Nurse Practitioner Role Research Articles

Facilitators and barriers in implementing the nurse practitioner role in Japan: A cross-sectional descriptive study.

To investigate the distribution of nurse practitioners (NPs) across Japan and their perceived facilitators and barriers to NP implementation in Japan. NP certification examinations have been conducted in Japan since 2011, and by 2020, there were 487 NPs in the country. The momentum of NP implementation is slower in Japan compared with other countries. A cross-sectional descriptive study, following the STROBE guidelines, was conducted. Web-based survey questionnaires, developed by the authors, were administered to 248 NPs whose email addresses were maintained by the certification management body. Valid responses were obtained from 101 NPs (response rate: 40.7%), of which 34% were male. The respondents had more than 12 years of registered nurse experience on an average before enrolling in the graduate NP program. 53% were employed as NPs from the beginning, while 25% were initially employed as registered nurses and later advanced to NPs, and 11% still worked as RNs. A majority worked in hospitals with beds. Many NPs perceived the lack of NP national licensure and reimbursement benefits as barriers to NP implementation, whereas recognition from superiors and organizations was considered facilitators. Despite their small numbers in Japan, NPs take on crucial tasks and contribute to the appropriate distribution of medical resources. The NP licensure system and recognition from superiors and organizations may be necessary to promote NP roles in Japan. Some certified NPs still work as registered nurses. Recognition from nursing and organization administrators is critical to implementing NPs. To this end, a reimbursement system benefiting the organizations and a legislation facilitating NP employment are required.

A Scoping Review of Nursing Roles in Hepatitis C Virus Telehealth

Little is known about the roles of nurse practitioners (NPs) and nurses in hepatitis C virus (HCV) telehealth care. This scoping review aims to understand what is known about the roles of NPs and nurses in HCV telehealth care. This review was guided by Arksey and O’Malley’s methodological framework. A search of 18 databases was completed. Of 718 results identified, 16 met the objective of this review. In HCV telehealth care, the roles of NPs involved patient coordination and follow-up, diagnosis, and prescribing; the roles of nurses mainly included patient coordination and follow-up.

NP Role and Patient Outcomes Are Supported by High-Level Evidence. Comment on Almutairi et al. Nurse Practitioner: Is It Time to Have a Role in Saudi Arabia? Nurs. Rep. 2020, 10, 41-47.

This is a letter to the editor in response to the article titled “Nurse Practitioner: Is it Time to Have a Role in Saudi Arabia?” Clarifications on the nurse practitioner role definition and description, educational preparation, and quality and value of care are made and supported with authoritative, high-quality evidence.

The Emerging Role of Nurse Practitioner in Evidence-Based Nursing

<p>醫療科技日新月異，不變的是人們對高質量照護的需求，實踐實證照護為提升護理照護品質的途徑之一。本文將概述實證護理之演進、闡釋能堪任醫療及護理的專科護理師於實證應用之角色與阻滯，及專科護理師教育之革新。最後，結合文末實際臨床情境之分享，期待本文可讓專科護理師瞭解實證在專科護理師實務上之應用，更進一步認同且致力實踐實證護理，以提升照護品質， 強化專科護理師在健康照護體系之定位，體現專業角色之獨特與重要性</p> <p> </p><p>In the era of rapidly advancing medical technology, the matter remains unchanged is people’s demand for high-quality care. The practice of evidence-based care is one of the ways to improve the quality of nursing care. This article outlines the evolution of evidence-based nursing, elaborates the role and impediment to the application of evidence-based nursing by nurse practitioners, and the revolution of professional nurse practitioners’ education was discussed. At the end of the article, two actual clinical cases were presented. Through the case studies, we expect that nurse practitioners can understand the application of evidence-based nursing in clinical settings and further to recognize and devote them­selves to practicing evidence-based nursing, for improving the quality of care and strengthening the role of nurse practitioners in the health care system</p> <p> </p>

