practice Delineation survey tool. In addition, demographic data were collected including position titles and levels of postgraduate education. A positive association was found between postgraduate education at any level and more time spent in advanced practice activities. Independent of level of postgraduate education, the role a nurse holds also effects the extent of involvement in advanced practice activities. There is an additional contribution made to the work environment by nurses with master's level education which occurs even when they are not employed in an advanced practice role. These findings are of significance to workforce policy and planning across the globe as countries work to sustain health services by increasing nursing capacity effectively within available resources. © 2018 International Council of Nurses.

Between two roles - Experiences of newly trained nurse practitioners in surgical care in Sweden: A qualitative study using repeated interviews.

PubMed

Jangland, Eva; Yngman Uhlin, Pia; Arakelian, Erebouni

2016-11-01

The position of Nurse Practitioner is a new role in Nordic countries. The transition from a registered nurse to the Nurse Practitioner role has been reported to be a personal challenge. This study, guided by the Nordic theoretical model for use in the education of advanced practice nurses, represents a unique opportunity to describe this transition for newly graduated Nurse Practitioners in an interprofessional surgical care team in Sweden. The aim was to explore how the first Nurse Practitioners in surgical care experienced the transition into a new role and what competences they used in the team. Eight new Nurse Practitioners with parallel work in clinical practice were interviewed twice around the time of their graduation. The qualitative analyses show that the participants integrated several central competences, but the focus in this early stage in their new role was on direct clinical praxis, consultation, cooperation, case management, and coaching. Transition from the role of clinical nurse specialist to nurse practitioner was a challenging process in which the positive response from patients was a driving force for the new Nurse Practitioners. The participants felt prepared for and determined to solve the challenging situations they approached working in the interprofessional team. Copyright © 2016 Elsevier Ltd. All rights reserved.

Marketing strategies of nurse practitioners in New York State.

PubMed

Nolan, C M; Conway, L G; Litteer, T B; Peterson-Sweeney, K; Richardson, K; Smith, S W; Stoler, P M

1988-08-01

As competition within the health care field increases, marketing strategies are becoming more important for all members of the health care team, including nurse practitioners. The purpose of this research was to identify marketing strategies being used by nurse practitioners in New York state. A total of 285 practitioners responded to a survey containing questions related to marketing techniques traditionally used in the business world: service differentiation, market segmentation and practice promotion. A majority of respondents did not report using many of the marketing strategies contained in the survey, although most nurse practitioners did report identifying themselves as primary care providers in one-on-one interactions with clients. Significantly higher marketing scores were found for nurse practitioners who attended a workshop or seminar on marketing strategies, had three or more years of experience, or who practiced in private outpatient settings.

Advanced Practice Nursing Committee on Process Improvement in Trauma: An Innovative Application of the Strong Model.

PubMed

West, Sarah Katherine

2016-01-01

This article aims to summarize the successes and future implications for a nurse practitioner-driven committee on process improvement in trauma. The trauma nurse practitioner is uniquely positioned to recognize the need for clinical process improvement and enact change within the clinical setting. Application of the Strong Model of Advanced Practice proves to actively engage the trauma nurse practitioner in process improvement initiatives. Through enhancing nurse practitioner professional engagement, the committee aims to improve health care delivery to the traumatically injured patient. A retrospective review of the committee's first year reveals trauma nurse practitioner success in the domains of direct comprehensive care, support of systems, education, and leadership. The need for increased trauma nurse practitioner involvement has been identified for the domains of research and publication.

Establishing an Australian nurse practitioner-led colorectal cancer screening clinic.

PubMed

Morcom, Joylene; Dunn, Sandra V; Luxford, Yoni

2005-01-01

In Australia, colorectal cancer is the most commonly occurring internal cancer affecting both men and women, and the second most common cause of cancer-related death. Flexible sigmoidoscopy has not been commonly used as a screening tool in Australia due primarily to lack of resources. Until now, people at average risk of developing bowel cancer frequently undergo colonoscopy after referral to a specialist. To fill an identified need, a nurse practitioner-led colorectal screening service providing fecal occult blood testing and flexible sigmoidoscopy, health education and promotion, patient counseling, information and a referral point for general practitioners, and a referral service for above average-risk patients was established in a South Australian metropolitan teaching hospital. Establishment of this clinic required advanced and extended theoretical and clinical preparation for the nurse practitioner, as well as development of interdisciplinary relationships, referral processes, clinical infrastructure, and a marketing strategy. An audit of the first 100 flexible sigmoidoscopy patients revealed service and procedural outcomes that compared favorably with other colorectal screening services as well as a high level of patient satisfaction.

Diagnostic Reasoning and Cognitive Biases of Nurse Practitioners.

PubMed

Lawson, Thomas N

2018-04-01

Diagnostic reasoning is often used colloquially to describe the process by which nurse practitioners and physicians come to the correct diagnosis, but a rich definition and description of this process has been lacking in the nursing literature. A literature review was conducted with theoretical sampling seeking conceptual insight into diagnostic reasoning. Four common themes emerged: Cognitive Biases and Debiasing Strategies, the Dual Process Theory, Diagnostic Error, and Patient Harm. Relevant cognitive biases are discussed, followed by debiasing strategies and application of the dual process theory to reduce diagnostic error and harm. The accuracy of diagnostic reasoning of nurse practitioners may be improved by incorporating these items into nurse practitioner education and practice. [J Nurs Educ. 2018;57(4):203-208.]. Copyright 2018, SLACK Incorporated.

Collaboration, not competition: cost analysis of neonatal nurse practitioner plus neonatologist versus neonatologist-only care models.

PubMed

Bosque, Elena

2015-04-01

Although advanced practice in neonatal nursing is accepted and supported by the American Academy of Pediatrics and National Association of Neonatal Nurse Practitioners, less than one-half of all states allow independent prescriptive authority by advanced practice nurse practitioners. The purpose of this study was to compare costs of a collaborative practice model that includes neonatal nurse practitioner (NNP) plus neonatologist (Neo) versus a neonatologist only (Neo-Only) practice in Washington state. Published Internet median salary figures from 3 sources were averaged to produce mean ± SD provider salaries, and costs for each care model were calculated in this descriptive, comparative study. Median NNP versus Neo salaries were $99,773 ± $5206 versus $228,871 ± $9654, respectively (P < .0001). The NNP + Neo (5 NNP/3 Neo full-time equivalents [FTEs]) cost $1,185,475 versus Neo-Only (8 Neo FTEs) cost $1,830,960. The NNP + Neo practice model with 8 FTEs suggests a cost savings, with assumed equivalent reimbursement, of $645,485/year. These results may provide the impetus for more states to adopt broader scope of practice licensure for NNPs. These data may provide rationale for analysis of actual costs and outcomes of collaborative practice.

42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Payment for a physician assistant's, nurse... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse practitioner's... services. (a) General rule. A physician assistant's, nurse practitioner's, and clinical nurse specialists...

42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Payment for a physician assistant's, nurse... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse practitioner's... services. (a) General rule. A physician assistant's, nurse practitioner's, and clinical nurse specialists...

42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Payment for a physician assistant's, nurse... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse practitioner's... services. (a) General rule. A physician assistant's, nurse practitioner's, and clinical nurse specialists...

42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Payment for a physician assistant's, nurse... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse practitioner's... services. (a) General rule. A physician assistant's, nurse practitioner's, and clinical nurse specialists...

Team Development Manual. Family Nurse Practitioner/Physician Assistant Program.

ERIC Educational Resources Information Center

Dostal, Lori

A manual is presented to help incorporate team development into training programs for nurse practitioners, physician assistants, and primary care physicians. It is also directed to practitioners who wish to improve teamwork and is designed to improve the utilization of the nurse practitioners and physician assistants. A group of one or more…

The core role of the nurse practitioner: practice, professionalism and clinical leadership.

PubMed

Carryer, Jenny; Gardner, Glenn; Dunn, Sandra; Gardner, Anne

2007-10-01

To draw on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand. Enacted legislation provides for mutual recognition of qualifications, including nursing, between New Zealand and Australia. As the nurse practitioner role is relatively new in both countries, there is no consistency in role expectation and hence mutual recognition has not yet been applied to nurse practitioners. A study jointly commissioned by both countries' Regulatory Boards developed information on the core role of the nurse practitioner, to develop shared competency and educational standards. Reporting on this study's process and outcomes provides insights that are relevant both locally and internationally. This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner program curricula and interviews with 15 nurse practitioners from the two countries. Data were analysed according to the appropriate standard for each data type and included both deductive and inductive methods. The data were aggregated thematically according to patterns within and across the interview and material data. The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care. A clearly articulated and research informed description of the core role of the nurse practitioner provides the basis for development of educational and practice competency standards. These research findings provide

Practice pattern and professional issues of nurse practitioners in mechanical circulatory support programs in the United States: a survey report.

PubMed

Casida, Jesus M; Pastor, Jessica

2012-09-01

Few data-based reports about the role and work environment of advanced practice nurses, specifically nurse practitioners in mechanical circulatory support programs, have been published. To describe the practice pattern and professional issues confronted by nurse practitioners in the rapidly evolving and expanding mechanical circulatory support programs in the United States. A descriptive research design was employed using the data from the 2010 mechanical circulatory support nurses survey. Quantitative and qualitative data that pertained to the demographic and practice profiles as well as barriers and overall issues faced by the nurse practitioners in their clinical practice were analyzed. Nonrandom sample of 48 nurse practitioners from 95 mechanical circulatory support programs nationwide. The practice pattern of nurse practitioners in mechanical circulatory support programs is similar to the practice pattern reported for nurse practitioners in acute and critical care settings. However, only 44% and 10% of nurse practitioners in mechanical circulatory support programs are authorized to admit and transfer patients into and out of the hospital, respectively. High workload, lack of institutional support, knowledge deficit, role ambiguity, lack of professional recognition, and burnout were the common issues faced by the participants in their clinical practice. The results provide preliminary evidence on the practice pattern, restrictions, and work environment issues that may threaten the viability of an mechanical circulatory support program in which nurse practitioners play a crucial role. Implications for clinical practice, research, and policy development are discussed.

A case study of nurse practitioner care compared to general practitioner care for children with respiratory tract infections.

PubMed

van Vugt, Saskia F; van de Pol, Alma C; Cleveringa, Frits G W; Stellato, Rebecca K; Kappers, Marieke P; de Wit, Niek J; Damoiseaux, Roger A M J

2018-05-13

To compare quality of care provided by nurse practitioners with care provided by general practitioners for children with respiratory tract infections in the Netherlands. Nurse practitioners increasingly manage acute conditions in general practice, with opportunities for more protocolled care. Studies on quality of nurse practitioners' care for children with respiratory tract infections are limited to the US health care system and do not take into account baseline differences in illness severity. Retrospective observational cohort study. Data were extracted from electronic healthcare records of children 0-6 years presenting with respiratory tract infection between January-December 2013. Primary outcomes were antibiotic prescriptions and early return visits. Generalized estimating equations were used to correct for potential confounders. A total of 899 respiratory tract infection consultations were assessed (168 seen by nurse practitioner; 731 by general practitioners). Baseline characteristics differed between these groups. Overall antibiotic prescription and early return visit rates were 21% and 24%, respectively. Adjusted odds ratio for antibiotic prescription after nurse practitioner vs. general practitioner delivered care was 1.40 (95% confidence interval 0.89-2.22) and for early return visits 1.53 (95% confidence interval 1.01-2.31). Important confounder for antibiotic prescription was illness severity. Presence of wheezing was a confounder for return visits. Complication and referral rates did not differ. Antibiotic prescription, complication and referral rates for paediatric respiratory tract infection consultations did not differ significantly between nurse practitioner and general practitioner consultations, after correction for potential confounders. General practitioners, however, see more severely ill children and have a lower return visit rate. A randomised controlled study is needed to determine whether nurse practitioner care quality is truly non

Autonomy of nurse practitioners in primary care: An integrative review.

PubMed

Choi, Min; De Gagne, Jennie C

2016-03-01

This integrative review of the existing literature was conducted to identify dimensions related to nurse practitioner (NP) autonomy and to recommend future areas of research related to the important topic of NP autonomy in this era of cost-conscious healthcare reform. Articles were identified from the following databases: CINAHL, MEDLINE, PubMed, Ovid, Scopus, Google Scholar, and EBSCO. Over 24 articles were found; 12 peer-reviewed articles met the inclusion criteria of research conducted with NPs, physicians, and patients. The results revealed three categories of association with regard to NP autonomy: job satisfaction, patient satisfaction, and physician-NP collaboration. This review was undertaken to advance understanding of autonomy among NPs and the dynamics involved in their delivery of care. Further research into the associations between NP autonomy and its dimensions are necessary to indicate a future direction to the NP role. ©2015 American Association of Nurse Practitioners.

Advanced practice nursing in child maltreatment: practice characteristics.

PubMed

Hornor, Gail; Herendeen, Pamela

2014-01-01

Child maltreatment is a problem of epidemic proportions in the United States. Pediatric nurse practitioners and other advanced practice nurses (APNs) have been caring for maltreated children for decades, yet to date no comprehensive assessment of their practice characteristics or their clinical and academic contributions to the field has been performed. The purpose of this study is to describe the practice characteristics of APNs who care for maltreated children. A descriptive design was used for this study. Child advocacy centers and children's hospitals were contacted to inquire about employment of child maltreatment APNs in their institution, and contact information for the lead APN was obtained. The Nurse Practitioner Survey was then sent to lead APNs by e-mail. The majority of APNs who work primarily in child maltreatment are pediatric nurse practitioners who work in child advocacy centers. They are providing care to children with physical and/or sexual abuse concerns; however, APNs provide care for children with all types of child maltreatment concerns. APNs play a vital role in the care of abused/neglected children. Their important contributions include not only clinical care but also the provision of clinical and didactic education to other professionals, parents, and the public. Research and publication are also essential to their role. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

The development of leadership outcome-indicators evaluating the contribution of clinical specialists and advanced practitioners to health care: a secondary analysis.

PubMed

Elliott, Naomi; Begley, Cecily; Kleinpell, Ruth; Higgins, Agnes

2014-05-01

To report a secondary analysis of data collected from the case study phase of a national study of advanced practitioners and to develop leadership outcome-indicators appropriate for advanced practitioners. In many countries, advanced practitioners in nursing and midwifery have responsibility as leaders for health care development, but without having leadership outcome measures available they are unable to demonstrate the results of their activities. In Ireland, a sequential mixed method research study was used to develop a validated tool for the evaluation of clinical specialists and advanced practitioners. Despite strong evidence of leadership activities, few leadership-specific outcomes were generated from the primary analysis. Secondary analysis of a multiple case study data set. Data set comprised 23 case studies of advanced practitioner/clinical specialists from 13 sites across each region in Ireland from all divisions of the Nursing Board Register. Data were collected 2008-2010. Data sources included non-participant observation (n = 92 hours) of advanced practitioners in practice, interviews with clinicians (n = 21), patients (n = 20) and directors of nursing/midwifery (n = 13) and documents. Analysis focused on leadership outcome-indicator development in line with the National Health Service's Good Indicators Guide. The four categories of leadership outcomes for advanced practitioner developed were as follows: (i) capacity and capability building of multidisciplinary team; (ii) measure of esteem; (iii) new initiatives for clinical practice and healthcare delivery; and (iv) clinical practice based on evidence. The proposed set of leadership outcome-indicators derived from a secondary analysis captures the complexity of leadership in practice. They add to existing clinical outcomes measuring advanced practice. © 2013 John Wiley & Sons Ltd.

42 CFR 418.304 - Payment for physician and nurse practitioner services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for physician and nurse practitioner... Payment for physician and nurse practitioner services. (a) The following services performed by hospice physicians and nurse practitioners are included in the rates described in § 418.302: (1) General supervisory...

Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions

PubMed Central

Smith, Tony; Harris, Jillian; Woznitza, Nick; Maresse, Sharon; Sale, Charlotte

2015-01-01

Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities. PMID:26451243

Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions.

PubMed

Smith, Tony; Harris, Jillian; Woznitza, Nick; Maresse, Sharon; Sale, Charlotte

2015-09-01

Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as 'a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care'. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities.

Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, Tony; Harris, Jillian; Woznitza, Nick

Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiencesmore » in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities.« less

Advancing Nursing Practice: Management of Neuropathic Pain With Capsaicin 8% Without Physician Supervision.

PubMed

O'Brien, Joanne; Keaveny, Joseph; Pollard, Valerie; Nugent, Linda Elizabeth

The purpose of this study was to examine the management of patient's neuropathic pain with capsaicin 8% in a nurse-led clinic when administered by 1 registered advanced nurse practitioner without physician supervision. A longitudinal, single-group, descriptive research design was used to assess pain scores and quality of life 3 times over 3 months after treatment. Patients with a diagnosis of neuropathic pain were assessed and treated with capsaicin 8% by 1 advanced nurse practitioner with prescriptive authority in a nurse-led clinic. Pain scores were collected at baseline, and self-assessed pain, activity level, and quality of life were assessed at 1 week, 4 weeks, and 3 months after treatment. Twenty-four patients were recruited, and data were analyzed using Friedman's test. In post hoc analysis, Wilcoxon signed-rank test was used with Bonferroni correction. Pain scores differed from pretreatment to posttreatment at each of the 3 time points, at rest (χ3 = 20.54, P = .001) and on movement (χ3 = 23.644, P = .001), and remained significant after Bonferroni correction. Overall, 62.5% (n = 15) of patients achieved at least a 30% reduction in self-reported pain at rest from pretreatment to 3 months, and 54% (n = 13) achieved the same reduction in pain on movement. Most improvements in patient's quality of life occurred between 1 and 4 weeks. Patient satisfaction was high, with 83% stating that they would be happy to have the treatment repeated. Single-dose capsaicin 8% decreased neuropathic pain after being administered in an outpatient setting by an experienced registered advanced nurse practitioner. Further multicenter research led by advanced nurse practitioners is needed to support high-quality, safe treatment of neuropathic pain with high-concentration capsaicin in nurse-led chronic pain clinics.

42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse practitioner's...

Culture Care Theory: a proposed practice theory guide for nurse practitioners in primary care settings.

PubMed

McFarland, Marilyn M; Eipperle, Marilyn K

2008-04-01

Leininger's Theory of Culture Care Diversity and Universality is presented as a foundational basis for the educational preparation, primary care contextual practice, and outcomes-focused research endeavours of advanced practice nursing. Discussion emphasises the value of care and caring as the essence of advanced practice nursing through the use of three modes of care, use of the Sunrise and other enablers, and the ethnonursing method. Education, research, practice, and key concepts of the theory are connected as essential components toward the provision of culturally congruent care to meet the healthcare needs of diverse individuals, families, groups, and communities by family nurse practitioners.

Measuring the influence of a mental health training module on the therapeutic optimism of advanced nurse practitioner students in the United Kingdom.

PubMed

Hemingway, Steve; Rogers, Melanie; Elsom, Stephen

2014-03-01

To evaluate the influence of a mental health training module on the therapeutic optimism of advanced nurse practitioner (ANP) students in primary care (family practice). Three cohorts of ANPs who undertook a Mental Health Problems in Primary Care Module as part of their MSc ANP (primary care) run by the University of Huddersfield completed the Elsom Therapeutic Optimism Scale (ETOS), in a pre- and postformat. The ETOS is a 10-item, self-administered scale, which has been used to evaluate therapeutic optimism previously in mental health professionals. All three cohorts who completed the scale showed an improvement in their therapeutic optimism scores. With stigma having such a detrimental effect for people diagnosed with a mental health problem, ANPs who are more mental health literate facilitated by education and training in turn facilitates them to have the skills and confidence to engage and inspire hope for the person diagnosed with mental health problems. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

Job satisfaction of nurse practitioners: an analysis using Herzberg's theory.

PubMed

Koelbel, P W; Fuller, S G; Misener, T R

1991-04-01

The current sociopolitical and economic forces affecting health care may lead to job dissatisfaction among nurse practitioners, according to results of a South Carolina study. A mailed survey that consisted of the Index of Job Satisfaction and the Minnesota Satisfaction Questionnaire--Short Form was used to test Herzberg's dual-factor theory of job satisfaction. A response rate of 90 percent was attained, with a final sample of 132 nurse practitioners and midwives. Consistent with the predictions of Herzberg's model, intrinsic factors served as sources of job satisfaction, while extrinsic factors were the primary sources of job dissatisfaction. Nurse practitioners in the sample reported a moderate amount of satisfaction with their "overall jobs." Suggestions are provided for ways both nurse practitioners and health administrators can enhance job satisfaction.

The case for renewed investment in the district nursing specialist practitioner qualification.

PubMed

Longstaff, Fiona

2013-09-01

District nursing as a profession has been under significant threat over the last few years due to a lack of foresight and funding, resulting in an undervalued and underinvested workforce. The once-heralded specialist practitioner programme was slowly decommissioned in all but a handful of universities, leaving no alternative but for community trusts to employ staff nurses in team leader roles without the development the added qualification gave them. In light of the renewed focus on the fundamental advancement of district nurses and recent Government publications clearly reinforcing the district nurse's role, this article argues for the need for educational commissioners and workforce planners to commit to continued investment in this vital profession.

A Cooperative Education Program for Nurse Practitioners/Physician's Assistants.

ERIC Educational Resources Information Center

Fowkes, Virginia; And Others

1979-01-01

Traditionally, nurse practitioners and physician's assistants have been trained separately. In l977, the Family Nurse Practitioner Program at the University of California, Davis, and the Primary Care Associate Program at Stanford University merged clinical curricula. The cooperative program is described and its first year evaluated. (Author/JMD)

Defining the unique role of the specialist district nurse practitioner.

PubMed

Barrett, Anne; Latham, Dinah; Levermore, Joy

2007-10-01

Due to the reorganization of primary care trusts across the country, certain trusts proposed a reduction in the specialist district nurse practitioner numbers in favour of less qualified community nurses and health care assistants. Such proposals in one PCT were blocked, partly in response to documentation compiled by practitioners at the sharp end of nursing practice. With the new agenda of practice based commissioning, it is imperative that commissioners and management alike are aware of the scope of specialist district nurse practitioners. This is the first of a series of articles looking at specific case histories where the role of the district nurse is highlighted. It is the intention to stress the importance of the clinical expertise and confidence required by the district nurse to care for patients with complex needs in the community.

Nurse Practitioners, Physician Assistants and Certified Nurse Midwives in California.

ERIC Educational Resources Information Center

California Univ., San Francisco. Center for California Health Workforce Studies.

Surveys were mailed to all nurse practitioners (NPs), physician assistants (PAs) and certified nurse midwives (CNMs) registered in California, asking questions about education, labor force participation, specialty, and location and type of practice site, as well as the demographic characteristics of these professionals and their patients. Response…

Practice Management Skills for the Nurse Practitioner.

ERIC Educational Resources Information Center

Sportsman, Susan; Hawley, Linda J.; Pollock, Susan; Varnell, Gayle

2001-01-01

An expert panel identified 20 business concepts important for a family nurse practitioner curriculum. A focus group of practitioners verified the concepts and clarified relevant information to be taught. The business concepts center on management and operations of a clinical practice. (SK)

Practice patterns and organizational commitment of inpatient nurse practitioners.

PubMed

Johnson, Janet; Brennan, Mary; Musil, Carol M; Fitzpatrick, Joyce J

2016-07-01

Nurse practitioners (NPs) deliver a wide array of healthcare services in a variety of settings. The purpose of this study was to examine the practice patterns and organizational commitment of inpatient NPs. A quantitative design was used with a convenience sample (n = 183) of NPs who attended the American Association of Nurse Practitioners (AANP) national conference. The NPs were asked to complete a demographic questionnaire, the Practice Patterns of Acute Nurse Practitioners tool and the Organizational Commitment Questionnaire. Over 85% of inpatient practice time consists of direct and indirect patient care activities. The remaining nonclinical activities of education, research, and administration were less evident in the NP's workweek. This indicates that the major role of inpatient NPs continues to be management of acutely ill patients. Moderate commitment was noted in the Organizational Commitment Questionnaire. Supportive hospital/nursing leadership should acknowledge the value of the clinical and nonclinical roles of inpatient NPs as they can contribute to the operational effectiveness of their organization. By fostering the organizational commitment behaviors of identification, loyalty, and involvement, management can reap the benefits of these professionally dedicated providers. ©2015 American Association of Nurse Practitioners.

The role of the neonatal nurse practitioner in the community hospital level I nursery.

PubMed

Hatch, Julie

2012-01-01

Neonatal nurse practitioners (NNPs) have played a significant role in providing medical coverage to many of the country's Level III neonatal intensive care units (NICUs). Extensive education and experience are required for a nurse practitioner (NP) to become competent in caring for these critically ill newborns. The NNP can take this competence and experience and expand her role out into the community Level I nurseries. Clinical care of the infants and close communication with parents, pediatricians, and the area tertiary center provide a community service with the goal of keeping parents and babies together in the community hospital without compromising the health of the baby. The NNP service, with 24-hour nursery and delivery coverage, supports an ongoing obstetric service to the community hospital. The NNP's experience enables her to provide a neonatal service that encompasses a multitude of advanced practice nursing roles.

Using vignettes to study nurse practitioners' performance in suspected domestic violence situations.

PubMed

Gagan, M J

2000-01-01

Vignettes have often been used to evaluate students or collect data in nursing research. The format is familiar to most nursing students as well as nurses and nurse researchers. This article presents the development and testing of the Nurse Practitioner Performance Tool (NPPT) which used vignettes as an approach to nurse practitioner performance evaluation. In this example, vignettes were used in a quasi-experimental design to collect data from Adult and Family Nurse Practitioners (A/FNP). The focus was on the diagnosis and intervention performance of the A/FNPs when addressing suspected cases of domestic violence.

Are biochemistry interpretative comments helpful? Results of a general practitioner and nurse practitioner survey.

PubMed

Barlow, Ian M

2008-01-01

Adding or incorporating clinical interpretative comments on biochemistry results is widespread in UK laboratories; although this consumes considerable human resource, there is still little evidence to suggest that it is either effective or appreciated by our clinical colleagues. I therefore decided to survey our local general practitioners (GPs) and nurse practitioners to analyse whether they found biochemistry comments on reports helpful. A simple questionnaire was designed and sent to 159 GPs and 81 nurse practitioners asking them whether they found this activity useful for the limited range of test groups that we routinely comment on and also whether they would like to see commenting on more groups of tests. Overall, 49.6% of questionnaires were returned. Of these, there was overwhelming support for commenting on reports and 77% would like to see comments on a greater range of tests. Although adding clinical interpretative comments is very time-consuming for senior laboratory staff, there is overwhelming support of this activity among our GPs and nurse practitioner users; therefore, our local policy of routinely adding clinical comments will remain for the foreseeable future.

Improving nurse practitioners' competence with genetics: Effectiveness of an online course.

PubMed

Whitt, Karen J; Macri, Charles; O'Brien, Travis J; Wright, Stephanie

2016-03-01

The purpose of this study was to assess the effectiveness of an online genetics course for improving nurse practitioners' knowledge, competence, and comfort with genetic principles and their application to clinical practice. A genetics knowledge test and survey were administered to 232 nurse practitioner students, between 2011 and 2013, before and after completing a 15-week online genetics course taught by a multidisciplinary team of instructors at a private east coast U.S. university. The 65-item survey allowed participants to rate competence regarding genetic principles, diseases, and terminology, as well as comfort performing various clinical tasks related to genetics. The 21-item knowledge test contained multiple choice questions regarding core competencies in genetics. Paired t-tests were used to compare mean pre- and postscores. Participants significantly increased postcourse knowledge (p < .001) and comfort with genetic core competencies and clinical skills related to genetics (p < .001). This study demonstrates the effectiveness of an online genetics course for increasing nurse practitioners' knowledge, competence, and confidence with genetics and identifies specific topics educators should consider when designing curricula for nurse practitioners. Findings from this study can improve genetics education for nurse practitioners, which will in turn improve patient health. ©2015 American Association of Nurse Practitioners.

Social support and factors associated with self-efficacy among acute-care nurse practitioners.

PubMed

Hu, Sophia H; Yu, Ya-Mei; Chang, Wen-Yin; Lin, Yen-Kuang

2018-02-01

To investigate the relationship of nurse practitioners' social support as well as other factors associated with perceived self-efficacy. There is a growing demand for nurse practitioners in Taiwan, for whom self-perceived efficacy is associated with performance. Nevertheless, research on the self-efficacy and social support of nurse practitioners is limited. This is a cross-sectional survey study. Questionnaires were distributed to nurse practitioners in seven hospitals in northern Taiwan from May 2015 to March 2016. In total, data from 335 (78% return rate) certified nurse practitioners were analysed. Social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS) and the Job Content Questionnaire (JCQ), and perceived self-efficacy was measured by the General Self-Efficacy Scale (GSE). Data were analysed by ANOVAs with post hoc test and multiple linear regression. The mean score for self-efficacy was 27.60 ± 6.17. Support scores were 11.574 ± 2.37 for supervisors, 12.795 ± 1.92 for coworkers and 64.07 ± 10.16 for family, friends and significant others. nurse practitioners in the high monthly salary group had significantly higher self-efficacy than nurse practitioners in the medium and low monthly salary group (F = 8.99; p < .01). Social support from coworkers (β = 0.18, p < .01) and family, friends and significant others (β = 0.15, p < .01) and a higher monthly salary were significant factors. The self-efficacy of nurse practitioners in hospitals in Taiwan is insufficient. Monthly salary and levels of social support were found to contribute to nurse practitioners' self-efficacy. Thus, to enhance nurse practitioners' self-efficacy and work performance, nursing leaders should address these issues. The findings inform hospital administrators to be aware of the importance of salary in relation to nurse practitioners' perceptions of social support and self-efficacy. © 2017 John Wiley & Sons Ltd.

Inclusion of disability-related content in nurse practitioner curricula.

PubMed

Smeltzer, Suzanne C; Blunt, Elizabeth; Marozsan, Heather; Wetzel-Effinger, Lisa

2015-04-01

To examine the integration of disability-content in a national sample of nurse practitioner curricula. Responses of National Organization of Nurse Practitioner Faculties (NONPF) members to an online 34-item survey designed to assess disability-related content included in nurse practitioner (NP) curricula; populations of people with disabilities addressed; models of disability; and resources used to teach about disability, facilitators and barriers to inclusion of disability, and respondents' assessment of the adequacy of coverage of disability in their programs. A survey used previously to assess integration of disability content in undergraduate nursing programs was modified to make it relevant to NP curricula. Nursing faculty and people with disability validated the survey to ensure its completeness and sensitivity to the disability community. Participating programs represent 111 (33.6%) NP programs. Lack of disability-related content reported by NP faculty in the majority of programs suggests that there is considerable room for improvement in efforts to address this often vulnerable population. Because people with disabilities can be found in any setting where health care is provided, all NPs need to be prepared to care for people with disabilities across the life span. Strategies need to be developed and implemented to increase the awareness of NP faculty about the health issues of people with disabilities and integration of disability-related content without disrupting existing overloaded NP curricula. © 2014 American Association of Nurse Practitioners.

Working in a 'third space': a closer look at the hybridity, identity and agency of nurse practitioners.

PubMed

Chulach, Teresa; Gagnon, Marilou

2016-03-01

Nurse practitioners (NPs), as advanced practice nurses, have evolved over the years to become recognized as an important and growing trend in Canada and worldwide. In spite of sound evidence as to the effectiveness of NPs in primary care and other care settings, role implementation and integration continue to pose significant challenges. This article utilizes postcolonial theory, as articulated by Homi Bhabha, to examine and challenge traditional ideologies and structures that have shaped the development, implementation and integration of the NP role to this day. Specifically, we utilize Bhabha's concepts of third space, hybridity, identity and agency in order to further conceptualize the nurse practitioner role, to examine how the role challenges some of the inherent assumptions within the healthcare system and to explore how development of each to these concepts may prove useful in integration of nurse practitioners within the healthcare system. Our analysis casts light on the importance of a broader, power structure analysis and illustrates how colonial assumptions operating within our current healthcare system entrench, expand and re-invent, as well as mask the structures and practices that serve to impede nurse practitioner full integration and contributions. Suggestions are made for future analysis and research. © 2015 John Wiley & Sons Ltd.

[International collaboration to develop a nurse practitioner master's program].

PubMed

Tang, Woung-Ru

2007-12-01

Because of the shortage of resident doctors and in order to raise standards, hospitals and medical centers have trained their own nurse practitioners (NPs). Given the absence of standard training criteria and an unevenness of faculty quality, however, many NPs play the role of medical substitute, which is far from the independent role performed by NPs in foreign countries. It is therefore necessary to include NP training within higher education. The Graduate Institute of Nursing at Chang Gung University established the first NP in-service training program in 2003 through international collaboration, with the purpose of cultivating advanced clinical nursing talents. The program emphasizes the importance of clinical reasoning and practical training, in order to enable students to perform the multiple roles of treatment and caring undertaken by NPs. Experts in advanced nursing and clinical medicine from Taiwan and abroad were invited to serve as lecturers. The students also had the opportunity to take NP courses at Oregon Health and Science University (USA) and participate in clinical visits. The results have been widely praised. International collaboration is built upon the mutual trust of the parties, and its success is determined by the measures that it involves, as well as by the global vision and competence of participants. This paper shares the advantages and disadvantages of the NP master's program through international collaboration.

Discovering the nature of advanced nursing practice in high dependency care: a critical care nurse consultant's experience.

