Acute Care Nurse Practitioner Research Articles

Use of Adult Gerontology Acute Care Nurse Practitioners on a Neurocardiology Team

The neurocardiology team provides innovative, evidence-based care for patients with cryptogenic stroke, stroke associated with a patent foramen ovale, and atrial fibrillation-related stroke in patients unsuitable for long-term anticoagulation. Considerable evidence supports the value of advanced practice registered nurses on process improvement metrics and clinical outcomes; however, current literature in stroke management almost exclusively emphasizes interdisciplinary collaboration between physicians. This clinical feature discusses ways in which the adult gerontology acute care nurse practitioner can aid in the delivery of evidence-based stroke care and contribute to educational, administrative, and research missions as a collaborative member of a multidisciplinary neurocardiology team.

Acute Care Nurse Practitioner: Collaboration in a Postpandemic World.

Acute Care Nurse Practitioner: Collaboration in a Postpandemic World.

Interprofessional teams with and without nurse practitioners and the level of adherence to best practice guidelines in cardiac surgery: A retrospective study.

To examine the level of adherence to best-practice guidelines of interprofessional teams with acute care nurse practitioners (ACNPs) compared to interprofessional teams without ACNPs. A retrospective observational study was conducted in 2023. A retrospective cohort was created including 280 patients who underwent a coronary artery bypass graft and/or a valve repair and hospitalised in a cardiac surgery unit of a university affiliated hospital in Québec (Canada) between 1 January 2019 to 31 January 2020. The level of adherence to best-practice guidelines was measured from a composite score in percentage. The composite score was created from a newly developed tool including 99 items across six categories (patient information, pharmacotherapy, laboratory tests, post-operative assessment, patient and interprofessional teams' characteristics). Multivariate linear and logistic regression models were computed to examine the effect of interprofessional teams with ACNPs on the level of adherence to best-practice guidelines. Most of the patients of the cohort were male and underwent a coronary artery bypass graft procedure. Patients under the care of interprofessional teams with ACNP were 1.72 times more likely to reach a level of adherence higher than 80% compared to interprofessional teams without ACNPs and were 2.29 times more likely to be within the highest quartile of the scores for the level of adherence to best-practice guidelines of the cohort. This study provides empirical data supporting the benefits of ACNP practice for patients, interprofessional teams and healthcare organisations. Our findings identify the important contributions of interprofessional teams that include ACNPs using a validated instrument, as well as their contribution to the delivery of high quality patient care. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies guidelines. No patient or public contribution.

Implementation and Evaluation of an End-of-Life Standardized Participant Simulation in an Adult/Gerontology Acute Care Nurse Practitioner Program.

Graduate nursing programs must provide end-of-life (EOL) content to prepare nurse practitioners to manage the holistic needs of patients. This project aimed to measure the End-of-Life Nursing Education Consortium curriculum's impact on student self-confidence and anxiety levels. A pretest/posttest study design was implemented using an EOL simulation and the Nursing Anxiety and Self-Confidence With Clinical Decision-Making Scale (NASC-CDM©) to compare baseline self-confidence and anxiety levels related to clinical decision-making. Results showed that the simulation increased student self-confidence, but anxiety level remained unchanged. Nurse educators should consider incorporating EOL simulation into graduate curricula to improve student confidence with clinical decision-making.

Bridging the gap: Implementing a pilot radiology-focused curriculum in an acute care Nurse Practitioner program.

Knowledge in diagnostic radiology and performance of point-of-care ultrasound are integral to acute care nurse practitioners (ACNPs) in the inpatient settings, especially true in specialty areas such as interventional radiology and critical care. However, existing ACNP training programs, including at our institution, often lack robust relevant course content. To address this educational gap, we designed and implemented a pilot acute care radiology course, incorporating a flipped classroom approach and hands-on simulation activities led by expert faculty. Our course evaluation revealed high levels of student satisfaction, self-reported confidence, and perceived course effectiveness. The course aligns with key competencies outlined by the American Association of Colleges of Nursing, demonstrating its potential to advance ACNP education in radiology content.

Incorporating Considerations for the Obstetric Patient in Acute Care Nurse Practitioner Curriculum.

