Direct Patient Care Hours Research Articles

To precept or not to precept: Perspectives from nurse practitioners.

Nurse practitioner (NP) preceptors are crucial to clinical education. Recent increases in the required direct patient care hours for NP students may worsen the current preceptor shortage. However, most studies of preceptorship only include NPs who are current preceptors and are therefore missing vital information from nonpreceptors. It is imperative to understand facilitators and barriers to preceptorship from the perspective of NPs who have stopped being or have never been preceptors. The purpose of this study was to understand the factors influencing NPs' decisions whether to precept. This was a descriptive, phenomenological study. Semistructured interviews were recorded in Zoom, transcribed verbatim, deidentified, and analyzed using thematic analysis. Sixty NPs participated in the study: 23 current preceptors, 22 previous preceptors, and 15 who had never been preceptors. Facilitators to preceptorship included institutional support of preceptorship, positive student characteristics, clear expectations from the educational facility, and incentives. Barriers to preceptorship included time constraints, specialty, negative student characteristics, no institutional support, and being uncomfortable in the clinical role. Preceptors and nonpreceptors shared similar themes-positive student characteristics and clear expectations as facilitators to preceptorship, and time as a barrier. However, other themes were unique to one preceptorship group. This provides new evidence for practice and research. Nurse practitioner programs can facilitate preceptorship by ensuring that students are well prepared and providing clear expectations. Strategies should be developed to manage the time burden of preceptorship. In addition, support for preceptorship by health care organizations and systems should be studied.

Assessing Student-Reported Perceptions of Prerequisite Usefulness in Preparation for Didactic Physician Assistant Education.

To gain admittance to a physician assistant (PA) school, applicants must complete program-specific prerequisite courses and experiences. The lack of standardization contributes to complexity, expense, and limits diversity. This research assessed current didactic PA students' perceptions of prerequisite courses, course delivery methods, and direct patient care (DPC) experiences to determine which were perceived as the most useful in preparation for didactic PA education. An online cross-sectional survey was sent to eligible PA students across the United States. The survey collected opinions on the usefulness of commonly required prerequisite courses, course delivery methods, and DPC experiences. Collected data underwent statistical analysis and qualitative analysis for open-response questions. A total of 527 students completed the survey. Greater than 50% reported prerequisite courses in science and psychology as well as speech, ethics, cardiopulmonary resuscitation (CPR), medical ethics, medical terminology, and nutrition "prepared them well" or "extremely well." The most frequently recommended educational delivery method was "in person." The DPC experiences reported to best prepare students were Medical Assistant, Certified Nursing Assistant, and Scribe. The reported recommended number of DPC hours was 1000 to 1499. Chi-square tests for courses that prepared students "well" and "extremely well" revealed that in-person delivery had a statistically significant association with anatomy, physiology, ethics, CPR, medical ethics, and Spanish. These significant findings should be considered by PA programs when evaluating their requirements for admission. Furthermore, PA education associations should consider universal requirements to reduce applicant barriers, complexity, and expense, which may lead to improved diversity.

Exploring Clinical Practice Hours in Postbaccalaureate-to-Doctor of Nursing Practice Nurse Practitioner Programs.

Advanced practice nursing education is evolving to the doctor of nursing practice (DNP) degree. The American Association of Colleges of Nursing (AACN) DNP Essentials required 1000 hours of direct patient care, whereas the Report of the National Task Force on Quality Nurse Practitioner Education (NTF) Criteria for Evaluation of Nurse Practitioner Programs required 500 direct patient care hours. Indirect hours were unclear and undefined. The AACN Essentials changed the 1000-hour requirement to 500 practice hours, and the NTF increased the direct patient care hours to 750. The study sought to describe the distribution of direct and indirect hours that the National Organization of Nurse Practitioner Faculties member schools offer in their seamless postbaccalaureate-to-DNP nurse practitioner (NP) program. A quantitative survey was distributed to schools of nursing. Eighty-six surveys represented 86 distinct schools and 112 NP programs. Supervised direct patient care hours were an average of 791.31 hours. Indirect hours averaged 170.08 hours. The DNP project hours served as an indirect hour activity. Many schools have more than 750 direct hours adhering to the 2022 NTF Standards. The indirect hour allocation varies and weighs heavily on the DNP project.

