Acute Care Nurse Practitioner Role Research Articles

Extracorporeal Membrane Oxygenation: Opportunities for Expanding Nurses' Roles.

Extracorporeal Membrane Oxygenation: Opportunities for Expanding Nurses' Roles.

Nurse Practitioner Job Satisfaction and the Healthy Work Environment.

Nurse Practitioner Job Satisfaction and the Healthy Work Environment.

Factors Related to Successful Transition to Practice for Acute Care Nurse Practitioners.

The transition from student to acute care nurse practitioner (ACNP) has been recognized as a time of stress. The purpose of this descriptive, correlational-comparative design pilot study was to examine: (1) the relationships among personal resources, community resources, successful transition, and job retention; (2) the difference between ACNPs with 0 to 4 years and ACNPs with more than 4 years of prior experience as a registered nurse in an intensive care unit or emergency department; and (3) the skills/procedures that ACNPs found difficult to perform independently. Thirty-four participants were recruited from a social media site for nurse practitioners. Organizational support, communication, and leadership were the most important elements of successful transition into the ACNP role. This information can help ACNP faculty and hospital orientation/fellowship program educators to help ACNPs transition into their first position after graduation.

How do nurse practitioners in acute care affect perceptions of team effectiveness?

To describe how acute care nurse practitioners affect perceptions of team effectiveness. Acute care nurse practitioners provide safe and effective care to patients. There is limited evidence of the effects of acute care nurse practitioner roles on healthcare teams, and many of the findings are contradictory. Research is lacking to describe how nurse practitioners affect perceptions of team effectiveness. A descriptive multiple-case study undertaken in two university-affiliated teaching hospitals in Canada. Data were collected from March-May 2009. Data sources included interviews (n=59), time and motion study, non-participant observations, documents and field notes. Interviews were conducted individually or in groups using a semi-structured interview guide. Data were analysed within and across the cases to identify similarities and differences in perceptions of team effectiveness. Team members believed the nurse practitioners improved the team's effectiveness. They identified six team processes they believed were improved by the addition of the nurse practitioners to the teams. The processes included decision-making, communication, cohesion, care coordination, problem-solving and focus on patients and families. The study contributes to our understanding of how nurse practitioners affect perceptions of team effectiveness. Improved team communication and care coordination were believed to be particularly important. Nurse practitioner can facilitate patient- and family-centred care in healthcare teams. Nurse practitioners improve perceptions of team effectiveness. Further work is needed in different contexts and with patients and families to determine their perceptions of team effectiveness. The nurse practitioner role was believed to be particularly important to improve team communication and care coordination. This constitutes an added value of acute care nurse practitioners roles in healthcare teams. Nurse practitioner roles contribute to patient-centred care and can improve the quality and safety of the care provided to patients and families.

Acute Care Nurse Practitioner Managed Home Monitoring Program for Patients With Complex Congenital Heart Disease: A Case Study

www.jpedhc.org Although patients with univentricular physiology, the most common manifestation of which is hypoplastic left heart syndrome (HLHS), account for only approximately 3% of all patients with congenital heart disease and only two to three per 10,000 live births in the United States annually, if left untreated, they represent up to 40% of neonatal cardiac deaths (Reller, Strickland, Riehle-Colarusso, Mahle, & Correa, 2008). Just 20 years ago, these patients often were managed with comfort care. With new surgical techniques and improved postoperative management, patients with HLHS today undergo a three-stage surgical palliation during the first 3 to 4 years of life, with an estimated 70% rate of survival to adulthood (Feinstein et al., 2012). The time from first surgical repair at birth to the second stage (the Glenn procedure), which occurs between 3 and 6 months of age, is referred to as the interstage period and carries the highest risk of mortality, with historic rates estimated as high as 20%. The Heart Center at the Lucile Packard Children s Hospital at Stanford has been at the forefront of innovative care for these patients, including early initiation of a nurse practitioner (NP) administered home monitoring program (HMP) to shepherd these infants through the highly vulnerable inter-stage period. In this unique program, the acute care NP role extends beyond inpatientmanagement and includesprovidingongoing telephonic surveillance, directing outpatient nutritional

Understanding acute care nurse practitioner communication and decision‐making in healthcare teams