Brower, Jennifer DNP, APRN, ACNP-BC, CCRN; Luebcke, Caitlin DNP, APRN, AGACNP-BC, AGNP-C, CCRN Author Information

Bridging the Gap Between Practicing Nurse Practitioners and Adult-Gerontology Acute Care Nurse Practitioner Post-Master’s Curriculum

The job growth for nurse practitioners (NPs) will exponentially grow by 2026 as registered nurses transition into this advanced practice role. Education is aligning with scope of practice. Although practice readiness has been looked at in the literature for new graduate nurses and new graduate NPs, the literature is lacking when describing practice readiness for NPs currently in practice who are back for a post-master’s certificate. This report describes the concept of practice readiness and how one school successfully prepares its students for clinical practice using a multimodal approach of didactic, simulation, and case-based learning.

Ethics: Crisis Standards of Care Simulation.

Ethical dilemmas exist with decision-making regarding resource allocations, such as critical care, ventilators and other critical equipment, and pharmaceuticals during pandemics. Triage artificial intelligence (AI) algorithms based on prognostication tools exist to guide these decisions; however, implicit bias may affect the decision-making process leading to deviation from the algorithm recommendations. Conflict within the ethical domain may be affected as well. A knowledge gap was identified within the Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) curriculum regarding ethics in crisis standards of care (CSC) medical decision-making. Incorporating a CSC simulation looked to address this knowledge gap. A simulation-based learning (SBL) experience was designed as a critical access setting where CSC are in place and three diverse, medically complex patients in need of critical care present to the hospital where one critical care bed remains open. Given the complexity of the simulation scenario, a table-top pilot test was selected. Three AG-ACNP fourth-quarter students in their critical care rotation volunteered for the pilot test. Students were provided with the topic, "ethics crisis standards of care" and the article, "A catalogue of tools and variables from crisis and routine care to support decision-making during pandemics" by M. Cardona et al. (2021), to read in advance. Students were provided with the triage AI algorithm (M. Cardona et al., 2021) utilizing prognostication tools to prioritize which patient requires the critical care bed. The expectation was that implicit bias would enter the decision-making process, causing deviation from the triage AI algorithm and moral distress. The debriefing session revealed that students deviated from the triage AI algorithm, experienced implicit bias, moral distress, and utilized clinical judgment and experience to care for all three patients. The pilot test results support that a CSC SBL experience addresses a critical knowledge gap in AG-ACNP education and an SBL experience incorporating ethical decision-making curriculum with standardized patients should be developed and trialed as the next step.

The Perspectives of Advanced Practice Provider Directors on Acute Care Nurse Practitioner Alignment and Hiring.

Demand for acute care is forecasted to grow in the United States. To meet this demand, nurse practitioners (NPs) are increasingly employed in acute care settings. Yet, there is concern about an adequate supply of acute care NPs given demand. Further, professional nursing organizations recommend aligning an NP's role with their education, certification, licensure, and practice. Given workforce constraints and the policy environment, little is known about how hospitals approach hiring NPs for acute care roles. The purpose of this study was to explore advanced practice provider (APP) directors' approaches to hiring NPs within the context of alignment and describe factors that influence hiring decisions. We conducted semi-structured interviews with 17 APP directors in hospitals and health systems. Interviews were recorded, transcribed, and coded using an iterative, hybrid inductive and deductive method. Two themes emerged: (1) local factors that inform aligned hiring and (2) adaptive hiring responses to changing environments. Practices around hiring NPs varied across institutions influenced by organization and state policies and regulations, workforce availability, and institutional culture. Most APP directors recognized trends towards hiring aligned NPs for acute care roles. However, they also identified barriers to fully aligning their NP workforce and described adaptive strategies including hiring physician assistants, building relationships with APP schools, and leveraging hospital resources to develop the APP workforce to meet care delivery demands given the current NP workforce supply. Future research is needed to assess widespread practices around acute care NP alignment and the implications of alignment for patient and organizational outcomes.

