Nurse practitioner malpractice data: Informing nursing education.

PubMed

Sweeney, Casey Fryer; LeMahieu, Anna; Fryer, George E

Nurse practitioners (NPs) are often identified in medical malpractice claims. However, the use of malpractice data to inform the development of nursing curriculum is limited. The purpose of this study is to examine medical errors committed by NPs. Using National Practitioner Data Bank public use data, years 1990 to 2014, NP malpractice claims were classified by event type, patient outcome, setting, and number of practitioners involved. The greatest proportion of malpractice claims involving nurse practitioners were diagnosis related (41.46%) and treatment related (30.79%). Severe patient outcomes most often occurred in the outpatient setting. Nurse practitioners were independently responsible for the event in the majority of the analyzed claims. Moving forward, nurse practitioner malpractice data should be continuously analyzed and used to inform the development of nurse practitioner education standards and graduate program curriculum to address areas of clinical weakness and improve quality of care and patient safety. Copyright © 2017 Elsevier Inc. All rights reserved.

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.

Role of Geography and Nurse Practitioner Scope-of-Practice in Efforts to Expand Primary Care System Capacity: Health Reform and the Primary Care Workforce.

PubMed

Graves, John A; Mishra, Pranita; Dittus, Robert S; Parikh, Ravi; Perloff, Jennifer; Buerhaus, Peter I

2016-01-01

Little is known about the geographic distribution of the overall primary care workforce that includes both physician and nonphysician clinicians--particularly in areas with restrictive nurse practitioner scope-of-practice laws and where there are relatively large numbers of uninsured. We investigated whether geographic accessibility to primary care clinicians (PCCs) differed across urban and rural areas and across states with more or less restrictive scope-of-practice laws. An observational study. 2013 Area Health Resource File (AHRF) and US Census Bureau county travel data. The measures included percentage of the population in low-accessibility, medium-accessibility, and high-accessibility areas; number of geographically accessible primary care physicians (PCMDs), nurse practitioners (PCNPs), and physician assistants (PCPAs) per 100,000 population; and number of uninsured per PCC. We found divergent patterns in the geographic accessibility of PCCs. PCMDs constituted the largest share of the workforce across all settings, but were relatively more concentrated within urban areas. Accessibility to nonphysicians was highest in rural areas: there were more accessible PCNPs per 100,000 population in rural areas of restricted scope-of-practice states (21.4) than in urban areas of full practice states (13.9). Despite having more accessible nonphysician clinicians, rural areas had the largest number of uninsured per PCC in 2012. While less restrictive scope-of-practice states had up to 40% more PCNPs in some areas, we found little evidence of differences in the share of the overall population in low-accessibility areas across scope-of-practice categorizations. Removing restrictive scope-of-practice laws may expand the overall capacity of the primary care workforce, but only modestly in the short run. Additional efforts are needed that recognize the locational tendencies of physicians and nonphysicains.

Can New Zealand achieve self-sufficiency in its nursing workforce?

PubMed

North, Nicola

2011-01-01

This paper reviews impacts on the nursing workforce of health policy and reforms of the past two decades and suggests reasons for both current difficulties in retaining nurses in the workforce and measures to achieve short-term improvements. Difficulties in retaining nurses in the New Zealand workforce have contributed to nursing shortages, leading to a dependence on overseas recruitment. In a context of global shortages and having to compete in a global nursing labour market, an alternative to dependence on overseas nurses is self-sufficiency. Discursive paper. Analysis of nursing workforce data highlighted threats to self-sufficiency, including age structure, high rates of emigration of New Zealand nurses with reliance on overseas nurses and an annual output of nurses that is insufficient to replace both expected retiring nurses and emigrating nurses. A review of recent policy and other documents indicates that two decades of health reform and lack of a strategic focus on nursing has contributed to shortages. Recent strategic approaches to the nursing workforce have included workforce stocktakes, integrated health workforce development and nursing workforce projections, with a single authority now responsible for planning, education, training and development for all health professions and sectors. Current health and nursing workforce development strategies offer wide-ranging and ambitious approaches. An alternative approach is advocated: based on workforce data analysis, pressing threats to self-sufficiency and measures available are identified to achieve, in the short term, the maximum impact on retaining nurses. A human resources in health approach is recommended that focuses on employment conditions and professional nursing as well as recruitment and retention strategies. Nursing is identified as 'crucial' to meeting demands for health care. A shortage of nurses threatens delivery of health services and supports the case for self-sufficiency in the nursing

Nursing: What's a Nurse Practitioner?

MedlinePlus

... nurses, or APNs) have a master's degree in nursing (MS or MSN) and board certification in their ... Nurse Practitioners (NAPNAP) and through local hospitals or nursing schools. Also, many doctors share office space with ...

Hawai‘i's Nursing Workforce: Keeping Pace with Healthcare

PubMed Central

Qureshi, Kristine

2015-01-01

Nursing is the largest segment of the healthcare workforce, but over the next decade even more nurses will be required. Changing population demographics, new technologies, and evolving models of healthcare will stimulate expansion of nursing roles and the need for a highly educated nursing workforce. The current nursing workforce is aging, and large numbers of retirements are anticipated. By 2025, the United States is expected to experience a nursing shortage; in Hawai‘i this shortfall is forecast to be 3,311 professional nurses. Currently there are nine nursing programs across the state in public and private universities and colleges. These programs are partnering to implement the Institute of Medicine's recommendations for the future of nursing. In Hawai‘i, nursing practice is being expanded; different pathways to advanced nursing education are being implemented; and nurses are partnering with other groups to reshape healthcare. The Hawai‘i State Center for Nursing collects ongoing data on the nursing workforce to inform strategic planning. Current gaps in nursing specialty education include school health and mental health. The purpose of this paper is to provide an overview of Hawai‘i's nursing workforce in relationship to statewide population demographics, healthcare needs and gaps, and then outline steps being taken by the profession to address these needs and gaps while implementing the Institute of Medicine recommendations. PMID:25755912

Work hazards for an aging nursing workforce.

PubMed

Phillips, Jennan A; Miltner, Rebecca

2015-09-01

To discuss selected work hazards and safety concerns for aging nurses. Greater numbers of older nurses remain in the workforce. Projections suggest that one-third of the nursing workforce will be over age 50 years by 2015. Employers will struggle to find ways to protect the health and safety of their aging workforce and prevent a massive loss of intellectual and human resources when these experienced nurses exit the workforce. Review of recent relevant literature in English language journals. Repetitive motion injuries, fatigue and slips, trips and falls are three major work hazards older nurses face. We discuss several factors for each hazard, including: the normal physiological aging effects of diminished strength, hearing and vision; workplace variables of work schedules, noise and clutter; and personal characteristics of sleep disturbances, overexertion and fatigue. Inconclusive evidence exists to guide best practices for designing safe workplace environments and shift patterns for nursing work. There are at least two areas administrators can reduce work hazards for older workers: (1) modification of the workplace, and (2) creating the infrastructure to support the aging workforce to encourage healthy behaviours. © 2014 John Wiley & Sons Ltd.

A scoping review of nursing workforce planning and forecasting research.

PubMed

Squires, Allison; Jylhä, Virpi; Jun, Jin; Ensio, Anneli; Kinnunen, Juha

2017-11-01

This study will critically evaluate forecasting models and their content in workforce planning policies for nursing professionals and to highlight the strengths and the weaknesses of existing approaches. Although macro-level nursing workforce issues may not be the first thing that many nurse managers consider in daily operations, the current and impending nursing shortage in many countries makes nursing specific models for workforce forecasting important. A scoping review was conducted using a directed and summative content analysis approach to capture supply and demand analytic methods of nurse workforce planning and forecasting. The literature on nurse workforce forecasting studies published in peer-reviewed journals as well as in grey literature was included in the scoping review. Thirty six studies met the inclusion criteria, with the majority coming from the USA. Forecasting methods were biased towards service utilization analyses and were not consistent across studies. Current methods for nurse workforce forecasting are inconsistent and have not accounted sufficiently for socioeconomic and political factors that can influence workforce projections. Additional studies examining past trends are needed to improve future modelling. Accurate nursing workforce forecasting can help nurse managers, administrators and policy makers to understand the supply and demand of the workforce to prepare and maintain an adequate and competent current and future workforce. © 2017 John Wiley & Sons Ltd.

The Impact of Out-Migration on the Nursing Workforce in Kenya

PubMed Central

Gross, Jessica M; Rogers, Martha F; Teplinskiy, Ilya; Oywer, Elizabeth; Wambua, David; Kamenju, Andrew; Arudo, John; Riley, Patricia L; Higgins, Melinda; Rakuom, Chris; Kiriinya, Rose; Waudo, Agnes

2011-01-01

Objective To examine the impact of out-migration on Kenya's nursing workforce. Study Setting This study analyzed deidentified nursing data from the Kenya Health Workforce Informatics System, collected by the Nursing Council of Kenya and the Department of Nursing in the Ministry of Medical Services. Study Design We analyzed trends in Kenya's nursing workforce from 1999 to 2007, including supply, deployment, and intent to out-migrate, measured by requests for verification of credentials from destination countries. Principle Findings From 1999 to 2007, 6 percent of Kenya's nursing workforce of 41,367 nurses applied to out-migrate. Eighty-five percent of applicants were registered or B.Sc.N. prepared nurses, 49 percent applied within 10 years of their initial registration as a nurse, and 82 percent of first-time applications were for the United States or United Kingdom. For every 4.5 nurses that Kenya adds to its nursing workforce through training, 1 nurse from the workforce applies to out-migrate, potentially reducing by 22 percent Kenya's ability to increase its nursing workforce through training. Conclusions Nurse out-migration depletes Kenya's nursing workforce of its most highly educated nurses, reduces the percentage of younger nurses in an aging nursing stock, decreases Kenya's ability to increase its nursing workforce through training, and represents a substantial economic loss to the country. PMID:21413982

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.

Nurses' perception of nursing workforce and its impact on the managerial outcomes in emergency departments.

PubMed

Hu, Yi-Chun; Chen, Jih-Chang; Chiu, Hsiao-Ting; Shen, Hsi-Che; Chang, Wen-Yin

2010-06-01

(1) To understand nurses' subjective perceptions of the current nursing workforce in their emergency departments, (2) to examine the relationship between nurses' workforce perceptions and its impact on the managerial outcomes and (3) to analyse the correlation between nurses' characteristics and the scores on workforce perception. While the association between workforce perceptions and nurse outcomes is well-documented, few studies have examined how emergency department nurses perceive current workforce and related outcomes. A cross-sectional questionnaire survey. A self-reported workforce perception questionnaire was used to survey 538 registered nurses in the emergency departments of 19 hospitals in northern Taiwan, during May to October 2006. Data were analysed using descriptive statistics, chi-square test, independent t-test, Pearson correlation and one-way anova. The mean score of workforce perception was 6.28 points (total = 10 points). Both overtime (p = 0.02) and number of callbacks on days off (p = 0.01) were significantly correlated to current nursing workforce and hospital level. Older nurses tended to have more emergency department experience (r = 0.37; p = 0.01) and those with more emergency department experience tended to have vacation accumulation (r = 0.09; p = 0.04), overtime (r = 0.10; p = 0.03) and better perception of their emergency department's current workforce (r = 0.09; p = 0.05). Although nurses' perceptions were found to be only moderate, overtime and number of callbacks on days off are potential problems that should be addressed by nursing leaders to benefit future emergency nurses. The findings can help drive strategies to ensure adequate staffing, to stabilise the nursing workforce and to prevent nurses from burnout factors such as working long hours, unpredictable schedules and a stressful work environment that may impact both the quality of emergency care and the quality of the nurses' work environment.

The costs of training a nurse practitioner in primary care: the importance of allowing for the cost of education and training when making decisions about changing the professional-mix.

PubMed

Curtis, Lesley; Netten, Ann

2007-05-01

What is already known on this topic * Cost containment through the most effective mix of staff achievable within available resources and organisational priorities is of increasing importance in most health systems. However, there is a dearth of information about the full economic implications of changing skill mix. * In the UK a major shift in the primary care workforce is likely in response to the rapidly developing role of nurse practitioners and policies aimed to encourage GP practices to transfer some of their responsibilities to other, less costly, professionals. * Previous research has developed an approach to incorporating the costs of qualifications, and thus the investment required to develop a skilled workforce, for a variety of health service professionals including GPs. What this study adds * This paper describes a methodology of costing nurse practitioners that incorporates the human capital cost implications of developing a skilled nurse practitioner workforce. With appropriate sources of data the method could be adapted for use internationally. * Including the full cost of qualifications results in nearly a 24 per cent increase in the unit cost of a Nurse Practitioner. * Allowing for all investment costs and adjusting for length of consultation, the cost of a GP consultation was nearly 60 per cent higher than that of a Nurse Practitioner.

Nurse practitioner (NP)

MedlinePlus

... nurse with a graduate degree in advanced practice nursing. This type of provider may also be referred to as an ARNP (Advanced Registered Nurse Practitioner) or APRN (Advanced Practice Registered Nurse). Types of health care providers is a related topic.

Internationally educated nurses: profiling workforce diversity.

PubMed

Blythe, Jennifer; Baumann, Andrea

2009-06-01

Nurses with diverse educational and cultural backgrounds are likely to adapt differently to new workforces. The aim of this study was to provide a profile of nurses educated in different countries who are employed in a major settlement jurisdiction. Despite difficulties in measuring its magnitude, it is evident that nurse migration has increased as a result of globalization. Major destinations for internationally educated nurses (IENs) include the USA, Canada, the UK, Australia and the Gulf States. Chief donor countries include the Philippines, India and other South Asian countries. Half of all IENs registered in Canada work in the province of Ontario. Published literature and secondary data were used to profile cohorts of nurses educated in different countries who are employed in the Ontario workforce. Statistics available on IENs in Ontario reveal a largely urban settlement pattern. There are major differences among IEN cohorts in terms of age, gender, work status, and type and place of employment. Although IENs resident in Ontario could not be quantified, a relatively detailed description of IENs in the workforce was possible. Comparison of nurse cohorts indicated that generalizations about IENs should be made with caution. Changes in regulatory conditions have a significant effect on IEN employment. Difficulties associated with international educational and regulatory differences illustrate the need to create global nursing standards. Further investigation of differences in workforce profiles should provide insights leading to improved utilization of IENs.

Neonatal nurse practitioners: identity as advanced practice nurses.

PubMed

Beal, J A; Maguire, D; Carr, R

1996-06-01

To define how neonatal nurse practitioners (NNPs) perceive their identity as advanced practice nurses. Non-experimental descriptive and correlational survey. Nationwide random sample drawn from NNPs certified by the National Certification Corporation. Two hundred fifty-eight neonatal nurse practitioners practicing in neonatal intensive-care units across the United States. Neonatal Nurse Practitioners indicated on a visual analogue scale at which point their philosophy of practice fell on a continuum from nursing to medicine and specified on a 5-point bipolar Likert scale how various role socialization factors influenced their identity. The NNPs predominantly were certificate-prepared and aligned themselves with a medical philosophy. Those NNPs who were master's-prepared (p < .01), precepted by another NNP (p < .05), espoused a philosophy of nursing (p < .001), belonged to a professional nursing organization (p < .05), and had an NNP role model (p < .001) were more likely to have a strong nursing identity (95% confidence interval). The issues of role differentiation, socialization, and identity of advanced practice nurses in tertiary care need further exploration. These data support the American Nurses' Association mandate of graduate nursing education for advanced nurse practitioners.

Establishing a sustainable nursing workforce.

PubMed

Knowles, Judie

2010-07-01

Occupational sustainability in healthcare services involves meeting the demands of a changing NHS without compromising the health and wellbeing of nurses. This article examines occupational sustainability in the nursing profession, focusing on issues of nursing workload, employee health and recruitment issues, and workforce diversity.

The value of workforce data in shaping nursing workforce policy: A case study from North Carolina.

PubMed

Fraher, Erin P

In 2015, the Institute of Medicine's Committee for Assessing Progress on Implementing the Future of Nursing recommendations noted that little progress has been made in building the data infrastructure needed to support nursing workforce policy. This article outlines a case study from North Carolina to demonstrate the value of collecting, analyzing, and disseminating state-level workforce data. Data were derived from licensure renewal information gathered by the North Carolina Board of Nursing and housed at the North Carolina Health Professions Data System at the University of North Carolina at Chapel Hill. State-level licensure data can be used to inform discussions about access to care, evaluate progress on increasing the number of baccalaureate nurses, monitor how well the ethnic and racial diversity in the nursing workforce match the population, and investigate the educational and career trajectories of licensed practical nurses and registered nurses. At the core of the IOM's recommendations is an assumption that we will be able to measure progress toward a "Future of Nursing" in which 80% of the nursing workforce has a BSN or higher, the racial and ethnic diversity of the workforce matches that of the population, and nurses currently employed in the workforce are increasing their education levels through lifelong learning. Without data, we will not know how fast we are reaching these goals or even when we have attained them. This article provides concrete examples of how a state can use licensure data to inform nursing workforce policy. Copyright © 2016 Elsevier Inc. All rights reserved.

Factors affecting the integration of immigrant nurses into the nursing workforce: A double hermeneutic study.

PubMed

Xiao, Lily Dongxia; Willis, Eileen; Jeffers, Lesley

2014-04-01

Variations in nursing practice and communication difficulties pose a challenge for the successful integration into the workforce of immigrant nurses. Evidence for this is found in cultural clashes, interpersonal conflicts, communication problems, prejudiced attitudes and discrimination towards immigrant nurses. While the evidence shows that integrating immigrant nurses into the nursing workforce is shaped by factors that are socially constructed, studies that examine social structures affecting workforce integration are sparse. The aim of this study was to examine interplaying relationships between social structures and nurses' actions that either enabled or inhibited workforce integration in hospital settings. Giddens' Structuration Theory with double hermeneutic methodology was used to interpret 24 immigrant and 20 senior nurses' perceptions of factors affecting workforce integration. Four themes were identified from the data. These were: (1) employer-sponsored visa as a constraint on adaptation, (2) two-way learning and adaptation in multicultural teams, (3) unacknowledged experiences and expertise as barriers to integration, and (4) unquestioned sub-group norms as barriers for group cohesion. The themes presented a critical perspective that unsuitable social structures (policies and resources) constrained nurses' performance in workforce integration in the context of nurse immigration. The direction of structural changes needed to improve workforce integration is illustrated throughout the discussions of policies and resources required for workforce integration at national and organisational levels, conditions for positive group interactions and group cohesion in organisations. Our study reveals inadequate rules and resources used to recruit, classify and utilise immigrant nurses at national and healthcare organisational levels can become structural constraints on their adaptation to professional nursing practice and integration into the workforce in a host

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...

The aging nursing workforce: How to retain experienced nurses.

PubMed

Cohen, Jeremye D

2006-01-01

In the face of an anticipated nursing shortage, healthcare organizations must evaluate their culture, operations, and compensation system to ensure that these elements align with organizational efforts to retain nurses who are approaching retirement age. Management should focus on enhancing elements of job satisfaction and job embeddedness that will motivate nurses to remain both in the workforce and with their employer. Although much of this responsibility falls on the nurse manager, nurse managers are often not provided the necessary support by top management and are neither recognized nor held accountable for nurse turnover. Other retention initiatives can include altering working conditions to reduce both physical and mental stress and addressing issues of employee health and safety. As for compensation, organizations may be well-served by offering senior nursing staff flexible working hours, salary structures that reward experience, and benefit programs that hold value for an aging workforce.

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...

Ethnic diversity in the nurse workforce: a literature review.

PubMed

Otto, Laureen A; Gurney, Cindy

2006-01-01

In the 2000-2003 New York State Nurses Association Strategic Plan, the Board of Directors called for an assessment of the progress made toward achieving an ethnically diverse nursing workforce as reflected in the literature. In this paper the authors have responded to that request and offer a snapshot of progress as well as standstills in the journey toward diversity. Although the literature has tended to focus on cultural competency of the healthcare worker, and includes numerous calls for action to diversify the nurse workforce, very little scholarly work has been conducted that rigorously evaluates such diversification activities. The purpose of this literature review is to explore existing scholarly work in ethnic diversity at three levels: in the general workforce, the healthcare workforce, and the nursing workforce. The authors explored the literature as it addresses two aspects: academic and career factors influencing diversity; and recruitment, retention, and other strategies employed to diversify the workforce. By exploring the existing research, gaps can be identified in order to either direct further research, or target funding to recruitment strategies to effectively enhance a more ethnically diverse nurse workforce.

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.

Policies to sustain the nursing workforce: an international perspective.

PubMed

Buchan, J; Twigg, D; Dussault, G; Duffield, C; Stone, P W

2015-06-01

Examine metrics and policies regarding nurse workforce across four countries. International comparisons inform health policy makers. Data from the OECD were used to compare expenditure, workforce and health in: Australia, Portugal, the United Kingdom (UK) and the United States (US). Workforce policy context was explored. Public spending varied from less than 50% of gross domestic product in the US to over 80% in the UK. Australia had the highest life expectancy. Portugal has fewer nurses and more physicians. The Australian national health workforce planning agency has increased the scope for co-ordinated policy intervention. Portugal risks losing nurses through migration. In the UK, the economic crisis resulted in frozen pay, reduced employment, and reduced student nurses. In the US, there has been limited scope to develop a significant national nursing workforce policy approach, with a continuation of State based regulation adding to the complexity of the policy landscape. The US is the most developed in the use of nurses in advanced practice roles. Ageing of the workforce is likely to drive projected shortages in all countries. There are differences as well as variation in the overall impact of the global financial crisis in these countries. Future supply of nurses in all four countries is vulnerable. Work force planning is absent or restricted in three of the countries. Scope for improved productivity through use of advanced nurse roles exists in all countries. © 2015 International Council of Nurses.

