Advanced Practice Registered Nurses Research Articles

Advanced practice nurse pharmacogenomics capacity and utilization.

Guided by Clinical Pharmacogenomic Implementation Consortium (CPIC) guidelines for >140 medications, pharmacogenomic tests inform medication selection and dosing to optimize efficacy while minimizing toxicities. This study assessed pharmacogenomic self-reported curricular content, knowledge, skills, attitudes, and usage in advanced practice registered nurses (APRNs) with prescriptive privileges. An online survey was administered assessing pharmacogenomic curricular content, knowledge, skills, attitudes, and usage. Data from 266 APRNs were analyzed. Most graduated with their highest nursing degree ∼10 years ago and reported pharmacogenomic curricular content (n = 124, 48%). Pharmacogenomic curricular content was associated with pharmacogenomic familiarity (p = .045) but not with knowledge confidence (p = .615). Pharmacogenomic usage, defined as ordering a pharmacogenomic test within the past year, was low (n = 76, 29%) and most (n = 210, 84%) reported never using CPIC Guidelines. Advanced practice registered nurses (n = 162) who did not anticipate ordering a pharmacogenomic test in the next year (n = 77, 48%) indicated that they did not know what test to order. Deficits were identified in APRN pharmacogenomic knowledge and skills despite academic training. Most reported not ordering pharmacogenomic tests, did not know what test to order, and did not use CPIC guidelines. Pharmacogenomics is a quality and safety issue. Academic training did not result in practice integration and most reported capacity deficits. Recommendation for overcoming academic deficits include: (1) assessment of pharmacogenomics curricular content and faculty teaching capacity; (2) training addressing identified deficiencies; and (3) Commission of Collegiate Nursing Education policies that include pharmacogenomics in advanced pharmacology. Practicing APRN plans include on-the-job training and/or mandatory training at the time of relicensure.

Designing an impactful APRN residency program for rural communities.

The largest healthcare system in New Mexico, in collaboration with the University of New Mexico College of Nursing, identified an opportunity to increase and retain the number of family practice NPs and certified nurse midwives in rural communities by creating an immersive 1-year rural residency program for newly graduated advanced practice registered nurses (APRNs). This article describes the journey to design this program and build its infrastructure with the aim of addressing the needs of both APRNs during their transition to practice and patients in rural areas, while providing a return on the healthcare system's business investment. Program results are also reported. Program funding was provided by a Health Resources and Services Administration grant, the Presbyterian Healthcare Services executive team, and the Presbyterian Healthcare Foundation.

LACE and the APRN Consensus Model: Implications for Advancing Nursing Practice.

Understanding the historical context and contemporary trends in advanced practice registered nurse (APRN) education and regulation is pivotal for effective professional advocacy. Until the release of the APRN Consensus Model in 2008, a uniform model for APRN regulation was lacking. Adopting the model's recommendations has implications for APRNs beyond licensure and regulation, including full practice authority, license portability, and patient access to APRN-led care. A comprehensive understanding of APRN education and regulation empowers nurses, APRNs, and stakeholders to drive the profession forward through informed advocacy.

Changing the Landscape of the Neighborhood: The Expanding Role of the Pediatric Palliative Advanced Practice Registered Nurse.

There is a dearth of information on the role of the pediatric palliative advanced practice registered nurse (APRN) reported in the literature, and yet, the role is expanding. Advances in technology and health care are helping children with medical complexity live longer, and the demand for pediatric palliative care is growing. As programs expand to meet this need, there are new opportunities for pediatric palliative APRNs to practice outside acute care consultative models, within large children's hospitals. The aim of this article was to describe the expanding role of the pediatric palliative APRN using a progressive case study that describes how these expanding roles can collaborate using evidence-based practice and expert consensus to define their roles. If pediatric palliative APRNs hesitate to define their practice, others will define it for them.

The implementation and impact of an advanced practice recognition program.