Acute Care Interprofessional Event Improved Knowledge, Attitudes, and Practices of Athletic Training and Nurse Practitioner Students

Objective In this study, we sought to assess the changes in the knowledge, attitudes, and practices (KAP) of athletic training program (ATP) and nurse practitioner (NP) graduate students before and after an acute care interprofessional education (IPE) workshop. Design and Setting This was a descriptive KAP survey to be taken by participants before and after the IPE event. This survey was administered using a QR code that participants scanned. The study occurred at the University of Central Florida College of Nursing before and after acute care skills were taught and practiced by each program’s students. Patients or Other Participants A total of 35 students from a professional master’s ATP and an adult gerontology acute care NP program were present at the workshop. Thirty-two students took the preworkshop survey, while 30 students completed the postworkshop survey. Main Outcome Measure(s) In this study, we aimed to measure the change in perceptions about the knowledge, skills, teaching, and IPE understanding of each respective program after the educational workshop. Surveys were distributed before the IPE workshop and then again after the workshop concluded. The survey responses were scored on a 5-point Likert scale. Scores for each section were averaged, and statistical analysis was done using repeated measures analyses of variance for total and subsection scores for both programs. Results A significant increase was found for each group in IPE understanding, knowledge, skills, and teaching scoring (P < .05) with moderate to large effect sizes. Conclusions Participating in this acute care IPE workshop showed significant increases in perceptions of the KAP among ATP and NP students.

ACNPs inthe U.S. Army-Medical Force Multipliers forLarge-Scale Combat Operations.

Operations in the Middle East have slowed, and near-peer tensions escalate. The U.S. Military has directed its attention from combating insurgencies toward preparedness for large-scale combat operations (LSCOs). The threat of LSCO demands a dramatic shift in strategy and resource and has raised questions about how the military will pivot from the counter-insurgency operations of the previous two decades. Innovation and change are needed to adequately receive, treat, hold, and transport the high volume of anticipated casualties in LSCO. Review of the current deployed medical structure has identified needs to increase emergency medical capabilities near the point of injury, increase patient holding capacity (particularly in critical care) in field hospitals and expeditionary medical facilities, and address likely delayed and prolonged medical evacuation. To address these new challenges, the authors offer recommendations for the addition of Acute Care Nurse Practitioners (ACNPs) to the U.S. Army Medical Department. ACNPs are advanced practice providers, specialized in acute and critical care. ACNPs are a potential medical force multiplier not currently utilized in the U.S. Army. If adapted, ACNPs could contribute significantly to meeting the demands of LSCO medical needs via multiple roles. Recommendations are provided by the authors, such as utilizing the ACNP within the Forward Resuscitative Surgical Detachment, Field Hospital intensive care unit, aeromedical evacuation, and/or Prolonged Care Augmentation Detachment. With support from the U.S. Army Nurse Corp and Army Medical Department, ACNPs could be integrated into the Army healthcare model, emulating the civilian standard of care for every soldier deployed. Furthermore, use of ACNPs in theater could advance deployed medical capabilities and help conserve the fighting force of the U.S. Military and its partners.

