Advanced Practice Competencies Research Articles

Why Pursue a Doctorate? Findings From a Study of Doctorally Prepared RNs in an Integrated Healthcare System.

The aim of this study was to examine the motivations and perceptions of RNs with completed doctorates in an integrated healthcare system. Historically, PhD preparation was the primary doctorate available for nurses, preparing them to conduct research and hold leadership positions. The recent growth of Doctor of Nursing Practice (DNP) programs that focus on either advanced clinical practice or executive competencies has significant implications for the future of nursing in practice settings. A 30-item survey was sent to all 93 RNs at a healthcare system who have completed doctorates. A response rate of 71% found DNPs outnumber PhDs 3 to 1. PhDs are significantly more likely to perceive concrete benefits associated with their degrees, and DNPs are more likely to report that their degrees have not made a difference in their jobs. Leaders in practice and education must collaborate to ensure that both DNPs and PhDs are engaged in positions that use their highest level of competence in any setting.

Incorporating the Transitional Care Model within NP program curricula to achieve care coordination competency

PurposeEducation for nurse practitioners (NPs) requires knowledge and skill acquisition for managing transitions in care, especially among older adults with complex care needs. A team of nurse researchers and educators provided a competency-based approach for educating future NPs on the care delivery of older adults using the Transitional Care Model's (TCM) evidence-based interventions. MethodsNP faculty integrated an online course offering didactic teaching that would enhance clinical learning. The online content included a case study of an NP navigating an older adult through transitions in care. Students completed evidence-based interventions with patients while in their clinical rotations. ResultsUsing the structured and purposeful interventions within the clinical practicum provided exposure to and experience with the application of the model's nine components. NP students applied knowledge and demonstrated skills through direct care experiences in the clinical setting. This learning supports the achievement of advanced nursing practice competencies depicted in the American Association of Colleges of Nursing (AACN)'s The Essentials: Core Competencies for Professional Nursing Education (2021). ConclusionsThis is one example of how a NP program integrates evidence-based interventions to ensure that NP graduates are well-positioned and ready for managing transitions of complex care for older adults.

Competency-Based Education: Developing an Advanced Competency Framework for Indonesian Pharmacists.

Introduction: Pharmacists need to be adaptable, flexible, and capable of advancing their practice to adapt to rapidly changing population health needs. We describe an educational approach to pharmacy workforce transformation in Indonesia through an advanced practice competency framework development using an “adopt and adapt” methodology.Methods: The competency framework development process comprised a translation phase, an adopt and adapt phase, validation through a nationwide mapping survey, and a completion phase through leadership consensus panels. We conducted a forward-backwards translation of a previously validated Advanced to Consultancy Level Framework (ACLF) to yield the Indonesian Advanced Development Framework (IADF) draft. The subsequent adoption and adaptation process was conducted through a series of consensus panels. We validated the IADF through a nationwide workforce survey. The final phase included leadership consensus panels with the professional leadership body in Indonesia. We analyzed the qualitative data thematically and the quantitative data using a Multiple Correspondence Analysis (MCA) technique.Results: We identified conceptual challenges in adopting and adapting the existing ACLF, which were addressed by providing a national glossary and concrete examples. A total of 6,212 pharmacists participated in the national workforce survey, of which 43% had <2 years of post-license (post-registration) experience. The MCA results showed that practitioner self-assessment to the IADF could discriminate their career development stages. The results also indicated a four-stage career model (including early years career training). Embedding this model in a structured national training program will enhance the professional workforce development through a more structured career journey.Conclusions: We describe the first validation of an advanced competency development framework for the pharmacy workforce in a non-Anglophone country, showing the possibility of transnational applicability of this framework. We argue that this methodology can be used in Low and Middle-income countries (LMICs) for the more rapid advancement of pharmaceutical care practice.

A critical review of the development of advanced practice competency frameworks and their contribution to autonomous practice

A critical review of the development of advanced practice competency frameworks and their contribution to autonomous practice

A Tool to Guide Clinical Nurse Specialist Orientation, Professional Development, and Evaluation.

Currently, orientation for clinical nurse specialists (CNSs) in the Baltimore region is based on past practices: facility-specific or position-specific. A Chesapeake Bay affiliate work group identified a need to develop a theory-driven, competency-based program and tool to guide orientation and ongoing professional development reflecting the scope of CNS practice. The tool incorporates Benner's concepts of novice-to-expert competence levels, guides progressive development of the CNS, and has relevant assessment metrics that highlight contributions to the patient, nurse, and system. The group developed a comprehensive orientation tool grounded in the spheres of influence and advanced practice competencies and specific, measurable behavioral statements related to competencies from the 2018 National Association of Clinical Nurse Specialists' draft. This program is adaptable to guide the practice of a CNS in any facility, validate competence, and relate to those with varied experience in the role. In a method similar to the process for developing nationally recognized educational standards used to develop the competencies, the program was revised based on an iterative, stepwise process. It was distributed to the membership for evaluation and feedback, which was incorporated into the final version.

