Perceptions Of Nurse Practitioners Research Articles

Perceptions of Nurse Practitioners and Physician Assistants/Associates Toward the Concept of Developing an Advanced Practice Postgraduate Residency/Fellowship Program at a Large Academic Medical Center.

Introduction There have been exponential growth and increased interest in postgraduate residency/fellowship formalized training among nurse practitioners (NPs) and physician assistants/associates (PAs). Although not a requirement for state licensure and entry-level practice, postgraduate NP and PA residency/fellowship programs offer a structured pathway for new graduates and experienced PAs and NPs looking to transition into a new medical or surgical specialty/subspecialty. In this article, we examine the perceptions of employed NPs and PAs toward postgraduate training including the concept of developing a program at our institution. Methodology This was a cross-sectional single-large academic medical center (AMC) study, where an anonymous electronic survey was initially developed by the director of advanced practice providers (APPs). The survey was piloted by members of the Advanced Practice Council (APC) comprising NPs, PAs, and certified registered nurse anesthetists (CRNAs), and their collective feedback was used to finalize the survey prior to distribution. Descriptive statistics were used to describe and summarize the data. In addition, we assessed the association between respondents' characteristics and perceptions regarding NP and PA residency/fellowship programs using chi-squared tests of independence. Results The majority of the respondents (69.1%; 65/94) believed that starting an advanced practice residency/fellowship program at our AMC has many benefits such as increasing specialty-specific knowledge and training (79.8%; 75/94), improving medical decision-making (73.4%; 69/94), promoting professional development and clinical education (73.4%; 69/94), and improving procedural competency (60.6%; 57/94). Moreover, over half of the respondents (53.2%; 50/94) indicated that there is value in an APP residency/fellowship program obtaining optional accreditation. Additionally, over half of the respondents (56.4%; 53/94)indicated that they would be interested in participating as a clinical preceptor if an APP residency/fellowship program was developed at our AMC. Lastly, about one-third of the respondents felt strongly that APP residency/fellowship training programs should offer post-professional doctoral degree options such as Doctor of Nursing Practice (DNP), Doctor of Medical Science (DMSc), and Doctor of Health Science (DHSc). Conclusion Although most respondents have never completed a formalized postgraduate training program and were less familiar with the published literature regarding these programs, our findings suggest that the attitudes ofemployed NPs and PAs aregenerally positivetoward the concept of postgraduate specialty-specific training.

Perspectives on Collaboration between Physicians and Nurse Practitioners in Japan: A Cross-Sectional Study.

Nurse practitioners (NPs) are known as effective healthcare providers worldwide. In Japan, nurse practitioner adoption is considered to be in a shaky period. Although nurse practitioners were introduced approximately 10 years ago at the initiative of educational institutions in Japan, the full extent of this trend is not known. Therefore, we have clarified the whole picture of nurse practitioners from two directions: the perception of nurse practitioners in Japan and the perception of physicians who work with nurse practitioners. This will inform discussions regarding the recruitment of nurse practitioners at the national level in Japan. From 18 June to 24 July 2021, we administered a nationwide cross-sectional survey of NPs and physicians working in the same clinical settings as NPs in Japan. The domains of the survey included "scope and content of work", "perceptions of NPs' clinical practice", and "individual clinical practice characteristics". The survey was distributed and collected digitally. The total number of respondents to the survey was 281, including 169 NPs and 112 physicians; the percentage of NPs who responded was 50.5%. The number of valid responses was 164 NPs and 111 physicians, for a total of 275 respondents. Approximately 60% of NPs are concentrated in Tokyo, the capital of Japan, and the three prefectures adjacent to Tokyo. They also worked fewer hours per week, cared for fewer patients per day, and earned less money than physicians. More physicians than NPs indicated that "more NPs would improve the quality of care". A total of 90.1% of physicians and 82.3% of NPs agreed that "Nurse practitioners should practice to the full extent of their education and training," and 73.9% of physicians and 81.7% of NPs agreed that "Nurse practitioners' scope of practice should be uniformly defined at a national level". This study clarified the present working conditions of NPs from NPs' and physicians' perspectives in Japanese contexts. Japanese NPs may be able to work effectively in collaboration with physicians. Therefore, the implementation of NPs in Japanese medical conditions should be discussed further for better healthcare.