The Heart of Cardiovascular Disease in Women

Heart disease is the leading cause of death (LCOD) for both men and women in the United States and kills approximately 1 in every 4 women. 1 Tsao C.W. Aday A.W. Almarzooq Z.I. et al. on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation. 2023; 147: e93-e621https://doi.org/10.1161/CIR.0000000000001123 Crossref PubMed Scopus (57) Google Scholar Despite widespread dissemination of staggering statistics, focused interventions, and national advocacy campaigns promoting cardiovascular disease (CVD) awareness, it is reported that only 45% to 56% of women identify CVD as the LCOD. 2 Bairey Merz C.N. Andersen H. Sprague E. et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women's Heart Alliance. J Am Coll Cardiol. 2017; 70: 1106-1107https://doi.org/10.1016/j.jacc.2017.07.721 Crossref Scopus (0) Google Scholar Also troubling is the downward trend of women identifying CVD as the LCOD as reported in the 2019 American Heart Association survey in which the percent dropped from 64.8% in 2009 to only 43.7% in 2019. 3 Cushman M. Shay C.M. Howard V.J. et al. Ten-year differences in women's awareness related to coronary heart disease: results of the 2019 American Heart Association National Survey: a special report From the American Heart Association. Circulation. 2021; 143: e239-e248https://doi.org/10.1161/CIR.0000000000000907 Crossref PubMed Scopus (85) Google Scholar Previously excluded from clinical studies that inform best practice guidelines today, women continue to face historically rooted gender inequities resulting in suboptimal screening, inaccurate risk stratification, and a delay in diagnosis and management. 2 Bairey Merz C.N. Andersen H. Sprague E. et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women's Heart Alliance. J Am Coll Cardiol. 2017; 70: 1106-1107https://doi.org/10.1016/j.jacc.2017.07.721 Crossref Scopus (0) Google Scholar ,4 Shaw L.J. Pepine C.J. Xie J. et al. Quality and equitable health care gaps for women: attributions to sex differences in cardiovascular medicine. J Am Coll Cardiol. 2017; 70: 373-388https://doi.org/10.1016/j.jacc.2017.05.051 Crossref PubMed Scopus (69) Google Scholar Women experience gender and sex-mediated risk factors for CVD and are disproportionally affected by traditional risk factors because of physiologic differences. 5 Cho L. Davis M. Elgendy I. et al. Summary of updated recommendations for primary prevention of cardiovascular disease in women: JACC state-of-the-art review. J Am Coll Cardiol. 2020; 75: 2602-2618https://doi.org/10.1016/j.jacc.2020.03.060 Crossref PubMed Scopus (104) Google Scholar Although this is well-documented in the health care literature, nurse practitioners (NPs) and other clinicians report a lack of high-level confidence and comfort in screening women who may be at risk for CVD. 2 Bairey Merz C.N. Andersen H. Sprague E. et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women's Heart Alliance. J Am Coll Cardiol. 2017; 70: 1106-1107https://doi.org/10.1016/j.jacc.2017.07.721 Crossref Scopus (0) Google Scholar ,4 Shaw L.J. Pepine C.J. Xie J. et al. Quality and equitable health care gaps for women: attributions to sex differences in cardiovascular medicine. J Am Coll Cardiol. 2017; 70: 373-388https://doi.org/10.1016/j.jacc.2017.05.051 Crossref PubMed Scopus (69) Google Scholar Catherine Nadeau, DNP, APRN, FNP-BC, CNE, is an assistant professor and concentration director of the Family Nurse Practitioner Program at the University of South Florida in Tampa. Dr Nadeau can be reached at [email protected] Christina Cardy, DNP, APRN, AGACNP-BC, is an assistant professor and concentration director of the Adult Gerontology Acute Care Nurse Practitioner Program at the University of South Florida. Elizabeth Remo, DNP, APRN, FNP-BC, is an assistant professor at the University of South Florida. Anthony W. McGuire, PhD, ACNP-BC, ACNPC, FAHA, is an associate professor at the University of South Florida. Andrea Efre, DNP, APRN, ANP, FNP-C, is an assistant professor at the University of South Florida. Christina Bricker, PhD, APRN, FNP-BC, FAHA, is an associate professor at the University of South Florida.

Development of the Acute Care Nurse Practitioner Competencies Scale: An Exploratory and Confirmatory Factor Analysis.

Nurse practitioners (NPs) play a vital role in healthcare, particularly in acute care settings in Taiwan. The professional competencies of NPs are essential for providing safe and effective care to patients. To date, no measurement tool is available for assessing the clinical competencies of NPs in acute care practices. The aim of this study was to develop and investigate the psychometric properties of the Acute Care Nurse Practitioner Competencies Scale (ACNPCS). Mixed-method research was employed using samples of experienced NPs. First, we used a focus group of seven experienced NPs who worked for medical centers, community hospitals, and regional hospitals to identify clinical competencies content. Second, we implemented consensus validation using two rounds of the Delphi study and revised it to a 39-item ACNPCS. Third, we conducted content validity with nine NP experts and modified the competency content to 36 items. Finally, we conducted a national survey of 390 NPs from 125 hospitals to determine the extent to which the NP competency content relates to their clinical practice. To examine the reliability of the tool, we tested the internal consistency reliability and test-retest reliability. Exploratory factor analysis, confirmatory factor analysis, and known-group validity were used to test the construct validity of the ACNPCS. The Cronbach's alpha coefficient for the overall scale was .92, with subscale coefficients ranging from .71 to .89. Test-retest reliability showed the two scores of the ACNPCS on the two occasions tested to be highly correlated (r = .85, p < .001). Exploratory factor analysis revealed that the scale had six factors: providing healthcare, evaluating care, collaboration, education, care quality/research, and leadership/professionalism. Factor loadings for each factor item ranged from .50 to .80 and explained 72.53% of the total variance in the NPs' competencies. Confirmatory factor analysis indicated that the six-factor model showed satisfactory model fit (χ2 = 780.54, p < .01), and the fit indices met the standards for adequate fit (goodness-of-fit index = .90, comparative fit index = .98, Tucker-Lewis index = .97, root mean square error of approximation = .04, and standardized root mean residual = .04). Known-group validity revealed that the total scores for novice NPs differed significantly from those of expert NPs in terms of the competencies (t = 3.26, p < .001). These results validated the psychometric soundness of the newly developed ACNPCS. The newly developed ACNPCS exhibited satisfactory reliability and validity, supporting the use of the ACNPCS as a tool to assess the clinical competencies of NPs in acute care settings.

