Mentorship Impact for Advanced Practice Registered Nurses and Physician Assistants/Physician Associates.

Commentaries on health services research

To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through "on the job" training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap.

The Emerging Role of APRNs in Hospital Nursing Practice: Perspectives From a Survey of Chief Nursing Officers

The purpose of this study was to determine the association between autonomy and empowerment of advanced practice registered nurses (APRNs) and predictor variables of physician oversight, geographical location, and practice setting. As the Patient Protection and Affordable Care Act (PPACA) is implemented, these characteristics are vital to understanding how APRNs practice and the relationship of APRNs to other healthcare team members, including physicians. This was a descriptive, correlational survey of APRNs in New Mexico exploring autonomy and empowerment in relation to variables of physician oversight, geographical location, and practice setting. New Mexico's APRN Nurse Practice Act supports independent practice and prescriptive authority. Results indicated that APRNs are highly empowered and autonomous. However, nearly 40% of respondents identified practicing with physician oversight. Further investigation of subscales of empowerment also provided insight of relationships among healthcare team members, particularly physicians. This research provides additional knowledge for policy changes that support APRNs assuming more responsibility for primary care. However, understanding the APRN role within the healthcare team is necessary for effective implementation of primary care in New Mexico.

Evaluating the Impact of Executive Orders Lifting Restrictions on Advanced Practice Registered Nurses During the COVID-19 Pandemic

Little is known about the effects of physician oversight on advanced practice registered nurses (APRNs). Examination of these relationships provides insight into the strength of independent practice. The purpose of this study was to examine whether APRNs' perceptions of autonomy and empowerment varied according to type of physician oversight, whether facilitative or restrictive. A cross-sectional survey design was used to examine whether APRNs' perceptions of autonomy and empowerment varied according to physician oversight, geographical location, and practice setting. Five hundred questionnaires were mailed in March 2013 with 274 returned. Participants were asked about autonomy, empowerment, demographics, physician oversight, geographical location, and practice setting. Among surveyed respondents, physician oversight was related to increased empowerment, regardless of whether the oversight was defined in facilitative or restrictive terms; both had similar positive effects on empowerment. If APRNs are to be part of the solution to the growing problem of healthcare access, it is important to study factors that contribute to their success. We speculate that increasing opportunities for collaboration and interaction with physicians, and possibly other healthcare professionals, could facilitate APRN empowerment, optimizing their contribution.

Mentorship Impact for Advanced Practice Registered Nurses

This study aimed to identify the modules of the End-of-Life Nursing Education Consortium-Japan Core Curriculum (ELNEC-J), which are particularly necessary for second- to fourth-year nurses. This cross-sectional study recruited certified nurse specialists in cancer nursing (CNSCNs) endorsed by the Japanese Nursing Association enrolled in Advanced Practice Registered Nurses (APRNs) in Japan. We asked individuals who were active members of the volunteer association of CNSCNs in the Tokai region to participate via email, and we collected data using Google Forms. The participants were asked about their background, including APRN experience and current position. Furthermore, we asked them to select three necessary modules for second- to fourth-year nurses' education from the 10 modules of the ELNEC-J. The study recruited a total of 19 (89%) APRNs (response rate: 100%). Out of them, 14 (73.6%) had more than six years of clinical experience in APRNs, and 12 (63.1%) held managerial positions. Regarding the 10 modules of the ELNEC-J, the responses for the necessary modules were as follows: nursing care at end-of-life 13 (68.4%), pain management 12 (63.2%), symptom management 10 (52.6%), communication 10 (52.6%), and ethical issues in palliative care nursing five (31.6%). According to the perspective of APRNs responsible for palliative care education for incumbent nurses, nursing care at the end of life, pain management, symptom management, and communication are required for second- to fourth-year nurse education.

Numerous nursing and physician studies have reported the effects of workload, environment, and life circumstances contributing to burnout. Effects may include job dissatisfaction, poor quality of life, and associated negative patient outcomes. Although assessing clinician burnout to determine effective interventions has become a topic of great importance, there are minimal studies specific to advanced practice registered nurses (APRNs). This single-center study was conducted to assess the prevalence and impact of APRN burnout and to recommend targeted interventions toward improvement of overall health and well-being. A cross-sectional, mixed methods design was used. The voluntary, anonymous survey examined perceptions of wellness, inclusion, social support, personal coping mechanisms, and status of burnout. The 78-question survey was sent to 1,014 APRNs (94%) and PAs (6%), with a 43.6% response rate (n = 433); 76.4% were nurse practitioners. Participants were identified as currently experiencing burnout, formerly burned out, or never having experienced burnout. Profiles were developed, and similarities and differences between each group were compared. Of 433 respondents, 40.4% (n = 175) reported having never experienced burnout, 33.3% (n = 144) reported they had formerly experienced burnout, and 26.3% (n = 114) reported they were currently experiencing burnout. The results of the study identified that some APRNs report experiencing burnout at different times in their careers. Recommendations by participants to mitigate burnout included self-care, organizational promotion of health and well-being, career development, and leadership support. This study is one of the first to report on burnout among APRNs and potential interventions to build resilience; however, additional research is warranted.

