Nurse Practitioner Role Research Articles

Educators’ Perceptions of the Development of Clinical Judgment of Direct-Entry Students and Experienced RNs Enrolled in NP Programs

<h3>Background</h3> Nurse practitioner (NP) education was originally reserved for experienced nurses, but it has gradually opened to nurses with little to no clinical experience at the registered nurse (RN) level as well as to non-nurses. The existence of multiple paths to NP training and practice raises questions about the role of generalist RN experience in learning clinical decision-making and other aspects of the NP role. <h3>Purpose</h3> To describe educators' perceptions of the role of prior nursing experience in the development of clinical judgment during NP graduate education. <h3>Methods</h3> In this qualitative descriptive study, 27 NP faculty from four universities participated in individual interviews. Transcripts were analyzed using a thematic approach. <h3>Results</h3> According to participants, previous nursing experience—or any relevant experience—can either be helpful or detrimental in the development of NP students' clinical judgment. Three themes were generated: variations in students' baseline knowledge and skills, different frames of reference to grasp new content and skills, and challenges related to professional identity. In addition, participants described factors that they believe can affect the impact of different types of experience. <h3>Conclusion</h3> Students with and without prior nursing experience face distinct challenges in learning NP-level clinical decision-making and judgment, but they reach similar end-of-program competence. Educators are confronted with contradictions between generally held wisdom, their professional socialization, and first-hand observations regarding the role of experience (inside and outside nursing) in preparing students to become NPs.

Evaluation of an APN service in acute inpatient care of patients with a malignant brain tumor: a qualitative study in a Swiss university hospital / Evaluation eines APN-Angebots in der akut-stationären Versorgung von Patienten und Patientinnen mit malignem Hirntumor: eine qualitative Studie in einem Schweizer Universitätsspital

Abstract Background Caring for patients with a malignant brain tumor is complex and requires a high degree of coordination. The disease reduces life expectancy and affects quality of life. Therefore, patients often depend on the support of their relatives. To achieve better care for such patients and their relatives, a Department of Neurosurgery at a Swiss university hospital introduced a Nurse Practitioner (NP) and their service in 2017. 18 months after implementation, an evaluation of this NP role was conducted. It was aimed for to explore the experience of the interprofessional health care team. Method A qualitative research design was used. Eight individual interviews and one focus group interview were conducted with representatives of the interprofessional health care team. Using a literature-based structured interview guide, the experience of participants was explored. Interviews were analyzed thematically. Results The NP and their service was appreciated. Collaboration with the medical profession and the coordination of profession-specific demands also improved. The NP as a constant person of contact had a positive effect on the continuity of care e.g., with regard to discharge management. Medical doctors and registered nurses experienced an improved patient satisfaction. Further need for improvement was identified regarding the clarification of the NP role and the interprofessional collaboration. Conclusion The study reports on the successful introduction of an NP and their service in oncological care; it demonstrates that the implementation of this role can also be beneficial in acute inpatient care.

Nurse practitioners’ perception of temporary full practice authority during a COVID-19 surge: A qualitative study

BackgroundAt the beginning of the COVID-19 pandemic in the United States, 22 state governors temporarily waived physician supervision of nurse practitioners to expand access to health care during the state of emergency. ObjectiveWe examined the nurse practitioner perception of the simultaneous scope of practice changes and the exigent pandemic demands during the initial COVID-19 surge in Massachusetts. MethodsQualitative descriptive design using content analysis of open-ended responses to a web-based survey of Massachusetts nurse practitioners conducted in May & June 2020. ResultsSurvey response rate was 40.6 percent (N = 389). Content analysis identified four themes including: 1) State waivers enabled more control over practice and more expedited care, 2) State waiver did not change practice either because of pre-established independence or employers not changing policy, 3) Perception of nurse practitioner role as both versatile and disposable and 4) Telehealth increased access to care and created an autonomous setting. ConclusionsAlthough findings suggest fewer barriers in some areas, the temporary removal of state-level restrictions alone is not sufficient to achieve immediate full scope of practice for nurse practitioners. There is a need for regulatory frameworks that optimize the capacity of the advanced practice nursing workforce to respond to global health emergencies. US-based policymakers and healthcare organizations should revise outdated scope of practice policies and capitalize on telehealth technology to utilize the full extent of nurse practitioners. Likewise, nursing leaders should be a voice for nurse practitioners to more effectively and safely maximize the nurse practitioner contribution during emergency responses. In countries where the role is under development, regulators can leverage these findings to establish modernized nurse practitioner scope of practice policies from the outset.