Artificial intelligence: Opportunities and challenges in NP education.

Keri Draganic is the Director of the Adult-Gerontology Acute Care Nurse Practitioner Program at The University of Texas at Arlington College of Nursing & Health Innovation, Arlington, Tex. Acknowledgments: ChatGPT was instrumental in generating ideas and outlining key points pertaining to its use in NP education for this Guest Editorial. ChatGPT also provided suggestions for presenting information more efficiently while maintaining the core message.

Role of Mentorship in the Transition From Registered Nurse to Acute Care Nurse Practitioner in the Cardiothoracic Intensive Care Unit

Role of Mentorship in the Transition From Registered Nurse to Acute Care Nurse Practitioner in the Cardiothoracic Intensive Care Unit

The state of acute care postgraduate training: Faculty observations

The benefits to postgraduate training programs (PTPs) for nurse practitioners (NPs) in all populations are being well established in the literature. As health care systems and teams evolve, acute care NPs (neonatal, pediatric, and adult-gerontology) are providing more specialized care to increasingly complex patients. As educators and clinicians, we recognize that acute care PTPs are playing an important role in preparing NPs to work to the top of their scope and training. This article provides our perspectives on the merits of PTPs for adult-gerontology acute care NPs and provides guidance for counseling NPs who are interested in acute care PTPs.

Noninvasive diagnostic modalities for the diagnosis of coronary artery disease: A guide for acute care NPs.

Selecting noninvasive diagnostic tests for coronary artery disease can be a daunting task to acute care NPs. This article provides an overview of the pathophysiology of coronary artery disease, relevant noninvasive diagnostic imaging modalities, and an evidence-based approach to guide subsequent diagnostic and therapeutic interventions.

Noninvasive diagnostic modalities for the diagnosis of coronary artery disease: A guide for acute care NPs.

Noninvasive diagnostic modalities for the diagnosis of coronary artery disease: A guide for acute care NPs.

Adult-Gerontology Nurse Practitioners: A Discussion of Scope and Expertise

Adult-gerontology primary care nurse practitioners (NPs) deliver longitudinal primary care in outpatient settings from adolescence to older adulthood, and adult-gerontology acute care NPs provide care to critically ill adults and older adults. Family NP programs vastly outnumber adult-gerontology NP programs nationwide, despite a rapidly aging population. This report discusses the differences in education and scope of practice of adult-gerontology primary care NPs, adult-gerontology acute care NPs, and family NPs and highlights the crucial and unique assets adult-gerontology NPs bring to any health care system or practice. Differences in competencies, certification examinations, and practice settings are discussed in depth.

Preparing Adult Gerontology Acute Care Nurse Practitioner Students for Role Transition Through Hospital Immersion

The study explored adult gerontology acute care nurse practitioner (AGACNP) student’s self-perception of confidence and competence in essential domains of nurse practitioner (NP) skills. A preclinical hospital immersion experience was developed to improve transition to the ACACNP role. AGACNP students participated in once-weekly sessions for 3 consecutive weeks, with 14 students completing the experience over a 3-year period. Data showed a 28.7% improvement in student’s self-perception of confidence and competence, with statistically significant improvement in clinical decision-making skills and NP role. AGACNP students requested additional days and appreciated direct faculty feedback, while faculty efficiently supported AGACNP role transition.