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.

Preparing the nursing workforce of the future.

PubMed

Ellenbecker, Carol H

2010-05-01

Nurse shortages coupled with the need for national healthcare reform present a challenge. We are not preparing enough nurses nor are we preparing nurses with the right skills to fully participate in a reformed healthcare system. Historical forces in nursing education have resulted in multiple levels of entry into nursing practice and an inadequate nursing workforce. Today's environment of expanding knowledge, the call for interdisciplinary healthcare delivery teams, and evidence of the relationship between nurse education and improved patient outcomes strongly indicate the need for nurses prepared at the baccalaureate level. Requiring a baccalaureate degree for entry into nursing practice, and as the initial degree of nursing education would prepare nurses earlier for graduate education and the much needed roles of educator, researcher and advanced practice nurse. The nursing profession should take the lead in advocating for educational policies that would adequately prepare the nurse workforce of the future.

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…

A model of succession planning for mental health nurse practitioners.

PubMed

Hampel, Sally; Procter, Nicholas; Deuter, Kate

2010-08-01

This paper reviews current literature on succession planning for mental health nurse practitioners (NPs) and discusses a model of succession planning that is underpinned by principals of leadership development, workforce participation and client engagement. The paper identifies succession planning as a means of managing a present and future workforce, while simultaneously addressing individual and organizational learning and practice development needs. A discussion of the processes attendant upon sustainable succession planning - collegial support, career planning and development, information exchange, capacity building, and mentoring is framed within the potential interrelationships between existing NP, developing NP and service directors and/or team managers. Done effectively and in partnership with wider clinical services, succession planning has the potential to build NP leadership development and leadership transition more broadly within mental health services.

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.

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.

Research lessons from implementing a national nursing workforce study.

PubMed

Brzostek, T; Brzyski, P; Kózka, M; Squires, A; Przewoźniak, L; Cisek, M; Gajda, K; Gabryś, T; Ogarek, M

2015-09-01

National nursing workforce studies are important for evidence-based policymaking to improve nursing human resources globally. Survey instrument translation and contextual adaptation along with level of experience of the research team are key factors that will influence study implementation and results in countries new to health workforce studies. This study's aim was to describe the pre-data collection instrument adaptation challenges when designing the first national nursing workforce study in Poland while participating in the Nurse Forecasting: Human Resources Planning in Nursing project. A descriptive analysis of the pre-data collection phase of the study. Instrument adaptation was conducted through a two-phase content validity indexing process and pilot testing from 2009 to September 2010 in preparation for primary study implementation in December 2010. Means of both content validation phases were compared with pilot study results to assess for significant patterns in the data. The initial review demonstrated that the instrument had poor level of cross-cultural relevance and multiple translation issues. After revising the translation and re-evaluating using the same process, instrument scores improved significantly. Pilot study results showed floor and ceiling effects on relevance score correlations in each phase of the study. The cross-cultural adaptation process was developed specifically for this study and is, therefore, new. It may require additional replication to further enhance the method. The approach used by the Polish team helped identify potential problems early in the study. The critical step improved the rigour of the results and improved comparability for between countries analyses, conserving both money and resources. This approach is advised for cross-cultural adaptation of instruments to be used in national nursing workforce studies. Countries seeking to conduct national nursing workforce surveys to improve nursing human resources policies may

Sustaining the rural workforce: nursing perspectives on worklife challenges.

PubMed

Hunsberger, Mabel; Baumann, Andrea; Blythe, Jennifer; Crea, Mary

2009-01-01

Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses' work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique requirements of nurses in rural practice environments. To investigate whether nurses receive the resources and supports necessary to meet the challenges of rural practice. Semi-structured interviews were conducted with 21 managers and 44 staff nurses in 19 selected rural hospitals in Ontario, Canada. The interviews were taped and transcripts interpreted through a thematic analysis. Major worklife themes were identified and analyzed within a healthy work environment model based on the work of Kristensen. Three interrelated dimensions of the model were relevant to workforce sustainability: the balance between demands and the resources of the person, the level of social support, and the degree of influence. The availability of resources and supports affected whether the nurses perceived challenges as stimulating or overwhelming. Deficits interfered with practice and the well-being of the nurses and patients. The nurses felt frustrated and powerless when they lacked resources, support, and influence to manage negative situations. Strategies to achieve workforce sustainability include resources to reduce stress in the workplace, education to meet the needs of new and experienced nurses, and offering of employment preferences to the workforce. Addressing resources, support, and influence of rural nurses is essential to alleviate workplace challenges and sustain the rural nursing workforce.

The 'greying' of the United Kingdom nursing workforce: implications for employment policy and practice.

PubMed

Buchan, J

1999-10-01

One in five nurses on the United Kingdom (UK) professional register is aged 50 years or older. Over the next few years, the profession will lose, through retirement, many of its most experienced practitioners. The significance for policy makers and for employers of this age-shift is two-fold. Firstly it is clear that greater numbers of nurses and midwives are reaching, or soon will reach, potential retirement age. Secondly many more nurses are now reaching their middle years and they are likely to have different requirements and attitudes to nursing work. This paper examines the employment policy and practice of the ageing of the UK nursing population. The paper examines data from official sources, and information from attitudinal surveys and case studies with employing organizations to assess the major effects of the ageing of the nursing workforce. Key findings are that the age profile of those nurses working in the National Health Service appears to be 'younger' than that of the total population, with the age profile of nurses working in nursing homes and as practice nurses being older than that of the NHS nursing workforce. However, the overall age profile of NHS nurses masks considerable variation between specialties and trusts, and the 'pool' of potential nurse returners from which the NHS and other employers attempts to recruit, is declining in numbers, as it too ages. Other major issues requiring policy attention are the provision of appropriate flexible hours to older nurses who have caring responsibilities, improving access to continuing professional development, and reducing pension provision inflexibility.

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.

A statewide strategy for nursing workforce development through partnerships in Texas.

PubMed

Kishi, Aileen; Green, Alexia

2008-08-01

Statewide efforts and partnerships were used for nursing workforce development to address the nursing shortage in Texas. A statewide strategic action plan was developed where partnerships and collaboration were the key components. One of the most important outcomes of these statewide partnerships was the passage of the Nursing Shortage Reduction Act 2001. Through this legislation, the Texas Center for Nursing Workforce Studies and its advisory committee were established. This article describes how a statewide infrastructure for nursing workforce policy and legislative and regulatory processes were further developed. An overview is provided on the contributions made by the organizations involved with these strategic partnerships. The ingredients for establishing successful, strategic partnerships are also identified. It is hoped that nursing and health care leaders striving to address the nursing shortage could consider statewide efforts such as those used in Texas to develop nursing workforce policy and legislation.

The role of internationally educated nurses in a quality, safe workforce.

PubMed

D Sherwood, Gwen; Shaffer, Franklin A

2014-01-01

Migration and globalization of the nursing workforce affect source countries and destination countries. Policies and regulations governing the movement of nurses from one country to another safeguard the public by ensuring educational comparability and competence. The global movement of nurses and other health care workers calls for quality and safety competencies that meet standards such as those defined by the Institute of Medicine. This article examines nurse migration and employment of internationally educated nurses (IENs) in the context of supporting and maintaining safe, quality patient care environments. Migration to the United States is featured as an exemplar to consider the following key factors: the impact of nurse migration on the nursing workforce; issues in determining educational comparability of nursing programs between countries; quality and safety concerns in transitioning IENs into the workforce; and strategies for helping IENs transition as safe, qualified members of the nursing workforce in the destination country. Copyright © 2014 Elsevier Inc. All rights reserved.

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.

Nurses supporting nurses: creating a mentoring program for staff nurses to improve the workforce environment.

PubMed

Latham, Christine L; Hogan, Mikel; Ringl, Karen

2008-01-01

The hospital workforce environment has been recognized as an important factor for nurse retention and patient safety, yet there is ongoing evidence that inadequate communication, intraprofessional oppression, and lack of collaboration and conflict resolution continue to disempower nurses and hinder improvement of workforce conditions. A 3-year academic-hospital partnership developed and used a registered nurse (RN) mentor and advocacy program to improve the RN work environment and selected patient outcomes. The partnership initiated mentor-mentee teams and a Workforce Environment Governance Board, and obtained preliminary data on outcomes related to mentor-mentee teamwork, changes in the level of support within each unit, and the impact of improved working conditions on nurse and patient satisfaction, nurse vacancy and turnover rates, and 3 patient safety outcomes related to fall and pressure ulcer prevention and use of restraints. Dedicated mentors not only engaged in supporting fellow nurses but also assisted with enhancing the overall work environment for RNs. The partnership enhanced mutual respect between frontline RNs and managers, and allowed frontline RNs to improve the culture of support. The comprehensive approach to incorporating mentor-mentee teams changes the way fellow nurses and others perceive nurses, augments support by managers and coworkers, and improves patient care outcomes.

Hospital churn and casemix instability: implications for planning and educating the nursing workforce.

PubMed

Chiarella, Mary; Roydhouse, Jessica K

2011-02-01

Health workforce planning is a priority for Australian governments at both state and federal levels. Nursing shortages are a significant problem and addressing these shortages is likely to be a component of any workforce plan. This paper looks at the case of hospital nursing and argues that casemix, workforce and management instability inhibit workforce planning for hospital nursing. These issues are related and any efforts to objectively plan the hospital nursing workforce must seek to address them in order to succeed.

Effective leadership, teamwork and mentoring--essential elements in promoting generational cohesion in the nursing workforce and retaining nurses.

PubMed

Nelsey, Lorraine; Brownie, Sonya

2012-01-01

Despite recent increases in nurse recruitment in Australia, the current nursing workforce is still below the predicted numbers for the future demands. The combination of an ageing workforce, high nursing staff turnover and an inability to attract and retain nurses is eroding the capacity of the health care sector to appropriately respond to the care needs of the community. Currently, the nursing workforce may have as many as four generations working together. Differences in employment needs and values, work ethics, attitudes towards authority, and professional aspirations, contribute to some of the cross-generational problems that emerge and the turnover of nursing staff. Strategies to improve the retention rates of nurses need to focus on building a cohesive workforce by utilising the strengths and skill sets that characterise different generations of nurses, and creating the conditions in which nurses across all generations feel supported and valued. The aim of this article is to explain how effective leadership, teamwork and mentoring can assist efforts to promote generational cohesion and address the decline in the number of nurses in the workforce.

Specialty distribution of physician assistants and nurse practitioners in North Carolina.

PubMed

Fraher, Erin P; Morgan, Perri; Johnson, Anna

2016-04-01

Physician workforce projections often include scenarios that forecast physician shortages under different assumptions about the deployment of physician assistants (PAs) and nurse practitioners (NPs). These scenarios generally assume that PAs and NPs are an interchangeable resource and that their specialty distributions do not change over time. This study investigated changes in PA and NP specialty distribution in North Carolina between 1997 and 2013. The data show that over the study period, PAs and NPs practiced in a wide range of specialties, but each profession had a specific pattern. The proportion of PAs-but not NPs-reporting practice in primary care dropped significantly. PAs were more likely than NPs to report practice in urgent care, emergency medicine, and surgical subspecialties. Physician workforce models need to account for the different and changing specialization trends of NPs and PAs.

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...

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...

ACCCN national nursing workforce survey of intensive care units.

PubMed

Williams, S; Ogle, K R; Leslie, G

2001-05-01

A descriptive study was designed and implemented by the Australian College of Critical Care Nurses (ACCCN) Workforce Planning Advisory Committee to capture data pertaining to workforce issues of intensive care nurses. All intensive care units (ICUs) within Australia were mailed a self reporting survey. Despite a low response rate (52 per cent) and difficulty reported by respondents in gaining the appropriate data requested, the results revealed an interesting snapshot of the intensive care nursing workforce. Types of services offered by units varied considerably; paid overtime hours were low (< 2 per cent of total hours worked) and use of both part-time and agency staff was also low (10 per cent of total hours worked). Private hospitals utilised a greater proportion of part-time and agency nursing staff than public hospitals (20:10 per cent). The turnover rate for registered nursing staff was estimated at 18 per cent, with education, skill acquisition and improved communication reported as the major incentives used by managers to attract and retain staff. This study demonstrated that valuable data are currently uncaptured and recommends a more refined process of a national database to record and manage this important information for future workforce planning.

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.

The globalization of the nursing workforce: Pulling the pieces together.

PubMed

Jones, Cheryl B; Sherwood, Gwen D

2014-01-01

The "globalization" of health care creates an increasingly interconnected workforce spanning international boundaries, systems, structures, and processes to provide care to and improve the health of peoples around the world. Because nurses comprise a large sector of the global health workforce, they are called upon to provide a significant portion of nursing and health care and thus play an integral role in the global health care economy. To meet global health care needs, nurses often move within and among countries, creating challenges and opportunities for the profession, health care organizations, communities, and nations. Researchers, policy makers, and industry and academic leaders must, in turn, grapple with the impacts of globalization on the nursing and health care workforce. Through this special issue, several key areas for discussion are raised. Although far from exhaustive, our intent is to expand and stimulate intra- and interprofessional conversations raising awareness of the issues, uncover unanticipated consequences, and offer solutions for shaping the nursing and health care workforce of the future. Copyright © 2014 Elsevier Inc. All rights reserved.

A qualitative study of advanced nurse practitioners' use of physical assessment skills in the community: shifting skills across professional boundaries.

PubMed

Raleigh, Mary; Allan, Helen

2017-07-01

To explore multiple perspectives on the use of physical assessment skills by advanced nurse practitioners in the UK. Physical assessment skills practices are embedded in advanced nursing practice roles in the UK. There is little evidence on how these skills are used by advanced nurse practitioners in the community. Case study. A qualitative interpretative single-embedded case study of 22 participants from South of England. A framework method analysed interview data collected by the researcher between March-August 2013. Participants included nurses, doctors, nurse educators and managers. Physical assessment skills education at universities is part of a policy shift to develop a flexible workforce in the UK. Shared physical assessment practices are less to do with role substitution and more about preparing practitioners with skills that are fit for purpose. Competence, capability and performance with physical assessment skills are an expectation of advanced nursing practice. These skills are used successfully by community advanced nurse practitioners to deliver a wide range of services in response to changing patient need. The introduction of physical assessment skills education to undergraduate professional preparation would create a firm foundation to develop these skills in postgraduate education. Physical assessment education prepares nurses with the clinical competencies to carry out healthcare reforms in the UK. Shared sets of clinical assessment competencies between disciplines have better outcomes for patients. Levels of assessment competence can depend on the professional attributes of individual practitioners. Unsupportive learning cultures can hinder professional development of advanced nursing practice. © 2016 John Wiley & Sons Ltd.

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.

A supply model for nurse workforce projection in Malaysia.

PubMed

Abas, Zuraida Abal; Ramli, Mohamad Raziff; Desa, Mohamad Ishak; Saleh, Nordin; Hanafiah, Ainul Nadziha; Aziz, Nuraini; Abidin, Zaheera Zainal; Shibghatullah, Abdul Samad; Rahman, Ahmad Fadzli Nizam Abdul; Musa, Haslinda

2017-08-18

The paper aims to provide an insight into the significance of having a simulation model to forecast the supply of registered nurses for health workforce planning policy using System Dynamics. A model is highly in demand to predict the workforce demand for nurses in the future, which it supports for complete development of a needs-based nurse workforce projection using Malaysia as a case study. The supply model consists of three sub-models to forecast the number of registered nurses for the next 15 years: training model, population model and Full Time Equivalent (FTE) model. In fact, the training model is for predicting the number of newly registered nurses after training is completed. Furthermore, the population model is for indicating the number of registered nurses in the nation and the FTE model is useful for counting the number of registered nurses with direct patient care. Each model is described in detail with the logical connection and mathematical governing equation for accurate forecasting. The supply model is validated using error analysis approach in terms of the root mean square percent error and the Theil inequality statistics, which is mportant for evaluating the simulation results. Moreover, the output of simulation results provides a useful insight for policy makers as a what-if analysis is conducted. Some recommendations are proposed in order to deal with the nursing deficit. It must be noted that the results from the simulation model will be used for the next stage of the Needs-Based Nurse Workforce projection project. The impact of this study is that it provides the ability for greater planning and policy making with better predictions.

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

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.

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...

Casualisation of the nursing workforce in Australia: driving forces and implications.

PubMed

Creegan, Reta; Duffield, Christine; Forrester, Kim

2003-01-01

This article provides an overview of the extent of casualisation of the nursing workforce in Australia, focusing on the impact for those managing the system. The implications for nurse managers in particular are considerable in an industry where service demand is difficult to control and where individual nurses are thought to be increasingly choosing to work casually. While little is known of the reasons behind nurses exercising their preference for casual work arrangements, some reasons postulated include visa status (overseas trained nurses on holiday/working visas); permanent employees taking on additional shifts to increase their income levels; and those who elect to work under casual contracts for lifestyle reasons. Unknown is the demography of the casual nursing workforce, how these groups are distributed within the workforce, and how many contracts of employment they have across the health service--either through privately managed nursing agencies or hospital managed casual pools. A more detailed knowledge of the forces driving the decisions of this group is essential if health care organisations are to equip themselves to manage this changing workforce and maintain a standard of patient care that is acceptable to the community.

The workforce trends of nurses in Lebanon (2009-2014): A registration database analysis.

PubMed

Alameddine, Mohamad; Chamoun, Nariman; Btaiche, Rachel; El Arnaout, Nour; Richa, Nathalie; Samaha-Nuwayhid, Helen

2017-01-01

Analysis of the nursing registration databases is a highly informative approach that provides accurate and reliable information supporting evidence based decisions relevant to the nursing workforce planning, management and development. This study presents the first systematic analysis of the nursing registration database in Lebanon. It Reports on the workforce distribution and trends using an updated version of the Order of Nurses in Lebanon (ONL) databases. This study presents a secondary data analysis of a de-identified subset of the updated ONL registration database. The workforce participation status of ONL registered nurses was categorized as active and eligible. For active nurses sectors and sub-sectors of employment were defined. Eligible nurses were categorized as unemployed, working outside nursing and working abroad. SPSS was used to conduct descriptive analysis to present workforce trends of Lebanese nurses for year 2009-2014 as frequencies, percentages and percentage changes. Increases in the size of the Active (35%) and Eligible (86%) nurses were observed over the past six years. The majority of nurses fell in the below 35 years age group (60% in 2014). The hospital sector remained the principle employer, with 87% of Lebanese nurses working in hospitals in 2014. A 173% increases was reported for nurses working abroad. Despite the growth of the Active nursing workforce, the skewed distribution of nurses in the below 35 age group and the growth in the Eligible category, especially for nurses living abroad, raise concerns on the longevity of nurses in the profession and the reasons for their attrition from the workforce. There is a need to investigate the push and pull factors that are affecting nurses and the design of policies and interventions that would encourage nurses to remain active in Lebanon. Furthermore, policies and interventions that would create employment opportunities outside hospitals, especially in the Community sector, are recommended.

An evaluation of a public health practitioner registration programme: lessons learned for workforce development.

PubMed

Rahman, Em; Wills, Jane

2014-09-01

This article explores the lessons learned for workforce development from an evaluation of a regional programme to support the assessment and registration of public health practitioners to the UK Public Health Register (UKPHR) in England. A summative and process evaluation of the public health practitioner programme in Wessex was adopted. Data collection was by an online survey of 32 public health practitioners in the Wessex area and semi-structured interviews with 53 practitioners, programme support, employers and system leaders. All survey respondents perceived regulation of the public health workforce as very important or important. Managers and system leaders saw a register of those fit to practise and able to define themselves as a public health practitioner as a necessary assurance of quality for the public. Yet, because registration is voluntary for practitioners, less value was currently placed on this than on completing a master's qualification. The local programme supports practitioners in the compilation of a retrospective portfolio of evidence that demonstrates fitness to practise; practitioners and managers stated that this does not support current and future learning needs or the needs of those working at a senior level. One of the main purposes of statutory regulation of professionals is to protect the public by an assurance of fitness to practise where there is a potential for harm. The widening role for public health practitioners without any regulation means that there is the risk of inappropriate interventions or erroneous advice. Regulators, policy makers and system leaders need to consider how they can support the development of the public health workforce to gain professional recognition at all levels of public health, including practitioners alongside specialists, and support a professional career framework for the public health system. © Royal Society for Public Health 2014.

An Assessment of the Current US Radiation Oncology Workforce: Methodology and Global Results of the American Society for Radiation Oncology 2012 Workforce Study

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

Vichare, Anushree; Washington, Raynard; Patton, Caroline

Purpose: To determine the characteristics, needs, and concerns of the current radiation oncology workforce, evaluate best practices and opportunities for improving quality and safety, and assess what we can predict about the future workforce. Methods and Materials: An online survey was distributed to 35,204 respondents from all segments of the radiation oncology workforce, including radiation oncologists, residents, medical dosimetrists, radiation therapists, medical physicists, nurse practitioners, nurses, physician assistants, and practice managers/administrators. The survey was disseminated by the American Society for Radiation Oncology (ASTRO) together with specialty societies representing other workforce segments. An overview of the methods and global results ismore » presented in this paper. Results: A total of 6765 completed surveys were received, a response rate of 19%, and the final analysis included 5257 respondents. Three-quarters of the radiation oncologists, residents, and physicists who responded were male, in contrast to the other segments in which two-thirds or more were female. The majority of respondents (58%) indicated they were hospital-based, whereas 40% practiced in a free-standing/satellite clinic and 2% in another setting. Among the practices represented in the survey, 21.5% were academic, 25.2% were hospital, and 53.3% were private. A perceived oversupply of professionals relative to demand was reported by the physicist, dosimetrist, and radiation therapist segments. An undersupply was perceived by physician's assistants, nurse practitioners, and nurses. The supply of radiation oncologists and residents was considered balanced. Conclusions: This survey was unique as it attempted to comprehensively assess the radiation oncology workforce by directly surveying each segment. The results suggest there is potential to improve the diversity of the workforce and optimize the supply of the workforce segments. The survey also provides a benchmark

An assessment of the current US radiation oncology workforce: methodology and global results of the American Society for Radiation Oncology 2012 Workforce Study.

