Advanced Practice Registered Nursing Students Research Articles

"I never thought of it as payment": Qualitative evaluation of workshops with advanced practice registered nurses on pharmaceutical industry payment reporting.

With the expansion of professional autonomy and prescriptive authority of advanced practice registered nurses (APRNs), interactions with industry are under greater scrutiny. As of July 1, 2021, pharmaceutical and medical device companies must publicly report all payments to APRNs through the Centers for Medicare and Medicaid Services' Open Payments website. To gauge APRNs' familiarity with, and perceptions of the Open Payments database and discuss whether and how APRNs should respond. Virtual workshops consisting of a didactic presentation and interactive exercises with APRNs recruited through professional networks, associations, and conferences. Transcripts were analyzed using a qualitative interpretive approach, grounded in an everyday ethics theoretical framework. Thirty-six APRN clinicians, students, and faculty participated in nine workshops. Seeing sponsored meals reported in Open Payments as "payments" prompted participants to see familiar interactions in a new way. Participants valued the enhanced transparency as a way to identify risks of bias but were concerned that reporting might undermine public trust in APRNs. Emphasizing awareness as a precursor to action, participants desired greater preparation for ensuring independence in practice. The importance of tackling the ethical issues associated with industry interactions is heightened within the context of an existing climate of distrust within health care. However, many participants were concerned about the effects of transparency on public trust rather than how APRNs individually or collectively can be more trustworthy. Open Payments can serve as a useful tool to catalyze broader conversations about ethics, integrity in decision making, and health policy advocacy.

Sustainable Academic-Clinical Alliance: A Model to Improve Academic-Practice Partnerships.

Background: National nurse shortages, ongoing nurse faculty retirements, and a dearth of clinical sites make it challenging to prepare advanced practice registered nurses (APRNs) who are ready to transition into independent provider roles, especially in acute care settings. One of the most effective ways to address these experiential learning challenges is for academic institutions and healthcare systems to form collaborative academic-practice partnerships. However, many partnerships between schools of nursing and healthcare institutions have found numerous challenges, including time to devote to the partnership, funding of ideas, competing initiatives and needs, and sustainability. Objective: The University of Maryland School of Nursing (UMSON) set out to expand the traditional academic-clinical partnership approach with a new collaborative model. Methods: Rather than both parties coming to the table with their own goals, the partnership focused on intentional relationship building, transparency, measurable outcomes, and sustainability. This model, further called the Sustainable Academic-Clinical Alliance (SACA), assures that both sides of the partnership benefit. The SACA model was used to create an academic-practice partnership with the University of Maryland Upper Chesapeake Health System in order to increase APRN clinical practice sites and readiness of APRN students to provide care across the continuum in the state of Maryland. Results: Since July 2016, the SACA model has enabled over 40 clinical providers in over 20 different clinical areas to offer 329 different clinical and nonclinical experiences to APRN students from UMSON. At the end of the 5-year alliance, 150 unique UMSON APRN students completed 257 different clinical rotations. Conclusion: The SACA model effectively promotes the development and achievement of sustainable academic-practice partnerships by focusing on (a) intentional relationship building, (b) transparency in goal setting and alliance maintenance, (c) development of outcome measures, and (d) sustainability. Implications for Nursing: The components of the SACA model made sustainability more achievable, which has eluded previous academic-clinical partnerships. This model can serve as a blueprint for other academic and healthcare institutions to establish sustainable academic-practice partnerships.

Trauma-informed care: Insights from a Q-methodology study of advanced practice registered nursing students

BackgroundTrauma-informed care (TIC) aims to create a safe and supportive healthcare environment that empowers patients and cultivates understanding of the role trauma plays in short-term and long-term health. TIC also has the potential to improve health outcomes and foster clinician wellness. Nurse educators must design evidence-based instruction to develop advanced practice registered nurses (APRNs) who deliver high-quality TIC while also protecting their own wellbeing. ObjectivesTo identify patterns in subjective viewpoints about TIC among APRN students and describe how those patterns influence their learning experience in an advanced health assessment course. DesignQ methodology was used to explore student perceptions of TIC. SettingA virtual advanced health assessment course at a large, midwestern university in the United States. ParticipantsNinety-five APRN students from six specialty APRN programs. MethodsStudents completed an online Q-sort activity by ranking 32 TIC statements according to how well the statements aligned with their own perspectives. Q-sorts were analyzed using factor analysis and narrative responses to open-ended questions. ResultsFour factors were extracted that revealed different student viewpoints on TIC and their learning experiences: Comfortable/Confident Learners, Uncomfortable/Apprehensive Learners, Empathetic/Hesitant Learners, and Inexperienced/Uncertain Learners. ConclusionsAll students acknowledged the need to learn about TIC to implement it effectively in practice. It is important for faculty to understand the potential range of divergent student viewpoints about TIC and acknowledge, accept, and support students who have anxiety related to learning about TIC.

