Nurse Practitioner Education Programs Research Articles

Scoping review: Diagnostic reasoning as a component of clinical reasoning in the U.S. primary care nurse practitioner education.

Diagnostic Reasoning (DR) is an essential competency requiring mastery for safe, independent Nurse Practitioner (NP) practice, but little is known about DR content included in NP education programs. The aims of this study were to identify whether and how the concept of DR is addressed in NP education. We conducted a scoping review on DR-related content and teaching innovations in U.S. primary care NP education programs, with implications for NP education programs worldwide. Concepts and principles with global applicability include: conducting focused and hypothesis-directed histories and exams, generating the problem statement, formulating the differential diagnosis, appropriate and relevant diagnostic testing, determining the working diagnosis and developing evidence-based, patient-centred management plans. N=1115 articles retrieved from Medline, Embase, PsycINFO, and CINAHL for the period 2005-2021. Forty-one scholarly articles met inclusion/exclusion criteria. Data were extracted, synthesized and grouped by theoretical frameworks, content included, educational interventions and assessment measures. Most articles provided descriptions of approaches for teaching NP clinical or diagnostic reasoning. Ten papers directly referenced the current science and theory of DR. The US NP education literature addressing DR is limited and demonstrates a lack of shared conceptualizations of DR. Whilst numerous components of DR are identifiable in the literature, a robust teaching/learning scholarship for DR has not yet been established in the US NP education literature. Whilst primary care NP education programs are beginning to incorporate DR education into their curricula, little research has been conducted to demonstrate the effectiveness of educational outcomes. Increased integration of DR content into NP education is needed, including increased educational research on teaching DR competencies. No patient or public contribution was included in this review, as the public is generally not familiar with DR or its teaching approaches.

The Tension Between Regulation and the Pursuit of Quality in Canadian Nurse Practitioner Education Programs.

Nurses in advanced practice roles have existed in Canada for over 100 years, yet only in the last two decades, have nurse practitioners (NPs) been recognized as advanced practice nurses (APNs). During this time, NP educational programs have increased and transitioned from post-baccalaureate level to graduate level. Legislation and national NP regulatory approval processes have contributed to existing barriers to NP role implementation and full scope of practice. While regulation is mandatory and focused on public safety, an emphasis towards quality has led to the introduction of a national voluntary NP program accreditation process. The purpose of this paper is to initiate a discussion between Canadian NP regulators and educators related to proposed regulatory approaches and accreditation processes that balance public safety while promoting quality and excellence in NP education. Having two separate and costly processes has led to tension during a time of provincial fiscal restraint on university budgets coupled with the COVID-19 pandemic and its impact on nursing education. An integrated pan-Canadian approach of regulation and accreditation may ensure public safety, continuity, and consistency in quality NP education, enhance mobility of the NP workforce, and systematic planning to guide successful future NP role development and practice.

Strategies to Move Entry-Level Nurse Practitioner Education to the Doctor of Nursing Practice Degree by 2025.

The National Organization of Nurse Practitioner Faculties (NONPF) has made the commitment to move all entry-level nurse practitioner (NP) education to the Doctor of Nursing Practice (DNP) degree by 2025. Although there are more than 250 DNP NP programs throughout the United States, many other NP programs have yet to transition to the doctoral level. Leaders representing licensure, accreditation, certification, education, and practice organizations attended a NONPF 2017 Summit to discuss the DNP degree as entry into NP practice. Summit participants strategized on building collective strengths and addressed barriers to implementation. A solution-oriented discussion with action items has been operationalized for the last 4 years. Four workgroups were created to address education, outcomes, capacity, and messaging related to moving all entry-level NP education to the DNP degree. Ongoing collaborative efforts are critical to facilitate advancing all NP education programs to the DNP degree by 2025.

Use of social determinants of health codes in home-based primary care.