Meaningful job recognition is a pillar for sustaining healthy work environments and proven beneficial for job satisfaction and retention. However, few dedicated award recognition programs exist for advanced practice registered nurses (APRNs), and no available literature evaluates the impact on professional practice, sense of belonging, and job retention or satisfaction. The purpose of this study was to introduce a novel award recognition program for APRNs and physician associates (PAs) in a large academic medical system and evaluate it's impact on job satisfaction, retention, and sense of belonging. Five awards were created to recognize areas of achievement for clinically practicing APRNs or PAs within an academic health system. Nomination letters were collected, deidentified, and reviewed by an award committee. Winners were announced and received a plaque. A survey was sent to employed APRNs evaluating their response to the program. The survey was sent to both APRNs (83%) and PAs (17%). Survey end points included job satisfaction, willingness to stay in role for 1 and 5 years, sense of community, something to work toward, and increasing recognition of APRNs. Results showed statistical significance in three areas. Advanced practice registered nurses or PAs who were aware of award opportunities and/or nominated for an award showed higher job satisfaction, more likely to stay in job for 1 year, and felt a greater level of recognition. Dedicated APRN award programs may have a positive impact on job satisfaction and retention. This model may be extrapolated to provide greater opportunities for meaningful recognition among clinical APRNs.

The Stress of Advancement: A Nurse Practitioner's Exploration in Providing Culturally Competent Obesity Prevention Counseling in Black Women.

Black women are diagnosed, disabled, and die from obesity and associated chronic diseases at higher rates than any other sex or race. Advanced practice registered nurses (APRN) can potentially improve culturally relevant health education and counseling by using health literacy communication tools. Explore individualized barriers and APRNs' role in providing obesity prevention education and counseling by assessing the efficacy of the Teach-Back Method (TBM) to understand health habits and attitudes. Black women aged 18-45, previously diagnosed as overweight or obese, and identified with perceived barriers were recruited from a predominantly Black church in Atlanta. They engaged in weekly, 1-hour educational sessions via Zoom, addressing four common barriers identified in the literature. Sessions ended with a 5-10 minute Teach-Back session. Pre- and post-intervention Readiness to Change Questionnaire (RCQ) were completed. Descriptive statistics and quantitative data from surveys and pre- and post-RCQ were analyzed. Twenty women completed the intervention. Paired sample t-test revealed no statistical significance or correlation between pre- and post-RCQ scores after using TBM in educational sessions. However, Pearson's correlation showed positive associations between elevated body mass index levels as one advances their education and annual income, with a p-value of 0.05. Increased rates of obesity are experienced despite higher educational attainment or pay. Stress and high-coping mechanisms contributed to disordered eating, decreased physical activity engagement, and decreased motivation toward habit change. Clinicians should be held accountable for delivering culturally sensitive care using the TBM, addressing social determinants of health, performing routine stress assessments, and checking their implicit biases.

Adolescent Simulation in a Health Assessment Course for Advanced Practice Nursing Students.

Advanced practice registered nurse (APRN) students face challenges transitioning to practice. They benefit greatly from simulated learning experiences that build confidence and increase competence in the skills needed to perform in an APRN role. The purpose of this quality improvement project was to evaluate the effectiveness of a simulated adolescent well visit in an advanced health assessment course. Using a pretest/posttest design, qualitative and quantitative data were collected from participants. Results included high learner satisfaction, an increase in both self-reported competence and confidence, and an appreciation for the "safe space" of learning.

Modules From the End-of-Life Nursing Education Consortium: Japan Core Curriculum Necessary for Second- to Fourth-Year Nurses as Assessed by Advanced Practice Registered Nurses.

This study aimed to identify the modules of the End-of-Life Nursing Education Consortium-Japan Core Curriculum (ELNEC-J), which are particularly necessary for second- to fourth-year nurses. This cross-sectional study recruited certified nurse specialists in cancer nursing (CNSCNs) endorsed by the Japanese Nursing Association enrolled in Advanced Practice Registered Nurses (APRNs) in Japan. We asked individuals who were active members of the volunteer association of CNSCNs in the Tokai region to participate via email, and we collected data using Google Forms. The participants were asked about their background, including APRN experience and current position. Furthermore, we asked them to select three necessary modules for second- to fourth-year nurses' education from the 10 modules of the ELNEC-J. The study recruited a total of 19 (89%) APRNs (response rate: 100%). Out of them, 14 (73.6%) had more than six years of clinical experience in APRNs, and 12 (63.1%) held managerial positions. Regarding the 10 modules of the ELNEC-J, the responses for the necessary modules were as follows: nursing care at end-of-life 13 (68.4%), pain management 12 (63.2%), symptom management 10 (52.6%), communication 10 (52.6%), and ethical issues in palliative care nursing five (31.6%). According to the perspective of APRNs responsible for palliative care education for incumbent nurses, nursing care at the end of life, pain management, symptom management, and communication are required for second- to fourth-year nurse education.