Knowledge and Perceptions of Nurse Practitioners on Adverse Events Following Immunization and Barriers to Reporting in the Central Region, Eritrea: A Cross-Sectional Study.

BackgroundThough vaccines are generally considered extremely safe and effective, they have been associated with some serious adverse events following immunization (AEFIs). AEFIs might be related to either the vaccine, immunization error, anxiety related to immunization, and/or coincidental events. If they are not reported and investigated in timely fashion, they can create rumors and confidence gaps. In the last few years, reporting AEFIs in the Central Region of Eritrea, compared to other regions, has been found to be very low, with the root cause for this variation unknown, making intervention strategies challenging. This study was conducted to assess nurse practitioners’ knowledge and perceptions on AEFI surveillance and barriers to reporting in the region.MethodsAn analytical cross-sectional study was conducted among all nurse practitioners who were directly or indirectly involved in immunization services working in all health facilities of the region. Data were collected between October 2019 and February 2020 using an interview-based questionnaire. Percentages and medians (IQR) were used as descriptive statistics, and Mann–Whitney and Kruskal–Wallis tests were used as inferential tools.ResultsA total of 130 respondents with a median age of 40 (IQR 23) years were included in the study. The overall median (IQR) knowledge score of the respondents on AEFI surveillance was 87.50 (19) out of 100. Furthermore, median (IQR) comprehensive perception score was 70 (20) out of 100 (range 40–95). Shortage of motivation and not knowing how to report were identified as the main barriers to reporting AEFIs.ConclusionKnowledge and perceptions of nurse practitioners in the Central Region on AEFI surveillance were generally encouraging. They should however need to be further trained on the basics of AEFI surveillance to bridge the identified barriers to reporting.

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.

Perceptions of Nurse Practitioners as Clinical Leaders in the Military

Health care systems need leaders to address complex challenges. This presents an opportunity for nurse practitioners (NPs). The United States Army is already using NPs as leaders. This study addresses the following 2 research questions: What are Army primary care clinicians’ perceptions of NPs as clinical leaders? and Are there differences in these perceptions? In this study, we used a survey that captured clinicians’ perceptions of NP leadership. Overall, respondents favored NPs as clinical leaders. Over 65% agreed that NPs were qualified as leaders within the Army. This study suggests clinicians perceive NPs as qualified and effective leaders at high levels throughout primary care.

Curbside Consultation for the Nurse Practitioner: Qualitative Inquiry for Education, Policy, and Practice.

Curbside consultation (CC), defined as pursuing information or recommendation regarding patient care, without request for formal consultation is a favored information source for nurse practitioners (NPs) when making clinical decisions in practice settings. Research and education concerning CC among NPs is lacking. The purpose of this study was to obtain an understanding of NP perceptions of interpersonal aspects of the CC process to inform NP clinical practice and education. Qualitative descriptive design and inductive content analysis was used. Twenty primary care and specialty care NP were recruited using purposive sampling for conduct of individual interviews. Content analysis identified themes describing interpersonal components of the CC process. NP practiced in collaboration with physicians in variable roles within primary care and specialty care settings. These collaborations varied dependent upon supervisory relationships with physicians. Additional themes concerned NP professional experience and characteristics of experts desired for CC. These characteristics included NP perceptions of colleague experience and expertise, trust, and interpersonal relationship dynamics. CC processes for NPs are multidimensional, including interpersonal themes as components of this communication exchange. Given CC is a highly utilized resource for NPs, further inquiry is critical for understanding of its implications for NP practice, policy, and education internationally.

