Knowledge translation: A Nurse Practitioner Clinical Ladder Advancement Program in a university-affiliated, integrated medical center

Professional Advancement Models for Nurse Practitioners and Physician Associates/Assistants: A historical overview and opportunities for future growth

ABSTRACT

Professional advancement models (PAM) are paramount in the growth of nurse practitioners (NP) and physician associates/assistants (PA) who seek professional challenges, clinical recognition, job satisfaction, upward mobility, and incentives for retention. Professional advancement models for NPs and PAs were born out of literature on clinical career ladders that date back to the 1970s for the nursing work force. Over time, PAMs have evolved to offer NPs and PAs structured pathways to guide and reward professional growth, education, advocacy, research, and quality improvement (QI). Although the first institutional account of PAM development for NPs and PAs was published in 1998, there has been a recent spike in case reports of PAMs from individual medical centers. This article (1) provides a historical timeline of published data on the development and implementation of PAMs for NPs and PAs, (2) critiques features of existing PAMs, and (3) offers recommendations regarding PAM innovation for more uniform adoption in medical institutions across the country.

Clinical ladders: A potential solution for retaining and promoting PAs

ABSTRACT

As the need for more healthcare providers increases, so does the need for leaders in the healthcare setting. Physician associates/assistants (PAs) are primed to step into these positions, given their key role in the clinical setting. Clinical ladder models are an established system for clinical, administrative, and academic advancement for healthcare providers. Although more research is needed, clinical ladders provide the opportunity for career advancement while helping to promote professional development and improve retention. Moreover, the opportunity for advancement via clinical ladders may help to prevent clinician burnout and turnover by providing more opportunities and career directions.

Development of the Acute Care Nurse Practitioner Competencies Scale: An Exploratory and Confirmatory Factor Analysis

BACKGROUND

Nurse practitioners (NPs) play a vital role in healthcare, particularly in acute care settings in Taiwan. The professional competencies of NPs are essential for providing safe and effective care to patients. To date, no measurement tool is available for assessing the clinical competencies of NPs in acute care practices.

PURPOSE

The aim of this study was to develop and investigate the psychometric properties of the Acute Care Nurse Practitioner Competencies Scale (ACNPCS).

METHODS

Mixed-method research was employed using samples of experienced NPs. First, we used a focus group of seven experienced NPs who worked for medical centers, community hospitals, and regional hospitals to identify clinical competencies content. Second, we implemented consensus validation using two rounds of the Delphi study and revised it to a 39-item ACNPCS. Third, we conducted content validity with nine NP experts and modified the competency content to 36 items. Finally, we conducted a national survey of 390 NPs from 125 hospitals to determine the extent to which the NP competency content relates to their clinical practice. To examine the reliability of the tool, we tested the internal consistency reliability and test-retest reliability. Exploratory factor analysis, confirmatory factor analysis, and known-group validity were used to test the construct validity of the ACNPCS.

RESULTS

The Cronbach's alpha coefficient for the overall scale was .92, with subscale coefficients ranging from .71 to .89. Test-retest reliability showed the two scores of the ACNPCS on the two occasions tested to be highly correlated ( r = .85, p < .001). Exploratory factor analysis revealed that the scale had six factors: providing healthcare, evaluating care, collaboration, education, care quality/research, and leadership/professionalism. Factor loadings for each factor item ranged from .50 to .80 and explained 72.53% of the total variance in the NPs' competencies. Confirmatory factor analysis indicated that the six-factor model showed satisfactory model fit (χ 2 = 780.54, p < .01), and the fit indices met the standards for adequate fit (goodness-of-fit index = .90, comparative fit index = .98, Tucker-Lewis index = .97, root mean square error of approximation = .04, and standardized root mean residual = .04). Known-group validity revealed that the total scores for novice NPs differed significantly from those of expert NPs in terms of the competencies ( t = 3.26, p < .001). These results validated the psychometric soundness of the newly developed ACNPCS.

CONCLUSIONS

The newly developed ACNPCS exhibited satisfactory reliability and validity, supporting the use of the ACNPCS as a tool to assess the clinical competencies of NPs in acute care settings.

Quantification of institutional and professional impact of a professional advancement program for advanced practice registered nurses and physician assistants

ABSTRACT

Professional advancement programs, also known as career or clinical ladders, have proliferated for advanced practice registered nurses (APRNs) and physician assistants (PAs) and recognize clinical and/or professional contributions within clinical agencies. Although the literature is rich in describing the benefits of these programs on job satisfaction and staff retention, there is a dearth of literature on the effect of these programs on clinical practice, institutions, and the respective professions. This article quantifies the impact on the institution and profession of APRNs and PAs who have been promoted through an institution's career ladder.