Nephrology Program Director Protected Time for Program Administration in the United States.

The Accreditation Council for Graduate Medical Education (ACGME) required that program directors receive 10-20 h/wk of protected time for program administration (including didactic teaching). In July 2022, this was reduced for all internal medicine subspecialties on the basis of program size, with 8 h/wk required for programs with fewer than seven fellows, the majority of nephrology programs. We surveyed all 151 US adult nephrology program directors (ACGME Public List of Programs 2021-2022) to determine how much protected time they receive, how much they think is necessary, and the division of their professional time. The anonymous 20-question online survey was administered from March 31 to April 30, 2022. The analysis was descriptive. Response rate was 66% (99 of 151). Geographic distribution and approved fellow positions were similar to programs nationally; 59% had fewer than seven approved positions. Median protected time was 10 h/wk (interquartile range, 5-10), with 8 h/wk (interquartile range, 5-10) for those with fewer than seven positions. Program directors estimated needing 12 h/wk (interquartile range, 10-16) to effectively administer programs, including those with fewer than seven positions, a median 5 h/wk (interquartile range, 0-7) more than received. Of program directors reporting <10 h/wk for program administration, 62% provided >20 hours of direct patient care. Thirty-nine percent had no protected time for core faculty. Fellow recruitment (68%) was the most time-consuming task, and didactic teaching (80%) was the most professionally rewarding. Approximately half of the nephrology programs surveyed were not in compliance with the ACGME-stipulated 10-h/wk minimum protected time for the 2021-2022 training year. Program directors estimated a median of 12 h/wk are needed to effectively manage programs.

Perceptions of Physical Therapists of Online Introduction and Training in the Home-based Older Persons Upstreaming Prevention Physical Therapy (HOP-UP-PT) Program: A Qualitative Study.

Introduction Traditionally, physical therapy has adopted a tertiary approach to preventative care. However, recent trends in fall-related injuries and deaths among older individuals suggest a dire need for earlier intervention. The Home-based Older Persons Upstreaming Prevention Physical Therapy (HOP-UP-PT) program has been developed to improve the health and overall function of community-dwelling older adults at risk of functional decline. As demand continually rises for HOP-UP-PT services, online training modules have been developedto safely and efficiently provide HOP-UP-PT competency to physical therapists. The purpose of this study was to examine self-reported experiences and perceptions of physical therapists after completing an asynchronous training program to deliver HOP-UP-PT. Methods After securing Oakland University IRB approval, a qualitative study using a sample of convenience used two structured focus group interviews. Inclusion criteria required participants to be licensed physical therapists (PTs) in the state of Michigan providing at least 20 hours of direct patient care per week.Participants completed eight 30-minute training modules, each with a corresponding quiz. Upon completion, PTs attended one of two video conference focus groups. Data was analyzed using the constant comparative method to develop themes and concepts based on responses about the training modules and the overall HOP-UP-PT program. Results Twelve PTs with a median age of 31-40 years participated. Analysis of two focus group sessions identified three concepts (Novel Approach to Physical Therapy Care, Integration of a Preventative Approach into Clinical Practice, and Knowledge Translation) and ten themes (Addressing an Unmet Need, Establishing a Working Relationship with Community Centers, Applicability to Various Settings, Shifting the Mindset to a Prevention-focused Paradigm, Applicability to Physical Therapists that Care for Older Adults, Patient Engagement and Prevention, Value for the Professional, Importance of Availability of Options in a Learning Platform, Ongoing Availability of Program Resources and Tools, and Clinical Application Practice). Conclusion PTs identified the HOP-UP-PT program as a novel, clinically applicable, and adding value to the profession. Furthermore, its upstream focus aligns with the growing role of preventative care by PTs; however, as HOP-UP-PT is not a traditional approach, additional training and clinical support materials may facilitate adoption and clinical application. HOP-UP-PT uses a preventative approach to clinical practice, but efforts to translate knowledge to PT are an important consideration. Additionally, the study identified a need for refinement and modifications to the existing HOP-UP-PT training modules.