Knowledge, attitudes, and perceptions of nurse practitioners about antibiotic stewardship.

Antibiotic stewardship (ABS) is a set of strategies to optimize antimicrobial use while reducing antibiotic resistance, improving patient outcomes, and decreasing unnecessary costs. Nurse practitioners (NPs) play an essential role in health care education and represent a valuable potential resource for ABS efforts. The purpose of this study was to describe the knowledge, attitudes, and perceptions of NPs toward ABS. A convenience sample of NPs attending the American Association of Nurse Practitioners annual conference was given a modified descriptive survey. Descriptive statistics were used to assess normality. A total of 194 NPs completed the questionnaire (88% female; 70% master's degree). Factors affecting the decisions of antibiotic prescriptions included patient condition (79%) and patient cost (58%). Nurse practitioners based their antibiotic decisions on the antibiogram (63%) in their setting, whereas 56% indicated they start with broad spectrum and tailor antibiotic choices after cultures are received. Nurse practitioners understood that inappropriate antibiotic use causes resistance (97%), harms the patient (97%), and optimum antibiotic use will reduce resistance (94%). Participants also recognized that strong knowledge of antibiotics was important (94%) and felt confident in using antibiotics (86%). However, 94% agreed that antibiotics are overused nationally, and only 62% thought antibiotics were overused in their setting. Nurse practitioners recognize that knowledge about antibiotics is important to their career and would like more education about antibiotics and feedback about their antibiotic choices. Finding effective ways to provide this education could change practice and improve antibiotic use.

Physician and nurse practitioner perceptions of social worker and community health worker roles in primary care practices caring for frail elders: Insights for social work

ABSTRACTSocial workers (SW) and community health workers (CHW) have emerged as key workforce personnel in efforts to care for elders in the U.S. However, little is known about the presence and roles of SW and CHW in primary care practices. This paper presents findings from a nationally representative survey of geriatrics and primary care practices. Physician and nurse practitioner clinicians were randomly selected within practices, stratifying by practice staffing and presence/absence of geriatric clinicians; our final sample for this analysis included 341 practices. Key findings include: reported challenges in meeting the social service needs of elders, underutilization of SW, and fuller utilization of social work competencies in practices in which both SW and CHW were present. These findings offer a unique perspective of SW on interprofessional teams and have implications for the future of the profession.

What is curbside consultation for the nurse practitioner?

Curbside or informal consultations between clinicians regarding patient care occur frequently in clinical practice. Evaluation of curbside consultation (CC) among nurse practitioners (NPs) is limited. To develop an understanding of NP perceptions of the CC process. A qualitative descriptive design was used to assess the context of CCs among NPs. Inductive content analysis was conducted, and Atlas.ti was used to organize the data. Purposive sampling was used to recruit 20 NPs within primary care and specialty settings. Themes describing CC included the description of the CC process, advantages and disadvantages, documentation, legal liability, unspoken rules, and patient-centered engagement. There was a lack of consensus on the boundaries of the CC definition including difficulty in distinguishing a CC from a formal consultation. Generally, the NP acknowledges limitations and views the CC favorably as a helpful tool for receiving practical feedback and expanding learning, collegiality, and collaboration. Findings provide insight regarding the common practice of CC in management of patients at the point of care, what it means to the NP, and a description of the breadth of the CC use. Given its potentially substantial impact on patient care, further assessment of the context of CC among NPs is obligatory.

Annual Medicare Wellness Visit: Advanced Nurse Practitioner Perceptions and Practices

Advanced Practice Nurses (APNs) can contribute to health prevention efforts with older adults by utilizing a health risk appraisal (HRA) during the Medicare Annual Wellness Visit. This study examined APN perceptions and practices concerning use of HRAs during Annual Wellness Visits (N = 51). Results indicate that respondents agree it is important to collaboratively identify risks and develop a personalized prevention plan, but only a small percentage (7.8%) use HRA data to do so. Reported concerns include reimbursement and time; further work on how to best integrate HRAs into APN practice to enhance prevention efforts with older adults is critical.

