Educating advanced practice nurses for practice reality

[Academised nursing in direct patient care-but how?]

Demographic change and the resulting increase in chronic diseases, rapid developments in medicine and digitization, and the increasing shortage of skilled workers pose challenges for the German healthcare system. A rethink in patient care is required. This means that new structures, areas of action, and responsibilities must be implemented for professional nursing. The advancing academicization in nursing is leading to new role developments for professional nursing personnel in healthcare. Using the example of Klinikum Oldenburg (Oldenburg Hospital) as a maximum care provider in the region, many patients are treated in highly complex care situations that require a qualitative and evidence-based nursing practice. In order to ensure this, the concept of practice development according to McCormack, Manley, and Garbett has been implemented as a theoretical framework. Through direct evidence-based practice, complications can be reduced, which has a positive impact on mortality rate, length of stay, and readmission. Another positive factor is interprofessional collaboration and the skill-grade mix with diverse competencies. Taken together, these factors increase team satisfaction and lead to a positive outcome for patients. A prerequisite for implementing academically trained nursing professionals is good planning and preparation of the units and their stakeholders. Scientific support is also necessary to evaluate and potentially adapt the concept.

Newly employed nurses' transition into their new role in the ambulance service- a qualitative study

BACKGROUND

Nurses are essential to ensure safe and high-quality care worldwide. The World Health Organization (WHO) forecasts a shortfall of 5.9 million nurses by the year 2030, and in the ambulance service, the turnover rate ranges between 20% and 30%. With this study, we seek to increase knowledge by exploring the transition of newly employed experienced nurses into their roles in the ambulance service using the Meleis theory of transition. Through understanding transition, support for newly employed nurses can be developed, turnover rates can decrease, and in the long term, patient safety may increase.

DESIGN

The study employed a qualitative approach.

METHODS

Eighteen newly employed experienced nurses were individually interviewed four times during their first six months of employment. Deductive qualitative content analysis was used to analyse the data. The reporting of this research adheres to the COREQ checklist.

RESULTS

The results show that the transition process for newly employed nurses in the ambulance service encompassed all five aspects of Meleis' transition theory: Awareness, Engagement, Change and Difference, Time Span, and Critical Points. The transition period varied among the participants, and it was also observed that not all nurses went through a transition in line with Meleis' theory. Additionally, there were findings that nurses highlighted the impact of the ambulance service culture on their transition.

CONCLUSIONS

The findings provide a more profound insight into how newly employed nurses with previous experience as nurses navigate their roles and transition into a new profession in a new context. An ambulance service where the organisation is aware of the newly employed nurses' transition processes and what the transition entails can develop and promote a supportive and permissive culture within the ambulance service. For newly employed nurses who are adequately supported, health transitions are more likely to occur, which may increase retention and in the long term increase patient safety. The insights gained from the study can empower ambulance organisations to improve their introduction programmes and offer enhanced support for newly employed experienced nurses entering the ambulance service.

Acute Care Pediatric Nurse Practitioners as Leaders: Perceptions, Self-Identity, and Role Congruity

INTRODUCTION

This study aimed to gain an understanding of practicing acute care pediatric nurse practitioners' (AC-PNPs') perceptions of themselves as leaders in both clinical and professional contexts.

METHOD

This qualitative study was conducted at a midwestern quaternary care children's hospital. Cultural domain analysis, semistructured interviews, and free listing techniques were employed to identify areas of consensus and variation among a convenience sample of AC-PNPs.

RESULTS

Findings demonstrated the AC-PNPs have a limited self-view of leadership.

DISCUSSION

Nurse practitioners need additional leadership capacity and capability building during graduate education, the transition to practice, and throughout their careers.