768 The Significant Impact of Having a Dedicated Ambulatory Clinical Social Worker in the Burn Clinic

IntroductionA licensed clinical social worker (LCSW) has been recognized as an essential role within the Burn Center inpatient multidisciplinary team. However, for ambulatory patients facing acute crisis, resources can be scarce; relying on clinic nursing staff or an inpatient LCSW to problem solve psychosocial concerns can leave large gaps of patient care unaddressed. An Ambulatory LCSW (ALCSW) assists transition of care working to prevent unnecessary Emergency Room visits and readmissions. We sought to examine our experience utilizing an ALCSW in the Burn Center.MethodsA full-time burn ALCSW position was approved in fall of 2020 at our ABA verified Burn Center. The role includes extensive assessments of mental health, substance use, domestic violence, and safety concerns, connecting clinic patients to resources for transportation, benefits, insurance coverage, employment, food, and housing. The ALCSW also conducts short term patient centered, family & group therapy sessions. A retrospective review was performed on duties of the ALCSW comparing 9 months (December-August) pre and post hire. Data collected included visit types, hours of patient care, and interventions performed.ResultsDuring the first 9 months, the ALCSW completed 1,008 patient encounters (approximately 25 hours of direct patient care per week) and 510 psychosocial assessments. In the first three months alone 258 substance use screens, 166 mental health assessments, 44 ASD/PTSD therapy sessions, 205 Homeless Shelter referrals and 128 community resource encounters were performed that would have otherwise been left unaddressed or added to the workload of our Burn Clinic RN or provider.The ALCSW was able to see up to 89.39% more patients per month (n=89) compared to the inpatient LCSW who only responding to clinic patients with emergent needs (n=13). The increase of ALCSW encounters showed a 35.37% increase of completed visits without IP admission (n=pre 665 vs post 1029), 39.73% decrease of IP admissions after clinic visit (n=pre 73 vs post 44), and 17.82% increase of patients without inpatient admissions entirely (n=pre 572 vs post 696). In addition, the added effort of an ambulatory LCSW, has increased SOAR support group participation by 60.13% in calendar year 2021 compared to calendar year 2020 (n= pre 63 vs post 158).ConclusionsHiring a dedicated Burn ALCSW can substantially increase the resources available to outpatients, fill voids of patient care, limit unnecessary hospital resources, and prevent admissions.

Adapting clinical experiences during a pandemic: One college of nursing's approach.

Graduate level nursing programs are having increasing difficulty obtaining clinical sites for their students. Nurse practitioner (NP) students need a minimum of 500 direct care hours in addition to indirect hours. Simulation experiences may not be used as direct patient care hours for NP students, but telehealth experiences may be used if the focus is on obtaining similar competencies to what would be acquired with face-to-face patient experiences. One college of nursing adapted several opportunities for NP students to acquire indirect clinical experiences and specific NP competencies during the coronavirus (COVID-19) pandemic. Several different clinically focused teaching methodologies were planned and implemented. These varied by NP specialty track and included complex case analyses, virtual (Zoom) rounds, well-child cases, and objective structured clinical examinations. These adapted clinical experiences are effective methods of helping students acquire clinical competencies and skills; however, they bring their own challenges. Post-COVID may be a time of new beginnings, moving nursing education forward on finding new and better ways to ensure that students acquire clinical competencies. What the new normal will be for nursing education is yet to be determined, but nursing education will likely never return to where we were before the pandemic.

Building coalitions: A statewide nursing organization's role in changing nursing education regulation during the COVID-19 pandemic.