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.

The Nurse Practitioner in Saudi Arabia: Potentials and Threats

The provision of the nurse practitioner (NP) began in the mid-1960s and is defined more clearly nowadays in many developed countries, such as the United States, Canada, United Kingdom, and Australia. Their scope of practice is legally well defined in these nations. However, the countries of the Middle East, including Saudi Arabia, face the problem of lack of enough numbers of NPs and even lack well-defined NPs’ roles and duties. Several challenges face the effective adoption of the NP title and roles in Saudi Arabia, where it cannot be identified successfully without a clear recognition, definition, scope, legislation, or a regulatory framework

A translational research framework for nurse practitioners.

This study aims to explore a proposed translational research continuum for nurse practitioners. Nurse practitioners are acknowledged as clinical leaders responsible for transforming health care delivery. It is important that nurse practitioners contribute to health care knowledge using scientific processes for the implementation of evidence-based practice and evaluation of outcomes of interventions for their patient groups. This paper provides a review of translational research literature including implementation science to align nurse practitioner activities to a modified translational research framework. A translational research framework has the potential to strengthen nursing research in the nurse practitioner role. Adapting an accepted translational research continuum for nurse practitioners places the clinical nursing leaders in an equitable research position with all health care professionals. The translational research continuum provides nursing management with a structure to benchmark nursing research. The continuum applies a modern research framework to support research engagement for the nurse practitioner role.

The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review.

To evaluate the effectiveness of the role of advanced nurse practitioners compared to physicians-led/ usual care (care managed by medical doctors or non-advanced nurse practitioners). Advanced nurse practitioners contribute to the improvement of quality patient care and have substantial potential to optimise the health of people globally. Since the formal recognition of advanced nurse practitioners by the International Council of Nurses, among others, the role has been adopted across most departments and clinical specialties, particularly in high-income countries. Systematic review of primary research evidence. MEDLINE, EMBASE, CINAHL, Cochrane registry, Cochrane trials, and Cochrane EPOC (PDQ Evidence) were searched for randomised controlled trials (RCTs) of patient care and health resource utilisation outcomes associated with advanced nurse practitioners. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The chosen articles were restricted to full-text English language trials published in the last 20 years, incorporating comparators of usual care. Search terms were limited to variations of advanced nurse practitioner role and practice. The eligible studies were bias risk assessed and quality assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Clinical and service outcomes were analysed using narrative synthesis as the marked heterogeneity between studies precluded meta-analysis. Thirteen RCTs were reviewed. All of them were conducted across high-income countries within primary care and hospital settings involving paediatric and adult patients. Five trials were assessed as high quality, and eight were of low to moderate quality. Positive effects were demonstrated for the impact of advanced nurse practitioners on usual care; for indigestion, mean difference [MD] 2.3: 95% CI 1.4, 3.1]), perceptions of health status [ (MD -140.6; 95% CI -184.8, -96.5)], satisfaction levels [ (MD ranged from -8.79; 95% CI -13.59, -3.98 to 0.61; 95% CI -4.84, 6.05)], physical function (1.58 [SD 0.76] v. 1.81 [SD 0.90]), and blood pressure control (systolic [133 [SD 21] v. 135 [SD 19] mmHg p=0.04] and diastolic [77 [SD 10] v. 80 [SD 11] mmHg p=0.007]) were looked at. Positive effects related to service provision included improved patient satisfaction and reductions in waiting times and costs, which significantly favored advanced nurse practitioners (all p<0.05). The evidence of this review supports the positive impact of advanced nurse practitioners on clinical and service-related outcomes: patient satisfaction, waiting times, control of chronic disease, and cost-effectiveness especially when directly compared to medical practitioner-led care and usual care practices - in primary, secondary and specialist care settings involving both adult and pediatric populations.