The 2017 Environmental Scan

President Message

Background and Purpose: Oral health is often related to other medical conditions. This study investigated the knowledge and opinions of California physicians, dentists, pharmacists, and advanced practice registered nurses (APRNs) regarding the interface between oral and overall health and their suggestions for strengthening this interface. Methods: A survey packet was mailed to randomly-selected California healthcare providers in Winter 2015. Twenty five-point Likert-type questions were used to measure the providers’ knowledge and opinions of the oral and overall health interface. Results: Sixtytwo physicians, 117 dentists, 136 pharmacists, and 289 Advanced Practice Registered Nurses (APRNs) responded (total N= 604). A majority of all health professionals agreed/strongly agreed that oral health topics received little attention in the education of non-dental health professionals (n=499, 82.6%), and that the dental discipline remains relatively segregated from other healthcare disciplines (n=500, 82.8%). Dentists and APRNs were more likely to agree/agree strongly that the inadvertent prescribing of medications that can have xerostomic effects without considering their oral health implications is a major problem. Conclusion: There is a need for more inter-professional collaboration by all primary care providers in managing the patients’ oral and overall health, as well as more oral health education and training for all non-dental health professionals.

Rural health inequities are due in part to a shortage of health care professionals in these areas. To determine the factors associated with health care professionals' decisions about where to practice. This prospective, cross-sectional survey study of health care professionals in Minnesota was administered by the Minnesota Department of Health from October 18, 2021, to July 25, 2022. Advanced practice registered nurses (APRNs), physicians, physician assistants (PAs), and registered nurses (RNs) renewing their professional licenses were eligible. Individuals' ratings on survey items related to their choice of practice location. Rural or urban practice location as defined by the US Department of Agriculture's Rural-Urban Commuting Area typology. A total of 32 086 respondents were included in the analysis (mean [SD] age, 44.4 [12.2] years; 22 728 identified as female [70.8%]). Response rates were 60.2% for APRNs (n = 2174), 97.7% for PAs (n = 2210), 95.1% for physicians (n = 11 019), and 61.6% for RNs (n = 16 663). The mean (SD) age of APRNs was 45.0 (10.3) years (1833 [84.3%] female); PAs, 39.0 (9.4) years (1648 [74.6%] female); physicians, 48.0 (11.9) years (4455 [40.4%] female); and RNs, 42.6 (12.3) years (14 792 [88.8%] female). Most respondents worked in urban (29 456 [91.8%]) vs rural (2630 [8.2%]) areas. Bivariate analysis suggested that family considerations are the most important determinant of practice location. Multivariate analysis revealed that having grown up in a rural area was the strongest factor associated with rural practice (odds ratio [OR] for APRNs, 3.44 [95% CI, 2.68-4.42]; OR for PAs, 3.75 [95% CI, 2.81-5.00]; OR for physicians, 2.44 [95% CI, 2.18-2.73]; OR for RNs, 3.77 [95% CI, 3.44-4.15]). When controlling for rural background, other associated factors included the availability of loan forgiveness (OR for APRNs, 1.42 [95% CI, 1.19-1.69]; OR for PAs, 1.60 [95% CI, 1.31-1.94]; OR for physicians, 1.54 [95% CI, 1.38-1.71]; OR for RNs, 1.20 [95% CI, 1.12-1.28]) and an educational program that prepared for rural practice (OR for APRNs, 1.44 [95% CI, 1.18-1.76]; OR for PAs. 1.70 [95% CI, 1.34-2.15]; OR for physicians, 1.31 [95% CI, 1.17-1.47]; OR for RNs, 1.23 [95% CI, 1.15-1.31]). Autonomy in one's work (OR for APRNs, 1.42 [95% CI, 1.08-1.86]; OR for PAs, 1.18 [95% CI, 0.89-1.58]; OR for physicians, 1.53 [95% CI, 1.31-1.78]; OR for RNs, 1.16 [95% CI, 1.07-1.25]) and a broad scope of practice (OR for APRNs, 1.46 [95% CI, 1.15-1.86]; OR for PAs, 0.96 [95% CI, 0.74-1.24]; OR for physicians, 1.62 [95% CI, 1.40-1.87]; OR for RNs, 0.96 [95% CI, 0.89-1.03]) were important factors associated with rural practice. Lifestyle and area considerations were not associated with rural practice; family considerations were associated with rural practice for RNs only (OR for APRNs, 0.97 [95% CI, 0.90-1.06]; OR for PAs, 0.95 [95% CI, 0.87-1.04]; OR for physicians, 0.92 [95% CI, 0.88-0.96]; OR for RNs, 1.05 [95% CI, 1.02-1.07]). Understanding the interconnected factors involved in rural practice requires modeling relevant factors. The findings of this survey study suggest that loan forgiveness, rural training, autonomy, and a broad scope of practice are factors associated with rural practice for most health care professionals. Other factors associated with rural practice vary by profession, suggesting that there may not be a one-size-fits-all approach to recruitment of rural health care professionals.