The California Association of Colleges of Nursing (CACN), representing California's baccalaureate and higher degree nursing education programs, has raised concerns for over two-years about the number, relevance, and legitimacy of nursing education regulations. Formal CACN letters to state regulators did not affect change. While California nursing education regulations require 75% direct patient contact for all clinical courses, meeting this requirement became impossible as clinical agencies closed to nursing students during the beginning of the COVID-19 pandemic. Nursing regulatory change was urgently needed to provide greater flexibility in meeting clinical course objectives using simulation and other online learning modalities. At stake was the graduation of over 14,971 RN students from public and private nursing programs. While state regulators opposed a legislative approach, CACN collaborated with stakeholders to support legislation that led to a reduction in direct patient care hours, allowing nursing students to progress and graduate. This longstanding advocacy work was accelerated by the pandemic and required leadership and knowledge about the legislative process for nurse educators to succeed. The ultimate goal for CACN is to forge a more respectful relationship and greater collaboration between educators and regulators to enhance quality, reduce costs, and redundancies in nursing education in this state.

Preparing for the COVID-19 Pandemic and Its Impact on a Nursing Simulation Curriculum.

This article describes one school's process to maintain their undergraduate nursing simulation program during campus closure and clinical placement suspension due to the COVID-19 pandemic. After the campus closure, faculty replaced clinical hours with simulation using virtual clinical education such as telehealth with standardized patients (SPs), virtual simulations using commercial products, and virtual faculty skills instruction. Using virtual clinical education and SP-based telehealth simulations provided an alternative for 50% of the required direct patient care hours. Virtual simulation accounted for 18,403 clinical hours completed by 244 students. Preparation for emergencies that force campus and clinical site closures should include processes to provide virtual simulation and remote simulations with SPs to replace clinical hours. Planning for the impacts of COVID-19 on the operation of this school of nursing highlights the importance of having a detailed plan to address campus closure due to emergencies. [J Nurs Educ. 2021;60(1):52-55.].

State of Simulation Research in Advanced Practice Nursing Education

Simulation is used in advanced practice nursing education for both formative learning experiences and summative competency testing. However, there has been a lack of cohesive data to support the use of simulation as a replacement for direct patient care hours. This chapter presents an overview of research designs and the leveled Kirkpatrick framework used in simulation research. Research articles evaluating the effect of simulation on advanced practice learners are presented by research design and Kirkpatrick level. There is evidence that simulation has a positive impact on Kirkpatrick Level 1 (Reactions) and Kirkpatrick Level 2 (Changes in Knowledge, Skills, and Attitudes). However, there is a tremendous need for evidence that simulation can impact Kirkpatrick Level 3 (Behavior) and Level 4 (Results and Outcomes).

Gender Differences in Reported Weekly Work Hours Among Family Physicians.

While women are entering family medicine at higher rates than men, little is known about the present differences in practice patterns between male and female family physicians (FPs). We used 2017 and 2018 American Board of Family Medicine Family Medicine Certification Examination practice demographic questionnaires to assess average weekly total hours and direct patient care hours by age and gender reported by FPs. We found a gender gap between both overall hours worked and direct patient care hours, with female FPs reporting fewer hours across age groups.

The Gender Penalty: Reasons for Differences in Reported Weekly Work Hours Among Male and Female Family Physicians.

The JABFM policy brief by Wilkensen et al[1][1] highlights gender differences in work hours between male and female family physicians, with men reporting significantly more hours of total and direct patient care across age groups. This comes as no surprise to me as a female family physician with 3

Physician Shortage in Canada: A Review of Contributing Factors

The physician shortage in Canada is multifactorial. It is important to identify potential factors and policies contributing to the problem. An extensive literature review to retrieve primary source articles was performed using the PubMed database. Other sources of information included reports identified using the websites of organizations, associations, government bodies and Google scholar, as well as additional primary source articles identified using reference lists of retrieved articles and reports. Healthcare policy changes in the 1990’s limited the growth of physician supply through the reduction of medical school enrolment, restrictions on recruitment of international medical graduates into the workforce, redistribution of family physician and specialist mix and loss of physicians to the US. Inadequate supply of primary care physicians is reflected in the low interest among medical students in a family medicine career and the shortage of physicians in rural areas. Reduction of physician productivity is characterized by an aging physician population, greater proportion of women in the workforce and the reduction of direct patient care hours among the new generation of physicians. The problem is further exacerbated by inefficiencies in healthcare expenditures, judging from high healthcare spending and low physician-to-population ratio. An understanding of factors contributing to the physician shortage is essential in order to develop successful strategies to alleviate inadequate physician supply.

