Preparation and Evolving Role of the Acute Care Nurse Practitioner

The state of acute care postgraduate training: Faculty observations

ABSTRACT

The benefits to postgraduate training programs (PTPs) for nurse practitioners (NPs) in all populations are being well established in the literature. As health care systems and teams evolve, acute care NPs (neonatal, pediatric, and adult-gerontology) are providing more specialized care to increasingly complex patients. As educators and clinicians, we recognize that acute care PTPs are playing an important role in preparing NPs to work to the top of their scope and training. This article provides our perspectives on the merits of PTPs for adult-gerontology acute care NPs and provides guidance for counseling NPs who are interested in acute care PTPs.

First-year experience of transitioning from registered nurse to nurse practitioner

BACKGROUND

Transitioning to advanced practice, novice nurse practitioners need to take on new roles, learn new practice areas, and develop new skills. This process requires breaking old practices and work habits and facing new challenges.

PURPOSE

To explore the nature of nurse practitioners' work experiences during the first year of transition from registered nurse to nurse practitioner.

METHODS

This qualitative study was based on Husserl's phenomenological methodology. A purposive sample of 16 first-year nurse practitioners was recruited. Data were collected through in-depth interviews and analyzed by thematic content analysis. The approaches of Lincoln & Guba were applied to improve the validity of the study.

RESULTS

Results showed that the first-year experience of transitioning from registered nurse to nurse practitioner fell into two overarching themes: challenge and adjustment. The challenge consists of five subthemes: "facing the expectation-reality gap," "managing others' expectations," "striving to acquire professional skills," "handling situational variability," and "bearing emotional burdens" subthemes. The adjustment includes five subthemes: "finding resources," "gaining experiences," "building relationships," "relieving stress," and "overcoming obstacles."

IMPLICATIONS FOR PRACTICE

Novice nurse practitioners face many challenges as they adjust to a new role during their first year on the job. New nurse practitioners develop coping strategies to help themselves adjust to their work. They also gradually gain new resources and experiences to help them stay positive in stressful situations and restore work-life balance. The challenges of transitioning from a registered nurse to a nurse practitioner cannot be overlooked. Novice nurse practitioners need appropriate support measures to adapt to advanced practice roles.

Acute Care Pediatric Nurse Practitioner: The 2018 Practice Analysis

INTRODUCTION

Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study informed an update of the Certified Pediatric Nurse Practitioner - Acute Care (CPNP-AC) examination content outline.

METHOD

A descriptive analysis of a survey completed in 2018 by 373 pediatric nurse practitioners (PNP) practicing as an acute care role (AC).

RESULTS

Respondents were primarily females aged 25 to 34 years (35.4%) and formally educated as AC PNPs (84.2%) and held the CPNP-AC credential (98.9%). Most respondents (83.6%) practiced in urban areas and spent 84% of their time in direct patient care with 74% working in inpatient settings. The majority (87%) worked in subspecialty practice such as critical care (18.5%) and cardiac intensive care (12.3%).

DISCUSSION

This is the fourth practice analysis of the AC PNP role that demonstrates continuous evolution in clinical practice, educational preparation, and subspecialty practice distribution.

Effects of a web-based education program for nurses using medical malpractice cases: A randomized controlled trial

BACKGROUND

Education on legal obligations in healthcare related to medical malpractice is insufficient, which has the potential to reduce patient safety. Nurses need to improve their understanding of legal obligations in order to enhance patient safety. However, no easily accessible education program has been developed that covers both the concepts of legal obligations and patient safety.

OBJECTIVE

This study sought to develop a web-based education program using medical malpractice cases and to evaluate the effectiveness with regard to legal obligations and patient safety competency of nurses.

DESIGN

The study design was a randomized controlled trial evaluating the effectiveness of a newly-developed web-based education program.

PARTICIPANTS AND SETTING

Seven experts and 19 learners evaluated the developed program. One hundred eighteen nurses working in three hospitals were randomly assigned to the intervention group (N = 59) and the control group (N = 59).

METHODS

The web-based program was developed using the analysis-design-development-implementation-evaluation model and evaluated by experts and learners. Data were collected from January to May 2019. The intervention was the five-week web-based education program. The post-test was conducted five weeks after the pre-test in the control and intervention groups.

RESULTS

The web-based program consisted of two modules on theoretical knowledge and seven modules on medical malpractice cases. The findings demonstrated significant differences in knowledge and cognition of legal obligations and patient safety competency between the control and intervention groups after the five-week intervention.

CONCLUSION

A web-based education program on medical malpractice cases enhanced nurses' awareness of legal obligations and patient safety competency. Therefore, this web-based educational program should be organized as an online continuing education program for clinical nurses. It will improve awareness of patient safety by clearly specifying the relationship between legal obligations and root causes of medical errors from various perspectives.

Nurse practitioner hospitalists: An empowered role

BACKGROUND

Nurse practitioners (NPs) are increasingly employed by hospital medicine groups and contribute to the care of the hospitalized adult patient. Prior research indicates NP hospitalists are empowered in their role.

PURPOSE

This national study describes the work experience of the NP hospitalist workforce.

METHOD

A qualitative exploratory study using five focus group sessions with NP hospitalists is described using thematic analysis and synthesis of transcriptions. Inductive coding identified and further refined themes explained by NP hospitalist participants.

FINDINGS

Psychological empowerment was reaffirmed as the overarching theme to describe the experience of NP hospitalists. Five subthemes of this empowerment emerged: collegiality, autonomy, role preparation, the road traveled, and pathfinder.

DISCUSSION

Three main implications of the study include: the need for educational programs to align with practice; hospital bylaws require updating to support current practice; and the APRN Consensus Model does not fully reflect hospitalist roles.

On-call simulation for adult gerontology acute care nurse practitioner students: A comparative descriptive study

BACKGROUND

It is now commonplace for acute care nurse practitioners (ACNPs) to work in positions that include an on-call component or management of emergent concerns through telephone. There are no published reports on the inclusion of an on-call component in ACNP clinical preparation of students; novice ACNPs feel unprepared to competently and confidently manage emergent patient situations and on-call responsibilities.

PURPOSE

To examine ACNP student perception of stress, necessary skills, confidence, and benefit of participating in a simulated on-call experience.

METHODS

Using simulated faculty callers as nurses, ACNP students participated in a simulated on-call experience that included receiving two calls, eliciting key information from the nurse, diagnosing and managing the patient, and submitting documentation of the encounter. Students completed preparticipation and postparticipation perception surveys, and they were evaluated by the simulated nurse (faculty) using standardized evaluation tools.

RESULTS

Acute care nurse practitioner students rated the simulated on-call experience as educationally valuable. High levels of anxiety before participation were notably improved after participation. Students identified critical thinking, clear communication, and knowledge with the specific disease as the most important skills needed to manage nurse calls successfully. Students reported marked improvement in their confidence and were receptive to accepting an nurse practitioner position with call/triage responsibilities after their on-call experience.

IMPLICATIONS FOR PRACTICE

Inclusion of a simulated on-call experience in the final semester of an ACNP program is both feasible and relevant to ACNP student development. On-call exposure within the clinical practicum is inconsistent and, therefore, should be added through simulation.