Tendency and foci of nurse practitioners: bibliometric analysis based on the CiteSpaceV†

Abstract Objective Nurse practitioners (NPs) have drawn significant attention recently and played a major role in healthcare. We aim to find the evaluation of NPs through published studies and then visualize the research status and hotspots in this field. Methods All data came from the Web of Science Core Collection, and the data were counted and entered into Excel 2016. The key documents nodes were excavated by analyzing the knowledge network map using CiteSpaceV software. In this study, these nodes of “author, country, institution, keyword, co-citation (reference\cited-author\cited-journal), and grant” were harvested for analysis and comparison. Results A total of 4912 records, which were published between 2007 and 2018 and pertained to NPs, were retrieved from the Web of Science Core Collection database (WoSCC) from a diversity of languages. The total and the annual number of publications and citations of these continually increased over time. Most publications were in 2018 (618 records). This study involved 8241 authors located in 98 countries and 4557 institutions totally. The United States (2737 records) and the University of Michigan (90 records) dominated in publication frequency. There are 902 journals and 2449 articles with funding support that have been analyzed. Most articles were from JAMA: The Journal of the American Medical Association (1386, IF = 47.661), followed by the Journal of Advanced Nursing (1359, IF = 2.267), and The New England Journal of Medicine (1109, IF = 79.258). The reference “The Role of Nurse Practitioners in Reinventing Primary Care” was co-cited most frequently, which revealed it as the highest landmark article in NP. The top-ranked keyword was “Care,” other than “Nurse practitioner,” which has an ultra-high frequency. Some of the high-frequency keywords represent the significant direction of NPs. Conclusions NPs are at the crux of health-care delivery and play an important role in providing high-quality nursing. Publications on NPs in WoSCC have increased notably during the recent years, and have appeared in some journals that have a high impact factor. Research frontiers and developmental trends were revealed by the analysis in this study, which can be used to forecast future research developments in NPs and taken as a reference to choose the right directions by subsequent researchers who wish to use these results. However, the grant support from administration or research institutions is still in need of improvement and the scope of research in NPs should be broadened in the future.

The role of palliative care nurse practitioner in promoting end-of-life care in residential care facilities

Background and objective: The neglect of older people at the end of life in residential care documented in the Australian Royal Commission into Aged Care and Quality and Safety mandates urgent solutions to improve care. This integrative literature review aimed to explore the potential role of the palliative care nurse practitioner (PC-NP) in promoting quality end of life in residential care.Methods: Databases Medline, Emcare, PsychINFO and CINAHL were searched from January 2010 to April 2022. Full text of primary articles meeting inclusion criteria encompassing residents living in residential care settings, the role of the PC-NP in supporting quality dying were obtained and independently screened to determine final studies for review. Findings were thematically analysed. Two reviewers independently extracted data and assessed level of evidence and quality ratings for both quantitative and qualitative studies.Results: Of 12 articles meeting eligibility criteria, four specifically focused on the PC-NP or the palliative care nurse in residential care, seven examined the generic nurse practitioner role, and one the aged care nurse role in supporting palliative care. Themes common to all roles including positive patient outcomes, advance care planning, hospital avoidance, staff education and enhanced communication with families. Themes specific to the PC-NP included meeting end-of-life needs, end-of-life prescribing, and enhancing the role of the General Practitioner.Conclusions: Although reflected in only a handful of studies, this integrative review has provided preliminary insights into potential contributions of the PC-NP to quality end-of-life care for residential care residents.

Physicians’ Perception About Primary Care Nurse Practitioners in Saudi Arabia

The purpose of this study was to explore physicians’ perception about the supply and demand of nurse practitioners (NPs) in primary care settings. We used a cross-sectional design and the National Survey of Primary Care Physicians and Nurse Practitioners to recruit physicians working in Saudi Arabia. Most participants agreed that the numbers of primary care physicians and NPs are less than the demand and increasing the NP supply would improve health care access and quality. Statistically significant differences were found between physicians based on demographic characteristics. Physicians support the development of the primary care NP role in Saudi Arabia to optimize health care access and quality.

