Certification alignment of nurse practitioners in acute care

Nurse practitioners' degrees and associations with time use, functional autonomy, and job outcomes

BACKGROUND

Doctorate of Nursing Practice preparation is recommended for entry to nurse practitioner (NP) practice but there are few comparative studies, and their designs conflate educational pathways.

PURPOSE

To investigate time use, functional autonomy, and job outcomes among NPs without a doctorate, NPs whose initial NP preparation and doctorate were separated by 2 or more years, and NPs whose NP preparation and doctorate were concurrent.

METHOD

We selected all NPs from the 2018 National Sample Survey of Registered Nurses, except those whose doctorates focused on research. We controlled for confounding and applied sample weights to produce nationally representative results.

DISCUSSION

NPs' educational pathways are associated with distinct practice roles and, moving forward, policy should be informed by evidence that accounts for their differences.

CONCLUSION

Concurrent NPs had higher levels of functional autonomy compared with NPs without a doctorate, but patterns of time use were essentially the same. Separate doctoral education was associated with teaching and administration.

The Perspectives of Advanced Practice Provider Directors on Acute Care Nurse Practitioner Alignment and Hiring

Demand for acute care is forecasted to grow in the United States. To meet this demand, nurse practitioners (NPs) are increasingly employed in acute care settings. Yet, there is concern about an adequate supply of acute care NPs given demand. Further, professional nursing organizations recommend aligning an NP's role with their education, certification, licensure, and practice. Given workforce constraints and the policy environment, little is known about how hospitals approach hiring NPs for acute care roles. The purpose of this study was to explore advanced practice provider (APP) directors' approaches to hiring NPs within the context of alignment and describe factors that influence hiring decisions. We conducted semi-structured interviews with 17 APP directors in hospitals and health systems. Interviews were recorded, transcribed, and coded using an iterative, hybrid inductive and deductive method. Two themes emerged: (1) local factors that inform aligned hiring and (2) adaptive hiring responses to changing environments. Practices around hiring NPs varied across institutions influenced by organization and state policies and regulations, workforce availability, and institutional culture. Most APP directors recognized trends towards hiring aligned NPs for acute care roles. However, they also identified barriers to fully aligning their NP workforce and described adaptive strategies including hiring physician assistants, building relationships with APP schools, and leveraging hospital resources to develop the APP workforce to meet care delivery demands given the current NP workforce supply. Future research is needed to assess widespread practices around acute care NP alignment and the implications of alignment for patient and organizational outcomes.

An evaluation of nurse practitioner and physician assistant hiring patterns after implementation of the advanced practice registered nurse consensus model

ABSTRACT

The Advanced Practice Registered Nurse (APRN) Consensus Model was developed in 2008 by the APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee. This model aims to improve access to APRN care through standardization of licensure, accreditation, certification, and education and has been adopted by many organizations throughout the United States. However, the Consensus Model is not a legislative document, and there is variation in adoption and implementation throughout states and organizations. Since the Consensus Model was developed, little is known about how this change has affected hiring practices for nurse practitioners (NPs) and physician assistants (PAs). There are concerns that the model may place burdensome hiring constraints on NP hires, which could inadvertently lead to preferential hiring of PAs over NPs. We evaluated whether there was a significant association between the proportion of NPs versus PAs hired after the implementation of the APRN Consensus Model in 2017 in a large not-for-profit health system in North Carolina. Our study revealed no association between implementation of hiring practices to align with the APRN Consensus Model and preferential hiring of PAs over NPs.

Estimating the Primary Care Workforce for Medicare Beneficiaries Using an Activity-Based Approach

BACKGROUND

The enumeration of the primary care workforce relies on potentially inaccurate specialty designations sourced from licensure registries and clinician surveys.

OBJECTIVE

To use an activity-based measure of primary care to estimate the number of physicians, nurse practitioners (NPs), and physician assistants (PAs) providing primary care to Medicare beneficiaries.

DESIGN

Observational study using Medicare fee-for-service (FFS) claims data.

SUBJECTS

All clinicians in the US billing Medicare in 2019 and their fee-for-service Medicare patients.

MAIN MEASURES

We construct three measures that together distinguish primary care from specialty clinicians: (1) presence of evaluation and management (E&M) services in a setting consistent with primary care, (2) the dispersion of clinical care across International Classification of Diseases-10 (ICD-10) chapters, and (3) the extent of provided services that are atypical of primary care (e.g., surgical procedure). We apply parameters to the measures to identify the clinicians likely providing primary care and compare the resulting classifications across provider type.

KEY RESULTS

Of physicians with at least 50 Medicare beneficiaries, 19-22% provide primary care. Of medical generalists (i.e., family medicine, internal medicine) with at least 50 beneficiaries, 61-68% provide primary care. We estimate that 40-45% of NPs and 27-30% of PAs meeting the panel size threshold are primary care providers in FFS Medicare.

CONCLUSIONS

Our findings suggest that based on a primary care practice style, the number of primary care physicians in FFS Medicare is likely smaller than conventional estimates. However, compared to prior estimates, the number of primary care NPs is larger and the number of PAs is similar.

Public health nursing workforce and learning needs: A national sample survey analysis

OBJECTIVES

Generate national estimates of the public health nursing workforce's (1) demographic and work characteristics and (2) continuing education learning needs in the United States.

DESIGN

Secondary data analysis of the 2018 National Sample Survey of Registered Nurses.

SAMPLE

Total 7352 of the 50,273 survey respondents were categorized as public health nurses (PHNs), representing an estimated 467,271 national workforce.

MEASUREMENTS

Survey items for demographics, practice setting, training topics, and language(s) spoken fluently were analyzed.

RESULTS

Workforce demographic characteristics are included. Mental health training was the most frequently endorsed topic by PHNs, followed by patient-centered care and evidence-based care. Training topic needs vary by practice setting.

CONCLUSIONS

Results here can be used as a needs assessment for national public health nursing professional development and education initiatives. Further research is needed to refine and survey a nationally representative sample in a manner meaningful to public health nursing practice.

Meeting the need for nurse practitioner clinicals: A survey of practitioners

BACKGROUND

The increase in the number of nurse practitioner (NP) students requires increased clinical practice sites and prepared preceptors.

PURPOSE

This study describes NPs' clinical experiences as a student and their current practices as an NP preceptor.

METHODOLOGY

A descriptive study design used a 38-item web-based survey conducted in June and July 2021.

RESULTS

A total of 334 NPs practicing in Texas responded; most had been NPs for 10 or fewer years (58.2%) and in their positions less than 5 years (50.3%). A plurality of respondents was required to find their own clinical placements (46%). The most common challenge in obtaining clinical placements was finding preceptors (33%). Nurse practitioners reported excellent clinical experiences (39.3%) as a student and believed that they were generally well prepared for the NP role (38.9%) and to care for their specialty patient population (46.1%) upon graduation. Sixty percent of respondents reported not currently precepting, 37.6% had never been asked to precept, whereas 32.8% reported that employers restricted precepting. Family NPs were the least likely to precept.

CONCLUSIONS

Nurse practitioners report positive clinical experiences that prepare them for NP careers. Multiple opportunities exist to enlist additional NPs as preceptors for NP students.

IMPLICATIONS

There is capacity within the current NP workforce to meet the clinical educational needs of NP students. Future work should examine best practices to engage NPs who are not currently preceptors. As policies change NP education, research should examine the implications of the preparation for NP roles at the time of graduation, organizational outcomes, and quality of care.