Nurse Practitioners Research Articles (Page 1)

Background: Rural and underserved communities face persistent shortages of Family Nurse Practitioners (FNPs), limiting access to high-quality care. Academic-Practice Partnerships (APPs) offer a strategy to build workforce readiness. Purpose: This study evaluated the effects of an enhanced APP model on FNP learners’ practice confidence and employment outcomes in underserved settings. Methods: Using a longitudinal, repeated-measures design, 33 FNP learners completed assessments at baseline, program completion, and 1-year post-graduation. Surveys measured confidence across 6 domains. Results: Practice confidence significantly increased across all domains post-program ( P < .001), with sustained gains at one year. Behavioral health and pharmacology showed initial surges followed by slight declines. One year after graduation, 63.6% remained at APP partner sites and 48.5% worked in rural areas. Conclusions: Enhanced APP models effectively build and sustain FNP practice confidence and retention in high-need settings, though continued post-graduation support is warranted.

Background: Virtual care offers a promising alternative to in-person visits for management of coronary artery disease (CAD). The aim of this study is to evaluate the feasibility of a nurse practitioner (NP)-led interdisciplinary virtual clinic dedicated to secondary prevention in stable CAD. Hypothesis: A NP-lead interdisciplinary virtual clinic will ensure patients receive recommended therapies and meet guideline-directed targets of therapy for secondary prevention of CAD. Methods A pilot feasibility study was conducted in an academic cardiology practice in an urban setting in Canada from July 2021 to July 2024. A convenience sampling of adults (age 18 and older) with diagnosis of stable CAD with normal LV function and stable symptoms were included. Video visits were conducted by the NP at minimum of one visit per year. Cases were reviewed with a cardiologist asynchronously. Primary outcomes: 1) percentage of patients receiving appropriate guideline-directed medical therapies (GDMT) and meeting treatment targets at 1-year vs baseline, 2) percentage of patients to successfully complete virtual visits at one year without need for in-person visit, and 3) patient satisfaction with the program using a post visit experience survey. Balancing measures included number of adverse events (hospitalization, unexpected MI or need for additional intervention). Results A total of 66 participants (mean age 66.6 years, 72.7% male) were enrolled in the virtual clinic; 43 patients completed a one year follow up and were included in the analysis. The percentage of patients on GDMT was not significantly different at baseline compared to one year follow up (Table 1). Although more patients at one year follow up met blood pressure and triglyceride targets compared to baseline, these trends were not significant (Appendix A). At one year, 64 participants (97%) were successfully evaluated virtually without need for in person visit. Only 1 participant experienced an adverse event during the study. Of the 58 participants (87.9%) who completed a survey, 91% were satisfied or very satisfied with their care and 77.6% reported their virtual visit experience was equal or better to in person visits. Conclusions A NP-led interdisciplinary virtual clinic is a feasible model to deliver secondary prevention for stable CAD. Further research is needed to better understand the efficacy of this intervention on improving GDMT and meeting targets of therapy in the long run.

Introduction: Quality improvement interventions may seek to identify positive and negative outlier clinicians to promote practice change. We sought to assess variability in performance metric achievement by clinician and patient characteristics in the Veterans Affairs (VA) Health System. Methods: We assessed performance measure achievement for cardiology clinicians with at least 50 annual outpatient encounters from 2017-2023 in the VA. We evaluated a composite performance metric of ten measures of guideline-directed medical therapies for coronary artery disease (CAD), heart failure with reduced ejection fraction (HFrEF), and atrial fibrillation or flutter with elevated stroke risk (AF). This opportunity composite was calculated as the proportion of times each applicable measure was achieved divided by the number of eligible encounters for each clinician. Data on clinician demographics, patient demographics, and patient diagnoses codes were collected. Clinician performance was considered a “low-outlier” or “high-outlier” if it was more than 2 standard deviations below or above the mean achievement, respectively, using a funnel plot that accounts for case volume. Results: Of 715,608 unique encounters, there were 312,331 CAD, 224,599 HFrEF, and 178,678 AF encounters. Of 1,043 clinicians, 53.1% were physicians, 9.3% were physician assistants (PA), and 37.6% were nurse practitioners (NP); 51.0% were female. Clinicians were 71.5% White, 19.4% Asian, 5.8% Black, 0.7% Native, and 2.6% unknown race. Clinicians achieved a mean composite measure achievement of 0.65 with outlier status varying by patient volume (Figure) . Low-outlier clinicians cared for patients with a greater number of cardiac diagnoses compared with non-outliers (Table) . In contrast, high-outliers cared for a higher proportion of patients with HF and patients who were Black, Hispanic, and from urban areas. NPs were overrepresented in both the low- and high-outlier groups, while PAs were modestly overrepresented in the low-outlier group. Regarding clinician demographics, Asian clinicians were more likely to be high-outliers, and white clinicians were more likely to be low-outliers, with women overrepresented in both groups. Conclusion: Positive and negative outlier performance by clinicians may be partially explained by case mix. Understanding differences in performance by clinician training and demographics may lead to interventions to support all clinicians in high quality care delivery.