Development of a Multidisciplinary Professional Advancement Framework

The creation of professional advancement programs is an important goal to support development of nurses and other team members. Maintaining consistency among programs within one institution poses a challenge. The development of an overarching framework has provided this structure. Our framework is composed of core components, key elements, and best practices that can be applied to ensure consistency among all programs. This framework can be applied to existing programs or guide new eight programs.

Supporting Advanced Practice Providers Through the Development and Implementation of an Advanced Practice Provider Professional Advancement Program

As the number of Advanced Practice Providers (APPs) has increased across health care settings, institutions have identified the need to provide opportunities for the advancement, growth, and development of APPs. An APP Professional Advancement Program was developed and implemented at our freestanding, pediatric academic medical center that employs over 700 APPs. This program was designed to support all APPs regardless of their role and practice setting by recognizing their accomplishments and providing the tools and resources needed to pursue opportunities to further their professional development and leadership. This article describes the development, implementation, and sustainment of an APP Professional Advancement Program.

The impact of organisational commitment and leadership style on job satisfaction of nurse practitioners in acute care practices

AIM

To determine the main factors that affect nurse practitioners' job satisfaction, especially the relationship between organisational commitment and leadership styles in acute care practices.

BACKGROUND

There is little known about the influence of organisational commitment and leadership on NPs' job satisfaction within acute care hospitals.

METHODS

A cross-sectional design with a national online survey that enrolled 1,205 nurse practitioners from the Taiwan Association of Nurse Practitioners to identify potential variables associated with job satisfaction using the multiple regression model.

RESULTS

Organisational commitment (mean=59.47), job satisfaction (mean=173.47), and leadership style (mean ranged from 13.29 to 28) were at a moderate level. Organisational commitment, leadership style, patient load and nurse practitioner advancement levels explained 63% of the variance in nurse practitioners' job satisfaction.

CONCLUSIONS

Organisational commitment and leadership styles, such as idealised influence and individual consideration, are major factors that impact nurse practitioners' job satisfaction.

IMPLICATIONS FOR NURSING MANAGEMENT

Healthcare organisations should develop policies targeting organisational commitment and managers' leadership styles to improve nurse practitioners' job satisfaction.

A ladder that matters: Conceptual development of a clinical ladder program for nurse practitioners and physician assistants

ABSTRACT

Clinical ladders are professional enhancement models that encourage and reward participants for continued professional engagement and leadership development. They have the potential to affect patient care through improved provider retention, advanced and refined clinical skills, and increased engagement. Recent literature has demonstrated development and implementation of clinical ladder models for nurse practitioners (NPs) in the acute care setting. A free standing pediatric academic hospital in Florida identified the need for such a program for nurse practitioners and given its increased utilization of physician assistants, these providers were also targeted for inclusion. This new clinical ladder included development strategies appropriate and attainable for both NP and PA scopes of practice. Consistent with Benner's theory of novice to expert (1982), each advancing rung in the ladder contains more stringent criteria and additional competencies demonstrating increased engagement, learning, and leadership. As this was a development project only, future directions for the new model include implementation and evaluation of various metrics including nurse practitioner and physician assistant retention and satisfaction. This model has laid the foundation for ladder development for additional health care professions within the institution.

Examining Job Satisfaction and Intent to Stay for Neonatal Nurse Practitioners: The Impact of Mentoring

BACKGROUND

In 2017, the National Association of Neonatal Nurse Practitioners (NANNP) recommended that organizations implement formalized mentoring programs for neonatal nurse practitioners (NNPs). There is significant evidence to support that mentoring positively impacts nurse practitioners' job satisfaction and retention. However, there is a lack of evidence-based literature specific to NNP mentoring.

PURPOSE

Determine the impact of participation in the NANNP formalized mentoring program on job satisfaction and retention for novice and experienced NNPs in an academic medical center in Tennessee.

METHODS

This quality improvement project utilized a secure online survey that included the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) and 2 intent-to-stay items prior to implementation of a 6-month mentoring program. Neonatal intensive care unit nurse practitioners completed the same electronic survey at 3 intervals after program implementation to determine the impact of the mentoring program on job satisfaction and intent to stay.

RESULTS

Project results identified a significant difference in MNPJSS scores for participants in a 6-month formal mentoring program using the NANNP tool kit. The MNPJSS scores moderately correlated with intent to stay at 1 year and strongly correlated with intent to stay at 3 years.