PubMed

Fairley, Debra

2005-06-01

This paper describes how a critical care nurse consultant's clinical role has evolved within a surgical high dependency unit (SHDU) in a large teaching hospitals trust. In order to provide some background to role development, an overview of the research exploring the nature of advanced nursing practice in the context of critical care will be presented. From the outset, advanced nursing practice was not perceived as the acquisition and application of technical procedures usually undertaken by doctors, but possibly an integration of medicine and nursing where holistic nursing assessment is combined with symptom-focused physical examination. A reflective account of practical problems encountered relating to role integration, professional autonomy, legal and consent issues, non-medical prescribing, and role evaluation will be presented. A model of working that can be applied to high dependency units, integrating the role of the advanced nurse practitioner within the clinical team, will be described.

The impact of advanced nurse practitioners on patient outcomes in chronic kidney disease: A systematic review.

PubMed

McCrory, Geraldine; Patton, Declan; Moore, Zena; O'Connor, Tom; Nugent, Linda

2018-06-11

Management of individuals with chronic kidney disease (CKD) requires a collaborative approach. Nurses have diversified their skills to take on roles which have been traditionally physician-led. The impact of such roles, mainly that of the advanced nurse practitioner (ANP), has not been previously assessed using a systematic approach. The aim of this systematic review (SR) was to determine the impact of the addition of an ANP on patient outcomes in adults with CKD. A SR, following the guidance of PRISMA was undertaken. Population: adults with CKD. ANP. Databases searched included The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase and Medline. Outcome measures were blood pressure (BP), lipids, haemoglobin A1c (HbA1c), phosphate and parathormone (PTH) measures and recommended medication use. Four studies met the inclusion criteria. All possessed external validity and demonstrated low risk for random sequence generation and allocation concealment but were at high risk of performance bias and detection bias. The addition of an ANP resulted in the superior management of BP in all studies. Three studies reported improved control of low-density lipoprotein (LDL) and PTH. One study reported greater achievement of phosphate control. Glycaemic control was equal in both groups. All studies reported higher rates of recommended medication use. The addition of an ANP is superior or equal to the usual care models for the management of BP, LDL, PTH and glycaemic control in adults with CKD. © 2018 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Making "cents" of the business side of nurse practitioner practice.

PubMed

Luster-Tucker, AtNena

2016-03-15

Nurse practitioners produce excellent patient outcomes and should be allowed to practice to the full extent of their education and training. In addition to clinical skills, nurse practitioners need to understand the business side of practice in order to ensure fair and equitable compensation.

Alliances of cooperation: negotiating New Hampshire nurse practitioners' prescribing practice.

PubMed

Sampson, Deborah A

2009-01-01

Nurse practitioner legislation varies among states, particularly in relation to practice without physician oversight, altering the legal environment within which nurse practitioners can use knowledge and skills to meet patient needs. Using New Hampshire as a case study, this historical analysis of nurse practitioners' negotiations over time for independent practice, defined in state practice acts, illuminates the complex social and economic factors affecting nurses' struggle to gain legal rights over their own professional practice without supervision and intervention from another profession. In New Hampshire, not only did organized medicine oppose nurses rights to practice, but pharmacists demanded the right to control all aspects of medication management, including who could prescribe and under what circumstances prescribing could occur. Shifting social and political terrain as well as changes in legislative and state professional board leadership affected the environment and negotiations of a small group of nurses who were ultimately successful in obtaining the right to define their own professional practice.

Job satisfaction among Arizona adult nurse practitioners.

PubMed

Schiestel, Charlotte

2007-01-01

A literature review for studies of job satisfaction among nurse practitioners (NPs) suggests that the true determinants of job satisfaction have not been discovered. The purpose of this study was to determine job satisfaction among adult health NPs (ANPs) practicing in Arizona. The Misener nurse practitioner job satisfaction scale was mailed to 329 Arizona ANPs who were certified by the Arizona State Board of Nursing (47% response rate). The mean overall satisfaction score was 4.69 out of a possible score of 6.0 for very satisfied. Differences in employer type, gender, annual income, membership in professional nursing organization, or full-time versus part-time employment status did not result in significantly different scores on the job satisfaction scale in this group. A deep and sustained nursing shortage, the exodus of experienced nurses from the profession, and a projected shortage of primary care providers have generated interest among professional groups, private and government healthcare commissions, and the healthcare industry in determining what factors may influence an individual to choose and remain active in nursing practice. Researchers, educators, employers, and the healthcare industry must look beyond well-worn assumptions about job satisfaction to explore what the individual NP finds satisfying about his or her role.

Continuing education for primary health care nurse practitioners in Ontario, Canada.

PubMed

Baxter, Pamela; DiCenso, Alba; Donald, Faith; Martin-Misener, Ruth; Opsteen, Joanne; Chambers, Tracey

2013-04-01

The Council of Ontario University Programs in Nursing offers a nine-university, consortium-based primary health care nurse practitioner education program and on-line continuing education courses for primary health care nurse practitioners. Our study sought to determine the continuing education needs of primary health care nurse practitioners across Ontario, how best to meet these needs, and the barriers they face in completing continuing education. Surveys were completed by 83 (40%) of 209 learners who had participated in continuing education offered by the Council of Ontario University Programs in Nursing between 2004 and 2007. While 83% (n=50) of nurse practitioners surveyed indicated that continuing education was extremely important to them, they also identified barriers to engaging in continuing education offerings including; time intensity of the courses, difficulty taking time off work, family obligations, finances and fatigue. The most common reason for withdrawal from a continuing education offering was the difficulty of balancing work and study demands. Continuing education opportunities are important to Ontario primary health care nurse practitioners, and on-line continuing education offerings have been well received, but in order to be taken up by their target audience they must be relevant, readily accessible, flexible, affordable and offered over brief, intense periods of time using technology that is easy to use and Internet sites that are easily navigated. Copyright © 2012 Elsevier Ltd. All rights reserved.

Nurse practitioner caseload in primary health care: Scoping review.

PubMed

Martin-Misener, Ruth; Kilpatrick, Kelley; Donald, Faith; Bryant-Lukosius, Denise; Rayner, Jennifer; Valaitis, Ruta; Carter, Nancy; Miller, Patricia A; Landry, Véronique; Harbman, Patricia; Charbonneau-Smith, Renee; McKinlay, R James; Ziegler, Erin; Boesveld, Sarah; Lamb, Alyson

2016-10-01

To identify recommendations for determining patient panel/caseload size for nurse practitioners in community-based primary health care settings. Scoping review of the international published and grey literature. The search included electronic databases, international professional and governmental websites, contact with experts, and hand searches of reference lists. Eligible papers had to (a) address caseload or patient panels for nurse practitioners in community-based primary health care settings serving an all-ages population; and (b) be published in English or French between January 2000 and July 2014. Level one testing included title and abstract screening by two team members. Relevant papers were retained for full text review in level two testing, and reviewed by two team members. A third reviewer acted as a tiebreaker. Data were extracted using a structured extraction form by one team member and verified by a second member. Descriptive statistics were estimated. Content analysis was used for qualitative data. We identified 111 peer-reviewed articles and grey literature documents. Most of the papers were published in Canada and the United States after 2010. Current methods to determine panel/caseload size use large administrative databases, provider work hours and the average number of patient visits. Most of the papers addressing the topic of patient panel/caseload size in community-based primary health care were descriptive. The average number of patients seen by nurse practitioners per day varied considerably within and between countries; an average of 9-15 patients per day was common. Patient characteristics (e.g., age, gender) and health conditions (e.g., multiple chronic conditions) appear to influence patient panel/caseload size. Very few studies used validated tools to classify patient acuity levels or disease burden scores. The measurement of productivity and the determination of panel/caseload size is complex. Current metrics may not capture

Psychometric evaluation of the Nurse Practitioner Satisfaction Survey (NPSS).

PubMed

Agosta, Lucie J

2009-01-01

The purpose of this study was to identify and define underlying latent constructs within the concept of patient satisfaction with nurse practitioner delivered primary health care. The Nurse Practitioner Satisfaction Survey (NPSS), a 28-item, Likert-type, researcher developed instrument was completed by 300 clients presenting for primary health care visits in a hospital outpatient clinic. Factor analysis with promax rotation resulted in a three factor model explaining 70.77% of the variance. Eighteen items loaded on general satisfaction. Six items loaded on communication, and four items loaded on accessibility and convenience. Cronbach's alpha internal consistency reliability coefficients were .98, .83, and .76 for the three factors, respectively. The NPSS was found to be reliable and valid for measuring patient satisfaction with nurse practitioner delivered primary health care services.

Oral Health Education for Pediatric Nurse Practitioner Students

PubMed Central

Golinveaux, Jay; Gerbert, Barbara; Cheng, Jing; Duderstadt, Karen; Alkon, Abbey; Mullen, Shirin; Lin, Brent; Miller, Arthur; Zhan, Ling

2014-01-01

The aim of this study was to evaluate whether an interdisciplinary, multifaceted oral health education program delivered to pediatric nurse practitioner students at the University of California, San Francisco, would improve their knowledge, confidence, attitudes, and behaviors regarding the provision of oral health assessments, consultations, referrals, and services to young children during well-child visits. Thirty pediatric nurse practitioner students were included in the study. Participants completed a written survey before and after receiving an interdisciplinary educational intervention that included didactic education, simulation exercises, and clinical observation by a pediatric dental resident. Between pre-intervention and post-intervention, a significant improvement was seen in the pediatric nurse practitioners’ knowledge of oral health topics (p<0.001), confidence when providing oral health counseling (p<0.001), and attitudes about including oral health counseling in their examinations (p=0.006). In the post-intervention survey, 83 percent of the subjects reported having incorporated oral examinations into their well-child visits. Our study suggests that providing an interdisciplinary oral health educational program for pediatric nurse practitioner students can improve their knowledge, confidence, attitudes, and behaviors regarding the incorporation of oral health care services during routine well-child visits. PMID:23658403

Cyberbullying: implications for the psychiatric nurse practitioner.

PubMed

Carpenter, Lindsey M; Hubbard, Grace B

2014-08-01

The purpose of this article is to inform and educate psychiatric nurse practitioners about the pervasiveness of the rapidly increasing problem of cyberbullying. As more children and adolescents obtain access to the Internet, mobile devices, and social networking sites, the exposure to bullying in the virtual format increases. Cyberbullying is a growing public health concern and can affect mental health and school performance. Cyberbullying often results in a range of psychiatric symptoms and has been linked to suicide attempts and completions. The psychiatric nurse practitioner is uniquely prepared to provide a range of interventions for patients, families, and communities who have experienced cyberbullying. © 2014 Wiley Periodicals, Inc.

Investigating the Nursing Practitioners Perspectives about Undergraduate Nursing Internship and Apprenticeship Courses: Is Renewing Required?

PubMed Central

Jamalmohammadi, Ali; Jafarabadi, Mohammad Asghari; Shajari, Jila; Modares, Maryam

2013-01-01

Nurses’ professional capacity plays an important role in the health system to achieve their mission. This study aimed to investigate the perspectives of nursing practitioners about undergraduate nursing internship and apprenticeship courses and possible ways of renewing the courses. This cross sectional survey was performed over 258 bachelors and practitioners of nursing graduates of Alborz University of medical sciences in the second half of 2012. Based on a multi-stage sampling schedule, questionnaires were used to collect data about the perspectives of nursing practitioners about undergraduate nursing internship and apprenticeship courses. There were 81.4% of females and 80.6%, 17.1% and 2.3% of organizational post of participants were nurse, head nurse and supervisor respectively. The occupied posts for 60.1%, 25.6% and 14.1% of subjects, respectively were nurse, head nurse and the supervisor. The application of the internship and apprenticeship courses in bachelor of nursing were in moderate to high levels. The highest percentages of responses for internship and apprenticeship training courses were in internal surgery nursing and special nursing and the minimum percentage of responses were for community hygiene nursing and mental health nursing. Due to observing moderate to high levels of fulfillment and lack of compliance of training courses, renewing to improve the quality and effectiveness of training programs are highly recommended. This can be effective in the future of nursing career and provide a practical training environment to achieve the goals of theoretical training and can lead nurses to become specialized in their field. PMID:23985116

Implementing two nurse practitioner models of service at an Australian male prison: A quality assurance study.

PubMed

Wong, Ides; Wright, Eryn; Santomauro, Damian; How, Raquel; Leary, Christopher; Harris, Meredith

2018-01-01

To examine the quality and safety of nurse practitioner services of two newly implemented nurse practitioner models of care at a correctional facility. Nurse practitioners could help to meet the physical and mental health needs of Australia's growing prison population; however, the nurse practitioner role has not previously been evaluated in this context. A quality assurance study conducted in an Australian prison where a primary health nurse practitioner and a mental health nurse practitioner were incorporated into an existing primary healthcare service. The study was guided by Donabedian's structure, processes and outcomes framework. Routinely collected information included surveys of staff attitudes to the implementation of the nurse practitioner models (n = 21 staff), consultation records describing clinical processes and time use (n = 289 consultations), and a patient satisfaction survey (n = 29 patients). Data were analysed descriptively and compared to external benchmarks where available. Over the two-month period, the nurse practitioners provided 289 consultations to 208 prisoners. The presenting problems treated indicated that most referrals were appropriate. A significant proportion of consultations involved medication review and management. Both nurse practitioners spent more than half of their time on individual patient-related care. Overall, multidisciplinary team staff agreed that the nurse practitioner services were necessary, safe, met patient need and reduced treatment delays. Findings suggest that the implementation of nurse practitioners into Australian correctional facilities is acceptable and feasible and has the potential to improve prisoners' access to health services. Structural factors (e.g., room availability and limited access to prisoners) may have reduced the efficiency of the nurse practitioners' clinical processes and service implementation. Results suggest that nurse practitioner models can be successfully integrated into a

Supporting nurse practitioners' practice in primary healthcare settings: a three-level qualitative model.

PubMed

Chouinard, Véronique; Contandriopoulos, Damien; Perroux, Mélanie; Larouche, Catherine

2017-06-26

While greater reliance on nurse practitioners in primary healthcare settings can improve service efficiency and accessibility, their integration is not straightforward, challenging existing role definitions of both registered nurses and physicians. Developing adequate support practices is therefore essential in primary healthcare nurse practitioners' integration. This study's main objective is to examine different structures and mechanisms put in place to support the development of primary healthcare nurse practitioner's practice in different healthcare settings, and develop a practical model for identifying and planning adequate support practices. This study is part of a larger multicentre study on primary healthcare nurse practitioners in the province of Quebec, Canada. It focuses on three healthcare settings into which one or more primary healthcare nurse practitioners have been integrated. Case studies have been selected to cover a maximum of variations in terms of location, organizational setting, and stages of primary healthcare nurse practitioner integration. Findings are based on the analysis of available documentation in each primary healthcare setting and on semi-structured interviews with key actors in each clinical team. Data were analyzed following thematic and cross-sectional analysis approaches. This article identifies three types of support practices: clinical, team, and systemic. This three-level analysis demonstrates that, on the ground, primary healthcare nurse practitioner integration is essentially a team-based, multilevel endeavour. Despite the existence of a provincial implementation plan, the three settings adopted very different implementation structures and practices, and different actors were involved at each of the three levels. The results also indicated that nursing departments played a decisive role at all three levels. Based on these findings, we suggest that support practices should be adapted to each organization's environment and

Can nurse practitioners and physicians beat parochialism into plowshares?

PubMed

Phillips, Robert L; Harper, Doreen C; Wakefield, Mary; Green, Larry A; Fryer, George E

2002-01-01

Nurse practitioners have evolved into a large and flexible workforce. Far too often, nurse practitioner and physician professional organizations do not work together but rather expend considerable effort jousting in policy arenas. Turf battles interfere with joint advocacy for needed health system change and delay development of interdisciplinary teams that could help patients. A combined, consistent effort is urgently needed for studying, training, and deploying a collaborative, integrated workforce aimed at improving the health care system of tomorrow. The country can ill afford doctors and nurses who ignore one another's capabilities and fail to maximize each other's contributions cost-effectively.

Nurse Practitioner Residency Programs: An Educational Journey

ERIC Educational Resources Information Center

Rys, Gregory P.

2016-01-01

Primary care is in a state of crisis due to the lack of clinicians and increasing numbers of insured patients. Encouraging more students to go directly through school for their doctor of nursing practice degree and nurse practitioner (NP) certifications is one proposal to alleviate this crisis. However, this approach would deliver graduates with…

RCN sets the bar high for advanced nursing status.

PubMed

2017-02-08

Details of how senior, specialist nurses will be able to accredit themselves as advanced practitioners are starting to emerge from the RCN. It is immediately apparent that qualifying for this status is going to be far from easy, given the significant expectations that are likely to be set.

The Employment of Nurse Practitioners and Physician Assistants in U.S. Nursing Homes

ERIC Educational Resources Information Center

Intrator, Orna; Feng, Zhanlian; Mor, Vince; Gifford, David; Bourbonniere, Meg; Zinn, Jacqueline

2005-01-01

Purpose: Nursing facilities with nurse practitioners or physician assistants (NPs or PAs) have been reported to provide better care to residents. Assuming that freestanding nursing homes in urban areas that employ these professionals are making an investment in medical infrastructure, we test the hypotheses that facilities in states with higher…

Cognitive dissonance experienced by nurse practitioner faculty.

PubMed

Fontenot, Holly B; Hawkins, Joellen W; Weiss, Josie A

2012-08-01

The purpose of this study was to explicate the concept of cognitive dissonance as experienced and reported by nurse practitioner (NP) faculty members. Responses from NP faculty members to an online survey about their experiences with cognitive dissonance. The respondents detailed their experiences with cognitive dissonance, citing differences between expectations for which they are rewarded and those for which they are paid. Expecting all faculty members to excel in practice, research, teaching, and service may create unrealistic workloads for NP faculty members. Examining expectations and considering creation of a clinical track for faculty who practice may be options administrators of NP programs might explore. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.

Investigating nurse practitioners in the private sector: a theoretically informed research protocol.

PubMed

Adams, Margaret; Gardner, Glenn; Yates, Patsy

2017-06-01

To report a study protocol and the theoretical framework normalisation process theory that informs this protocol for a case study investigation of private sector nurse practitioners. Most research evaluating nurse practitioner service is focused on public, mainly acute care environments where nurse practitioner service is well established with strong structures for governance and sustainability. Conversely, there is lack of clarity in governance for emerging models in the private sector. In a climate of healthcare reform, nurse practitioner service is extending beyond the familiar public health sector. Further research is required to inform knowledge of the practice, operational framework and governance of new nurse practitioner models. The proposed research will use a multiple exploratory case study design to examine private sector nurse practitioner service. Data collection includes interviews, surveys and audits. A sequential mixed method approach to analysis of each case will be conducted. Findings from within-case analysis will lead to a meta-synthesis across all four cases to gain a holistic understanding of the cases under study, private sector nurse practitioner service. Normalisation process theory will be used to guide the research process, specifically coding and analysis of data using theory constructs and the relevant components associated with those constructs. This article provides a blueprint for the research and describes a theoretical framework, normalisation process theory in terms of its flexibility as an analytical framework. Consistent with the goals of best research practice, this study protocol will inform the research community in the field of primary health care about emerging research in this field. Publishing a study protocol ensures researcher fidelity to the analysis plan and supports research collaboration across teams. © 2016 John Wiley & Sons Ltd.

The transition to first position as nurse practitioner.

PubMed

Kelly, N R; Mathews, M

2001-04-01

The nurse who graduates from a nurse practitioner program leaves a comfort zone of nursing practice to enter a new position where feelings of insecurity and stress are common. Because the role of the nurse practitioner (NP) continues to evolve and is influenced by many environmental issues, the preparation of the NP by the academic institution needs to be assessed on a frequent basis. The purpose of this research was to obtain a better understanding of the transitional phase to the first position as NP after graduation. The perceptions of preparation, gains, losses, barriers, facilitators, and strategies for adjustment were explored. A qualitative approach using focus groups was developed in which 21 recent NP graduates from a large university participated in one of four focus groups. Peer debriefing and participant verification were techniques used to ensure credibility and trustworthiness of the data and subsequent analysis. The themes identified were: loss of personal control of time and privacy; changes and losses in relationships; feelings of isolation and uncertainty in establishing the NP role; and a special bonding with clients. Although the participants perceived they were adequately prepared for their role, they also described feelings of guilt and uncertainty from not knowing information they believed they should know. They concluded that they functioned differently than the physician as well as other nurses and found it necessary to distance themselves from the role of other health care providers. This study has implications for colleagues, academic institutions, and the individual nurse practitioner.

NURSE PRACTITIONERS. THE ROAD LESS TRAVELLED.

PubMed

Dragon, Natalie

2016-11-01

With the Australian healthcare system struggling to keep up with surging demand, nurse practitioners are ideally placed and suited to fulfill the role for which they were envisioned. Natalie Dragon looks at the challenges to realize the NP potential.

A triadic interplay between academics, practitioners and students in the nursing theory and practice dialectic.

PubMed

Chan, Engle Angela; Chan, Kitty; Liu, Yat Wa Justina

2012-05-01

  This article is a report of a descriptive study of the effectiveness of classroom teaching by clinical nurse specialists on students' transfer of theory into practice.   Ongoing concern about a theory-practice merger in nursing has led to collaborative initiatives between academics and practitioners globally. There are different forms of collaborative efforts, but information on their evaluation is scarce and inconclusive. Integration of theory and practice is important for an outcome-based approach, which emphasizes students' clinical competence as the measure of success. The limited nursing discussion on theory and practice collaboration in education was our impetus for the study.   Between 2007 and 2008, focus group interviews were held, first with 75 and then with 35 from the same group of first-year students, regarding their learning experience from the lectures of the two clinical nurse specialists in diabetes and colostomy care, respectively, prior to and after their clinical placements. Six of their clinical instructors and the two clinical nurse specialists were also interviewed. The audiotaped interviews were transcribed verbatim and analysed using content analysis.   Three themes were identified: impact of students' vicarious learning from clinical nurse specialists' stories of experience; improving the collaboration between clinical nurse specialists and subject lecturers for junior students' learning experience; continuity in the clinical integration of theory-practice as dialectic through an interplay between academics, practitioners and students.   The theory and practice issue is best addressed as a triadic paradigm in a community of practice with the collaboration among academics, practitioners and students. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

The role of ICT in supporting disruptive innovation: a multi-site qualitative study of nurse practitioners in emergency departments

PubMed Central

2012-01-01

Background The disruptive potential of the Nurse Practitioner (NP) is evident in their ability to offer services traditionally provided by primary care practitioners and their provision of a health promotion model of care in response to changing health trends. No study has qualitatively investigated the role of the Emergency NP in Australia, nor the impact of Information and Communication Technology (ICT) on this disruptive workforce innovation. This study aimed to investigate ways in which Nurse Practitioners (NP) have incorporated the use of ICT as a mechanism to support their new clinical role within Emergency Departments. Methods A cross-sectional qualitative study was undertaken in the Emergency Departments (EDs) of two large Australian metropolitan public teaching hospitals. Semi-structured, in-depth interviews were conducted with five nurse practitioners, four senior physicians and five senior nurses. Transcribed interviews were analysed using a grounded theory approach to develop themes in relation to the conceptualisation of the ED nurse practitioner role and the influences of ICT upon the role. Member checking of results was achieved by revisiting the sites to clarify findings with participants and further explore emergent themes. Results The role of the ENP was distinguished from those of Emergency nurses and physicians by two elements: advanced practice and holistic care, respectively. ICT supported the advanced practice dimension of the NP role in two ways: availability and completeness of electronic patient information enhanced timeliness and quality of diagnostic and therapeutic decision-making, expediting patient access to appropriate care. The ubiquity of patient data sourced from a central database supported and improved quality of communication between health professionals within and across sites, with wider diffusion of the Electronic Medical Record holding the potential to further facilitate team-based, holistic care. Conclusions ICT is a

The role of ICT in supporting disruptive innovation: a multi-site qualitative study of nurse practitioners in emergency departments.

PubMed

Li, Julie; Westbrook, Johanna; Callen, Joanne; Georgiou, Andrew

2012-04-02

The disruptive potential of the Nurse Practitioner (NP) is evident in their ability to offer services traditionally provided by primary care practitioners and their provision of a health promotion model of care in response to changing health trends. No study has qualitatively investigated the role of the Emergency NP in Australia, nor the impact of Information and Communication Technology (ICT) on this disruptive workforce innovation. This study aimed to investigate ways in which Nurse Practitioners (NP) have incorporated the use of ICT as a mechanism to support their new clinical role within Emergency Departments. A cross-sectional qualitative study was undertaken in the Emergency Departments (EDs) of two large Australian metropolitan public teaching hospitals. Semi-structured, in-depth interviews were conducted with five nurse practitioners, four senior physicians and five senior nurses. Transcribed interviews were analysed using a grounded theory approach to develop themes in relation to the conceptualisation of the ED nurse practitioner role and the influences of ICT upon the role. Member checking of results was achieved by revisiting the sites to clarify findings with participants and further explore emergent themes. The role of the ENP was distinguished from those of Emergency nurses and physicians by two elements: advanced practice and holistic care, respectively. ICT supported the advanced practice dimension of the NP role in two ways: availability and completeness of electronic patient information enhanced timeliness and quality of diagnostic and therapeutic decision-making, expediting patient access to appropriate care. The ubiquity of patient data sourced from a central database supported and improved quality of communication between health professionals within and across sites, with wider diffusion of the Electronic Medical Record holding the potential to further facilitate team-based, holistic care. ICT is a facilitator through which the disruptive

Nurse practitioners in Taiwan: today and tomorrow.

PubMed

Wei, Ching-Wen; Tung, Heng-Hsin; Tsay, Shiow-Luan; Lin, Che-Wei

2012-03-01

To describe the barriers that nurse practitioners (NPs) face and their hopes for the future. The study used a qualitative research design, with 10 certified NPs who were recruited through convenience sampling. Data were collected through a face-to-face semi-structured interview, and content analysis was used to analyze the data. NPs in Taiwan are challenged by a number of barriers; however, they remain positive that their circumstances will improve. The results of this study suggest that there is a need for better communication between policymakers and NPs. Additionally, as recommended by the International Council of Nursing, there is a need for NPs to earn a master's degree and to have formal training prior to beginning work as an NP. Furthermore, to evaluate the NPs' performance, outcome studies need to be conducted. Implementing such recommendations should enable NPs to earn the respect and support of healthcare professionals and administrators. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.

Using a Web-Based e-Visit Simulation to Educate Nurse Practitioner Students.

PubMed

Merritt, Lisa Schaeg; Brauch, Allison N; Bender, Annah K; Kochuk, Daria

2018-05-01

The purpose of this pilot study was to develop and implement a Web-based, e-Visit simulation experience for nurse practitioner students and evaluate student satisfaction and perceived learning. The convenience sample consisted of 26 senior-level Master of Science in Nursing students in the Pediatric Nurse Practitioner and Adult-Gerontology Nurse Practitioner programs. A Likert survey was used for evaluation that measured items from 1 (strongly disagree) to 5 (strongly agree). Students reported that the simulation cases closely resembled real-world patients (97%; M = 4.42, SD = 0.69), providing them with a better understanding of complaints commonly addressed via telehealth services (96%; M = 4.46, SD = 0.57). Accuracy of diagnosis and treatment on first attempt was 95%. A Web-based, e-Visit simulation can be a useful learning experience for nurse practitioner students with knowledge gained that is transferable to real clinical situations. [J Nurs Educ. 2018;57(5):304-307.]. Copyright 2018, SLACK Incorporated.

Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing.

PubMed

O'Connell, Jane; Gardner, Glenn; Coyer, Fiona

2014-12-01

This paper presents a discussion on the application of a capability framework for advanced practice nursing standards/competencies. There is acceptance that competencies are useful and necessary for definition and education of practice-based professions. Competencies have been described as appropriate for practice in stable environments with familiar problems. Increasingly competencies are being designed for use in the health sector for advanced practice such as the nurse practitioner role. Nurse practitioners work in environments and roles that are dynamic and unpredictable necessitating attributes and skills to practice at advanced and extended levels in both familiar and unfamiliar clinical situations. Capability has been described as the combination of skills, knowledge, values and self-esteem which enables individuals to manage change, be flexible and move beyond competency. A discussion paper exploring 'capability' as a framework for advanced nursing practice standards. Data were sourced from electronic databases as described in the background section. As advanced practice nursing becomes more established and formalized, novel ways of teaching and assessing the practice of experienced clinicians beyond competency are imperative for the changing context of health services. Leading researchers into capability in health care state that traditional education and training in health disciplines concentrates mainly on developing competence. To ensure that healthcare delivery keeps pace with increasing demand and a continuously changing context there is a need to embrace capability as a framework for advanced practice and education. © 2014 John Wiley & Sons Ltd.

Experiences of nurse practitioners and medical practitioners working in collaborative practice models in primary healthcare in Australia - a multiple case study using mixed methods.

PubMed

Schadewaldt, Verena; McInnes, Elizabeth; Hiller, Janet E; Gardner, Anne

2016-07-29

In 2010 policy changes were introduced to the Australian healthcare system that granted nurse practitioners access to the public health insurance scheme (Medicare) subject to a collaborative arrangement with a medical practitioner. These changes facilitated nurse practitioner practice in primary healthcare settings. This study investigated the experiences and perceptions of nurse practitioners and medical practitioners who worked together under the new policies and aimed to identify enablers of collaborative practice models. A multiple case study of five primary healthcare sites was undertaken, applying mixed methods research. Six nurse practitioners, 13 medical practitioners and three practice managers participated in the study. Data were collected through direct observations, documents and semi-structured interviews as well as questionnaires including validated scales to measure the level of collaboration, satisfaction with collaboration and beliefs in the benefits of collaboration. Thematic analysis was undertaken for qualitative data from interviews, observations and documents, followed by deductive analysis whereby thematic categories were compared to two theoretical models of collaboration. Questionnaire responses were summarised using descriptive statistics. Using the scale measurements, nurse practitioners and medical practitioners reported high levels of collaboration, were highly satisfied with their collaborative relationship and strongly believed that collaboration benefited the patient. The three themes developed from qualitative data showed a more complex and nuanced picture: 1) Structures such as government policy requirements and local infrastructure disadvantaged nurse practitioners financially and professionally in collaborative practice models; 2) Participants experienced the influence and consequences of individual role enactment through the co-existence of overlapping, complementary, traditional and emerging roles, which blurred perceptions of

Validation of Nurse Practitioner Primary Care Organizational Climate Questionnaire: A New Tool to Study Nurse Practitioner Practice Settings.

PubMed

Poghosyan, Lusine; Chaplin, William F; Shaffer, Jonathan A

2017-04-01

Favorable organizational climate in primary care settings is necessary to expand the nurse practitioner (NP) workforce and promote their practice. Only one NP-specific tool, the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), measures NP organizational climate. We confirmed NP-PCOCQ's factor structure and established its predictive validity. A crosssectional survey design was used to collect data from 314 NPs in Massachusetts in 2012. Confirmatory factor analysis and regression models were used. The 4-factor model characterized NP-PCOCQ. The NP-PCOCQ score predicted job satisfaction (beta = .36; p < .001) and intent to leave job (odds ratio = .28; p = .011). NP-PCOCQ can be used by researchers to produce new evidence and by administrators to assess organizational climate in their clinics. Further testing of NP-PCOCQ is needed.

Nurse practitioner role transition: a concept analysis.

PubMed

MacLellan, Lorna; Levett-Jones, Tracy; Higgins, Isabel

2015-07-01

Transitioning from registered nurse to nurse practitioner (NP) can be challenging personally and professionally. Insight into transition experiences may help validate the experiences of new NPs and provide greater understanding of the challenges faced during their professional journey. The purpose of this article is to report a concept analysis of transition from registered nurse to NP. The article provides new knowledge, understanding, and clarity about the concept of transition. Walker and Avants' framework for concept analysis was used to identify the attributes, antecedents, and consequences of the concept. A literature review of refereed journals was undertaken. Model cases from an ethnographic study conducted in Australia provide real life examples of the attributes of transition. Transitioning to the role of NP is complex and dependent on the individual and the attitudes of healthcare colleagues. Change and adaptation are required of both the NP and members of the healthcare team. Failure to adapt by either party undermines the potential for NPs to deliver improved health care. Mentorship along with a nurturing environment may be effective strategies for increasing the NP's self-confidence and ensuring a smooth and successful transition period. ©2014 American Association of Nurse Practitioners.

Student and Preceptor Advancement in a Dedicated Education Site: Innovation in Clinical Education for Advanced Practice Nurses.

PubMed

Hall, Katherine C; Diffenderfer, Sandy K; Stidham, April; Mullins, Christine M

2018-04-19

In the 1990s, dedicated education units transformed undergraduate preceptorships, but graduate preceptorships remain static. The dyadic nurse practitioner preceptorship model supports an environment where faculty, students, and preceptors may overlook nuances that affect the teaching-learning process. This article describes an innovative clinical education model, Student and Preceptor Advancement in a Dedicated Education Site, designed to improve preceptorships for advanced practice nurses. The focus is on adaptations made to facilitate use in advanced practice nursing programs.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Establishing a nurse practitioner collaborative: evolution, development, and outcomes.

