Should Nurse Practitioner Programs Share Courses?

The Pediatric Nurse Practitioner Workforce: Meeting the Health Care Needs of Children

To review use of simulation in the education of advanced practice nurses and to describe an innovative simulation program for family nurse practitioner (NP) students. The literature was reviewed using MEDLINE and CINAHL searches for descriptions of simulation programs for advanced practice nursing (APN) students. A description of a simulation program in a family NP program was provided. The literature on the use of simulation in primary care APN programs is scant, but simulation seems to represent an active learning strategy that would be of benefit to primary care APN students in increasing knowledge and confidence about the management of clinical situations. Students can also work with faculty to create simulation experiences based on the knowledge of their own learning needs and expertise in specialty areas of nursing. More information about the use of simulation programs for APN students is needed along with more information about educational outcomes.

Nurse practitioners (NPs) are certified within a population-focused specialty area, practice in a variety of settings, and treat a wide range of patients. Little is known about what agreement exists between certification obtained and actual site of practice. Keough, Stevenson, Martinovich, Young, and Tanabe (2011, p. 195) There is an ongoing debate about which qualifications are necessary to work in emergency care settings. BACKGROUND Statistics There are currently more than 205,000 NPs in the United States and 9,000–12,000 are employed in emergency departments (EDs) and related areas (e.g., urgent care centers; American Association of Nurse Practitioners [AANP], 2015). Last year NPs cared for approximately 4% (5.4 million) of the 136 million patients seen in EDs in the United States (Centers for Disease Control and Prevention, 2015). Consensus Model In 2008, the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education developed by the American Nurses Credentialing Center (ANCC; 2008) became the framework for NP licensure, accreditation, certification, and education. The model delineates advanced practice nursing based on role (NP, clinical nurse specialist, nurse midwife, or nurse anesthetist) and population-focused competencies (family/individual across the life span, adult-gerontology, pediatrics, neonatal, psych/mental health, and women's health/gender specific; ANCC, 2008). Specialty practice encompasses additional competencies, and it is at the specialty level within the Consensus Model that concerns about scope of practice reside. Primary Certification Upon graduation, primary certification for NPs is achieved by the successful completion of the board examination at the population level: Family nurse practitioners (FNPs) are awarded board certification as a Family Nurse Practitioner, Board Certified (FNP-BC), through the ANCC or the American Academy of Nurse Practitioner Certification Program that awards an FNP-C; Acute care NPs are awarded an Acute Care Nurse Practitioner Certification from the AACN Certification Corporation or an Acute Care Nurse Practitioner, Board Certified (ACNP-BC) from the ANCC; Pediatric NPs may have ANCC certification as a pediatric primary care nurse practitioner or certification by the Pediatric Nursing Certification Board as a pediatric acute care nurse practitioner. Once certified, a pediatric, family, or an adult-gerontology NP may be hired to work in an ED. Because the educational preparation of pediatric and adult-gerontology NPs does not include the care of patients across the life span and because many EDs see patients of all ages, the pediatric and adult-gerontology NPs are limited to practicing in EDs within larger metropolitan areas that see only older adults or children. Competencies/Specialty Certification Competencies for emergency nurse practitioners (ENPs) were initially published by the Emergency Nurses Association (ENA) in 2008 in the Nurse Practitioner Delphi Study: Competencies for Practice in Emergency Care (ENA, 2010). In conjunction with the AANP, individuals on this committee led stakeholders to develop entry-level competencies for NPs in emergency care. The competencies were also endorsed by the American Nurses Association and by the National Organization of Nurse Practitioner Faculties. These competencies are the basis of ENP curricula in the United States. The ANCC established emergency nurse practitioner board certification (ENP-BC) via portfolio in 2013 (ANCC, 2013). To obtain ENP-BC, the NP applicant must have obtained certification in a population focus, 2 years or 2,000 hr of emergency care practice (within the past 3 years), 30 hr of continuing education in emergency care, and exemplary performance in two of five professional development/leadership areas. Submission of self- and peer performance evaluations is also required. Finally, the applicant must complete a written exemplar demonstrating expertise as an emergency care provider. REQUIREMENTS TO WORK IN AN ED The ability of an FNP and/or ACNP to work in an ED is based on the (1) regulatory agency (state board of nursing [BON]), (2) academic preparation, (3) additional preparation, and (4) credentialing. Regulation