Exploring the perceptions of governance arrangements for nurse practitioners: A pilot study

<h2>ABSTRACT</h2><h3>Objective</h3> The objective of this study was to evaluate changes to governance arrangements for nurse practitioners (NP) in one organisation in New South Wales (NSW), Australia. <h3>Background</h3> Organisations within NSW Health are required to credential a NP's scope of practice to outline the parameters of their practice within their service and to operationalise the role. Some confusion remains about NPs and their governance arrangements. Activities such as credentialing fall within the remit of clinical governance, which is one of eight national safety and quality standards required of Australian health organisations. <h3>Study design and methods</h3> A mixture of quantitative and qualitative data were collected from a group comprised of endorsed NPs, transitional nurse practitioners, nurse managers and medical officers via a questionnaire. <h3>Results</h3> Sixty-four questionnaires were distributed to the group with 29 (45%) responding. Results were themed using Braun and Clarke's thematic analysis into three categories, Awareness, Achievements and Improvements. <h3>Conclusion</h3> This is the first Australian study specifically addressing the clinical governance of NP roles. Establishing strong organisational governance with clear terms of reference may reduce ambiguity regarding NP positions, their scopes of practice and models of care. Improved participation in organisational governance may also result in greater awareness, achievements and improvements for NP roles, collaboration between professions and engagement with senior organisational leaders. Further research is required to better understand governance of NP roles.

The role of primary care Nurse Practitioners in reducing barriers to cervical cancer screening: A literature review.

Nearly all cases of cervical cancer (CC) are caused by persistent infection by human papillomavirus (HPV). CC remains the second most prevalent carcinoma among women and, in 2017, Canada's screening rates were off target by 19%. For example, screening rates as low as 57.6% were observed in low-income neighbourhoods in Ontario, compared to 70% in highest-income neighbourhoods. Complex, multifactorial barriers affect women's participation in cervical cancer screening (CCS). The most common barriers to screening are directly linked to disparities within determinants of health, including belonging to a minority ethnic group, low socioeconomic status, lack of education, and lack of access to healthcare. Nurse Practitioners (NPs) can reduce these barriers by providing innovative, evidence-based, culturally competent women-friendly care while building trusting relationships with patients and, thus, play a greater role in preventing the disease. The objective of this literature review is to summarize barriers to CCS and the role Canadian NPs can have in reducing them.

A realist evaluation case study of the implementation of advanced nurse practitioner roles in primary care in Scotland.

AimTo evaluate Advanced Nurse Practitioner (ANP) role implementation in primary care across Scotland in contributing to primary care transformation, and establish what works, for whom, why and in what context.DesignA realist evaluation using multiple case studies.MethodsTwo phases, conducted March 2017 to May 2018: (1) multiple case studies of ANP implementation in 15 health boards across Scotland, deductive thematic analysis of interviews, documentary analysis; (2) in‐depth case studies of five health boards, framework analysis of interviews and focus groups.ResultsSixty‐eight informants were interviewed, and 72 documents were reviewed across both phases. ANP roles involved substitution for elements of the GP role for minor illness and injuries, across all ages. In rural areas ANPs undertook multiple nursing roles, were more autonomous and managed greater complexity. Mechanisms that facilitated implementation included: the national ANP definition; GP, primary care team and public engagement; funding for ANP education; and experienced GP supervisors. Contexts that affected mechanisms were national and local leadership; remote, rural and island communities; and workload challenges. Small‐scale evaluations indicated that ANPs: make appropriate decisions; improve patient access and experience.ConclusionsAt the time of the evaluation, the implementation of ANP roles in primary care in Scotland was in early stages. Capacity to train ANPs in a service already under pressure was challenging. Shifting elements of GPs workload to ANPs freed up GPs but did little to transform primary care. Local evaluations provided some evidence that ANPs were delivering high‐quality primary care services and enhanced primary care services to nursing homes or home visits.ImpactANP roles can be implemented with greater success and have more potential to transform primary care when the mechanisms include leadership at all levels, ANP roles that value advanced nursing knowledge, and appropriate education programmes delivered in the context of multidisciplinary collaboration.