PubMed

Vichare, Anushree; Washington, Raynard; Patton, Caroline; Arnone, Anna; Olsen, Christine; Fung, Claire Y; Hopkins, Shane; Pohar, Surjeet

2013-12-01

To determine the characteristics, needs, and concerns of the current radiation oncology workforce, evaluate best practices and opportunities for improving quality and safety, and assess what we can predict about the future workforce. An online survey was distributed to 35,204 respondents from all segments of the radiation oncology workforce, including radiation oncologists, residents, medical dosimetrists, radiation therapists, medical physicists, nurse practitioners, nurses, physician assistants, and practice managers/administrators. The survey was disseminated by the American Society for Radiation Oncology (ASTRO) together with specialty societies representing other workforce segments. An overview of the methods and global results is presented in this paper. A total of 6765 completed surveys were received, a response rate of 19%, and the final analysis included 5257 respondents. Three-quarters of the radiation oncologists, residents, and physicists who responded were male, in contrast to the other segments in which two-thirds or more were female. The majority of respondents (58%) indicated they were hospital-based, whereas 40% practiced in a free-standing/satellite clinic and 2% in another setting. Among the practices represented in the survey, 21.5% were academic, 25.2% were hospital, and 53.3% were private. A perceived oversupply of professionals relative to demand was reported by the physicist, dosimetrist, and radiation therapist segments. An undersupply was perceived by physician's assistants, nurse practitioners, and nurses. The supply of radiation oncologists and residents was considered balanced. This survey was unique as it attempted to comprehensively assess the radiation oncology workforce by directly surveying each segment. The results suggest there is potential to improve the diversity of the workforce and optimize the supply of the workforce segments. The survey also provides a benchmark for future studies, as many changes in the healthcare field

Does State Legislation Improve Nursing Workforce Diversity?

PubMed

Travers, Jasmine; Smaldone, Arlene; Cohn, Elizabeth Gross

2015-08-01

A health-care workforce representative of our nation's diversity is a health and research priority. Although racial and ethnic minorities represent 37% of Americans, they comprise only 16% of the nursing workforce. The purpose of this study was to examine the effect of state legislation on minority recruitment to nursing. Using data from the National Conference of State Legislatures, American Association of Colleges of Nursing, and U.S. census, we compared minority enrollment in baccalaureate nursing programs of states (Texas, Virginia, Michigan, California, Florida, Connecticut, and Arkansas) before and 3 years after enacting legislation with geographically adjacent states without legislation. Data were analyzed using descriptive and chi-square statistics. Following legislation, Arkansas (13.8%-24.5%), California (3.3%-5.4%), and Michigan (8.0%-10.0%) significantly increased enrollment of Blacks, and Florida (11.8%-15.4%) and Texas (11.2%-13.9%) significantly increased enrollment of Hispanic baccalaureate nursing students. States that tied legislation to funding, encouragement, and reimbursement had larger enrollment gains and greater minority representation. © The Author(s) 2015.

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.

Economic evaluation of nurse practitioner and clinical nurse specialist roles: A methodological review.

PubMed

Lopatina, Elena; Donald, Faith; DiCenso, Alba; Martin-Misener, Ruth; Kilpatrick, Kelley; Bryant-Lukosius, Denise; Carter, Nancy; Reid, Kim; Marshall, Deborah A

2017-07-01

Advanced practice nurses (e.g., nurse practitioners and clinical nurse specialists) have been introduced internationally to increase access to high quality care and to tackle increasing health care expenditures. While randomised controlled trials and systematic reviews have demonstrated the effectiveness of nurse practitioner and clinical nurse specialist roles, their cost-effectiveness has been challenged. The poor quality of economic evaluations of these roles to date raises the question of whether current economic evaluation guidelines are adequate when examining their cost-effectiveness. To examine whether current guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles. Our methodological review was informed by a qualitative synthesis of four sources of information: 1) narrative review of literature reviews and discussion papers on economic evaluation of advanced practice nursing roles; 2) quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials; 3) review of guidelines for economic evaluation; and, 4) input from an expert panel. The narrative literature review revealed several challenges in economic evaluations of advanced practice nursing roles (e.g., complexity of the roles, variability in models and practice settings where the roles are implemented, and impact on outcomes that are difficult to measure). The quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials identified methodological limitations of these studies. When we applied the Guidelines for the Economic Evaluation of Health Technologies: Canada to the identified challenges and limitations, discussed those with experts and qualitatively synthesized all findings, we concluded that standard guidelines for economic evaluation are appropriate for economic

Five generations in the nursing workforce: implications for nursing professional development.

PubMed

Bell, Julie A

2013-01-01

Positive patient outcomes require effective teamwork, communication, and technological literacy. These skills vary among the unprecedented five generations in the nursing workforce, spanning the "Silent Generation" nurses deferring retirement to the newest "iGeneration." Nursing professional development educators must understand generational differences; address communication, information technology, and team-building competencies across generations; and promote integration of learner-centered strategies into professional development activities.

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.

Nurse migration and health workforce planning: Ireland as illustrative of international challenges.

PubMed

Humphries, Niamh; Brugha, Ruairi; McGee, Hannah

2012-09-01

Ireland began actively recruiting nurses internationally in 2000. Between 2000 and 2010, 35% of new recruits into the health system were non-EU migrant nurses. Ireland is more heavily reliant upon international nurse recruitment than the UK, New Zealand or Australia. This paper draws on in-depth interviews (N=21) conducted in 2007 with non-EU migrant nurses working in Ireland, a quantitative survey of non-EU migrant nurses (N=337) conducted in 2009 and in-depth interviews conducted with key stakeholders (N=12) in late 2009/early 2010. Available primary and secondary data indicate a fresh challenge for health workforce planning in Ireland as immigration slows and nurses (both non-EU and Irish trained) consider emigration. Successful international nurse recruitment campaigns obviated the need for health workforce planning in the short-term, however the assumption that international nurse recruitment had 'solved' the nursing shortage was short-lived and the current presumption that nurse migration (both emigration and immigration) will always 'work' for Ireland over-plays the reliability of migration as a health workforce planning tool. This article analyses Ireland's experience of international nurse recruitment 2000-2010, providing a case study which is illustrative of health workforce planning challenges faced internationally. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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.

The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on.

PubMed

Halcomb, Elizabeth J; Salamonson, Yenna; Davidson, Patricia M; Kaur, Rajneesh; Young, Samantha Am

2014-03-25

Nursing in Australian general practice has grown rapidly over the last decade in response to government initiatives to strengthen primary care. There are limited data about how this expansion has impacted on the nursing role, scope of practice and workforce characteristics. This study aimed to describe the current demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time. In the nascence of the expansion of the role of nurses in Australian general practice (2003-2004) a national survey was undertaken to describe nurse demographics, clinical roles and competencies. This survey was repeated in 2009-2010 and comparative analysis of the datasets undertaken to explore workforce changes over time. Two hundred eighty four nurses employed in general practice completed the first survey (2003/04) and 235 completed the second survey (2009/10). Significantly more participants in Study 2 were undertaking follow-up of pathology results, physical assessment and disease specific health education. There was also a statistically significant increase in the participants who felt that further education/training would augment their confidence in all clinical tasks (p < 0.001). Whilst the impact of legal implications as a barrier to the nurses' role in general practice decreased between the two time points, more participants perceived lack of space, job descriptions, confidence to negotiate with general practitioners and personal desire to enhance their role as barriers. Access to education and training as a facilitator to nursing role expansion increased between the two studies. The level of optimism of participants for the future of the nurses' role in general practice was slightly decreased over time. This study has identified that some of the structural barriers to nursing in Australian general practice have been addressed over time. However, it also identifies continuing barriers that impact practice nurse

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.

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.

A Phenomenological Study of Nurse Administrators: Leading the Multigenerational Workforce of Registered Nurses

ERIC Educational Resources Information Center

Desir, Johanna E.

2017-01-01

Nurse shortages and nurse turnover are major issues in the health care industry. As 4 generations of nurses are working side-by-side for the first time in history in the health care industry, nurse leaders need to understand the generational differences in order to bridge the gap on retaining the nurses in the workforce. The primary focus of this…

The workforce trends of nurses in Lebanon (2009–2014): A registration database analysis

PubMed Central

Chamoun, Nariman; Btaiche, Rachel; El Arnaout, Nour; Richa, Nathalie; Samaha-Nuwayhid, Helen

2017-01-01

Background Analysis of the nursing registration databases is a highly informative approach that provides accurate and reliable information supporting evidence based decisions relevant to the nursing workforce planning, management and development. This study presents the first systematic analysis of the nursing registration database in Lebanon. It Reports on the workforce distribution and trends using an updated version of the Order of Nurses in Lebanon (ONL) databases. Methods This study presents a secondary data analysis of a de-identified subset of the updated ONL registration database. The workforce participation status of ONL registered nurses was categorized as active and eligible. For active nurses sectors and sub-sectors of employment were defined. Eligible nurses were categorized as unemployed, working outside nursing and working abroad. SPSS was used to conduct descriptive analysis to present workforce trends of Lebanese nurses for year 2009–2014 as frequencies, percentages and percentage changes. Results Increases in the size of the Active (35%) and Eligible (86%) nurses were observed over the past six years. The majority of nurses fell in the below 35 years age group (60% in 2014). The hospital sector remained the principle employer, with 87% of Lebanese nurses working in hospitals in 2014. A 173% increases was reported for nurses working abroad. Discussion Despite the growth of the Active nursing workforce, the skewed distribution of nurses in the below 35 age group and the growth in the Eligible category, especially for nurses living abroad, raise concerns on the longevity of nurses in the profession and the reasons for their attrition from the workforce. Conclusion There is a need to investigate the push and pull factors that are affecting nurses and the design of policies and interventions that would encourage nurses to remain active in Lebanon. Furthermore, policies and interventions that would create employment opportunities outside hospitals

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.

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.

The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on

PubMed Central

2014-01-01

Background Nursing in Australian general practice has grown rapidly over the last decade in response to government initiatives to strengthen primary care. There are limited data about how this expansion has impacted on the nursing role, scope of practice and workforce characteristics. This study aimed to describe the current demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time. Methods In the nascence of the expansion of the role of nurses in Australian general practice (2003–2004) a national survey was undertaken to describe nurse demographics, clinical roles and competencies. This survey was repeated in 2009–2010 and comparative analysis of the datasets undertaken to explore workforce changes over time. Results Two hundred eighty four nurses employed in general practice completed the first survey (2003/04) and 235 completed the second survey (2009/10). Significantly more participants in Study 2 were undertaking follow-up of pathology results, physical assessment and disease specific health education. There was also a statistically significant increase in the participants who felt that further education/training would augment their confidence in all clinical tasks (p < 0.001). Whilst the impact of legal implications as a barrier to the nurses’ role in general practice decreased between the two time points, more participants perceived lack of space, job descriptions, confidence to negotiate with general practitioners and personal desire to enhance their role as barriers. Access to education and training as a facilitator to nursing role expansion increased between the two studies. The level of optimism of participants for the future of the nurses’ role in general practice was slightly decreased over time. Conclusions This study has identified that some of the structural barriers to nursing in Australian general practice have been addressed over time. However, it also

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.

Why older nurses leave the workforce and the implications of them staying.

PubMed

Duffield, Christine; Graham, Elizabeth; Donoghue, Judith; Griffiths, Rhonda; Bichel-Findlay, Jen; Dimitrelis, Sofia

2015-03-01

To identify factors that motivate older nurses to leave the workforce. As many older nurses are now reaching retirement age and will be eligible for government-funded pensions, governments are concerned about the impending financial burden. To prepare for this scenario, many are looking at increasing the age of retirement to 67 or 70 years. Little is known about how this will affect the continuing employment of older nurses and the consequences for employers and the nurses themselves if they remain longer in the workforce. Prospective randomised quantitative survey study. The Mature Age Workers Questionnaire, Job Descriptive Index and Job in General Scale were used to measure job satisfaction, intention to retire and factors encouraging retirement in registered nurses aged 45 years and over (n = 352) in Australia (July-August 2007). There were 319 respondents. The mean age proposed for leaving the workforce was 61·7 years. Key motivators were: financial considerations (40·1%), primarily financial security; nurse health (17·4%) and retirement age of partner (13·3%). Older nurses are leaving the workforce prior to retirement or pension age, primarily for financial, social and health reasons, taking with them significant experience and knowledge. As financial considerations are important in older nurses decisions to continue to work, increasing the age of retirement may retain them. However, consideration will need to be given to ensure that they continue to experience job satisfaction and are physically and mentally able to undertake demanding work. Increasing retirement age may retain older nurses in the workforce, however, the impact on the health of older nurses is not known, nor is the impact for employers of older nurses continuing to work known. Employers must facilitate workplace changes to accommodate older nurses. © 2014 John Wiley & Sons Ltd.

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.

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.

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

General practitioners' experiences as nursing home medical consultants.

PubMed

Kirsebom, Marie; Hedström, Mariann; Pöder, Ulrika; Wadensten, Barbro

2017-03-01

To describe general practitioners' experiences of being the principal physician responsible for a nursing home. Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation. Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety. The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems. © 2016 Nordic College of Caring Science.

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.

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.

A transition program to primary health care for new graduate nurses: a strategy towards building a sustainable primary health care nurse workforce?

PubMed

Gordon, Christopher J; Aggar, Christina; Williams, Anna M; Walker, Lynne; Willcock, Simon M; Bloomfield, Jacqueline

2014-01-01

This debate discusses the potential merits of a New Graduate Nurse Transition to Primary Health Care Program as an untested but potential nursing workforce development and sustainability strategy. Increasingly in Australia, health policy is focusing on the role of general practice and multidisciplinary teams in meeting the service needs of ageing populations in the community. Primary health care nurses who work in general practice are integral members of the multidisciplinary team - but this workforce is ageing and predicted to face increasing shortages in the future. At the same time, Australia is currently experiencing a surplus of and a corresponding lack of employment opportunities for new graduate nurses. This situation is likely to compound workforce shortages in the future. A national nursing workforce plan that addresses supply and demand issues of primary health care nurses is required. Innovative solutions are required to support and retain the current primary health care nursing workforce, whilst building a skilled and sustainable workforce for the future. This debate article discusses the primary health care nursing workforce dilemma currently facing policy makers in Australia and presents an argument for the potential value of a New Graduate Transition to Primary Health Care Program as a workforce development and sustainability strategy. An exploration of factors that may contribute or hinder transition program for new graduates in primary health care implementation is considered. A graduate transition program to primary health care may play an important role in addressing primary health care workforce shortages in the future. There are, however, a number of factors that need to be simultaneously addressed if a skilled and sustainable workforce for the future is to be realised. The development of a transition program to primary health care should be based on a number of core principles and be subjected to both a summative and cost

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.

Addressing the primary care workforce: a study of nurse practitioner students' plans after graduation.

PubMed

Budd, Geraldine M; Wolf, Andrea; Haas, Richard Eric

2015-03-01

Primary care is a growing area, and nurse practitioners (NPs) hold promise for meeting the need for additional providers. This article reports on the future plans of more than 300 primary care NP students in family, adult, and adult gerontology programs. The sample was obtained through NP faculty, and data were collected via an online survey. Results indicated that although these students chose primary care, only 48% anticipated working in primary care; 26% planned to practice in rural areas, and 16% planned to work in an inner city. Reasons cited as important for pursuing a primary care position included the long-term patient relationship, faculty and preceptor mentors from the NP program, and clinical experiences as a student. Implications include providing more intensive faculty mentoring to increase the number of individuals seeking primary care positions after graduation and help with future career planning to meet personal career and nursing profession needs. Copyright 2015, SLACK Incorporated.

Exploring the role of advanced nurse practitioners in leadership.

PubMed

Anderson, Claire

2018-05-02

There have been several changes to healthcare services in the UK over recent years, with rising NHS costs and increasing demands on healthcare professionals to deliver high-quality care. Simultaneously, public inquiries have identified suboptimal leadership throughout the NHS, which has been linked to a lack of clear leadership across the healthcare professions. In nursing, the role of the advanced nurse practitioner is regarded as a solution to this leadership challenge. This article examines the background to the development of the advanced nurse practitioner role. It also explores the various factors that may affect nurse leadership and the role of the advanced nurse practitioner, including professional identity, gender, nursing's strategic influence, clinical outcomes, and recruitment and retention. The article concludes that while advanced nurse practitioners can positively influence clinical outcomes and cost efficiency, they must also be adequately prepared to undertake a leadership role. © 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.

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.

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…

A Nursing Workforce Diversity Project: Strategies for Recruitment, Retention, Graduation, and NCLEX-RN Success.

PubMed

Murray, Ted A; Pole, David C; Ciarlo, Erica M; Holmes, Shearon

2016-01-01

The purpose of this article is to describe a collaborative project designed to recruit and retain students from underrepresented minorities and disadvantaged backgrounds into nursing education. Ethnic minorities remain underrepresented in the nursing workforce in comparison to the general population. The numbers of minorities enrolled in nursing education programs are insufficient to meet the health care workforce diversity needs of the future. High school students were provided with a preprofessional education program to prepare them for admission into a nursing program. Retention strategies were implemented for newly admitted and enrolled nursing education students. Twenty-one high school students enrolled in a nursing education program. The students enrolled in the nursing education program graduated and passed the licensure examination. Early recruitment and multiprong retention programs can be successful in diversifying the registered nurse workforce.

A comparison of job descriptions for nurse practitioners working in out-of-hours primary care services: implications for workforce planning, patients and nursing.

PubMed

Teare, Jean; Horne, Maria; Clements, Gill; Mohammed, Mohammed A

2017-03-01

To compare and contrast job descriptions for nursing roles in out-of-hours services to obtain a general understanding of what is required for a nurse working in this job. Out-of-hours services provide nursing services to patients either through telephone or face-to-face contact in care centres. Many of these services are newly created giving job opportunities to nurses working in this area. It is vital that nurses know what their role entails but also that patients and other professionals know how out-of-hours nurses function in terms of competence and clinical role. Content analysis of out-of-hours job descriptions. Content analysis of a convenience sample of 16 job descriptions of out-of-hours nurses from five out-of-hours care providers across England was undertaken. The findings were narratively synthesised, supported by tabulation. Key role descriptors were examined in terms of job titles, managerial skills, clinical skills, professional qualifications and previous experience. Content analysis of each out-of-hours job description revealed a lack of consensus in clinical competence and skills required related to job title although there were many similarities in skills across all the roles. This study highlights key differences and some similarities between roles and job titles in out-of-hours nursing but requires a larger study to inform workforce planning. Out-of-hours nursing is a developing area of practice which requires clarity to ensure patient safety and quality care. © 2016 John Wiley & Sons Ltd.

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

Racial and ethnic diversity of the U.S. national nurse workforce 1988-2013.

PubMed

Xue, Ying; Brewer, Carol

2014-01-01

The objective of this article is to examine the racial and ethnic diversity profile of the nurse workforce over time and by geographic region. We conducted survey analysis using the National Sample Survey of Registered Nurses from 1988 to 2008, and further supplemented our trend analysis using published findings from the 2013 National Workforce Survey of Registered Nurses. The gap in racial/ethnic minority representation between the RN workforce and the population has been persistent and has widened over time. This diversity gap is primarily due to underrepresentation of Hispanics and Blacks in the RN workforce, which varied across states and regions, with the largest gaps occurring for Hispanics in the South and West and for Blacks in the South. Greater levels of sustained and targeted support to increase nurse workforce diversity are needed and should be geared not only to specific underrepresented groups but also to the regions and states with the greatest needs. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Vacant hospitals and under-employed nurses: a qualitative study of the nursing workforce management situation in Nepal.

PubMed

Adhikari, Radha

2015-04-01

It is vital for all healthcare systems to have a sufficient number of suitably trained health professionals including nurses at all levels of health services to deliver effective healthcare. An ethnographic, qualitative method was chosen for this study, which included open-ended, in-depth interviews with a range of stakeholders including student nurses, qualified nurses, nurse managers and lecturers, and the human resource co-ordinator in the Ministry of Health and Population. Available records and policy documents were also analysed. Study findings suggest that there is a severe mal-distribution of the nursing workforce in rural and urban healthcare centres in Nepal. Although there is an oversupply of newly qualified nurses in hospitals in Kathmandu, the staffing situation outside the valley is undesirable. Additionally, the turnover of junior nursing staff remains high in major urban hospitals. Most qualified nurses aspire to work in developed countries, such as the UK, North America, Australia and New Zealand. Between 2000 and 2008, as many as 3000 nurses have left Nepal for jobs in the developed west. There is no effective management strategy in place to retain a nursing workforce, particularly in rural Nepal. This article concludes by proposing some suggestions for a nursing workforce retention policy to address this critical issue. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

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

Strategic Workforce Planning for Health Human Resources: A Nursing Case Analysis.