The BON in each state determines the scope of practice and is the final authority on whether an NP can work in an ED. Currently, there is limited consensus among state BONs on the interpretation of the Consensus Model related to the scope of practice for NPs providing care within EDs. Academic Preparation Formal educational programs to prepare NPs to work in EDs have been available since the 1990s. The domains in emergency care include critical care, urgent care, primary care, behavioral medicine, public health, and social medicine (Chan & Garbez, 2006). Nurse practitioners prepared as primary care providers have competencies different from those prepared for acute care roles. These unique educational differences govern an NP's scope of practice (American Academy of Emergency Nurse Practitioners, 2015). Recently, several FNP programs have revised their curricula to incorporate didactic and clinical content in emergent and urgent care. Nurse practitioners educated as acute care providers are prepared with didactic and clinical practice in acute care settings; they do not have the academic preparation to care for pediatric patients in emergency care settings. Additional Preparation Emergency Care Fellowships Both FNPs and ACNPs may obtain additional education in emergency care by completing an emergency care fellowship program. Pediatric and adult-gerontology ACNPs who receive additional educational preparation in emergency care and acute stabilization and resuscitation of medically unstable patients across the life span are prepared to provide safe, high-quality care in their respective EDs. Emergency trained FNPs or ACNPs graduating from academic ENP programs and fellowships should be recognized as having the knowledge, skills, and competencies to practice in the ED and be considered board-eligible for ENP certification. FNPs can obtain knowledge and skills in the acute resuscitation and critical skills required for safe practice in an ED either by completing an ENP graduate program or by attending a structured emergency fellowship program. Continuing Education/On-the-Job Training Continuing education is one method of obtaining the competency, knowledge, skills, and behaviors necessary to practice in an ED setting. On-the-job training can also teach NPs valuable skills (e.g., ultrasound technique). Credentialing Regardless of each state BON's authority to regulate practice or the educational preparation of an FNP or ACNP, the ability to work in an ED is ultimately granted by the medical staff of the hospital through a process called credentialing. Credentialing or obtaining privileges is the process of establishing the qualifications of an individual to work in a specific environment. This generally includes a background check along with an assessment of academic and certification credentials, work history, recent continuing education, and current licensure. FNPs OR ACNPs IN THE ED? In a study conducted by Keough et al. (2011), FNPs, adult NPs, and ACNPs were surveyed regarding certification, demographics, practice setting, routine responsibilities, and additional preparation (2011). The FNP, adult nurse practitioner (ANP), and ACNP respondents (5%, 7%, and 42%, respectively) reported practicing in a nontraditional practice setting. Of the NPs practicing in a nontraditional setting, 74% were ACNPs, with 90% of those ACNPs practicing in a nontraditional, ambulatory care setting. Sixty-five percent of the FNPs who were practicing in a nontraditional setting worked in a high-acuity ED, whereas 56% of the ANPs working in a nontraditional setting were employed in intensive care units. Additional training and education for these NPs included, but were not limited to, pharmacology, laboratory interpretation, and the ordering of diagnostic tests. The authors concluded that “while greater than 90% of ANPs and FNPs practice in settings consistent with their certification, a proportion of NPs practice in nontraditional settings may benefit from additional education (formal, on-the-job, and continuing education) and mentoring” (Keough et al., 2011, p. 195). Among NPs working in emergency care, a snowball sample of 164 NPs surveyed found that 78% reported were certified as an FNPs whereas only 10% reported certification in acute care (E. Ramirez, oral communication, August 20, 2015). Current initiatives to help prepare NPs to attain the ENP core competencies include establishing educational standards for graduate education of ENPs and appropriate postgraduate continuing education. Other important activities to support and promote ENP practice include updating the ENP core competencies and exploring partnerships with nursing and medical organizations to improve continuing education, recruitment, and retention of qualified ENPs. Nurse practitioners will continue to work in EDs, whereas state BONs strive for congruence with the Consensus Model. Ultimately, all NPs working in emergency settings must demonstrate ENP competencies because certification for ENPs is in the best interest of patient safety. That's the bottom line. —K. Sue Hoyt, PhD, RN, FNP-BC, CEN, FAEN, FAANP, FAAN Emergency Nurse Practitioner St. Mary Medical Center Long Beach, CA —Jean A. Proehl, RN, MN, CEN, CPEN, FAEN Emergency Clinical Nurse Specialist Proehl PRN, LLC Cornish, NH