The Affordable Care Act created funding for nurse practitioner education programs to transform the primary health care workforce through student awareness of how social, political, economic, and environmental factors influence individual and population health. Funding established Academic Clinical Partnerships (ACPs) that created value-based health care models, which improved patient outcomes and decreased hospital and emergency department admissions and health care costs. The ACP established a home-based primary health care (HBPC) program to deliver primary care and collect patient data. The purposes were to describe the incidence of chronic conditions for HBPC patients and determine associations between chronic conditions and presence of social determinants of health (SDoH). Nurse practitioner students were assigned to HBPC clinical placements. A convenience sample of 102 high-risk, homebound patients was identified. Nurse practitioners and students recorded deidentified patient data, including ICD-10-CM codes into a Health Insurance Portability and Accountability Act compliant platform. Secondary analysis of patient records assessed for SDoH through Z codes. Patients had high incidences of hypertension, diabetes, pulmonary disease, heart disease, chronic pain, mood, and substance abuse disorders. Secondary analysis revealed that 92% of patients had indications for the use of Z codes, but these were not recorded. Common Z codes were personal risk factors, housing/economic circumstances, care provider dependency, lifestyle, and family support. By coding for SDoH, providers and agencies can realize higher reimbursement rates in HBPC settings. Nurse practitioners can use this information to provide better treatment recommendations, more accurate diagnoses, and referrals to enhance primary care services to a patient population negatively affected by SDoH.

The growing need to provide training in clinical procedures in family nurse practitioner educational programs.

Family nurse practitioners (FNPs) have a plethora of employment options upon graduation. Besides primary care, many are working in nontraditional settings such as urgent care, emergency departments, retail health, and specialty practices. In many of these settings, practitioners are required to perform procedures. However, more information is needed on the type of settings in which recent FNP graduates are working, the procedures being performed in these settings, and the perceptions of graduates of how prepared they felt to perform these procedures. Family nurse practitioners who completed an FNP program within the previous five years and who attended the 2019 AANP National Conference were invited to participate in a survey to assess their preparation in clinical procedures. Results revealed that more than half of the 198 respondents reported doing incision and drainage of abscesses and laceration repair. Respondents were divided on how they first learned to perform the procedures, with 47% stating that a preceptor demonstrated procedures to them during a clinical practicum experience, 42% stating that they learned on the job after graduation, and 43% reported that their FNP program provided training or simulation activities related to procedures. More than a quarter of respondents reported that they took a class on procedures. In all, 61% reported that they did not feel adequately prepared to perform procedures on graduation. Results indicated that colleges of nursing should ensure that FNP students have opportunities to master the procedures that are frequently performed by FNPs.

Meeting preceptor expectations to facilitate optimal nurse practitioner student clinical rotations.

Preceptors are essential to nurse practitioner (NP) students' transition from being a student to competent entry-level NP graduate. The literature is replete with data pertaining to the benefits of and barriers to preceptors engaging in the clinical education of NP students, and little has changed in the last two decades in this regard. Therefore, faculty solicited preceptor input to enhance curriculum revision and clinical training preparation. This qualitative inquiry project derived data from interviews with 13 preceptors in a variety of clinical settings. Interviews were audio-recorded, transcribed verbatim, and analyzed using a content analysis method. Recruiting, training, and retaining qualified, willing preceptors are of paramount importance to NP programs. This article describes preceptor expectations of NP students' knowledge, skills, and attitudes for optimal clinical rotation experiences. The results have important implications for innovative NP educational models, developing trust in NP education programs and promoting competency development of the NP student using entrustable professional activities.

A call to action: Building evidence for use of simulation in nurse practitioner education.

Leaders from national nursing organizations, nursing schools, and health care simulation vendors convened in early 2019 to discuss simulation in nurse practitioner (NP) education. Nurse practitioner clinical education needs a more standardized, efficient, and sustainable model to prepare NPs to provide quality care in complex health care systems. Currently, a major shortage of clinical sites and preceptors to educate students creates challenges for NP programs and nursing faculty. One strategy used by nursing programs to overcome this challenge is using simulation to provide clinical training for NP students in a safe, controlled environment. There remains, however, a lack of evidence linking these simulation experiences with clinical skills acquisition and program outcomes. Implementing competency-based education through standardized simulations has the potential to demonstrate quality, safety, and accountability across NP education programs. Ultimately, the expansion and acceptance of simulation hours in NP education is dependent on strong and favorable evidence from rigorous, high-quality studies.

Development of a Gerontology Graduate Certificate in Post-Acute and Long-Term Care.

Nurse practitioners (NPs) can provide safe, effective, quality care to older adults in post-acute and long-term care (PALTC) settings. However, there is a paucity of exposure to PALTC settings in most NP educational programs. Therefore, the current authors developed an elective graduate certificate in gerontology with an emphasis in PALTC for NP students. The graduate certificate curriculum was developed by faculty with expertise in nursing and gerontology education. The PALTC certificate comprises 15 credit hours of online didactic courses, 80 leadership hours, 200 clinical hours, and a scholarly project dedicated to PALTC. Completion of a graduate certificate in PALTC is a novel model for preparing NP students for practice in PALTC settings. The current article serves as a framework for other programs to reference as they develop individualized graduate certificate PALTC programs in their academic institutions. [Journal of Gerontological Nursing, 45(10), 47-52.].