IMPLICATIONS FOR PRACTICE

The results of this project support the positive impact of a formalized mentoring program on job satisfaction for new graduate nurse practitioners. Recognizing the challenge to recruit and retain NNPs, organizations should explore creative solutions to develop and support formalized mentoring programs.

IMPLICATIONS FOR RESEARCH

Further research is warranted to validate use of the NANNP tool kit in the establishment and evaluation of a formalized mentoring program.Video abstract available at:https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.

Advanced practice nurse professional advancement programs: a scoping review

OBJECTIVE

The objective of this review was to explore existing literature related to advanced practice nurse professional advancement programs, to examine and map the evidence, and to identify any gaps in the literature.

INTRODUCTION

Internationally, there is literature regarding the implementation and benefits of professional advancement programs for staff nurses, but there is scant literature addressing professional advancement programs for advanced practice nurses. Professional advancement programs may enhance workplace engagement and foster retention by empowering employees to grow and excel.

INCLUSION CRITERIA

This scoping review considered studies that included advanced practice nurses in direct patient care roles participating in professional advancement programs. The concept of the review was advanced practice nurse professional advancement programs and related criteria and characteristics (eg, length of service, performance review, educational preparation) and outcomes (eg, improved recruitment, retention, employee satisfaction). Studies conducted in any setting and geographical location where advanced practice nurses were employed were included.

METHODS

Studies published in English from 1965 to search date were included. The databases searched included PubMed, CINAHL, Embase, Scopus, and PsycINFO. The search for unpublished evidence and gray literature included ProQuest Dissertations and Theses, MedNar, and various hospital websites. Retrieval of full-text studies and data extraction was performed independently by two reviewers. The extracted data is presented in diagrammatic or tabular form with an accompanying narrative summary.

RESULTS

Nine descriptive studies were included in this review. All nine studies detailed the names of advancement programs, and provided characteristics and criteria for advancement for those participating in the programs. In addition, six studies described benefits of advancement, two studies described outcomes associated with advancement, and two studies described outcomes and benefits.

CONCLUSION

There are few advanced practice nurse professional advancement programs discussed in the literature. In the included studies detailing these programs, there were wide variations in the names, criteria, and characteristics. There is also limited data available regarding outcomes associated with advanced practice nurse professional advancement programs.

Supporting Advanced Practice Providers' Professional Advancement: The Implementation of a Professional Advancement Model at an Academic Medical Center

Organizational commitment to a structured professional advancement model (PAM) is critical for advanced practice provider (APP) development in order to promote and reward excellence, enhance job satisfaction and improve retention and recruitment. A PAM may also serve as a motivational tool for personal and professional growth by developing and promoting a professional, evidence-based collaborative practice environment. A voluntary PAM was implemented at a large Midwestern academic medical center to recognize experienced APPs including certified nurse practitioners, certified nurse-midwives and physician assistants. This manuscript describes the case for creating a PAM, implementation and evaluation.

Development and testing of an advanced practice clinical advancement program within an academic medical center

BACKGROUND

Faculty advanced practice registered nurses (APRNs) and physician assistants (PAs) employed by Vanderbilt University Medical Center (VUMC) have historically participated in rank promotion tracks for recognition of professional accomplishments in education, practice, and research. However, there has not been a clinical advancement program for nonfaculty practitioners. Satisfaction, engagement, and health surveys indicated VUMC APRNs and PAs were seeking opportunities for professional growth and development. Many health care organizations have incorporated clinical advancement programs as key recruitment and retention strategies. With a growing number of nonfaculty APRNs and PAs, VUMC began to explore the development, implementation, and evaluation of a clinical advancement program.

PURPOSE

A VUMC Clinical Advancement Task Force was created to explore, develop, implement, and evaluate an advanced practice clinical advancement pilot.

METHODS

Two teams were selected to participate in a 6-month pilot. Presurveys and postsurveys were conducted, and postpilot focus groups were held with participating practitioners. A 9-square tool was developed as a rubric for evaluating the practitioner's progress. Applications, leader assessments, and recommendations were housed in a secure database for a selected advancement committee to evaluate.

RESULTS

Of 23 participants, 47% indicated satisfaction with professional development opportunities, when compared with 84% postpilot. Postpilot focus groups further improved the tool and the process for the program.

IMPLICATIONS FOR PRACTICE

Opportunities for advancement/professional development positively influence APRN and PA perceptions of job satisfaction. This program could be tested with other APRN and PA teams for impact on job satisfaction, engagement, and retention.