This paper aims to describe communication and decision-making in healthcare teams following the introduction of an acute care nurse practitioner role. Healthcare teams need to establish clear processes for communication and decision-making about patient care to be effective. Little is known about how acute care nurse practitioners affect these team processes. Observational/descriptive study. Structured non-participant observations of acute care nurse practitioners and healthcare team members during routine patient care activities were completed to identify the verbal and non-verbal behaviours. Data were collected in two hospitals in one Canadian province from March-May 2009 for a total of 17 hours and 23 minutes. Descriptive statistics were generated. Differences in communication and decision-making were noted between the cases. The acute care nurse practitioners in Case 1 spoke most frequently with physicians when making patient care decisions while the acute care nurse practitioners in Case 2 spoke most frequently with the nurses. The acute care nurse practitioners needed to validate all patient care decisions if prescriptive authority had not been transferred to them. Much of the potential of acute care nurse practitioner roles rests on the ability to enact the full scope of their role. Acute care nurse practitioner scope of practice depends on the legislation, the transfer of decision-making authority in the organisation, and the messages received form the medical and nursing leadership group. This appears to be the first in-depth description of communication and decision-making in healthcare teams following the introduction of acute care nurse practitioners and furthers our understanding of how system-level imperatives filter down to healthcare teams. The transfer of prescriptive authority to acute care nurse practitioners affected communication and decision-making and changed the way routine activities were conducted.

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

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.

Boundary work and the introduction of acute care nurse practitioners in healthcare teams

This article is a report of a study of boundary work following the introduction of an acute care nurse practitioner role in healthcare teams. Acute care nurse practitioners enacting their roles in healthcare teams have faced a number of challenges including a mix of positive and negative views of the acute care nurse practitioner role from healthcare team members and acute care nurse practitioner roles crossing the boundaries between the medical and nursing professions. Understanding the process by which the boundaries between professions changed following the introduction of an acute care nurse practitioner role was important since this could affect scope of practice and the team's ability to give patient care. The study was conducted in two university-affiliated teaching hospitals in Canada. A descriptive multiple case study design was used. Data were collected from March to May 2009. Participants (N = 59) described boundary work as a process that included: (1) creating space; (2) loss of a valued function; (3) trust; (4) interpersonal dynamics; and (5) time. The development of trust among team members was essential. The co-location of team members working on common projects, and medical and nursing leadership facilitated boundary work. The micro-level processes of boundary work in healthcare teams have important implications for the development of full scope of practice for acute care nurse practitioners, effective inter-professional teamwork and the integration of new roles in healthcare systems. Future research needs to be undertaken in different contexts, and with patients and families.

Cardiology Nurse Practitioners

Background. The role of the acute care nurse practitioner (ACNP) evolved as a response to a reduction in the health care workforce and the increased acuity of illness in hospitalized patients. Objective. This article reviews the purpose of the ACNP role at a university medical center in the specialty area of cardiology. An overview of role development as well as expansion of the role in the division of cardiology at The Mount Sinai Hospital in New York City, where there are currently more than 200 NPs now employed, is discussed. The responsibilities of the Cardiology Telemetry NP service are reviewed, including discussion of physician satisfaction with the collaborative clinical decision-making process. Conclusion. The role of the cardiology NP has evolved as a result of a focused effort at expanding the care provided by NPs to patients in cardiology. Clinical Implications. Strategies used by this service may be used in other departments to promote the development of the ACNP role, including garnering administrative support, promoting collegial practice relationships with medical departments, demonstration of advance knowledge and skills, and professional role modeling.

The Acute Care Nurse Practitioner Role in Canada

The acute care nurse practitioner (ACNP) role was developed in Canada in the late 1980s to offset rapidly increasing physician workloads in acute care settings and to address the lack of continuity of care for seriously ill patients and increased complexity of care delivery. These challenges provided an opportunity to develop an advanced practice nursing role to care for critically ill patients with the intent of improving continuity of care and patient outcomes. For this paper, we drew on the ACNP-related findings of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing. The synthesis revealed that ACNPs are working in a range of clinical settings. While ACNPs are trained at the master's level, there is a gap in specialty education for ACNPs. Important barriers to the full integration of ACNP roles into the Canadian healthcare system include lack of full utilization of role components, limitations to scope of practice, inconsistent team acceptance and funding issues. Facilitators to ACNP role implementation include clear communication about the role, with messages tailored to the specific information needs of various stakeholder groups; supportive leadership of healthcare managers; and stable and predictable funding. The status of ACNP roles continues to evolve across Canada. Ongoing leadership and continuing research are required to enhance the integration of these roles into our healthcare system.