Holistic Nursing Values in Nurse Practitioner Education

Much has been written about the inclusion of holistic nursing values and practices in undergraduate nursing education, but their inclusion and influence in advanced practice nursing education has not been fully explored. Nurse practitioners (NPs) are nurses, so it is assumed that the nursing perspective provides a framework for NP education and practice, and that NP education represents the blending of a holistic nursing approach with medical diagnosis and treatment. Nurse practitioners are taking increasing responsibility for filling the gap in primary healthcare availability in the U.S., and in the current political and economic healthcare climate, NPs are in a position to promote primary care models that honor comprehensive, patient-centered, and relationship-based care. As a result, it becomes essential to quantify the inclusion of these values in NP educational programs and coursework, as instilling core values for practice begins in educational environments. This quantitative, descriptive study explored the inclusion of holistic nursing values by NP faculty, using the Nurse Practitioner Holistic Caring Instrument (NPHCI). The NPHCI exhibited quite high reliability and validity in the sample, including confirmation of its three subscales. Survey results suggest that NP faculty actively incorporate holistic nursing values in educational coursework, and that age, length of time teaching in NP programs, highest educational degree, and academics as the primary area of practice were important indicators of the inclusion of holistic nursing values in NP program curricula. Findings add to knowledge of NP education, but further study is warranted.

Developing an Information Literacy Workshop to Foster Evidence-Based Practice Among Nurse Practitioner Students.

The increased autonomy and responsibility associated with the nurse practitioner (NP) role compounded with the plethora of electronic health information requires advanced practice registered nursing (APRN) students to possess information literacy (IL) skills associated with identifying, locating, and evaluating the quality of health-related literature (Majid, Chaudhry, & Xue, 2008). Without the proper IL skills needed to select high-quality clinical practice guidelines (CPGs) for decision making when developing treatment plans, NP students will be ill-equipped to perform evidence-based practice (EBP) during their clinical practicum experiences. The incorporation of IL skills training in NP educational programs is paramount for the actualization of EBP in clinical nursing (Majid et al., 2008). However, few studies have discussed IL skills and EBP as they relate to NP students' abilities to critically appraise CPGs and make EBP clinical decisions. This article discusses the development of a 4-hr IL workshop to enhance NP students' abilities to effectively search and critically appraise evidence-based research to make well-informed clinical decisions as advanced practice nurses.

Exploring conceptual and theoretical frameworks for nurse practitioner education: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE The objective of this review is to examine conceptual and/or theoretical frameworks that are relevant to nurse practitioner education. The specific review question is: What conceptual and/or theoretical frameworks are available that are relevant to the structuring of nurse practitioner education? INCLUSION CRITERIA Types of participants This review will consider studies that include nurse practitioners in any specialty or the education of nurse practitioners in any specialty at the graduate or post-graduate level. Phenomena of interest In this review, we will consider documents that describe or evaluate frameworks, maps or conceptual structures for NP education at the graduate degree or post-graduate degree level. Literature that presents a framework for the graduate education of students in other health care disciplines at the university level will also be considered for inclusion. Frameworks for utilization in other jurisdictions (e.g. Provincial and Territorial regulatory frameworks) and metrics that assist in measuring, describing and organizing key concepts required for nurse practitioner education will be examined. Outcomes of interest for this review will include framework components in either narrative or illustrative form. Context This scoping review will consider studies that have been conducted in the provision of graduate level education of students in health care disciplines. Specific contextual focus will be directed to identify frameworks for educational programming for nurse practitioner students. Frameworks for curriculum development and/or delivery in other disciplines will also be considered.

Capacity of, and Demand for, Neonatal Nurse Practitioner Educational Programs: A Missing Piece of the Workforce Puzzle.

Studies have demonstrated a dramatic increase in the number of new nurse practitioners (NPs) overall completing NP education each year. However, NPs who provide specialized care to children have not experienced increases in their pipeline at all. This has resulted in shortages of neonatal nurse practitioners (NNPs). The aim of this study was to gain a greater understanding of the NNP pipeline and potential for increasing the number of new NNPs graduating each year. Telephone survey of all NNP educational programs. Approximately one fourth of all NNP education programs had closed over the past several years. This is despite a strong job market, planned increases in hiring NNPs, and a seemingly growing shortage of NNPs. Problems with the NNP pipeline are not due to a lack of capacity of existing programs, but rather to difficulties in increasing the enrollment demand.