Closing the Opioid Treatment Gap Through Advance Practice Nursing Activation: Curricular Design and Initial Outcomes.

Buprenorphine, an effective medication for opioid use disorder (MOUD), reduces opioid-related harms including overdose, but a significant gap exists between MOUD need and treatment, especially for marginalized populations. Historically, low MOUD treatment capacity is rising, driven by advanced practice registered nurses (APRNs). A graduate nursing course was designed to increase equitable buprenorphine treatment delivery by APRNs. We report on baseline findings of a curriculum evaluation study with a pretest-posttest design. Computerized surveys assessed trainee satisfaction with the course, trainee knowledge for providing MOUD, and trainee satisfaction in working with people who use drugs. Quantitative survey results utilizing Likert scales are presented. Baseline precourse surveys revealed less than half (44%) of APRN students agreed/strongly agreed that they had a working knowledge of drugs and drug-related problems and 37% agreed/strongly agreed that they knew enough about the causes of drug problems to carry out their roles when working with people who use drugs. Approximately two thirds of APRN students agreed/strongly agreed that they want to work with people who use drugs (63%), that it is satisfying to work with people who use drugs (66%), and that it is rewarding to work with people who use drugs (63%). Nearly all students reported high satisfaction with the course. APRN students reported high satisfaction with a novel course grounded in health equity that has potential to reduce health disparities and accelerate the closure of the MOUD treatment gap, particularly for racial/ethnic minorities, rural populations, and transition-age youth.

The Use of Virtual Reality in Teaching Diagnostic Reasoning to Advanced Practice Registered Nurse Students.

The Use of Virtual Reality in Teaching Diagnostic Reasoning to Advanced Practice Registered Nurse Students.

Promoting a culture of reciprocity to build social capital in advanced practice nursing students.

A virtual activity integrating the evidence-based Reciprocity Ring model was designed to enhance confidence and skills for building social capital for advanced practice registered nursing (APRN) students. The central objective of the activity was to reduce the stigma of asking for help by providing a framework for the balanced exchange of favors, thus supporting new connections and feelings of trust among APRN students. Students from two APRN practice tracks (N = 44) participated in a virtual Reciprocity Ring activity where they could post and respond to requests for help. On average, students posted 2.5 requests and received three offers for assistance; 220 connections were made overall with the major theme requests related to stress management. A retrospective survey was administered at the conclusion of the activity. Questions inquired about student confidence before, and then after, the activity for identifying resources, providing help to others, finding personal support when needed, accessing resources related to academic success, and finding solutions to problems. Student mean confidence scores were significantly higher after the activity compared with mean confidence scores before the activity (p = .01). Additionally, the effect size was large (Cohen d = 0.89). Therefore, we suggest that integrating Reciprocity Ring exercises into nursing curricula and practice can be a useful tool for promoting skills related to productive help-seeking that will support APRN students' academic and professional success.

Comorbid HIV Infection and Opioid Use Disorder Simulation for Nurse Practitioner Students.

Human immunodeficiency virus (HIV) infection and opioid use disorder (OUD) often occur as comorbid conditions. Many nurse practitioners are treating these conditions in their practice. Most advanced practice registered nursing (APRN) students do not encounter a medically complex patient with both HIV infection and OUD during their clinical experiences. We present an unfolding simulated standardized patient scenario involving both HIV infection and OUD for APRN students. During each of 3 semesters, the students encounter the patient as he presents for a sexually transmitted infection, an OUD relapse, and, finally, new-onset HIV infection. The scenarios become increasingly complex as the students progress in their clinical experiences. This innovative series of scenarios introduces APRN students to complex comorbid patient situations, with many issues to consider.