Evaluation of a nurse practitioner role within a specialist palliative care service in Australia

In Australia, despite the growing need for palliative care, there is a shortage of palliative care professionals. The literature suggests that nurse practitioners (NPs) are well positioned to innovate the current model of palliative medicine. This prospective study evaluates the implementation of a new NP role within an established multidisciplinary palliative care service. In this study, patients under the care of the NP had fewer admissions to an acute hospital compared to the rest of the service (17.0% vs. 27.2%), as well as no acute admissions for terminal care and a greater number of patients who achieved their preferred place of death (87.2% vs. 72.2%). A survey of the multidisciplinary team revealed that the majority of responders (93.3%) felt that the NP role had a positive impact on patient care and was holistic, safe, and met patients’ needs. Neutral or negative survey responses highlighted the need for further education or refinement of the role in areas such as prescribing and ability to refer patients directly to medical specialists. Overall, study results were positive and support the introduction of the NP role into a specialist palliative care service but more research is required to assess the effectiveness of the role.

Practice Patterns of Nurse Practitioners in a Multi-Site Academic Healthcare Setting.

The objective of this paper is to describe the day-to-day activities, known as practice patterns, of nurse practitioners (NPs) across a four-site academic healthcare network in Ontario, which comprises acute, primary, rehabilitation and complex continuing care. Information regarding NP practice patterns is available from other jurisdictions and practice settings, but information specific to large, urban and multi-site organizations is available to a lesser extent. This information can inform and support leaders' decisions about NP roles and responsibilities. A cross-sectional online survey was sent to the 125 NPs employed in this healthcare network. Respondents (n = 45) were primarily experienced, graduate-prepared NPs, who work with specialized populations and support the education of healthcare professional trainees. The majority of these NPs' activities focused on direct and indirect care, with fewer activities centred on leadership/administration, education, research and personal breaks. Clinical care activities varied among NPs and were contextual to the population and program. While direct and indirect care are vital components of NP practice, the overwhelming emphasis on these components indicates that the organization and the healthcare system are losing opportunities to capitalize on advanced nursing practice knowledge and skills in the domains of leadership, research and education.

Extracorporeal Membrane Oxygenation: Opportunities for Expanding Nurses' Roles.

Extracorporeal Membrane Oxygenation: Opportunities for Expanding Nurses' Roles.

State‐Level Scope of Practice Regulations and Impact on Organizational‐Level Work Environments for Nurse Practitioners