PubMed

Quinn, Karen; Hudson, Peter

2014-09-01

The first Australian palliative care nurse practitioner (NP) was endorsed in 2003. In 2009 the Victoria Department of Health funded the development of the Victorian Palliative Care Nurse Practitioner Collaborative (VPCNPC). Its aim was to promote the NP role, develop resources, and provide education and mentorship to NPs, nurse practitioner candidates (NPCs), and health service managers. Four key objectives were developed: identify the demographic profile of palliative care NPCs in Victoria; develop an education curriculum and practical resources to support the training and education of palliative care NPCs and NPs; provide mentorship to NPs, NPCs, and service managers; and ensure effective communication with all key stakeholders. An NPC survey was also conducted to explore NPC demographics, models of care, the hours of study required for the role, the mentoring process, and education needs. This paper reports on the establishment of the VPCNPC, the steps taken to achieve its objectives, and the results of the survey. The NP role in palliative care in Australia continues to evolve, and the VPCNPC provides a structure and resources to clearly articulate the benefits of the role to nursing and clinical services.

Job satisfaction and perceived autonomy for nurse practitioners working in nurse-managed health centers.

PubMed

Pron, Ann Linguiti

2013-04-01

More primary care providers are needed to deliver health care to Americans living in poverty and those soon to be insured under the Affordable Care Act. Nurse practitioners (NPs) in nurse-managed health centers (NMHCs) are poised to meet this need. This research study examined the characteristics of NPs working in NMHCs and measured job satisfaction and perceived level of autonomy. No studies about job satisfaction or autonomy for NPs working in NMHCs had been previously reported. This descriptive, quantitative study surveyed primary care NPs working in NMHCs that are part of the National Nursing Centers Consortium (NNCC). NP e-mail addresses were obtained from NNCC center directors. Of 198 NPs invited to the electronic survey, 99 completed the Misener Nurse Practitioner Job Satisfaction Scale, demographic questionnaire, questions about perceived autonomy, and whether they would recommend working in an NMHC. Participants came from 16 states and 46 NMHCs. NPs working in NMHCs have job satisfaction, perceive their role as autonomous, and are satisfied with the autonomy they have. NMHCs can provide access to primary health care for many Americans. More NPs may choose employment in NMHCs for job satisfaction and autonomy. ©2012 The Author(s) Journal compilation ©2012 American Association of Nurse Practitioners.

Continuity of care by cardiothoracic nurse practitioners: impact on outcome.

PubMed

Southey, Dawn; Mishra, Pankaj Kumar; Nevill, Alan; Aktuerk, Dincer; Luckraz, Heyman

2014-10-01

There have been recent reports on increased mortality in British National Health Service hospitals during weekends. This study aimed to assess the impact on patient care following the introduction of nurse practitioner cover for the cardiothoracic ward, including weekends. Prospectively collected and validated data of patients operated on from January 2005 to October 2011 were analyzed. The patients were grouped according to era: before (n = 2385) and after (n = 3910) the introduction of nurse practitioners in October 2007. There were no significant differences in preoperative patient characteristics such as age, logistic EuroSCORE, sex, smoking, and extracardiac vascular problems. There were more patients from an Asian background (p < 0.01), more with noninsulin-dependent diabetes (p < 0.01), and more requiring urgent cardiac surgery (p < 0.01) in the later era. Following the introduction of nurse practitioner grade, there was a decrease in the rate of cardiac intensive care unit readmission from 2.6% to 1.9% (p = 0.05) and length of hospital stay from 10 to 8 days (p < 0.01). There was a significant improvement in overall survival after cardiac surgery from 96.5% to 98.0% (p < 0.01). Logistic regression analysis confirmed that the presence of nurse practitioners on the ward was the strongest predictor of survival with an odds ratio of 1.9 (95% confidence interval: 1.23-3.01). The introduction of the nurse practitioner grade to provide continuity in patient care including at weekends has been confirmed to improve patient outcomes including survival after cardiac surgery. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Nurse Practitioner Care Improves Renal Outcome in Patients with CKD

PubMed Central

van Zuilen, Arjan D.; van den Brand, Jan A.J.G.; Bots, Michiel L.; van Buren, Marjolijn; ten Dam, Marc A.G.J.; Kaasjager, Karin A.H.; Ligtenberg, Gerry; Sijpkens, Yvo W.J.; Sluiter, Henk E.; van de Ven, Peter J.G.; Vervoort, Gerald; Vleming, Louis-Jean; Blankestijn, Peter J.; Wetzels, Jack F.M.

2014-01-01

Treatment goals for patients with CKD are often unrealized for many reasons, but support by nurse practitioners may improve risk factor levels in these patients. Here, we analyzed renal endpoints of the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners (MASTERPLAN) study after extended follow-up to determine whether strict implementation of current CKD guidelines through the aid of nurse practitioners improves renal outcome. In total, 788 patients with moderate to severe CKD were randomized to receive nurse practitioner support added to physician care (intervention group) or physician care alone (control group). Median follow-up was 5.7 years. Renal outcome was a secondary endpoint of the MASTERPLAN study. We used a composite renal endpoint of death, ESRD, and 50% increase in serum creatinine. Event rates were compared with adjustment for baseline serum creatinine concentration and changes in estimated GFR were determined. During the randomized phase, there were small but significant differences between the groups in BP, proteinuria, LDL cholesterol, and use of aspirin, statins, active vitamin D, and antihypertensive medications, in favor of the intervention group. The intervention reduced the incidence of the composite renal endpoint by 20% (hazard ratio, 0.80; 95% confidence interval, 0.66 to 0.98; P=0.03). In the intervention group, the decrease in estimated GFR was 0.45 ml/min per 1.73 m2 per year less than in the control group (P=0.01). In conclusion, additional support by nurse practitioners attenuated the decline of kidney function and improved renal outcome in patients with CKD. PMID:24158983

Telehealth and eHealth in nurse practitioner training: current perspectives

PubMed Central

Rutledge, Carolyn M; Kott, Karen; Schweickert, Patty A; Poston, Rebecca; Fowler, Christianne; Haney, Tina S

2017-01-01

Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1) defining telehealth, 2) telehealth etiquette, 3) interprofessional collaboration, 4) regulations, 5) reimbursement, 6) security/Health Insurance Portability and Accountability Act (HIPAA), 7) ethical practice in telehealth, and 8) satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1) didactics, 2) simulations including standardized patient encounters, 3) practice immersions, and 4) telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care. PMID:28721113

Decreasing barriers for nurse practitioner social entrepreneurship.

PubMed

Sharp, Dayle B; Monsivais, Diane

2014-10-01

To describe difficulties associated with the business-related aspects of practice in role transition of rural nurse practitioners (NPs), and to give practice implications. This focused ethnographic study derived data from semi-structured interviews. Participants provided information about rural NP practice ownership and barriers. The sample consisted of 24 rural NPs living throughout the United States. The majority were 51-60 years of age (45%) and females (93%) who had been in rural practice for 1 to over 20 years. NP social entrepreneurs experience difficulties related to scope of practice, business skills, and role conflict. To decrease barriers for NP clinic ownership and management, NPs need to receive education related to financing a rural practice, legal/regulatory practices, strategic planning, leadership, and clinic management. ©2014 American Association of Nurse Practitioners.

Canadian nurse practitioner job satisfaction.

PubMed

LaMarche, Kimberley; Tullai-McGuinness, Susan

2009-01-01

To examine the level of job satisfaction and its association with extrinsic and intrinsic job satisfaction characteristics among Canadian primary healthcare nurse practitioners (NPs). A descriptive correlational design was used to collect data on NPs' job satisfaction and on the factors that influence their job satisfaction. A convenience sample of licensed Canadian NPs was recruited from established provincial associations and special-interest groups. Data about job satisfaction were collected using two valid and reliable instruments, the Misener Nurse Practitioner Job Satisfaction Survey and the Minnesota Satisfaction Questionnaire. Descriptive statistics, Pearson correlation and regression analysis were used to describe the results. The overall job satisfaction for this sample ranged from satisfied to highly satisfied. The elements that had the most influence on overall job satisfaction were the extrinsic category of partnership/collegiality and the intrinsic category of challenge/autonomy. These findings were consistent with Herzberg's Dual Factor Theory of Job Satisfaction. The outcomes of this study will serve as a foundation for designing effective human health resource retention and recruitment strategies that will assist in enhancing the implementation and the successful preservation of the NP's role.

The effectiveness of nurse practitioners working at a GP cooperative: a study protocol.

PubMed

Wijers, Nancy; Schoonhoven, Lisette; Giesen, Paul; Vrijhoef, Hubertus; van der Burgt, Regi; Mintjes, Joke; Wensing, Michel; Laurant, Miranda

2012-08-07

In many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high) accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting. A quasi experimental study is undertaken at one "general practitioner cooperative" to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012. Data will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals) and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes are: patient satisfaction; general practitioners workload; quality

Trends in nurse practitioners' prescribing to older adults in Ontario, 2000-2010: a retrospective cohort study

PubMed Central

Tranmer, Joan E.; Colley, Lindsey; Edge, Dana S.; Sears, Kim; VanDenKerkhof, Elizabeth; Levesque, Linda

2015-01-01

Background: Nurse prescribing is a practice that has evolved and will continue to evolve in response to emerging trends, particularly in primary care. The goal of this study was to describe the trends and patterns in medication prescription to adults 65 years of age or older in Ontario by nurse practitioners over a 10-year period. Methods: We conducted a population-based descriptive retrospective cohort study. All nurse practitioners registered in the Corporate Provider Database between Jan. 1, 2000, and Dec. 31, 2010, were identified. We identified actively prescribing nurse practitioners through linkage of dispensed medications to people aged 65 years or older from the Ontario Drug Benefit database. For comparison, all prescription medications dispensed by family physicians to a similar group were identified. Geographic location was determined based on site of nurse practitioner practice. Results: The number and proportion of actively prescribing nurse practitioners prescribing to older adults increased during the study period, from 44/340 (12.9%) to 888/1423 (62.4%). The number and proportion of medications dispensed for chronic conditions by nurse practitioners increased: in 2010, 9 of the 10 top medications dispensed were for chronic conditions. There was substantial variation in the proportion of nurse practitioners dispensing medication to older adults across provincial Local Health Integration Networks. Interpretation: Prescribing by nurse practitioners to older adults, particularly of medications related to chronic conditions, increased between 2000 and 2010. The integration of nurse practitioners into primary care has not been consistent across the province and has not occurred in relation to population changes and perhaps population needs. PMID:26457291

Articulating nurse practitioner practice using King's theory of goal attainment.

PubMed

de Leon-Demare, Kathleen; MacDonald, Jane; Gregory, David M; Katz, Alan; Halas, Gayle

2015-11-01

To further understand the interactions between nurse practitioners (NPs) and patients, King's nursing theory of goal attainment was applied as the conceptual framework to describe the interactions between NPs and patients in the primary care setting. Six dyads of NPs and their patients were video- and audio-taped over three consecutive clinic visits. For the purposes of this arm of the study, the audio-taped interactions were transcribed and then coded using King's concepts in her theory of goal attainment. King's theory was applicable to describe NP practice. King's concepts and processes of nurse-patient interactions, such as disturbances, mutual goal setting, and transactions, were observed in NP-patient interactions. Disturbances during clinical encounters were essential in the progression toward goal attainment. Elements, such as social exchange, symptom reporting, role explanation, and information around clinical processes facilitated relationship building. NPs as practitioners need to be reflective of their own practice, embrace disturbances in the clinical encounter, and attend to these as opportunities for mutual goal setting. ©2015 American Association of Nurse Practitioners.

Nurse Practitioners' Education, Awareness, and Therapeutic Approaches for the Management of Fibromyalgia.

PubMed

Hughes, Linda; Adair, Jean; Feng, Feng; Maciejewski, Stephanie; Sharma, Harsha

2016-01-01

In the United States, fibromyalgia affects 2%-5% of the adult population, rendering it the most common chronic, widespread pain condition. The American College of Rheumatology has published diagnostic criteria for fibromyalgia, with the latest version in 2010. The purpose of this study was to evaluate nurse practitioners' education and awareness of fibromyalgia and to evaluate nurse practitioners' practices for the management of fibromyalgia. Sixty-six nurse practitioners voluntarily completed an online survey regarding their education, diagnosis, and treatment options for patients with fibromyalgia. The majority of participants reported that they always or occasionally had difficulty diagnosing fibromyalgia and worried about labeling their patients as having fibromyalgia. The most commonly used agents were nonsteroidal anti-inflammatory drugs (70%), serotonin norepinephrine reuptake inhibitors (61%), selective serotonin reuptake inhibitors (51%), and muscle relaxants (44%). Nondrug therapies included exercise (88%), cognitive behavior therapy (58%), and nutrition (56%). Further education is needed for nurse practitioners to increase confidence in diagnosing and managing fibromyalgia.

Professional identity of Korean nurse practitioners in the United States.

PubMed

Seo, Kumsook; Kim, Miyoung

2017-04-01

Despite nurse practitioners' (NPs) professional identity having important implications for the confirmation of nursing practice characteristics, few studies have examined the professional identity of NPs overlaid with the immigrant experience. The aim of this study was to explore the career characteristics of Korean nurse immigrants who became NPs in the United States. Seven Korean NPs in the United States underwent in-depth interviews from August 2013 to May 2015. Content analysis was employed for data analysis. Five themes were identified regarding their professional identity as NPs: patient-centered thinking, responsibility for patient care, dedicated life, diligence, and feelings of achievement. Of these, patient-centered thinking appeared to be the overriding theme. The findings add to nursing knowledge about immigrant nurses and their abilities and striving to develop into new roles in nursing. The participants focused on listening, interpersonal relationships, and education in patient care, which helped differentiate their roles from those of other healthcare professionals. Nurse managers should consider the study findings when making policies to assist immigrant nurses to acculturate into practice, and there is a need for the development of educational materials to guide and promote the NPs' professional role. ©2017 American Association of Nurse Practitioners.

Essential nurse practitioner business knowledge: An interprofessional perspective.

PubMed

LaFevers, David; Ward-Smith, Peggy; Wright, Wendy

2015-04-01

To describe business practice knowledge from the perspectives of nurse practitioners (NPs) who are practicing clinicians, academic instructors, and clinic managers. Using the eight domains of business practice attitudes identified by the Medical Group Management Associations Body of Knowledge (MGMA), which are supported by the American Association of Colleges of Nursing (AACN), a study-specific survey was developed. Data, which describe the knowledge and attitudes with respect to business practices, were obtained from 370 participants. Regardless of their job classification, these participants described (1) quality management, (2) risk management, and (3) patient care systems as critical business practice knowledge. Consensus was also achieved when ranking the content for business practice knowledge: (1) patient care systems, (2) business operation, and (3) financial management. These data identify gaps in business practice knowledge and content that should be included in educational programs. Business practice knowledge is essential for a successful clinical practice and should be a professional practice skill for the NP. ©2015 American Association of Nurse Practitioners.

Faculty mentorship: support for nurse practitioner students and staff within the rural community health setting.

PubMed

Hanson, C M; Hilde, E

1989-01-01

As pointed out in the introduction, there are certain practical concepts within our base of nursing knowledge that can only be taught through experience. Many things are easier to teach by example. As we turn back the clock in nursing, we can see how Florence Nightingale, Clara Barton, and Lillian Wald were role models to their nursing peers in their era. They taught nursing by example, by role modeling their clinical expertise. Today, this model is still effective and faculty mentoring of nurse practitioner students and CHNs in a compassionate and collegial leadership results in higher quality of health care for our nation's needy clients and their families. But greater yet are the opportunities for flexible nurse practitioner faculty practice and personal interactions on many levels for nursing faculty who wish to share their expertise. Mentorship by nurse practitioner faculty for nurse practitioner students and CHNs in a rural clinical setting has revealed many positive aspects in providing quality care for rural clients and growth for nurses. Exposure to the rural community health system helps us, as nurses, to identify the many strengths it possesses for innovative rural nursing practice.

Professional online community membership and participation among healthcare providers: An extension to nurse practitioners and physician assistants.

PubMed

Betts, Kevin R; O'Donoghue, Amie C; Aikin, Kathryn J; Kelly, Bridget J; Boudewyns, Vanessa

2016-12-01

Professional online communities allow healthcare providers to exchange ideas with their colleagues about best practices for patient care. Research on this topic has focused almost exclusively on primary care physicians and specialists, to the exclusion of advanced practice providers such as nurse practitioners and physician assistants. We expand this literature by examining membership and participation on these websites among each of these provider groups. Participants (N = 2008; approximately 500 per provider group) responded to an Internet-based survey in which they were asked if they use professional online communities to dialogue with colleagues and if so, what their motivation is for doing so. Nearly half of the participants in our sample reported utilizing professional online communities. Select differences were observed between provider groups, but overall, similar patterns emerged in their membership and participation on these websites. Nurse practitioners and physician assistants utilize professional online communities in similar proportion to primary care physicians and specialists. Providers should be cognizant of the impact this use may have for both themselves and their patients. Researchers are urged to take into account the various professional roles within the healthcare community while developing research on this topic. ©2016 American Association of Nurse Practitioners.

The effectiveness of Nurse Practitioners working at a GP cooperative: a study protocol

PubMed Central

2012-01-01

Background In many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high) accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting. Design A quasi experimental study is undertaken at one “general practitioner cooperative” to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012. Methods Data will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals) and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes are: patient satisfaction

A protocol for a pragmatic randomized controlled trial evaluating outcomes of emergency nurse practitioner service.

PubMed

Jennings, Natasha; Gardner, Glenn; O'Reilly, Gerard

2014-09-01

To evaluate emergency nurse practitioner service effectiveness on outcomes related to quality of care and service responsiveness. Increasing service pressures in the emergency setting have resulted in the adoption of service innovation models; the most common and rapidly expanding of these is the emergency nurse practitioner. The delivery of high quality patient care in the emergency department is one of the most important service indicators to be measured in health services today. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this model in outcomes related to safety and quality of patient care. Pragmatic randomized controlled trial at one site with 260 participants. This protocol describes a definitive prospective randomized controlled trial, which will examine the impact of emergency nurse practitioner service on key patient care and service indicators. The study control will be standard emergency department care. The intervention will be emergency nurse practitioner service. The primary outcome measure is pain score reduction and time to analgesia. Secondary outcome measures are waiting time, number of patients who did not wait, length of stay in the emergency department and representations within 48 hours. Scant research enquiry evaluating emergency nurse practitioner service on patient effectiveness and service responsiveness exists currently. This study is a unique trial that will test the effectiveness of the emergency nurse practitioner service on patients who present to the emergency department with pain. The research will provide an opportunity to further evaluate emergency nurse practitioner models of care and build research capacity into the workforce. Trial registration details: Australian and New Zealand Clinical Trials Registry dated 18th August 2013, ACTRN12613000933752. © 2014 John Wiley & Sons Ltd.

Evaluation Study of Family Nurse Practitioners in US Army Health Care.

DTIC Science & Technology

1982-01-01

Practitioners: The Family Nurse Practitioner Survey consisted of five parts: (1) Demographic; (2) Attitude Scale; (3) Present Assignment; (4) Role...Demographics; (2) Attitudes ; and (3) Role Functions/Diagnostic Categories. All results are displayed in Appendix 2. The information on the functions/diagnostic...requirements at least at the major Family Practice Departments for the FNP. This attitude is shared by a great majority of the ANC nurse managers queried

Development and testing of an instrument to measure holistic nursing values in nurse practitioner care.

PubMed

Kinchen, Elizabeth

2015-01-01

As primary care delivery evolves in the United States with nurse practitioners (NPs) as key providers, exploring the patient's perception of the nature and quality of NPs' care is of critical importance to healthcare consumers, providers, educators, policy makers, and underwriters. The aim of this study was to describe the development and testing of the Nurse Practitioner Holistic Caring Instrument, a new, investigator-developed measure of the preservation of holistic nursing values in NP care. Results suggest that NPs provide patient-centered, comprehensive, and clinically competent care, rendering them ideally suited to leading primary health care delivery. However, further testing in more diverse populations and settings is needed to strengthen preliminary findings.

Role of nurse practitioners in reducing cardiovascular risk factors: a retrospective cohort study.

PubMed

Klemenc-Ketis, Zalika; Terbovc, Alenka; Gomiscek, Bostjan; Kersnik, Janko

2015-11-01

To determine the impact of nurse practitioners' counselling on reducing cardiovascular risk factors in patients participating in routine preventive check-ups. A new model of 'renewed' family practice was introduced in Slovenia as a pilot project in 2011, in which nurse practitioners are included in a team carrying out preventive activities and managing patients with stable chronic diseases. A retrospective cohort study. This study was conducted in 16 family medicine practices (eight renewed and eight regular family practices). In each family practice, a systematic sample was selected of registered patients participating in a cardiovascular preventive check-up. Data on sex, age, blood pressure, cholesterol, blood sugar, smoking, level of physical activity and cardiovascular risk were collected. Patients attending renewed family practices received counselling on risk factors from nurse practitioners (test group), and patients attending regular family practices received counselling from family physicians (control group). Data were collected again at least one and no more than five years after the baseline consultation. There were 128 patients in the test group and 129 patients in the control group. At the control visit, the patients counselled by nurse practitioners had significantly lower levels of systolic blood pressure and cholesterol and practiced regular physical activity significantly more often than patients counselled by family physicians. Nurse practitioners can be at least as successful as physicians when counselling patients on cardiovascular risk factors during their preventive check-ups. This study showed that nurse practitioners have an important role in managing patients at the primary care level. © 2015 John Wiley & Sons Ltd.

42 CFR 405.2415 - Services and supplies incident to nurse practitioner and physician assistant services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... practitioner and physician assistant services. 405.2415 Section 405.2415 Public Health CENTERS FOR MEDICARE... Services and supplies incident to nurse practitioner and physician assistant services. (a) Services and supplies incident to a nurse practitioner's or physician assistant's services are reimbursable under this...

42 CFR 405.2415 - Services and supplies incident to nurse practitioner and physician assistant services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... practitioner and physician assistant services. 405.2415 Section 405.2415 Public Health CENTERS FOR MEDICARE... Services and supplies incident to nurse practitioner and physician assistant services. (a) Services and supplies incident to a nurse practitioner's or physician assistant's services are reimbursable under this...

42 CFR 405.2415 - Services and supplies incident to nurse practitioner and physician assistant services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... practitioner and physician assistant services. 405.2415 Section 405.2415 Public Health CENTERS FOR MEDICARE... Services and supplies incident to nurse practitioner and physician assistant services. (a) Services and supplies incident to a nurse practitioner's or physician assistant's services are reimbursable under this...

Accuracy and Safety of External Ventricular Drain Placement by Physician Assistants and Nurse Practitioners in Aneurysmal Acute Subarachnoid Hemorrhage.

PubMed

Enriquez-Marulanda, Alejandro; Ascanio, Luis C; Salem, Mohamed M; Maragkos, Georgios A; Jhun, Ray; Alturki, Abdulrahman Y; Moore, Justin M; Ogilvy, Christopher S; Thomas, Ajith J

2018-06-11

In the current dynamic health environment, increasing number of procedures are being completed by advanced practitioners (nurse practitioners and physician assistants). This is the first study to assess the clinical outcomes and safety of external ventricular drain (EVD) placements by specially trained advanced practitioners. Compare the safety and outcomes of EVD placement by advanced practitioners in patients with subarachnoid hemorrhage (SAH). A cohort comparison study was performed from an aneurysmal SAH database selecting patients treated with EVD from a single major academic institution in the USA between June 2007 and June 2017. Safety, accuracy, and complications of EVD placement were compared between advanced practitioners and neurosurgical physicians (attending neurosurgeon and subspecialty clinical fellow). Statistical analysis was performed using the Mann-Whitney test for continuous variables and χ 2 test for categorical variables, with p values set at < 0.05 for significance. We identified 203 patients for this cohort with 238 EVD placements; eighty-seven (36.6%) placements were performed by advanced practitioners and 151 (63.4%) by neurosurgeons. Most of the ventriculostomies were placed in the emergency room (n = 114; 47.9%). Additional procedures performed concurrently with the EVD placements were significantly higher among the physicians' group (21.8 vs. 4.6%; p < 0.001). Bedside placement and usage of Ghajar guide were significantly higher among advanced practitioner's (58.3 vs. 98.9 and 9.9 vs. 64.4%, respectively, with a p < 0.001 for both). There were, however, no significant differences in terms of the number of attempts for insertion, intraprocedural complications, tract hemorrhages, accuracy, infection rates, catheter dislodgments, and need for repositioning/replacement of EVD. After appropriate training, EVD placement can be safely performed by advanced practitioners with an adequate accuracy of placement.

"Under the radar": nurse practitioner prescribers and pharmaceutical industry promotions.

PubMed

Ladd, Elissa C; Mahoney, Diane Feeney; Emani, Srinivas

2010-12-01

To assess nurse practitioners' interactions with pharmaceutical industry promotional activities and their perception of information reliability and self-reported prescribing behaviors. Self-administered online survey. A nationally randomized sample of nurse practitioner prescribers was surveyed. Eligibility criteria included current clinical practice and licensure to prescribe medications in their state of practice. A total of 263 responses were analyzed. Almost all respondents (96%) reported regular contact with pharmaceutical sales representatives, and most (71%) reported receiving information on new drugs directly from pharmaceutical sales representatives some or most of the time. A large portion (66%) dispensed drug samples regularly to their patients, and 73% believed that samples were somewhat or very helpful in learning about new drugs. Eighty-one percent of respondents thought that it was ethically acceptable to give out samples to anyone, and 90% believed that it was acceptable to attend lunch and dinner events sponsored by the pharmaceutical industry. Almost half (48%) stated that they were more likely to prescribe a drug that was highlighted during a lunch or dinner event. Most respondents stated that it was ethically acceptable for speakers to be paid by industry. Nurse practitioner prescribers had extensive contact with pharmaceutical industry promotional activities such as pharmaceutical representative contact, receipt of drug samples, and regular attendance at industry-sponsored meal events and continuing education programs. They reported that industry interface with nurse practitioner prescribers in the form of sponsored meals, education events, and paid speakers was ethically acceptable.

Nurse practitioners and controlled substances prescriptive authority: improving access to care.

PubMed

Ambrose, Michelle A; Tarlier, Denise S

2013-03-01

In 2007, Health Canada proposed a new framework to regulate prescriptive authority for controlled substances, titled New Classes of Practitioners Regulations (NCPR). The new regulatory framework was passed in November 2012; it gives nurse practitioners (NPs), midwives and podiatrists the authority to prescribe controlled medications under the Controlled Drugs and Substances Act. It is expected that authorizing NPs to write prescriptions for certain controlled substances commonly used in primary care will enhance flexibility and timeliness in primary care service delivery. Studies from the United States have shown positive outcomes in primary care access, decreased healthcare costs and the evolution and advancement of the NP role when prescriptive authority was expanded to include controlled substances. The purpose of this paper is to examine how NPs' prescriptive authority for controlled substances affects access to primary care and NP role development. Three key issues identified from the experience of one group of NPs in the United States (access to care, professional autonomy and prescriber knowledge) offer insight into the practice changes that may be anticipated for NPs in Canada now that they have acquired prescriptive authority for controlled substances. Recommendations are offered to assist nurse leaders and educators to best support NPs as they take on this new and important role responsibility.

A Practice-Based Theory of Healing Through Therapeutic Touch: Advancing Holistic Nursing Practice.

PubMed

Hanley, Mary Anne; Coppa, Denise; Shields, Deborah

2017-08-01

For nearly 50 years, Therapeutic Touch (TT) has contributed to advancing holistic nursing practice and has been recognized as a uniquely human approach to healing. This narrative explores the development of a practice-based theory of healing through TT, which occurred between 2010 and 2016. Through the in-depth self-inquiry of participatory reflective dialogue in concert with constant narrative analysis, TT practitioners revealed the meaning of healing within the context of their TT practice. As the community of TT experts participated in an iterative process of small group and community dialogues with analysis and synthesis of emerging themes, the assumptions and concepts central to a theory of healing emerged, were clarified and verified. Exemplars of practice illustrate the concepts. A model of the theory of healing illuminates the movement and relationship among concepts and evolved over time. Feedback from nursing and inter-professional practitioners indicate that the theory of healing, while situated within the context of TT, may be useful in advancing holistic nursing practice, informing healing and caring approaches, stimulating research and education, and contributing to future transformations in health care.

From Entry to Practice to Advanced Nurse Practitioner - The Progression of Competencies and How They Assist in Delivery of eHealth Programs for Healthy Ageing.

PubMed

Rodger, Daragh; Hussey, Pamela

2017-01-01

Most of the health issues encountered in persons of older age are the result of one or more chronic diseases. The evidence base reports that chronic diseases can be prevented or delayed by engaging in healthy behaviors. Education provides a cost effective intervention on both economic grounds in addition to delivery of optimal patient outcomes. Information and Communication Technology (ICT) increasingly is viewed as a critical utility in eHealth delivery, providing scope for expanding online education facilities for older persons. Developing nursing competencies in the delivery of eHealth solutions to deliver user education programs therefore makes sense. This chapter discusses nursing competencies on the development of targeted eHealth programs for healthy ageing. The role of Advanced Nurse Practitioner in Ireland and its associated competency set identifies how a strong action learning model can be designed to deliver eHealth educational programs for effective delivery of healthy ageing in place.

42 CFR 405.2415 - Services and supplies incident to nurse practitioner and physician assistant services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Services and supplies incident to nurse... Services and supplies incident to nurse practitioner and physician assistant services. (a) Services and supplies incident to a nurse practitioner's or physician assistant's services are reimbursable under this...

Journey to Becoming a Neonatal Nurse Practitioner: Making the Decision to Enter Graduate School.

PubMed

Brand, M Colleen; Cesario, Sandra K; Symes, Lene; Montgomery, Diane

2016-04-01

Neonatal nurse practitioners (NNPs) play an important role in caring for premature and ill infants. Currently, there is a shortage of NNPs to fill open positions. Understanding how nurses decide to become NNPs will help practicing nurse practitioners, managers, and faculty encourage and support nurses in considering the NNP role as a career choice. To describe how nurses decide to enter graduate school to become nurse practitioners. A qualitative study using semistructured interviews to explore how 11 neonatal intensive care unit nurses decided to enter graduate school to become NNPs. Key elements of specialization, discovery, career decision, and readiness were identified. Conditions leading to choosing the NNP role include working in a neonatal intensive care unit and deciding to stay in the neonatal area, discovering the NNP role, deciding to become an NNP, and readiness to enter graduate school. Important aspects of readiness are developing professional self-confidence and managing home, work, and financial obligations and selecting the NNP program. Neonatal nurse practitioners are both positive role models and mentors to nurses considering the role. Unit managers are obligated to provide nurses with opportunities to obtain leadership skills. Faculty of NNP programs must be aware of the impact NNP students and graduates have on choices of career and schools. Exploring the decision to become an NNP in more geographically diverse populations will enhance understanding how neonatal intensive care unit nurses decide to become NNPs.

Introducing the nurse practitioner into the surgical ward: an ethnographic study of interprofessional teamwork practice.

PubMed

Kvarnström, Susanne; Jangland, Eva; Abrandt Dahlgren, Madeleine

2017-08-22

The first nurse practitioners in surgical care were introduced into Swedish surgical wards in 2014. Internationally, organisations that have adopted nurse practitioners into care teams are reported to have maintained or improved the quality of care. However, close qualitative descriptions of teamwork practice may add to existing knowledge of interprofessional collaboration when introducing nurse practitioners into new clinical areas. The aim was to report on an empirical study describing how interprofessional teamwork practice was enacted by nurse practitioners when introduced into surgical ward teams. The study had a qualitative, ethnographic research design, drawing on a sociomaterial conceptual framework. The study was based on 170 hours of ward-based participant observations of interprofessional teamwork practice that included nurse practitioners. Data were gathered from 2014 to 2015 across four surgical sites in Sweden, including 60 interprofessional rounds. The data were analysed with an iterative reflexive procedure involving inductive and theory-led approaches. The study was approved by a Swedish regional ethics committee (Ref. No.: 2014/229-31). The interprofessional teamwork practice enacted by the nurse practitioners that emerged from the analysis comprised a combination of the following characteristic role components: clinical leader, bridging team colleague and ever-present tutor. These role components were enacted at all the sites and were prominent during interprofessional teamwork practice. The participant nurse practitioners utilised the interprofessional teamwork practice arrangements to enact a role that may be described in terms of a quality guarantee, thereby contributing to the overall quality and care flow offered by the entire surgical ward team. © 2017 Nordic College of Caring Science.

42 CFR Appendix B to Part 130 - Confidential Physician or Nurse Practitioner Affidavit

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Confidential Physician or Nurse Practitioner Affidavit B Appendix B to Part 130 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... 130—Confidential Physician or Nurse Practitioner Affidavit ER31MY00.002 ER31MY00.003 ...

42 CFR Appendix B to Part 130 - Confidential Physician or Nurse Practitioner Affidavit

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Confidential Physician or Nurse Practitioner Affidavit B Appendix B to Part 130 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... 130—Confidential Physician or Nurse Practitioner Affidavit ER31MY00.002 ER31MY00.003 ...

An explanatory model of nurse practitioner job satisfaction.

PubMed

Koelbel, P W; Fuller, S G; Misener, T R

1991-01-01

Job satisfaction influences employee retention, worker productivity, and performance quality. To retain qualified nurse practitioners (NPs), health administrators must identify sources of job satisfaction and dissatisfaction. Herzberg's dual-factor theory of job satisfaction addresses extrinsic and intrinsic work-related factors. Expansion of the model to include global job satisfaction and individual differences provided a broad framework for the assessment of nurse practitioner job satisfaction. The expanded model was used to analyze the job satisfaction of 132 NPs registered with the South Carolina State Board of Nursing in 1988 (final response rate = 90%). Participants completed the Index of Job Satisfaction (IJS), the Minnesota Satisfaction Questionnaire-Short Form (MSQ-SF), and the Personal and Work Background Questionnaire (PWBQ). Although the NPs were moderately satisfied with their overall jobs, extrinsic factors were found to be major sources of dissatisfaction. The optimal combination of variables predicted by regression analysis to influence global job satisfaction were age, number of children, urban locations, achievement, company policies and practices, creativity, independence, and compensation. Implications for health administrators to improve the work environments of NPs are discussed.