PREPARED NP: Preparation for Emergency Care Delivery Among Nurse Practitioners

The PREPARED NP (Preparation for Emergency Care Delivery Among Nurse Practitioners) study sought to describe the certification of the advanced practice registered nurse working in emergency care settings. A 14-item survey using the nomenclature and classification of advanced practice registered nurses from the Consensus Model for APRN (Advanced Practice Registered Nurse) Regulation was disseminated widely via social media, email, and newsletters. A total of 746 respondents completed the survey, with 713 respondents reporting that they work in the emergency care setting as advanced practice nurses. The majority reported their current certification as a family nurse practitioner (FNP). The data from this study underscore the variability in certification requirements for NPs working in emergency care settings. The lack of a single population-level certification examination that meets the needs of emergency care NPs appears to have national implications. Although further clarification and understanding of advanced practice nurse certification in emergency care settings are needed, the findings in this study support further research to inform practice and policy surrounding the emergency NP workforce.

36th Annual APRN Legislative Update: Improving practice scope and authority, one state at a time.

Advanced practice registered nurses (APRNs) across the US continue to remove statutory and regulatory barriers to patients' full access to APRN care. The status of APRN practice in each US state and Washington, D.C. is examined, with any updates to practice authority and reimbursement reported.

Advanced Practice Registered Nurses’ Views of the APRN Compact: Survey Findings From Five U.S. States

Advanced Practice Registered Nurses’ Views of the APRN Compact: Survey Findings From Five U.S. States

MEASURING IMPLEMENTATION FIDELITY OF THE TRANSITIONAL CARE MODEL IN THE MIRROR-TCM TRIAL

Abstract Examining the fidelity to the implementation of multi-component evidence-based interventions is essential but challenging. To capture the application of the Transitional Care Model (TCM) as designed, an advanced practice registered nurse (APRN)-led, team-based, care management strategy in a replication RCT conducted in three diverse health systems, an innovative method was utilized. This session describes the procedures, challenges, and decision-making processes associated with measuring the fidelity of the implementation of TCM’s core components over the trial. Standardized data collection forms were created for the APRNs to document the TCM elements addressed during each contact with and on behalf of the hospitalized older adults and their caregivers who had been randomly assigned to the TCM group (N=480). Measurable performance expectations for each element were established a priori (e.g., a minimum of 9 in-person visits). A dichotomous variable was created for each of the 38 elements making up the 10 TCM components which were provided monthly to each site to monitor their intervention implementation. Since not all elements were applicable to all older adults, the overall patient-level fidelity score required scaling to standardize the maximum fidelity score to 38. The individual components were inherently weighted according to their complexity as reflected by their respective number of elements. The average overall patient-level fidelity score was 34.2 (standard deviation: 3.5), median = 34.7. Higher fidelity scores indicated implementation of the minimum dose of the intervention elements. The findings provide critical insight into how to develop measures of implementation fidelity for complex multi-component evidence-based interventions.

Perspectives on APRN prescribing of medications for opioid use disorder: Key barriers remain

IntroductionDeaths from drug overdoses are rising dramatically in the United States. Treatment for opioid use disorders may include behavioral treatments as well as medications for opioid use disorders (MOUD). Buprenorphine can be prescribed by physicians, nurse practitioners (NPs), other advanced practice registered nurses (APRNs), and physician assistants (PAs) and required a training and a federal waiver until recently. The number of NP MOUD prescribers grew steadily over the past decade, but research has identified state-level scope of practice regulations as a barrier to NP MOUD prescribing. This article explores the contributions of, and remaining barriers faced by NP and other APRN MOUD prescribers. We describe qualitative findings from a study of NPs and other key stakeholders involved in MOUD treatment in four states with two differing levels of regulatory structure. MethodsIn this qualitative study, we conducted site visits and semi-structured interviews with NPs and other APRNs, physicians, clinic managers, and regulators in four states including New Mexico and West Virginia (full practice authority for NPs), and Ohio and Michigan (which require physician supervision). Interview notes were entered into a qualitative software package and coded and reviewed by two members of the research team. Data were grouped into key themes. ResultsA total of 76 participants participated in individual or small group interviews in the four states. We found key themes and several subthemes that describe NP practice in MOUD. Participants described key contributions of NP engagement in MOUD, including increasing access, serving rural areas, the unique role of psychiatric NPs, and the value of the nursing model of care in working with people with substance use disorders (SUD). Participants also identified barriers including scope of practice regulations, other regulatory barriers, stigma, and lack of supportive services to address psychosocial needs. ConclusionsThe waiver requirements were eliminated at the end of 2022 in federal budget legislation. Other barriers for NP and other APRN prescribers remain and should be addressed in practice, and in state and federal regulations. Research needs to explore the impact of the waiver elimination on MOUD prescribing and access to services.