Virtual Simulation for Advanced Practice Registered Nurse Students: Adapting to Shortage of Clinicals

Beginning Spring 2020, a global pandemic dictated the rapid integration of advanced practice registered nurse graduate simulation education as clinical practicums were unexpectedly limited. Using an established computer-based platform, family nurse practitioner, adult gerontology clinical nurse specialist, and adult gerontology acute care nurse practitioner students participated in simulation experiences with complex patients and interprofessional health care teams. This experience was purposefully designed to align with the International Nursing Association of Clinical Simulation Learning Standards of Best Practice. After each simulation, students completed a worksheet and participated in an intraprofessional debriefing session. A survey was administered to solicit student feedback about the experience.

The Missing Link: The iSOAP Model for Incorporating Telehealth Within Simulations

BackgroundTelehealth has escalated as a method for delivering healthcare. Faculty are now realizing that telehealth must be integrated within advanced practice registered nursing (APRN) education. With simulation being a leading method for teaching clinical skills, faculty need a structure for integrating telehealth within simulations. MethodFaculty members from varying advanced practice tracks were tasked with the job of creating simulations that included telehealth. They identified the importance of having a template to follow. ResultsThe iSOAP model for Telehealth Simulation was developed to aid faculty in developing simulation cases to represent telehealth encounters. ConclusionThe iSOAP model can be used to develop simulated experiences that enable faculty to educate and evaluate APRN students as they strive to meet required telehealth competencies needed for practice.

Perspectives, experiences, and opinions precepting advanced practice registered nurse students

BackgroundSignificant growth in advanced practice registered nurse (APRN) student placements for clinical practicums have forced APRN preceptors, hospitals, and clinics to restrict the volume of APRN students they can accommodate. PurposeDescribe the experiences and opinions of APRNs regarding their precepting experiences of APRN students in three main areas; placement antecedents, placement postcedents, and preceptor incentives. MethodsQuality improvement study conducted via electronic survey that contained quantitative short answer and a qualitative open-ended question of APRNs licensed in the State of Iowa in June, 2019. FindingsA total of 757 surveys were quantitatively analyzed. Qualitative thematic analysis resulted in identifying one overarching theme, the need for shared responsibility and accountability, and six unique primary themes. DiscussionOur findings indicate that APRN preceptors recognize their critical role but lack support and preparation to fully execute academic and profession strategic goals and objectives. There is the need for academic and professional ownership of APRN education at every level.

Improving Holistic Care Skills for Advanced Practice Registered Nurses: Integration of a Complementary and Alternative Medicine Course into a Doctor of Nursing Practice Curriculum.

Complementary alternative medicine (CAM) is an expanding domain of healing practices harmonized with Western medicine to provide comprehensive treatment of individuals as holistic beings. Patients and healthcare providers worldwide are increasingly inviting and employing CAM practices into healthcare delivery routines. Implementation of courses to introduce CAM into Advanced Practice Registered Nurse (APRN) programs exposes future practitioners to current best practices for integrative treatment strategies and encourages consideration when developing a holistic patient-centered care plan. A case presentation of an interprofessional CAM course delivered to military graduate nursing students with a pretest posttest course survey to evaluate student's confidence and knowledge of CAM theory and practices. The format included online modules, evidence-based literature critique, knowledge checks, and an immersive hands-on immersion experience. A total of 240 pre-/postcourse surveys were completed by military graduate nursing students (N = 140) participating in a CAM course. Statistically significant increases in CAM knowledge, communication, and skills confidence levels were found. Following participation in the course, nearly all students (97%) agreed CAM is important and benefits future advanced practice. CAM is a compendium of holistic healing modalities increasingly being utilized by patients worldwide with similar requests for alternative care techniques from healthcare providers. Military APRN students participating in a CAM course increased knowledge and confidence, and garnered appreciation for an expanded skill set to augment future practice. Case presentation is compelling for standard inclusion of CAM and similar graduate interprofessional courses into all APRN programs.

Innovative Simulation Roadmap for Faculty to Prepare Advanced Practice Registered Nurses for Entry Into Practice.