Remote nursing certified practice: viewing nursing and nurse practitioner practice through a social justice lens.

PubMed

Tarlier, Denise S; Browne, Annette J

2011-06-01

Remote Nursing Certified Practice (RNCP) was introduced in 2010 to regulate nursing practice in remote, largely First Nations communities in British Columbia, Canada. These are communities that often experience profound health and health-care inequities. Typically nurses are the main health-care providers. Using a critical social justice lens, the authors explore the clinical and ethical implications of RNCP in terms of access to equitable, high-quality primary health care.They examine the fit between the level and scope of health services provided by registered nurses working under RNCP and the health needs of remote First Nations communities. In doing so, they draw comparisons between nurse practitioners (NPs) and outpost nurses working in NP roles who historically were employed to provide health care in these communities.The authors conclude by calling for nursing regulations that support equitable, high-quality primary care for all British Columbians.

42 CFR 410.75 - Nurse practitioners' services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... statutory exclusions; and (3) Performs them while working in collaboration with a physician. (i) Collaboration is a process in which a nurse practitioner works with one or more physicians to deliver health... State in which the services are performed. (ii) In the absence of State law governing collaboration...

[Advanced nursing practice: a must for the quality of care and mental health services].

PubMed

Ricard, Nicole; Page, Claire; Laflamme, France

2014-01-01

New professional legislation and reorganization of mental health services have had a significant influence on mental health nursing practice. Many nurses have demonstrated clinical leadership and have been able to adapt their services to the needs of the population specially in the primary health care setting. However, many believe that the role of nurses is not sufficiently known and optimally utilized in mental health services. In this article we take a critical look at the mental health nursing practice in Quebec and at the essential requirements for its development. This review aims to: 1) describe current trends in the changing roles and the modernization of mental health nursing practice in Quebec, 2) provide an overview of the development of advanced nursing practice and its impact on the quality of mental health services; 3) clarify the concept of advanced nursing practice and position its development in Quebec and 4) propose various strategies for optimizing the role of nurses and their complementarity with other professionals providing mental health services. This review presents innovative practices developed by nurses in the context of the restructuring of mental health services. For example, new nursing roles have been developed to improve the collaboration with general practitioners groups in primary care settings and facilitate the evaluation and monitoring of patient presenting medical and psychological problems. Another interesting innovation was set up by nurses in developing a new service to allow timely access to integrated care for patients with substance abuse and mental health problems. The various testimonies reported in this article illustrate the potential contribution of these nursing innovations in improving the mental health services in Quebec. Also, in few countries, the reform of mental health services has been a good time to recognize this potential. Thus, some countries have repositioned the role of mental health nurses and

The effectiveness of a nurse practitioner-led pain management team in long-term care: A mixed methods study.

PubMed

Kaasalainen, Sharon; Wickson-Griffiths, Abigail; Akhtar-Danesh, Noori; Brazil, Kevin; Donald, Faith; Martin-Misener, Ruth; DiCenso, Alba; Hadjistavropoulos, Thomas; Dolovich, Lisa

2016-10-01

Considering the high rates of pain as well as its under-management in long-term care (LTC) settings, research is needed to explore innovations in pain management that take into account limited resource realities. It has been suggested that nurse practitioners, working within an inter-professional model, could potentially address the under-management of pain in LTC. This study evaluated the effectiveness of implementing a nurse practitioner-led, inter-professional pain management team in LTC in improving (a) pain-related resident outcomes; (b) clinical practice behaviours (e.g., documentation of pain assessments, use of non-pharmacological and pharmacological interventions); and, (c) quality of pain medication prescribing practices. A mixed method design was used to evaluate a nurse practitioner-led pain management team, including both a quantitative and qualitative component. Using a controlled before-after study, six LTC homes were allocated to one of three groups: 1) a nurse practitioner-led pain team (full intervention); 2) nurse practitioner but no pain management team (partial intervention); or, 3) no nurse practitioner, no pain management team (control group). In total, 345 LTC residents were recruited to participate in the study; 139 residents for the full intervention group, 108 for the partial intervention group, and 98 residents for the control group. Data was collected in Canada from 2010 to 2012. Implementing a nurse practitioner-led pain team in LTC significantly reduced residents' pain and improved functional status compared to usual care without access to a nurse practitioner. Positive changes in clinical practice behaviours (e.g., assessing pain, developing care plans related to pain management, documenting effectiveness of pain interventions) occurred over the intervention period for both the nurse practitioner-led pain team and nurse practitioner-only groups; these changes did not occur to the same extent, if at all, in the control group

Perceptions of the Utilization of Family Nurse Practitioners by Current Air Force Outpatient Physicians

DTIC Science & Technology

1996-03-26

detection and management of acute self-limiting conditions and management of chronic stable conditions within a family . A FNP provides primary...APPROVAL SHEET Title of thesis: "Perceptions of the Utilization of Family Nurse Practitioners by Current Air Force Outpatient Physicians" Name...of Candidate: Patrick Edward Bertz Master of Science in Nursing Family Nurse Practitioner APPROVED, ~J.~ Comm~tte Chalrperson ·Committee Me her

Precepting nurse practitioner students: A new view-Results of two national surveys of nurse practitioner preceptors.

PubMed

Roberts, Mary Ellen; Wheeler, Kathy J; Tyler, Diane O; Padden, Diane L

2017-08-01

The aim of two national studies was to identify characteristics of nurse practitioners (NPs) who precept and the benefits, incentives, and barriers associated with the NP preceptor role. Stratified randomized sampling was used to invite a representative number of NPs from each state to participate in a 2015 survey and a follow-up survey in 2016. These descriptive, exploratory studies distributed electronic questionnaires to 5000 randomly selected NPs in the 2015 survey and 40,000 NPs in the 2016 survey. Responses from 10.9% (n = 548) and 9.9% (n = 3970), respectively, were analyzed. The findings show strong support among our NP colleagues to assist with educating future NPs. Several benefits, barriers, and motivators among stakeholders were identified that need to be considered when working with preceptors. This study provides a basis for understanding the current climate in education when working with clinical preceptors. Many areas become apparent where NP education could enhance the experience for both the student and the preceptor. Educational settings need to consider preceptor time, issues with online learning, and the rise of specialty practices. Offering incentives linked to the most valued, positive aspects of the role and methods to overcome barriers should be explored. ©2017 American Association of Nurse Practitioners.

Building nurses' capacity to address health inequities: incorporating lesbian, gay, bisexual and transgender health content in a family nurse practitioner programme.

PubMed

Yingling, Charles T; Cotler, Karen; Hughes, Tonda L

2017-09-01

To describe our experience in incorporating lesbian, gay, bisexual and transgender health content into the family nurse practitioner curriculum at a Midwestern college of nursing in the United States. Globally, lesbian, gay, bisexual and transgender people face disparities in the domains of physical health, behavioural risks, mental health and victimisation. There remains a paucity of nursing research on most aspects of lesbian, gay, bisexual and transgender health and access to care. To date, nursing leadership and curricular bodies have not provided clear guidance on the role of nurse educators in preparing nursing students to provide care to lesbian, gay, bisexual and transgender people. Discursive paper describing the development of a lesbian, gay, bisexual and transgender health learning module for inclusion in a family nurse practitioner programme. We summarise health disparities experienced by lesbian, gay, bisexual and transgender people, describe the process of module development and outline the learning content included in the module. We also discuss challenges faced in incorporating lesbian, gay, bisexual and transgender content into nursing curricula. Despite the lack of formal direction from the nursing sector, nursing faculty should prepare nursing students to provide culturally sensitive and competent care to lesbian, gay, bisexual and transgender people. Our experience incorporating lesbian, gay, bisexual and transgender-specific content into the family nurse practitioner programme has proven to be positive for both students and faculty. Given their large numbers and presence across systems of care, nurses are uniquely positioned to address barriers to care faced by lesbian, gay, bisexual and transgender people. Modules such as the one described here can be used by nurse faculty to guide the inclusion of lesbian, gay, bisexual and transgender-specific content in family nurse practitioner or other nursing courses-as well as to guide the development

Beyond the physical examination: the nurse practitioner's role in adolescent risk reduction and resiliency building in a school-based health center.

PubMed

Davis, Teresa K

2005-12-01

School-based health centers in high schools provide a unique setting in which to deliver risk-reduction and resilience-building services to adolescents. The traditional health care system operating in the United States focuses on the treatment of illness and disease rather than on preventing problems originating from health risk behaviors. Nurse practitioners can promote healthy behavior in adolescents through linkages to parents, schools, and community organizations; by conducting individual risk assessments; and by providing health education and access to creative health programs that build resilience and promote protective factors. With a focus on wellness, nurse practitioners as advanced practice nurses and specialists in disease prevention and health promotion can establish students' health priorities in the context of the primary health care they deliver on a daily basis.

How do we capture the emergency nurse practitioners' contribution to value in health service delivery?

PubMed

Jennings, Natasha; Lutze, Matthew; Clifford, Stuart; Maw, Michael

2017-03-01

The emergency nurse practitioner is now a well established and respected member of the healthcare team. Evaluation of the role has focused on patient safety, effectiveness and quality of care outcomes. Comparisons of the role continue to focus on cost, with findings based on incomplete and almost impossible to define, recognition of contribution to service delivery by paralleled practitioners. Currently there is no clear definition as to how nurse practitioners contribute to value in health service delivery. Robust and rigorous research needs to be commissioned taking into consideration the unique hybrid nature of the emergency nurse practitioner role and focusing on the value they contribute to health care delivery.

Practice activities of privately-practicing nurse practitioners: Results from an Australian survey.

PubMed

Currie, Jane; Chiarella, Mary; Buckley, Thomas

2018-03-01

To facilitate expansion of privately-practicing nurse practitioners in community and primary care settings, a legislative amendment in 2010 made privately-practicing nurse practitioners eligible to provide services subsidised through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. To evaluate their practice activities, a national survey of privately-practicing nurse practitioners in Australia was conducted, and data analysed using descriptive statistics and thematic analysis (n = 73). As part of their role, 96% (n = 70) participants reported undertaking direct patient care, 95% (n = 69) patient education and health promotion, 95% (n = 69) prescribed medications, 92% (n = 67) referred patients for diagnostic investigations, and 88% (n = 64) reported making a diagnosis. Over 50% of participants saw up to 15 patients daily, and 80% (n = 58) treated the same patients on a regular basis. Of the participants, 59% (n = 43) perceived that they worked to their full scope of practice. The mainstay of privately-practicing nurse practitioner services is provision of direct patient care in community and primary healthcare settings, suggesting they have emerging potential in addressing the ever-increasing demand for healthcare in Australia. © 2017 John Wiley & Sons Australia, Ltd.

Exploring conceptual and theoretical frameworks for nurse practitioner education: a scoping review protocol.

PubMed

Wilson, Rosemary; Godfrey, Christina M; Sears, Kim; Medves, Jennifer; Ross-White, Amanda; Lambert, Natalie

2015-10-01

The objective of this review is to examine conceptual and/or theoretical frameworks that are relevant to nurse practitioner education.The specific review question is: What conceptual and/or theoretical frameworks are available that are relevant to the structuring of nurse practitioner education? The use of conceptual and theoretical frameworks to organize the educational curriculum of nursing programs is essential to protect and preserve the focus and clarity of nursing's distinct contribution to health care. Conceptual frameworks of nursing provide a means to look at nursing in relationship to external factors, thereby assigning meaning to the practice. Graduate level nursing education in the preparation of Nurse Practitioners (NPs) specifically and Advanced Practice Nurses (APNs) in general, is significantly compromised by the tendency to conceptualize the learning in these complex programs as being primarily related to skills-based tasks and competencies alone. According to Baumann, advanced nursing education must focus on the uniqueness of the NP position, in contrast to other health care professions. To do this, Baumann suggests using a conceptual nursing model and nursing theory as opposed to a strictly biomedical model. This allows NPs to interpret information in a way that differs from the strict biomedical model, providing opportunities for the NPs to be truly present in the lives of their patients.Canadian Nurse Practitioner (NP) practice competency documents are based primarily on the Canadian Nurses Association (CNA) Nurse Practitioner (NP) Core Competency Framework. This document defines the core set of entry-level competencies required for all NPs to practice in all Canadian jurisdictions, settings and client populations. The Core Competencies in the CNA NP Framework are organized within four main categories: professional role, responsibility and accountability; health assessment and diagnosis; therapeutic management; and health promotion and

Cost-effectiveness of a WOC Advanced Practice Nurse in the Acute Care and Outpatient Setting

PubMed Central

2014-01-01

Increasing numbers of advanced practice nurses who practice within the WOC specialty are challenged by the need to justify their role by demonstrating clinical and fiscal benefits to the employing agency. This View From Here column describes the steps I took while completing such an analysis for a position for a nurse practitioner with WOC certification in upstate New York. PMID:24918767

Human trafficking education for nurse practitioners: Integration into standard curriculum.

PubMed

Lutz, Rebecca M

2018-02-01

Human trafficking is a crime resulting in serious negative health outcomes for the victims. To provide optimal care, thus improving health outcomes, healthcare providers must be able to identify victims as they seek care for acute and chronic physical illness, communicable diseases, sexually transmitted infections, and mental health disorders (Lederer and Wetzel, 2014; Oram et al., 2012). Unfortunately, healthcare providers lack appropriate knowledge of clues that would lead to victim identification. This may result in a failure to identify victims (Beck et al., 2015; Ross et al., 2015; Konstantopoulos et al., 2013; Chisolm-Straker et al., 2012). Increasing the number of healthcare providers able to identify, treat, and refer victims of trafficking for further care is imperative. The study evaluated the knowledge level of student nurse practitioners enrolled in an adult, family, or pediatric clinical course. Knowledge domains included the definitions, laws, prevalence, identification, treatment, and community and social service resources. The study was designed as a non-probability sampling of adult, family, and pediatric nurse practitioner students (n=73). Participants included students enrolled in the Adult & Older Adult I or the Primary Care of the Child & Adolescent I course at a large public university. The study was designed as a one hour educational intervention intended for presentation in a lecture-style format. The educational intervention included a PowerPoint lecture and embedded videos. The pre-survey, designed as a paper survey, contained a demographic section followed by six survey questions covering the six domains of interest. Following the intervention, participants completed the post-survey prior to leaving the classroom. Pre-survey results pinpointed knowledge gaps across all six domains under investigation. Post-survey results revealed an increase in knowledge across all six domains of interest. The educational intervention increased knowledge

Using Simulation in a Psychiatric Mental Health Nurse Practitioner Doctoral Program.

PubMed

Calohan, Jess; Pauli, Eric; Combs, Teresa; Creel, Andrea; Convoy, Sean; Owen, Regina

The use and effectiveness of simulation with standardized patients in undergraduate and graduate nursing education programs is well documented. Simulation has been primarily used to develop health assessment skills. Evidence supports using simulation and standardized patients in psychiatric-mental health nurse practitioner (PMHNP) programs is useful in developing psychosocial assessment skills. These interactions provide individualized and instantaneous clinical feedback to the student from faculty, peers, and standardized patients. Incorporating simulation into advanced practice psychiatric-mental health nursing curriculum allows students to develop the necessary requisite skills and principles needed to safely and effectively provide care to patients. There are no documented standardized processes for using simulation throughout a doctor of nursing practice PMHNP curriculum. The purpose of this article is to describe a framework for using simulation with standardized patients in a PMHNP curriculum. Students report high levels of satisfaction with the simulation experience and believe that they are more prepared for clinical rotations. Faculty feedback indicates that simulated clinical scenarios are a method to ensure that each student experiences demonstrate a minimum standard of competency ahead of clinical rotations with live patients. Initial preceptor feedback indicates that students are more prepared for clinical practice and function more independently than students that did not experience this standardized clinical simulation framework. Published by Elsevier Inc.

Team science of nursing, engineering, statistics, and practitioner in the development of a robotic reflexology device.

PubMed

Wyatt, Gwen; Sikorskii, Alla; Bush, Tamara Reid; Mukherjee, Ranjan

2010-01-01

The purpose of this article is to share the lessons learned in forming an interdisciplinary team that implements a team science approach to integrative medicine (IM) research. The disciplines of nursing, statistics, and engineering, along with consultants and a reflexology practitioner, formed this university-based team to conceptualize and develop a prototype robotic device for reflexology for breast cancer patients. The nurse investigator contributed the intervention background and access to the population; the statistician guided the team thinking on factors that needed to be controlled for; the engineers provided the expertise in device design and development; consultants facilitated the team's thinking in new directions; and the reflexology practitioner prescribed the protocol. We discuss the contributions and achievements of each discipline, as well as the challenges, and share the team experiences with the intent to help guide the formation of new IM teams that promote a conducive atmosphere for carrying out cutting-edge IM research and advancing the science.

Simulation and Advanced Practice Nursing Education

ERIC Educational Resources Information Center

Blue, Dawn I.

2016-01-01

This quantitative study compared changes in level of confidence resulting from participation in simulation or traditional instructional methods for BSN (Bachelor of Science in Nursing) to DNP (Doctor of Nursing Practice) students in a nurse practitioner course when they entered the clinical practicum. Simulation has been used in many disciplines…

How do nurse practitioners work in primary health care settings? A scoping review.

PubMed

Grant, Julian; Lines, Lauren; Darbyshire, Philip; Parry, Yvonne

2017-10-01

This scoping review explores the work of nurse practitioners in primary health care settings in developed countries and critiques their contribution to improved health outcomes. A scoping review design was employed and included development of a research question, identification of potentially relevant studies, selection of relevant studies, charting data, collating, summarising and reporting findings. An additional step was added to evaluate the methodological rigor of each study. Data sources included literature identified by a search of electronic databases conducted in September 2015 (CINAHL, Informit, Web of Science, Scopus and Medline) and repeated in July 2016. Additional studies were located through hand searching and authors' knowledge of other relevant studies. 74 articles from eight countries were identified, with the majority emanating from the United States of America. Nurse practitioners working in communities provided care mostly in primary care centres (n=42), but also in community centres (n=6), outpatient departments (n=6), homes (n=5), schools (n=3), child abuse clinics (n=1), via communication technologies (n=6), and through combined face-to-face and communication technologies (n=5). The scope of nurse practitioner work varied on a continuum from being targeted towards a specific disease process or managing individual health and wellbeing needs in a holistic manner. Enhanced skills included co-ordination, collaboration, education, counselling, connecting clients with services and advocacy. Measures used to evaluate outcomes varied widely from physiological data (n=25), hospital admissions (n=10), use of health services (n=15), self-reported health (n=13), behavioural change (n=14), patient satisfaction (n=17), cost savings (n=3) and mortality/morbidity (n=5). The majority of nurse practitioners working in community settings did so within a selective model of primary health care with some examples of nurse practitioners contributing to

The Role of the Advanced Practice Nurse in Geriatric Oncology Care.

PubMed

Morgan, Brianna; Tarbi, Elise

2016-02-01

To describe how the Advanced Practice Nurse (APN) is uniquely suited to meet the needs of older adults throughout the continuum of cancer, to explore the progress that APNs have made in gero-oncology care, and make suggestions for future directions. Google Scholar, PubMed, and CINAHL. Search terms included: "gero-oncology," "geriatric oncology," "Advanced Practice Nurse," "Nurse Practitioner," "older adult," "elderly," and "cancer." Over the last decade, APNs have made advances in caring for older adults with cancer by playing a role in prevention, screening, and diagnosis; through evidence-based gero-oncology care during cancer treatment; and in designing tailored survivorship care models. APNs must combat ageism in treatment choice for older adults, standardize comprehensive geriatric assessments, and focus on providing person-centered care, specifically during care transitions. APNs are well-positioned to help understand the complex relationship between risk factors, geriatric syndromes, and frailty and translate research into practice. Palliative care must expand beyond specialty providers and shift toward APNs with a focus on early advanced care planning. Finally, APNs should continue to establish multidisciplinary survivorship models across care settings, with a focus on primary care. Copyright © 2015 Elsevier Inc. All rights reserved.

Does contact by a family nurse practitioner decrease early school absence?

PubMed

Kerr, Jill; Price, Marva; Kotch, Jonathan; Willis, Stephanie; Fisher, Michael; Silva, Susan

2012-02-01

Chronic early school absence (preschool through third grade) is associated with school failure. The presence of school nurses may lead to fewer absences, and nurse practitioners in school-based health centers (SBHCs) can facilitate a healthier population resulting in improved attendance. Efforts to get students back to school are unexplored in nursing literature. This article describes a nursing intervention to decrease early school absence in two elementary schools K-3 (N = 449) and a Head Start program (N = 130). The Head Start Family Nurse Practitioner (FNP) contacted families of chronically and excessively absent students by telephone, clinic visit at school, or home visit. The aggregate percentage attendance was evaluated by grades (preschool to third grade), schools (Head Start, Elementary Schools 1 and 2), and grades and schools and compared with publicly available school district aggregate data. There were statistically significant increases in attendance from Year 1 to Year 2 at p < .05 at the elementary level but not at the Head Start level. Student demographics, types of contacts, absence reasons (including sick child), and medical diagnoses are described.

Advancing nursing practice: redefining the theoretical and practical integration of knowledge.

PubMed

Christensen, Martin

2011-03-01

The aim of this paper is to offer an alternative knowing-how knowing-that framework of nursing knowledge, which in the past has been accepted as the provenance of advanced practice. The concept of advancing practice is central to the development of nursing practice and has been seen to take on many different forms depending on its use in context. To many it has become synonymous with the work of the advanced or expert practitioner; others have viewed it as a process of continuing professional development and skills acquisition. Moreover, it is becoming closely linked with practice development. However, there is much discussion as to what constitutes the knowledge necessary for advancing and advanced practice, and it has been suggested that theoretical and practical knowledge form the cornerstone of advanced knowledge. The design of this article takes a discursive approach as to the meaning and integration of knowledge within the context of advancing nursing practice. A thematic analysis of the current discourse relating to knowledge integration models in an advancing and advanced practice arena was used to identify concurrent themes relating to the knowing-how knowing-that framework which commonly used to classify the knowledge necessary for advanced nursing practice. There is a dichotomy as to what constitutes knowledge for advanced and advancing practice. Several authors have offered a variety of differing models, yet it is the application and integration of theoretical and practical knowledge that defines and develops the advancement of nursing practice. An alternative framework offered here may allow differences in the way that nursing knowledge important for advancing practice is perceived, developed and coordinated. What has inevitably been neglected is that there are various other variables which when transposed into the existing knowing-how knowing-that framework allows for advanced knowledge to be better defined. One of the more notable variables is

Evaluation of a Pharmacist and Nurse Practitioner Smoking Cessation Program.

PubMed

Afzal, Zubair; Pogge, Elizabeth; Boomershine, Virginia

2017-08-01

To evaluate the efficacy of a smoking cessation program led by a pharmacist and a nurse practitioner. During a 6-month period, patients attended 7 one-on-one face-to-face smoking cessation counseling sessions with a pharmacist and 1 to 2 one-on-one face-to-face smoking cessation counseling sessions with a nurse practitioner. The primary outcome was smoking cessation point prevalence rates at months 1, 3, and 5 post-quit date. Secondary outcomes included medication adherence rates at months 1, 3, and 5 post-quit date, nicotine dependence at baseline versus program end, and patient satisfaction. Nine (47%) of 19 total participants completed the program. Seven of the 9 patients who completed the program were smoke-free upon study completion. Point prevalence rates at months 1, 3, and 5 post-quit date were 66%, 77%, and 77%, respectively, based on patients who completed the program. Medication adherence rates were 88.6%, 54.6%, and 75% at months 1, 3, and 5 post-quit date, respectively. Based on the Fagerstrom test, nicotine dependence decreased from baseline to the end of the study, 4.89 to 0.33 ( P < .001). Overall, participants rated the program highly. A joint pharmacist and nurse practitioner smoking cessation program can assist patients in becoming smoke-free.

Conceptual framework of acute care nurse practitioner role enactment, boundary work, and perceptions of team effectiveness.

PubMed

Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Lamothe, Lise; Ritchie, Judith A; Doran, Diane

2013-01-01

This article describes a new conceptual framework for acute care nurse practitioner role enactment, boundary work and perceptions of team effectiveness. Acute care nurse practitioners contribute positively to patient care by enacting an expanded scope of practise. Researchers have found both positive and negative reactions to the introduction of acute care nurse practitioners in healthcare teams. The process of role enactment, shifting role boundaries, and perceptions of team effectiveness has been studied disparately. A framework linking team structures and processes to desirable outcomes is needed. Literature was obtained by searching CINAHL, PsycInfo, MedLine, PubMed, British Nursing Index, Cochrane Library, JSTOR Archive, Web of Science, and Google Scholar from 1985-2010. A descriptive multiple-case study was completed from March 2009-May 2009. A new conceptual framework describing how role enactment and boundary work affect perceptions of team effectiveness was developed by combining theoretical and empirical sources. The framework proposes proximal indicators used by team members to assess their team's performance. The framework identifies the inter-related dimensions and concepts that different stakeholders need to consider when introducing nurse practitioners in healthcare teams. Further study is needed to identify team-level outcomes that reflect the contributions of all providers to quality patient care, and explore the patients' and families' perceptions of team effectiveness following the introduction of acute care nurse practitioners. The new framework can guide decision-making and research related to the structures, processes, and outcomes of nurse practitioner roles in healthcare teams. © 2012 Blackwell Publishing Ltd.

Evaluating newly acquired authority of nurse practitioners and physician assistants for reserved medical procedures in the Netherlands: a study protocol

PubMed Central

De Bruijn-Geraets, Daisy P; Van Eijk-Hustings, Yvonne JL; Vrijhoef, Hubertus JM

2014-01-01

Aim The study protocol is designed to evaluate the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care. Background Recent (temporarily) enacted legislation in Dutch health care authorizes nurse practitioners and physician assistants to indicate and perform specified medical procedures, i.e. catheterization, cardioversion, defibrillation, endoscopy, injection, puncture, prescribing and simple surgical procedures, independently. Formerly, these procedures were exclusively reserved to physicians, dentists and midwives. Design A triangulation mixed method design is used to collect quantitative (surveys) and qualitative (interviews) data. Methods Outcomes are selected from evidence-based frameworks and models for assessing the impact of advanced nursing on quality of health care. Data are collected in various manners. Surveys are structured around the domains: (i) quality of care; (ii) costs; (iii) healthcare resource use; and (iv) patient centredness. Focus group and expert interviews aim to ascertain facilitators and barriers to the implementation process. Data are collected before the amendment of the law, 1 and 2·5 years thereafter. Groups of patients, nurse practitioners, physician assistants, supervising physicians and policy makers all participate in this national study. The study is supported by a grant from the Dutch Ministry of Health, Welfare and Sport in March 2011. Research Ethics Committee approval was obtained in July 2011. Conclusion This study will provide information about the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care. Study findings aim to support policy makers and other stakeholders in making related decisions. The study design enables a cross-national comparative analysis. PMID:24684631

Exploring the transition from registered nurse to family nurse practitioner.

PubMed

Poronsky, Cathlin Buckingham

2013-01-01

There is limited information available regarding the transition from registered nurse (RN) to family nurse practitioner (FNP). Several authors described this transition as taking place in 4 stages, and others described it as a 2-phase process. However, there is a lack of consensus about the definition of these stages and phases and at what point they occur for nurses who are making the transition from an RN to an FNP. From what is known, this multistage/2-phase transition is accompanied by feelings of anxiety, stress, role confusion, and emotional turmoil. As a nurse faculty member, the author theorized that nurse faculty might be in a position to provide support for graduate students making this transition in role. However, there was little information available about the transition phases, stages, and needs of students during graduate school. The search for a framework to explore transition yielded transition theory, which is described and applied to FNP transition in this article. Transition theory may be useful for examining more fully the phases and stages of RN-to-FNP transition. In this time of increased need for qualified primary care providers, it is essential that graduates of FNP programs transition into practice following graduation. Copyright © 2013 Elsevier Inc. All rights reserved.

Advanced Nursing Education: Critical Factors That Influence Diploma and Associate Degree Nurses to Advance.

PubMed

McGhie-Anderson, Rose Lavine

The purpose of this study was to gain an understanding of the social processes associated with the decision of diploma and associate degree nurses to advance academically. Advanced nursing education needs to be pursued along the continuum of the nursing career path. This education process is indispensable to the role of nurses as educator, manager, nurse leader, and researcher who will effect policy changes, assume leadership roles as revolutionary thinkers, and implement paradigmatic shifts. Data were collected from two groups of participants using face-to-face, semistructured interviews. Group 1 consisted of diploma and associate degree nurses; Group 2 consisted of baccalaureate, masters, and doctoral degree nurses who have progressed academically. Emerging from the thick, rich data were core categories of rewarding, motivating, and supporting as critical factors that influence professional advancement. This qualitative study elucidated that professional advancement was the social process that grounds. The emergent theory was the theory of professional advancement.

Advanced Beginner to Competent Practitioner: New Graduate Nurses' Perceptions of Strategies That Facilitate or Hinder Development.

PubMed

St-Martin, Lyne; Harripaul, Anastasia; Antonacci, Rosetta; Laframboise, Devon; Purden, Margaret

2015-09-01

New graduate nurses (NGNs) are a precious resource, but their development from advanced beginners to competent nurses is challenging. This qualitative descriptive study explored NGNs' perceptions of strategies that influenced their development in the first 2 years of employment. Semistructured interviews were conducted with a sample of 13 nurses. The study revealed that NGNs learn to master aspects of the nursing role as they construct a professional identity. They identified organizational, educational, and personal strategies as being important to their development, including tailored orientation, opportunities for skill acquisition, and personal support. Few strategies supported the development of professional identity. Mastering the nursing role and constructing a professional identity is central to NGNs' development. Further attention from nursing leaders is needed to promote concurrent development in both dimensions. Nurses with a strong professional identity are more likely to remain in the profession. Copyright 2015, SLACK Incorporated.

Quality measures for nurse practitioner practice evaluation.

PubMed

Kleinpell, Ruth; Kapu, April N

2017-08-01

Evaluating the impact of nurse practitioner (NP) practice has become a priority area of focus for demonstrating outcomes. A number of quality measures are available to enable practice-specific evaluation of NP roles and initiatives. This article reviews sources of quality measures that can be used to facilitate quantifying the outcomes of NP practice as part of an overall evaluation agenda. National resources and published literature on NP quality measures were reviewed. Various resources and toolkits exist to assist NPs in identifying outcomes of practice using quality measures. The need to demonstrate outcomes of NP practice remains an ongoing priority area regardless of the clinical practice setting. A variety of sources of quality measures exist that can be used to showcase the effect of NP care. The use of quality measures can be effectively integrated into evaluation of NP role and NP-directed initiatives to demonstrate impact, and enhance the conduct of an NP outcomes assessment. The use of organizational, NP-specific, and national-related quality measures can help to showcase how NP care improves the quality, safety, and costs of health care. ©2017 American Association of Nurse Practitioners.

A modest proposal: nurse practitioners to improve clinical quality and financial viability in critical access hospitals.

PubMed

Marsh, Leslie; Diers, Donna; Jenkins, Allan

2012-11-01

Rural health care has achieved a new focus of attention with the passage of the Affordable Care Act (ACA). This article argues that nurse practitioners may be an important resource to help rural hospitals, especially critical access hospitals (CAH), achieve their mission of community service while protecting their always-delicate financial sustainability. Nurse practitioners' scope of practice is well suited to the needs of rural patients, and their ability to participate in expanding preventive services is especially essential in remote areas. Barriers to nurse practitioner practice include restrictive state laws and federal and state policies.

Nurse practitioners' focus on health care in terms of cure and care: analysis of graduate theses using the International Classification of Functioning, Disability and Health.

PubMed

Stallinga, Hillegonda A; Jansen, Gerard J; Kastermans, Marijke C; Pranger, Albert; Dijkstra, Pieter U; Roodbol, Petrie F

2016-07-01

To explore the focus of nurse practitioners on health care in terms of cure and care. Nurse practitioners are expected to act on the intersection of cure and care. However, in clinical practice and education, a clear model covering this area is lacking; therefore, it is unknown to what extent nurse practitioners are focused on this specific area. Graduate theses may reflect the focus of nurse practitioners. Sequential exploratory mixed method. In total, 413 published abstracts of graduate theses of a Dutch Master of Advanced Nursing Practice (2000-2015) were analysed using the International Classification of Functioning, Disability and Health. Data source included aim, question and outcome of each thesis and graduates' characteristics. A qualitative deductive approach was used for the analyses. Theses were classified as focused on cure, care, or on the intersection of cure and care. A small majority of 53% (N = 219) of the graduate theses addressed patient's health status and could be classified in the International Classification of Functioning, Disability and Health. Of the classified theses, 48% were focused on cure, 39% on the intersection of cure and care and 13% on care. While the percentage of theses addressing health status increased significantly over the 15-year period, the percentage of theses focused on cure, care and on the intersection of cure and care remained the same. The graduate theses reflected that nurse practitioners are increasingly oriented towards patients' health status. However, their focus is predominantly on cure rather than on the intersection of cure and care. © 2016 John Wiley & Sons Ltd.