Do Patients Treated for Colorectal Cancer Benefit from General Practitioner Support? A Video Vignette Study.

BackgroundPatients who have been treated for colorectal cancer in Australia can consult their general practitioner (GP) for advice about symptoms or side effects at any time following their treatment. However, there is no evidence that such patients are consistently advised by GPs, and patients experience substantial unmet need for reassurance and advice.ObjectiveTo explore the patient management options selected by GPs to treat a set of patients describing their symptoms following treatment for colorectal cancer.MethodsThis was an Internet-based survey. Participants (GPs) viewed 6 video vignettes of actors representing patients who had been treated for colorectal cancer. The actor-patients presented problems that resulted from their treatment. Participants indicated their diagnosis and stated if they would prescribe, refer, or order tests, based on that diagnosis. These responses were then rated against the management decisions for those vignettes as recommended by a team of colorectal cancer experts.ResultsIn total, 52 GPs consented to take part in the study, and 40 (77%) completed the study. Most GPs made a diagnosis of colorectal cancer treatment side effects/symptoms of recurrence that was consistent with the experts’ opinions. However, correct diagnosis was dependent on the type of case viewed. Compared with radiation proctitis, GPs were more likely to recognize peripheral neuropathy (odds ratio, OR, 4.43, 95% CI 1.41-13.96, P=.011) and erectile dysfunction (OR 9.70, 95% CI 2.48-38.03, P=.001), but less likely to identify chemotherapy-induced fatigue (OR 0.19, 95% CI 0.08-0.44). GPs who had more hours of direct patient care (OR 0.38, 95% CI 0.17-0.84, P=.02), were experienced (OR 9.78, 95% CI 1.18-8.84, P=.02), and consulted more patients per week (OR 2.48, 95% CI 1.16-5.30, P=.02) suggested a management plan that was consistent with the expert opinion.ConclusionsIn this pilot study, years of experience and direct patient contact hours had a significant and positive impact on the management of patients. This study also showed promising results indicating that management of the common side effects of colorectal cancer treatment can be delegated to general practice. Such an intervention could support the application of shared models of care. However, a larger study, including the management of side effects in real patients, needs to be conducted before this can be safely recommended.

Factors associated with subjective well‐being in cancer workers in Queensland

This study aims to describe factors associated with subjective well-being (SWB) in cancer workers in Queensland and compares results to normative data for the Australian population. This study was based on a cross-sectional survey of 544 cancer workers in Queensland with a response rate of 54%. SWB was measured using the Personal Wellbeing Index for Adults. Multiple regression analyses were performed to identify explanatory variables, which were independently associated with SWB. Results were compared with normative Australian data. The overall mean SWB for study participants was 74.63, which was comparable to the mean of 75.02 for the Australian population (P = 0.47). Female cancer workers had significantly lower levels of SWB compared to the normative data of female Australians (74.44 compared to 75.7, P = 0.03). Multiple regression analyses showed that higher levels of SWB were associated with having 11-30 h of direct patient care hours per week, being married, no child or elder care commitments, good physical health, low levels of both psychological distress and burnout, and high levels of work engagement. Cancer workers' overall levels of SWB were similar to the national mean scores. Amount of time in direct patient care was linked with SWB, with an optimal time between 11 and 30 h per week associated with high SWB. The majority of the factors significantly associated with SWB were of a personal nature such as marital status and physical and mental health. These data provide a valuable baseline for future research in this area, especially in the area of interventions to promote SWB of workers.