Nurse practitioner's perceptions of the impact of the nurse practitioner-led clinic model on the quality of care of complex patients.

AimTo evaluate the organizational processes that influence the quality of care for patients with multimorbidity at nurse practitioner-led clinics (NPLCs). BACKGROUND: People are living longer, most with one or more chronic diseases (mulitmorbidity) and primary healthcare for these patients has become increasingly complex. One response was the establishment of new models of primary healthcare. NPLCs are an example of a model developed in Ontario, Canada, which feature nurse practitioners as the primary care providers practicing within an interprofessional team. Evaluation of the extent to which the processes within NPLC model addressed the needs of patients with multimorbidity is warranted. METHODS: Eight nurse practitioners were interviewed to determine their perception of the quality of care provided to patients with multimorbidity at NPLCs. Interpretive description guided the analysis and themes were identified.FindingsThree themes arose from the analysis, each of which has an impact on the quality of care. The level of patient vulnerability at the NPLCs was high resulting in the need to address social and financial issues before the care of chronic conditions. Dynamics within the interprofessional team impacted the quality of patient care, including NP recruitment and retention, leaves of absence and turnover in staff at the NPLCs had an effect on interprofessional team functioning and patient care. Finally, coordination of care at the NPLCs, such as length of appointments, determined the extent to which attention was given to individual clinical issues was a factor. Strategies to address social determinants of health and for recruitment and retention of NPs is essential for improved quality of care. Comprehensive orientation to the interprofessional team as well as flexibility in care processes may also have positive effects on the quality of care of patients with complex clinical issues.

Nurse practitioner perceptions of barriers and facilitators in providing health care for deaf American Sign Language users

Pendergrass, Kathy M. PhD, FNP‐BC; (Assistant Professor)*,1; Nemeth, Lynne PhD, RN, FAAN; (Professor)2; Newman, Susan D. PhD, RN, CRRN; (Associate Professor)2; Jenkins, Carolyn M. DrPH, MSN, RD, LD, FAAN; (Research Professor)2; Jones, Elaine G. PhD, RN; (Associate Professor)3 Author Information

Nurse Practitioner Perceptions of a Diabetes Risk Assessment Tool in the Retail Clinic Setting.

IN BRIEF This article describes a study to gain insight into the utility and perceived feasibility of the American Diabetes Association’s Diabetes Risk Test (DRT) implemented by nurse practitioners (NPs) in the retail clinic setting. The DRT is intended for those without a known risk for diabetes. Researchers invited 1,097 NPs working in the retail clinics of a nationwide company to participate voluntarily in an online questionnaire. Of the 248 NPs who sent in complete responses, 114 (46%) indicated that they used the DRT in the clinic. Overall mean responses from these NPs indicated that they perceive the DRT as a feasible tool in the retail clinic setting. Use of the DRT or similar risk assessment tools in the retail clinic setting can aid in the identification of people at risk for type 2 diabetes.

Nurse practitioner perceptions of the impact of physician oversight on quality and safety of nurse practitioner practice.

Nurse practitioner (NP) regulation and physician oversight (PO) of NP practice are inextricably intertwined. A flexible, well-prepared workforce is needed to meet consumer healthcare needs. All outcome studies have revealed that NPs provide safe, effective, quality care with outcomes equal to or better than that of physicians or physician assistants. Variability in state regulation of NP practice limits the full deployment of these proven healthcare providers, threatens the quality and safety of NP-delivered care, and limits consumer choice in healthcare access. The purpose of this study was to document NP perceptions of the impact of PO on the safety and quality of NP practice. A total of 1139 NP respondents completed an exploratory survey, Impact of Regulatory Requirements for Physician Oversight on Nurse Practitioner Practice. Participants were asked their perceptions of the impact of PO on patient care and NP practice. Descriptive statistics on the state of residence regulatory requirements and personal demographics were also collected. NP perceptions of the impact of PO on the safety and quality of NP practice were predicted by NP experience and state regulatory environment ranking. The results of this study have implications for educators, policy makers, and nursing advocacy groups seeking to increase access to care in U.S. Study participants perceived that requirements for PO impacted their practice and may jeopardize patient safety. An understanding of the impact of influences on regulatory processes is critical to ensuring full deployment of NPs as interprofessional leaders to meet current and future healthcare access.