Cost-effectiveness of a nurse practitioner-family physician model of care in a nursing home: controlled before and after study.

PubMed

Lacny, Sarah; Zarrabi, Mahmood; Martin-Misener, Ruth; Donald, Faith; Sketris, Ingrid; Murphy, Andrea L; DiCenso, Alba; Marshall, Deborah A

2016-09-01

To examine the cost-effectiveness of a nurse practitioner-family physician model of care compared with family physician-only care in a Canadian nursing home. As demand for long-term care increases, alternative care models including nurse practitioners are being explored. Cost-effectiveness analysis using a controlled before-after design. The study included an 18-month 'before' period (2005-2006) and a 21-month 'after' time period (2007-2009). Data were abstracted from charts from 2008-2010. We calculated incremental cost-effectiveness ratios comparing the intervention (nurse practitioner-family physician model; n = 45) to internal (n = 65), external (n = 70) and combined internal/external family physician-only control groups, measured as the change in healthcare costs divided by the change in emergency department transfers/person-month. We assessed joint uncertainty around costs and effects using non-parametric bootstrapping and cost-effectiveness acceptability curves. Point estimates of the incremental cost-effectiveness ratio demonstrated the nurse practitioner-family physician model dominated the internal and combined control groups (i.e. was associated with smaller increases in costs and emergency department transfers/person-month). Compared with the external control, the intervention resulted in a smaller increase in costs and larger increase in emergency department transfers. Using a willingness-to-pay threshold of $1000 CAD/emergency department transfer, the probability the intervention was cost-effective compared with the internal, external and combined control groups was 26%, 21% and 25%. Due to uncertainty around the distribution of costs and effects, we were unable to make a definitive conclusion regarding the cost-effectiveness of the nurse practitioner-family physician model; however, these results suggest benefits that could be confirmed in a larger study. © 2016 John Wiley & Sons Ltd.

Measuring the impact of the advanced practitioner role: a practical approach.

PubMed

Neville, Lillian; Swift, Juliette

2012-04-01

This paper aims to illuminate difficulties in evaluating the advanced practitioner role and to offer a practical solution. The advanced practice role has been part of the workforce strategy in the Northwest of England since 2005. However capturing hard evidence of the impact of this role has been problematic. Current restrictions on resources require the provision of evidence of the value of roles and services. Critical analysis of literature has identified challenges in evaluating the advanced practice role. The case study design takes account of current policy initiatives, notably QIPP. There is no common approach to evaluating the role of advanced practitioners. The case study has the potential to be a useful tool to organise evidence of the impact of advanced practitioner roles. Advanced practitioners need to have appropriate knowledge and skills to provide evidence of the impact of their role. There is potential for this work to be applied to other roles across the NHS. Managers need to work in partnership with workforce planners and educationalists to support advanced practitioners to utilise their skills in methods of providing evidence that they do work of value. Clear strategic direction for advanced practitioners is advised as part of the workforce strategy. © 2012 Blackwell Publishing Ltd.

Does Contact by a Family Nurse Practitioner Decrease Early School Absence?

ERIC Educational Resources Information Center

Kerr, Jill; Price, Marva; Kotch, Jonathan; Willis, Stephanie; Fisher, Michael; Silva, Susan

2012-01-01

Chronic early school absence (preschool through third grade) is associated with school failure. The presence of school nurses may lead to fewer absences, and nurse practitioners in school-based health centers (SBHCs) can facilitate a healthier population resulting in improved attendance. Efforts to get students back to school are unexplored in…

The Business Management Preceptorship within the Nurse Practitioner Program.

ERIC Educational Resources Information Center

Wing, Donna Marie

1998-01-01

A nurse practitioner business preceptorship provides students with knowledge of basic business, accounting, finance, economics, marketing, and reimbursement. A lack of qualified faculty can be offset with adjunct business faculty. Selection of placement sites should provide challenging management experiences. (SK)

Nurse Practitioners, Physician Assistants, and Certified Nurse-Midwives: A Policy Analysis. Health Technology Case Study 37.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Office of Technology Assessment.

This case study was conducted to analyze the cost-effectiveness of nurse practitioners (NPs), physicians' assistants (PAs), and certified nurse midwives (CNMs) by examining (1) the contributions of each group in meeting health-care needs; (2) the effect of changing the method of payment for their services on the health-care delivery system; and…

Physician Assistant and Nurse Practitioner Prescribing: 1997-2002

ERIC Educational Resources Information Center

Hooker, Roderick S.; Cipher, Daisha J.

2005-01-01

Context: Physician assistants (PAs) and nurse practitioners (NPs) have licensure to practice in all states and they have prescriptive authority in 47 and 40 states, respectively. However, there have been no published studies from a national standpoint comparing urban and rural settings. Purpose: The objective of this study was to describe the…

A new assessment model and tool for pediatric nurse practitioners.

PubMed

Burns, C

1992-01-01

This article presents a comprehensive assessment model for pediatric nurse practitioner (PNP) practice that integrates familiar elements of the classical medical history, Gordon's Functional Health Patterns, and developmental fields into one system. This model drives the diagnostic reasoning process toward consideration of a broad range of disease, daily living (nursing diagnosis), and developmental diagnoses, which represents PNP practice better than the medical model does.

A Study of Family Nurse Practitioners: Perceived Competencies and Some of Their Implications for Nursing Education.

ERIC Educational Resources Information Center

Ward, Mary Jane Morrow

This study was designed to determine the most common health needs and problems that family nurse practitioners (FNP) deal with, to determine how competent FNPs judge themselves to be, to determine what sources in nursing education FNPs judge to be most valuable, and to determine whether or not there were significant differences in the level of…

Neonatal nurse practitioner role transition: the process of reattaining expert status.

PubMed

Cusson, Regina M; Strange, Sally Nelson

2008-01-01

Neonatal nurse practitioners (NNPs) have managed care for high-risk hospitalized infants in the United States for over 30 years. The journey from being expert nurse to being novice NNP and then finally to being expert NNP is fraught with many challenges. This study used a qualitative descriptive design to describe advanced practice role transition among 70 NNPs. The data consisted of participants' written responses to open-ended questions. Four themes emerged that depicted a linear progression of the transition process from school preparation to beginning feelings in the new role and then development into a more confident practice. Theme 1: First impressions emphasized the ambivalence novice NNPs experienced regarding their preparedness for the role during a stressful and exciting adjustment period. Theme 2: The transition demonstrated the overwhelmingly similar feelings of anxiety, insecurity, exhaustion, and lack of confidence that plagued decision making. Theme 3: Making it as a real NNP indicated that the 1-year mark was a consistent, significant timeframe for feeling like a real NNP. Theme 4: The helpers and hinderers revealed the vulnerability of the novice NNPs to harsh criticism as well as the importance of support, especially from nurse colleagues. NNPs are a valuable resource; thus, enhancing transition is a worthy goal.

The universal, collaborative and dynamic model of specialist and advanced nursing and midwifery practice: A way forward?

PubMed

O'Connor, Laserina; Casey, Mary; Smith, Rita; Fealy, Gerard M; Brien, Denise O'; O'Leary, Denise; Stokes, Diarmuid; McNamara, Martin S; Glasgow, Mary Ellen; Cashin, Andrew

2018-03-01

To inform and guide the development of a future model of specialist and advanced nursing and midwifery practice. There is a sizable body of empirical literature supporting the unique contributions of specialist and advanced practice roles to health care. However, there is very little international evidence to inform the integration of a future model for advanced or specialist practice in the Irish healthcare system. A qualitative study was conducted to initiate this important area of inquiry. Purposive sampling was used to generate a sample of informants (n = 15) for the interviews. Nurses and midwives working in specialist and advanced practice and participants from other areas such as legislative, regulatory, policy, medicine and education were included in the sampling frame. Arguments for a new model of specialist and advanced practice were voiced. A number of participants proposed that flexibility within specialist and advanced practitioner career pathways was essential. Otherwise, there existed the possibility of being directed into specialised "silos," precluding movement to another area of integrated practice. Future specialist and advanced practice education programmes need to include topics such as the development of emotional and political intelligence. The contribution of specialist and advanced practice roles to the health service includes providing rapid access to care, seamless patient flow across services, early discharge and lead coordinator of the patient's care trajectory. There was a recommendation of moving towards a universal model to cultivate specialist and advanced nurse and midwife practitioners. The model design has Universal application in a range of contexts "U." It is Collaborative in its inclusivity of all key stakeholders "C." The model is Dynamic pertinent to accommodating movement of nurses and midwives across health continua rather than plateauing in very specialised "silos" "D." © 2017 John Wiley & Sons Ltd.

Current Directions in Family Nurse Practitioner Curricula. Proceedings of a National Conference of Representatives from Family Nurse Practitioner Programs (Chapel Hill, North Carolina, January 29-31, 1976)

ERIC Educational Resources Information Center

Pickard, C. Glenn, Jr., Ed.; Watkins, Julia D., Ed.

The conference reported here was held for nurse faculty and physicians from twenty-five family nurse practitioner (FNP) programs based in twenty-one states to provide the participants with an opportunity to consider their common curriculum problems and successes in FNP education. The first half of this booklet contains five paper presentations…

Estimating the Net Career Income of a Geriatrician and a Nurse Practitioner: Still Want to Be a Doctor?

PubMed

Golden, Adam G; Xu, Peixin; Wan, Thomas T H; Issenberg, Saul Barry

2016-07-01

With a continual shortage of geriatricians, adult-gerontology primary care nurse practitioners have assumed a greater role in the delivery of outpatient care for older adults. Given the long duration of physician training, the high cost of medical school, and the lower salaries compared with subspecialists, the financial advantage of a career as a geriatrician as opposed to a nurse practitioner is uncertain. This study compares the estimated career earnings of a geriatrician and an adult-gerontology primary care nurse practitioner. We used a synthetic model of estimated net earnings during a 43-year career span for a 22-year old person embarking on a career as a geriatrician versus a career as an adult-gerontology primary care nurse practitioner. We estimated annual net income and net retirement savings using different annual compound rates and calculated the financial impact of forgiving medical student loans, shortening the duration of physician training, and reinstituting the practice pathway for geriatric medicine certification. Career net incomes for the geriatrician did not match the nurse practitioner until almost age 40. At 65 years of age, the difference between the geriatrician and nurse practitioner was 30.6%. A higher annual compound rate was associated with an even smaller percentage difference. Combining all three health policy interventions lowered the break-even age to 28 and more than doubled the difference in career earnings. Small estimated differences in net career earnings exist between geriatricians and adult-gerontology primary care nurse practitioners. Health policy interventions had a dramatic positive effect on geriatricians' lifetime net earnings in calculated estimates.

Processes in healthcare teams that include nurse practitioners: what do patients and families perceive to be effective?

PubMed

Kilpatrick, Kelley; Jabbour, Mira; Fortin, Chantal

2016-03-01

To explore patient and family perceptions of team effectiveness of teams those include nurse practitioners in acute and primary care. Nurse practitioners provide safe and effective care. Patients are satisfied with the care provided by nurse practitioners. Research examining patient and family perceptions of team effectiveness following the implementation of nurse practitioners in teams is lacking. A descriptive qualitative design was used. We used purposeful sampling to identify participants in four clinical specialties. We collected data from March 2014-January 2015 using semi-structured interviews and demographic questionnaires. Content analysis was used. Descriptive statistics were generated. Participants (n = 49) believed that the teams were more effective after the implementation of a nurse practitioner and this was important to them. They described processes that teams with nurse practitioners used to effectively provide care. These processes included improved communication, involvement in decision-making, cohesion, care coordination, problem-solving, and a focus on the needs of patients and families. Participants highlighted the importance of interpersonal team dynamics. A human approach, trust, being open to discussion, listening to patient and family concerns and respect were particularly valued by participants. Different processes emerged as priorities when data were examined by speciality. However, communication, trust and taking the time to provide care were the most important processes. The study provides new insights into the views of patients and families and micro-level processes in teams with nurse practitioners. The relative importance of each process varied according to the patient's health condition. Patients and providers identified similar team processes. Future research is needed to identify how team processes influence care outcomes. The findings can support patients, clinicians and decision-makers to determine the processes to focus on to

Online Faculty Mentoring and Transition Balance in Family Nurse Practitioner Students

ERIC Educational Resources Information Center

Poronsky, Cathlin B.

2011-01-01

The purpose of this study was to examine the effect of online faculty mentoring on Registered Nurse (RN) to Family Nurse Practitioner (FNP) role transition balance during graduate education. Making the transition from RN to an FNP can seem daunting and there is limited information in the literature about RN to FNP role transition during graduate…

New Hampshire Nurse Practitioners Take the Lead in Forming an Accountable Care Organization.

PubMed

Wright, Wendy L

In 2012, New Hampshire nurse practitioners (NPs), along with Anthem Blue Cross/Blue Shield, formed the first Patient Centered Shared Savings Program in the nation, composed of patients managed by nurse practitioners employed within NP-owned and operated clinics. In this accountable care organization (ACO), NP-attributed patients were grouped into one risk pool. Data from the ACO and the NP risk pool, now in its third year, have produced compelling statistics. Nurse practitioners participating in this program have met or exceeded the minimum scores for 29 quality metrics along with a demonstrated cost-savings in the first 2 years of the program. Hospitalization rates for NP-managed patients are among the lowest in the state. Cost of care for NP-managed patients is $66.85 less per member per month than the participating physician-managed patients. Data from this ACO provide evidence that NPs provide cost-effective, quality health care and are integral to the formation and sustainability of any ACO.

Estimating the Net Career Income of a Geriatrician and a Nurse Practitioner: Still Want to Be a Doctor?

PubMed Central

Golden, Adam G.; Xu, Peixin; Wan, Thomas T.H.; Issenberg, S. Barry

2016-01-01

Objectives With a continual shortage of geriatricians, adult-gerontology primary care nurse practitioners have assumed a greater role in the delivery of outpatient care for older adults. Given the long duration of physician training, the high cost of medical school, and the lower salaries compared with subspecialists, the financial advantage of a career as a geriatrician as opposed to a nurse practitioner is uncertain. This study compares the estimated career earnings of a geriatrician and an adult-gerontology primary care nurse practitioner. Methods We used a synthetic model of estimated net earnings during a 43-year career span for a 22-year old person embarking on a career as a geriatrician versus a career as an adult-gerontology primary care nurse practitioner. We estimated annual net income and net retirement savings using different annual compound rates and calculated the financial impact of forgiving medical student loans, shortening the duration of physician training, and reinstituting the practice pathway for geriatric medicine certification. Results Career net incomes for the geriatrician did not match the nurse practitioner until almost age 40. At 65 years of age, the difference between the geriatrician and nurse practitioner was 30.6%. A higher annual compound rate was associated with an even smaller percentage difference. Combining all three health policy interventions lowered the break-even age to 28 and more than doubled the difference in career earnings. Conclusions Small estimated differences in net career earnings exist between geriatricians and adult-gerontology primary care nurse practitioners. Health policy interventions had a dramatic positive effect on geriatricians’ lifetime net earnings in calculated estimates. PMID:27364024

Value of wireless personal digital assistants for practice: perceptions of advanced practice nurses.

PubMed

Garrett, Bernard; Klein, Gerri

2008-08-01

The aims were to explore advanced practice nurses' perceptions on wireless Personal Digital Assistant technologies, to establish the type and range of tools that would be useful to support their practice and to identify any requirements and limitations that may impact the implementation of wireless Personal Digital Assistants in practice. The wireless Personal Digital Assistant is becoming established as a hand-held computing tool for healthcare professionals. The reflections of advanced practice nurses' about the value of wireless Personal Digital Assistants and its potential to contribute to improved patient care has not been investigated. A qualitative interpretivist design was used to explore advanced practice nurses' perceptions on the value of wireless Personal Digital Assistant technologies to support their practice. The data were collected using survey questionnaires and individual and focus group interviews with nurse practitioners, clinical nurse specialists and information technology managers based in British Columbia, Canada. An open-coding content analysis was performed using qualitative data analysis software. Wireless Personal Digital Assistant's use supports the principles of pervasivity and is a technology rapidly being adopted by advanced practice nurses. Some nurses indicated a reluctance to integrate wireless Personal Digital Assistant technologies into their practices because of the cost and the short technological life cycle of these devices. Many of the barriers which precluded the use of wireless networks within facilities are being removed. Nurses demonstrated a complex understanding of wireless Personal Digital Assistant technologies and gave good rationales for its integration in their practice. Nurses identified improved client care as the major benefit of this technology in practice and the type and range of tools they identified included clinical reference tools such as drug and diagnostic/laboratory reference applications and wireless

Mary Grant Seacole: the first nurse practitioner.

PubMed

Messmer, P R; Parchment, Y

1998-01-01

Mary Grant Seacole was born in 1805, in Kingston, Jamaica, to a Jamaican doctress (medicine woman) and a Scottish naval officer. Later Seacole became a doctress, nursing British soldiers during epidemics of cholera, dysentery, and yellow fever in Jamaica, Cuba, and Panama. After refusals by both the British government and Florence Nightingale to be allowed to practice in Scutari, she financed her own way to the scene of the Crimean War and then established the British Hotel to serve both the comfort and medical needs of the wounded soldiers. At night, Seacole worked side by side with Nightingale at Scutari as a volunteer nurse. Seacole's fame grew proportionately after she was seen helping wounded soldiers on the battlefields even while the battles were still raging. Seacole died on May 14, 1881, in London. One hundred years later, many members of the London black community, a few members of the Nurses Association of Jamaica and the Friends of Mary Seacole marched to her grave, honoring her as one of the greatest women of all times. Mary Grant Seacole rose above the barriers of racial prejudice and demonstrated the determinism, compassion, and caring that have became the hallmark of nurse practitioners.

Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

PubMed

van der Plas, Annicka G M; Onwuteaka-Philipsen, Bregje D; Vissers, Kris C; Deliens, Luc; Jansen, Wim J J; Francke, Anneke L

2016-01-01

To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for complex situations. Acceptance of and cooperation with specialist palliative care providers by the general practitioner and community nurse is pivotal. Cross-sectional questionnaire study. Questionnaire data from 168 general practitioners and 125 community nurses were analysed using chi-square tests, univariate and multivariate logistic regression. Data were gathered between March 2011-December 2013. Of general practitioners, 46% rated the case manager as helpful in realizing care that is appropriate for the patient; for community nurses this was 49%. The case manager did not hinder the process of care and had added value for patients, according to the general practitioners and community nurses. The tasks of the case manager were associated with whether or not the case manager was helpful in realizing appropriate care, whereas patient characteristics and the number of contacts with the case manager were not. General practitioners and community nurses are moderately positive about the support from the case manager. To improve cooperation further, case managers should invest in contact with general practitioners and community nurses. © 2015 John Wiley & Sons Ltd.

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

PubMed

Athey, Erin K; Leslie, Mayri Sagady; Briggs, Linda A; Park, Jeongyoung; Falk, Nancy L; Pericak, Arlene; El-Banna, Majeda M; Greene, Jessica

2016-06-01

Nurse practitioners (NPs) have reported aspects of their jobs that they are more and less satisfied with. However, few studies have examined the factors that predict overall job satisfaction. This study uses a large national sample to examine the extent to which autonomy and work setting predict job satisfaction. The 2012 National Sample Survey of Nurse Practitioners (n = 8311) was used to examine bivariate and multivariate relationships between work setting and three autonomy variables (independent billing practices, having one's NP skills fully utilized, and relationship with physician), and job satisfaction. NPs working in primary care reported the highest levels of autonomy across all three autonomy measures, while those working in hospital surgical settings reported the lowest levels. Autonomy, specifically feeling one's NP skills were fully utilized, was the factor most predictive of satisfaction. In multivariate analyses, those who strongly agreed their skills were being fully utilized had satisfaction scores almost one point higher than those who strongly disagreed. Work setting was only marginally related to job satisfaction. In order to attract and retain NPs in the future, healthcare organizations should ensure that NPs' skills are being fully utilized. ©2015 American Association of Nurse Practitioners.

A Multi-Institutional Simulation Boot Camp for Pediatric Cardiac Critical Care Nurse Practitioners.

PubMed

Brown, Kristen M; Mudd, Shawna S; Hunt, Elizabeth A; Perretta, Julianne S; Shilkofski, Nicole A; Diddle, J Wesley; Yurasek, Gregory; Bembea, Melania; Duval-Arnould, Jordan; Nelson McMillan, Kristen

2018-06-01

Assess the effect of a simulation "boot camp" on the ability of pediatric nurse practitioners to identify and treat a low cardiac output state in postoperative patients with congenital heart disease. Additionally, assess the pediatric nurse practitioners' confidence and satisfaction with simulation training. Prospective pre/post interventional pilot study. University simulation center. Thirty acute care pediatric nurse practitioners from 13 academic medical centers in North America. We conducted an expert opinion survey to guide curriculum development. The curriculum included didactic sessions, case studies, and high-fidelity simulation, based on high-complexity cases, congenital heart disease benchmark procedures, and a mix of lesion-specific postoperative complications. To cover multiple, high-complexity cases, we implemented Rapid Cycle Deliberate Practice method of teaching for selected simulation scenarios using an expert driven checklist. Knowledge was assessed with a pre-/posttest format (maximum score, 100%). A paired-sample t test showed a statistically significant increase in the posttest scores (mean [SD], pre test, 36.8% [14.3%] vs post test, 56.0% [15.8%]; p < 0.001). Time to recognize and treat an acute deterioration was evaluated through the use of selected high-fidelity simulation. Median time improved overall "time to task" across these scenarios. There was a significant increase in the proportion of clinically time-sensitive tasks completed within 5 minutes (pre, 60% [30/50] vs post, 86% [43/50]; p = 0.003] Confidence and satisfaction were evaluated with a validated tool ("Student Satisfaction and Self-Confidence in Learning"). Using a five-point Likert scale, the participants reported a high level of satisfaction (4.7 ± 0.30) and performance confidence (4.8 ± 0.31) with the simulation experience. Although simulation boot camps have been used effectively for training physicians and educating critical care providers, this was a novel

A process-based framework to guide nurse practitioners integration into primary healthcare teams: results from a logic analysis.

PubMed

Contandriopoulos, Damien; Brousselle, Astrid; Dubois, Carl-Ardy; Perroux, Mélanie; Beaulieu, Marie-Dominique; Brault, Isabelle; Kilpatrick, Kelley; D'Amour, Danielle; Sansgter-Gormley, Esther

2015-02-27

Integrating Nurse Practitioners into primary care teams is a process that involves significant challenges. To be successful, nurse practitioner integration into primary care teams requires, among other things, a redefinition of professional boundaries, in particular those of medicine and nursing, a coherent model of inter- and intra- professional collaboration, and team-based work processes that make the best use of the subsidiarity principle. There have been numerous studies on nurse practitioner integration, and the literature provides a comprehensive list of barriers to, and facilitators of, integration. However, this literature is much less prolific in discussing the operational level implications of those barriers and facilitators and in offering practical recommendations. In the context of a large-scale research project on the introduction of nurse practitioners in Quebec (Canada) we relied on a logic-analysis approach based, on the one hand on a realist review of the literature and, on the other hand, on qualitative case-studies in 6 primary healthcare teams in rural and urban area of Quebec. Five core themes that need to be taken into account when integrating nurse practitioners into primary care teams were identified. Those themes are: planning, role definition, practice model, collaboration, and team support. The present paper has two objectives: to present the methods used to develop the themes, and to discuss an integrative model of nurse practitioner integration support centered around these themes. It concludes with a discussion of how this framework contributes to existing knowledge and some ideas for future avenues of study.

Use of the consultation satisfaction questionnaire to examine patients' satisfaction with general practitioners and community nurses: reliability, replicability and discriminant validity.

PubMed Central

Poulton, B C

1996-01-01

BACKGROUND: Primary health care services are the most frequently used in the health care system. Consumer feedback on these services is important. Research in this area relates mainly to doctor-patient relationships which fails to reflect the multidisciplinary nature of primary health care. AIM: A pilot study aimed to examine the feasibility of using a patient satisfaction questionnaire designed for use with general practitioner consultations as an instrument for measuring patient satisfaction with community nurses. METHOD: The questionnaire measuring patient satisfaction with general practitioner consultations was adapted for measuring satisfaction with contacts with a nurse practitioner, district nurses, practice nurses and health visitors. A total of 1575 patients in three practices consulting general practitioners or community nurses were invited to complete a questionnaire. Data were subjected to principal components analysis and the dimensions identified were tested for internal reliability and replicability. To establish discriminant validity, patients' mean satisfaction scores for consultations with general practitioners, the nurse practitioner, health visitors and nurses (district and practice nurses) were compared. RESULTS: Questionnaires were returned relating to 400 general practitioner, 54 nurse practitioner, 191 district/practice nurse and 83 health visitor consultations (overall response rate 46%). Principal components analysis demonstrated a factor structure similar to that found in an earlier study of the consultation satisfaction questionnaire. Three dimensions of patient satisfaction were identified: professional care, depth of relationship and perceived time spent with the health professional. The dimensions were found to have acceptable levels of reliability. Factor structures obtained from data relating to general practitioner and community nurse consultations were found to correlate significantly. Comparison between health professionals

An emergency department-based mental health nurse practitioner outpatient service: part 2, staff evaluation.

PubMed

Wand, Timothy; White, Kathryn; Patching, Joanna; Dixon, Judith; Green, Timothy

2011-12-01

The nurse practitioner role incorporates enhancing access to health-care services, particularly for populations that are underserved. This entails working collaboratively with colleagues across multidisciplinary teams and emphasizing a nursing model of practice within the nurse practitioner role. In Australia, the added value associated with establishing mental health nurse practitioner (MHNP) positions based in the emergency department (ED) is emerging. This paper presents qualitative findings from a study using a mixed-method design to evaluate an ED-based MHNP outpatient service in Sydney, Australia. One component of the evaluation involved semistructured interviews conducted with a random selection of study participants and a stratified sample of ED staff. This is the second of a two-part paper that presents an analysis of the qualitative data derived from the staff interviews (n = 20). Emergency staff were very supportive of the outpatient service, and perceived that it enhanced overall service provision and improved outcomes for patients. Moreover, staff expressed interest in receiving more formal feedback on the outcomes of the service. Staff also felt that service provision would be enhanced through additional mental health liaison nurses working in the department, especially after hours. An ED-based MHNP outpatient service expedites access to follow up to individuals with a broad range of problems, and supports ED staff in the provision of safe, effective, and more holistic care. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

Advanced Critical Care Practitioners - Practical experience of implementing the Advanced Critical Care Practitioner Faculty of Intensive Care Medicine Curriculum in a London Critical Care Unit.

PubMed

Lee, Geraldine; Gilroy, Jo-Anne; Ritchie, Alistair; Grover, Vimal; Gull, Keetje; Gruber, Pascale

2018-05-01

With a chronic shortage of doctors in intensive care, alternative roles are being explored. One of these is the role of the Advanced Critical Care Practitioner. The Advanced Critical Care Practitioner Curriculum was developed by the Faculty of Intensive Care Medicine and is used to provide a structured programme of training. The Advanced Critical Care Practitioner programme consists of an academic and clinical component. This article outlines a practical approach of how the programme was developed and is currently being delivered at a single institution. This new advanced practice role offers opportunities to fill gaps in the medical workforce, improve continuity of patient care, provide mentoring and training for less experienced staff as well as offering a rewarding clinical role.

Meta-synthesis on nurse practitioner autonomy and roles in ambulatory care.

PubMed

Wang-Romjue, Pauline

2018-04-01

Many healthcare stakeholders view nurse practitioners (NPs) as an important workforce resource to help fill the anticipated shortage of 20,400 ambulatory care physicians that is expected by 2020. Multiple quantitative studies revealed the attributes of NPs' practice autonomy and roles. However, there is no qualitative meta-synthesis that describes the experiences of NPs' practice autonomy and roles. To describe and understand the experiences of NPs regarding their practice autonomy and roles in various ambulatory settings through the exploration of existing qualitative studies: meta-synthesis. A qualitative meta-synthesis was conducted to gain insight into ambulatory NPs' practice autonomy and roles through content analysis and reciprocal translation. Articles published between 2000 and 2017 were retrieved by searching 7 databases using the following key words: U.S. qualitative studies, advance practice nurses, NP role in ambulatory care, NP autonomy, and outpatient care. Autonomy, NPs' roles and responsibilities, practice relationships, and organizational work environment pressures are the four main themes that emerged from the content analysis of the nine selected qualitative studies. Within and between states, NPs' experiences with autonomy and NPs' roles are multifaceted depending on state regulations, practice relationships, and organizational work environments. © 2017 Wiley Periodicals, Inc.

Knowledge and motivation: two elements of health literacy that remain low with regard to nurse practitioners in Australia.

PubMed

Cashin, Andrew; Heartfield, Marie; Cox, Darlene; Dunn, Sandra; Stasa, Helen

2015-09-01

This paper presents analysis of consumer focus groups that were undertaken as a part of the project to develop the now current Nursing and Midwifery Board of Australia's Nurse Practitioner Standards for Practice. Six focus groups were conducted with consumers around Australia, including urban and remote areas. One purpose for these groups was to explore what was known of nurse practitioners and whether consumers could articulate the difference between the regulated titles of enrolled nurse, registered nurse and nurse practitioner. Consumers' knowledge of nurses' roles in the Australian primary healthcare system, and hence system literacy (particularly in terms of navigating the system), was low. Of perhaps greatest importance is the fact that those consumers with low health systems literacy also exhibited a low level of motivation to seek new knowledge. Many consumers relied on the medical profession to direct care. The low levels of health literacy raise questions of how to meaningfully include health consumers in innovative health-related policy work.

Advanced nursing practice.

PubMed

Carroll, Mark

Mark Carroll examines the concept of advanced nursing practice and highlights a number of the difficulties in assessing and defining different levels of practice. Some of the differences and similarities between advanced practice in the US and UK are compared and contrasted. Issues of élitism and the lack of correlation between the needs of the healthcare system and professional self-interest prevent the advancement of specialist roles in the UK. The continuing focus of local trusts on the medicalisation of roles to meet the demands of the healthcare system appears to ignore the need for nursing to expand from within the profession.

Complementary and Alternative Medicine: Core Competencies for Family Nurse Practitioners.

ERIC Educational Resources Information Center

Burman, Mary E.

2003-01-01

Directors of family nurse practitioner education programs (n=141) reported inclusion of some complementary/alternative medicine content (CAM), most commonly interviewing patients about CAM, critical thinking, evidence-based medicine, laws, ethics, and spiritual/cultural beliefs. Definition of CAM was medically, not holistically based. More faculty…

Illness prevention and health promotion services provided by nurse practitioners: predicting potential consumers.

PubMed Central

Pender, N J; Pender, A R

1980-01-01

A cross-sectional survey of 388 residents of a northern Illinois county explored the relationships between psychosocial and behavioral characteristics of the population and intentions to use illness prevention and health promotion services provided by nurse practitioners. Results of the study indicated that 61 per cent of the respondents intended to use one or more of the nurse-provided services when they became available within the community. The best predictors of intention to use the services were: expressed interest in use of prevention and health promotion services for direct pay, education beyond high school, and a low level of life stress. Intentions to use the services did not differ significantly between individuals with a regular personal physician and those without a regular physician. These data were interpreted as indicating a need within the community for nurse practitioners to provide prevention and health promotion care. The findings also supported the complementary roles of nurses and physicians in providing health care to ambulatory populations. PMID:7416338

Are reporting radiographers fulfilling the role of advanced practitioner?

PubMed

Milner, R C; Snaith, B

2017-02-01

Advanced practice roles are emerging in all disciplines at a rapid pace and reporting radiographers are ideally placed to work at such level. Advanced practitioners should demonstrate expert practice and show progression into three other areas of higher level practice. Most existing literature has focussed on the image interpretation aspect of the role, however there is little evidence that plain film reporting radiographers are undertaking activities beyond image interpretation and fulfilling the role of advanced practitioner. Letters were posted to every acute NHS trust in the UK, inviting reporting radiographers to complete an online survey. Both quantitative and qualitative information was sought regarding demographics and roles supplementary to reporting. A total of 205 responses were analysed; 83.3% of reporting radiographers describe themselves as advanced practitioner, however significantly less are showing progression into the four core functions of higher level practice. A total of 97.0% undertake expert practice, 54.7% have a leadership role, 19.8% provide expert lectures and 71.1% have roles encompassing service development or research, though most of these fall into the service development category. 34.5% felt that they were aware of the differences between extended and advanced practice though much less (9.3%) could correctly articulate the difference. Few individuals are aware of the difference between extended and advanced practice. Though the majority of plain film reporting radiographers identify themselves as advanced practitioners, significantly less evidence all four core functions of higher level practice. The number of individuals undertaking research and providing expert-level education is low. Copyright © 2016 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Evaluating an australian emergency nurse practitioner candidate training program.

PubMed

Plath, Sharyn J; Wright, Mary; Hocking, Julia

2017-11-01

Nurse Practitioners (NPs) receive core clinical training at master's level, with their employer providing the opportunity to upskill in clinical and procedural competencies. It is increasingly recognised that this generic education requires supplementary training for operating effectively within a specific clinical environment. In this paper we describe a pilot program designed to train Australian NP Candidates to work effectively within the Emergency Department Fast Track model of care. The training program consisted of a 12-month period: four hours in-house training per week over two semesters, running concurrently with the NP candidate's University semesters, and 3 months' clinical practice to consolidate. The training team defined milestones for Semesters one and two, and developed a case review form to assess application of the candidate's knowledge in new clinical situations, as well as check for gaps in understanding. A clinical skills guide was developed for the candidate to work toward, and a comprehensive assessment was carried out at two time points in the training program. Feedback was obtained from the mentors and the candidate at the end point of the training program, and has been used to refine the program for 2017. This in-house training program provided specialised, evidence-based training for the emergency department environment, resulting in development of the nurse practitioner candidate as a high functioning team member. Copyright © 2017 College of Emergency Nursing Australasia. All rights reserved.