BackgroundDiagnostic testing and treatment recommendations can vary when medical care is sought by individuals for low back pain (LBP), leading to variation in quality and costs of care. We examine how the first provider seen by an individual at initial diagnosis of LBP influences downstream utilization and costs.MethodsUsing national private health insurance claims data, individuals age 18 or older were retrospectively assigned to cohorts based on the first provider seen at the index date of LBP diagnosis. Exclusion criteria included individuals with a diagnosis of LBP or any serious medical conditions or an opioid prescription recorded in the 6 months prior to the index date. Outcome measures included use of imaging, back surgery rates, hospitalization rates, emergency department visits, early- and long-term opioid use, and costs (out-of-pocket and total costs of care) twelve months post-index date. We used a two-stage residual inclusion (2SRI) estimation approach comparing copay for the initial provider visit and differential distance as the instrumental variable to reduce selection bias in the choice of first provider, controlling for demographics.ResultsAmong 3,799,593 individuals, cost and utilization varied considerably based on the first provider seen by the patient. Copay and differential distance provided similar results, with copay preserving a greater sample size. The frequency of early opioid prescription was significantly lower when care began with an acupuncturist or chiropractor, and highest for those who began with an emergency medicine physician or advanced practice registered nurse (APRN). Long-term opioid prescriptions were low across most providers except physical medicine and rehabilitation physicians and APRNs. The frequency and time to serious illness varied little across providers. Total cost of care was lowest when starting with a chiropractor ($5093) or primary care physician ($5660), and highest when starting with an orthopedist ($9434) or acupuncturist ($9205).ConclusionThe first provider seen by individuals with LBP was associated with large differences in health care utilization, opioid prescriptions, and cost while there were no differences in delays in diagnosis of serious illness.

We explored the differences in potentially avoidable/unavoidable hospital transfers in a retrospective analysis of Interventions to Reduce Acute Care Transfers (INTERACT) Acute Transfer Tools (ACTs) completed by advanced practice registered nurses (APRNs) working in the Missouri Quality Improvement (QI) Initiative (MOQI). Cross-sectional descriptive study of 3996 ACTs for 32.5 calendar months from 2014 to 2016. Univariate analyses examined differences between potentially avoidable vs unavoidable transfers. Multivariate logistic regression analysis of candidate factors identified those contributing to avoidable transfers. Sixteen nursing homes (NHs), ranging from 120 to 321 beds, in urban, metro, and rural communities within 80 miles of a large midwestern city. A total of 5168 residents with a median age of 82 years. Data from 3946 MOQI-adapted ACTs. A total of 54% of hospital transfers were identified as avoidable. QI opportunities related to avoidable transfers were earlier detection of new signs/symptoms (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 1.61-3.42; P < .001); discussions of resident/family preference (OR = 2.12; 95% CI = 1.38-3.25; P < .001); advance directive/hospice care (OR = 2.25; 95% CI = 1.33-3.82; P = .003); better communication about condition (OR = 4.93; 95% CI = 3.17-7.68; P < .001); and condition could have been managed in the NH (OR = 16.63; 95% CI = 10.9-25.37; P < .001). Three factors related to unavoidable transfers were bleeding (OR = .59; 95% CI = .46-.77; P < .001), nausea/vomiting (OR = .7; 95% CI = .54-.91; P = .007), and resident/family preference for hospitalization (OR = .79; 95% CI = .68-.93; P = .003). Reducing avoidable hospital transfers in NHs requires challenging assumptions about what is avoidable so QI efforts can be directed to improving NH capacity to manage ill residents. The APRNs served as the onsite coaches in the use and adoption of INTERACT. Changes in health policy would provide a revenue stream to support APRN presence in NH, a role that is critical to improving resident outcomes by increasing staff capacity to identify illness and guide system change. J Am Geriatr Soc 67:1953-1959, 2019.