A survey of nurse practitioner perceptions of integration into acute care organisations across one region in Ireland.

AimThe purpose of the study was to explore nurse practitioner perceptions of integration practices in acute hospitals across one health care region in Ireland.BackgroundA recent Department of Health National policy towards developing a critical mass of nurse practitioners was implemented across Ireland. Successful integration of nurse practitioner roles is integral to the success of the service and sustainability of the roles for the long term.MethodAn electronic survey was circulated to a convenience sample of 85 nurse practitioners across a single, acute health care region in Ireland.ResultsSixty‐six (78%) of nurse practitioners participated. A standardized governance structure was reported by 24 (36%) participants. Thirty‐two (48%) participants expressed their job description clearly defined their role. Consultant physicians were identified as the most supportive stakeholder by participants.ConclusionsThis research identifies that nurse practitioner integration is not currently structured. A framework to support nurse practitioner integration is required to ensure ongoing support for the role. This research identifies that integration is not currently optimized.Implications for Nursing ManagementFailure to successfully integrate the nurse practitioner role risks the long‐term sustainability of the role and is a missed opportunity to demonstrate the success of advanced clinical leadership to health care.

Evaluation of the implementation of an online psychiatric nurse practitioner program for primary care nurse practitioners: Use of a Participatory Evidence-Informed (PEPPA-Plus) framework

To address a growing need for primary care nurse practitioners to provide mental health care, grant support was obtained to create an accelerated online post-master's psychiatric-mental health nurse practitioner (PMHNP) program. A participatory evidence-informed framework (PEPPA-Plus) was used to 1) evaluate the program structures and processes from the perspectives of program graduates, and within this context, to evaluate outcomes following graduation, and 2) to evaluate the impact of the program through the implementation of the dual nurse practitioner role. Approximately half (56%) of the graduates completed a 40-item web-based survey. Ninety-nine percent of those who had taken the PMHNP exam were certified as PMHNPs, 99% were dually certified as primary care NPs, 86% reported that their scope of practice had changed to include the delivery of more mental health care services, and 27% were providing both mental and physical health care in integrated care settings. The vast majority (90%) reported a moderate to very high level of confidence in their PMHNP competency, 60% were teaching psychiatric-mental health nursing as preceptors, educators, or new program directors and 29% were providing care in communities with <50,000 residents. Over half of the graduates were committed to staying in their current practice position for at least the next five years. These findings demonstrate the success of the online program in producing graduates who utilize dual NP competencies in practice, at least 25% of whom are treating populations in non-urban settings, in integrated care settings, and treating populations with high social and environmental risk factors.

Preparing Adult Gerontology Acute Care Nurse Practitioner Students for Role Transition Through Hospital Immersion

The study explored adult gerontology acute care nurse practitioner (AGACNP) student’s self-perception of confidence and competence in essential domains of nurse practitioner (NP) skills. A preclinical hospital immersion experience was developed to improve transition to the ACACNP role. AGACNP students participated in once-weekly sessions for 3 consecutive weeks, with 14 students completing the experience over a 3-year period. Data showed a 28.7% improvement in student’s self-perception of confidence and competence, with statistically significant improvement in clinical decision-making skills and NP role. AGACNP students requested additional days and appreciated direct faculty feedback, while faculty efficiently supported AGACNP role transition.