Advanced practice registered nurse (APRN) programs are challenged to provide clinical learning experiences that prepare graduates with the full continuum of expected competencies. Preparing the APRN in academia, in terms of didactic and clinical application for novice entry, is often a vexing balance between board certification preparedness and the actualities of clinical practice. This article presents an innovative strategy to examine the perplexing reflective question often asked by educators: Does the current approach for simulation development prepare our APRN students sufficiently for entry into practice, and is it current to what is occurring in practice?

Academic-Service Partnerships: Increasing the Advanced Nurse Workforce.

Clinical education placement for advanced practice registered nurse (APRN) students is challenging for most graduate schools of nursing. This study describes the experiences of hospitals that formed academic-service partnerships to facilitate clinical education placement for APRN students. Hospital staff, schools of nursing administration and clinical faculty staff, clinical preceptors, and APRN students participated in the focus group and interview sessions during the evaluation of the Graduate Nurse Education demonstration project. Content analysis resulted in seven themes: APRN Student Enrollment, Clinical Placements/Process, Clinical Education Sites, Clinical Preceptors, Communication and Collaboration, Sustainability, and Funding Process. Future partnerships between hospitals, schools of nursing, and clinical education sites should consider collaborating in multiple regions to increase enrollment and clinical education placement opportunities for APRN students. [J Nurs Educ. 2021;60(4):190-195.].

Academic-Practice Partnership in Rural Maryland: Opportunities for Advanced Practice Registered Nurse Training and Employment.

This case study describes how an innovative, triple-win, academic-practice partnership model can be used to deepen the clinical expertise of advanced practice registered nurse (APRN) students and improve rural Americans' access to quality patient care. It features the experience and strategies used by a school of nursing and a local rural hospital system collaborating to provide clinical experiences for APRN students pursuing doctor of nursing practice degrees.

Collaboration, culture and communication: Preparing the next generation to provide rural primary health care

Background and objective: In an ever-changing landscape of health care needs and demands, the ability to provide care for rural communities is often overwhelming. Rural health care in a new decade demands targeted programs to improve recruitment, training, and sustained employment of primary care providers. This project served to address rural primary healthcare needs by the development of a project model to recruit, train, educate and evaluate Advanced Practice Registered Nurse students (APRN) students who were rigorously selected for a rural traineeship and practiced in rural counties. The evaluation of preceptors was also done to assist in retention and increased numbers of rural preceptors and clinical sites. This program was designed collaboratively and implemented with rural community partners and rural healthcare leaders.Methods: Graduate nursing students completed both a paper application and in person interviews to be selected for a rigorous 16-week clinical traineeship in the rural communities. Qualitative data were collected during interview and feedback sessions during their traineeship. Quantitative Data were collected on Process and Outcome Measures focused on learning objectives during their rural traineeship. These data were analyzed and evaluated to measure the effectiveness of program goals, outcomes, and sustainability of the program. Results and conclusions: The results support the structured process for selecting graduate students and with an innovative program design focused on rural culture and accessing resources for patients in these same rural areas. Both students and preceptors had improved performance and satisfaction over time. The results provide a road map to recreate programs with high clinical impact and increasing numbers of rural healthcare providers. Current follow-up data with APRN post program completion demonstrated increase in employment within rural areas post-graduation.

Preparing Advanced Practice Registered Nursing Students to Provide Primary Palliative Care.

Advanced practice registered nursing students need primary palliative care education to care for the growing number of patients with serious illness and their families and to fill the serious resource gaps in specialty palliative care. There has been a lack of primary palliative care education in most graduate nursing programs and little direction as to competencies and essential content. In an effort to support faculty to teach palliative care content, the End-of-Life Nursing Education Consortium (ELNEC) has created an online curriculum that meets the new American Association of Colleges of Nursing Graduate-Competencies and Recommendations for Educating Nursing Students in primary palliative care for master's degree and doctor of nursing practice students. During the first 9 months of its release, more than 170 nursing programs have accessed the ELNEC Graduate curriculum, and there have been more than 200 student completions. Primary palliative care education is essential for all advanced practice nursing students. The new ELNEC Graduate curriculum offers the opportunity to provide quality education remotely.

Using ANCC Certification Renewal Criteria as a Roadmap for Career Development and Lifelong Learning.