Discordance Between Measured Frailty and Provider Perceptions of Frailty.

Background: Frailty, a measure of physiologic reserve, is a predictor of poor outcomes after transplantation. However, frailty is not routinely measured, and providers instead rely on perceptions of physiologic reserve to assess overall patient health status and guide clinical decisions. Thus, we sought to explore the agreement between measured frailty and provider perceptions of frailty. Methods: We measured frailty in prevalent dialysis patients from a single hemodialysis center based on five components (exhaustion, weakness, low physical activity, weight loss, and slow gait speed) and categorized frailty scores as nonfrail, prefrail, and frail according to the Fried index. We also asked providers (nephrologists and nurse practitioners (NPs)) to estimate whether they would expect their patient to be nonfrail, prefrail, and frail. Weighted kappa was used to determine agreement, and ordinal logistic regression was used to identify correlates. Results: Of 126 study participants, mean age was 60.5 years (SD 13.6), 46.2% were female, 84.1% were African American, median time on dialysis was 3.6 years (IQR 1.43-6.12), mean BMI was 28.6 (SD 8.0), and 31.1% were measured as frail. Nephrologist perceptions agreed poorly with measured frailty (weighted kappa, 0.12), while NP perceptions were borderline fair in agreement (weighted kappa, 0.21). Nephrologists rated 42.1% of nonfrail patients as frail or prefrail (overestimation) and 41.5% of frail/prefrail patients as nonfrail (underestimation). NPs overestimated the frailty of 36.1% of nonfrail patients and underestimated the frailty of 23.1% of frail/prefrail patients. Adjusting for race, gender, time on dialysis, BMI, and measured frailty, nephrologists were more likely to misclassify older patients as frail (aOR 1.08, p<0.001); NPs were more likely to misclassify older (aOR 1.03, p=0.04), female (aOR 2.27, p=0.049), and non-African American (aOR 4.60, p=0.01) patients as frail. Conclusions: Provider perceptions of frailty are discordant with measured frailty and may be biased by non-modifiable patient characteristics. Since perceptions of frailty likely reflect overall impressions of patient health status, efforts to standardize the measurement of frailty in the clinical setting and to dispel misconceptions about the predictors of frailty might improve the clinical decision making process.

Neurocritical Care Clinicians’ Perceptions of Nurse Practitioners and Physician Assistants in the Intensive Care Unit

The contributions and perceptions of staff regarding nurse practitioners (NPs) and physician assistants (PAs) in neuroscience intensive care units (ICUs) throughout the country are not well known. The objectives of this study were to determine the impact of neuroscience NPs and PAs and assess demographics of ICUs. All members of the Neurocritical Care Society were asked to complete a survey to obtain their perception regarding the addition of NPs and PAs to the ICU team. Participants rated the abilities of NPs and PAs to provide safe patient care, promote a team environment, anticipate or prevent neurological deterioration, address patient or staff concerns in a timely manner, and communicate effectively on a Likert scale of 1-5. In addition, members were asked to provide basic demographics and background information on the type and size of ICU, type of provider in charge, and role of NPs and PAs in their ICU, including procedures performed, documents written, and number of patients per provider. Both quantitative and qualitative data were collected and analyzed. A Mantel-Haenszel chi square and ordinal logistic regression model were used to determine the relationship between the background information and the perception of the abilities of NPs and PAs. The study cohort was composed of 10% of Neurocritical Care Society members. Additional responsibility of NPs and PAs was associated with higher scores in safety, the ability to promote a team environment, address patient or staff concerns, communication, and most importantly, the ability to anticipate or prevent a neurological deterioration (all ps < .0001). Number of NPs and PAs, number of years of employing NP/PAs, number of procedures, and amount of documentation also positively affected safety. Additional responsibility of NPs and PAs has strong potential to improve staff, patient, and family satisfaction and safety and prevent neurological deterioration. Thus, NPs and PAs should be utilized to the full extent of their role.