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.

A Framework for Strategic Development and Integration of the Advanced Practice Executive

Health care organizations have immense opportunities to transform enterprise performance through strategic development and integration of advanced practice providers (APPs). The projected growth rate for APPs, which include advanced practice registered nurses (APRNs) and physician assistants, is 45% and 31%, respectively. This projection is based on the shortfall of physicians and the increased need to provide cost-effective care. Successful integration of APPs requires organizations to invest in the infrastructure to support this rapidly growing profession. Many health care organizations are preparing by creating a system advanced practice executive role to oversee the organizational design systemness, workforce strategy and optimization, and care design and innovation. This paper results from system advanced practice executives collaborating to define a system-level APP leader's role and responsibilities and the value brought to the health system.

Nurses can be key “REACH” accountable care organization partners to mitigate Medicare inequity

Abstract We propose that Advanced Practice Registered Nurses (APRNs) can be key Accountable Care Organization (ACO) partners in mitigating Medicare inequity due to a shortage of primary care physicians. This shortage particularly impacts minority Medicare beneficiaries residing in urban and rural Health Professional Shortage Areas. In order to expand the primary care workforce to open the gateway to our health care system for these beneficiaries, we propose that APRNs provide primary care in a Medicare Neighborhood Clinic, as key partners of a modified “REACH” (Realizing Equity, Access, and Community Health) ACO model. We review the long history of ineffective efforts to alleviate the physician primary care shortage. After highlighting a report emphasizing the importance of nurses in achieving health equity, we describe the APRN role in a Medicare Neighborhood Clinic, and its potential for alleviating the primary care shortage. This clinic, as part of the modified “REACH” strategy, provides nurses with a key role in achieving Medicare equity. We contend that this strategy, as a means of APRNs providing value-based care to all Medicare beneficiaries while restraining the Medicare budget, contributes to transforming primary care for Medicare equity.

Data-Driven Analytics to Discover APRN's Impact on Nursing Home Hospitalization: Causal Discovery Analysis.

Research shows advanced practice registered nurses (APRNs) embedded in nursing homes (NHs) reduce resident hospitalizations. However, the specific APRN activities that reduce hospitalizations have not been adequately investigated. This study aims to identify the causal links between APRN activities and NHs resident hospitalization. The study also examined relationships among other variables, including advanced directives, clinical diagnosis, and length of hospitalization. Secondary data analysis. Residents of NHs participating in the Missouri Quality Initiative for Nursing Homes, 2016-2019. We performed a secondary analysis of data from the Missouri Quality Initiative for Nursing Homes Intervention using causal discovery analysis, a machine learning, data-driven technique to determine causal relationships across data. The resident roster and INTERACT resident hospitalization datasets were combined to create the final dataset. Variables in the analysis model were divided into before and after hospitalization. Expert consensus was used to validate and interpret the outcomes. The research team analyzed 1161 hospitalization events and their associated NH activities. APRNs evaluated NH residents before a transfer, expedited follow-up nursing assessments, and authorized hospitalization when necessary. No significant causal relationships were found between APRN activities and the clinical diagnosis of a resident. The analysis also showed multifaceted relationships related to having advanced directives and duration of hospitalization. This study demonstrated the importance of APRNs embedded in NHs to improve resident outcomes. APRNs in NHs can facilitate communication and collaboration among the nursing team, leading to early identification and treatment for resident status changes. APRNs can also initiate more timely transfers by reducing the need for physician authorization. These findings emphasize the crucial role of APRNs in NHs and suggest that budgeting for APRN services may be an effective strategy to reduce hospitalizations. Additional findings regarding advance directives are discussed.

Advanced Practitioners in Hematology and Oncology: State of the Workforce

Advanced practitioners (APs), including nurse practitioners (NP), physician assistants (PA), pharmacists, and nurses with advanced degrees, including advanced practice registered nurses (APRNs), play a critical role in quality, timely, and expert cancer care. Burnout, retention, and resilience have been studied in physician groups. However, there is a paucity of data specific to APs in hematology and oncology. The Advanced Practitioner Society for Hematology and Oncology (APSHO) conducted an online survey that used validated tools to measure burnout and work-life balance among APs who are members of APSHO. Among the 366 respondents completing all items of the Maslach Burnout Inventory (MBI) and the Areas of Worklife Survey (AWS), participants felt engaged (34.2%) but overextended (37.4%) and reported burnout (17.8%). These results indicate a need to evaluate workloads, improve communication, and deploy strategies for support and advocacy to improve work-life balance within this group. The stability of the AP workforce is essential to excellence in patient care, provider resilience, and cancer outcomes. Creating a culture of open communication and strong AP leadership with data streams and metrics specific to the hematology and oncology workforce will help to inform health systems, consumers of health care, professional societies, educational institutions, and APs. Systematic and regular assessment of burnout and barriers to work-life balance for APs is essential to sustained adaptation of strategies to reduce burnout and retain APs.