Developing Quality Social Work Field Placements in Dialysis Clinics

Dialysis clinics provide rich field placement settings for social work students. In this article, field placements for advanced practice MSW students are carefully examined, as they are best suited to work with patients on a higher clinical level. This article also provides an outline of how advanced practice competencies can be applied in such settings with attention to supervision and the role of the field instructor.

Knowledge and Perspectives of Postgraduate Nurses regarding competency of Advanced Nursing Practice in Kurdistan Region of Iraq

Background and objectives: Advanced nursing practice (ANP) involves integration role domains, which are related to clinical practice, education, research, professional development and organizational leadership. The objectives of this study were to assess the knowledge and perspective of graduated nurse regarding competency of advanced nursing practice and explain the domains of advanced nursing practice competency. Methods: This cross-sectional study sought to determine knowledge and perspective of graduated nurses regarding advanced nursing practice in Kurdistan region from 20th June 2014 to 20th December 2014. Nurses who held degrees including Master of Science, and Philosophy of Doctorate or both were invited to participate. One hundred and fifty participants met the inclusion criteria, and 50 completely responded to the questionnaire. Data were analyzed by using Statistical Package for the Social Sciences (SPSS) Version (20). Results: The total 50 of interviewed participants responded to the survey, with 24 (48%) considering that an ANP should have autonomy in clinical practice. While 28 (56 %) and 35 (70 %) of participants mentioned that an ANP should be able to manage complexity throughout clinical placement. Conclusion: Considerable number of participants in this study did not have adequate and satisfactory knowledge regarding advanced nursing practice.

Nurses’ Knowledge Regarding Heart Failure Education Principles in Erbil Teaching Hospital

Background and objective: Heart Failure is a major public health problem often associated with a decreased quality of life and high mortality rate. To optimize the quality of management and support patients to care for themselves in their own homes, they need to be well-educated about all aspects of the heart failure. This study aims to investigate nurses’ knowledge regarding the treatments that can be taught to heart failure patients to improve self-care.Methods: Cross-sectional study, 64 nurses out of 85 working at three public hospitals in Erbil City took part, the data was collected from 15th February to 15th March 2017 through interviews using a questionnaire schedule. The data was analyzed using Statistical Package for the Social Science (SPSS) program version 20.Results: Majority of the participants were young (87.6% within the range of 21-40), male (62.5%), and graduated with a technical diploma (60.9%). More than half of them (53.1%) have between 1–5 years of nursing experience, 50% of the nurses work in the Surgical Speciality Hospital - Cardiac Centre and 43.8% of them have general knowledge of Cardiac care. The majority of participants achieved a good knowledge score (70.3%). There was a significant association between level of knowledge of nurses working in the Surgical Speciality Hospital - Cardiac Centre and Rizgary Teaching Hospital, while few of them are in Hawler Teaching Hospital (53.3%, 26.7% and 20% respectively P <0.002).Conclusion: The study concluded that the nurses have good knowledge score, but still need continuous knowledge and practical training to educate patients regarding heart failure. High level of significance was found between the levels of knowledge and the working area.

International Family Nursing Association Position Statement on Advanced Practice Competencies for Family Nursing

International Family Nursing Association Position Statement on Advanced Practice Competencies for Family Nursing

Development of advanced practice competency standards for dietetics in Australia.

This study aimed to explore the work roles, major tasks and core activities of advanced practice dietitians in Australia to define the Competency Standards for advanced practice. A qualitative approach was used to review advanced dietetic practice in Australia involving experienced professionals, mostly dietitians. Four focus groups were conducted with a total of 17 participants and an average of 20 years experience: 15 dietitian practitioners plus 2 employers (1 dietitian and 1 non-dietitian). The focus groups explored the key purpose, roles and outcomes of these practitioners. Data from the focus groups were confirmed with in-depth interviews about their core activities with a purposive sample of 10 individuals recently recognised as Advanced Accredited Practising Dietitians. Data from both focus groups and interviews were analysed adductively to identify key themes. The key theme that emerged to define advanced dietetics practice was leadership, with four subthemes that described in more detail the major work roles and outcomes of advanced practice. These subthemes identified that advanced practitioners were (i) outcome-focused, having impact; (ii) influence others and advocate; (iii) innovate and embrace change; and (iv) inspire others and are recognised for their practice. These outcomes were conceptualised within a broad generalist framework to generate revised Competency Standards. This study confirmed that leadership rather than specialist practice skills is the key determinant of advanced practice.