Research ObjectiveThe growing nurse practitioner (NP) workforce can play a critical role in meeting the demand for health care services especially in primary care. Yet, many policy and organizational barriers affect this workforce and their ability to deliver high quality care. State‐level scope of practice (SOP) regulations have received substantial attention due to their impact on access and quality of care. Yet, little is known how these state‐level polices also affect organizations employing NPs and potentially NPs' ability to deliver care. This study investigated the relationship between SOP policies governing NP practice and organizational‐level work environment in primary care practices.Study DesignWe collected survey data from primary care NPs about their work environments from six states (Arizona, Washington, New Jersey, Pennsylvania, California, and Texas) in 2018–2019. All NPs in Arizona and New Jersey, a 75% random sample of NPs in Pennsylvania, and a 50% random sample of NPs for California and Texas were sampled. NPs completed a validated work environment tool, the Nurse Practitioner‐Primary Care Organizational Climate Questionnaire, which measures four domains of work environment: NP Administration Relations (NP‐AR), NP‐Physician Relations (NP‐PR), Independent Practice and Support (IPS), and Professional Visibility (PV). Regression models were used to assess the relationship between state level‐SOP and organizational‐level work environment domains. The models were controlled for demographic and work characteristics.Population StudiedData were collected from 1244 NPs in 1109 practices. Arizona and Washington were characterized as having full SOP for NPs‐NPs independently deliver care. New Jersey and Pennsylvania had reduced SOP‐physician collaboration is required for care delivery; and California and Texas had restricted SOP‐physician supervision required.Principal FindingsNP practices from full SOP states were more likely to have higher PV scores compared to practices within reduced (B = 0.16; P‐value = 0.005) and restricted (B = 0.12; P‐value = 0.02) SOP states. Practices from full SOP states were more likely to have higher NP‐AR scores compared to practices from reduced (B:0.22; P‐value = 0.0003) and restricted (B = 0.15; P‐value = 0.009) SOP states. In addition, practices from full SOP states were more likely to have higher IPS score compared to practices from reduced (B:0.14; P‐value = 0.0003) and restricted (B = 0.09; P‐value = 0.01) SOP states. There was no relationship between SOP type and practice‐level NP‐PR score.ConclusionsFindings show that state‐level policies indeed affect organizational‐level work environment. NP work environment is more favorable in states with more favorable policy environment which does not require physician supervision or collaboration for NP care delivery. NPs practicing in full SOP states have better relationships with administration, report more visibility in NP role, and more support within their organizations for independent NP practice.Implications for Policy or PracticeNPs play a critical role in the U.S. health care system and creating optimal state‐ and organizational‐ level policies will help to optimally utilize NPs and maximize their contributions to patient care and the overall health care system. Full SOP regulations should be the gold‐standard, and policy makers in reduced and restricted SOP states should invest efforts to remove unnecessary restrictions. Practice administrators should create favorable work environments for NPs.Primary Funding SourceNational Institutes of Health.

The Expanding Role of Nurse Practitioners in the Completion of Oregon Portable Orders for Life-Sustaining Treatment.

The Expanding Role of Nurse Practitioners in the Completion of Oregon Portable Orders for Life-Sustaining Treatment.

Practice environment, independence, and roles among DNP- and MSN-prepared primary care nurse practitioners

BackgroundMany nursing schools are adopting the Doctor of Nursing Practice (DNP) as the preferred model of nurse practitioner (NP) education and eliminating Master of Science in Nursing (MSN) programs. To date, no studies have explored the relationship between DNP preparation and NP practice environment, independence, and roles. PurposeThe purpos of this study is to compare practice environment, independence, and roles among DNP- and MSN-prepared primary care NPs. MethodsThis study used a cross-sectional design and observational regression analysis of survey data. FindingsDNP-prepared NPs reported: 1) more favorable NP-Physician Relationships, 2) fewer clinical hours, and 3) more practice leadership. These differences were, however, small and not significant at 0.05 level. DiscussionWe found no major differences in practice environment, independence, and roles among DNP- and MSN-prepared primary care NPs. As more nursing schools establish DNP programs and more DNP-prepared NPs enter the field, it is especially important to continue to study the impact of DNP preparation on the NP workforce.

Nurse practitioner led model of after-hours emergency care in an Australian rural urgent care Centre: health service stakeholder perceptions

BackgroundThe challenges of providing and accessing quality health care in rural regions have long been identified. Innovative solutions are not only required but are also vital if effective, timely and equitable access to sustainable health care in rural communities is to be realised. Despite trial implementation of some alternative models of health care delivery, not all have been evaluated and their impacts are not well understood. The aim of this study was to explore the views of staff and stakeholders of a rural health service in relation to the implementation of an after-hours nurse practitioner model of health care delivery in its Urgent Care Centre.MethodsThis qualitative study included semi-structured individual and group interviews with professional stakeholders of a rural health service in Victoria, Australia and included hospital managers and hospital staff who worked directly or indirectly with the after-hours NPs in addition to local GPs, GP practice nurses, and paramedics. Thematic analysis was used to generate key themes from the data.ResultsFour themes emerged from the data analysis: transition to change; acceptance of the after-hours nurse practitioner role; workforce sustainability; and rural context.ConclusionsThis study suggests that the nurse practitioner-led model is valued by rural health practitioners and could reduce the burden of excessive after-hour on-call duties for rural GPs while improving access to quality health care for community members. As pressure on rural urgent care centres further intensifies with the presence of the COVID-19 pandemic, serious consideration of the nurse practitioner-led model is recommended as a desirable and effective alternative.