Tracheal Intubation by Advanced Practice Registered Nurses in Pediatric Critical Care: Retrospective Study From the National Emergency Airway for Children Registry (2015-2019).

To describe tracheal intubation (TI) practice by Advanced Practice Registered Nurses (APRNs) in North American PICUs, including rates of TI-associated events (TIAEs) from 2015 to 2019. Retrospective study using the National Emergency Airway Registry for Children with all TIs performed in PICU and pediatric cardiac ICU between January 2015 and December 2019. The primary outcome was first attempt TI success rate. Secondary outcomes were TIAEs, severe TIAEs, and hypoxemia. Critically ill children requiring TI in a PICU or pediatric cardiac ICU. None. Among 11,012 TIs, APRNs performed 1,626 (14.7%). Overall, TI by APRNs, compared with other clinicians, occurred less frequently in patients with known difficult airway (11.1% vs. 14.3%; p < 0.001), but more frequently in infants younger than 1 year old (55.9% vs. 44.4%; p < 0.0001), and in patients with cardiac disease (26.3% vs. 15.9%; p < 0.0001).There was lower odds of success in first attempt TI for APRNs vs. other clinicians (adjusted odds ratio, 0.70; 95% CI, 0.62-0.79). We failed to identify a difference in rates of TIAE, severe TIAE, and oxygen desaturation events for TIs by APRNs compared with other clinicians. The TI first attempt success rate improved with APRN experience (< 1 yr: 54.2%, 1-5 yr: 59.4%, 6-10 yr: 67.6%, > 10 yr: 63.1%; p = 0.021). TI performed by APRNs was associated with lower odds of first attempt success when compared with other ICU clinicians although there was no appreciable difference in procedural adverse events. There appears to be a positive relationship between experience and success rates. These data suggest there is an ongoing need for opportunities to build on TI competency with APRNs.

Mentorship Education for Advanced Practice Registered Nurses.

Background: Mentorship is a vital part of the nursing profession. The evidence suggests that competent mentors aid in facilitating role transitions, improving job satisfaction, enhancing patient care, and decreasing nursing turnover. Advanced practice registered nurses (APRNs) have the skills and knowledge to provide safe, high-quality, patient-centered care; however, they may be lacking in mentorship abilities. Objective: Currently, there is no formal mentorship training in the organization, which may cause variability in the mentoring of new staff. The focus of this project was to create a staff educational intervention to improve the mentoring competency of surgical APRNs. The knowledge gap, lack of mentoring education given to APRNs acting as mentors to novice practitioners, was noted, and this project identified a staff educational intervention on mentorship training that was developed and implemented. Methods: The project practice-focused question asked if a formal APRN mentorship training program geared toward the six elements of mentoring (as measured by the Mentoring Competency Assessment [MCA]) increased the mentoring competency of APRNs serving in a mentorship role. Benner's theory guided the planning and development of this project, while the MCA was used for the self-reflection survey. Following a pretest survey, participants experienced an educational intervention geared toward mentoring and mentoring competencies. Formal APRN mentorship training program with an educational intervention that addressed the six domains of mentoring competency geared toward increasing the mentoring competency of APRNs who serve in a mentorship role. Results: A total of 18 surgical APRNs (N = 18) with more than 2 years of experience participated in the staff educational intervention. There was a statistically significant difference in six of the 26 individual items and in the overall pretest mean scores and the posttest mean scores (z = -3.41, p < .01), indicating that the APRN mentorship training increased the mentoring competency of the APRNs. Conclusion: The results of this quality improvement project demonstrated how an educational intervention geared toward mentoring competencies can increase the knowledge among a group of APRNs. Educating APRNs in mentorship competencies may enhance mentorship abilities and result in positive patient and organizational outcomes. Implications for Nursing: Educating APRNs in mentorship competencies may enhance mentorship abilities and result in positive patient and organizational outcomes.