Informing innovative models of nurse practitioner education: A formative qualitative study

Despite major changes in health care, the one- to- one model of nurse practitioner (NP) clinical education programs has changed little in 50 years contributing to a lack of preceptors for NP education programs. More efficient models to educate NPs and are needed to ensure a sustainable primary care NP workforce. The purpose of this formative evaluation study was to assess barriers and facilitators to precepting NP students and adopting new models of NP education in clinical academic partnerships. Eight participants provided rich data from which to better understand the barriers and facilitators to precepting multiple NP students. Two major themes emerged; the student-academic-practice partnership and the health care system. Systems factors pertain to those not modifiable by NP programs such as time available, scheduling and space. Implications for development of a NP attending clinical model and academic curricula models are discussed.

Capacity of, and Demand for, Pediatric Nurse Practitioner Educational Programs: A Missing Piece of the Workforce Puzzle.

In contrast to family nurse practitioners and other adult nurse practitioners, the percentage of new pediatric nurse practitioners (PNPs) graduating each year has not increased. The aim of this study was to determine whether the marginal increase in the pipeline for PNPs is related to a limit in the capacity of educational programs or whether unfilled student openings exist. Self-administered survey of program directors at all recognized PNP educational programs in the United States. Approximately 10% of PNP programs in the United States were either closed, put on hold, or did not have new graduates in the last 3 years. Even with these closures, over 25% of active programs did not fill all available positions for the class entering in 2012. Despite evidence that demonstrates plans by employers to hire a greater number of PNPs in a variety of clinical venues including pediatric hospitals, primary care and subspecialty pediatric practices, the PNP pipeline has remained relatively stagnant. More than one third of program directors do not believe that their PNP program is currently at capacity, indicating that underutilized capacity to educate PNPs is a hindrance to meeting the current and future demands for these professionals.

Nurse practitioner student preceptor orientation via a Wiki

Nurse practitioner education programs have always partnered with nurse practitioners (NPs) to serve as preceptors for students completing clinical requirements of their graduate level nurse practitioner programs. In this model faculty rely on nurse practitioners for the clinical education of nurse practitioner students. Therefore, the preceptor role is a crucial element of NP education particularly in distance learning programs. Orientation to the role is essential to ensure educational competencies are achieved. Nursing faculty struggle with implementation of orientation that is efficient and meets the needs of all preceptors for all clinical courses. Orientation requirements to the nurse practitioners’ role as preceptor can be a barrier to acquiring and retaining preceptors. The purpose of this study was to acquire information from NP preceptors regarding willingness to participate in a NP preceptor orientation program, the type of information they desired in a NP preceptor orientation, and the preferred delivery system for this information. Former preceptors from our school of nursing’s database were sent an online survey with 15 questions regarding orientation for NP preceptors. Descriptive statistics were used to summarize preceptor needs and preceptor barriers. Qualitative findings from written comments found many preceptors perceive school of nursing faculty organizational support is vital in terms of how positively they view their role as a preceptor and their willingness to participate in an orientation program. The results of the survey were used to re-design nurse practitioner preceptor orientation in our school of nursing. The WIKI online method was chosen due to its ease of information dissemination, which met the administrative needs of faculty; and its convenience and availability, which met the accessibility needs of preceptors.

Commentaries on health services research

Commentaries on health services research

Faculty strategies that influence the student transition from registered nurse to nurse practitioner: a systematic review protocol

Review question/objective The objective of this review is to identify the best available evidence related to strategies implemented by faculty (behaviors, teaching methods and other factors) that have been found through student report of experiences that impact role transition from registered nurse (RN) to nurse practitioner (NP). The specific review question to be addressed is: what are NP student perceptions of faculty strategies that inhibit or facilitate student role transition from RN to NP? Inclusion criteria Types of participants Nurse practitioner (NP) students and recent graduates (within their first year of practice) of nurse practitioner educational programs. For the purposes of this review, nurse practitioner can encompass: adult nurse practitioner, adult-gerontology nurse practitioner, gerontology nurse practitioner, pediatric nurse practitioner, or family nurse practitioner. Phenomena of interest The experiences of NP students of the facilitators and inhibitors, such as faculty behaviors and strategies, that influence the transition process from the role of RN to NP. Context Graduate nursing studies

Risk factors for COPD: What do NPs know?