Detraumatizing Nurse Practitioner Orientation

Health care reform and legislation of restricted resident work hours lead to the evaluation and the changes in health care delivery. In the early 1990s, the Acute Care Nurse Practitioner role evolved to fill the care gaps created by these changes. As the numbers and opportunities for nurse practitioners (NPs) in tertiary settings continue to increase, how to successfully integrate these providers into the health care setting becomes more of a challenge with limited published assimilation models to provide guidance. With few role models, the responsibility of integration is left in the hands of novice NPs, hospital administrators, or physician colleagues. The purpose of this article was to outline orientation, implementation, and evaluation strategies to optimize the transition of trauma NP into the inpatient setting.

Praxis and the role development of the acute care nurse practitioner

Acute care nurse practitioner roles have been introduced in many countries. The acute care nurse practitioner provides nursing and medical care to meet the complex needs of patients and their families using a holistic, health-centred approach. There are many pressures to adopt a performance framework and execute activities and tasks. Little time may be left to explore domains of advanced practice nursing and develop other forms of knowledge. The primary objective of praxis is to integrate theory, practice and art, and facilitate the recognition and valuing of different types of knowledge through reflection. With this framework, the acute care nurse practitioner assumes the role of clinician and researcher. Praxis can be used to develop the acute care nurse practitioner role as an advanced practice nursing role. A praxis framework permeates all aspects of the acute care nurse practitioner's practice. Praxis influences how relationships are structured with patients, families and colleagues in the work setting. Decision-makers at different levels need to recognize the contribution of praxis in the full development of the acute care nurse practitioner role. Different strategies can be used by educators to assist students and practitioners to develop a praxis framework.

The evolving role of the acute care nurse practitioner in critical care

The newest nurse practitioner role is the acute care nurse practitioner. This paper presents the latest data on the role from both a US and international perspective. Now present in the USA for at least 15 years, the acute care nurse practitioner role has become well established in critical care settings and is moving into international healthcare. The few outcome studies conducted to date demonstrate the acute care nurse practitioner provides quality patient and family care, improves patient satisfaction, is cost effective, and is an answer to the hospital's shortage of medical residents with new restrictions on working hours. The role of acute care nurse practitioners in critical care is increasing worldwide. Most countries are experimenting with this latest nurse practitioner as an extended-role healthcare provider with many potential benefits to patients and their families, as well as the healthcare system.

Acute Care Nurse Practitioner Practice: Results of a 5-Year Longitudinal Study

The role of acute care nurse practitioners (ACNPs) has developed in capacity. More than 3500 advanced practice nurses have been certified as ACNPs, and the number of practice settings where these professionals work is continually expanding. Beginning in 1996, a series of surveys were conducted of nurse practitioners seeking national certification as ACNPs. What started as an attempt to gather information on the role of ACNPs evolved into a national 5-year longitudinal survey of ACNP practice. The cumulative results of the project are reported, and how the role of the ACNP was established in advanced practice nursing is discussed.

Longitudinal survey of acute care nurse practitioner practice: year 2.

The acute care nurse practitioner (ACNP) is a unique advanced practice nursing role that has expanded since the first national certification examination became available in 1995. This article reports on the results of year 2 of an annual survey of ACNPs as part of a 5-year longitudinal study exploring ACNP role development. Responses from 545 ACNPs 2 years after national certification reveal continued development and challenges in practice. Role components continue to highlight the comprehensive care model of ACNP practice in terms of coordination of patient care, interactions with family members, consultation, and discharge planning. Important issues identified by participants including the need for clinical experience, the importance of negotiation, and networking also are discussed.

Organizational Factors Influencing Nurse Practitioners' Role Implementation in Acute Care Settings

The purpose of this study was to explore the influence of organizational factors on the Acute Care Nurse Practitioner (ACNP) role implementation. A descriptive correlational design, incorporating quantitative and qualitative methods for data collection was used. The sample of convenience consisted of 57 ACNPs assigned to various medical and surgical programs within acute care hospitals. Ten ACNPs participated in the unstructured qualitative interviews. In addition to the interviews, data pertinent to various organizational factors, including role formalization, receptivity of the role by others, perceived autonomy, role strain, and additional factors that may interfere with role implementation, were collected through a self-report structured questionnaire. A four-diary day was completed to gather data on role implementation. Descriptive and correlational statistics were used to analyze the quantitative data. The qualitative data were content analyzed. The ACNPs engaged most frequently in activities reflective of the clinical practice component of the role and less frequently in the non-clinical components (i.e., education, administration, and research). Results of the quantitative and qualitative analyses indicated that lack of formal clear job description, conflicting demands and expectations, lack of receptivity of the role by others, lack of autonomy, and increased workload were negatively correlated with the ACNP role implementation. The ACNP role implementation varies across practice settings. This variability should be accounted for when examining outcomes of ACNP care.