Nursing continuing professional development (NCPD) requires strategic planning and a lifelong commitment. Advanced practice registered nurses (APRNs) not only engage in specific NCPD to meet regulatory and certification requirements, but also to expand their professional practice in other areas such as leadership and education. Collaboration between APRNs and nursing professional development (NPD) practitioners provides an opportunity for NCPD to be tailored to the specific needs of APRN students and practicing APRNs. [J Contin Educ Nurs. 2020;51(10):444-446.].

Use of simulation for global health pre-departure training

BackgroundOpportunities for students to participate in global health mission trips have expanded. However, lack of pre-departure training is often reported and has been associated with negative outcomes for participants. Simulation is an effective method for providing customized situational learning. ObjectiveTo evaluate the effectiveness of a Pre-Departure Training program incorporating simulation for advanced practice registered nursing (APRN) students prior to a global health mission trip. DesignThis program employed a pre-posttest design with surveys administered at baseline, after a computer-based learning module, and after a simulation-based learning experience. SettingA university in the Southeastern United States. ParticipantsTwenty-two APRN students in their first clinical rotation of the program. MethodsAPRN students with interest in global health missions partake in a pre-departure training program. Pre-departure training includes a computer-based learning module followed by an outdoor simulation replicating a low-income setting. Pre-posttest surveys assessed students' perceptions of confidence, skill, knowledge and comfort regarding global health. A skills checklist was used to evaluate student clinical patient presentation during the simulation. ResultsStudents' preparedness scores increased after the computer-based learning and significantly increased after the simulation. In the simulation, 42% of students successfully completed their patient presentation during their first attempt while 58% required remediation. ConclusionAfter the pre-departure program, students felt more confident in their global health knowledge, and felt significantly more prepared to provide health care in a low-income country. Schools of nursing offering global health mission trips or study abroad programs should consider implementing pre-departure programs using simulation as a teaching method.

Learning about Rurality: From Classroom to Community

Ensuring that advanced practice registered nurse (APRN) students have optimal health promotion/disease prevention skills is critical as increasing numbers train and later work in rural and underserved areas. APRN students are more likely to have clinical training in rural areas in response to workforce initiatives designed to create a pipeline from nursing school to practice in rural and underserved communities. Therefore, they need both didactic and experiential learning to truly understand the social determinants of health in a community. We begin with a brief discussion about how APRNs meet needs in both rural America and women’s health. The article continues with an exemplar that considers how to prepare women’s health APRNs for a population in rural California. With the support of a rural consultant, a unique community assessment tool Mind Your Own Business was used by students to explore a new rural clinical placement area in southern California. We present the community assessment assignment and tool, analysis of student reflections; and subsequently identified community needs and offer future implications for education and practice. Nurse educators are encouraged to both enhance curriculum with activities to prepare students to work with rural populations, and expand clinical placements in these areas.

An innovative course to prepare advanced practice registered nurses to spearhead quality and safety initiatives for older adults.

Current trends dictate that advanced practice registered nurses (APRNs) must be competent to address quality/safety issues specific to older adults. A gap analysis and review of key competencies in an adult-gerontology APRN-Doctorate of Nursing Practice (DNP) curriculum prompted the design and evaluation of an innovative online course, Quality and Safety for the Aging Adult. Course objectives align with key competencies, including graduate-level Quality and Safety Education for Nurses (QSEN) and the DNP Essentials. The course purpose was to prepare adult-gerontology APRN-DNP students as leaders to promote quality/safety outcomes for aging adults. The six-step Knowledge-to-Action Framework guided course development and evaluation. Select graduate-level QSEN competencies were used to construct a 20-item Quality and Safety Survey (4-point Likert scale) (Cronbach's alpha, 0.916). This survey was used during week 1 (pre) and week 15 (post) of the semester to evaluate students' preparation and confidence to perform key QSEN competencies. Significant improvements (p < .000) between pre/post scores on the Quality and Safety Survey were found across five classes. Students felt more prepared and confident to apply selected QSEN competencies on course completion. Moreover, nearly 60% (primary care) and nearly 35% (acute care) adult-gerontology APRN students selected the older adult population for their DNP projects. The Quality and Safety for the Aging Adult course positively influenced five classes of adult-gerontology APRN-DNP students. Integrating QSEN competencies with gerontology and quality/safety content is an effective strategy to prepare APRNs to lead quality/safety initiatives in aging adults. This innovative online course offers a successful model for innovative DNP education of adult-gerontology APRNs.