Labour saver or building a cohesive interprofessional team? The role of the nurse practitioner within hospitals

Nurse practitioners (NP) are employed within hospital interprofessional (IP) teams in several countries worldwide. There have been some efforts to describe the nature of the NP role within IP teams largely focussing on how the role may augment care processes. Here, using a constructivist grounded theory approach, the perceptions of NPs about their role were compared and integrated into a previously published team perspective as the second phase of a larger study. Seventeen hospital-based (HB) NPs across Ontario, Canada, participated in group and individual interviews. The NP perspective substantiated and expanded the previously reported team perspective, resulting in an IP perspective. The three practice foci illustrating role value meaning of this perspective became: evolve NP role and advance the specialty, focus on team working, and hold patient care together. The IP perspective, juxtaposed with an existing contingency approach, revealed that NPs were promoting IP work, predominantly at the collaboration and teamwork levels, and aiding IP team transitions to appropriate forms of IP work. The practice, “focus on team working”’ was strongly related to promoting IP work. The findings were consistent with HB NPs enacting a role in building IP team cohesiveness rather than merely acting as a labour saver. This is the first study to align NP and team understanding of HB NP role value using an IP framework.

Perceptions of NPs and administrators in regard to the governing and supervision of NPs in Taiwan

To determine the perceptions of nurse practitioners (NPs) and administrators in regard to the governing and supervision of NPs, using a qualitative approach. The study used a qualitative research design, with 14 participants recruited through purposive sampling. Data were collected through a semi-structured interview and were analyzed through content analysis to identify the concepts and themes. NPs in Taiwan are challenged by a number of barriers; however, they remain positive that their circumstances will improve. The results indicated that clinicians and hospital managers, including NPs themselves, need to have a solid understanding of NP regulations. Communication with other disciplines and policymakers is key to success in the NP role. This study provides valuable information for NPs, other healthcare professionals, and administrators in terms of promoting the role of NPs.

Perceived Barriers to Nurse Practitioner Practice in Rural Settings

Rural residents experience the same incidence of acute illness as urban populations and have higher levels of chronic illness. Overall, access to adequate rural health care is limited. Nurse practitioners (NPs) have been identified as safe, cost-effective providers in meeting these challenges in rural settings. This replication study was conducted to examine NP perceptions of barriers to rural practice in Minnesota. Findings were compared to earlier studies to examine issues that have persisted over time. A Barriers to Practice checklist was mailed to NPs from the database of the Board of Nursing of a midwestern state. Rural NPs (n = 191) identified and described barriers to practice and rated the overall restrictiveness of their practice. Barriers to practice were perceived to be prevalent. Persisting barriers continued to stand in the way of full utilization of NP roles. Lack of understanding of NP roles on the part of the public and other health professionals has been particularly problematic over time. Key issues in 2001 were low salaries, lack of adequate office space, and a limited peer network. Perceived restrictiveness of the practice climate, gauged as somewhat restrictive, remained unchanged between 1996 and 2001. NPs have an excellent history of meeting rural primary health care needs. Enhancing the NP work environment could prove instrumental to retaining these professionals in the work force and thereby contribute to improved access and quality of care in underserved rural communities.

The Standard Days Method: Nurse-Midwife and Nurse-Practitioner Perceptions of a New Method of Family Planning

The Standard Days Method: Nurse-Midwife and Nurse-Practitioner Perceptions of a New Method of Family Planning