Benzodiazepine and Z drug cessation in elderly patients: A qualitative study on the perception of healthcare providers and the place of advanced practice nurses

Sedative-use disorder can occur in elderly individuals, but remains a taboo subject. France is the second top-consuming country of benzodiazepines (BZDs) and Z drugs in Europe, with 38% of women >80 years old using these drugs. Despite the recommendations of the French National Authority for Health (HAS) to general practitioners, deprescription remains rare. The aim of this study was to understand the perception of healthcare providers towards BZD or Z drug withdrawal within a psychogeriatric unit and to provide insights from advanced practice nurses (APRNs) on this topic. Eight healthcare providers from different professions in a psychogeriatric unit were interviewed. The interviews were recorded and transcribed verbatim, and the data were analysed following the interpretive phenomenological approach. The COREQ statement was used as a guide in the reporting of the study. Four themes were identified in the interview transcripts: (i) problems specific to the elderly; (ii) problems specific to BZD or Z drug consumption; (iii) present care; and (iv) envisioned practice. While the healthcare providers interviewed appeared to have knowledge on the adverse effects of BZDs, it appears difficult to taper the use of BZDs outside crisis periods of behaviour disorders in elderly patients. Caregivers recommend an evolution of practices, such as introducing BDZ and Z drug withdrawal programs that could involve the emerging profession of APRNs in general practice in France. APRNs could be a valuable resource to screen for BZD-related disorders and to manage withdrawal strategies in complex cases.

Content in nurse practitioner education - A scoping review

OBJECTIVE

Globally, the role of nurse practitioner is evolving to meet increased healthcare demands. Nevertheless, there are factors hindering the development of this role, one of which involves differences in nurse practitioner education worldwide. Therefore, the objective of the present study is to identify what is known in the research field on the content of nurse practitioner educational programmes.

DESIGN AND DATA SOURCES

The literature scoping review follows a six-stage methodological framework including: i) formulate research questions, ii) identify relevant studies, iii) select studies, iv) chart data, v) collate, summarize and report the results, vi) consultations. Data bases searched included CINAHL, PubMed and ERIC and were followed by manual searching of reference list in the included papers. Of the 1553 papers identified, 16 met the aim of this study.

REVIEW METHODS

To answer the research questions 'what is the content of curricula in nurse practitioner education?' a deductive content analysis was used.

RESULTS

Two main categories emerged. The first was related to the professional nurse practitioner role and includes research and nursing theories, leadership and collaboration, and organizational, political, economic, regulatory and legislative issues. The second is related to becoming an autonomous practitioner and includes health promotion and disease prevention, and other medically oriented content.

CONCLUSIONS

The content identified is consistent with the core competencies that nurse practitioners are expected to have after graduation, which have been described by the International Council of Nurses and by other researchers. Given the lack of recent research in nurse practitioner education, the results of the present study advance knowledge in this research field. Additionally, this study may be of practical value in developing new nurse practitioner educational programmes.

An educational intervention to enhance nurse practitioner role transition in the first year of practice

BACKGROUND AND PURPOSE

Role transition is a natural process that occurs when the registered nurse pursues additional education to become a nurse practitioner (NP). Role transition generates feelings of anxiety and insecurity, leading to a longer and more tumultuous adjustment. This study investigated whether an evidence-based role transition webinar would support NP role transition during this critical period.

METHODS

This study was a nonrandomized, pretest-posttest, and single-group study using a convenience sample to address the research question: "Does completion of a role transition webinar enhance the perception of new NPs of their ability to perform well in their role?"

CONCLUSIONS

The educational webinar was shown to have a positive influence on some aspects of the participant's reported perceptions of NP role transition. Having practical and assessable educational interventions to optimize NP role transition and determining factors that contribute to the success of these interventions would be prudent.

IMPLICATIONS FOR PRACTICE

This is the first quantitative study to investigate the positive association between an online educational intervention and NP role transition. A timelier and less tumultuous transition would allow NPs to perform more effectively in their new role.

Variation in job titles within the nursing workforce

AIMS AND OBJECTIVES/BACKGROUND

The work of specialist nursing has been under scrutiny for many years in the UK due to a perception that it is not cost-effective. A common issue is the lack of consistency of job titles, which causes confusion to the public, employing organisations, colleagues and commissioners of services. Lack of consistency has implications for the wider perception of advanced specialist practice in the worldwide community and the workforce more generally. This study aims to understand the variation in job titles in the UK population.