Impact of a Head and Neck Cancer Chemoradiation (HNC CRT) Nurse Practitioner (NP) on Patient Outcomes

<h3>Purpose/Objective(s)</h3> In addition to chemotherapy toxicities, most HNC patients receiving CRT experience moderate to severe radiation-induced pharyngitis. Management includes escalating analgesics, dietary modification, supplemental hydration, and feeding tubes for nutritional support as needed. Uncontrolled symptoms can interrupt or truncate curative intent treatment, impacting both quality of life and cancer outcomes. In 2014, a fulltime NP role dedicated to symptom management during and immediately post-CRT was initiated at our center. We assessed the impact on patient Emergency Department (ER) visits, hospitalizations and deaths. <h3>Materials/Methods</h3> Patients receiving definitive primary CRT with curative intent were identified during 12 month periods prior to (April 2012-March 2013) and three years after (April 2017-March 2018) initiation of the NP from records of H&N MDT case conferences. We hypothesized that ER visits and hospitalizations would be reduced with NP care. Effects on treatment delivery were secondary outcomes. Patient demographic, tumor, treatment, ER visit, hospital admission, and mortality data were extracted retrospectively from the electronic medical record. Unadjusted comparisons were done using the chi-square test for categorical variables and t-test for continuous variables with p<0.05 considered of significance. This project was approved by the institutional REB. <h3>Results</h3> 105 and 120 patients were identified in the pre-NP and post-NP cohorts, respectively. Post-NP patients were younger (mean age 63.2 vs 67.3 years), more often had oropharyngeal cancer (81.5% vs 56.2%), did not receive weekly carboplatin (0.0% vs 8.6%), and received cisplatin scheduled q3weekly less often (45.0% vs 71.4%) and weekly more often (48.3% vs 16.2%). Patients received a mean of 3.6 visits and 4.3 phone calls with the NP. There was no difference in ER visits within 42 days of treatment between cohorts (55.2% vs 55.8%). However, hospital admissions were reduced (60.0% vs 45.8%, p=0.034). Length of stay was similar, and there was no difference in 90-day mortality (2.9% vs 2.5%). <h3>Conclusion</h3> This before-and-after study showed a 23.7% reduction in hospitalizations after introduction of the NP role, consistent with the findings of others (Terzo 2017). Over 50% of patients visited the ER at least once and 1 in 40 died in both cohorts. Time trends included a 14.3% increase in the number of patients receiving CRT; and shifts in patient age, cancer type and cisplatin schedule consistent with an increasing incidence of HPV-related oropharyngeal cancer. We cannot rule out effects of these trends or other interventions on our results. Additional limitations include inability to harmonize staging between cohorts and lack of quality of life and cost effectiveness data. Nevertheless, these data support the value of a NP role focused on HNC patients receiving CRT to optimize outcomes.

Cognitive preceptorship: An emerging nurse practitioner role transition to practice model.

Transition to practice is difficult for nurse practitioners (NP) pre and post-graduation. At the core of NPs' successful transition to practice is clinical education. There is a lack of theoretical knowledge to guide NPs' transition to practice through preceptorship. The current academic clinical education model and onboarding process in clinical settings require restructuring. Preceptorship is the most important element of NPs' transition to practice; it is in need of restructuring. There is a need for evidence to guide the restructuring of pre and post-graduation NP preceptorship. This paper aims to provide a description and application of the Cognitive Preceptorship Model to the nurse practitioner role transition process. An extensive literature review of NPs' preceptorship during role transition was conducted and the Cognitive Preceptorship Model (CPM) derived from the literature review of other theories and models: the Schlossberg's Transition Theory; Collin's et al. Cognitive Apprenticeship Model;. and Barnes's NP transition attributes. The CPM model's concepts and application to practice are described; included is a description of preceptorship, CPM model origination, as well as CPM model concepts and application. The CPM model's concepts guide the specific application of the preceptorship process to both NP students and novice NPs' transition to practice pre and post-graduation.

Partners for Vulnerable Youth and the Alliance for Children in Trafficking: Using the Policy Circle Model as a Framework for Change.