REVIEW QUESTION/OBJECTIVE The objective of this review is to examine conceptual and/or theoretical frameworks that are relevant to nurse practitioner education. The specific review question is: What conceptual and/or theoretical frameworks are available that are relevant to the structuring of nurse practitioner education? INCLUSION CRITERIA Types of participants This review will consider studies that include nurse practitioners in any specialty or the education of nurse practitioners in any specialty at the graduate or post-graduate level. Phenomena of interest In this review, we will consider documents that describe or evaluate frameworks, maps or conceptual structures for NP education at the graduate degree or post-graduate degree level. Literature that presents a framework for the graduate education of students in other health care disciplines at the university level will also be considered for inclusion. Frameworks for utilization in other jurisdictions (e.g. Provincial and Territorial regulatory frameworks) and metrics that assist in measuring, describing and organizing key concepts required for nurse practitioner education will be examined. Outcomes of interest for this review will include framework components in either narrative or illustrative form. Context This scoping review will consider studies that have been conducted in the provision of graduate level education of students in health care disciplines. Specific contextual focus will be directed to identify frameworks for educational programming for nurse practitioner students. Frameworks for curriculum development and/or delivery in other disciplines will also be considered.

An Advanced Practice Nurse (APN) is a specialized nurse who has acquired context specific knowledge, complex decision-making skills, and clinical competencies. Previously in Norway, APN education programs had a prerequisite of a minimum of two years of clinical nursing experience. Recently, the government decided to abandon this prerequisite. The objectives of this study were to assess APN's and APN students' (1) perspectives on the impact of clinical nursing experience on various aspects of nursing practice, (2) perspectives on the association between APN students' previous clinical experience and the ability to achieve the learning outcomes in the education program, and (3) attitudes towards clinical nursing practice as a prerequisite before entry to APN education programs. An observational, cross-sectional design. APN and APN students were invited to respond to a researcher-developed questionnaire. A snowballing sampling method was used. The questionnaire included 24 questions scored on a five-point Likert scale, and two questions with text responses. Quantitative data were analyzed using descriptive statistics, and text responses with thematic analysis. In total, 1767 APNs (92.9%) and APN students (7.1%) responded. Between 93.6 and 98.2% of the respondents (n = 1767) agreed that clinical nursing experience leads to experience with communication, collaboration, basic procedures, medical equipment and documentation, and to the development of situation awareness, increased awareness on own role in teams, the ability to provide person-centered nursing, an independent nursing identity, and feeling of security. Over 90% of the respondents agreed that students' previous clinical experience was associated with the ability to achieve the learning outcomes in the APN program. In addition, 93.7% of the respondents agreed that clinical nursing experience should be a prerequisite before entry to APN programs. Advantages of clinical experience were reported as 'Professional identity', 'Intuitive grasp', 'Integration of technical skills', and 'See the whole picture'. Disadvantages were reported as 'Prejudice and bad habits', 'The importance of relevant experience', and 'Recruitment issues'. This study adds insights into the impact of clinical nursing experience as a prerequisite to APN education programs. The results indicate that clinical nursing experience is an essential contributor to the development of nursing competence and a nursing identity. This study was not registered.

Preparing Nurse Practitioner Students for Virtual Visits: An Innovative Computer-Based Text-Messaging Simulation

The curriculum for nurse practitioner (NP) students often overlooks the assessment of the oral cavity. In recognition of this, the HEENT (head, eyes, ears, nose, and throat) assessment was expanded to HEENOT (head, ears, eyes, nose, oral, and throat) through integration of an interprofessional educational (IPE) activity developed for University of Colorado NP and dental students. The aim of this study was to assess NP students' perceptions of an IPE activity in which dental faculty and students taught NP students how to conduct an oral exam, recognize oral health pathology, and apply fluoride varnish. Afterwards, the NP students completed an evaluation survey focusing on their thoughts, comfort level, organization, and understanding of the activity. This IPE activity was repeated over four semesters from 2014 to 2017, and significant differences among the semesters were compared. All NP students in the four semesters participated in the activity and the survey: semester one N=25, semester two N=31, semester three N=43, and semester four N=25. In all semesters, NP students reported feeling more confident conducting oral health exams after completion of the IPE activity. Semester four students agreed more with the idea of interprofessional collaboration (OR: 0.103) and receiving educational information not learned elsewhere in the curriculum (OR: 0.134) compared to semester one students. Higher odds for the session being well organized and conducted in a suitable time were found for semester four compared to semester two (OR: 0.217). These comparisons reflect improvement in teaching methodologies over the four semesters and an overall increased confidence for NP students in performing an oral health assessment.