Evidence-based use of electronic clinical tracking systems in advanced practice registered nurse education: an integrative review.

PubMed

Branstetter, M Laurie; Smith, Lynette S; Brooks, Andrea F

2014-07-01

Over the past decade, the federal government has mandated healthcare providers to incorporate electronic health records into practice by 2015. This technological update in healthcare documentation has generated a need for advanced practice RN programs to incorporate information technology into education. The National Organization of Nurse Practitioner Faculties created core competencies to guide program standards for advanced practice RN education. One core competency is Technology and Information Literacy. Educational programs are moving toward the utilization of electronic clinical tracking systems to capture students' clinical encounter data. The purpose of this integrative review was to evaluate current research on advanced practice RN students' documentation of clinical encounters utilizing electronic clinical tracking systems to meet advanced practice RN curriculum outcome goals in information technology as defined by the National Organization of Nurse Practitioner Faculties. The state of the science depicts student' and faculty attitudes, preferences, opinions, and data collections of students' clinical encounters. Although electronic clinical tracking systems were utilized to track students' clinical encounters, these systems have not been evaluated for meeting information technology core competency standards. Educational programs are utilizing electronic clinical tracking systems with limited evidence-based literature evaluating the ability of these systems to meet the core competencies in advanced practice RN programs.

An advanced practice psychiatric nurse's guide to professional writing.

PubMed

Campanelli, Peter C; Feferman, Robert; Keane, Chris; Lieberman, Harvey J; Roberson, Deborah

2007-10-01

Many good ideas are not communicated to the community of mental health practitioners because advanced practice psychiatric nurses (APPNs) are not being well informed about writing for public dissemination. This study aims to support APPNs through the various stages of manuscript preparation so they can enlarge the scope of their written contributions to the mental health field. An appreciation for the skills, mechanics, and attitudes that support the authoring enterprise can result in APPNs enjoying the multiple benefits that accrue to those who write about their professional activities for clinical, administrative, advocacy, fund-raising, and other purposes.

Physician Assistant and Nurse Practitioner Malpractice Trends.

PubMed

Brock, Douglas M; Nicholson, Jeffrey G; Hooker, Roderick S

2017-10-01

Trends in malpractice awards and adverse actions (e.g., revocation of provider license) following an act or omission constituting medical error or negligence were examined. The National Practitioner Data Bank was used to compare rates of malpractice reports and adverse actions for physicians, physician assistants (PAs), and nurse practitioners (NPs). During 2005 through 2014, there ranged from 11.2 to 19.0 malpractice payment reports per 1,000 physicians, 1.4 to 2.4 per 1,000 PAs, and 1.1 to 1.4 per 1,000 NPs. Physician median payments ranged from 1.3 to 2.3 times higher than PAs or NPs. Diagnosis-related malpractice allegations varied by provider type, with physicians having significantly fewer reports (31.9%) than PAs (52.8%) or NPs (40.6%) over the observation period. Trends in malpractice payment reports may reflect policy enactments to decrease liability.

Relationships among factors affecting advanced practice registered nurses' job satisfaction and intent to leave: A systematic review.

PubMed

Han, Robin M; Carter, Patricia; Champion, Jane Dimmitt

2018-02-01

This systematic review explores relationships between advanced practice registered nurses' (APRN) job satisfaction and intent to leave. There exists a dearth of APRN providers compared with the ever-growing need for their services. Furthermore, the organizational costs associated with the APRN turnover are extremely high. It, therefore, behooves practice administrators to understand what factors most contribute to APRN job satisfaction and retention. A search of research databases CINAHL, PubMed, and PsycINFO, using keywords "Advanced Practice Registered Nurse," "job satisfaction," "intent to leave," "anticipated turnover," and "Nurse Practitioner" to yield articles included in this review. The strength of existing evidence for this topic is weak. Studies have found that extrinsic factors, such as administrative support and salary, significantly contribute to job dissatisfaction, whereas intrinsic factors, such as autonomy and finding work meaningful, most significantly contribute to job satisfaction. Additional research is needed to better understand the factors relating to APRN job satisfaction and dissatisfaction, and how those factors influence practitioners' intent to leave. Efforts to improve APRN job satisfaction will have positive implications for provider retention, practices, and patients. Administrators should consider the job satisfaction factors identified herein when implementing practice improvement and retention efforts.

Using advanced mobile devices in nursing practice--the views of nurses and nursing students.

PubMed

Johansson, Pauline; Petersson, Göran; Saveman, Britt-Inger; Nilsson, Gunilla

2014-09-01

Advanced mobile devices allow registered nurses and nursing students to keep up-to-date with expanding health-related knowledge but are rarely used in nursing in Sweden. This study aims at describing registered nurses' and nursing students' views regarding the use of advanced mobile devices in nursing practice. A cross-sectional study was completed in 2012; a total of 398 participants replied to a questionnaire, and descriptive statistics were applied. Results showed that the majority of the participants regarded an advanced mobile device to be useful, giving access to necessary information and also being useful in making notes, planning their work and saving time. Furthermore, the advanced mobile device was regarded to improve patient safety and the quality of care and to increase confidence. In order to continuously improve the safety and quality of health care, advanced mobile devices adjusted for nursing practice should be further developed, implemented and evaluated in research. © The Author(s) 2013.

International practice settings, interventions and outcomes of nurse practitioners in geriatric care: A scoping review.

PubMed

Chavez, Krista S; Dwyer, Andrew A; Ramelet, Anne-Sylvie

2018-02-01

To identify and summarize the common clinical settings, interventions, and outcomes of nurse practitioner care specific to older people. Scoping review of the international published and grey literature. A structured literature search was conducted of CINAHL, EMBASE, MEDLINE, Google Scholar, and Cochrane Collaboration and Joanna Briggs Institute databases. Following the Arksey and O'Malley framework, randomized controlled and quasi-experimental studies of Masters-prepared nurse practitioners providing care for patients over 65 years were included. Studies were reviewed independently by two investigators. Data were extracted, collated by setting, summarized in tables and synthesized for analysis. In total, 56 primary research studies from four countries and 23 systematic reviews were identified. Primary studies were conducted in primary care (n=13), home care (n=14), long-term care (n=10), acute/hospital care (n=9), and transitional care (n=10). Nurse practitioner interventions included substitutive as well as a supplementation NP role elements to meet specific unmet patient care needs. Studies examined six main outcome measures: service utilization (n=41), cost (n=24), length of stay (n=14), health indices (n=44), satisfaction (n=14) and quality of life (n=7). Cumulatively, nurse practitioners demonstrated enhanced results in 83/144 (58%) of outcomes compared to physician-only or usual care. The most commonly measured financial-related outcome was service utilization (n=41) and benefits were frequently reported in home care (8/9, 89%) and long-term care (7/10, 70%) settings. Among patient and care-related outcomes health indices were most frequently measured (n=44). Primary care most frequently reported improved health indices (11/13, 85%). Transitional care reported improved outcomes across all measures, except for service utilization. This review demonstrates improved or non-inferiority results of nurse practitioner care in older people across settings. More well

A case study of nurse practitioner role implementation in primary care: what happens when new roles are introduced?

PubMed Central

2013-01-01

Background At the time of this study (2009) the role of the nurse practitioner was new to the province of British Columbia. The provincial government gave the responsibility for implementing the role to health authorities. Managers of health authorities, many of whom were unfamiliar with the role, were responsible for identifying the need for the NP role, determining how the NP would function, and gaining team members’ acceptance for the new role. Method The purpose of the study was to explain the process of nurse practitioner role implementation as it was occurring and to identify factors that could enhance the implementation process. An explanatory, single case study with embedded units of analysis was used. The technique of explanation building was used in data analysis. Three primary health care settings in one health authority in British Columbia were purposively selected. Data sources included semi-structured interviews with participants (n=16) and key documents. Results The results demonstrate the complexity of implementing a new role in settings unfamiliar with it. The findings suggest that early in the implementation process and after the nurse practitioner was hired, team members needed to clarify intentions for the role and they looked to senior health authority managers for assistance. Acceptance of the nurse practitioner was facilitated by team members’ prior knowledge of either the role or the individual nurse practitioner. Community health care providers needed to be involved in the implementation process and their acceptance developed as they gained knowledge and understanding of the role. Conclusion The findings suggest that the interconnectedness of the concepts of intention, involvement and acceptance influences the implementation process and how the nurse practitioner is able to function in the setting. Without any one of the three concepts not only is implementation difficult, but it is also challenging for the nurse practitioner to fulfill

Expanding rural access to mental health care through online postgraduate nurse practitioner education.

PubMed

Kverno, Karan; Kozeniewski, Kate

2016-12-01

Workforce shortages in mental health care are especially relevant to rural communities. People often turn to their primary care providers for mental healthcare services, yet primary care providers indicate that more education is needed to fill this role. Rural primary care nurse practitioners (NPs) are ideal candidates for educational enhancement. Online programs allow NPs to continue living and working in their communities while developing the competencies to provide comprehensive and integrated mental healthcare services. This article presents a review of current online postgraduate psychiatric mental health NP (PMHNP) options. Website descriptions of online PMHNP programs were located using keywords: PMHNP or psychiatric nurse practitioner, postgraduate or post-master's, and distance or online. Across the United States, 15 online postgraduate certificate programs were located that are designed for primary care NPs seeking additional PMHNP specialization. For rural primary care NPs who are ready, willing, and able, a postgraduate PMHNP specialty certificate can be obtained online in as few as three to four semesters. The expected outcome is a cadre of dually credentialed NPs capable of functioning in an integrated role and of increasing rural access to comprehensive mental healthcare services. ©2016 American Association of Nurse Practitioners.

Convergence: How Nursing Unions and Magnet are Advancing Nursing.

PubMed

Johnson, Joyce E; Billingsley, Molley

2014-01-01

Historically, unions and professional associations such as the American Nurses Association have been adversaries in the fight to represent the best interests of the nursing profession. We reviewed the literature on the evolution of nursing unions, nursing's historical unease about unions, the Magnet designation in nursing, the tensions between the unions and Magnet, the core values and commonalities they share, and the obligations of nursing as a profession. Refocusing on the advancement of our profession provides a positive pathway in which the collective efforts of nursing unions and professional initiatives such as the Magnet designation converge during these turbulent times for our profession. The single, central organizing idea of nursing-where nursing unions and Magnet converge-is the pivotal role of nurses in delivering high-quality patient care. The often-maligned dialectic between unions and Magnet has advanced and not hindered the nursing profession. © 2014 Wiley Periodicals, Inc.

Acute care nurse practitioners in trauma care: results of a role survey and implications for the future of health care delivery.

PubMed

Noffsinger, Dana L

2014-01-01

The role of acute care nurse practitioners (ACNPs) in trauma care has evolved over time. A survey was performed with the aim of describing the role across the United States. There were 68 respondents who depicted the typical trauma ACNP as being a 42-year-old woman who works full-time at a level I American College of Surgeons verified trauma center. Trauma ACNPs typically practice with 80% of their time for clinical care and are based on a trauma and acute care surgery service. They are acute care certified and hold several advanced certifications to supplement their nursing license.

Novice nurse practitioner workforce transition and turnover intention in primary care.

PubMed

Faraz, Asefeh

2017-01-01

Little is known about the workforce transition and turnover intention of novice nurse practitioners (NPs) in primary care (PC). This research aimed to describe the individual characteristics, role acquisition and job satisfaction of novice NPs, and identify factors associated with their successful transition and turnover intention in the first year of PC practice. A descriptive, cross-sectional study was conducted via online survey administered to a national sample of 177 NPs who graduated from an accredited NP program and were practicing in a PC setting for 3-12 months. This study demonstrated that greater professional autonomy in the workplace is a critical factor in turnover intention in novice NPs in the PC setting. Further research is needed regarding the novice NP workforce transition to provide adequate professional autonomy and support during this critical period. ©2016 American Association of Nurse Practitioners.

How can a competency framework for advanced practice support care?

PubMed

Stanford, Pamela Elizabeth

2016-11-10

Aim To explore whether perception of nurse practitioners in relation to whether a competency framework for advanced practice can support their work. Method A qualitative cross-sectional design was used, embedded in an interpretative paradigm of research. A non-probability sample of eight experienced nurse practitioners took part in focus groups and answered questionnaires. A mixture of phenomenological and grounded theory approaches were used to collect the data. Findings Four major themes were identified: competency frameworks can identify individual strengths and weaknesses, they can be used to set clear goals and targets, they can improve how practice is organised, and they have the potential to limit practice in terms of narrowing boundaries. The study also found competency frameworks could provide an structure to guide the development and evaluation of educational programmes. Conclusion Competency frameworks can be used so to target the development of new advanced nurse practitioners. They can address workforce development and governance by ensuring nurse practitioners have the competencies to provide safe, autonomous practice. Competency frameworks have been shown to ensure consistency in clinical practice skills underpinned with nurse practitioners' theoretical knowledge. They provide a clear development structure for career development and advanced practice. However, internationally, there is still a lack of definition of advanced practice and its core competencies.

A comparative study on the clinical decision-making processes of nurse practitioners vs. medical doctors using scenarios in a secondary care environment.

PubMed

Thompson, Stephen; Moorley, Calvin; Barratt, Julian

2017-05-01

To investigate the decision-making skills of secondary care nurse practitioners compared with those of medical doctors. A literature review was conducted, searching for articles published from 1990 - 2012. The review found that nurse practitioners are key to the modernization of the National Health Service. Studies have shown that compared with doctors, nurse practitioners can be efficient and cost-effective in consultations. Qualitative research design. The information processing theory and think aloud approach were used to understand the cognitive processes of 10 participants (5 doctors and 5 nurse practitioners). One nurse practitioner was paired with one doctor from the same speciality and they were compared using a structured scenario-based interview. To ensure that all critical and relevant cues were covered by the individual participating in the scenario, a reference model was used to measure the degree of successful diagnosis, management and treatment. This study was conducted from May 2012 - January 2013. The data were processed for 5 months, from July to November 2012. The two groups of practitioners differed in the number of cue acquisitions obtained in the scenarios. In our study, nurse practitioners took 3 minutes longer to complete the scenarios. This study suggests that nurse practitioner consultations are comparable to those of medical doctors in a secondary care environment in terms of correct diagnoses and therapeutic treatments. The information processing theory highlighted that both groups of professionals had similar models for decision-making processes. © 2016 John Wiley & Sons Ltd.

Grants for nurse practitioner traineeship programs--PHS. Interim final regulations.

PubMed

1984-08-01

These regulations set forth requirements for grants to schools of nursing, medicine, and public health, to public or nonprofit private hospitals, and to other public or nonprofit private entities to meet the costs of traineeships for training nurse practitioners. A trainee must sign a commitment with the Secretary to practice full-time as a nurse practitioner in a primary medical care health manpower shortage area, designated under section 332 of the Public Health Service Act (the Act), for a period equal to 1 month for each month of traineeship support, after completion of the training. If this obligation is not fulfilled, a trainee must pay back traineeship support. The purpose of these regulations is to respond to the comments on the 1980 interim final regulations and to conform 42 CFR Part 57, Subpart AA, with the Paperwork Reduction Act of 1980, Pub. L. 96-511, and with the Omnibus Budget Reconciliation Act of 1981, Pub. L. 97-35, which requires, among other provisions, that the Secretary provide, by regulation, for the waiver or suspension of the repayment obligation under certain conditions. In addition, other minor changes have been made and Office of Management and Budget (OMB) numbers are cited in those sections which have approved reporting and recordkeeping requirements.

Survey to child/adolescent psychiatry and developmental/behavioral pediatric training directors to expand psychiatric-mental health training to nurse practitioners.

PubMed

Schwartz, Richard H; O'Laughlen, Mary C; Kim, Joshua

2017-06-01

There is an ongoing shortage of child mental health professionals. Nurse practitioners (NPs) who completed behavioral and mental health training have proven that they can diagnose and manage many pediatric problems. To ask the training directors of both child/adolescent psychiatry (CAP) and developmental/behavioral pediatric (DBP) programs about their receptivity and willingness to give additional training for NPs who provide care to children with behavioral and mental health issues and examine the main obstacles to the development of such programs. A survey was sent to 151 CAP and DBP training directors in the United States. The return rate was 67% (N = 101). Only 12% expressed objection to the concept of additional NP training in CAP or DBP, but only 53% of training directors currently reported having sufficient faculty to do so. Some training directors reported already having advanced behavioral and mental health training programs for NPs (31%) and most (82%) would consider expanding, if funded. There is support for advanced training for NPs, but funding is needed to make this a reality. Expansion of such programs might rapidly improve accessibility and reduce waiting time of mental health providers for children and adolescents. ©2017 American Association of Nurse Practitioners.

Job Satisfaction Among Family Nurse Practitioners in the United States Air Force

DTIC Science & Technology

1999-05-01

role, attitude of health personnel, Herzberg, workplace, organizational culture, personnel management , workload. vi JOB SATISFACTION AMONG FAMILY NURSE...find assistance through USUHS or from the functional manager of the Family Nurse Practitioner Program. We wish you success with your research and with...Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington

Nurse practitioners, certified nurse midwives, and physician assistants in physician offices.

PubMed

Park, Melissa; Cherry, Donald; Decker, Sandra L

2011-08-01

The expansion of health insurance coverage through health care reform, along with the aging of the population, are expected to strain the capacity for providing health care. Projections of the future physician workforce predict declines in the supply of physicians and decreasing physician work hours for primary care. An expansion of care delivered by nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) is often cited as a solution to the predicted surge in demand for health care services and calls for an examination of current reliance on these providers. Using a nationally based physician survey, we have described the employment of NPs, CNMs, and PAs among office-based physicians by selected physician and practice characteristics. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Nurse practitioner and physician assistant scope of practice in 118 acute care hospitals.

PubMed

Kartha, Anand; Restuccia, Joseph D; Burgess, James F; Benzer, Justin; Glasgow, Justin; Hockenberry, Jason; Mohr, David C; Kaboli, Peter J

2014-10-01

Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs) are cost-effective substitutes for physicians, with similar outcomes in primary care and surgery. However, little is understood about APP roles in inpatient medicine. Describe APPs role in inpatient medicine. Observational cross-sectional cohort study. One hundred twenty-four Veterans Health Administration (VHA) hospitals. Chiefs of medicine (COMs) and nurse managers. Surveys included inpatient medicine scope of practice for APPs and perceived healthcare quality. We conducted bivariate unadjusted and multivariable adjusted analyses. One hundred eighteen COMs (95.2%) and 198 nurse managers (75.0%) completed surveys. Of 118 medicine services, 56 (47.5%) employed APPs; 27 (48.2%) used NPs only, 15 (26.8%) PAs only, and 14 (25.0%) used both. Full-time equivalents for NPs was 0.5 to 7 (mean = 2.22) and PAs was 1 to 9 (mean = 2.23). Daily caseload was similar at 4 to 10 patients (mean = 6.5 patients). There were few significant differences between tasks. The presence of APPs was not associated with patient or nurse manager satisfaction. Presence of NPs was associated with greater overall inpatient and discharge coordination ratings by COMs and nurse managers, respectively; the presence of PAs was associated with lower overall inpatient coordination ratings by nurse managers. NPs and PAs work on half of VHA inpatient medicine services with broad, yet similar, scopes of practice. There were few differences between their roles and perceptions of care. Given their very different background, regulation, and reimbursement, this has implications for inpatient medicine services that plan to hire NPs or PAs. © 2014 Society of Hospital Medicine.

Nurse Leaders' Experiences of Implementing Career Advancement Programs for Nurses in Iran.

PubMed

Sheikhi, Mohammad Reza; Fallahi Khoshknab, Masoud; Mohammadi, Farahnaz; Oskouie, Fatemeh

2015-02-24

Career advancement programs are currently implemented in many countries. In Iran, the first career advancement program was Nurses' Career Advancement Pathway. The purpose of this study was to explore nurse leaders' experiences about implementing the Nurses' Career Advancement Pathway program in Iran. This exploratory qualitative study was conducted in 2013. Sixteen nurse managers were recruited from the teaching hospitals affiliated to Shahid Behesthi, Qazvin, and Iran Universities of Medical Sciences in Iran. Participants were recruited using purposive sampling method. Study data were collected through in-depth semi-structured interviews. The conventional content analysis approach was used for data analysis. participants' experiences about implementing the Nurses' Career Advancement Pathway fell into three main categories including: a) the shortcomings of performance evaluation, b) greater emphasis on point accumulation, c) the advancement-latitude mismatch. The Nurses' Career Advancement pathway has several shortcomings regarding both its content and its implementation. Therefore, it is recommended to revise the program.

A clinical trial of nurse practitioner care in residential aged care facilities.

PubMed

Arendts, Glenn; Deans, Pamela; O'Brien, Keith; Etherton-Beer, Christopher; Howard, Kirsten; Lewin, Gill; Sim, Moira

2018-05-04

Optimising quality of life and reducing hospitalisation for people living in residential aged care facilities (RACF) are important health policy goals. A cluster controlled clinical trial of nurse practitioner care in RACF. Six facilities were included: three randomly allocated to intervention where nurse practitioners working with general practitioners and using a best practice guide were responsible for care, and three control. Participants were followed up for a minimum of 12 months unless dead or transferred to another facility. We enrolled two hundred patients (101 intervention and 99 control) with a mean (SD) follow up of 604 (276) days. There were 98 ED visits by intervention participants, resulting in 56 hospitalisations, compared with 121 ED visits and 70 hospitalisations for controls (risk reduction = 8%, 95% CI = -1% -17%, p = 0.10). For the pre-specified secondary outcomes of transfers within the first 12 months of enrolment, the number of residents making at least one visit (46 in each study arm) and rate of ED attendance (0.66 visits per intervention resident versus 0.70 visits per control resident) was not affected by the intervention. After adjusting for dependency and comorbidity, the intervention group had non-significantly lower transfers (OR 0.7, 95% CI 0.3-1.5, p = 0.34). There was a reduction in the rate of decline in the quality of life of intervention compared to control residents. Nurse practitioner care coordination resulted in no statistically significant change in rates of ED transfer or health care utilisation, but better maintained resident quality of life. Copyright © 2018 Elsevier B.V. All rights reserved.

Effect of systematic review of medication by general practitioner on drug consumption among nursing-home residents.

PubMed

Khunti, K; Kinsella, B

2000-09-01

nursing-home patients usually have many medical problems and often take many drugs. They are therefore at risk from drug side effects and interactions. to evaluate the impact of a visit by a general practitioner and a comprehensive repeat prescribing review on the consumption of inappropriate drugs in nursing homes. two general practitioners made one comprehensive visit to four randomly selected nursing homes. In each home we discussed all patients in detail with a senior member of staff. We reviewed the prescribing record of each patient and stopped items if we considered them inappropriately prescribed or unnecessary. repeat prescriptions were altered in 65% of patients: 51% had an item stopped and 26% had an item changed to a cheaper alternative or the dose reduced. There was a reduction in the mean number of repeat prescriptions prescribed. a single visit by a general practitioner to a nursing home and a comprehensive repeat prescribing review can lead to a reduction in the number of items prescribed and to substantial savings for the health service. Further rigorous, cost-effectiveness studies are needed.

Attributes of advanced practice registered nurse care coordination for children with medical complexity.

PubMed

Cady, Rhonda G; Kelly, Anne M; Finkelstein, Stanley M; Looman, Wendy S; Garwick, Ann W

2014-01-01

Care coordination is an essential component of the pediatric health care home. This study investigated the attributes of relationship-based advanced practice registered nurse care coordination for children with medical complexity enrolled in a tertiary hospital-based health care home. Retrospective review of 2,628 care coordination episodes conducted by telehealth over a consecutive 3-year time period for 27 children indicated that parents initiated the majority of episodes and the most frequent reason was acute and chronic condition management. During this period, care coordination episodes tripled, with a significant increase (p < .001) between years 1 and 2. The increased episodes could explain previously reported reductions in hospitalizations for this group of children. Descriptive analysis of a program-specific survey showed that parents valued having a single place to call and assistance in managing their child's complex needs. The advanced practice registered nurse care coordination model has potential for changing the health management processes for children with medical complexity. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Alcohol Abuse Curriculum Guide for Nurse Practitioner Faculty. Health Professions Education Curriculum Resources Series. Nursing 3.

ERIC Educational Resources Information Center

Hasselblad, Judith

The format for this curriculum guide, written for nurse practitioner faculty, consists of learning objectives, content outline, teaching methodology suggestions, references and recommended readings. Part 1 of the guide, Recognition of Early and Chronic Alcoholism, deals with features of alcoholism such as epidemiological data and theories,…

Nurse practitioners' work hours and overtime: How much, and under what working conditions?

PubMed

Bae, Sung-Heui; Champion, Jane Dimmitt

2016-03-01

To explore the nature and prevalence of nurse practitioner (NP) overtime, work hours, and their relationship to practice within NP work conditions. A secondary analysis of data extracted from the 2012 National Sample Survey of Nurse Practitioners. The focus in this study was on data from NPs in active practice in clinical settings. The final analytic sample consisted of 9010 NPs. NPs working in hospitals and long-term care settings tended to work more than 40 h/week (p < .001). When healthcare facilities used electronic health records (p < .001) or had recently adopted electronic health records (p = .002), NPs were found to work more hours per week than those who did not. Regarding the type of relationships with physicians, NPs who worked more than 40 h/week either had hierarchical relationships with them (p < 0.001), or relationships in which the physician examined and signed off on patients whom the NP had examined (p < .001). These analyses provide a preliminary description of the nature and prevalence of NP work hours/overtime and work conditions related to longer work hours. Further study is indicated to assess the potential impact of work hours/overtime on NP roles and patient outcomes. ©2015 American Association of Nurse Practitioners.

Nurse practitioners in aged care: documentary analysis of successful project proposals.

PubMed

Clark, Shannon J; Parker, Rhian M; Davey, Rachel

2014-11-01

Meeting the primary health care needs of an aging population is an increasing challenge for many Western nations. In Australia, the federal government introduced a program to develop, test, and evaluate nurse practitioner models in aged care settings. In this article, we present a documentary analysis of 32 project proposals awarded funding under the Nurse Practitioner-Aged Care Models of Practice Program. Successfully funded models were diverse and were operated by a range of organizations across Australia. We identified three key priorities as underlying the proposed models: "The right care," "in the right place," and "at the right time." In this article, we explore how these priorities were presented by different applicants in different ways. Through the presentation of their models, the program's applicants identified and proposed to address current gaps in health services. Applicants contrasted their proposed models with available services to create persuasive and competitive applications for funding. © The Author(s) 2014.

Doctors' and nurses' perceptions of interdisciplinary collaboration in the NICU, and the impact of a neonatal nurse practitioner model of practice.

PubMed

Copnell, Beverley; Johnston, Linda; Harrison, Denise; Wilson, Anita; Robson, Anne; Mulcahy, Caroline; Ramudu, Louisa; McDonnell, Geraldine; Best, Christine

2004-01-01

The importance of interdisciplinary collaboration has been attested to by a number of authors. Some have suggested that Nurse Practitioners (NPs) may be able to improve collaboration between doctors and nurses, but this assertion does not appear to have been researched. To investigate doctors' and nurses' perceptions of interdisciplinary collaboration in two neonatal intensive care units, and to assess the impact of a Neonatal Nurse Practitioner (NNP) practice model on these perceptions. The study was conducted as part of a larger project to develop a NNP model of practice. Survey, pre- and post-intervention. Medical and nursing staff in both units were surveyed before and after introduction of the NP model of practice. The instrument consisted of 25 statements relating to nurse-doctor interactions, with which respondents indicated their level of agreement on a five-point Likert scale. The Mann-Whitney U-test was used to compare scores for individual items and for overall collaboration between various groups of staff, and between the first and second surveys. Significant differences between the responses of nurses and doctors were found on both surveys. Areas of disagreement chiefly concerned doctors' behaviour and their attitudes towards nurses, rather than nurses' behaviour or environmental factors. Doctors consistently reported a higher degree of collaboration than did nurses. Few differences were found between first and second surveys. Results suggest that problems in nurse-physician interactions exist in both units. No impact of the NNP role, as established in this project, on interdisciplinary collaboration could be demonstrated. Further research in this area is warranted.

The importance of social support for people with type 2 diabetes - a qualitative study with general practitioners, practice nurses and patients.

PubMed

Goetz, Katja; Szecsenyi, Joachim; Campbell, Stephen; Rosemann, Thomas; Rueter, Gernot; Raum, Elke; Brenner, Herrmann; Miksch, Antje

2012-01-01

Social support is an important element of family medicine within a primary care setting, delivered by general practitioners and practice nurses in addition to usual clinical care. The aim of the study was to explore general practitioner's, practice nurse's and people with type 2 diabetes' views, experiences and perspectives of the importance of social support in caring for people with type 2 diabetes and their role in providing social support. Interviews with general practitioners (n=10) and focus groups with practice nurses (n=10) and people with diabetes (n=9). All data were audio-recorded, fully transcribed and thematically analysed using qualitative content analysis by Mayring. All participants emphasized the importance of the concept of social support and its impacts on well-being of people with type 2 diabetes. Social support is perceived helpful for people with diabetes in order to improve diabetes control and give support for changes in lifestyle habits (physical activity and dietary changes). General practitioners identified a lack of information about facilities in the community like sports or self-help groups. Practice nurses emphasized that they need more training, such as in dietary counselling. Social support given by general practitioners and practice nurses plays a crucial role for people with type 2 diabetes and is an additional component of social care. However there is a need for an increased awareness by general practitioners and practice nurses about the influence social support could have on the individual's diabetes management.

Competency frameworks for advanced practice nursing: a literature review.

PubMed

Sastre-Fullana, P; De Pedro-Gómez, J E; Bennasar-Veny, M; Serrano-Gallardo, P; Morales-Asencio, J M

2014-12-01

This paper describes a literature review that identified common traits in advanced practice nursing that are specific to competency development worldwide. There is a lack of international agreement on the definition of advanced practice nursing and its core competencies. Despite the lack of consensus, there is an ongoing process worldwide to establish and outline the standards and competencies for advanced practice nursing roles. International agencies, such as the International Council of Nurses, have provided general definitions for advanced practice nursing. Additionally, a set of competency standards for this aim has been developed. A literature review and a directed search of institutional websites were performed to identify specific developments in advanced practice nursing competencies and standards of practice. To determine a competency map specific to international advanced practice nursing, key documents were analysed using a qualitative approach based on content analysis to identify common traits among documents and countries. The review process identified 119 relevant journal articles related to advanced practice nursing competencies. Additionally, 97 documents from grey literature that were related to advanced practice nursing competency mapping were identified. From the text analysis, 17 worldwide transversal competency domains emerged. Despite the variety of patterns in international advanced practice nursing development, essential competency domains can be found in most national frameworks for the role development of international advanced practice nursing. These 17 core competencies can be used to further develop instruments that assess the perceived competency of advanced practice nurses. The results of this review can help policy developers and researchers develop instruments to compare advanced practice nursing services in various contexts and to examine their association with related outcomes. © 2014 International Council of Nurses.

Emergency nurse practitioners: a three part study in clinical and cost effectiveness

PubMed Central

Sakr, M; Kendall, R; Angus, J; Saunders, A; Nicholl, J; Wardrope, J

2003-01-01

Aims: To compare the clinical effectiveness and costs of minor injury services provided by nurse practitioners with minor injury care provided by an accident and emergency (A&E) department. Methods: A three part prospective study in a city where an A&E department was closing and being replaced by a nurse led minor injury unit (MIU). The first part of the study took a sample of patients attending the A&E department. The second part of the study was a sample of patients from a nurse led MIU that had replaced the A&E department. In each of these samples the clinical effectiveness was judged by comparing the "gold standard" of a research assessment with the clinical assessment. Primary outcome measures were the number of errors in clinical assessment, treatment, and disposal. The third part of the study used routine data whose collection had been prospectively configured to assess the costs and cost consequences of both models of care. Results: The minor injury unit produced a safe service where the total package of care was equal to or in some cases better than the A&E care. Significant process errors were made in 191 of 1447 (13.2%) patients treated by medical staff in the A&E department and 126 of 1313 (9.6%) of patients treated by nurse practitioners in the MIU. Very significant errors were rare (one error). Waiting times were much better at the MIU (mean MIU 19 minutes, A&E department 56.4 minutes). The revenue costs were greater in the MIU (MIU £41.1, A&E department £40.01) and there was a great difference in the rates of follow up and with the nurses referring 47% of patients for follow up and the A&E department referring only 27%. Thus the costs and cost consequences were greater for MIU care compared with A&E care (MIU £12.7 per minor injury case, A&E department £9.66 per minor injury case). Conclusion: A nurse practitioner minor injury service can provide a safe and effective service for the treatment of minor injury. However, the costs of such a service

Physician Assistants and Nurse Practitioners as a Usual Source of Care

ERIC Educational Resources Information Center

Everett, Christine M.; Schumacher, Jessica R.; Wright, Alexandra; Smith, Maureen A.