Emphasizing the Nurse Practitioner Role in Addressing Unique Challenges Associated with Benzodiazepine use among the Elderly

Aim: The aim of this paper is to discuss the use of benzodiazepine medications among the elderly, and the role of a nurse practitioner within this patient population. &#x0D; Background: Benzodiazepines are well known to have a negative impact on the mobility of elderly patients and to contribute to increased falls. These medications also have an impact on elderly patients’ ability to perform activities of daily living and to drive. Nurse practitioners offer holistic care to elderly patients. This includes prescribing medications, monitoring therapy, deprescribing medications and identifying opportunities for safe alternatives to treat a variety of conditions.&#x0D; Methods: This paper presents a narrative review focused on the effect of benzodiazepine medications on the elderly patient population, with an emphasis on the use of benzodiazepines in insomnia. &#x0D; Conclusions: Findings of this review confirm the known risks associated with the use of benzodiazepines in the elderly and that these medications should be carefully considered in ongoing management. The conclusions of this review support the use of nurse practitioners in the enhancement of the healthcare of the elderly through the continuum of assessment, monitoring, deprescribing of benzodiazepine medications when appropriate, as well as opportunities to implement alternative treatments.

A Critical Analysis of Funding Models: Sustainability of the Nurse Practitioner Role in Canada

Numerous barriers inhibit the integration of full role components of nurse practitioners (NPs) in Canada. Although the number of NPs in Canada has increased substantially over the past decade, the contributions made by NPs to patient care and the health system are undervalued and insufficiently recognized. A critical analysis of the current state of Canadian NP funding models utilizing the Sustainability of Innovation Framework was conducted. Our analysis suggest that Canadian NP funding models need to be flexible, modern, affordable, responsive to the needs of a wide range of patient populations and support the work of health care leaders, funders, and policymakers in sustaining NP practice models across the nation.

The association between advanced practice nursing roles and outcomes in adults following cardiac surgery: A systematic review of randomized controlled trials

BackgroundEmpirical findings have shown significant and non-significant effects of advanced practice nursing roles within postoperative cardiac settings. The inconsistencies of the current literature preclude the identification of a significant effect of advanced practice nursing roles on patient and organizational outcomes. Objective1) identify patient and organizational outcomes of advanced practice nursing roles in postoperative cardiac surgery and 2) synthesize the evidence of current roles of advanced practice nurses in postoperative cardiac surgery to provide the best quality of care for patients. MethodA systematic review of randomized controlled trials was conducted in six electronic databases, including Medline, CINHAL, Embase, Cochrane Database, Joanna Briggs Database and Web of Science, and the grey literature. Randomized controlled trials published after 1999 were included if they examined advanced practice nursing roles and recruited patients who underwent cardiac surgery. The study selection was performed by two independent reviewers, and consensus was achieved with a third reviewer. Data extraction was conducted by one reviewer and revised by a second reviewer. The methodological quality of the included studies was assessed with the Evidence Project risk of bias tool by two independent reviewers and revised by a third reviewer. A narrative synthesis of the available evidence was completed. No meta-analysis technique was attempted because of the high heterogeneity of the included studies. ResultsAmong 4,448 retrieved papers, ten randomized controlled trials and three secondary analyses were included in this review. The methodological quality of the included studies was moderate. All studies included a comparison group and the majority of the studies collected data using a blinded researcher. However, all studies were based on small sample sizes and failed to randomly recruit participants. Five studies implemented nurse practitioner roles and five studies implemented clinical nurse specialist roles. The advanced practice nursing care included health condition management, lifestyle promotion and coping strategies with patients. A total of 22 outcomes were identified, including 13 patient outcomes (e.g., depressive symptoms) and nine organizational outcomes (e.g., rehospitalization after discharge). Each outcome was examined in one to five studies. All of the included outcomes were associated with inconsistent findings. ConclusionThe findings from existing literature remain inconsistent. The high risk of bias and the small sample sizes could potentially explain the non-significant findings. Avenues for future research should focus on the development of methodologically high-quality studies with larger sample sizes to enhance our understanding of the effectiveness of advanced practice nursing roles.