The National Association of Pediatric Nurse Practitioners (NAPNAP) was the first-ever professional organization for nurse practitioners (NPs) and remains dedicated to advancing the NP role to improve child health. In 2016, NAPNAP Partners for Vulnerable Youth (NPVY) was established as a 501(c)(3) to take a leadership role in advocacy and education efforts for at-risk pediatric populations. NPVY launched the Alliance for Children in Trafficking (ACT), with far-reaching implications for nursing leadership to leverage expertise from collective organizational membership to improve health. This paper will demonstrate use of the Policy Circle model as a framework for planned policy change.

Genitourinary Syndrome of Menopause and the Role of Nurse Practitioners

Genitourinary syndrome of menopause (GSM) encompasses menopausal genital and urinary symptoms associated with estrogen declines, which can have a negative impact on quality of life. Several options are available for treatment, with over-the-counter vaginal lubricants and moisturizers as first-line therapy, followed by local vaginal estrogens that treat the underlying condition. Nurse practitioners are positioned to help diagnose GSM as they are comfortable initiating the conversations necessary to put women at ease to disclose information necessary for an accurate diagnosis. They can then effectively communicate various options for treating the symptoms of GSM.

Educating Mental Health Nurse Practitioners on Interprofessional Collaboration and Preparing Them for Collaborative Practice.

Although interprofessional collaboration (IPC) has been discussed for over 40 years, in nursing education as well as the majority of health professionals, education continues to primarily take place in silos with curricula that is discipline specific. Educators need to implement models of education that are linked to collaborative practice and team-based care. To introduce the principles from the Core Competencies for Interprofessional Collaborative Practice, the American Association of Colleges of Nursing Essentials of Doctoral Education for Advanced Nursing Practice and the National Organization of Nurse Practitioners Faculties Nurse Practitioner Core Competencies into the coursework. To demonstrate an application process for incorporating collaboration in their future nurse practitioner roles. Students in the Doctor of Nursing Practice mental health nurse practitioner program participated in a set of assignments to develop essential knowledge and skills for integration of IPC into practice. A pretest-posttest design was used to evaluate student attitudes towards IPC following immersion in IPC subject matter and experiential learning with other healthcare providers working together to coordinate patient care. There were significant findings for six of the 18 survey questions. This project can serve as an example for successful implementation of IPE in the nursing curricula.

Consultation With Nurse Practitioners Over the Telephone in Prison Health

The nurse practitioner (NP) role presents opportunities to improve access to care for the management of those in prisons, including telephone consultations with the nursing team after hours. This qualitative study used semistructured interviews with prison nurses to gain insights into the role and capability of NPs to provide telephone advice and direction within an after-hours prison health model of care. Three main themes emerged: value and capability, nursing team, and safety of the on-call model. This study adds to our understanding of the capability of the NP in the prison setting and the value of an on-call model of care within a primary team structure.

Association Among Work Characteristics, Role Transition, and Job Burnout in Nurse Practitioners in Taiwan.

Workplace burnout is common among nurse practitioners (NPs) and often occurs during role transition from a registered nurse to an NP. This study aimed to explore the predictors of job burnout in nurse practitioners (NPs). A quantitative cross-sectional design was conducted on 361 convenience sample of NPs from four hospitals in central Taiwan. Data on the demographic and working characteristics (hospital grade, years of experience as an RN and NP, practice setting, working shifts, working hours, average number of patients take care, salary, and performance bonus), Chinese version of the Nurse Practitioner Role Transition Scale, and Occupational Burnout Inventory were used. The enrolled NPs showed medium-level role transition scores (mean = 65.73, SD = 9.59), and the prevalence of personal burnout, client-related burnout, and over-commitment was 51.2%, 19.4%, and 49.9%, respectively. Role transition, hospital grade, practice setting, working hours, and number of patients take care were significant predictors of personal burnout, client-related burnout, and over-commitment after adjusting for cofounding variables, possibly explaining 52.8%, 42.1%, and 36.3% of variance, respectively. Hospital administrators should provide necessary assistance to help NPs transition to new role and ensure a positive work environment and reasonable workload so as to prevent the impact of job burnout on NPs.