Advanced Practice Nursing student knowledge in obesity management: A mixed methods research study

Advanced practice nursing students: Pilot test of a simulation scenario

Increasing Families' Health Care Access and Choice Through Full Practice Authority

The purposes or this study were to (a) describe the prevention practices of nurse practitioners (NPs) regarding childhood obesity, (b) compare the practices of NPs by specialty, practice setting, and awareness of childhood obesity prevention guidelines, (c) identify relationships between prevention practices and demographic variables of NPs, and (d) examine the resources for and barriers to implementing prevention practices. A convenience sample of 99 family NPs (FNPs) and pediatric NPs (PNPs) from the Intermountain area was used. Participants completed a questionnaire based on documented risk factors for childhood obesity as well as prevention guidelines developed by the American Academy of Pediatrics (AAP). NPs working in family practice or general pediatric practice settings were not consistently using the BMI-for-age index to screen for childhood obesity, as recommended by the AAP. However, they were teaching parents to promote healthy food choices and physical activity in their families. PNPs and FNPs working in a pediatric practice setting and NPs who were aware of prevention guidelines were more likely to perform several prevention strategies than FNPs working in a family practice setting and those who were unaware of guidelines. Major barriers to implementing childhood obesity prevention strategies included parental attitudes, the American lifestyle, and lack of resources for both the NP and the family. The main resources NPs used in preventing childhood obesity were a dietician, journal articles, and Web sites. Although the majority of the NPs in this study reported being aware of childhood obesity prevention guidelines (73.7%), most were not consistently using BMI for age or monitoring children at increased risk for obesity. Because childhood obesity is escalating at such a rapid rate, it is critical that NPs working in family practice and pediatric practice settings take the necessary steps to help curtail obesity in childhood, including calculating BMI for age, targeting children at risk, and helping families develop healthy nutrition and physical activity habits. In addition to proper health supervision of children, NPs also need to be advocates in their communities to overcome barriers to childhood obesity prevention.

I'm in an NP State of Mind: A Tribute to Dr. Henry K. Silver on the 50th Anniversary of the Nurse Practitioner Profession

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) persons account for 3.5% of the population. Nursing programs in the United States provide a median of 2.13 hours of formal content regarding LGBTQ health, which contributes to iatrogenic barriers to care. Patient experiences related to inadequate provider preparation include misguided treatment strategies, impedance of communication, and abuse. A pilot educational project was developed to provide advanced practice nursing (APRN) students meaningful clinical interactions with LGBTQ-identifying standardized patients (SPs) to better prepare them to care for LGBTQ patients with cultural humility. This project was determined to be Exempt by the Institutional Review Board at the University of Michigan. Implemented in an advanced health assessment course with 99 APRN students, components of the project included course readings, lecture content, laboratory activities, an SP experience, and both large and small debriefing sessions. The SP experience itself was a 15-minute clinical encounter with a patient presenting with "abdominal pain," with an emphasis on history-taking, communication, and cultural humility. Qualitative data analysis was performed using the constant comparison method to interpret the results from student evaluations and other written feedback. This pilot project has promise to inform future educational offerings and set the standard for LGBTQ health content and application for APRN students. Further research is needed to evaluate the quality of LGBTQ content in APRN curricula to improve the ability of APRN students to provide care to LGBTQ patients.

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

BackgroundIn response to the growing body of evidence supporting the need for expanded interprofessional education among health professions, an interprofessional education program, based on the Interprofessional Education Collaborative Core Competencies, was piloted with nurse practitioner and dental students. ObjectivesThe purpose of this pilot study was to evaluate a technology enhanced interprofessional education program focused on the oral-systemic health connection for nurse practitioner and dental students. DesignA two-group comparative study using cross-sectional data and a quasi-experimental one-group pre-test/post-test design were used to evaluate students' knowledge of IPE core competencies, attitudes toward interprofessional education and interdisciplinary teamwork, and self-efficacy in functioning as a member of an interdisciplinary team. Setting and participantsThis program was implemented with master of science in nursing students pursuing a primary care nurse practitioner (NP) degree and dental students at a large urban academic health sciences center. Cohort 1 (N = 75) consisted of NP (n = 34) and dental students (n = 41) at the end of their degree program who participated in a one-time survey. Cohort 2 (N = 116) was comprised of second-year NP students (n = 22) and first-year dental students (n = 94) who participated in the IPE program. MethodsStudents participated in a multi-faceted educational program consisting of technology- enhanced delivery as well as interactive exercises in the joint health assessment course. Data were collected prior to the initiation and at the conclusion of the program. ResultsNurse practitioner and dental students who participated in the program had better self-efficacy in functioning as a member of an interdisciplinary team than graduating students who did not participate. Students from both nursing and dentistry who participated in the program had significantly improved self-efficacy in functioning in interprofessional teams from pre- to post-test. ConclusionAn interprofessional education program can be a valuable addition to the health professions curriculum of nurse practitioner and dental students. Care must be taken to address logistical issues when working with students in different academic programs.