Where is the psychotherapy content in PMHNP programs?

Psychotherapy is the essence of the Psychiatric-Mental Health Nurse Practitioner (PMHNP) role. Yet much debate exists within programs as to the best way to include psychotherapy in an already loaded curriculum. Two large midwestern universities review their approaches to psychotherapy education; student evaluations measure the quality and effectiveness. Data revealed a high level of student satisfaction. Programs will vary on how to teach psychotherapy skills, but the use of psychotherapy within the PMHNP role is crucial and informs the entire practice. Examples of how others teach psychotherapy can inform educators of innovative ways to prepare PMHNP students to practice psychotherapy.

Implications of State Scope-of-Practice Regulations for Pediatric Intensive Care Unit Nurse Practitioner Roles.

Nurse practitioner (NP) advocacy efforts often focus on attaining full practice authority. While the effects of full practice authority in primary care are well described, implications for hospital-based NPs are less clear and may differ because of hospitals' team-based care and administrative structure. This study examines associations between state scope-of-practice (SSOP) and clinical roles of hospital-based pediatric intensive care unit (PICU) NPs. We conducted a national survey to assess clinical roles of PICU NPs including daily patient care, procedural, and consultation responsibilities as well as hospital-level administrative oversight practices. We classified SSOP as full or limited (reduced or restricted SSOP) practice. We present descriptive statistics and evaluate differences in clinical roles and hospital-level administrative oversight based on SSOP. The final sample included 55 medical directors and 58 lead (senior or supervisory) NPs from 93 of the 140 (66.4%) PICUs with NPs. There were no significant differences in daily patient care, procedural, or consultation responsibilities based on SSOP (p > .05). However, NPs in full practice authority states were more likely to bill for care than those in limited practice states (66.7% vs. 31.8%, p = .003), while those in limited practice states were more likely to report to advanced practice managers (36.7% vs. 13%, p = .03). For PICU NPs, SSOP was not associated with variation in clinical responsibilities; conversely, there were differences in billing and reporting practices. Future work is needed to understand implications of variation in hospital-level administrative oversight.

The Pain Nurse Practitioner and Pain Nurse's Role and Views on Opioid Management in Australia: A National Questionnaire Survey

BackgroundThe demand for access to Australian pain management services is growing. The dual crisis of opioid misuse and chronic pain, means pain nurses and nurse practitioners (NPs) have a unique opportunity to meet clinical demands and advance their scope of practice. AimsTo understand the role of pain nurses and pain NPs across Australia and explore their perceptions of current opioid management. DesignThis cross-sectional study involved pain nurses or pain NPs working in Australia who are a members of a pain interest group, which are subgroups of The Australian Pain Society. MethodsThis cross-sectional study involved pain nurses or pain NPs working in Australia who are a members of a pain interest group, which are subgroups of The Australian Pain Society. Survey respondents were contacted via the eight nursing Pain Interest Groups in Australia. ResultsAcute pain management (92.7%) and chronic pain management (80.5%) were the primary services provided, with pain specialty nurses providing nurse education (100.0%), patient support, clinician education, and policy development. Pain nurses believed there was an over prescription of opioid analgesics in Australia (97.6%), with NPs able to reduce opioid medication doses as part of opioid harm mitigation. ConclusionsPain nurses have a breadth of knowledge and experience highlight they can contribute to opioid management in the future, with the support of policy and organizations.