This article underscores the pivotal role of Neonatal Nurse Practitioners (NNPs) within healthcare teams, highlighting the critical need for greater recognition and support for their contributions. NNPs are advanced practice nurses who enter the field of neonatology with specialized training and prior experience in bedside neonatal nursing. NNPs are primarily found in acute care centers with varying levels of Neonatal Intensive Care Unit (NICU) designation, Newborn Nurseries, or Delivery facilities. This article also provides insight into the need for collaboration and policy reform. A case scenario is included that describes how the NNP can be utilized to provide high-quality, evidence-based neonatal care. By fostering increased awareness, advocacy, and role clarity, physician-practitioner team dynamics can flourish and thrive, ultimately improving neonatal care outcomes.

Introduction: Analysis of patient safety incidents and complaints is an essential form of learning for healthcare institutions, with harm to patients having major human, moral, ethical and financial implications¹. In response to common and repeated incidents, weekly in-situ simulation-based education has been implemented on the Older Persons’ Medicine (OPM) ward to enhance learning amongst the multidisciplinary team. The team included Doctors, Nurses, Healthcare Assistants and Advanced Nurse Practitioners. Aims of the in-situ training: • To enhance staff engagement with the learning from incidents process, reducing repeated incidents on the following topics: seizures, pulmonary embolism, rapid tranquilisers, hypoglycaemia and opiate toxicity. •To improve multidisciplinary team technical and non-technical skills and knowledge. Methods: This was a prospective study to deliver in-situ simulation to an OPM ward at a tertiary NHS hospital based on repeated clinical incidents that took place between 2022 and 2024. A pilot session was carried out for 3 months, and simulation-based education and psychological safety rules for debriefing were introduced to the staff. Weekly in-situ simulation training was delivered for 2 years. Incidents and complaints were collected via the incident recording system. In-situ simulation training was implemented where the multidisciplinary staff were allocated protected time weekly for simulation training. Scenarios were created based on repeated incidents and each scenario was delivered for a month to capture all the staff on the department. Feedback from staff was collected via QR code after sessions and staff were empowered to suggest service improvement initiatives within their feedback questionnaire. Feedback was reviewed and ward managers instigated the necessary changes suggested by the staff. Debriefing is undertaken after the scenario delivery to reinforce individual learning. Alongside weekly in-situ simulation, an unannounced drill is performed twice a year on scenarios that have been previously delivered to ensure staff are retaining knowledge. Results: Using in-situ simulation has been incredibly well received by ward staff. The team showed a willingness to learn through simulation. Feedback amongst staff is very positive, Table 1. 90% of staff in the department are now trained, inclusive of staff on long-term absence and new recruits. The impact of the training has resulted in a decrease in repeated incidents from 5 cases in 2022 to 1 incident in 2024. Discussion: Simulation has proven its impact on limiting the number of patient safety incidents and complaints, thus improving patient care. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable

Nurse practitioners (NPs) have become indispensable to clinical care. However, few studies have used qualitative research designs to explore health care providers' perspectives on the roles played by NPs in clinical care. Investigating health care providers' perspectives on the roles played by NPs in clinical care in Taiwan. A qualitative research design was employed in a single medical center in Taiwan. A semistructured interview guide was used to conduct face-to-face interviews with medical-surgical health care providers in groups. A total of nine participants, including physicians, nursing supervisors, and NPs, were interviewed in this study. The findings of this study highlight three themes concerning the roles played by NPs in clinical care in Taiwan: (1) guardian of care: NPs are keen observers, caregivers, and strong advocates for patients; (2) bridge for communication: NPs are persuasive communicators and effective mediators who use resources effectively; and (3) promoter of improvement in the quality of care: NPs are experienced and dedicated professionals. The themes of guardian of care, bridge for communication, and promoter of improvement in the quality of care characterized the roles played by NPs in clinical care from the perspectives of health care providers. Future researchers could further examine these roles from the perspective of patients and investigate the impacts of NPs' role characteristics on clinical outcomes. The role characteristics of keen observers, meticulous caregivers, and advocators could be incorporated into cultivating and training NPs.