Role delineation study of advanced practice nursing, a cross-sectional study of practice domains and trends in role functions

Role delineation study of advanced practice nursing, a cross-sectional study of practice domains and trends in role functions

Pharmacists' self-perceptions in relation to the 'Advanced Pharmacy Practice Framework'.

The Australian Pharmacy Practice Framework was developed by the Advanced Pharmacy Practice Steering Committee and endorsed by the Pharmacy Board of Australia in October 2012. The Steering Committee conducted a study that found practice portfolios to be the preferred method to assess and credential Advanced Pharmacy Practitioner, which is currently being piloted by the Australian Pharmacy Council. Credentialing is predicted to open to all pharmacists practising in Australia by November 2015. To explore how Australian pharmacists self-perceived being advanced in practice and how they related their level of practice to the Australian Advanced Pharmacy Practice Framework. This was an explorative, cross-sectional study with mixed methods analysis. Advanced Pharmacy Practice Framework, a review of the recent explorative study on Advanced Practice conducted by the Advanced Pharmacy Practice Framework Steering Committee and semi-structured interviews (n = 10) were utilized to create, refine and pilot the questionnaire. The questionnaire was advertised across pharmacy-organizational websites via a purposive sampling method. The target population were pharmacists currently registered in Australia. Seventy-two participants responded to the questionnaire. The participants were mostly female (56.9%) and in the 30-40 age group (26.4%). The pharmacists self-perceived their levels of practice as either entry, transition, consolidation or advanced, with the majority selecting the consolidation level (38.9%). Although nearly half (43.1%) of the participants had not seen the Framework beforehand, they defined Advanced Pharmacy Practice similarly to the definition outlined in the Framework, but also added specialization as a requirement. Pharmacists explained why they were practising at their level of practice, stating that not having more years of practice, lacking experience, or postgraduate/post-registration qualifications, and more involvement and recognition in practice were the main reasons for not considering themselves as an Advanced Pharmacy Practitioner. To be considered advanced by the Framework, pharmacists would need to fulfill at least 70% of the Advanced Practice competency standards at an advanced level. More than half of the pharmacists (64.7%) that self-perceived as being advanced managed to fulfill 70% or more of these Advanced Practice competency standards at the advanced level. However, none of the self-perceived entry level pharmacists managed to match at least 70% of the competencies at the entry level. Participants' self-perception of the term Advanced Practice was similar to the definition in the Advanced Pharmacy Practice Framework. Pharmacists working at an advanced level were largely able to demonstrate and justify their reasons for being advanced practitioners. However, pharmacists practising at the other levels of practice (entry, transition, consolidation) require further guidance regarding their advancement in practice.

Social Workers in Combat: Application of Advanced Practice Competencies in Military Social Work and Implications for Social Work Education

This article illustrates the types of situations that U.S. uniformed social workers have experienced in combat deployments to Iraq and Afghanistan with the purpose of preparing current and future social workers to effectively serve military and veteran clients in either military or civilian settings. Vignettes demonstrate the application of the military social work competencies as delineated by the Council on Social Work Education based on the 2008 Educational Policy and Accreditation Standards. Implications for social work education are discussed along with the use of case studies through a problem-based learning approach.

Chief Nursing Officers' Perceptions of the Doctorate of Nursing Practice Degree

Nurse executives practice in a business environment, which requires a skill set that has traditionally not been included in advanced nursing curriculum. The Doctorate of Nursing Practice (DNP) essentials are designed to address this gap in education while maintaining the focus on advanced nursing practice and executive management competency. Current literature supports the appropriateness of the DNP with practice focus areas of advanced practice specialties and nursing leadership. Although certification and educational bodies, and some professional nursing organizations, have embraced the DNP as the terminal degree for non-research-focused nurses, there remains a gap in the literature in regards to the perceptions of validity of the DNP for nurse executives. The purpose of this capstone project was to investigate the perceptions of practicing chief nursing officers (CNOs) in the acute care setting regarding the application of the DNP degree for nurse leaders. Utilizing an online survey, specific perceptions investigated included application and appropriateness of the DNP in a business-based practice model and managing daily nursing operations. CNOs practicing in the acute care setting differed on their responses regarding whether the DNP should be the recommended or the required degree in CNO development programs. CNOs with tenure responded more positively to the perception that the DNP curricula contains advanced nursing knowledge content appropriate to nurse executive practice. Practicing CNOs in the acute care setting do perceive the DNP as an appropriate degree option for nurse executive roles at aggregate, system, and organizational levels.