METHODS

A pre-existing data set of accrued studies into the work of nurses working in specialisms was mined for insight (N = 17,960). This study used knowledge discovery through data and descriptive statistics to perform secondary analysis.

RESULTS

Mining these data revealed 595 job titles in use in 17,960 specialist posts once the specialism had been removed. The most commonly used titles were Clinical Nurse Specialist, Nurse Specialist/Specialist Nurse, Advanced Nurse Practitioner and Nurse Practitioner. There were three other primary groupings. These were variants with a specialist or technical prefix of suffix, for example Nurse Endoscopist, variants of seniority such as trainee, senior nurse for [specialism] or variants of function such as Nurse Prescriber. The clustering was driven primarily by pay band. A total of 323 posts were recorded as holding titles such as Advanced Nurse Practitioner or Specialist Nurse who were not registered with the Nursing & Midwifery Council.

RELEVANCE TO CLINICAL PRACTICE

In this data set, there is a large array of titles, which appear to have little relationship with other factors like education. This is confusing to the public, employers and those commissioning services. It also demonstrates that the previous assumptions by Council for Healthcare Regulatory Excellence that advanced practice labels are associated with career progression are unsound and should be addressed by the regulator.

An overview of the outcomes and impact of specialist and advanced nursing and midwifery practice, on quality of care, cost and access to services: A narrative review

OBJECTIVES

This paper presents the results of a systematic rapid review and narrative synthesis of the literature of the outcomes and impact of specialist and advanced nursing and midwifery practice regarding quality of care, cost and access to services.

DESIGN

A rapid review was undertaken of the relevant national and international literature, regulatory and policy documents relating to the establishment and definition of nurses' and midwives' specialist and advanced practice roles.

DATA SOURCES

A search of the Cumulative Index to the Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE) was undertaken from 2012 to 2015. The study also included primary data collection on the perceived impact of specialist and advanced practice nursing and midwifery roles and enablers and barriers to these roles using semi-structured interviews. These are not included in this paper.

REVIEW METHOD

To facilitate a systematic approach to searching the literature, the PICO framework, was adapted.

RESULTS

The database search yielded 437 articles relevant to the analysis of specialist and advanced practice in relation to quality care, cost and access to services with additional articles added in a manual review of reference lists. In the final review a total of 86 articles were included as they fulfilled the eligibility criteria.

CONCLUSION

The evidence presented in the 86 articles indicates that nursing and midwifery practitioners continue to be under-utilised despite the evidence that greater reliance on advanced nurse practitioners could improve accessibility of primary care services while also saving on cost. Results point to continued difficulties associated with accurate measurement of the impact of these roles on patient outcomes. This review demonstrates that there is a need for robust measurement of the impact of these roles on patient outcomes.

Factors Related to Successful Transition to Practice for Acute Care Nurse Practitioners

The transition from student to acute care nurse practitioner (ACNP) has been recognized as a time of stress. The purpose of this descriptive, correlational-comparative design pilot study was to examine: (1) the relationships among personal resources, community resources, successful transition, and job retention; (2) the difference between ACNPs with 0 to 4 years and ACNPs with more than 4 years of prior experience as a registered nurse in an intensive care unit or emergency department; and (3) the skills/procedures that ACNPs found difficult to perform independently. Thirty-four participants were recruited from a social media site for nurse practitioners. Organizational support, communication, and leadership were the most important elements of successful transition into the ACNP role. This information can help ACNP faculty and hospital orientation/fellowship program educators to help ACNPs transition into their first position after graduation.

Advancing Nursing Practice: The Emergence of the Role of Advanced Practice Nurse in Saudi Arabia

BACKGROUND

The roots of advanced practice nursing (APN) can be traced back to the 1890s, but the nurse practitioner (NP) emerged in Western countries during the 1960s in response to the unmet healthcare needs of populations in rural areas. These early NPs utilized the medical model of care to assess, diagnose and treat. Nursing has since grown as a profession, with its own unique and distinguishable, holistic, science-based knowledge, which is complementary within the multidisciplinary team. Today, APNs demonstrate nursing expertise in clinical practice, education, research and leadership, and are no longer perceived as "physician replacements" or assistants. Saudi Arabia has yet to define, legislate or regulate APN.