Nurse Practitioners (NPs) are integral to addressing the evolving demands of health care, delivering high-quality, cost-effective care across diverse settings. Despite their critical role, research exploring the impact of organizational belonging on NPs' job satisfaction, burnout, and retention remains limited. The purpose of the study was to explore the association between organizational practice environment and organizational belonging for NPs who work across all practice environments. This is a cross-sectional, descriptive study surveying NP's across primary, acute, and specialty care areas. Multiple validated instruments were used to scale organizational practice environment, NP organizational belonging, provider comanagement, burnout, job satisfaction, mental health, and intention to leave one's job. Among 73 respondents, organizational climate significantly influenced NP belonging (β = 1.14, p = .001) and job satisfaction (β = -2.06, p = .002). Organizational belonging was associated with job satisfaction (β = -2.06, p = .010), comanagement (β = 1.87, p = .045), and burnout (β = -3.45, p = .001). To enhance NP job satisfaction, health care organizations should prioritize fostering a sense of belonging. Key strategies include promoting role clarity, supporting collaborative practice, and involving NPs in leadership and decision-making processes. The lack of institutional belonging among NPs is a complex issue influenced by workplace dynamics, role recognition, and organizational culture. Addressing these factors is essential for improving NP retention, job satisfaction, and overall workforce well-being.

There is a growing demand for intensive care unit (ICU) providers at the time of physician shortages, increased provider burnout, and attrition. Evidence supports safe utilization of nurse practitioners (NPs) and physician assistants (PAs) in the ICU. An ICU team using intensivists (medical doctors) and doctors of osteopathic medicine, NPs, and PAs experiencing staffing challenges because of staff shortages and increased clinical responsibilities. An evidence-based pre-post quality improvement project. Utilization of NPs and PAs overnight instead of intensivists in a community medical/surgical ICU with electronic ICU support. Primary measures were mortality, procedural complications, central line-associated bloodstream infection, and catheter-associated urinary tract infections preimplementation and postimplementation. Secondary measure was qualitative data on facilitators and barriers to implementation. Catheter-associated urinary tract infection rates preimplementation and postimplementation were zero. Central line-associated bloodstream infection rates decreased from one pre to zero post. Procedural complication rate decreased by 0.4% ( p = .687). The survey had an 80% response rate, with >90% answering that implementation positively affected quality and communication. Communication, collaboration, focus on quality care, and increased accessibility were identified as facilitators. Role understanding, acceptance, and communication with other services were identified as barriers. A collaborative model of care using NPs and PAs overnight in a community ICU is a feasible, safe, and effective staffing solution. The hybrid model provided additional support for NPs, PAs, and nursing staff, which helped with transition and overall satisfaction. Further research on NP and PA implementation in a hybrid model is needed on a national, multisite scale.

Recommendations for NP/Physician Collaborative Relationships in Long-Term Care Homes.

Developmental-Behavioral Mental Health Nurse Practitioners: Clinical Roles, Practice Challenges, and Educational Needs to Increase Access to Care for Children With Developmental-Behavioral Challenges.

In passing legislation in 2016 to allow medical assistance in dying (MAID), Canada became the world’s first jurisdiction to allow nurse practitioners (NPs) to act as MAID assessors and providers. Health Canada’s annual report shows that the demand for MAID in Canada increases each year, as does the proportion of MAID cases that NPs provide. The purpose of this study was to better understand factors that motivate or deter nurse practitioners from becoming MAID assessors and providers. The study design was a secondary analysis of a large qualitative dataset guided by interpretive description methodology. Primary data collection took place from 2018 to 2023 via semi-structured interviews with nurses and NPs. Secondary analysis of transcripts of all of the NPs interviewed for the primary study allowed for identifying significant motivational and deterring themes in their accounts. The analysis yielded two categories of motivating factors (philosophical perspectives; experiences with death and dying) and three deterring factors (moral complexity; health system barriers; professional and social considerations), and further generated insights around supports and practices that make NP MAID work viable. As the first study that explicitly sought to understand what explains Canadian NPs’ willingness to participate in MAID, these findings fill a gap in the available knowledge.

A nurse practitioner service in an adult tertiary intensive care unit: A prospective observational evaluation.