An Educator's Guide to the Development of Advanced Practice Competencies in Clinical Social Work

The 2008 Educational Policy and Accreditation Standards identified 10 core competencies that all social work graduates should master. MSW programs found themselves with a need to identify knowledge, values, and skill statements that reflected what concentration-year students were expected to know and be able to do. In 2009 a group of educators convened at the Council on Social Work Education in Alexandria, VA to develop a model of advanced practice in clinical social work. This article describes the work group's process; identifies and describes the resulting advanced clinical knowledge, values, and skills statements; discusses the key debates and issues that arose during the development of the statements; and concludes with the implications for social work education and practice.

Euro-American Discussion Document on Entry-Level and Advanced Practice in Nuclear Medicine

The European Association of Nuclear Medicine Technologist Committee (EANMTC) and the Society of Nuclear Medicine Technologist Section (SNMTS) meet biannually to consider matters of mutual importance. These meetings are held during the SNM and EANM annual conferences. For several years, within these meetings, EANMTC and SNMTS have considered the value of having a Euro-American initiative in defining entry-level and advanced practice competencies for nuclear medicine radiographers (NMRs) and nuclear medicine technologists (NMTs). In June 2009, during the SNM annual conference in Toronto, it was agreed that a Euro-American working party would be established to consider advanced practice. It was recognized that any consideration of a definition for advanced practice would be predicated on an understanding or definition of entry-level practice. As a result, both types of practice would have to be considered. This discussion document outlines some of the background issues associated with advanced practice generally and specifically within nuclear medicine. The primary purpose of this document is to stimulate debate, on a Euro-American level, about the perceived value of advanced practice for NMRs and NMTs within nuclear medicine and to develop an internationally accepted list of entry-level competencies and scope of practice for NMRs and NMTs within nuclear medicine.

Education of Advanced Practice Nurses in Canada

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.

Clinical Nurse Specialist Practice Patterns

The study purpose was to describe clinical nurse specialist (CNS) practice patterns (activities, outcomes, and practice barriers). A cross-sectional survey design was used for this research study. California Board of Registered Nursing certified CNSs (N = 1,523). Surveys were mailed to CNSs and included the CNS Activity Questionnaire, the Clinical Nurse Specialist Outcomes and Barriers Analysis Survey, and a demographic survey. Descriptive (means, percentages) and inferential (t tests and one-way analyses of variance) statistics were used to analyze the data. Practicing CNSs (n = 947) demonstrated a role preference for expert clinical practice. Practice patterns (activities, outcomes, and barriers) differed in terms of CNS specialty, years of experience, number of units covered, and CNS reporting structure. Clinical nurse specialists are spending time in the 5 broad role components expert (clinical practice, consultation, education, clinical leadership, and research) utilized by the California Board of Registered Nursing as an organizing framework for practice; however, CNS practice patterns from this study reflect more discrete and functional activities that may be better encompassed under the CNS spheres of influence practice model. A number of barriers to practice exist, the most commonly reported being reporting structure. Years of experience in the role result in differences in both practice patterns and perceptions of barriers. Recommendations for CNSs and organizations include evaluating CNS reporting structures, developing advanced practice outcome-based job descriptions and competencies, and designing performance evaluations that recognize differences between inexperienced and experienced CNSs.

Pharmacy Students' Perceptions of Their Preparedness to Provide Pharmaceutical Care

To assess students' perceptions of their preparedness to perform advanced pharmacy practice competencies. The Preparedness to Provide Pharmaceutical Care (PREP) survey was modified and administered to each class at a Midwestern university from 2005-2008. Factor analysis and 1-way ANOVA with multiple comparisons were applied to assess the effectiveness of changes made in the pharmacy curriculum. Factor analysis yielded patterns similar to those reported in the literature. Students rated themselves highest on the psychological aspects and lowest on the administrative aspects of care. Perceived pharmaceutical care skills grew as students progressed through the curriculum, and changes in coursework were reflected in the competencies. Students' perceived competencies (ie, communication, psychological, technical, administrative) were similar to those at other institutions and perceptions of competencies increased in a manner consistent with actual program outcomes.

AORN Advanced Practice Registered Nurse Resources and Initiatives

Multiple resources are available to the perioperative advanced practice registered nurse (APRN). Among these resources are the Association of periOperative Registered Nurses (AORN) position statements, advanced practice competency statements, specialty assemblies, educational offerings, posters, and publications. The AORN is also actively involved in many of the regulatory issues impacting perioperative APRNs. Additional resources are listed at the end of this article.