Evaluation of an Advanced Health Assessment Course for Acute Care Nurse Practitioners

The Acute Care Nurse Practitioner (ACNP) role is being implemented in many centres in Canada. Administrators need to be aware there are very few universities in Canada that prepare ACNPs for advanced health assessment. Therefore, a need may exist for continuing education in the work environment. The ACNPs in London, Ontario recognized such a need, and developed and implemented an Advanced Health Assessment Course using available resources, and administrators supported participation in the course. A pre-post course evaluation based on Bandura's Self-Efficacy theory (1997) was performed. From pre-test to post-test there were significant increases in: (a) the use of health assessement skills; (b) confidence in performing these skills; and (c) confidence in recognizing abnormalities on health assessment. The reasons most often cited for infrequent skill use were "inappropriate to clinical setting" and "used only if problem suspected". The majority of participants agreed that the course met their needs. Implications for practice include administrative support for continuing education at other centres to enhance health assessment skills of ACNPs.

Advanced practice nursing role delineation in acute and critical care: Application of the Strong Model of Advanced Practice

Purpose: This purpose of this study was to differentiate between the roles of clinical nurse specialists and acute care nurse practitioners. Background and Significance: Hypothesized blending of the clinical nurse specialist and acute care nurse practitioner roles is thought to result in an acute care clinician who integrates the clinical skills of the nurse practitioner with the systems knowledge, educational commitment, and leadership ability of the clinical nurse specialist. Ideally, this role blending would facilitate excellence in both direct and indirect patient care. The Strong Model of Advanced Practice, which incorporates practice domains of direct comprehensive care, support of systems, education, research, and publication and professional leadership, was tested to search for practical evidence of role blending. Methods: This descriptive, exploratory, pilot study included subjects (N = 18) solicited from an academic medical center and from an Internet advanced practice listserv. Questionnaires included self-ranking of expertise in practice domains, as well as valuing of role-related tasks. Content validity was judged by an expert panel of advanced practice nurses. Results: Analyses of descriptive statistics revealed that clinical nurse specialists, who had more experience both as registered nurses and in the advanced practice nurse role, self-ranked their expertise higher in all practice domains. Acute care nurse practitioners placed higher importance on tasks related to direct comprehensive care, including conducting histories and physicals, diagnosing, and performing diagnostic procedures, whereas clinical nurse specialists assigned greater importance to tasks related to education, research, and leadership. Conclusions: Levels of self-assessed clinical expertise as well as valuing of role-related tasks differed among this sample of clinical nurse specialists and acute care nurse practitioners. Groundwork has been laid for continuing exploration into differentiation in advanced practice nursing roles. Implications: As the clinical nurse specialist role changes and the acute care nurse practitioner role emerges, it is imperative that advanced practice nurses describe their contribution to health care. Associating advanced practice nursing activities with outcomes will help further characterize these 2 advanced practice roles. (Heart Lung® 2000;29:210-21.)

Reports of role descriptions of acute care nurse practitioners.

Expanded roles and practice settings are evolving for the Acute Care Nurse Practitioner (ACNP). In this study, the ACNP's role is described by 384 people seeking certification. Although ACNPs continue to work predominantly in tertiary care centers, ACNP roles in secondary and other facilities have emerged. Acute care nurse practitioners report that managing patient care; providing care consistency; interacting with family members; planning for patient discharge; and teaching the patient, family, and other members of the health care team are major focuses of the role. Changes in health care will continue to give rise to new and innovative settings for ACNP practice. Communication about the ACNP remains essential to gaining acceptance of the role and enabling its expansion.

Integrating the acute care nurse practitioner into clinical practice: strategies for success.

As the role of the Acute Care Nurse Practitioner (ACNP) gains more recognition, ACNPs as well as prospective employers are eager to incorporate the position into a practice setting. Because the role is in its infancy, there has been limited experience from which to draw on to provide guidance in ACNP role implementation within a practice, either private or institutional. This article will provide foundational information and strategies on how to integrate the ACNP role into a practice setting. These strategies will be useful to not only the ACNP, but also nurse administrators, case managers, clinical nurse specialists, and nurse educators in acute and critical care who are responsible for seeking innovative ways to maintain seamless quality and cost-effective patient care.