This reflective commentary is a response to a recent publication in Artificial Intelligence (AI), Computer Science, and Robotics Technology, which evaluated ChatGPT's performance on nurse practitioner (NP) certification examination questions. The provocative framing questioning whether AI nurse practitioners may become a reality prompted this critical reflection on what truly defines NP expertise, particularly in an era of expanding AI capabilities. Our response challenges the notion that correct examination answers alone constitute clinical readiness and instead highlights the depth of contextual judgment, human connection, and advanced clinical reasoning-the capability we term clinical intelligence-that nurse practitioners uniquely bring to patient care. Although AI literacy is a growing part of essential NP knowledge, caution is needed around any assertion that large language models like ChatGPT can replicate or replace nursing roles of any kind.

Trends in Staffing at State Veterans Homes: Do They Meet the 2024 Centers for Medicare & Medicaid Nursing Home Staffing Standards?

Nurse practitioners (NPs) and physician assistants (PAs) play a vital role in health care delivery. To meet growing health care demands, NPs and PAs have increased levels of autonomy, face early productivity expectations, and care for increasingly complex patients. This paper aims to describe, define, and standardize the role of the advanced practice education and professional development specialist across organizations. Using survey methodology, an anonymous survey was emailed to an informal group of advanced practice educators. The survey was sent out three times over approximately 8 weeks, with the last survey sent after the annual National Association of Pediatric NPs meeting. Of the 24 survey respondents, there were 13 different titles. Most respondents (75%) had worked as an APP for over 10 years. Most providers in educator roles were new to the position; 33% had been in the role for less than 1 year, and 29% for 1-3 years. Fifty percent of respondents were matrixed to the entire health system, whereas 42% stated their work is delineated to a specific department. Only 17% of survey respondents felt that leaders at their organization understood their role as advanced practice educators. As advanced practice leadership roles become more formalized with focused initiatives, including onboarding, student placement, and professional development, the educator and professional development role must be clearly defined. Standardizing the title and role responsibilities of the educator and professional development specialist is crucial to supporting a robust, engaged, and expert workforce, thus improving provider and family satisfaction and quality of care.

The transition to competency-based education in nurse practitioner (NP) programs requires a systematic approach for curriculum development and assessment. The PRIME-NP Model structures competency progression across five roles-Professional, Reporter, Interpreter, Manager, and Educator/Evaluator. A consortium of nursing schools collaborated to integrate PRIME-NP into their curricula. This article describes their experience using the model to structure curriculum development and student progression. PRIME-NP should be integrated through horizontal and vertical curriculum mapping to ensure competency development across didactic and clinical courses. Strategies such as case studies, simulations, clinical evaluations, and reflective journaling can align with PRIME-NP competencies at each level. PRIME-NP provides a structured, competency-based framework for NP education, ensuring measurable skill development, competency tracking, and alignment with professional standards. As institutions adopt this model, it will play a pivotal role in preparing practice-ready NPs.

Clinical preceptors play a vital role in nurse practitioner education, yet recruitment and retention remain challenging. This article describes a survey of preceptor satisfaction after the implementation of revised benefits along with motivational factors. A comprehensive online survey was distributed to more than 2,400 preceptors to assess their perceptions of the newly introduced benefits and communication strategies. Although 88.89% of preceptors perceived support, nearly half were unaware of the enhancements, indicating a significant communication gap. Although many appreciated the benefits, they did not significantly influence preceptor motivation. The survey findings highlight the need for improved communication strategies and underscore the importance of ongoing program evaluation. By addressing these gaps, colleges of nursing can foster a more supportive precepting environment to enhance the quality of nurse practitioner education and the nursing profession.

Veterans experiencing homelessness have complex physical, mental health, and substance use disorders that impact their ability to obtain and maintain housing. The Veterans Health Administration (VHA) maintains robust homeless programs with MSW social workers as case managers. In the absence of on-site specialized healthcare services, there is a gap in communication between the homeless program social worker and the broader healthcare system. This article reports on the development and implementation of a six-month interdisciplinary project designed to provide the homeless program social workers at one Veterans Administration Medical Center access to consultation with a dually prepared primary care and psychiatric nurse practitioner embedded in the VHA homeless program team. Three different consultation modalities were implemented: face-to-face, curbside, and electronic consultation (e-consult). The six-month project included 21 consultations. In locations where on-site healthcare providers are not readily available, e-consults can be an effective and sustainable means for communication between homeless program social workers and the healthcare system to improve advocacy for veterans experiencing homelessness and empowerment of the social workers.

Mentorship Effects on Stress and Practice Readiness for Nurse Practitioner Students

Subcontracting, Employment Characteristics, and COVID-19 Infections Among Staff and Residents of Nursing Homes in Canada.