PubMed

Baumann, Andrea; Crea-Arsenio, Mary; Akhtar-Danesh, Noori; Fleming-Carroll, Bonnie; Hunsberger, Mabel; Keatings, Margaret; Elfassy, Michael David; Kratina, Sarah

2016-01-01

Background Health-care organizations provide services in a challenging environment, making the introduction of health human resources initiatives especially critical for safe patient care. Purpose To demonstrate how one specialty hospital in Ontario, Canada, leveraged an employment policy to stabilize its nursing workforce over a six-year period (2007 to 2012). Methods An observational cross-sectional study was conducted in which administrative data were analyzed to compare full-time status and retention of new nurses prepolicy and during the policy. The Professionalism and Environmental Factors in the Workplace Questionnaire® was used to compare new nurses hired into the study hospital with new nurses hired in other health-care settings. Results There was a significant increase in full-time employment and a decrease in part-time employment in the study hospital nursing workforce. On average, 26% of prepolicy new hires left the study hospital within one year of employment compared to 5% of new hires during policy implementation. The hospital nurses scored significantly higher than nurses employed in other health-care settings on 5 out of 13 subscales of professionalism. Conclusions Decision makers can use these findings to develop comprehensive health human resources guidelines and mechanisms that support strategic workforce planning to sustain and strengthen the health-care system.

Cultivating the Role of Nurse Practitioners in Providing Primary Care to Vulnerable Populations in an Era of Health-Care Reform.

PubMed

Xue, Ying; Intrator, Orna

2016-02-01

The evolving role of nurse practitioners (NPs) as primary care providers, especially for vulnerable populations, is central to the debate regarding strategies to address the growing need for primary care services. The current article provides policy recommendations for leveraging and expanding the historic role of NPs in caring for vulnerable populations, by focusing on three key policy levers: NP scope-of-practice regulation, distribution of the NP workforce, and NP education. These policy levers must go hand in hand to build a sufficient and equitably distributed NP workforce, to help meet the escalating need for primary care in an era of health-care reform. © The Author(s) 2016.

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...

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.

Will the NP workforce grow in the future? New forecasts and implications for healthcare delivery.

PubMed

Auerbach, David I

2012-07-01

The nurse practitioner (NP) workforce has been a focus of considerable policy interest recently, particularly as the Patient Protection and Affordable Care Act may place additional demands on the healthcare professional workforce. The NP workforce has been growing rapidly in recent years, but fluctuation in enrollments in the past decades has resulted in a wide range of forecasts. To forecast the future NP workforce using a novel method that has been applied to the registered nurse and physician workforces and is robust to fluctuating enrollment trends. An age-cohort regression-based model was applied to the current and historical workforce, which was then forecasted to future years assuming stable age effects and a continuation of recent cohort trends. A total of 6798 NPs who were identified as having completed NP training in the National Sample Survey of Registered Nurses between 1992 and 2008. The future workforce is projected to grow to 244,000 in 2025, an increase of 94% from 128,000 in 2008. If NPs are defined more restrictively as those who self-identify their position title as "NP," supply is projected to grow from 86,000 to 198,000 (130%) over this period. The large projected increase in NP supply is higher and more grounded than other forecasts and has several implications: NPs will likely fulfill a substantial amount of future demand for care. Furthermore, as the ratio of NPs to Nurse Practitioners to physicians will surely grow, there could be implications for quality of care and for the configuration of future care delivery systems.

Casualisation of the teaching workforce: implications for nursing education.

PubMed

Halcomb, Elizabeth J; Andrew, Sharon; Peters, Kath; Salamonson, Yenna; Jackson, Debra

2010-08-01

Internationally, nursing faculty shortages have been reported and there is a potential for them to worsen into the next decade as existing faculty age. To, in part, address this issue, across disciplines there is clearly an international trend towards the increasing casualisation of the higher education workforce. Despite the potential impact of this two-tiered workforce structure, there has been limited examination of the discipline specific issues related to the employment of a growing number of sessional nursing staff. This paper provides a critical review of the literature related to the employment of sessional teachers in higher education. The paper advances the discourse around the role and implications of employing sessional teachers in undergraduate nursing schools. Recommendations for supporting sessional staff and further research are presented. Copyright 2009 Elsevier Ltd. All rights reserved.

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...

Nurse workforce characteristics and infection risk in VA Community Living Centers: a longitudinal analysis.

PubMed

Uchida-Nakakoji, Mayuko; Stone, Patricia W; Schmitt, Susan K; Phibbs, Ciaran S

2015-03-01

To examine effects of workforce characteristics on resident infections in Veterans Affairs (VA) Community Living Centers (CLCs). A 6-year panel of monthly, unit-specific data included workforce characteristics (from the VA Decision Support System and Payroll data) and characteristics of residents and outcome measures (from the Minimum Data Set). A resident infection composite was the dependent variable. Workforce characteristics of registered nurses (RN), licensed practical nurses (LPN), nurse aides (NA), and contract nurses included: staffing levels, skill mix, and tenure. Descriptive statistics and unit-level fixed effects regressions were conducted. Robustness checks varying workforce and outcome parameters were examined. Average nursing hours per resident day was 4.59 hours (SD=1.21). RN tenure averaged 4.7 years (SD=1.64) and 4.2 years for both LPN (SD=1.84) and NA (SD=1.72). In multivariate analyses RN and LPN tenure were associated with decreased infections by 3.8% (incident rate ratio [IRR]=0.962, P<0.01) and 2% (IRR=0.98, P<0.01) respectively. Robustness checks consistently found RN and LPN tenure to be associated with decreased infections. Increasing RN and LPN tenure are likely to reduce CLC resident infections. Administrators and policymakers need to focus on recruiting and retaining a skilled nursing workforce.

Internationally educated nurses in Canada: predictors of workforce integration.

PubMed

Covell, Christine L; Primeau, Marie-Douce; Kilpatrick, Kelley; St-Pierre, Isabelle

2017-04-04

Global trends in migration accompanied with recent changes to the immigrant selection process may have influenced the demographic and human capital characteristics of internationally educated nurses (IENs) in Canada and in turn the assistance required to facilitate their workforce integration. This study aimed to describe the demographic and human capital profile of IENs in Canada, to explore recent changes to the profile, and to identify predictors of IENs' workforce integration. A cross-sectional, descriptive, correlational survey design was used. Eligible IENs were immigrants, registered and employed as regulated nurses in Canada. Data were collected in 2014 via online and paper questionnaires. Descriptive statistics were used to examine the data by year of immigration. Logistic regression modeling was employed to identify predictors of IENs' workforce integration measured as passing the licensure exam to acquire professional recertification and securing employment. The sample consisted of 2280 IENs, representative of all Canadian provincial jurisdictions. Since changes to the immigrant selection process in 2002, the IEN population in Canada has become more racially diverse with greater numbers emigrating from developing countries. Recent arrivals (after 2002) had high levels of human capital (knowledge, professional experience, language proficiency). Some, but not all, benefited from the formal and informal assistance available to facilitate their workforce integration. Professional experience and help studying significantly predicted if IENs passed the licensure exam on their first attempt. Bridging program participation and assistance from social networks in Canada were significant predictors if IENs had difficulty securing employment. Nurses will continue to migrate from a wide variety of countries throughout the world that have dissimilar nursing education and health systems. Thus, IENs are not a homogenous group, and a "one size fits all" model may not be

District nursing workforce planning: a review of the methods.

PubMed

Reid, Bernie; Kane, Kay; Curran, Carol

2008-11-01

District nursing services in Northern Ireland face increasing demands and challenges which may be responded to by effective and efficient workforce planning and development. The aim of this paper is to critically analyse district nursing workforce planning and development methods, in an attempt to find a suitable method for Northern Ireland. A systematic analysis of the literature reveals four methods: professional judgement; population-based health needs; caseload analysis and dependency-acuity. Each method has strengths and weaknesses. Professional judgement offers a 'belt and braces' approach but lacks sensitivity to fluctuating patient numbers. Population-based health needs methods develop staffing algorithms that reflect deprivation and geographical spread, but are poorly understood by district nurses. Caseload analysis promotes equitable workloads but poorly performing district nursing localities may continue if benchmarking processes only consider local data. Dependency-acuity methods provide a means of equalizing and prioritizing workload but are prone to district nurses overstating factors in patient dependency or understating carers' capability. In summary a mixed method approach is advocated to evaluate and adjust the size and mix of district nursing teams using empirically determined patient dependency and activity-based variables based on the population's health needs.

The public sector nursing workforce in Kenya: a county-level analysis

PubMed Central

2014-01-01

Background Kenya’s human resources for health shortage is well documented, yet in line with the new constitution, responsibility for health service delivery will be devolved to 47 new county administrations. This work describes the public sector nursing workforce likely to be inherited by the counties, and examines the relationships between nursing workforce density and key indicators. Methods National nursing deployment data linked to nursing supply data were used and analyzed using statistical and geographical analysis software. Data on nurses deployed in national referral hospitals and on nurses deployed in non-public sector facilities were excluded from main analyses. The densities and characteristics of the public sector nurses across the counties were obtained and examined against an index of county remoteness, and the nursing densities were correlated with five key indicators. Results Of the 16,371 nurses in the public non-tertiary sector, 76% are women and 53% are registered nurses, with 35% of the nurses aged 40 to 49 years. The nursing densities across counties range from 1.2 to 0.08 per 1,000 population. There are statistically significant associations of the nursing densities with a measure of health spending per capita (P value = 0.0028) and immunization rates (P value = 0.0018). A higher county remoteness index is associated with explaining lower female to male ratio of public sector nurses across counties (P value <0.0001). Conclusions An overall shortage of nurses (range of 1.2 to 0.08 per 1,000) in the public sector countrywide is complicated by mal-distribution and varying workforce characteristics (for example, age profile) across counties. All stakeholders should support improvements in human resources information systems and help address personnel shortages and mal-distribution if equitable, quality health-care delivery in the counties is to be achieved. PMID:24467776

The public sector nursing workforce in Kenya: a county-level analysis.

PubMed

Wakaba, Mabel; Mbindyo, Patrick; Ochieng, Jacob; Kiriinya, Rose; Todd, Jim; Waudo, Agnes; Noor, Abdisalan; Rakuom, Chris; Rogers, Martha; English, Mike

2014-01-27

Kenya's human resources for health shortage is well documented, yet in line with the new constitution, responsibility for health service delivery will be devolved to 47 new county administrations. This work describes the public sector nursing workforce likely to be inherited by the counties, and examines the relationships between nursing workforce density and key indicators. National nursing deployment data linked to nursing supply data were used and analyzed using statistical and geographical analysis software. Data on nurses deployed in national referral hospitals and on nurses deployed in non-public sector facilities were excluded from main analyses. The densities and characteristics of the public sector nurses across the counties were obtained and examined against an index of county remoteness, and the nursing densities were correlated with five key indicators. Of the 16,371 nurses in the public non-tertiary sector, 76% are women and 53% are registered nurses, with 35% of the nurses aged 40 to 49 years. The nursing densities across counties range from 1.2 to 0.08 per 1,000 population. There are statistically significant associations of the nursing densities with a measure of health spending per capita (P value = 0.0028) and immunization rates (P value = 0.0018). A higher county remoteness index is associated with explaining lower female to male ratio of public sector nurses across counties (P value <0.0001). An overall shortage of nurses (range of 1.2 to 0.08 per 1,000) in the public sector countrywide is complicated by mal-distribution and varying workforce characteristics (for example, age profile) across counties. All stakeholders should support improvements in human resources information systems and help address personnel shortages and mal-distribution if equitable, quality health-care delivery in the counties is to be achieved.

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

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.

Nursing workforce policy and the economic crisis: a global overview.

PubMed

Buchan, James; O'May, Fiona; Dussault, Gilles

2013-09-01

To assess the impact of the global financial crisis on the nursing workforce and identify appropriate policy responses. This article draws from international data sources (Organisation for Economic Co-operation and Development [OECD] and World Health Organization), from national data sources (nursing regulatory authorities), and the literature to provide a context in which to examine trends in labor market and health spending indicators, nurse employment, and nurse migration patterns. A variable impact of the crisis at the country level was shown by different changes in unemployment rates and funding of the health sector. Some evidence was obtained of reductions in nurse staffing in a small number of countries. A significant and variable change in the patterns of nurse migration also was observed. The crisis has had a variable impact; nursing shortages are likely to reappear in some OECD countries. Policy responses will have to take account of the changed economic reality in many countries. This article highlights key trends and issues for the global nursing workforce; it then identifies policy interventions appropriate to the new economic realities in many OECD countries. © 2013 Sigma Theta Tau International.

Dental practitioner rural work movements: a systematic review.

PubMed

Godwin, Diana M; Hoang, Ha; Crocombe, Leonard A; Bell, Erica

2014-01-01

There is a globally observed unequal distribution of dental and other health practitioners between urban and rural areas in OECD countries. Dental practitioners provide important primary healthcare services to rural populations. Workforce shortages and stability issues in underserved areas can have negative effects on rural communities. Strategies used to fix the dental practitioner workforce maldistribution need to be investigated. The study had primary focus on Australia and included relevant international literature. Databases used were PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Informit, Web of Science, Scopus and Summon. Search terms included dental practitioner, rural, remote, retention, recruitment and strategies. Sixteen articles met the inclusion criteria. The articles described a total of eight different positive factors and 12 negative factors towards rural practice. The positive factors related to the nature of the type of clinical work being a 'challenge', close social and professional support networks, enjoyment of rural lifestyle and successful integration into the rural community. The negative factors mentioned included social and professional isolation, workload and type of clinical work, access to further education opportunities, access to facilities, education for children and job opportunities for a partner, and inability to integrate into the rural community. The articles that analysed recruitment incentives described three strategies currently used to influence recruitment, all of which were financial or contractual in nature. Articles mentioning retention factors described seven long-term retention motivators; of these, six of them were personal reasons. The most commonly mentioned motivational factor for recruitment and retention of the rural dental practitioner workforce was the effect of prior rural exposure for dental practitioners. The results of this review indicate that the most important influences on

Nurse Workforce Characteristics and Infection Risk in VA Community Living Centers: A Longitudinal Analysis

PubMed Central

Uchida-Nakakoji, Mayuko; Stone, Patricia W.; Schmitt, Susan K.; Phibbs, Ciaran S.

2015-01-01

Objective To examine effects of workforce characteristics on resident infections in Veterans Affairs (VA) Community Living Centers (CLCs). Data Sources A six-year panel of monthly, unit-specific data included workforce characteristics (from the VA Decision Support System and Payroll data) and characteristics of residents and outcome measures (from the Minimum Data Set). Study Design A resident infection composite was the dependent variable. Workforce characteristics of registered nurses (RN), licensed practical nurses (LPN), nurse aides (NA), and contract nurses included: staffing levels, skill mix and tenure. Descriptive statistics and unit-level fixed effects regressions were conducted. Robustness checks varying workforce and outcome parameters were examined. Principal Findings Average nursing hours per resident day was 4.59 hours (sd = 1.21). RN tenure averaged 4.7 years (sd = 1.64) and 4.2 years for both LPN (sd= 1.84) and NA (sd= 1.72). In multivariate analyses RN and LPN tenure were associated with decreased infections by 3.8% (IRR= 0.962 p<0.01) and 2% (IRR=0.98 p<0.01) respectively. Robustness checks consistently found RN and LPN tenure to be associated with decreased infections. Conclusions Increasing RN and LPN tenure are likely to reduce CLC resident infections. Administrators and policymakers need to focus on recruiting and retaining a skilled nursing workforce. PMID:25634087

Evaluating the Outcomes of Advanced Neonatal Nurse Practitioner Programmes.

ERIC Educational Resources Information Center

Redshaw, Margaret; Hart, Bev; Harvey, Merryl; Harris, Anne

The outcomes of advanced neonatal nurse practitioner (ANNP) programs in the United Kingdom were examined. The different programs of education currently available for nurses wishing to become ANNPs were compared, and the outcomes of ANNP programs, as demonstrated in the levels of performance of practitioners undertaking different programs, were…

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.

Diffusion of a nursing education innovation: nursing workforce development through promotion of RN/BSN education.

PubMed

Diaz Swearingen, Connie; Clarke, Pamela N; Gatua, Mary Wairimu; Sumner, Christa Cooper

2013-01-01

Despite state, national, and organizational objectives to increase the proportion of nurses with a bachelor's degree or higher, a majority of nurses hold an associate's degree in nursing. To address the need for a better-prepared nursing workforce in this rural state, an RN/BSN recruitment and retention project was implemented. The authors discuss the Leadership Education to Advance Practice project and its outcomes.

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

Returning nurses to the workforce: developing a fast track back program.

PubMed

Burns, Helen K; Sakraida, Teresa J; Englert, Nadine C; Hoffmann, Rosemary L; Tuite, Patricia; Foley, Susan M

2006-01-01

Fast Track Back: Re-entry into Nursing Practice program. Describes the development, implementation, and evaluation of a state-of-the-art re-entry program facilitating the return of licensed nonpracticing RNs to the workforce through a quality education program that retools them for the workforce in the areas of pharmacology, skill development using the latest technology, practice standards, and nursing issues. The program consists of didactic content taught via classroom, Internet, skills laboratory, and high fidelity human simulated technology and a clinical component. The program is a mechanism that enables re-entry nurses to improve skills and competencies necessary to practice in today's healthcare environment.

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.

Exploring the Links Between Macro-Level Contextual Factors and Their Influence on Nursing Workforce Composition

PubMed Central

Squires, Allison; Beltrán-Sánchez, Hiram

2012-01-01

Research that links macro-level socioeconomic development variables to healthcare human resources workforce composition is scarce at best. The purpose of this study was to explore the links between non-nursing factors and nursing workforce composition through a secondary, descriptive analysis of year 2000, publicly available national nursing human resources data from Mexico. Building on previous research, the authors conducted multiple robust regression analysis by federal typing of nursing human resources from 31 Mexican states against macro-level socioeconomic development variables. Average education in a state was significantly associated in predicting all types of formally educated nurses in Mexico. Other results suggest that macro level indicators have a different association with each type of nurse. Context may play a greater role in determining nursing workforce composition than previously thought. Further studies may help to explain differences both within and between countries. PMID:22513839

The Maternity Care Nurse Workforce in Rural U.S. Hospitals.

PubMed

Henning-Smith, Carrie; Almanza, Jennifer; Kozhimannil, Katy B

To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce. Cross-sectional survey study. Maternity care units within rural hospitals in nine U.S. states. Maternity care unit managers. We calculated descriptive statistics to characterize the rural maternity care nursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals. Of the 263 hospitals, 51% were low volume (<300 annual births) and 49% were high volume (≥300 annual births). Among low-volume hospitals, 78% used a shared nurse staff model. In contrast, 31% of high-volume hospitals used a shared nurse staff model. Respondents praised the teamwork, dedication, and skill of their maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses. Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Building leadership capacity in advanced nurse practitioners - the role of organisational management.

PubMed

Elliott, Naomi

2017-01-01

To highlight the organisation-level management's role in building leadership capacity in advanced nurse practitioners and the need for appropriate supports to increase their becoming leaders. Little is published about the role of organisation-level management in building leadership capacity and in developing the next generation of nurse leaders. In times of economic constraint, organisations need to focus their efforts on targeted leadership initiatives. Advanced nurse practitioners are ideally positioned to act as leaders both within and beyond the health care organisation. From the available research evidence, several support structures and mechanisms are identified as enablers for advanced nurse practitioners to enact their leadership role. Health care organisations need to include building leadership capacity as a priority in their strategic plan and take action to build-up the level of advanced nurse practitioner leadership. Nurse executives have a vital role in influencing the organisation's strategic plan and making a business case for prioritising leadership capacity building within advanced nurse practitioners. A challenge for nurse executives faced with competing service and leadership development demands, involves strategic decision-making regarding whether the advanced nurse practitioner's role is limited to service delivery or its potential in leading health care reforms is realised. © 2016 John Wiley & Sons Ltd.

A flexible nursing workforce: realities and fallouts.

PubMed

Grinspun, Doris

2002-01-01

While policy-makers are increasingly concerned about a looming nursing shortage, almost half of Canada's nursing workforce is currently employed on a part-time or casual basis. Why are so many nurses not working full-time and providing the nursing care that would help to alleviate such shortages in our healthcare organizations? Do nurses want to work part-time, or are they driven into this by labour market forces, life demands, poor working conditions and policy decisions external to them? The answers to these questions are critical to ensure that care will be there for all of us. This article presents a brief analysis of flexible employment arrangements in nursing, particularly part-time and casual work, and the impact on nurses, patients and the healthcare system as a whole. Given the sharp increases in these work arrangements in Canada during the last decade, the limited discussion of these trends in the literature is both surprising and troublesome.

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.

A nursing career lattice pilot program to promote racial/ethnic diversity in the nursing workforce.

PubMed

Sporing, Eileen; Avalon, Earlene; Brostoff, Marcie

2012-03-01

The nursing career lattice program (NCLP) at Children's Hospital Boston has provided employees with social, educational, and financial assistance as they begin or advance their nursing careers. At the conclusion of a pilot phase, 35% of employees in the NCLP were enrolled in nursing school and 15% completed nursing school. The NCLP exemplifies how a workforce diversity initiative can lead to outcomes that support and sustain a culture rich in diversity and perpetuate excellence in nursing in one organization.

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.

Exploring the links between macro-level contextual factors and their influence on nursing workforce composition.

PubMed

Squires, Allison; Beltrán-Sánchez, Hiram

2011-11-01

Research that links macro-level socioeconomic development variables to health care human resources workforce composition is scarce at best. The purpose of this study was to explore the links between nonnursing factors and nursing workforce composition through a secondary, descriptive analysis of year 2000, publicly available national nursing human resources data from Mexico. Building on previous research, the authors conducted multiple robust regression analysis by federal typing of nursing human resources from 31 Mexican states against macro-level socioeconomic development variables. Average education in a state was significantly associated in predicting all types of formally educated nurses in Mexico. Other results suggest that macro-level indicators have a different association with each type of nurse. Context may play a greater role in determining nursing workforce composition than previously thought. Further studies may help to explain differences both within and between countries.

2015 American College of Rheumatology Workforce Study: Supply and Demand Projections of Adult Rheumatology Workforce, 2015-2030.