Chronic obstructive pulmonary disease (COPD) has been identified as the fourth leading cause of death. The primary purpose of this article is to discuss risk factors for COPD and identify at-risk populations. A secondary purpose is to report the findings of a recent survey of nurse practitioners (NPs) in Colorado regarding their knowledge about the risk factors for COPD. Data sources A list of registered NPs in the State of Colorado was obtained from the State Board of Nursing. Surveys were sent to 2916 NPs to assess their knowledge about risk factors for COPD. Although the response rate was less than 10%, this survey highlighted that there were gaps in knowledge especially for pediatric, women's health, and geriatric NPs. NPs are on the front lines in assisting with the prevention, early diagnosis, and management of this complex disease. Formal NP educational programs (regardless of focus) should highlight that through recognition of risk factors, NPs can play a significant role in primary and secondary preventive measures that may decrease the impact of COPD. Public media campaigns to educate the public about risk factors may encourage the individual patients to address these risk factors with the primary care provider.

What do nurse practitioners do? Analysis of a skills survey of nurse practitioners

To report findings from a survey, analysis, and evaluation of the frequency and criticality of clinical skills and procedures (CSPs) used by nurse practitioners (NPs). In addition, data regarding NP demographic, geographic, and educational preparation were also obtained. Participants were a convenience sample of 452 NPs in Oregon (31% response rate). Findings point to the importance of assessing both frequency and criticality of practice skills. Demographic and geographic data reflected significant dichotomies between urban and rural practice. Rural NPs face challenges of providing care with more distant physician specialists and reported the use of a greater number of CSPs. A majority of participants reported learning most of the CSPs used in practice outside of their NP educational programs. The frequency and criticality of CSPs utilized in practice are both important considerations for NP clinicians and educators. NPs planning to practice in rural areas may need broader exposure and training in CSPs. An understanding of CSPs used by NPs may better inform administrative, reimbursement, licensure, and certification issues for advanced practice nursing. NP clinicians and faculty involved in NP education should seek to promote improved congruence between the CSPs taught in programs and those used in clinical practice.

Strategic Framework on Multiple Chronic Conditions Will Influence NP Practice

PhD, NP T he Affordable Care Act, with its emphasis on disease prevention, brings new attention to how US healthcare is provided and focuses attention on nurse practitioners (NPs) as an important component of the healthcare system. This new focus has stressed the importance of learning how to care for our patients in a better way, particularly those who have chronic illnesses. A close examination of US healthcare statistics reveals that more than a quarter of all Americans—and 2 of 3 older Americans—have multiple chronic conditions. Treatment for individuals with chronic illnesses accounts for 66% of the country’s healthcare budget, whether it is public or privately funded. These numbers of individuals with chronic illnesses are expected to rise as the number of older Americans increases. An analysis of current healthcare shows that the system is largely designed to treat one disease or condition at a time. This is an antiquated treatment format, often resulting from the high utilization of specialists who focus on one disease entity and where coordination of overall care is often missing or fragmented. As the number of chronic conditions that a person has increases, so do the risks of drug and physiologic complications, including adverse drug events, duplication or gaps in services, unnecessary hospitalizations, and confusion caused by conflicting medical advice. The US Health and Human Services recently issued the report “Strategic Framework on Multiple Chronic Conditions.” This report is a strong indictment of the current healthcare system and a call for change. (See http://www.hhs.gov/news/press/2010pres/12/20101214a. html for more information about this report.) A press release from HHS indicates the report outlines a new strategic framework to be coordinated by the agency. The report claims the new framework is designed to reduce the risks of complications and improve the overall health status of individuals with multiple chronic conditions. The framework is meant to provide more information and better tools to help health professionals and patients learn how to better coordinate and manage care. The framework also aims to facilitate research to improve oversight and care of patients. As such, all healthcare providers should learn about the new framework and how they will fit into the impending system. The report emphasizes, “The management of multiple chronic conditions has major cost implications for both the country and individuals. Increased spending on chronic diseases is a key factor driving the overall growth in spending in the Medicare program.” Especially during these times of fiscal constraint, individuals with multiple chronic conditions face increased out-of-pocket costs for their care, prescriptions, and support services. The integration and coordination of care for this Medicare population is foundational if better care, lower costs, greater efficiency, and quality are to be realized. NPs need to be adequately prepared if they are to participate fully in the opportunities to keep chronic conditions from occurring in the first place and to improve the quality of life for patients who have them. Nurse practitioner educational programs must be responsive to making changes in how to care for patients with chronic diseases. In this effort, JNP is timely in our focus throughout 2011 on the management of chronic diseases.