Work engagement in cancer workers in Queensland: The flip side of burnout

The study aimed to investigate factors associated with work engagement and burnout in cancer workers in Queensland. A cross-sectional survey of 579 cancer workers in Queensland was undertaken. Burnout was measured using the Oldenberg Burnout Inventory (OLBI) and work engagement was measured using the Utrecht Work and Well-being Survey. Multiple regression analyses were performed to identify explanatory variables that were independently associated with burnout and work engagement. The survey response rate was 57%. Total levels of burnout and work engagement in the sample were 31.1% and 34.5%, respectively. Multiple regression analyses showed that shift work, 6-9 years experience, working >20 hours/week, administrative professional stream and being single were associated with higher levels of burnout. There was a positive association between work engagement and nonshift workers, <5 years experience, medical and allied health workers, and workers >45 years of age. In this study, gender, income, hours of direct patient care, location of the centre in regional centres or within the private setting did not have an independent effect on the levels of burnout or work engagement. There was a negative association between burnout and work engagement (P < 0.001). Approximately one-third of the workers sampled reported burnout. Conversely, one-third reported being highly engaged in their work. Further research is required to study the effectiveness of interventions to improve personal resources and prevent burnout. Understanding the factors associated with work engagement is equally important in designing organisational programs to enhance employee engagement.

Productivity in Audiology and Speech-Language Pathology

Productivity in Audiology and Speech-Language Pathology

Do new cohorts of family physicians work less compared to their older predecessors? The evidence from Canada

Although demographics, cohort, and contextual factors are expected to influence physician supply at the intensive margin, much of the literature has examined the demographics and very limited cohort analysis is undertaken. This paper employs a cross-classified fixed-effects methodology to examine the importance of age, period and cohort, and contextual factors in explaining the declining work hours of Canadian family physicians. We define cohorts with five-year intervals according to year of graduation from medical school. Contrary to the previous literature, we find no evidence of reduced hours of work provided by the new cohorts of physicians. Compared to the 1995–99 cohort, older male cohorts perform similar total hours of work per week except those who graduated in the 1960’s while older female cohorts consistently perform fewer total work hours in the range of 3–10 h per week. Consistent with the literature, it is found that female and older physicians provide fewer hours of work compared to the male and younger counterparts, respectively. Although there has been a decline in total hours of work for all physicians in the range of 2–3 h per week in each period, we find a large decline in direct patient care hours (about 4–6 h) and a marginal increase in indirect patient care (about 2–4 h) over the period. Having children less than 6 years and children aged 6–15 years in the physician’s family reduce the work hours of female family physicians by about 7 h and 3 h, respectively. A number of other contextual factors influence work hours of physicians in the expected direction.

County-Level Estimates of Need for Mental Health Professionals in the United States

County-Level Estimates of Need for Mental Health Professionals in the United States

The feminisation of Canadian medicine and its impact upon doctor productivity

We examined the differences in work patterns between female and male doctors in Canada to gain insight into the effect of an increased number of female doctors on overall doctor productivity. Data on the practice profiles of female and male doctors across Canada were extracted from the 2007 National Physician Survey. A doctor productivity measure, 'work hours per week per population' (WHPWPP), was created, based on the number of weekly doctor hours spent providing direct patient care per 100,000 citizens. The predicted WHPWPP was calculated for a hypothetical time-point when the female and male doctor populations reach equilibrium. The differences in current and predicted WHPWPP were then analysed. Female medical students currently (2007) outnumber male medical students (at 57.8% of the medical student population). The percentage of practising doctors who are women is highest in the fields of paediatrics, obstetrics and gynaecology, psychiatry and family practice. Female doctors work an average of 47.5 hours per week (giving 30.0 hours of direct patient care), compared with 53.8 hours worked by male doctors (35.0 hours of direct patient care) (P < 0.01, chi(2) test). Female doctors tend to work less on call hours per week and see fewer patients while on-call. Female doctors are also more likely to take parental leave or a leave of absence (P < 0.01, chi(2) test). The difference in current and predicted WHPWPP was found to be 2.6%, equivalent to 1853 fewer full-time female doctors or 1588 fewer full-time male doctors. Gender appears to have a significant influence on the practice patterns of doctors in Canada. If the gender-specific work patterns described in the present study persist, an overall decrease in doctor productivity is to be anticipated.