Professional Conference Poster Presentation: Innovative Professional Development Assignment in Nurse Practitioner Education

BACKGROUND

This innovative assignment converted a traditional presentation to an assignment that addressed several National Organization of Nurse Practitioner Faculties competencies and the growing trend toward nurse practitioner professional advancement models.

METHOD

The professional conference poster assignment spanned two semesters. The first semester assignment included a focused literature review and abstract development. The second semester assignment included a formal presentation using a digital poster format.

RESULTS

Only three of the 23 respondents indicated ever having developed an abstract or a professional conference poster prior to the assignment. Students identified new skills acquired as a result of the professional conference poster assignment: writing an abstract (78%), writing a biographical statement (87%), constructing a digital poster (91%), speaking at a conference (87%), and searching the evidence (48%).

CONCLUSION

Nurse practitioner students evaluated this assignment highly, learned valuable dissemination skills that met core competencies, and were instilled with a culture of clinical scholarship and dissemination. [J Nurs Educ. 2020;59(6):345-348.].

Pediatric nurse practitioner's perceived organizational support in academic and nonacademic institutions

BACKGROUND

The role of the pediatric nurse practitioner (PNP) has changed since its inception over 50 years ago. Pediatric nurse practitioner practice has evolved from providing outpatient primary care to children to providing complex care in the acute practice environment.

PURPOSE

The purpose of this study was to describe whether a difference existed in perceptions of organizational support (POS) of PNPs working in academic and nonacademic institutions and to describe the differences between PNP reporting structures and POS.

METHODS

A quantitative cross-sectional design was used with a convenience sample (n = 86) of PNPs from the membership list of the Pediatric Nurse Credentialing Board (PNCB). A formal written request was sent to the PNCB to access their membership after which institutional review board approval was obtained from Case Western Reserve University. Participants received an online cover letter with links to the surveys to be completed. The PNPs were asked to complete a demographic/institution characteristic survey and Eisenberger Perceived Organizational Support Survey (POS).

RESULTS

More than 63% of the PNPs participating in this national survey, practicing in both academic and nonacademic affiliated hospitals, had positive perceptions of organizational support. No differences were found between the academic and the nonacademic affiliations.

IMPLICATIONS FOR PRACTICE

Because PNPs are integral to the provision of care to children, providing opportunities for PNPs to continue to enhance their clinical skills and practice to the full extent of their scope of practice will only enhance their perceptions of organizational support. This dynamic creates a win-win for the PNP, the institution, the patients they care for, and the US health care system.

Nurse career mapping: a qualitative case study of a new hospital

BACKGROUND

Career mapping is an effective strategy for providing nurses with a clear direction and a realistic time scale for achieving their career goals. The purpose of this research is to investigate career mapping for nurses at a new hospital in Jakarta.

METHOD

The study design is qualitative and implements a focussed case study approach. Data were collected from focus group discussions (FGDs) with two groups: one group consisted of eight staff nurses and the other consisted of six nurse managers. An inductive content analysis of all transcripts from the FGDs and of field notes was conducted independently.

RESULT

This research produced seven themes that together portray the entire career mapping process. In Hospital X, the career map for a particular nurse is based on the level of formal education, the length and nature of their work experience and a competency assessment. A self-assessment process and considerations related to competence in all aspects of nursing have been included in the process for nurses at Hospital X. The idea that nurses should be positioned in a working environment that matches their level of competency is a fundamental principle for nursing managers.

CONCLUSION

As a new hospital, Hospital X has implemented nurse career mapping and striven for accreditation. Career developments not only become the responsibility of an organisation but also the responsibility of individuals to develop themselves and their careers.

Competency-based Professional Advancement Model for Advanced Practice RNs

The process of developing a 3-tiered advanced practice RN (APRN) competency-based professional advancement model at Boston Children's Hospital is described. The model recognizes the contributions of entry-level and expert APRNs to advanced clinical practice and outcomes, impact, and leadership, while incorporating the tenets of Patricia Benner's Novice to Expert Model and the American Association of Critical- Care Nurses Synergy Model of Care.

Development, Implementation, and Satisfaction With a Nurse Practitioner Professional Ladder: A Children's Hospital Experience

This article describes the development and implementation of a nurse practitioner professional ladder (NPPL) at a large freestanding urban pediatric hospital. The NPPL was created to recognize advanced practice registered nurses and differentiate levels of clinical expertise, role development, leadership, and professional contributions into a three-tiered approach, designated as NP I, NP II, and NP III. The results of a nurse practitioner satisfaction survey at Year 2 and Year 4 after the development of the NPPL are summarized. The NPPL helped create an empowering environment for continued nurse practitioner professional growth.