2009-01-01

Purpose: To identify characteristics and outcomes of patients who use physician assistants and nurse practitioners (PA/NPs) as a usual source of care. Methods: Cross sectional analysis using the telephone and mail surveys of the Wisconsin Longitudinal Study (WLS), a prospective cohort study of Wisconsin high school graduates and selected siblings…

Implementing an MSN nursing program at a distance through an urban-rural partnership.

PubMed

Zukowsky, Ksenia; Swan, Beth Ann; Powell, Mary; Frisby, Tony; Lauver, Lori; West, Margaret Mary; Marsella, Alexis

2011-04-01

Recruiting, retaining, and educating advanced practice nurses is essential to meet the growing need for advanced practice nurses in rural and urban communities. Through the support of Health Resources and Services Administration funding, the urban school of nursing expanded its MSN program and implemented the graduate curriculum on its rural campus by utilizing emerging online and distance education technologies. The purpose of this manuscript is to provide an overview of expanding an existing MSN program offered in an urban, traditional classroom setting to rural graduate nursing students via an online synchronous format. In addition, the article will describe the rural growth of the existing neonatal nurse practitioner program as an exemplar and the different methodologies that are being used in each program to engage the rural nurse practitioner students in clinical courses. In addition, strategies to address barriers related to rural nurse practitioner student recruitment and retention will be discussed.

Personal digital assistant use by nurse practitioners: a descriptive study.

PubMed

Stroud, Sally D; Smith, Carol A; Erkel, Elizabeth A

2009-01-01

We sought to describe the prevalence and patterns of use of personal digital assistants (PDAs) among active nurse practitioners (NPs). A descriptive correlational survey was conducted among NPs in the United States (N = 126). Participants were randomly selected from members of the American Academy of Nurse Practitioners who had listed a practice site on their application. Sixty-four percent of participants used PDAs. A drug reference was reported to be the most useful and frequently installed application. A large majority of PDA users believed that PDA use supported clinical decision making (91%), promoted patient safety (89%), and increased productivity (75%). Sixty-two percent predicted that PDA use would change their practice within the next 5 years. As innovative PDA applications with potential to improve patient outcomes become increasingly available, handheld computer skills will be a fundamental practice competency. To prevent errors in clinical decision making with quick access to PDA reference materials, NPs must critically evaluate the legitimacy and worth of PDA software programs. There is a critical need to evaluate the effectiveness of PDA use in clinical settings and develop an evidence base to guide use of the PDA in solving clinical problems.

A national survey of the primary and acute care pediatric nurse practitioner educational preparation.

PubMed

Hawkins-Walsh, Elizabeth; Berg, Mary; Docherty, Sharron; Lindeke, Linda; Gaylord, Nan; Osborn, Kristen

2011-01-01

The past decade has been marked by a gradual expansion of the traditional primary care role of the pediatric nurse practitioner (PNP) into practice arenas that call for more acute and critical care of children. The purpose of the study was to explore the educational programming needs of dual (combined) track PNP programs that prepare graduates to provide care to children and adolescents across the continuum of health and illness. A two-phase, exploratory, mixed method design was utilized. An electronic survey was completed by 65% of PNP program directors in the country. Semi-structured telephone interviews were conducted with hospital-based PNPs who were practicing in roles that met a range of health care needs across the primary and acute care continuum. Primary care and acute care programs have more common than unique elements, and the vast majority of clinical competencies are common to both types of program. Only three competencies appear to be unique to acute care programs. The Association of Faculties of Pediatric Nurse Practitioner Programs should utilize existing evidence and develop guidelines for dual PNP programs that focus on the provision of care to children across a wide continuum of health and illness. Copyright © 2011 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Workforce characteristics of privately practicing nurse practitioners in Australia: Results from a national survey.

PubMed

Currie, Jane; Chiarella, Mary; Buckley, Thomas

2016-10-01

Australian private practice nurse practitioner (PPNP) services have grown since legislative changes in 2010 enabled eligible nurse practitioners (NPs) to access reimbursement for care delivered through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). This article provides data from a national survey on the workforce characteristics of PPNPs in Australia. PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. There were 73 completed surveys. One of the intentions of expanding access to MBS and PBS for patients treated by NPs was to increase patients' access to health care through greater flexibility in the healthcare workforce. The results of this survey confirm that the workforce characteristics of PPNPs provide a potentially untapped resource to meet current primary healthcare demand. The findings of this study allow us to understand the characteristics of PPNP services, which are significant for workforce planning. The focus of PPNP practice is toward primary health care with PPNPs working predominantly in general practice settings. The largest age group of PPNPs is over 50 years and means a proportion will be retiring in the next 15 years. ©2016 American Association of Nurse Practitioners.

Preparation and Evolving Role of the Acute Care Nurse Practitioner.

PubMed

Hoffman, Leslie A; Guttendorf, Jane

2017-12-01

Acute care nurse practitioners (ACNPs) are increasingly being employed as members of critical care teams, an outcome driven by increasing demand for intensive care services, a mandated reduction in house officer hours, and evidence supporting the ability of ACNPs to provide high-quality care as collaborative members of critical care teams. Integration of adult ACNPs into critical care teams is most likely to be successful when practitioners have appropriate training, supervision, and mentoring to facilitate their ability to practice efficiently and effectively. Accomplishing this goal requires understanding the educational preparation and skill set potential hires bring to the position as well as the development of an orientation program designed to integrate the practitioner into the critical care team. Pediatric ACNPs are also commonly employed in critical care settings; however, this commentary focuses on the adult ACNP role. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Evolution of a Family Nurse Practitioner Program to Improve Primary Care Distribution

ERIC Educational Resources Information Center

Andrus, Len Hughes; Fenley, Mary D.

1976-01-01

Describes a Family Nurse Practitioner Program that has effectively improved the distribution of primary health care manpower in rural areas. Program characteristics include selection of personnel from areas of need, decentralization of clinical and didactic training sites, competency-based portable curriculum, and circuit-riding institutionally…

Mentoring Nurse Practitioners in a Hospital Setting.

PubMed

Pop, Rodica S

2017-08-01

Nursing philosophy is the foundation of nurse practitioner (NP) training. However, NP practice is based on the medical care model. Thus, the necessity of mediating between these two approaches is often problematic for new NPs who are transitioning into their new roles. Mentoring has been used successfully to facilitate role transition and role understanding for nurses, NPs, and physicians. However, mentoring has been rarely studied in NPs. The purpose of this study was to develop a theory of mentoring for new NPs in a hospital setting. Grounded theory methodology was used. The sampling approach was initially purposive and was then shifted to theoretical to ensure the collection of meaningful data. Semistructuredinterviews were recorded and transcribed into Word documents for analysis. The three-phase analysis developed by Corbin and Strauss was initiated after the second interview. Sixteen participants (eight mentors and eight mentees) were interviewed between February and June 2011. The core category that emerged from the data was "defining self," and the main categories were forming the relationship, developing the relationship, and mentoring outcomes. A well-designed formal mentoring program may greatly improve the transition of NPs into a new role. The theory generated by the data from these study participants provides clearly defined categories that may be operationally defined and utilized to develop evaluation tools for mentoring programs.

Training Advanced Practice Palliative Care Nurses.

ERIC Educational Resources Information Center

Sherman, Deborah Witt

1999-01-01

Describes the role and responsibilities of advanced-practice nurses in palliative care and nursing's initiative in promoting high-quality care through the educational preparation of these nurses. (JOW)

Long-term care legislation: an issue of concern for nurse practitioners.

PubMed

Jennings, J P

1989-01-01

Comprehensive long-term care policy has many hurdles to overcome before it becomes a reality. The biggest hurdle is the price tag! Estimates range from $6 billion (Pepper's home-care bill) to $46 billion (Stark's long-term care coverage bill). Congressional insiders predict that federal long-term care coverage must contain "pay-as-you-go" financing to win congressional passage. The medicare catastrophic health care act is cited by many in the Congress as establishing the precedent for self-financing of new federal benefits. In a pay-as-you-go era in public spending, any new program can only come from trimming existing programs and shifting those funds to new programs or from generating new revenues. The latter could result from increased beneficiary cost-sharing, an increase in the medicare payroll tax, or by eliminating the $45,000 cap on income exposed to the current 1.45% medicare payroll tax. Federal proposals to date build on existing medicare and medicaid programs. In them, quality assurance measures have been strengthened, consumer input encouraged, and a new layer of bureaucracy established to screen potential clients and provide case-management services. The scope of services is broad in most of the current proposals, and reimbursement is provided for respite care to allow family care givers relief and assistance. Access to nurse practitioners' services is an important feature of Kennedy's Lifecare proposal and is the focus of lobbying efforts for all public and private proposals. It is time for nurse practitioners to become involved in long-term care legislation. This may be initiated by reviewing current proposals and long-term care packages offered by major insurance companies. Any future long-term care benefit should bear the imprint of the nurse practitioner's professional perspective and the profession's commitment to humane, caring health policy.

Training Nurse Practitioners and Physician Assistants. How Important Is State Financing?

ERIC Educational Resources Information Center

Henderson, Tim M.; Fox-Grage, Wendy

This report identifies issues in state financing of programs to train nurse practitioners and physician assistants and presents findings of a national survey of 51 such training programs. An introductory chapter gives the main arguments for increased use of nonphysician providers of primary health care; this is followed by a chapter on barriers to…

The impact of nurse practitioners on care delivery in the emergency department: a multiple perspectives qualitative study

PubMed Central

2013-01-01

Background Despite well-articulated benefits, the introduction of Nurse Practitioners (NPs) in Australia has been slow. Poorly defined nomenclature relating to advanced practice roles in nursing and variations in such roles both across Australia and worldwide have resulted in confusion and uncertainty regarding the functions and roles of NPs. Qualitative studies focussing on the perceived impact on the care settings into which NPs are introduced are scarce, but are valuable in providing a complete contextual account of NPs in care delivery settings. This study aimed to investigate the perceived impact of the NP on the delivery of care in the ED by senior doctors, nurses, and NPs. Results will facilitate adoption and best use of this human resource innovation. Methods A cross-sectional qualitative study was undertaken in the Emergency Departments (EDs) of two large Australian metropolitan public teaching hospitals. Semi-structured, in-depth interviews were conducted with five nurse practitioners, four senior doctors (staff specialists and ED directors) and five senior nurses. Transcribed interviews were analysed using a grounded theory approach to develop themes in relation to the conceptualisation of the impact of the NP role on the ED. Member checking of results was conducted by revisiting the sites to clarify findings with participants and further explore emergent themes. Results The impact of the NP role was perceived differently by different groups of participants. Whilst NPs were observed to deliver few quantitative improvements to ED functioning from the perspective of ED directors, NPs believed that they assisted doctors in managing the increasing subacute presentations to the contemporary ED. NPs also believed they embraced a preventative paradigm of care which addressed the long term priorities of chronic disease prevention and cost containment in the broader healthcare environment. The ambiguous position of the NP role, which crosses the gap between

Nurse-Performed Endoscopy: Implications for the Nursing Profession in Australia.

PubMed

Duffield, Christine; Chapman, Susan; Rowbotham, Samantha; Blay, Nicole

2017-02-01

Increasing demands for health care globally often lead to discussions about expanding the involvement of nurses in a range of nontraditional roles. Several countries have introduced nurse endoscopists as a means of easing the burden of demand for a range of endoscopic procedures. A shortage of medical staff in Australia combined with increasing demand for endoscopy led to the implementation of nurse endoscopists as a pilot program in the state of Queensland, where a nurse practitioner model was implemented, and Victoria, where an advanced practice model was used. This article will discuss the implementation of and responses from the nursing, medical, and policy community to nurse-performed endoscopy in this country. Regarding health policy, access to cancer screening may be improved by providing nurses with advanced training to safely perform endoscopy procedures. Moreover, issues of nurse credentialing and payment need to be considered appropriate to each country's health system model.

Modifiable risk factors for impaired fertility in women: what nurse practitioners need to know.

PubMed

Kelly-Weeder, Susan; O'Connor, Alane

2006-06-01

To provide an overview of impaired fertility in childbearing-aged women, to review the current research on modifiable lifestyle risk factors implicated in its development, and to suggest strategies for nurse practitioners (NPs) to assist women in behavioral changes that will allow them to protect their fertility. Original research articles and comprehensive review articles identified through Medline, CINAHL, and OVID databases. Research has shown that advancing age, a history of a sexually transmitted infection and/or pelvic inflammatory disease, extremes of body weight, and tobacco and caffeine use are potentially modifiable risk factors in the development of impaired fertility. NPs must be aware of the link between these behaviors and the development of impaired fertility in order to assist women in preserving their fertility. Individual counseling, education, and community-wide education strategies are discussed.

Chronic kidney disease in an Aboriginal population: A nurse practitioner-led approach to management.

PubMed

Barrett, Elizabeth; Salem, Lesley; Wilson, Sue; O'Neill, Claire; Davis, Kathleen; Bagnulo, Sharif

2015-12-01

Chronic kidney disease (CKD) is a significant health problem impacting Australia's Aboriginal and Torres Strait Islander population. After age adjustment, the prevalence of kidney disease is 3.7 times higher in Aboriginal people and 7.3 times higher for end-stage kidney disease compared with the wider population. Yet at an Aboriginal Community Controlled Health Service (ACCHS) with a significant patient population, fewer than expected numbers of Aboriginal patients were identified with CKD. The ACCHS engaged a nurse practitioner to lead a systematic approach to the identification and treatment of CKD. This nurse practitioner-led approach to CKD was developed and implemented at a rural NSW ACCHS, with the support of a partnership formed between the nurse practitioner, the ACCHS, a nephrologist from a referral hospital and a statewide NGO. The primary measure for improvement has been to identify and stage patients with CKD and establish management plans as appropriate. This nurse-led project was established to: (i) identify patients with CKD; (ii) provide access for CKD patients to appropriate services; (iii) commence pharmacological and non-pharmacological strategies that enable remission or regression of CKD; and (iv) educate practice GPs and other staff members on CKD clinical guidelines and best practice. The CKD project has improved access to essential health care for vulnerable and at-risk populations, with 187 patients to date having been identified with kidney disease and staged for its severity. The need for strong multi-disciplinary teamwork has been demonstrated with good communication strategies implemented. © 2015 National Rural Health Alliance Inc.

Pilot survey of NICU nurses' interest in the neonatal nurse practitioner role.

PubMed

Rasmussen, Lynn B; Vargo, Lyn E; Reavey, Daphne A; Hunter, Kim S

2005-02-01

This descriptive, qualitative pilot study explored the interest and perceptions of neonatal intensive care unit (NICU) nurses regarding the neonatal nurse practitioner (NNP) role. Motivating factors to become an NNP, challenges facing NNPs, and rewards of the NNP role from the perspectives of NICU nurses were explored. The convenience sample was obtained using 2 survey techniques. The first sample group included nurses who were employed in Level III NICUs located within 2 major Midwestern cities. In order to confirm the data and to expand the scope, the second sample group was recruited from NICU nurses who were attending a regional educational conference. All participants were currently employed NICU nurses and were therefore potential NNP students. Combining the participants of both enrollment techniques resulted in a potential of 696 subjects. A simple self-administered survey was used to collect data. Narrative data were qualitatively analyzed. Demographic data and categorical items were quantified. This study achieved a total 30% response rate (n = 209). Of the total participants, only 32% of Level III NICU nurses were interested in becoming an NNP. Analysis of the data revealed 6 major categories (themes) of reasons why nurses were not interested in the NNP role. The themes most often mentioned by the participants were (1) obligations to family and/or work (46%) and (2) too much responsibility in the NNP role (30%). The data also revealed several different rewards and challenges for those in the NNP role as well as factors that may motivate nurses to become an NNP. Given the current NNP shortage, an increase in the supply of NNPs for the workforce is imperative. Current enrollment in NNP academic programs does not appear to be meeting the demand. Exploring the factors that influence enrollment in NNP programs from the perspective of potential NNP students is the first step towards increasing the supply of NNPs. The majority of participants were not interested

Advancing nursing scholarship: the Mozambique model

PubMed Central

Bruce, Judith C.; Dippenaar, Joan; Schmollgruber, Shelley; Mphuthi, David D.; Huiskamp, Agnes

2017-01-01

ABSTRACT Background: Despite the importance of Human Resources for Health for the development and functioning of health systems worldwide, many countries continue to be plagued by poor health systems and a lack of adequate health care. Health systems failures may be attributed to both quantitative and qualitative nursing shortages including the lack of advanced skills to lead health initiatives, to conduct research and to educate other nurses. The response by development partners is usually framed around the production of skilled nurses through the processes of up-skilling and scaling-up. The outcome is expanded practice but with scant attention to the professional advancement of nurses. Objectives: In this paper we present a two-phased capacity development model that adopted professionalization strategies to advance nursing scholarship and consequent postgraduate specialization of the first cohort of nurses in Mozambique. The main objectives were to: develop and implement a clinical course work master’s degree in nursing; and ensure sustainability by capacitating the host institution to continue with the master’s programme following graduation. Methods: Rigorous processes for project discussions, negotiations and monitoring were necessary amid limited resources and a challenging political climate. Forging in-country partnerships, sustaining alliances and government investment are thus key to the success of the Mozambique model. Outcomes: Notwithstanding some difficulties, the process unfolded over a five-year period, graduating the first cohort of 11 senior nurses with a master’s degree, specializing either in critical care and trauma nursing, or maternal and neonatal health. Conclusions: Bridging the skills gap between generalist and specialist nurses is essential for them to manage complex and high acuity cases and to reverse associated morbidity and mortality. We conclude that this model serves as a professionalization strategy to advance nurses�

The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: a systematic review.

PubMed

Jennings, Natasha; Clifford, Stuart; Fox, Amanda R; O'Connell, Jane; Gardner, Glenn

2015-01-01

To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. The delivery of quality care in the emergency department is emerging as one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. A comprehensive search of four electronic databases from 2006 to 2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. A three step approach was used. Following a comprehensive search, two reviewers assessed all identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data were extracted using standardised tools. Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis. Synthesis of the available research attempts to provide an

An evaluation of the quality of Emergency Nurse Practitioner services for patients presenting with minor injuries to one rural urgent care centre in the UK: a descriptive study.

PubMed

McDevitt, Joe; Melby, Vidar

2015-02-01

To evaluate the quality of the emergency nurse practitioner service provided to people presenting to a rural urgent care centre with minor injuries. The three objectives that were focused were an evaluation of the safety and effectiveness of the emergency nurse practitioner service, an assessment of patients' satisfaction with the emergency nurse practitioner service and a determination of factors that may enhance the quality of the emergency nurse practitioner service. Urgent care centres have become increasingly prevalent across the UK. Emergency nurse practitioner services at these rural urgent care centres remain largely unevaluated. This study attempts to redress this deficit by evaluating the quality of an emergency nurse practitioner service in relation to the care of patients presenting with minor injuries to a rural urgent care centre. This descriptive study used a case-note review and a survey design with one open-ended exploratory question. Patient views were collected using a self-completed questionnaire and a data extraction tool to survey patients' case notes retrospectively. Despite comparatively low total length-of-stay times, most patients felt they had enough time to discuss things fully with the emergency nurse practitioner. Although emergency nurse practitioners routinely impart injury advice, feedback from some patients suggests a need for the provision of more in-depth information regarding their injury. The vast majority (97·3%) of patients felt that the quality of the emergency nurse practitioner service was of a high standard. Contrary to some other studies, the findings in this study indicate that patient satisfaction is not influenced by waiting times. Emergency nurse practitioners in rural urgent care centres have the potential to deliver a safe and effective quality service that is reflected in high levels of patient satisfaction. This study provides some evidence to support the continued expansion of the emergency nurse practitioner

Obstacles to preventive care for individuals with disability: Implications for nurse practitioners.

PubMed

Marrocco, Anna; Krouse, Helene J

2017-05-01

Individuals with disabilities have been identified as a population with a significantly lower usage of preventive services. Nurse practitioners (NPs) provide a key access point in the healthcare delivery system for preventive services for vulnerable populations such as those with disabilities. It is essential to understand existing barriers that prohibit access to effective preventive care for this vulnerable population. Systematic search and review of Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PubMed, Google Scholar, and government reports and World Health Organizations reports. Twenty-six articles were included in the review. This literature review confirmed previous notions that people with disabilities are receiving much fewer preventive services than the general population. The studies reviewed identified four major barriers that contributed to the lack of preventive care. These barriers included physical environment and system, transportation, provider knowledge and attitude, and financial. Recognition of the obstacles that this subpopulation faces in accessing preventive care services is the first step to effectively remedying this problem. Preventive services have been identified as one of the cornerstones to improving health and quality of life. By understanding the circumstances that restrict those with disabilities from accessing preventive services, NPs can provide meaningful and effective solutions. ©2017 American Association of Nurse Practitioners.

Integration of the Nurse Practitioner Into Your Child Abuse Team.

PubMed

Herold, Beth; St Claire, Karen; Snider, Scott; Narayan, Aditee

Child maltreatment is a leading cause of childhood morbidity in the United States, often leading to lifelong adverse health consequences. Currently, there is a nationwide shortage of child abuse pediatricians (CAPs), resulting in many unfilled child abuse positions throughout the United States. In addition, the number of future CAPs currently in fellowship training will meet neither the current need for CAPs nor provide replacements for the senior CAPs who will be retiring in the next 5 to 10 years. Although it is recognized that pediatric nurse practitioners (PNPs) play an important role in the care of maltreated children, there are few available data on the impact of the PNP as an integral member of the child abuse team. Using the outcomes logic model, we present a systematic process through which the PNP can be effectively integrated into a medical child abuse team. The outcomes from this process show that the addition of PNPs to the child abuse team not only provides immediate relief to the nationwide CAP shortage but also significantly augments the diverse clinical skills and expertise available to the child abuse team. Copyright © 2018 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Dutch advanced nursing practice students: role development through international short-term immersion.

PubMed

Ter Maten, Ada; Garcia-Maas, Lillian

2009-04-01

At Rotterdam University in The Netherlands, the master's advanced nursing practice (ANP) program focuses on the role of the nurse practitioner (NP) and emphasizes leadership development. An international experience is compulsory and is incorporated into the leadership course. Twenty master's ANP students were surveyed before and after participating in an international exchange program. The following research questions were examined: (a) Does the international exchange program affect the vision of the NP students about their role as an NP in The Netherlands? (b) Does the international exchange program encourage students to develop the NP role? Gaining insight into a well-established NP environment can help empower Dutch NP students to create the foundations for role development to distinguish itself as an autonomous profession. An international experience fostered a new sense of pride in this relatively new ANP role in The Netherlands.

Full Practice Authority for Advanced Practice Registered Nurses is a Gender Issue

PubMed

Rudner Lugo, Nancy

2016-05-04

In the United States, Advanced Practice Registered Nurse (APRN) regulations are determined at the state level, through legislation and rule making. The lack of an evidence base to APRN regulation has resulted in a patchwork of varied regulations and requirements for nurse practitioners. The author begins this article by reviewing the history of the Equal Rights Amendment (ERA) in the United States and describing her study that assessed APRN fullpractice authority in states that ratified the ERA versus states that opposed it. She presents the study findings, limitations of the comparison, and discussion of the findings and implications. In conclusion, the findings demonstrated that progress toward full APRN practice will require building strategies for political support and framing the need to update APRN regulations in a manner that aligns with each state’s social and political values.

Physical Activity of Nurse Clinical Practitioners and Managers.

PubMed

Jirathananuwat, Areeya; Pongpirul, Krit

2017-11-01

This study was aimed (1) to compare the level of physical activity (PA) between working and nonworking hours and (2) to compare the level of PA during working hours of nurse clinical practitioners (NCPs) with that of nurse managers (NMs). This cross-sectional survey was conducted at a Thai university hospital from October 2015 to March 2016. All randomly selected participants wore an activity tracker on their hip for 5 days, except during bathing and sleeping periods, to record step counts and time points. Of 884 nurses, 289 (142 NCPs and 147 NMs) were randomly selected. The average age was 35.87 years. They spent 9.76 and 6.01 hours on work and nonwork activities, respectively. Daily steps per hour were significantly lower during work than nonwork periods (P < .001). An NCP had significantly higher overall hourly PA (P = .002). The number of steps per hour during work period of NCP was significantly higher than that of NM even after adjusting for age, work experience, and body mass index (P = .034). NCP had higher overall PA than NM, which was partly contributed by work-related PA. Level of PA for a professional with variation of actual work hours should be measured on hourly basis.

Factors Influencing Successful Use of Information Retrieval Systems by Nurse Practitioner Students

PubMed Central

Rose, Linda; Crabtree, Katherine; Hersh, William

1998-01-01

This study examined whether a relationship exists between selected Nurse Practitioner students' attributes and successful information retrieval as demonstrated by correctly answering clinical questions using an information retrieval system (Medline). One predictor variable, attitude toward current computer technology, was significantly correlated (r =0.43, p ≤ .05) with successful literature searching.

Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial.

PubMed

Brazil, Kevin; Carter, Gillian; Cardwell, Chris; Clarke, Mike; Hudson, Peter; Froggatt, Katherine; McLaughlin, Dorry; Passmore, Peter; Kernohan, W George

2018-03-01

In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor. To evaluate the effectiveness of advance care planning with family carers in dementia care homes. Paired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff. A total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions. The primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (-10.5, 95% confidence interval: -16.4 to -4.7; p < 0.001). Advance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.

Assistant practitioners: lessons learned from licensed practical nurses.

PubMed

Whittingham, Katrina

The role of the assistant practitioner (AP) needs to be defined so they have clear career pathways and opportunities for professional development. The author sought to learn from other countries where a sustained effort had been made to support practitioners fulfilling this intermediate role. The equivalent of an AP in Canada is the licensed practical nurse (LPN); LPNs are subject to clear regulation and practice within their remit of their license. The author travelled to Alberta, Canada, and performed a qualitative study to investigate the role of the LPN. LPNs undertake a 2-year diploma-level course and have the opportunity to enhance their careers through specialist courses or to train as a RN. LPNs benefit from careful regulation, enabling them to have a clear scope of practice, a career structure with opportunities for development and consistent ethical standards. Lessons can be learned from the LPN model and put in practice in the UK; APs need a consistent education programme, a career pathway that promotes development and effective regulation.

Basic principles to consider when opening a nurse practitioner-owned practice in Texas.

PubMed

Watson, Michael

2015-12-01

Advanced Practice Registered Nurse (APRN)-owned clinics in Texas are becoming more common and because of the success of these early clinics, more APRNs are considering opening their own practice; but Texas remains one of the most restrictive states for APRN practice and many questions remain. What are the regulations about physician delegation? Will you get reimbursed from insurance companies and at what rates? Can you be a primary care provider (PCP)? Changes enacted after the adoption of Senate Bill 406 improved the opportunities for APRNs in Texas yet several requirements must be met and early consultation with a lawyer and accountant can facilitate the initial business setup. The Prescriptive Authority Agreement simplified the delegation requirements and allows the APRN increased flexibility in obtaining and consulting with a delegating physician. Becoming credentialed as a PCP with private insurance companies is often complicated; however, utilizing the Council for Affordable Quality Healthcare's Universal Provider Data source for initial credentialing can facilitate this. Although this article does not discuss the financial implications of opening a practice, it does cover many aspects including legislative and regulatory requirements for practice, credentialing process and challenges, business structure, and tax implications. ©2015 American Association of Nurse Practitioners.

Health insurance status and the care of nursing home residents with advanced dementia.

PubMed

Goldfeld, Keith S; Grabowski, David C; Caudry, Daryl J; Mitchell, Susan L

Nursing home residents with advanced dementia commonly experience burdensome and costly hospitalizations that may not extend survival or improve the quality of life. Fragmentation in health care has contributed to poor coordination of care for acutely ill nursing home residents. To compare patterns of care and quality outcomes for nursing home residents with advanced dementia covered by managed care with those covered by traditional fee-for-service Medicare. Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life (CASCADE) was a prospective cohort study including 22 nursing homes in the Boston, Massachusetts, area that monitored 323 nursing home residents for 18 months to better understand the course of advanced dementia at or near the end of life. Data from CASCADE and Medicare were linked to determine the health insurance status of study participants. The health insurance status of the resident, either managed care or traditional fee for service. The outcomes included survival, symptoms related to comfort, treatment of pain and dyspnea, presence of pressure ulcers, presence of a do-not-hospitalize order, treatment of pneumonia, hospital transfer (admission or emergency department visit) for an acute illness, hospice referral, primary care visits, and family satisfaction with care. Residents enrolled in managed care (n = 133) were more likely to have do-not-hospitalize orders compared with those in traditional Medicare fee for service (n = 158) (63.7% vs 50.9%; adjusted odds ratio, 1.9; 95% CI, 1.1-3.4), were less likely to be transferred to the hospital for acute illness (3.8% vs 15.7%; adjusted odds ratio, 0.2; 95% CI, 0.1-0.5), had more primary care visits per 90 days (mean [SD], 4.8 [2.6] vs 4.2 [5.0]; adjusted rate ratio, 1.3; 95% CI, 1.1-1.6), and had more nurse practitioner visits (3.0 [2.1] vs 0.8 [2.6]; adjusted rate ratio, 3.0; 95% CI, 2.2-4.1). Survival, comfort, and other treatment outcomes did not differ significantly

Development and psychometric testing of the Nurse Practitioner Primary Care Organizational Climate Questionnaire.

PubMed

Poghosyan, Lusine; Nannini, Angela; Finkelstein, Stacey R; Mason, Emanuel; Shaffer, Jonathan A

2013-01-01

Policy makers and healthcare organizations are calling for expansion of the nurse practitioner (NP) workforce in primary care settings to assure timely access and high-quality care for the American public. However, many barriers, including those at the organizational level, exist that may undermine NP workforce expansion and their optimal utilization in primary care. This study developed a new NP-specific survey instrument, Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), to measure organizational climate in primary care settings and conducted its psychometric testing. Using instrument development design, the organizational climate domain pertinent for primary care NPs was identified. Items were generated from the evidence and qualitative data. Face and content validity were established through two expert meetings. Content validity index was computed. The 86-item pool was reduced to 55 items, which was pilot tested with 81 NPs using mailed surveys and then field-tested with 278 NPs in New York State. SPSS 18 and Mplus software were used for item analysis, reliability testing, and maximum likelihood exploratory factor analysis. Nurse Practitioner Primary Care Organizational Climate Questionnaire had face and content validity. The content validity index was .90. Twenty-nine items loaded on four subscale factors: professional visibility, NP-administration relations, NP-physician relations, and independent practice and support. The subscales had high internal consistency reliability. Cronbach's alphas ranged from.87 to .95. Having a strong instrument is important to promote future research. Also, administrators can use it to assess organizational climate in their clinics and propose interventions to improve it, thus promoting NP practice and the expansion of NP workforce.

MASTERPLAN: study of the role of nurse practitioners in a multifactorial intervention to reduce cardiovascular risk in chronic kidney disease patients.

PubMed

Van Zuilen, Arjan D; Wetzels, Jack F M; Bots, Michiel L; Van Blankestijn, Peter J

2008-01-01

Moderate to severe chronic kidney disease (CKD) is associated with increased cardiovascular risk. Usually nephrologists are primarily responsible for the care of CKD patients. However, in many cases treatment goals, as formulated in guidelines, are not met. The addition of a nurse practitioner might improve the quality of care. The Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners (MASTERPLAN) study is a randomized controlled multicenter trial, aimed at investigating whether a multifactorial approach in patients with moderate to severe CKD (stage 3 and 4) to achieving treatment goals using both a polydrug strategy and lifestyle treatment either with or without the addition of a nurse practitioner will reduce cardiovascular risk and slow the decline of kidney function. Patients (n=793) have been randomized to nurse care or physician care. In the nurse-care arm of the study, nurse practitioners use flowcharts to address risk factors requiring drug and/or lifestyle modification. They have been trained to coach patients by motivational interviewing with the aim of improving patient self-management. At baseline, both treatment groups show equal distributions with regard to key variables in the study. Moreover, in only 1 patient were all risk factors within the limits as defined in various guidelines, which underscores the relevance of our initiative.

Trends in Nurse Practitioner and Physician Assistant Practice in Nursing Homes, 2000-2010.

PubMed

Intrator, Orna; Miller, Edward Alan; Gadbois, Emily; Acquah, Joseph Kofi; Makineni, Rajesh; Tyler, Denise

2015-12-01

To examine nurse practitioner (NP) and physician assistant (PA) practice in nursing homes (NHs) during 2000-2010. Data were derived from the Online Survey Certification and Reporting system and Medicare Part B claims (20 percent sample). NP/PA state average employment, visit per bed year (VPBY), and providers per NH were examined. State fixed-effect models examined the association between state regulations and NP/PA use. NHs using any NPs/PAs increased from 20.4 to 35.0 percent during 2000-2010. Average NP/PA VPBY increased from 1.0/0.3 to 3.0/0.6 during 2000-2010. Average number of NPs/PAs per NH increased from 0.2/0.09 to 0.5/0.14 during 2000-2010. The impact of state scope-of-practice regulations was mixed. NP and PA scope-of-practice regulations impact their practice in NHs, not always as intended. © Health Research and Educational Trust.

Nurses' self-efficacy and academic degree advancement.

PubMed

Winslow, Susan; DeGuzman, Pamela; Kulbok, Pamela; Jackson, Stephanie

2014-01-01

The last decade has brought about a synergy of influences for registered nurses to advance their academic preparation. Literature indicates that there is correlation between self-efficacy and goal establishment and success. The purpose of this project was to evaluate the relationship between self-efficacy and advancing academic aspirations of registered nurses. Findings indicated that there was a trend toward a difference in the self-efficacy of nurses who began their career with a diploma or associate degree and went on for academic advancement and those who did not.