PubMed

Battafarano, Daniel F; Ditmyer, Marcia; Bolster, Marcy B; Fitzgerald, John D; Deal, Chad; Bass, Ann R; Molina, Rodolfo; Erickson, Alan R; Hausmann, Jonathan S; Klein-Gitelman, Marisa; Imundo, Lisa F; Smith, Benjamin J; Jones, Karla; Greene, Kamilah; Monrad, Seetha U

2018-04-01

To describe the character and composition of the 2015 US adult rheumatology workforce, evaluate workforce trends, and project supply and demand for clinical rheumatology care for 2015-2030. The 2015 Workforce Study of Rheumatology Specialists in the US used primary and secondary data sources to estimate the baseline adult rheumatology workforce and determine demographic and geographic factors relevant to workforce modeling. Supply and demand was projected through 2030, utilizing data-driven estimations regarding the proportion and clinical full-time equivalent (FTE) of academic versus nonacademic practitioners. The 2015 adult workforce (physicians, nurse practitioners, and physician assistants) was estimated to be 6,013 providers (5,415 clinical FTE). At baseline, the estimated demand exceeded the supply of clinical FTE by 700 (12.9%). By 2030, the supply of rheumatology clinical providers is projected to fall to 4,882 providers, or 4,051 clinical FTE (a 25.2% decrease in supply from 2015 baseline levels). Demand in 2030 is projected to exceed supply by 4,133 clinical FTE (102%). The adult rheumatology workforce projections reflect a major demographic and geographic shift that will significantly impact the supply of the future workforce by 2030. These shifts include baby-boomer retirements, a millennial predominance, and an increase of female and part-time providers, in parallel with an increased demand for adult rheumatology care due to the growing and aging US population. Regional and innovative strategies will be necessary to manage access to care and reduce barriers to care for rheumatology patients. © 2018, American College of Rheumatology.

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.

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.

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.

Flexible working and the contribution of nurses in mid-life to the workforce: a qualitative study.

PubMed

Harris, Ruth; Bennett, Janette; Davey, Barbara; Ross, Fiona

2010-04-01

With the changing demographic profile of the nursing workforce, retaining the skill and experience of nurses in mid-life is very important. Work-life balance is a concept that is gaining increasing prominence in today's society. However, little is known about older nurses' experience of family friendly policies and flexible working. This study explored the organisational, professional and personal factors that influence perceptions of commitment and participation in the workforce for nurses working in mid-life (aged 45 and over). A qualitative study using a range of methods including biographical methods, semi-structured face-to-face interviews, focus groups and telephone interviews. Data were analysed using constant comparative method. A large inner city acute teaching hospital and an inner city mental health and social care trust providing both community and inpatient health and social care. 34 nurses and 3 health care assistants participated in individual interviews, 10 nurses participated in two focus groups and 17 managers participated in individual telephone interviews. Four themes emerged: the nature of nursing poses a challenge to the implementation of flexible working, differences in perceptions of the availability of flexible working, ward managers have a crucial role in the implementation of flexible working policies and the implementation of flexible working may be creating an inflexible workforce. The findings suggest that there are limits to the implementation of flexible working for nurses. In some areas there is evidence that the implementation of flexible working may be producing an inflexible workforce as older nurses are required to compensate for the flexible working patterns of their colleagues. Ward managers have a key role in the implementation of family friendly policies and require support to fulfil this role. There is a need for creative solutions to address implementation of flexible working for all nurses to ensure that workforce policy

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

Globalisation, localisation and implications of a transforming nursing workforce in New Zealand: opportunities and challenges.

PubMed

Callister, Paul; Badkar, Juthika; Didham, Robert

2011-09-01

Severe staff and skill shortages within the health systems of developed countries have contributed to increased migration by health professionals. New Zealand stands out among countries in the Organisation for Economic Co-operation and Development in terms of the high level of movements in and out of the country of skilled professionals, including nurses. In New Zealand, much attention has been given to increasing the number of Māori and Pacific nurses as one mechanism for improving Māori and Pacific health. Against a backdrop of the changing characteristics of the New Zealand nursing workforce, this study demonstrates that the globalisation of the nursing workforce is increasing at a faster rate than its localisation (as measured by the growth of the Māori and New Zealand-born Pacific workforces in New Zealand). This challenges the implementation of culturally appropriate nursing programmes based on the matching of nurse and client ethnicities. © 2011 Blackwell Publishing Ltd.

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

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…

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 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.

Nurse practitioner organizational climate in primary care settings: implications for professional practice.

PubMed

Poghosyan, Lusine; Nannini, Angela; Stone, Patricia W; Smaldone, Arlene

2013-01-01

The expansion of the nurse practitioner (NP) workforce in primary care is key to meeting the increased demand for care. Organizational climates in primary care settings affect NP professional practice and the quality of care. This study investigated organizational climate and its domains affecting NP professional practice in primary care settings. A qualitative descriptive design, with purposive sampling, was used to recruit 16 NPs practicing in primary care settings in Massachusetts. An interview guide was developed and pretested with two NPs and in 1 group interview with 7 NPs. Data collection took place in spring of 2011. Individual interviews lasted from 30-70 minutes, were audio recorded, and transcribed. Data were analyzed using Atlas.ti 6.0 software by 3 researchers. Content analysis was applied. Three previously identified themes, NP-physician relations, independent practice and autonomy, and professional visibility, as well as two new themes, organizational support and resources and NP-administration relations emerged from the analyses. NPs reported collegial relations with physicians, challenges in establishing independent practice, suboptimal relationships with administration, and lack of support. NP contributions to patient care were invisible. Favorable organizational climates should be promoted to support the expanding of NP workforce in primary care and to optimize recruitment and retention efforts. © 2013.

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.

Continuing challenges for the mental health consumer workforce: a role for mental health nurses?

PubMed

Cleary, Michelle; Horsfall, Jan; Hunt, Glenn E; Escott, Phil; Happell, Brenda

2011-12-01

The aim of this paper is to discuss issues impacting on consumer workforce participation and challenges that continue to arise for these workers, other service providers, and the mental health system. The literature identifies the following issues as problematic: role confusion and role strain; lack of support, training, and supervision structures; job titles that do not reflect actual work; poor and inconsistent pay; overwork; limited professional development; insufficient organizational adaptation to expedite consumer participation; staff discrimination and stigma; dual relationships; and the need to further evaluate consumer workforce contributions. These factors adversely impact on the emotional well-being of the consumer workforce and might deprive them of the support required for the consumer participation roles to impact on service delivery. The attitudes of mental health professionals have been identified as a significant obstacle to the enhancement of consumer participation and consumer workforce roles, particularly in public mental health services. A more comprehensive understanding of consumer workforce roles, their benefits, and the obstacles to their success should become integral to the education and training provided to the mental health nursing workforce of the future to contribute to the development of a more supportive working environment to facilitate the development of effective consumer roles. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

Ensuring the availability of the nursing workforce through philanthropy: a case study.

PubMed

Bolton, Linda Burnes; Swanson, Jane; Zamora, Elizabeth

2014-01-01

The Institute of Medicine report on the Future of Nursing identified the need to increase the preparation of nurses, create pathways for nurses to lead as partners to improve health by promoting interprofessional education and practice, and to remove barriers to full practice of nurses across the continuum. This case study shares the experience of large systems and their creativity using philanthropy in their quest to ensure the availability of a qualified nursing workforce.

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.

New Careers in Nursing: An Effective Model for Increasing Nursing Workforce Diversity.

PubMed

Craft-Blacksheare, Melva

2018-03-01

The Robert Wood Johnson Foundation and the American Association of Colleges of Nursing developed the New Careers in Nursing (NCIN) program to address the nursing shortage, increase workforce diversity, and raise the profession's educational level. The program provided scholarships to second-degree underrepresented or economically disadvantaged (UED) students attending an accelerated nursing program to earn a Bachelor of Science in Nursing degree. A midwestern university received three academic-year cycles of NCIN funding. The program's model, resources, and functioning are described. The NCIN provided exceptional financial and program support that received high marks from participants. During the three award cycles, 20 UED scholars graduated with a Bachelor of Science in Nursing degree. Nineteen of the 20 scholars passed the NCLEX-RN on the first attempt. While the NCIN program has ended, nursing school administrators and faculty wishing to promote UED student success should consider using the program's model and resources as the basis for their own program. [J Nurs Educ. 2018;57(3):178-183.]. Copyright 2018, SLACK Incorporated.

Disrupting Communities of Practice? How "Reluctant" Practitioners View Early Years Workforce Reform in England

ERIC Educational Resources Information Center

Payler, Jane K.; Locke, Rachel

2013-01-01

This article reports on the views of early years practitioners in England from settings that were identified as "reluctant to engage" with one of the government's key policies, the introduction of Early Years Professional Status (EYPS), to drive forwards workforce reform. Focus groups, interviews and a survey were undertaken in 2009 with…

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

Understanding Value as a Key Concept in Sustaining the Perioperative Nursing Workforce.

PubMed

Kapaale, Chaluza C

2018-03-01

Perioperative nursing is faced with a staffing crisis attributed in part to minimal numbers of newly graduated nurses choosing a career in this specialty. This article analyzes and applies the concept of value to explore how to maintain an adequate perioperative nursing workforce; recruit newly graduated nurses; and encourage career professional, nurse educator, and student collaboration to generate meaningful value for perioperative nursing. This analysis revealed that value co-creation for perioperative nursing could lead to newly graduated nurses increasingly choosing perioperative nursing as a career, and enjoying satisfying perioperative nursing careers while providing high-quality patient care. © AORN, Inc, 2018.

Preparing mental health nurses for the future workforce: an exploration of postgraduate education in Victoria, Australia.

PubMed

Happell, Brenda; Gough, Karla

2009-10-01

Problems with recruitment and retention in the mental health nursing workforce have been consistently acknowledged in the Australian literature. An Australian workforce scoping study conducted in 1999 revealed a significant shortfall between the number of nurses completing postgraduate mental health nursing programmes and both current and future workforce demands. Despite this, there has been no systematic analysis of these programmes to explain why they are not meeting workforce expectations. The primary aim of the current study was to elicit information about the number of applicants, enrolments, and completions during the 5-year period, 2000-2004. This information was obtained through structured interviews with representatives from Victorian universities (n = 6) who offered postgraduate mental health nursing programmes. Supplementary information, such as approaches to course advertising and student demographics, was also collected. The findings showed an overall increase in the number of students applying to and completing these degrees, although changes in the level of programmes students undertook were evident during this period. Despite revealing important insights regarding postgraduate mental health nursing courses within Victorian universities, the lack of systematic and comprehensive data collection was identified as a problem that limits the extent to which university data can inform recruitment strategies.

Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review.

PubMed

Cummings, Greta G; MacGregor, Tara; Davey, Mandy; Lee, How; Wong, Carol A; Lo, Eliza; Muise, Melanie; Stafford, Erin

2010-03-01

Numerous policy and research reports call for leadership to build quality work environments, implement new models of care, and bring health and wellbeing to an exhausted and stretched nursing workforce. Rarely do they indicate how leadership should be enacted, or examine whether some forms of leadership may lead to negative outcomes. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments. The search strategy of this multidisciplinary systematic review included 10 electronic databases. Published, quantitative studies that examined leadership behaviours and outcomes for nurses and organizations were included. Quality assessments, data extractions and analysis were completed on all included studies. 34,664 titles and abstracts were screened resulting in 53 included studies. Using content analysis, 64 outcomes were grouped into five categories: staffsatisfaction with work, role and pay, staff relationships with work, staff health and wellbeing, work environment factors, and productivity and effectiveness. Distinctive patterns between relational and task focused leadership styles and their outcomes for nurses and their work environments emerged from our analysis. For example, 24 studies reported that leadership styles focused on people and relationships (transformational, resonant, supportive, and consideration) were associated with higher nurse job satisfaction, whereas 10 studies found that leadership styles focused on tasks (dissonant, instrumental and management by exception) were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes. Our results document evidence of various forms of leadership and their differential effects on the nursing workforce and work environments. Leadership focused on task completion alone is not sufficient to achieve optimum outcomes for the nursing workforce. Efforts by organizations and individuals to

Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review.

PubMed

Cummings, Greta G; Tate, Kaitlyn; Lee, Sarah; Wong, Carol A; Paananen, Tanya; Micaroni, Simone P M; Chatterjee, Gargi E

2018-05-03

Leadership is critical in building quality work environments, implementing new models of care, and bringing health and wellbeing to a strained nursing workforce. However, the nature of leadership style, how leadership should be enacted, and its associated outcomes requires further research and understanding. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments. The search strategy of this systematic review included 10 electronic databases. Published, quantitative studies that examined the correlations between leadership behaviours and nursing outcomes were included. Quality assessments, data extractions and analysis were completed on all included studies by independent reviewers. A total of 50,941 titles and abstracts were screened resulting in 129 included studies. Using content analysis, 121 outcomes were grouped into six categories: 1) staff satisfaction with job factors, 2) staff relationships with work, 3) staff health & wellbeing, 4) relations among staff, 5) organizational environment factors and 6) productivity & effectiveness. Our analysis illuminated patterns between relational and task focused leadership styles and their outcomes for nurses and nursing work environments. For example, 52 studies reported that relational leadership styles were associated with higher nurse job satisfaction, whereas 16 studies found that task-focused leadership styles were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes. The findings of this systematic review provide strong support for the employment of relational leadership styles to promote positive nursing workforce outcomes and related organizational outcomes. Leadership focused solely on task completion is insufficient to achieve optimum outcomes for the nursing workforce. Relational leadership practices need to be encouraged and supported by individuals and organizations to

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.

Measuring job satisfaction of advanced nurse practitioners and advanced midwife practitioners in the Republic of Ireland: a survey.

PubMed

O'Keeffe, Anne Paula; Corry, Margarita; Moser, Debra K

2015-01-01

To describe the level of job satisfaction of advanced nurse practitioners (ANP) and advanced midwife practitioners in the Republic of Ireland (RoI). Job satisfaction is related to productivity, performance, turnover and health, and thus is a challenge for nursing and healthcare organisations. Job satisfaction data were collected from 47 ANPs using the Misener Nurse Practitioner Job Satisfaction Scale. High levels of global job satisfaction were reported. All ANPs reported satisfaction with autonomy, sense of accomplishment, challenge, social interaction and status in the organisation. Lower levels of job satisfaction were attributed to the amount of involvement in research (55%), opportunities to receive compensation for services provided outside normal working hours (55%), the amount (44%) and the quality of administrative support (51%), and the opportunity to negotiate bonuses and resources in return for productivity (36%). Advanced nurse practitioners in RoI have high levels of job satisfaction with areas relating to clinical practice but are dissatisfied with areas that lead to empowerment within organisations. Efforts to improve the negotiating and leadership skills of ANPs may improve job satisfaction. Enhancing inter-professional collegial relationships and improving managerial recognition of the role within nursing are key areas to be targeted to promote job satisfaction of ANPs. © 2013 John Wiley & Sons Ltd.

The state of racial/ethnic diversity in North Carolina's health workforce.

PubMed

McGee, Victoria; Fraher, Erin

2012-01-01

Increasing the racial and ethnic diversity of the health care workforce is vital to achieving accessible, equitable health care. This study provides baseline data on the diversity of health care practitioners in North Carolina compared with the diversity of the state's population. We analyzed North Carolina health workforce diversity using licensure data from the respective state boards of selected professions from 1994-2009; the data are stored in the North Carolina Health Professions Data System. North Carolina's health care practitioners are less diverse than is the state's population as a whole; only 17% of the practitioners are nonwhite, compared with 33% of the state's population. Levels of diversity vary among the professions, which are diversifying slowly over time. Primary care physicians are diversifying more rapidly than are other types of practitioners; the percentage who are nonwhite increased by 14 percentage points between 1994 and 2009, a period during which 1,630 nonwhite practitioners were added to their ranks. The percentage of licensed practical nurses who are nonwhite increased by 7 percentage points over the same period with the addition of 1,542 nonwhite practitioners to their ranks. Nonwhite health professionals cluster regionally throughout the state, and 79% of them practice in metropolitan counties. This study reports on only a selected number of health professions and utilizes race/ethnicity data that were self-reported by practitioners. Tracking the diversity among North Carolina's health care practitioners provides baseline data that will facilitate future research on barriers to health workforce entry, allow assessment of diversity programs, and be useful in addressing racial and ethnic health disparities.

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.

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

Healthcare context and nursing workforce in a main city of Angola.

PubMed

Costa Mendes, I A; Marchi-Alves, L M; Mazzo, A; Nogueira, M S; Trevizan, M A; de Godoy, S; Bistafa Pereira, M J; Leonardo de Oliveira Gaioli, C C; Arena Ventura, C A

2013-03-01

Angola is one of the largest African countries with continuing levels of insecurity, considerable weakness in terms of respect for human rights, destroyed infrastructure and low transparency and social accountability levels. The health system displays gaps and nursing represents the main contingent among human resources in health. This research aims to understand the healthcare context in Angola from the perspective of Brazilian nurses who were involved in helping their Angolan colleagues. This general view of health services is followed by a description of nursing workforce particularities at a tertiary health service in the province of Luanda. Data were extracted from the database of the Global Network of World Health Organization Collaborating Centres for Nursing and Midwifery Development, constructed based on technical visits to Angola in 2009. Information related to health service characteristics was used, focusing on nursing human resource activities at two tertiary, one secondary and one primary health institutions located in the province of Luanda. The study data were analysed through descriptive statistics. Among the problems the nursing workforce faces, the lack of human, material and financial resources stands out, as well as insufficient professional qualification, excessive work journeys, low remunerations, non-valuation of professionals, leading to unsatisfactory work environments and discouraged human resources. Nursing in Angola is conquering its professional space. Therefore, regulatory policies are fundamental, defining the rights and obligations of all categories involved, with a view to determining nurses' function in the health team, including respect for and acknowledgement of their role in the community. © 2012 The Authors. International Nursing Review © 2012 International Council of Nurses.

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.

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.

Scaling up the global nursing health workforce: contributions of an international organization.

PubMed

Rukholm, Ellen E; Stamler, Lynnette Leeseberg; Talbot, Lise R; Bednash, Geraldine; Raines, Fay; Potempa, Kathleen; Nugent, Pauline; Clark, Dame Jill Macleod; Bernhauser, Sue; Parfitt, Barbara

2009-01-01

In this paper key highlights of the scholarly work presented at the Toronto 2008 Global Alliance for Nursing Education & Scholarship (GANES) conference are summarized, challenges opportunities and issues facing nursing education globally arising from the conference discourse are outlined and initial steps are suggested as a way forward to a shared global view of baccalaureate and graduate nursing education and scholarship. This shared view arises from beginning understandings of the issues and opportunities we face globally starting with and building upon the lessons learned from the literature and from the experiences of nursing educators and nursing education organization locally, regionally, nationally and internationally. The theme of the groundbreaking GANES Toronto conference was "Educating the future nursing and health workforce: A global challenge". One hundred seventy delegates from 17 countries attended the event, with over 80 papers presented. A primary focus of GANES is the contribution of a strategic alliance of national nursing education organizations to contribute to nursing education leading practices and policy that address the scaling up of global nursing and health workforce. The founding members of GANES see a clear link between a strong educational infrastructure and strong scholarship activities in nursing and the ability of a society to be healthy and prosperous. Evidence presented at the recent GANES conference supports that belief. Through the strength of partnerships and other capacity-building efforts, member countries can support each other to address the global nursing education and health challenges while respecting the local issues.

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.

Sustaining the Rural Workforce: Nursing Perspectives on Worklife Challenges

ERIC Educational Resources Information Center

Hunsberger, Mabel; Baumann, Andrea; Blythe, Jennifer; Crea, Mary

2009-01-01

Context: Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses' work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique…

Pre-implementation studies of a workforce planning tool for nurse staffing and human resource management in university hospitals.

PubMed

van Oostveen, Catharina J; Ubbink, Dirk T; Mens, Marian A; Pompe, Edwin A; Vermeulen, Hester

2016-03-01

To investigate the reliability, validity and feasibility of the RAFAELA workforce planning system (including the Oulu patient classification system - OPCq), before deciding on implementation in Dutch hospitals. The complexity of care, budgetary restraints and demand for high-quality patient care have ignited the need for transparent hospital workforce planning. Nurses from 12 wards of two university hospitals were trained to test the reliability of the OPCq by investigating the absolute agreement of nursing care intensity (NCI) measurements among nurses. Validity was tested by assessing whether optimal NCI/nurse ratio, as calculated by a regression analysis in RAFAELA, was realistic. System feasibility was investigated through a questionnaire among all nurses involved. Almost 67 000 NCI measurements were performed between December 2013 and June 2014. Agreement using the OPCq varied between 38% and 91%. For only 1 in 12 wards was the optimal NCI area calculated judged as valid. Although the majority of respondents was positive about the applicability and user-friendliness, RAFAELA was not accepted as useful workforce planning system. Nurses' performance using the RAFAELA system did not warrant its implementation. Hospital managers should first focus on enlarging the readiness of nurses regarding the implementation of a workforce planning system. © 2015 John Wiley & Sons Ltd.

Academic-correctional health partnerships: preparing the correctional health workforce for the changing landscape-focus group research results.

PubMed

Hale, Janet Fraser; Haley, Heather-Lyn; Jones, Judy L; Brennan, Allyson; Brewer, Arthur

2015-01-01

Providing health care in corrections is challenging. Attracting clinicians can be equally challenging. The future holds a shortage of nurses and primary care physicians. We have a unique opportunity, now, to develop and stabilize our workforce, create a positive image, and enhance quality before the health care landscape changes even more dramatically. Focus groups were conducted with 22 correctional health care professionals divided into three groups: physicians (6), nurses (4), and nurse practitioners/physician assistants (12). Content focused on curricular themes, but additional themes emerged related to recruitment and retention. This article describes recruitment challenges, strategic themes identified, and the proposed initiatives to support a stable, high-quality correctional health workforce. © The Author(s) 2014.

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.

Night and day in the VA: associations between night shift staffing, nurse workforce characteristics, and length of stay.

PubMed

de Cordova, Pamela B; Phibbs, Ciaran S; Schmitt, Susan K; Stone, Patricia W

2014-04-01

In hospitals, nurses provide patient care around the clock, but the impact of night staff characteristics on patient outcomes is not well understood. The aim of this study was to examine the association between night nurse staffing and workforce characteristics and the length of stay (LOS) in 138 veterans affairs (VA) hospitals using panel data from 2002 through 2006. Staffing in hours per patient day was higher during the day than at night. The day nurse workforce had more educational preparation than the night workforce. Nurses' years of experience at the unit, facility, and VA level were greater at night. In multivariable analyses controlling for confounding variables, higher night staffing and a higher skill mix were associated with reduced LOS. © 2014 Wiley Periodicals, Inc.

The nursing workforce in Kuwait to the year 2020.

PubMed

Al-Jarallah, K F; Moussa, M A A; Hakeem, S K; Al-Khanfar, F K

2009-03-01

The study addresses the supply and demand for nurses in Kuwait in the light of emerging variables such as increasing population, economic growth, changes in healthcare strategies and expansion of healthcare facilities. To project the future demand for nurses in Kuwait for the years 2007-2020 based on the period 1994-2006. Population projections were derived using the average annual natural increase rate of the 1994-2006 populations. The future demand for nurses was projected using the average nurse to population ratios for the years 1994-2006. The number of Kuwaiti indigenous nurses is declining at an average decrement rate of 3.3% per annum. There is a gap between the numbers of native and migrant nurses, which will be wider with time. In 2006, native nurses constituted only 6.6% of the nursing workforce; this affects the quality of provided health care owing to language, religions and socio-cultural barriers between foreign nurses and patients. The supply of indigenous nurses in Kuwait should be increased in order to deliver effective nursing care with shared culture and language in the modern healthcare system of Kuwait. This can be achieved through an improvement in recruitment and retention of indigenous nurses and nursing students.

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.

Generational differences of the frontline nursing workforce in relation to job satisfaction: what does the literature reveal?

PubMed

Saber, Deborah A

2013-01-01

The job satisfaction of registered nurses has been found to be associated with retention, organizational commitment, workforce safety, and cost savings to health care organizations. Satisfaction of the workforce is vital because nursing turnover can be detrimental for a labor force that is growing older. However, the summation of the most important variables that are linked to job satisfaction has been difficult to discern in part because the workforce includes 3 main generations (ie, Baby Boomers, Gen Xers, and Millennials) with unique work values that drive their job satisfiers. This article provides a review of existing literature to examine the differences in variables that are linked to job satisfaction that exist between the generational cohorts. Differences in stress sources, need for work-life balance, and compensation are discussed. The knowledge about generationally driven variables that influence job satisfaction can help managers develop strategies to maintain a diverse nursing workforce.

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.

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

Are "part-time" general practitioners workforce idlers or committed professionals?

PubMed

Dwan, Kathryn M; Douglas, Kirsty A; Forrest, Laura E

2014-09-19

The traditional view of general practice holds that only general practitioners (GPs) in full-time clinical practice can provide quality patient care. Nevertheless, increasing numbers of GPs are choosing to work sessionally, that is, ostensibly "part-time". There are concerns about the health workforce's ability to meet demand and also fears that patient care may be compromised. We sought answers to a) what activities do GPs undertake when not consulting patients, b) why do they choose to work sessionally, and c) does sessional general practice reflect a lack of commitment to patients and the profession? Semi-structured interviews were conducted with GPs who worked sessionally, (i.e. six or fewer sessions a week in clinical general practice, where a session comprises four consecutive hours of patient care). These data were analysed qualitatively and saturation was reached. The majority of participants were in full-time paid employment, while part-time in clinical general practice. They reported that consultations increasingly required the management of patients with complex, chronic conditions who also required psychological management. Coupled with unrealistic patient expectations, these factors led GPs to be concerned about maintaining the quality patient care they considered professionally desirable. Many diversified their work activities to ensure that they retained their professional standards. "Part-time" general practice is a misnomer that masks the contribution these GPs make as part of the health workforce. Sessional practice more accurately describes the nature of our participants' clinical work. Their choice of sessional work is a professional response to the increasing demands within the consultation. It enables GPs to maintain their commitment to quality patient care and their profession, while attenuating the challenges of demanding consultations. Sessional general practitioners demonstrate strong commitment to their patients and the profession.

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.

New opportunities for nurses and other healthcare professionals? A review of the potential impact of the new GMS contract on the primary care workforce.

PubMed

Leese, Brenda

2006-01-01

The paper seeks to show that the new General Medical Services (GMS) contract will provide opportunities for NHS staff to enhance their roles, so it is important that adequate training assessment and quality control systems are set in place. This paper assesses the implications for NHS staff in primary care. In this paper a review of policy documents was undertaken. The paper finds that enhanced services set out in the new GMS contract may be provided by primary care organisations and healthcare professionals other than those located in general practitioner (GP) practices. As nurses and other healthcare professionals take on tasks previously conducted by GPs, so GPs will take on more consultant tasks previously confined to secondary care. Personal Medical Services (PMS) and GMS are converging in their contractual obligations and the opportunities offered to staff. As well as General Practitioners with Special Interests (GPwSIs), Practitioners with Special Interests (PwSIs) are important developments, which could promote recruitment and retention in the nursing and allied health professional workforce. Nurses and other healthcare professionals will be the main source of staffing for services shifted from secondary care. The paper shows that it will be important to identify whether these professionals can substitute for GPs, the boundaries to that substitution, and whether recruitment and retention are enhanced. Training for GPwSIs and PwSIs will be introduced or expanded but also needs accreditation and validation. The paper provides an overview of the implications of the new GMS contract for nurses and other NHS professionals.

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.

Nurses for Wisconsin: A Collaborative Initiative to Enhance the Nurse Educator Workforce.

PubMed

Young, Linda K; Adams, Jan L; Lundeen, Sally; May, Katharyn A; Smith, Rosemary; Wendt, L Elaine

2016-01-01

Wisconsin, like much of the nation, is currently suffering from a growing nursing shortage. The University of Wisconsin-Eau Claire College of Nursing and Health Sciences, in partnership with the University of Wisconsin-Madison, University of Wisconsin-Milwaukee, and University of Wisconsin Oshkosh nursing programs, took advantage of a University of Wisconsin System Incentive Grant for economic and workforce development to address this problem. With a $3.2 million award, the Nurses for Wisconsin goal is to increase the number of baccalaureate registered nurses by expanding the nursing education capacity within the University of Wisconsin System. Nurses for Wisconsin is accelerating the preparation of nursing faculty by supporting nurses to enroll in doctor of nursing practice or nursing doctor of philosophy programs with pre- and postdoctoral fellowship awards ranging from $21,500 to $90,000 and the recruitment of faculty with a loan repayment program of up to $50,000. In exchange for the financial support, fellows and faculty must make a 3-year commitment to teach in a UW System nursing program. Two conferences for program participants are also funded through the award. The first conference was held in October 2014. The second conference is scheduled for summer 2015. With the first year of the 2-year project completed, this article describes Nurses for Wisconsin from inception to implementation and midterm assessment with a focus on lessons learned. A follow-up article addressing final outcomes and next steps is planned. Copyright © 2016 Elsevier Inc. All rights reserved.

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...

Why we need multi-level health workforce governance: Case studies from nursing and medicine in Germany.

PubMed

Kuhlmann, Ellen; Larsen, Christa

2015-12-01

Health workforce needs have moved up on the reform agendas, but policymaking often remains 'piece-meal work' and does not respond to the complexity of health workforce challenges. This article argues for innovation in healthcare governance as a key to greater sustainability of health human resources. The aim is to develop a multi-level approach that helps to identify gaps in governance and improve policy interventions. Pilot research into nursing and medicine in Germany, carried out between 2013 and 2015 using a qualitative methodology, serves to illustrate systems-based governance weaknesses. Three explorative cases address major responses to health workforce shortages, comprising migration/mobility of nurses, reform of nursing education, and gender-sensitive work management of hospital doctors. The findings illustrate a lack of connections between transnational/EU and organizational governance, between national and local levels, occupational and sector governance, and organizations/hospital management and professional development. Consequently, innovations in the health workforce need a multi-level governance approach to get transformative potential and help closing the existing gaps in governance. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

"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.

United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit.

PubMed

Zhang, Xiaoming; Tai, Daniel; Pforsich, Hugh; Lin, Vernon W

This is a reevaluation of registered nurse (RN) supply and demand from 2016 to 2030 using a previously published work forecast model and grading methodology with more recent workforce data. There will be a shortage of 154 018 RNs by 2020 and 510 394 RNs by 2030; the South and West regions will have higher shortage ratios than Northeast and Midwest regions. This reflects a nearly 50% overall improvement when compared with the authors' prior study, and the low-performing states have improved from 18 "D" and 12 "F" grades as published earlier to 13 "D" and 1 "F" in this study. Although progress has been made, efforts to foster the pipelines for improving the nursing workforce need to be continued.

More care out of hospital? A qualitative exploration of the factors influencing the development of the district nursing workforce in England.

PubMed

Drennan, Vari M

2018-01-01

Objectives Many countries seek to improve care for people with chronic conditions and increase delivery of care outside of hospitals, including in the home. Despite these policy objectives in the United Kingdom, the home visiting nursing service workforce, known as district nursing, is declining. This study aimed to investigate the factors influencing the development of district nursing workforces in a metropolitan area of England. Methods A qualitative study in a metropolitan area of three million residents in diverse socio-economic communities using semi-structured interviews with a purposive sample of senior nurses in provider and commissioning organizations. Thematic analysis was framed by theories of workforce development. All participants reported that the context for the district nursing service was one of major reorganizations in the face of wider National Health Service changes and financial pressures. The analysis identified five themes that can be seen to impact the ways in which the district nursing workforce was developed. These were: the challenge of recruitment and retention, a changing case-mix of patients and the requirement for different clinical skills, the growth of specialist home visiting nursing services and its impact on generalist nursing, the capacity of the district nursing service to meet growing demand, and the influence of the short-term service commissioning process on the need for long-term workforce development. Conclusion There is an apparent paradox between health policies which promote more care within and closer to home and the reported decline in district nursing services. Using the lens of workforce development theory, an explanatory framework was offered with factors such as the nature of the nursing labour market, human resource practices, career advancement opportunities as well as the contractual context and the economic environment.

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.

Nursing and health sciences workforce diversity research using PhotoVoice: a college and high school student participatory project.

PubMed

Benavides-Vaello, Sandra; Katz, Janet R; Peterson, Jeffery Chaichana; Allen, Carol B; Paul, Robbie; Charette-Bluff, Andrea Lelana; Morris, Phyllis

2014-04-01

This participatory study used PhotoVoice and qualitative description to (a) mentor baccalaureate nursing and college students in workforce diversity research; (b) explore barriers and facilitators encountered by rural American Indian, Hispanic, and other high school students when attending college and pursuing careers in nursing or the health sciences; and (c) model a process of social action to help existing and future students. Baccalaureate nursing and graduate students participated in all stages of research, including dissemination. Five themes emerged from analysis of PhotoVoice data: (a) being afraid; (b) believing; (c) taking small steps; (d) facing fears; and (e) using support systems. Findings underscore the importance of helping students participate in efforts to increase work-force diversity through research. Increasing nursing and health sciences workforce diversity may require strategies developed within and tailored to specific cultures and communities. Copyright 2014, SLACK Incorporated.

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 ...

Ageing of the baby boomer generation: how demographic change will impact on city and rural GP and nursing workforce.

PubMed

Schofield, D J; Page, S L; Lyle, D M; Walker, T J

2006-01-01

To compare the impact of ageing on the GP and nursing rural and city workforce. Cohort analysis of Australian Bureau of Statistics census data. The data was used to examine the age distribution of the city and rural GP and nursing workforce; patterns of attrition for those 50 years and over; and the impact of changes in working hours. The rural GP and nursing workforce is significantly older than their city counterparts (p<0.001) with the 'baby boomer' generation making up 52% of city GPs but 59% of rural GPs in 2001. While a large proportion of city and rural GPs continued to work past the age of 65 years, rural GPs left the workforce at a significantly younger age than city doctors (p<0.001). Rural nurses are older than their city peers (p<0.001) but retire at an older age than city nurses (p<0.001). In 1986, a significantly higher proportion of rural GPs in all age cohorts worked more than 41 hours per week compared with their city counterparts (p<0.001). By 2001, rural 'generation X' GPs were no more likely to work long hours than those in the city (p<0.001). However, significantly more rural than city 'baby boomers' continued to work long hours. Rural GPs are retiring faster than city GPs and strategies to attract rural GPs and nurses will be critical to ensure adequate rural health care and that current rural workforce shortage do not worsen.

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.

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.

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...

Baby boomer doctors and nurses: demographic change and transitions to retirement.

PubMed

Schofield, Deborah J; Beard, John R

2005-07-18

To examine the effect of demographic change on employment patterns for general practitioners, medical specialists and nurses since 1986, and to compare their patterns of retirement. Secondary analysis of previously unpublished Australian Bureau of Statistics Census data for the years 1986, 1991, 1996 and 2001. Age distribution of GPs, specialists and nursing workforce; attrition rates as GPs, specialists and nurses left the workforce; and hours worked according to age group. The age profile of the GP, specialist and nursing workforce has aged since 1986 (P < 0.001), with the "baby boomer" generation making up more than half the workforce in 2001. A large proportion of GPs continued to work beyond the traditional retirement age of 65 years, with nurses retiring at a younger age than doctors (P < 0.001). All GP cohorts worked fewer hours in 2001 than they did in 1986 (P < 0.001), with "generation X" GPs working fewer hours than the baby boomers did at the same age (P < 0.001). Attrition of baby boomer clinicians will place unprecedented pressure on the medical workforce, and policy makers face a critical challenge to ensure workforce needs are met over the next 20 years. Policies and incentives to encourage ongoing employment among older clinicians, albeit at reduced hours, are crucial if the Australian health workforce is to be adequate to meet the growing community demand of the 21st century.

Nurses who work in rural and remote communities in Canada: a national survey.

PubMed

MacLeod, Martha L P; Stewart, Norma J; Kulig, Judith C; Anguish, Penny; Andrews, Mary Ellen; Banner, Davina; Garraway, Leana; Hanlon, Neil; Karunanayake, Chandima; Kilpatrick, Kelley; Koren, Irene; Kosteniuk, Julie; Martin-Misener, Ruth; Mix, Nadine; Moffitt, Pertice; Olynick, Janna; Penz, Kelly; Sluggett, Larine; Van Pelt, Linda; Wilson, Erin; Zimmer, Lela

2017-05-23

In Canada, as in other parts of the world, there is geographic maldistribution of the nursing workforce, and insufficient attention is paid to the strengths and needs of those providing care in rural and remote settings. In order to inform workforce planning, a national study, Nursing Practice in Rural and Remote Canada II, was conducted with the rural and remote regulated nursing workforce (registered nurses, nurse practitioners, licensed or registered practical nurses, and registered psychiatric nurses) with the intent of informing policy and planning about improving nursing services and access to care. In this article, the study methods are described along with an examination of the characteristics of the rural and remote nursing workforce with a focus on important variations among nurse types and regions. A cross-sectional survey used a mailed questionnaire with persistent follow-up to achieve a stratified systematic sample of 3822 regulated nurses from all provinces and territories, living outside of the commuting zones of large urban centers and in the north of Canada. Rural workforce characteristics reported here suggest the persistence of key characteristics noted in a previous Canada-wide survey of rural registered nurses (2001-2002), namely the aging of the rural nursing workforce, the growth in baccalaureate education for registered nurses, and increasing casualization. Two thirds of the nurses grew up in a community of under 10 000 people. While nurses' levels of satisfaction with their nursing practice and community are generally high, significant variations were noted by nurse type. Nurses reported coming to rural communities to work for reasons of location, interest in the practice setting, and income, and staying for similar reasons. Important variations were noted by nurse type and region. The proportion of the rural nursing workforce in Canada is continuing to decline in relation to the proportion of the Canadian population in rural and remote

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

The role of the clinical nurse specialist/neonatal nurse practitioner in a breastfeeding clinic: a model of advanced practice.

PubMed

Gibbins, S A; Green, P E; Scott, P A; MacDonell, J W

2000-03-01

A commitment to quality health care requires the development of innovative models of care. An example of such a model is the Clinical Nurse Specialist/Neonatal Nurse Practitioner in the role as consultant to Lactation Consultants in a large breastfeeding clinic. The role of the Clinical Nurse Specialist/Neonatal Nurse Practitioner in this ambulatory setting encompasses all the dimensions of the advanced practice model including research, leadership, education, and clinical practice. The evolution of this model of care is described. A conceptual framework of this advanced practice model is presented, supported by examples of the role in the clinic.

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

The applicability of the UK Public Health Skills and Knowledge Framework to the practitioner workforce: lessons for competency framework development.

PubMed

Shickle, Darren; Stroud, Laura; Day, Matthew; Smith, Kevin

2018-06-05

Many countries have developed competency frameworks for public health practice. While the number of competencies vary, frameworks cover similar knowledge and skills although they are not explicitly based on competency theory. A total of 15 qualitative group interviews (of up to six people), were conducted with 51 public health practitioners in 8 local authorities to assess the extent to which practitioners utilize competencies defined within the UK Public Health Skills and Knowledge Framework (PHSKF). Framework analysis was applied to the transcribed interviews. The overall framework was seen positively although no participants had previously read or utilized the PHSKF. Most could provide evidence, although some PHSKF competencies required creative thinking to fit expectations of practitioners and to reflect variation across the domains of practice which are impacted by job role and level of seniority. Evidence from previous NHS jobs or education may be needed as some competencies were not regularly utilized within their current local authority role. Further development of the PHSKF is required to provide guidance on how it should be used for practitioners and other members of the public health workforce. Empirical research can help benchmark knowledge/skills for workforce levels so improving the utility of competency frameworks.

Which family physicians work routinely with nurse practitioners, physician assistants or certified nurse midwives.

PubMed

Peterson, Lars E; Blackburn, Brenna; Petterson, Stephen; Puffer, James C; Bazemore, Andrew; Phillips, Robert L

2014-01-01

Facing rising numbers of insured with implementation of the Affordable Care Act, policy makers are interested in building teams of providers that can accommodate a growing demand for primary care services. Nurse Practitioners (NPs), Physician Assistants (PAs), and Certified Nurse Midwives (CNMs) already augment the physician workforce, particularly in rural areas. Our objective was to determine what physician and areal-level characteristics were associated with working with NPs, PAs or CNMs. The sample consisted of a convenience sample of physicians through the American Board of Family Medicine (ABFM) website in the fall of 2011. We linked these data to demographic and practice information collected by the ABFM and with provider information supplied from the National Provider Identifier file aggregated at the Primary Care Service Area level. Hierarchical logistic regression models were used to determine variables associated with working with NPs, PAs, or CNMs. Of the 3,855 family physicians in our sample, 60% reported routinely working with NPs, PAs, or CNMs. In regression analysis, characteristics positively associated with working with NPs, PAs, or CNMs were providing gynecological care (Odds Ratio = 1.23 [95% confidence interval, 1.06-1.42]), multispecialty group practice (OR = 1.72 [1.36-2.18]), any rural setting, and higher availability of PAs (OR = 1.40 [1.10-1.79]). Restrictive NP scope of practice laws failed to reach significance (OR = 0.86 [0.71-1.05]). This study suggests that the number of family physicians routinely working with NPs, PAs, and CNMs continues to increase, which may allow for improved access to health care, particularly in rural areas. © 2013 National Rural Health Association.

Advanced nursing practice hours as part of endorsement requirements for nurse practitioners in Australia: a definitional conundrum.

PubMed

Scanlon, Andrew; Cashin, Andrew; Watson, Ngaire; Bryce, Julianne

2012-11-01

To define what can be considered to be nursing practice, time that can be calculated as the practice of nursing as well as what is considered to be advanced nursing practice and how all this can be related to the current endorsement process for nurse practitioner (NP) in Australia. Current codes and guidelines cited by the Nurse and Midwifery Board of Australia related to nursing practice and NPs, cited competency standards from the Australian Midwifery Accreditation Council, as well as published material of peak nursing bodies from within Australia as well as internationally were used. Information was also obtained through government health and professional organization websites. All information in the literature regarding current and past status and nomenclature of advanced practice nursing was considered relevant. The definitional entanglement of what is considered to be nursing practice, the calculation of specific hours and what is advanced nursing practice interferes with endorsement of NPs in Australia, and a clear understanding of what is meant by advanced practice is required to move forward. Dependent on how practice is interpreted by the Nurse and Midwifery Board of Australia directly affects the outcome of the endorsement proceedings for individual NP candidates. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.

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.

Cultural similarity, cultural competence, and nurse workforce diversity.

PubMed

McGinnis, Sandra L; Brush, Barbara L; Moore, Jean

2010-11-01

Proponents of health workforce diversity argue that increasing the number of minority health care providers will enhance cultural similarity between patients and providers as well as the health system's capacity to provide culturally competent care. Measuring cultural similarity has been difficult, however, given that current benchmarks of workforce diversity categorize health workers by major racial/ethnic classifications rather than by cultural measures. This study examined the use of national racial/ethnic categories in both patient and registered nurse (RN) populations and found them to be a poor indicator of cultural similarity. Rather, we found that cultural similarity between RN and patient populations needs to be established at the level of local labor markets and broadened to include other cultural parameters such as country of origin, primary language, and self-identified ancestry. Only then can the relationship between cultural similarity and cultural competence be accurately determined and its outcomes measured.