Predictors of advance directives among nursing home residents with dementia.

PubMed

Huang, Hsiu-Li; Shyu, Yea-Ing Lotus; Weng, Li-Chueh; Chen, Kang-Hua; Hsu, Wen-Chuin

2018-03-01

ABSTRACTBackground:Advance directives are important for nursing home residents with dementia; for those with advanced dementia, surrogates determine medical decisions. However, in Taiwan, little is known about what influences the completion of these advance directives. The purpose of this study was to identify factors, which influence the presence of advance directives for nursing home residents with dementia in Taiwan. Our cross-sectional study analyzed a convenience sample of 143 nursing home dyads comprised of residents with dementia and family surrogates. Documentation of residents' advance directives, physical and cognitive status was obtained from medical charts. Surrogates completed the stress of end-of-life care decision scale and a questionnaire regarding their demographic characteristics. Nursing home characteristics were obtained from each chief administrator. Less than half of the nursing home residents (39.2%) had advance directives and most (96.4%) had been completed by family surrogates. The following were predictors of an advance directive: surrogates had previously signed a do-not-resuscitate as a proxy and had been informed of advance directives by a healthcare provider; nursing homes had policies for advance directives and a religious affiliation. Advance directives were uncommon for nursing home residents with dementia. Presence of an advance directive was associated with surrogate characteristics and the nursing home facilities; there was no association with characteristics of the nursing home resident. Our findings emphasize the need to develop policies and strategies, which ensure that all residents of nursing homes and their surrogates are aware of their right to an advance directive.

Open Mouth, Open Mind: Expanding the Role of Primary Care Nurse Practitioners.

PubMed

Clark, Carol A; Kent, Kathleen A; Jackson, Richard D

2016-01-01

Oral health is essential to overall health at any age, although in children it is particularly important because poor oral health can have a deleterious effect on deciduous and permanent dentition. For decades, oral health providers have urged primary care providers to incorporate oral health assessment, risk factor identification, parent education, and preventive therapy into routine well-child visits. Despite recommendations from various professional associations and governmental organizations, the incidence of dental disease in young children remains relatively unchanged. Although the literature has clearly demonstrated that preventive care treatments, such as the application of fluoride varnish performed in the primary care setting, improve oral health in children, very few primary care providers include oral health services in their well-child visits. The purpose of this article is to reduce the barriers and knowledge gaps identified in recent pediatric oral health research and educate primary care nurse practitioners on the application of fluoride varnish to reduce the risk of the development of dental caries in young children. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Diabetes Mellitus Care Provided by Nurse Practitioners vs Primary Care Physicians.

PubMed

Kuo, Yong-Fang; Goodwin, James S; Chen, Nai-Wei; Lwin, Kyaw K; Baillargeon, Jacques; Raji, Mukaila A

2015-10-01

To compare processes and cost of care of older adults with diabetes mellitus cared for by nurse practitioners (NPs) with processes and cost of those cared for by primary care physicians (PCPs). Retrospective cohort study. Primary care in communities. Individuals with a diagnosis of diabetes mellitus in 2009 who received all their primary care from NPs or PCPs were selected from a national sample of Medicare beneficiaries (N = 64,354). Propensity score matching within each state was used to compare these two cohorts with regard to rate of eye examinations, low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (HbA1C) testing, nephropathy monitoring, specialist consultation, and Medicare costs. The two groups were also compared regarding medication adherence and use of statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (for individuals with a diagnosis of hypertension), and potentially inappropriate medications (PIMs). Nurse practitioners and PCPs had similar rates of LDL-C testing (odds ratio (OR) = 1.01, 95% confidence interval (CI) = 0.94-1.09) and nephropathy monitoring (OR = 1.05, 95% CI = 0.98-1.03), but NPs had lower rates of eye examinations (OR = 0.89, 95% CI = 0.84-0.93) and HbA1C testing (OR = 0.88, 95% CI = 0.79-0.98). NPs were more likely to have consulted cardiologists (OR = 1.29, 95% CI = 1.21-1.37), endocrinologists (OR = 1.64, 95% CI = 1.48-1.82), and nephrologists (OR = 1.90, 95% CI = 1.67-2.17) and more likely to have prescribed PIMs (OR = 1.07, 95% CI = 1.01-1.12). There was no statistically significant difference in adjusted Medicare spending between the two groups (P = .56). Nurse practitioners were similar to PCPs or slightly lower in their rates of diabetes mellitus guideline-concordant care. NPs used specialist consultations more often but had similar overall costs of care to PCPs. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Financial viability, benefits and challenges of employing a nurse practitioner in general practice.

PubMed

Helms, Christopher; Crookes, Jo; Bailey, David

2015-04-01

This case study examines the financial viability, benefits and challenges of employing a primary healthcare (PHC) nurse practitioner (NP) in a bulk-billing healthcare cooperative in the Australian Capital Territory. There are few empirical case reports in the Australian literature that demonstrate financial sustainability of this type of healthcare professional in primary healthcare. This case study demonstrates that the costs of employing a PHC-NP in general practice are offset by direct and indirect Medicare billings generated by the PHC-NP, resulting in a cost-neutral healthcare practitioner. The success of this model relies on bidirectional collaborative working relationships amongst general practitioners and NPs. PHC-NPs should have a generalist scope of practice and specialist expertise in order to maximise their utility within the general practice environment.

Advanced and specialist nursing practice: attitudes of nurses and physicians in Israel.

PubMed

Brodsky, Eithan; Van Dijk, Dina

2008-01-01

With the introduction of new and advanced nursing roles, the nursing profession is undergoing dynamic change. Realizing changes will be easier to accomplish if the nursing community and other healthcare professionals welcome the process. Recently the nursing staff mix in Israel has been undergoing a transformation: encouraging registered nurses to enhance their status by acquiring academic degrees and advanced professional training, and initiating the adoption of new nursing roles. Our goal is to evaluate Israeli nurses' and physicians' attitudes to the introduction of new nursing roles and to expanding the scope of nursing practice. Two hundred and fifteen nurses and 110 physicians from three large general hospitals and 15 community clinics filled in a questionnaire. In general the majority of the nurses supported expansion of nursing practice, and such expansion did not cause significant opposition among physicians. However when the task affected patients' health, physicians were less willing to permit nurses to perform skills previously their responsibility alone. In addition, using multiple logistic regressions, support of the expansion of nursing practice was significantly higher among nurses in management or training positions, and among academically accredited nurses. Support for expanded roles was prominent among hospital physicians, graduates from Israeli schools of medicine, and less-tenured physicians. We suggest that confirmation by various groups of physicians and nurses of standardized definitions of the new boundaries in the scope of nursing practice roles could successfully promote development of new roles and facilitate integration of the Israeli healthcare system into the global context of change. Inter- and intra-professional collaboration, agreement, and understanding regarding advanced nursing practice roles and their introduction into the healthcare system might improve the relationship between healthcare professions and ultimately increase

Factors which influence nurse practitioners ability to carry out physical examination skills in the clinical area after a degree level module--an electronic Delphi study.

PubMed

McElhinney, Evelyn

2010-11-01

The aim of the study was to identify the factors that influence nurse practitioners ability to practice physical examination skills in the clinical area. The changing health care needs of the population require new ways of working for many health professionals. Physical examination (core skills of inspection, palpation, percussion and auscultation) of patients is a fairly new role for nurses in secondary care in the United Kingdom. However, implementing new roles in the clinical area can be challenging for the practitioners involved, and several factors have been identified which are seen to help or hinder their success. A Delphi study was undertaken using blind copy email over six weeks in 2008. The participants included a purposive sample of 21 nurses from 10 clinical areas who had completed a degree level module in physical examination as part of a nurse practitioner pathway. This study generated valuable opinion of factors that can help or hinder the ability of nurses to practice physical examination in the clinical area. The results highlight the importance of individual self-confidence, role clarity, effective educational preparation and support from other disciplines to the nurse practitioners ability to carry out this new role. Several factors reported by the participants concur and add to factors reported in previous studies of new role implementation. There appears to be a continued need for clear job descriptions, role clarity, authority and autonomy to practice for nurse practitioners undertaking physical examination. Physical examination knowledge and skills are part of the role of nurse practitioners. This study highlights several factors which need to be addressed to ensure practitioners are able to carry out this new role on return to the clinical area. © 2010 Blackwell Publishing Ltd.

[The Role of Nursing Education in the Advancement of the Nursing Profession].

PubMed

Chang Yeh, Mei

2017-02-01

The present article discusses the role of nursing education in the advancement of the nursing profession in the context of the three facets of knowledge: generation, dissemination, and application. Nursing is an applied science and the application of knowledge in practice is the ultimate goal of the nursing profession. The reform of the healthcare delivery model requires that nurses acquire and utilize evidence-based clinical knowledge, critical thinking, effective communication, and team collaboration skills in order to ensure the quality of patient care and safety. Therefore, baccalaureate education has become the minimal requirement for pre-licensure nursing education. Schools of nursing are responsible to cultivate competent nurses to respond to the demands on the nursing workforce from the healthcare system. Attaining a master's education in nursing helps cultivate Advanced Practice Registered Nurses (APRNs) to further expand the roles and functions of the nursing profession in order to promote the quality of care in clinical practice. Nursing faculty and scholars of higher education institutions generate nursing knowledge and develop professional scholarship through research. Attaining a doctoral education in nursing cultivates faculties and scholars who will continually generate and disseminate nursing knowledge into the future.

An overview of the outcomes and impact of specialist and advanced nursing and midwifery practice, on quality of care, cost and access to services: A narrative review.

PubMed

Casey, Mary; O'Connor, Laserina; Cashin, Andrew; Smith, Rita; O'Brien, Denise; Nicholson, Emma; O'Leary, Denise; Fealy, Gerard; McNamara, Martin; Glasgow, Mary Ellen; Stokes, Diarmuid; Egan, Claire

2017-09-01

This paper presents the results of a systematic rapid review and narrative synthesis of the literature of the outcomes and impact of specialist and advanced nursing and midwifery practice regarding quality of care, cost and access to services. A rapid review was undertaken of the relevant national and international literature, regulatory and policy documents relating to the establishment and definition of nurses' and midwives' specialist and advanced practice roles. A search of the Cumulative Index to the Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE) was undertaken from 2012 to 2015. The study also included primary data collection on the perceived impact of specialist and advanced practice nursing and midwifery roles and enablers and barriers to these roles using semi-structured interviews. These are not included in this paper. To facilitate a systematic approach to searching the literature, the PICO framework, was adapted. The database search yielded 437 articles relevant to the analysis of specialist and advanced practice in relation to quality care, cost and access to services with additional articles added in a manual review of reference lists. In the final review a total of 86 articles were included as they fulfilled the eligibility criteria. The evidence presented in the 86 articles indicates that nursing and midwifery practitioners continue to be under-utilised despite the evidence that greater reliance on advanced nurse practitioners could improve accessibility of primary care services while also saving on cost. Results point to continued difficulties associated with accurate measurement of the impact of these roles on patient outcomes. This review demonstrates that there is a need for robust measurement of the impact of these roles on patient outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Advanced practice psychiatric mental health nursing, finding our core: the therapeutic relationship in 21st century.

PubMed

Perraud, Suzanne; Delaney, Kathleen R; Carlson-Sabelli, Linnea; Johnson, Mary E; Shephard, Rebekah; Paun, Olimpia

2006-11-01

Increasingly, students from various professional backgrounds are enrolling in Psychiatric Mental Health (PMH) Nursing graduate programs, especially at the post-master's level. Faculty must educate these students to provide increasingly complex care while socializing them as PMH advanced practitioners. To present how one online program is addressing these issues by reasserting the centrality of the relationship and by assuring it has at least equal footing with the application of a burgeoning knowledge base of neurobiology of mental illness. Published literature from nursing and psychology. The PMH graduate faculty believes that they have developed strategies to meet this challenge and to help build a PMH workforce that will maintain the centrality of the relationship in PMH practice.

A randomised controlled crossover trial of nurse practitioner versus doctor led outpatient care in a bronchiectasis clinic

PubMed Central

Sharples, L; Edmunds, J; Bilton, D; Hollingworth, W; Caine, N; Keogan, M; Exley, A

2002-01-01

Background: With the decrease in junior doctor hours, the advent of specialist registrars, and the availability of highly trained and experienced nursing personnel, the service needs of patients with chronic respiratory diseases attending routine outpatient clinics may be better provided by appropriately trained nurse practitioners. Methods: A randomised controlled crossover trial was used to compare nurse practitioner led care with doctor led care in a bronchiectasis outpatient clinic. Eighty patients were recruited and randomised to receive 1 year of nurse led care and 1 year of doctor led care in random order. Patients were followed up for 2 years to ensure patient safety and acceptability and to assess differences in lung function. Outcome measures were forced expiratory volume in 1 second (FEV1), 12 minute walk test, health related quality of life, and resource use. Results: The mean difference in FEV1 was 0.2% predicted (95% confidence interval –1.6 to 2.0%, p=0.83). There were no significant differences in the other clinical or health related quality of life measures. Nurse led care resulted in significantly increased resource use compared with doctor led care (mean difference £1497, 95% confidence interval £688 to £2674, p<0.001), a large part of which resulted from the number and duration of hospital admissions. The mean difference in resource use was greater in the first year (£2625) than in the second year (£411). Conclusions: Nurse practitioner led care for stable patients within a chronic chest clinic is safe and is as effective as doctor led care, but may use more resources. PMID:12149523

Clinical practice: new challenges for the advanced practice nurse.

PubMed

Bartel, J C; Buturusis, B

2000-12-01

This report describes the challenges for advanced practice nurses (APNs) relative to supply and demand issues. The article also includes opportunities with the Balanced Budget Act, physician acceptance of Advanced Practice Nurses, and expanding practice opportunities. The challenges include the nursing shortage (both in nursing students and faculty), the aging of the nursing workforce, and a lag in nursing salaries; increased demand for nursing based on aging baby boomers, increasing patient acuity and technology, and new arenas for practice. The Balanced Budget Act of 1997 provided new opportunities for advanced practice nurses, including enhanced autonomy to provide services and bill independently of physicians. With these changes come new opportunities for advanced practice nurse entrepreneurs in the areas of independent practice, including opportunities to positively impact the health of families and communities in alignment with the Federal government's vision for "Healthy People 2010." As physician acceptance of advanced practice nurses continues to grow and in light of the changes in medical practice and education (residency reduction), opportunities to expand collaborative practice arrangements also exist. APNs are best suited to make the most of these changes. One example of an opportunity for independent practice, a Community Wellness Center, is developed as an entrepreneurial venture benefiting both the APN and the health of a community. Who better than registered nurses (RNs), especially those practicing at the advanced level, can ensure that these opportunities and challenges are addressed in an ethical manner and focused on the needs and health of the community?

Exploring the scope of expanding advanced nursing practice in nurse-led clinics: a multiple-case study.

PubMed

Shiu, Ann T Y; Lee, Diana T F; Chau, Janita P C

2012-08-01

This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong. Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice. A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted. The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics. The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond. © 2011 Blackwell Publishing Ltd.

The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

PubMed Central

Varley, Anna; Warren, Fiona C.; Richards, Suzanne H.; Calitri, Raff; Chaplin, Katherine; Fletcher, Emily; Holt, Tim A.; Lattimer, Valerie; Murdoch, Jamie; Richards, David A.; Campbell, John

2016-01-01

Background Nurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings. Objective To investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition. Design Questionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage. Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a general practitioner or nurse. Settings 15 general practices and 7012 patients receiving the nurse triage intervention in four regions of the UK. Participants 45 nurse practitioners and practice nurse trained in the use of clinical decision support software. Methods We investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling. Results Valid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio 0.19, 95% confidence interval 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more

The Development of an HIV Training Program for Nurse Practitioners.

PubMed

McGee, Kara S; Relf, Michael; Harmon, James L

2016-01-01

Responding to a national need for a new workforce of HIV care providers as the first generation of providers decrease their practices or retire, the Duke University School of Nursing, with funding from the Health Resources and Services Administration, developed and implemented a program to train nurse practitioners (NP) to assume the full spectrum of primary care services needed by people living with HIV infection and various co-morbidities. The 12-credit program includes course work in HIV-related epidemiology; pathogenesis; psychosocial, political, ethical, and legal issues; and pharmacology and clinical management. Students complete 392 hours of HIV-specific clinical practice in addition to clinical hours required of all NP students. The program is the only distance-based program of its kind in the United States. Online didactic instruction is complemented by campus-based sessions with interprofessional faculty. We describe the 5 overarching goals that frame the program, and challenges and progress toward achieving those goals. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Nurse practitioners' role perception, stress, satisfaction, and intent to stay at a Midwestern academic medical center.

PubMed

Brom, Heather M; Melnyk, Bernadette M; Szalacha, Laura A; Graham, Margaret

2016-05-01

There is a growing demand for nurse practitioners (NPs) within academic medical centers (AMCs) because of physician shortages and increased need for access to care. In order to retain these NPs, it is important to assess their role perception and satisfaction. The purpose of this study was to evaluate these concepts and their relationships to stress and intent to stay. A 90-item descriptive survey, including a new role perception scale and the Misener Nurse Practitioner Job Satisfaction Scale, was administered to all NPs at a Midwestern AMC. The response rate was 62.4% (n = 181). Overall, the NPs had moderate role perception (M = 4.30, SD = 1.23) and were somewhat satisfied (M = 4.23, SD = 0.74). Over a third (39.4%) reported they were unsure about staying or did not intend to stay in their position. Intent to stay and stress were moderately correlated with overall satisfaction and weakly correlated with role perception. There were significant differences in the intrapractice and professional aspects of job satisfaction based on their supervisor. With increased NP needs, it is crucial for AMCs and NP supervisors to assess role perception, satisfaction, and stress among NPs in order to ensure a stable, satisfied, and productive workforce. ©2015 American Association of Nurse Practitioners.

Implications of utility and deontology for the clinical nurse specialist.

PubMed

Ayres, L

1989-01-01

Faced with prospective payment plans and personnel shortages nurses in advanced clinical practice are under pressure to find practical solutions. These solutions may reflect the institutional philosophy of utility rather than the traditional nursing ethic of deontology, illustrating the need to examine the differences between utilitarian and deontological principles as they affect nursing practice. This paper discusses deontology and utility as they apply to nursing practice, considers how these different philosophical positions may affect advanced practitioners, and describes the current status of ethics in nursing.

Neonatal nurse practitioners: distribution, roles and scope of practice.

PubMed

Freed, Gary L; Dunham, Kelly M; Lamarand, Kara E; Loveland-Cherry, Carol; Martyn, Kristy K

2010-11-01

We sought to determine the distribution and scope of practice of the neonatal nurse practitioner (NNP) workforce across the United States. To determine distribution, we used counts of certified NNPs from the National Certification Corp (Chicago, IL). We calculated state NNP/child population ratios as the number of NNPs divided by the state population 0 to 17 years of age. We calculated NNP/NICU bed ratios as the number of NNPs divided by the total number of NICU beds per state. To characterize roles and scope of practice, we conducted a mail survey of a random national sample of 300 NNPs in states that license nurse practitioners to practice independently and 350 NNPs in states that require physician involvement. The greatest concentrations of NNPs per capita were in the Midwest, South, and Mid-Atlantic region. Thirty-one states had <100 total NNPs. The survey response rate was 77.1%. More than one-half of NNP respondents (54% [n = 211]) reported that they spent the majority of their time in a community hospital, whereas more than one-third (37% [n = 144]) were in an academic health center. Only 2% (n = 7) reported that they engaged in independent practice. As with many health care professionals, the supply of NNPs may not be distributed according to need. With increasing concern regarding the availability of NNPs, comprehensive studies that examine the demand for NNPs and the roles of other clinicians in the NICU should provide a greater understanding of appropriate NICU workforce capacity and needs.

Organizational climate in primary care settings: implications for nurse practitioner practice.

PubMed

Poghosyan, Lusine; Nannini, Angela; Clarke, Sean

2013-03-01

The purpose of this review is to investigate literature related to organizational climate, define organizational climate, and identify its domains for nurse practitioner (NP) practice in primary care settings. A search was conducted using MEDLINE, PubMed, HealthSTAR/Ovid, ISI Web of Science, and several other health policy and nursingy databases. In primary care settings, organizational climate for NPs is a set of organizational attributes, which are perceived by NPs about their practice setting, emerge from the way the organization interacts with NPs, and affect NP behaviors and outcomes. Autonomy, NP-physician relations, and professional visibility were identified as organizational climate domains. NPs should be encouraged to assess organizational climate in their workplace and choose organizations that promote autonomy, collegiality between NPs and physicians, and encourage professional visibility. Organizational and NP awareness of qualities that foster NP practice will be a first step for developing strategies to creating an optimal organizational climate for NPs to deliver high-quality care. More research is needed to develop a comprehensive conceptual framework for organizational climate and develop new instruments to accurately measure organizational climate and link it to NP and patient outcomes. ©2012 The Author(s) Journal compilation ©2012 American Association of Nurse Practitioners.

Reflections on independence in nurse practitioner practice.

PubMed

Weiland, Sandra A

2008-07-01

To examine factors that influence the ability of nurse practitioners (NPs) to practice as independent primary care providers. Extensive literature search on CINAHL, OVID, MEDLINE, Internet journal sources, and professional association Web sites. The legal authority for NPs to practice independently is recognized; however, the ability to put that authority into practice is undermined by the historical failure of political, professional, and social entities to recognize NPs as providers capable of providing primary care autonomously. Nonrecognition is responsible for complex reimbursement policies (both federal and state) that economically and professionally restrain the NP role; hence, NPs remain in a financially dependent relationship despite 40 years of proven safe practice. NPs must articulate their independence as practitioners more vociferously in order to meet society's healthcare requirements, as well as to attain professional fulfillment and forge collegial relationships. NPs will never be seen as members of a profession by either themselves or others without the practicality of independence and autonomy. Although legal independence is a fact, real practice independence in the pragmatic sense is contingent upon reimbursement. Without fiscal sustainability, practice independence is an impossibility. And, without professional autonomy, NPs will have only an employee's voice in the dynamic healthcare system in which they are really key players in providing healthcare services to the poor and undeserved populations.

Skills Required for Nursing Career Advancement: A Qualitative Study.

PubMed

Sheikhi, Mohammad Reza; Fallahi-Khoshnab, Masoud; Mohammadi, Farahnaz; Oskouie, Fatemeh

2016-06-01

Nurses require certain skills for progression in their field. Identifying these skills can provide the context for nursing career advancement. This study aimed to identify the skills needed for nurses' career advancement. A qualitative approach using content analysis was adopted to study a purposive sample of eighteen nurses working in teaching hospitals affiliated with the Qazvin, Shahid Beheshti, and Iran Universities of Medical Sciences. The data were collected through semi-structured interviews, and analyzed using conventional content analysis. The three themes extracted from the data included interpersonal capabilities, competency for career success, and personal capacities. The results showed that acquiring a variety of skills is essential for career advancement. The findings showed that personal, interpersonal, and functional skills can facilitate nurses' career advancement. The effects of these skills on career advancement depend on a variety of conditions that require further studies.

Nursing's next advance: an internal classification for nursing practice.

PubMed

Clark, J; Lang, N

1992-01-01

An International Classification of Nursing Practice (ICNP) is needed to support the processes of nursing practice and advance the knowledge necessary for cost-effective delivery of quality nursing care. Below, the authors present their case for developing such a system that will provide nursing with a nomenclature, a language and a classification that can be used to describe and organize nursing data. It is their belief that this landmark project is achievable and that ICN should lead the work in collaboration with its member associations, the World Health Organization and key national, international, governmental and nongovernmental groups. But to ensure that the system will be adaptable across borders, nurses and organizations are being encouraged to share their ideas and research on such a system.

Shifting patterns of practice: nurse practitioners in a managed care environment.

PubMed

Johnson, Rosemary

2005-01-01

The purpose of this qualitative study was to uncover patterns across nurse practitioner (NP) experiences that contribute to understanding their perceptions of managed care, how it affects daily practice, and how NPs respond to a changing managed care workplace. In-depth interviews were conducted with 14 NPs representing primary care, specialty, and independent practices. Over an 18-month period, data collection and analysis occurred simultaneously using standard methods of purposive sampling, constant comparison, memoing, and member checks. This study illuminates the tension NPs experience between a business and a professional ethic and the strategies they use to reconcile this difference with core nursing values. Type of setting, workplace dynamics, and length of time in practice contributed to variation in NP perspectives.

Discharge of Non-Acute Coronary Syndrome Chest Pain Patients From Emergency Care to an Advanced Nurse Practitioner-Led Chest Pain Clinic: A Cross-Sectional Study of Referral Source and Final Diagnosis.

PubMed

Ingram, Shirley J; McKee, Gabrielle; Quirke, Mary B; Kelly, Niamh; Moloney, Ashling

Chest pain is a common presentation to emergency departments (EDs). Pathways for patients with non-acute coronary syndrome (ACS) chest pain are not optimal. An advanced cardiology nurse-led chest pain service was commenced to address this. The aim of the study was to assess the outcomes of non-ACS patients discharged from ED to an advanced cardiology nurse-led chest pain clinic and compare by referral type (nurse or ED physician). The service consisted of advanced cardiology nurse or ED physician consultation in the ED and discharge to advanced nurse-led chest pain clinic review less than 72 hours after discharge. Referrals were by the advanced nurses during consult hours and out-of-hours were by the ED physicians. Data were extracted from case notes. This was a 1-site cross-sectional study of patients attending the chest pain clinic over 2 years. Confirmed coronary disease was diagnosed in 24% of patients. Of the 1041 patients, 45% were referred by the advanced nurses, who referred significantly more patients who were older (56.5 years/52.3 years), had positive exercise stress test results (21%/12%), and were diagnosed with stable coronary artery disease (19%/11%) and less patients with musculoskeletal diagnosis (5%/13%) and other noncardiac pain (36%/45%). The study fills a gap in the literature on the follow up of non-ACS patients who present to ED and used advanced cardiology nursing expertise in the ED and chest pain clinic. The advanced nurse referred more patients who were diagnosed with coronary disease, reflecting the expertise, experience, and efficiency of the advanced cardiology nurse-led service.

[Reflection on the Differences and Similarities of Mental Health Care in Virginia and Taiwan: Geography, History, Culture, and Nurse Practitioners].

PubMed

Lu, Chueh-Fen; Tung, Ching-Chuan; Ely, Linda

2016-12-01

Sponsored by the pilot overseas internships project of the Ministry of Education, Taiwan, the authors and ten undergraduate students from Taiwan visited several mental health facilities in Virginia for one month. These facilities included the Catawba State Hospital, Salem Veteran Affairs Medical Center, Carilion Saint Albans Behavioral Health (New River Valley Medical Center), Warm Hearth Village, Adult & Child Family Counseling private outpatient clinic, the Free Clinic of the New River Valley, New Life Clubhouse, and Self-Government Program for Assertive Community Treatment. In-depth dialogue and participation in nursing care under the supervision of registered nurses facilitated the authors' reflection on mental health care and the roles and functions of Taiwanese nurse practitioners. The present article adopts a macro view in order to compare the related issues between Taiwan and Virginia, including: geographic features, history, culture of health-seeking behavior, healthcare insurance, and the relationships among various professionals. How these issues relate to social-cultural background and how the overall healthcare environment impacts upon the roles of nurse practitioners in Taiwan are rarely discussed in literature. We expect that this cross-cultural contrast and reflection will elicit a better understanding of how these factors have shaped and affected the roles of Taiwanese nurse practitioners. Further, suggestions about how to improve the nursing profession in Taiwan are presented.

Quality of Dying in Nursing Home Residents Dying with Dementia: Does Advanced Care Planning Matter? A Nationwide Postmortem Study

PubMed Central

Vandervoort, An; Houttekier, Dirk; Vander Stichele, Robert; van der Steen, Jenny T.; Van den Block, Lieve

2014-01-01

Background Advance care planning is considered a central component of good quality palliative care and especially relevant for people who lose the capacity to make decisions at the end of life, which is the case for many nursing home residents with dementia. We set out to investigate to what extent (1) advance care planning in the form of written advance patient directives and verbal communication with patient and/or relatives about future care and (2) the existence of written advance general practitioner orders are related to the quality of dying of nursing home residents with dementia. Methods Cross-sectional study of deaths (2010) using random cluster-sampling. Representative sample of nursing homes in Flanders, Belgium. Deaths of residents with dementia in a three-month period were reported; for each the nurse most involved in care, GP and closest relative completed structured questionnaires. Findings We identified 101 deaths of residents with dementia in 69 nursing homes (58% response rate). A written advance patient directive was present for 17.5%, GP-orders for 56.7%. Controlling for socio-demographic/clinical characteristics in multivariate regression analyses, chances of having a higher mean rating of emotional well-being (less fear and anxiety) on the Comfort Assessment in Dying with Dementia scale were three times higher with a written advance patient directive and more specifically when having a do-not-resuscitate order (AOR 3.45; CI,1.1–11) than for those without either (AOR 2.99; CI,1.1–8.3). We found no association between verbal communication or having a GP order and quality of dying. Conclusion For nursing home residents with dementia there is a strong association between having a written advance directive and quality of dying. Where wishes are written, relatives report lower levels of emotional distress at the end of life. These results underpin the importance of advance care planning for people with dementia and beginning this process as

Consumer perspectives on nurse practitioners and independent practice.

PubMed

Brown, Deonne J

2007-10-01

The purposes of this study were to report the results of a survey for determining the feasibility and sustainability of independently managed nurse practitioner (NP) practices, to identify the characteristics of consumers who would likely choose an independent NP practice, to assess consumer needs, and to define a target market for competitively positioning NPs. An anonymous electronic survey of 1000 employees (response rate = 21%) at a large nonprofit organization in King County, Washington. This organization employs persons in a wide range of socioeconomic and vocational situations. Descriptive statistics and chi-square analyses were applied to determine associations between demographic characteristics and having used an NP or having the intent to use an independent NP practice. Most respondents knew about NPs, and the majority had seen an NP for their care. Most were satisfied or very satisfied with NP care. A much larger percentage (90%) than previous studies knew about NPs; 58% had seen an NP for their care, making NPs the most used practitioner alternative to physicians. Evidence suggests that NP users are more likely to be female and younger. Eighty-two percent of NP users were satisfied or very satisfied with the care they had received compared to a 70% satisfaction rate for current providers. Women, relatively younger respondents, those who had seen a physician assistant or NP, and those who considered NPs to provide quality and more personalized care were significantly more likely to indicate that they would choose an independent NP practice in their community. Based on a standard marketing formula, 30% of the sample in this study would be expected to change their health care to such a practice. This is the first descriptive study to suggest widespread acceptance of NPs as independent practitioners. Compared to a 1985 study of Seattle residents, consumers are far more likely to know about NPs. Consumer studies such as this one identify the characteristics

Public Opinions Regarding Advanced Dental Hygiene Practitioners in a High-Need State.

PubMed

Walsh, Sarah E; Chubinski, Jennifer; Sallee, Toby; Rademacher, Eric W

2016-10-01

Purpose: The new Advanced Dental Hygiene Practitioner (ADHP) profession is expected to increase access to oral health care for the general population, particularly in rural and underserved areas. In order for this strategy to be successful, the public must feel comfortable with the care provided by ADHPs and seek out their services, yet consumer receptivity has been overlooked in the literature. The current study explores comfort with ADHPs for one high-need state: Kentucky. Methods: Consumer receptivity to the ADHP was assessed using a large, random sample telephone survey. As a point of comparison, respondents were first asked about their comfort with care provided by two other advanced practice clinicians already licensed in the state: advanced practice registered nurses (APRN) and physician assistants (PA). Results: After hearing a brief description of the profession, nearly 3 in 4 Kentucky adults said they would be somewhat (35.4%) or very (38.2%) comfortable seeing an ADHP for routine dental care. The total proportion of Kentucky adults who were comfortable seeking care from an ADHP (73.6%) was slightly less than the proportion indicating comfort seeing an APRN (79.7%) or PA (81.3%). Conclusion: Overall, this study demonstrates that adults are receptive to new models of care delivery and report high levels of comfort with ADHPs. Consumer concerns are unlikely to be a barrier to expanded licensure for dental hygienists in high-need areas like Kentucky. Copyright © 2016 The American Dental Hygienists’ Association.

Meaningful Use of Data in Care Coordination by the Advanced Practice Registered Nurse: The TeleFamilies Project

PubMed Central

Looman, Wendy S.; Erickson, Mary M.; Garwick, Ann W.; Cady, Rhonda G.; Kelly, Anne; Pettey, Carrie; Finkelstein, Stanley M.

2012-01-01

Meaningful use of electronic health records to coordinate care requires skillful synthesis and integration of subjective and objective data by practitioners to provide context for information. This is particularly relevant in the coordination of care for children with complex special health care needs. The purpose of this paper is to present a conceptual framework and example of meaningful use within an innovative telenursing intervention to coordinate care for children with complex special health care needs. The TeleFamilies intervention engages an advanced practice nurse in a full-time care coordinator role within an existing hospital-based medical home for children with complex special health care needs. Care coordination is facilitated by the synthesis and integration of internal and external data using an enhanced electronic health record and telehealth encounters via telephone and videoconferencing between the advanced practice nurse and the family at home. The advanced practice nurse’s ability to maintain an updated plan of care that is shared across providers and systems and build a relationship over time with the patient and family supports meaningful use of these data. PMID:22948406

An investigation of the international literature on nurse practitioner private practice models.