Nurse Workforce Challenges in the United States: Implications for Policy. OECD Health Working Papers, No. 35

ERIC Educational Resources Information Center

Aiken, Linda H.; Cheung, Robyn

2008-01-01

The United States has the largest professional nurse workforce in the world numbering close to 3 million but does not produce enough nurses to meet its growing demand. A shortage of close to a million professional nurses is projected to evolve by 2020. An emerging physician shortage will further exacerbate the nurse shortage as the boundaries in…

Using the Donabedian framework to examine the quality and safety of nursing service innovation.

PubMed

Gardner, Glenn; Gardner, Anne; O'Connell, Jane

2014-01-01

To evaluate the safety and quality of nurse practitioner service using the audit framework of Structure, Process and Outcome. Health service and workforce reform are on the agenda of governments and other service providers seeking to contain healthcare costs whilst providing safe and effective health care to communities. The nurse practitioner service is one health workforce innovation that has been adopted globally to improve timely access to clinical care, but there is scant literature reporting evaluation of the quality of this service innovation. A mixed-methods design within the Donabedian evaluation framework was used. The Donabedian framework was used to evaluate the Structure, Process and Outcome of nurse practitioner service. A range of data collection approaches was used, including stakeholder survey (n = 36), in-depth interviews (11 patients and 13 nurse practitioners) and health records data on service processes. The study identified that adequate and detailed preparation of Structure and Process is essential for the successful implementation of a service innovation. The multidisciplinary team was accepting of the addition of nurse practitioner service, and nurse practitioner clinical care was shown to be effective, satisfactory and safe from the perspective of the clinician stakeholders and patients. This study demonstrated that the Donabedian framework of Structure, Process and Outcome evaluation is a valuable and validated approach to examine the safety and quality of a service innovation. Furthermore, in this study, specific Structure elements were shown to influence the quality of service processes further validating the framework and the interdependence of the Structure, Process and Outcome components. Understanding the Structure and Process requirements for establishing nursing service innovation lays the foundation for safe, effective and patient-centred clinical care. © 2013 John Wiley & Sons Ltd.

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

Achieving workforce growth in UK nursing: policy options and implications.

PubMed

Buchan, James

2009-01-01

This paper examines how the National Health Service (NHS) in the UK achieved significant nursing workforce growth during the period between 2000 and 2006 and discusses the policy implications of the methods used to achieve this staffing growth. Data analysis, literature review and policy analysis. NHS nurse staffing growth was approximately 25% over the period 1997-2007, with most growth occurring in the years between 1999 and 2005. Whilst increases in intakes to home-based pre-registration education was a factor in achieving growth, the pace and level of growth which occurred was only possible by using active international recruitment, which was adopted as a deliberate national policy. The numbers of nurses and midwives entering the UK from other countries increased rapidly from 1999 onwards, to a peak in 2002, and then reduced markedly in the period from 2005 onwards. The policy of supporting international recruitment shifted rapidly in late 2005/2006 when financial difficulties hit the NHS and staffing growth was curtailed. Active international recruitment can contribute to health sector staffing growth, assuming the recruiting country has the resources to recruit and can tap into international markets, but it may not be effective in addressing all types of skills shortages. If it is not well linked to other components of workforce planning it may cause difficulties of over expansion, as well as raising broader issues of the ethics and impact.

Kenya's health workforce information system: a model of impact on strategic human resources policy, planning and management.

PubMed

Waters, Keith P; Zuber, Alexandra; Willy, Rankesh M; Kiriinya, Rose N; Waudo, Agnes N; Oluoch, Tom; Kimani, Francis M; Riley, Patricia L

2013-09-01

Countries worldwide are challenged by health worker shortages, skill mix imbalances, and maldistribution. Human resources information systems (HRIS) are used to monitor and address these health workforce issues, but global understanding of such systems is minimal and baseline information regarding their scope and capability is practically non-existent. The Kenya Health Workforce Information System (KHWIS) has been identified as a promising example of a functioning HRIS. The objective of this paper is to document the impact of KHWIS data on human resources policy, planning and management. Sources for this study included semi-structured interviews with senior officials at Kenya's Ministry of Medical Services (MOMS), Ministry of Public Health and Sanitation (MOPHS), the Department of Nursing within MOMS, the Nursing Council of Kenya, Kenya Medical Practitioners and Dentists Board, Kenya's Clinical Officers Council, and Kenya Medical Laboratory Technicians and Technologists Board. Additionally, quantitative data were extracted from KHWIS databases to supplement the interviews. Health sector policy documents were retrieved from MOMS and MOPHS websites, and reviewed to assess whether they documented any changes to policy and practice as having been impacted by KHWIS data. Interviews with Kenyan government and regulatory officials cited health workforce data provided by KHWIS influenced policy, regulation, and management. Policy changes include extension of Kenya's age of mandatory civil service retirement from 55 to 60 years. Data retrieved from KHWIS document increased relicensing of professional nurses, midwives, medical practitioners and dentists, and interviewees reported this improved compliance raised professional regulatory body revenues. The review of Government records revealed few references to KHWIS; however, documentation specifically cited the KHWIS as having improved the availability of human resources for health information regarding workforce planning

Nursing Workforce in Hubei China: Implications for the Development of Traditional Chinese Medicine Education.

PubMed

Cai, Yi; Mao, Zongfu; Corazzini, Kirsten; Petrini, Marcia A; Wu, Bei

2015-01-01

Research evidence suggests that educating nurses about traditional Chinese medicine (TCM) significantly improves their nursing care practice and the health care outcomes of community residents. The purpose of this study was to describe the current use of TCM by China's nursing workforce, as well as the typical nurse to physician ratio and types of TCM education that nurses receive in health care facilities. A large retrospective survey was conducted in Hubei Province, China, in 2010. The sample included 620 non-TCM hospitals, 120 TCM hospitals, and 1254 community health centers (CHCs). Descriptive analysis and 1-way analysis of variance were used to test statistical differences. There were 79 447 nurses employed, of which 1527 had a TCM degree and 5689 had on-the-job TCM education. Non-TCM hospitals employed more nurses than TCM hospitals and CHCs, and TCM hospitals employed more TCM nurses than non-TCM hospitals and CHCs. The median nurse to physician ratio varied by level of urbanization and type of health care facility, from 0.6 in rural CHCs to 1.3 in rural non-TCM hospitals. Differences in TCM education preparation of nurses were significantly different in the urban and rural settings and by type of health care facility. The study suggested a shortage of nurses educated in TCM in Hubei Province China, as well as uneven TCM workforce distribution. More opportunities for TCM education are needed for nurses, especially in CHCs where health promotion and chronic disease management are the most important and mandated functions.

The Department of Veterans Affairs Nursing Academy (VANA): forging strategic alliances with schools of nursing to address nursing's workforce needs.

PubMed

Bowman, Candice C; Johnson, Linda; Cox, Malcolm; Rick, Catherine; Dougherty, Mary; Alt-White, Anna C; Wyte, Tamar; Needleman, Jack; Dobalian, Aram

2011-01-01

In 2007, the Department of Veterans Affairs (VA) established the VA Nursing Academy (VANA), a 5-year, $60-million pilot program funding 15 partnerships between schools of nursing and local VA health care facilities nationwide, to expand nursing faculty, enhance clinical faculty development, increase nursing student enrollment, and promote educational innovations. VA is an ideal setting for educating nursing students owing to a well-educated registered nurse staff, an array of traditional and nontraditional settings, a state-of-the-art computerized electronic health record system, and a unique patient population. Challenges related to the complex nature of VANA partnerships, conceptualized as strategic alliances created between disparate subunits, each embedded in a larger organization, require careful governance to ensure smooth implementation. To ensure the program's aims are met, a 6-year national evaluation has been funded to help identify which strategies best achieve VANA's goals. The speed of economic recovery and the resulting changes in the nursing workforce are important determinants of VANA's future. Published by Mosby, Inc.

Global nurse leader perspectives on health systems and workforce challenges.

PubMed

Gantz, Nancy Rollins; Sherman, Rose; Jasper, Melanie; Choo, Chua Gek; Herrin-Griffith, Donna; Harris, Kathy

2012-05-01

As part of the 2011 annual American Organization of Nurse Executives conference held in San Diego, California, a session was presented that focused on nursing workforce and health systems challenges from a global perspective. This article includes content addressed during the session representing nurse leader perspectives from the UK, Singapore and the USA. Recent events in global economic markets have highlighted the interdependence of countries. There is now a global focus on health-care costs and quality as government leaders struggle to reduce budgets and remain solvent. Finding solutions to these complex problems requires that nurse leaders adopt more of a world view and network with one another as they look for best practices and creative strategies. Nursing leadership challenges such as staffing, competency development, ageing populations, reduced health-care funding and maintaining quality are now common global problems. There is a need for innovation in nursing practice to accommodate the enormous challenges facing nursing's future. Opportunities on an international scale for nurse leaders to have dialogue and network, such as the conference presentation discussed in this article, will become increasingly more important to facilitate the development of innovative leadership strategies. © 2012 Blackwell Publishing Ltd.

Associations between Australian clinical medical practitioner exposure to workplace aggression and workforce participation intentions.

PubMed

Hills, Danny J

2016-02-01

The aim of the present study was to determine the association between clinician exposure to workplace aggression from any source in the previous 12 months and workforce participation intentions. A cross-sectional survey, in the third wave of the Medicine in Australia: Balancing Employment and Life (MABEL) study, was conducted between March 2010 and June 2011. Respondents were a representative sample of 9449 Australian general practitioners (GPs) and GP registrars (n = 3515), specialists (n = 3875), hospital non-specialists (n = 1171) and specialists in training (n = 888). Associations between aggression exposure and workforce participation intentions were determined using logistic regression modelling. In adjusted models, aggression exposure was positively associated with a greater likelihood of intending to reduce clinical workload in the next 5 years (odds ratio (OR) = 1.15, 95% confidence interval (CI) 1.02-1.29) and intending to leave patient care within 5 years (OR = 1.20, 95% CI 1.07-1.35). When also accounting for well being factors, aggression exposure remained positively associated with intending to leave patient care within 5 years (OR = 1.13, 95% CI 1.00-1.27). Exposure to workplace aggression presents a risk to the retention of medical practitioners in clinical practice and a potential risk to community access to quality medical care. More concerted efforts in preventing and minimising workplace aggression in clinical medical practice are required.

An ethnographic study exploring the role of ward-based Advanced Nurse Practitioners in an acute medical setting.

PubMed

Williamson, Susan; Twelvetree, Timothy; Thompson, Jacqueline; Beaver, Kinta

2012-07-01

This article is a report of a study that aimed to examine the role of ward-based Advanced Nurse Practitioners and their impact on patient care and nursing practice. Revised doctor/nurse skill mix combined with a focus on improving quality of care while reducing costs has had an impact on healthcare delivery in the western world. Diverse advanced nursing practice roles have developed and their function has varied globally over the last decade. However, roles and expectations for ward-based Advanced Nurse Practitioners lack clarity, which may hinder effective contribution to practice. An ethnographic approach was used to explore the advanced nurse practitioner role. Participant observation and interviews of five ward-based Advanced Nurse Practitioners working in a large teaching hospital in the North West of England during 2009 were complemented by formal and informal interviews with staff and patients. Data were descriptive and broken down into themes, patterns and processes to enable interpretation and explanation. The overarching concept that ran through data analysis was that of Advanced Nurse Practitioners as a lynchpin, using their considerable expertise, networks and insider knowledge of health care not only to facilitate patient care but to develop a pivotal role facilitating nursing and medical practice. Sub-themes included enhancing communication and practice, acting as a role model, facilitating the patients' journey and pioneering the role. Ward-based Advanced Nurse Practitioners are pivotal and necessary for providing quality holistic patient care and their role can be defined as more than junior doctor substitutes. © 2012 Blackwell Publishing Ltd.

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?

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

General practitioner workforce planning: assessment of four policy directions.

PubMed

Teljeur, Conor; Thomas, Stephen; O'Kelly, Fergus D; O'Dowd, Tom

2010-06-02

Estimating the supply of GPs into the future is important in forecasting shortages. The lengthy training process for medicine means that adjusting supply to meet demand in a timely fashion is problematic. This study uses Ireland as a case study to determine the future demand and supply of GPs and to assess the potential impact of several possible interventions to address future shortages. Demand was estimated by applying GP visit rates by age and sex to national population projections. Supply was modelled using a range of parameters derived from two national surveys of GPs. A stochastic modelling approach was adopted to determine the probable future supply of GPs. Four policy interventions were tested: increasing vocational training places; recruiting GPs from abroad; incentivising later retirement; increasing nurse substitution to enable practice nurses to deliver more services. Relative to most other European countries, Ireland has few GPs per capita. Ireland has an ageing population and demand is estimated to increase by 19% by 2021. Without intervention, the supply of GPs will be 5.7% less than required in 2021. Increasing training places will enable supply to meet demand but only after 2019. Recruiting GPs from overseas will enable supply to meet demand continuously if the number recruited is approximately 0.8 per cent of the current workforce per annum. Later retirement has only a short-term impact. Nurse substitution can enable supply to meet demand but only if large numbers of practice nurses are recruited and allowed to deliver a wide range of GP services. A significant shortfall in GP supply is predicted for Ireland unless recruitment is increased. The shortfall will have numerous knock-on effects including price increases, longer waiting lists and an increased burden on hospitals. Increasing training places will not provide an adequate response to future shortages. Foreign recruitment has ethical considerations but may provide a rapid and effective

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.

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.

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.

The impact of hospital structure and restructuring on the nursing workforce.

PubMed

Duffield, Christine; Kearin, Mark; Johnston, Judy; Leonard, Joanna

2007-01-01

Health systems throughout much of the world have been subject to 'reform' in recent years as countries have attempted to contain the rapidly rising costs of health care. Changes to hospital structures (restructuring) have been an important part of these reforms. A significant impact of current approaches to restructuring is the loss of, or changes to, nursing management roles and functions. Australian hospitals Little evaluation has been undertaken to determine the impact of hospital structure and organisational restructuring on the nursing workforce. There is some indication that nurses have experienced a loss of key management positions, which may impact on their capacity to ensure that adequate and safe care is provided at the ward level.

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.

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.

National Advisory Council on Nurse Education and Practice Report to the Secretary of the Department of Health and Human Services on the Basic Registered Nurse Workforce.

ERIC Educational Resources Information Center

National Advisory Council on Nurse Education and Practice, Rockville, MD.

The National Advisory Council on Nurse Education and Practice (NACNEP) initiated an examination of basic registered nurse workforce issues in December 1994. NACNEP took into account the environment in which registered nurses (RNs) would practice, the appropriate educational qualifications needed, and the status of the registered nurse population…

The nursing informatics workforce: who are they and what do they do?

PubMed

Murphy, Judy

2011-01-01

Nursing informatics has evolved into an integral part of health care delivery and a differentiating factor in the selection, implementation, and evaluation of health IT that supports safe, high-quality, patient-centric care. New nursing informatics workforce data reveal changing dynamics in clinical experience, job responsibilities, applications, barriers to success, information, and compensation and benefits. In addition to the more traditional informatics nurse role, a new position has begun to emerge in the health care C-suite with the introduction of the chief nursing informatics officer (CNIO). The CNIO is the senior informatics nurse guiding the implementation and optimization of HIT systems for an organization. With their fused clinical and informatics background, informatics nurses and CNIOs are uniquely positioned to help with "meaningful use" initiatives which are so important to changing the face of health care in the United States.

Recent graduate nurse views of nursing, work and leadership.

PubMed

Cleary, Michelle; Horsfall, Jan; Jackson, Debra; Muthulakshmi, Paulpandi; Hunt, Glenn E

2013-10-01

To assess recent nurse graduates of a large university and seeks their views of university preparation, requisite nursing skills and qualities, workplace transition, supports received, nurse leadership and role models, and career development and retention. Concern about attracting and retaining registered nurses is a continuing workforce issue in parts of Asia and throughout the world. Qualitative interviews with recent nursing graduates. Seventeen face-to-face interviews took place using a structured schedule of 23 questions. Data were coded and analysed by hand to determine clusters of interest and develop themes. Four broad topics emerged: (1) skills and qualities graduates consider central to nursing; (2) the support they received during the transition from graduate to novice practitioner and that which continues; (3) elements they value in nursing role models and leaders; and (4) the ward characteristics that will encourage them to remain in nursing and develop a career. Interviewees expressed concerns about retention-related issues, making suggestions for improvements. Unique findings focus on the blaming culture that many respondents consider they are working in, and the system whereby they are not free to access postgraduate studies until a specific time frame has elapsed, and when they do pursue further studies, they are bonded to the auspicing hospital/health service. Responses unique to this research are the explicit concerns about a blaming culture, and complaints about rigid rules (bonding system) that virtually prevent an individual from accessing postgraduate studies independent of the hospital system. Interviewees strongly resent the bonding system that indentures them to that place of work. Quality health care is dependent on a well-educated, sustainable and skilled nursing workforce. Recognition of the concerns of newly graduated nurses in relation to nursing skill acquisition, workplace support issues and career concerns can assist in ensuring

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.

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.

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.

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.

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.

Sustaining and growing the rural nursing and midwifery workforce: understanding the issues and isolating directions for the future.

PubMed

Francis, Karen L; Mills, Jane E

2011-01-01

Nurses and midwives represent the largest group of health professionals in the Australian health care system. In rural environments nurses and midwives make up a greater proportion of the health workforce than in urban settings, which makes their role in service provision even more significant. The role and scope of these nurses and midwives' practice is by necessity more generalist than specialist, which results in disciplinary strengths and weaknesses. As generalist health professionals they work in diverse settings such as public hospitals, multi-purpose services, community health, aged care and in non-government and private for profit and no-profit organisations including general practices. Their scope of practice covers prevention, intervention and rehabilitation and is lifespan inclusive. Rural nurses and midwives are older than their metropolitan based counterparts, work part-time and traditionally have limited access to professional development often due to ineffective locum relief programs. Workplace inflexibility, access to acceptable housing and partner employment are factors cited as inhibitors to growing this workforces. The future of the rural nursing and midwifery workforce will only be secured if Government invests to a greater degree in both education and training and the development of a nationally agreed remuneration scale that allows for part-time work.

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…

Effect of Prior Health-Related Employment on the Registered Nurse Workforce Supply.

PubMed

Yoo, Byung-kwan; Lin, Tzu-chun; Kim, Minchul; Sasaki, Tomoko; Spetz, Joanne

2016-01-01

Registered nurses (RN) who held prior health-related employment in occupations other than licensed practical or vocational nursing (LPN/LVN) are reported to have increased rapidly in the past decades. Researchers examined whether prior health-related employment affects RN workforce supply. A cross-sectional bivariate probit model using the 2008 National Sample Survey of Registered Nurses was esti- mated. Prior health-related employment in relatively lower-wage occupations, such as allied health, clerk, or nursing aide, was positively associated with working s an RN. ~>Prior health-related employ- ment in relatively higher-wage categories, such as a health care manager or LPN/LVN, was positively associated with working full-time as an RN. Policy implications are to promote an expanded career ladder program and a nursing school admission policy that targets non-RN health care workers with an interest in becoming RNs.

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…

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.

Cost implications of organizing nursing home workforce in teams.

PubMed

Mukamel, Dana B; Cai, Shubing; Temkin-Greener, Helena

2009-08-01

To estimate the costs associated with formal and self-managed daily practice teams in nursing homes. Medicaid cost reports for 135 nursing homes in New York State in 2006 and survey data for 6,137 direct care workers. A retrospective statistical analysis: We estimated hybrid cost functions that include team penetration variables. Inference was based on robust standard errors. Formal and self-managed team penetration (i.e., percent of staff working in a team) were calculated from survey responses. Annual variable costs, beds, case mix-adjusted days, admissions, home care visits, outpatient clinic visits, day care days, wages, and ownership were calculated from the cost reports. Formal team penetration was significantly associated with costs, while self-managed teams penetration was not. Costs declined with increasing penetration up to 13 percent of formal teams, and increased above this level. Formal teams in nursing homes in the upward sloping range of the curve were more diverse, with a larger number of participating disciplines and more likely to include physicians. Organization of workforce in formal teams may offer nursing homes a cost-saving strategy. More research is required to understand the relationship between team composition and costs.

Advanced psychiatric nurse practitioners' ideas and needs for supervision in private practice in South Africa.

PubMed

Temane, Annie M; Poggenpoel, Marie; Myburgh, Chris P H

2014-04-07

Supervision forms an integral part of psychiatric nursing. The value of clinicalsupervision has been demonstrated widely in research. Despite efforts made toward advancedpsychiatric nursing, supervision seems to be non-existent in this field. The aim of this study was to explore and describe advanced psychiatric nursepractitioners' ideas and needs with regard to supervision in private practice in order tocontribute to the new efforts made in advanced psychiatric nursing in South Africa. A qualitative, descriptive, exploratory, and contextual design using a phenomenological approach as research method was utilised in this study. A purposive sampling was used. Eight advanced psychiatric nurse practitioners in private practice described their ideas and needs for supervision during phenomenological interviews. Tesch's method of open coding was utilised to analyse data. After data analysis the findings were recontextualised within literature. The data analysis generated the following themes - that the supervisor should have or possess: (a) professional competencies, (b) personal competencies and (c) specificfacilitative communication skills. The findings indicated that there was a need for supervision of advanced psychiatric nurse practitioners in private practice in South Africa. This study indicates that there is need for supervision and competent supervisors in private practice. Supervision can be beneficial with regard to developing a culture of support for advanced psychiatric practitioners in private practice and also psychiatric nurse practitioners.

The Profile of Saudi Nursing Workforce: A Cross-Sectional Study

PubMed Central

Magarey, Judy; Wiechula, Richard

2017-01-01

Introduction The Royal Monarchy in Saudi Arabia decreed that all sectors of the workforce would be subject to a policy of “Saudisation” to reduce the reliance on the expatriate workforce and to reduce the unemployment rate of Saudi nationals (Al-Mahmoud et al., 2012). Methodology A cross-sectional design was chosen to investigate the research questions. The population of this study comprised Saudi Registered Nurses working in MOH hospitals in Riyadh which is the main health care provider in Saudi Arabia (Aboul-Enein, 2002; MOH, 2009). Results and Findings A total number of 1,198 questionnaires were distributed and 61.2% (n = 741) were returned. The findings of the study showed that the questionnaires were collected from an equal portion of the study locale and that a sample of 741 is enough to create a strong conclusion and answer the problem set in this study and all the questions in the study have been provided with answers with enough data and literatures to supports its findings. Conclusion and Recommendations The results indicate that an increase in the recruitment of Saudi males may simply reflect cultural issues such as gender specific facilities and the Saudisation program's nondiscriminatory approach to employment of both genders into nursing. PMID:29214078

A study examining senior nursing students' expectations of work and the workforce.

PubMed

Saber, Deborah A; Anglade, Debbie; Schirle, Lori M

2016-03-01

This study explored traditional and accelerated Bachelor of Science nursing students' expectations of nursing work and the workforce. Role transition difficulty is blamed for much of the 15-60% newly licensed registered nurse turnover in their first 3 years of employment. This qualitative study consisted of 14 focus groups (n = 98) to determine Bachelor of Science nursing students' expectations of work as newly licensed registered nurses. Two overriding themes for accelerated and traditional students emerged: stressors and coping strategies. Students believe four stressors will affect their progression into the newly licensed registered nurse role and have developed coping strategies. This study suggests that students have experienced stressors in the clinical environment and anticipate them in the newly licensed registered nurse role. During transition, strategies such as 'fitting in' and 'staying safe' will be employed to ensure work success. Younger generations value a healthy work-life balance and a positive working environment. These nurses will not tolerate positions that do not align with their values. With the aging of citizens in the USA and the predicted nursing shortage, nursing management needs to employ strategies to retain newly licensed registered nurses. © 2015 John Wiley & Sons Ltd.

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.

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.

Why nurses chose to remain in the workforce: Portraits of resilience.

PubMed

Cope, Vicki; Jones, Bronwyn; Hendricks, Joyce

2016-01-01

This study explored why nurses chose to remain in the Western Australian workforce and to develop insights into the role of resilience of nurses and to identify the key characteristics of resilience displayed by these nurses. Nursing is a stressful profession. Prolific quantitative research which measures job stress and resilience has been implemented; however, there is a dearth of qualitative studies which hear the personal narratives as to why nurses remain and thrive in a stressful workplace. Vignettes of nursing resilience reveal underlying themes of resilience where personal stories and events are presented as narrative. Portraiture recognises the inherent value of the nurses' stories giving attention to the nature of their resilience. Interpretation illuminates the portraits or verbal canvasses of the told experience, reflecting success and positivity despite disarray in healthcare settings. Eight themes were identified. The portraits highlight a sometimes imperceptible theme of resilience within nursing. Nurses are resilient; they rely on the social support of colleagues, family and friends to continue to bear their mantle of responsibility. They take pride in their work and accomplishments and give to others altruistically. They laugh, they love nursing and they keep the needs of their patients, clients, residents or students foremost. This paper describes the hallmarks of resilience demonstrated by nurses. Resilience and its relationship to coping in times of adversity are captured within the portraits presented.

Hospital Nursing Workforce Costs, Wages, Occupational Mix,and Resource Utilization.

PubMed

Welton, John M

2015-10-01

The objective of the study was to better understand how hospitals use different types of RNs, LPNs, and nurse aides in proprietary (for-profit), nonprofit, and government-owned hospitals and to estimate the wages, cost, and intensity of nursing care using a national data set. This is a cross-sectional observational study of 3,129 acute care hospitals in all 50 states and District of Columbia using data from the 2008 Occupational Mix Survey administered by the Centers for Medicare &Medicaid Services (CMS). Nursing skill mix, hours, and labor costs were combined with other CMS hospital descriptive data, including type of hospital ownership, urban or rural location, hospital beds, and case-mix index. RN labor costs make up 25.5% of all hospital expenditures annually, and all nursing labor costs represent 30.1%, which is nearly a quarter trillion dollars ($216.7 billion) per year for inpatient nursing care. On average, proprietary hospitals employ 1.3 RNs per bed and 1.9 nursing personnel per bed in urban hospitals compared with 1.7 RNs per bed and 2.3 nursing personnel per bed for nonprofit and government-owned hospitals (P G .05). States with higher ratios of RN compared with LPN licenses used fewer LPNs in the inpatient setting. The findings from this study can be helpful in comparing nursing care across different types of hospitals, ownership, and geographic locations and used as a benchmark for future nursing workforce needs and costs.

Hospital nursing workforce costs, wages, occupational mix, and resource utilization.

PubMed

Welton, John M

2011-01-01

: The objective of the study was to better understand how hospitals use different types of RNs, LPNs, and nurse aides in proprietary (for-profit), nonprofit, and government-owned hospitals and to estimate the wages, cost, and intensity of nursing care using a national data set. : This is a cross-sectional observational study of 3,129 acute care hospitals in all 50 states and District of Columbia using data from the 2008 Occupational Mix Survey administered by the Centers for Medicare & Medicaid Services (CMS). Nursing skill mix, hours, and labor costs were combined with other CMS hospital descriptive data, including type of hospital ownership, urban or rural location, hospital beds, and case-mix index. : RN labor costs make up 25.5% of all hospital expenditures annually, and all nursing labor costs represent 30.1%, which is nearly a quarter trillion dollars ($216.7 billion) per year for inpatient nursing care. On average, proprietary hospitals employ 1.3 RNs per bed and 1.9 nursing personnel per bed in urban hospitals compared with 1.7 RNs per bed and 2.3 nursing personnel per bed for nonprofit and government-owned hospitals (P < .05). States with higher ratios of RN compared with LPN licenses used fewer LPNs in the inpatient setting. : The findings from this study can be helpful in comparing nursing care across different types of hospitals, ownership, and geographic locations and used as a benchmark for future nursing workforce needs and costs.

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

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.

Enhancing computer literacy and information retrieval skills: A rural and remote nursing and midwifery workforce study.

PubMed

Mills, Jane; Francis, Karen; McLeod, Margaret; Al-Motlaq, Mohammad

2015-01-01

Nurses and midwives collectively, represent the largest workforce category in rural and remote areas of Australia. Maintaining currency of practice and attaining annual licensure with the Australian Health Practitioners Regulatory Authority (AHPRA) present challenges for individual nurses and midwives and for their health service managers. Engagement with information and communication technologies, in order for geographically isolated clinicians to access ongoing education and training, is considered a useful strategy to address such challenges. This paper presents a pre- and post-test study design. It examines the impact of an online continuing professional development (CPD) program on Australian rural nurses and midwives. The aims of the program were to increase basic skill acquisition in the utilisation of common computer software, the use of the Internet and the enhancement of email communication. Findings from the study demonstrate that participants who complete a relevant CPD program gain confidence in the use of information and communication technologies. Further, increased confidence leads to increased access to contemporary, reliable and important health care information on the Internet, in addition to clinicians adopting email as a regular method of communication. Health care employers commonly assume employees are skilled users of information and communication technologies. However, findings from this study contradict such assumptions. It is argued in the recommendations that health care employees should be given regular access to CPD programs designed to introduce them to information and communication technologies. Developing knowledge and skills in this area has the potential to improve staff productivity, raise health care standards and improve patient outcomes.

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.

Cost Implications of Organizing Nursing Home Workforce in Teams

PubMed Central

Mukamel, Dana B; Cai, Shubing; Temkin-Greener, Helena

2009-01-01

Objective To estimate the costs associated with formal and self-managed daily practice teams in nursing homes. Data Sources/Study Setting Medicaid cost reports for 135 nursing homes in New York State in 2006 and survey data for 6,137 direct care workers. Study Design A retrospective statistical analysis: We estimated hybrid cost functions that include team penetration variables. Inference was based on robust standard errors. Data Collection Formal and self-managed team penetration (i.e., percent of staff working in a team) were calculated from survey responses. Annual variable costs, beds, case mix-adjusted days, admissions, home care visits, outpatient clinic visits, day care days, wages, and ownership were calculated from the cost reports. Principal Findings Formal team penetration was significantly associated with costs, while self-managed teams penetration was not. Costs declined with increasing penetration up to 13 percent of formal teams, and increased above this level. Formal teams in nursing homes in the upward sloping range of the curve were more diverse, with a larger number of participating disciplines and more likely to include physicians. Conclusions Organization of workforce in formal teams may offer nursing homes a cost-saving strategy. More research is required to understand the relationship between team composition and costs. PMID:19486181

The U.S. Presidential Election and Health Care Workforce Policy

PubMed Central

McHugh, Matthew D.; Aiken, Linda H.; Cooper, Richard A.; Miller, Phillip

2009-01-01

The candidates for the 2008 presidential election have offered a range of proposals that could bring significant changes in health care. Although few are aimed directly at the nurse and physician workforce, nearly all of the proposals have the potential to affect the health care workforce. Furthermore, the success of the proposed initiatives is dependent on a robust nurse and physician workforce. The purpose of this article is to outline the current needs and challenges for the nurse and physician workforce and highlight how candidates’ proposals intersect with the adequacy of the health care workforce. Three general themes are highlighted for their implications on the physician and nurse workforce supply, including (a) expansion of health care coverage, (b) workforce investment, and (c) cost control and quality improvement. PMID:18436702

Fast-track for fast times: catching and keeping generation Y in the nursing workforce.

PubMed

Walker, Kim

2007-04-01

There is little doubt we find ourselves in challenging times as never before has there been such generational diversity in the nursing workforce. Currently, nurses from four distinct (and now well recognised and discussed) generational groups jostle for primacy of recognition and reward. Equally significant is the acute realisation that our ageing profession must find ways to sustain itself in the wake of huge attrition as the 'baby boomer' nurses start retiring over the next ten to fifteen years. These realities impel us to become ever more strategic in our thinking about how best to manage the workforce of the future. This paper presents two exciting and original innovations currently in train at one of Australia's leading Catholic health care providers: firstly, a new fast-track bachelor of nursing program for fee-paying domestic students. This is a collaborative venture between St Vincent's and Mater Health, Sydney (SV&MHS) and the University of Tasmania (UTas); as far as we know, it is unprecedented in Australia. As well, the two private facilities of SV&MHS, St Vincent's Private (SVPH) and the Mater Hospitals, have developed and implemented a unique 'accelerated progression pathway' (APP) to enable registered nurses with talent and ambition to fast track their career through a competency and merit based system of performance management and reward. Both these initiatives are aimed squarely at the gen Y demographic and provide potential to significantly augment our capacity to recruit and retain quality people well into the future.

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.

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.

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.

The productivity of physician assistants and nurse practitioners and health work force policy in the era of managed health care.

PubMed

Scheffler, R M; Waitzman, N J; Hillman, J M

1996-01-01

Managed care is spreading rapidly in the United States and creating incentives for physician practices to find the most efficient combination of health professionals to deliver care to an enrolled population. Given these trends, it is appropriate to reexamine the roles of physician assistants (PAs) and nurse practitioners (NPs) in the health care workforce. This paper briefly reviews the literature on PA and NP productivity, managed care plans' use of PAs and NPs, and the potential impact of PAs and NPs on the size and composition of the future physician workforce. In general, the literature supports the idea that PAs and NPs could have a major impact on the future health care workforce. Studies show significant opportunities for increased physician substitution and even conservative assumptions about physician task delegation imply a large increase in the number of PAs and NPs that can be effectively deployed. However, the current literature has certain limitations that make it difficult to quantify the future impact of PAs and NPs. Among these limitations is the fact that virtually all formal productivity studies were conducted in fee-for-service settings during the 1970s, rather than managed care settings. In addition, the vast majority of PA and NP productivity studies have viewed PAs and NPs as physician substitutes rather than as members of interdisciplinary health care teams, which may become the dominant health care delivery model over the next 10-20 years.

Guide for applied public health workforce research: an evidence-based approach to workforce development.

PubMed

Thacker, Stephen B

2009-11-01

Essential to achievement of the public health mission is a knowledgeable, competent, and prepared workforce; yet, there is little application of science and technical knowledge to ensuring the effectiveness of that workforce, be it governmental or private. In this article, I review the evidence for effective workforce development and argue for an increased emphasis on an evidence-based approach to ensuring an effective workforce by encouraging the generation of the evidence base that is required. To achieve this, I propose the appointment of an independent Task Force on Public Health Workforce Practice to oversee the development of a Guide for Public Health Workforce Research and Practice (Workforce Guide), a process that will generate and bring together the workforce evidence base for use by public health practitioners.

Inconsistencies in authoritative national paediatric workforce data sources.

PubMed

Allen, Amy R; Doherty, Richard; Hilton, Andrew M; Freed, Gary L

2017-12-01

Objective National health workforce data are used in workforce projections, policy and planning. If data to measure the current effective clinical medical workforce are not consistent, accurate and reliable, policy options pursued may not be aligned with Australia's actual needs. The aim of the present study was to identify any inconsistencies and contradictions in the numerical count of paediatric specialists in Australia, and discuss issues related to the accuracy of collection and analysis of medical workforce data. Methods This study compared respected national data sources regarding the number of medical practitioners in eight fields of paediatric speciality medical (non-surgical) practice. It also counted the number of doctors listed on the websites of speciality paediatric hospitals and clinics as practicing in these eight fields. Results Counts of medical practitioners varied markedly for all specialties across the data sources examined. In some fields examined, the range of variability across data sources exceeded 450%. Conclusions The national datasets currently available from federal and speciality sources do not provide consistent or reliable counts of the number of medical practitioners. The lack of an adequate baseline for the workforce prevents accurate predictions of future needs to provide the best possible care of children in Australia. What is known about the topic? Various national data sources contain counts of the number of medical practitioners in Australia. These data are used in health workforce projections, policy and planning. What does this paper add? The present study found that the current data sources do not provide consistent or reliable counts of the number of practitioners in eight selected fields of paediatric speciality practice. There are several potential issues in the way workforce data are collected or analysed that cause the variation between sources to occur. What are the implications for practitioners? Without accurate

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

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.

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.

Occupational closure in nursing work reconsidered: UK health care support workers and assistant practitioners: A focus group study.

PubMed

Traynor, Michael; Nissen, Nina; Lincoln, Carol; Buus, Niels

2015-07-01

In healthcare, occupational groups have adopted tactics to maintain autonomy and control over their areas of work. Witz described a credentialist approach to occupational closure adopted by nursing in the United Kingdom during the 19th and early 20th centuries. However, the recent advancement of assistant, 'non-qualified' workers by governments and managers forms part of a reconfiguration of traditional professional work. This research used focus groups with three cohorts of healthcare support workers undertaking assistant practitioner training at a London university from 2011 to 13 (6 groups, n = 59). The aim was to examine how these workers positioned themselves as professionals and accounted for professional boundaries. A thematic analysis revealed a complex situation in which participants were divided between articulating an acceptance of a subordinate role within traditional occupational boundaries and a usurpatory stance towards these boundaries. Participants had usually been handpicked by managers and some were ambitious and confident in their abilities. Many aspired to train to be nurses claiming that they will gain recognition that they do not currently get but which they deserve. Their scope of practice is based upon their managers' or supervisors' perception of their individual aptitude rather than on a credentialist claim. They 'usurp' nurses claim to be the healthcare worker with privileged access to patients, saying they have taken over what nursing has considered its core work, while nurses abandon it for largely administrative roles. We conclude that the participants are the not unwilling agents of a managerially led project to reshape the workforce that cuts across existing occupational boundaries. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

Mobile learning: a workforce development strategy for nurse supervisors.

PubMed

Mather, Carey; Cummings, Elizabeth

2014-01-01

Digital technology provides opportunities for using mobile learning strategies in healthcare environments. To realise the vision of the National Workforce Development Strategy there needs to be innovation of health professionals to further develop knowledge and skills of clinical supervisors to access and gain an understanding of the value of mobile learning at the workplace. The use of digital technology by clinical supervisors was explored in 2012 as part of a teaching development grant to evaluate the use of Web 2.0 technology to develop a community of practice about clinical supervision. Prior to developing the virtual network of clinical supervisors, feedback about the use of Web 2.0 technology by clinicians was sought via an online survey. Over 90% of respondents used social media, 85% understood what a blog and wiki were and approximately half of the respondents used smart phones. More than one-third indicated they would participate in a virtual community of practice and would like to receive information about clinical facilitation at least once per week. Findings indicate both inhibitors and opportunities for workforce development within healthcare environments that need to be addressed. Support of graduate-ready nurses can be achieved through an integrated outlook that enables health professionals within organisations to undertake mobile learning in situ. A flexible and collaborative approach to continuing professional development within organisations could enhance practice development and could positively impact on workforce development.

An Undergraduate Research Fellowship Program to Prepare Nursing Students for Future Workforce Roles

PubMed Central

Slattery, Mary Jo; Logan, Bridget; Mudge, Bridget; Secore, Karen; Von Reyn, LInda J.; Maue, Robert A.

2016-01-01

It is important for nurses today and for those joining the workforce in the future to have familiarity and training with respect to interprofessional research, evidence-based practice, and quality improvement. In an effort to address this need, we describe a 10-week summer research program that immerses undergraduate nursing students in a broad spectrum of clinical and translational research projects as part of their exposure to advanced nursing roles. In doing so, the program increases the ability of the students to participate in research, effectively interact with academic medical center researchers, and incorporate elements of evidence-based practice into future nursing interventions. Their mentors are nurses practicing in roles as nurse researcher, advanced practice nurses involved in evidence-based practice or quality improvement, and clinical trials research nurses. Each student is matched with 3 of these mentors and involved in 3 different projects. Through this exposure, the students benefit from observing multiple nursing roles, taking an active role in research-related activities participating in interdisciplinary learning experiences. Overall, the program provides benefits to the students, who demonstrate measured improvement with respect to the program objectives, and to their mentors and each of the participating organizations. PMID:27964811

Patterns of resident health workforce turnover and retention in remote communities of the Northern Territory of Australia, 2013-2015.

PubMed

Russell, Deborah J; Zhao, Yuejen; Guthridge, Steven; Ramjan, Mark; Jones, Michael P; Humphreys, John S; Wakerman, John

2017-08-15

The geographical maldistribution of the health workforce is a persisting global issue linked to inequitable access to health services and poorer health outcomes for rural and remote populations. In the Northern Territory (NT), anecdotal reports suggest that the primary care workforce in remote Aboriginal communities is characterised by high turnover, low stability and high use of temporary staffing; however, there is a lack of reliable information to guide workforce policy improvements. This study quantifies current turnover and retention in remote NT communities and investigates correlations between turnover and retention metrics and health service/community characteristics. This study used the NT Department of Health 2013-2015 payroll and financial datasets for resident health workforce in 53 remote primary care clinics. Main outcome measures include annual turnover rates, annual stability rates, 12-month survival probabilities and median survival. At any time point, the clinics had a median of 2.0 nurses, 0.6 Aboriginal health practitioners (AHPs), 2.2 other employees and 0.4 additional agency-employed nurses. Mean annual turnover rates for nurses and AHPs combined were extremely high, irrespective of whether turnover was defined as no longer working in any remote clinic (66%) or no longer working at a specific remote clinic (128%). Stability rates were low, and only 20% of nurses and AHPs remain working at a specific remote clinic 12 months after commencing. Half left within 4 months. Nurse and AHP turnover correlated with other workforce measures. However, there was little correlation between most workforce metrics and health service characteristics. NT Government-funded remote clinics are small, experience very high staff turnover and make considerable use of agency nurses. These staffing patterns, also found in remote settings elsewhere in Australia and globally, not only incur higher direct costs for service provision-and therefore may compromise long

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

Long-term trends in supply and sustainability of the health workforce in remote Aboriginal communities in the Northern Territory of Australia.

PubMed

Zhao, Yuejen; Russell, Deborah J; Guthridge, Steven; Ramjan, Mark; Jones, Michael P; Humphreys, John S; Carey, Timothy A; Wakerman, John

2017-12-19

International evidence suggests that a key to improving health and attaining more equitable health outcomes for disadvantaged populations is a health system with a strong primary care sector. Longstanding problems with health workforce supply and turnover in remote Aboriginal communities in the Northern Territory (NT), Australia, jeopardise primary care delivery and the effort to overcome the substantial gaps in health outcomes for this population. This research describes temporal changes in workforce supply in government-operated clinics in remote NT communities through a period in which there has been a substantial increase in health funding. Descriptive and Markov-switching dynamic regression analysis of NT Government Department of Health payroll and financial data for the resident health workforce in 54 remote clinics, 2004-2015. The workforce included registered Remote Area Nurses and Midwives (nurses), Aboriginal Health Practitioners (AHPs) and staff in administrative and logistic roles. total number of unique employees per year; average annual headcounts; average full-time equivalent (FTE) positions; agency employed nurse FTE estimates; high and low supply state estimates. Overall increases in workforce supply occurred between 2004 and 2015, especially for administrative and logistic positions. Supply of nurses and AHPs increased from an average 2.6 to 3.2 FTE per clinic, although supply of AHPs has declined since 2010. Each year almost twice as many individual NT government-employed nurses or AHPs are required for each FTE position. Following funding increases, some clinics doubled their nursing and AHP workforce and achieved relative stability in supply. However, most clinics increased staffing to a much smaller extent or not at all, typically experiencing a "fading" of supply following an initial increase associated with greater funding, and frequently cycling periods of higher and lower staffing levels. Overall increases in workforce supply in remote NT

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.