AIMS

This article aims to disseminate information from a Saudi APN thought leadership meeting, to chron.icle the history of APN within Saudi Arabia, while identifying strategies for moving forward.

CONCLUSION

It is important to build an APN model based on Saudi healthcare culture and patient popu.lation needs, while recognizing global historical underpinnings. Ensuring that nursing continues to distinguish itself from other healthcare professions, while securing a seat at the multidisciplinary healthcare table will be instrumental in advancing the practice of nursing.

Comparing Clinical Nurse Specialist Students' Socialization Based on Magnet Employment

PURPOSE

The purpose of this study is to ascertain if clinical nurse specialist students differed on measures of professional socialization based on employment in a Magnet-oriented hospital.

DESIGN

A secondary analysis of data from a previous national study of the socialization of clinical nurse specialist students was used. Anticipatory socialization variables (nursing leadership, workplace exposure to the role, and preconceived impression of the role), mentorship by a clinical nurse specialist, and socialization outcomes (self-concept, perceived preparedness for practice, and nursing specialty certification) were explored.

METHODS

Data were divided into 2 groups: Magnet (n = 106) and non-Magnet (n = 119). Comparisons between the groups on researcher-designed items and the Professionalism and Work Ethic subscales of the Nurses Self-Description Form were analyzed.

RESULTS

The Magnet group was more likely to be exposed to the clinical nurse specialist role in the workplace. Overall, there were no group differences in socialization outcome measures; but in the subset of students with workplace exposure to the role, those with Magnet experience had higher professionalism self-concept scores.

CONCLUSIONS

Magnet employment was not a significant socializing factor for nurses pursuing clinical nurse specialist education. The graduate program is likely the primary socializing agent for these students.

Anaesthesia nursing education in the Nordic countries: Literature review

OBJECTIVES

The purpose of this review was to analyse post-registration anaesthesia nursing education in the Nordic countries. The analysis was based on key determinants fundamental to analysing nursing education: 1) the sys]tem of anaesthesia nursing education, 2) entry requirements, 3) credits, the duration and the title or degree awarded, and 4) the amount of practical training.

METHODS

A scoping review was approached in a systematic manner. The literature was analysed using deductive content analysis. Data was gathered based on key determinants. The data were quantified into frequencies and percentages to compare the similarities and differences of anaesthesia nursing.

RESULTS

The Nordic countries have different types of post-registration anaesthesia nursing education from non-degree supplementary programmes to Master's degree programmes. Even though the entry requirements correspond between countries, many more differences than similarities in anaesthesia nursing education were noted. A title granting the right to work as a nurse anaesthetist can be obtained through a variety of educational systems, credit requirements, the duration, and the amount of practical training in post-registration anaesthesia nursing programmes.

CONCLUSION

This aim of the study was to analyse post-registration anaesthesia nursing education from the Nordic perspective. Harmonising the educational system and minimum education requirements in anaesthesia nursing education is recommended in order to facilitate free movement and assure the quality of care from the Nordic perspective. Since each Nordic country has its own native language, it was difficult to gather information from all the Nordic countries. Therefore, creating common educational database published in English can help to bench mark each country's educational system.

Taking charge of the challenge: factors to consider in taking your first nurse practitioner job

PURPOSE

To describe factors that ensure a smooth transition from nurse practitioner (NP) student to independent NP during the first year of practice.

DATA SOURCES

Two contrasting case examples, the authors' experiences, and selected professional literature.

CONCLUSIONS

Key points to consider upon searching or taking a first NP job include patient, colleague, and clinic factors. Patient factors include mix of patient presentations, complexity of patient presentations, insurance status, and population. Colleague factors include mentorship, charting, mix of providers, and availability of providers. Perhaps most importantly, clinic factors include productivity expectations, practice mission, charting systems, on-call requirements, supervision of other staff, and teaching status. Together, these factors can largely determine whether an NP's days are satisfying or frustrating in a new job.

IMPLICATIONS FOR PRACTICE

The transition from NP student to independent NP can be daunting. Although nursing schools and practice sites have responsibilities to ensure the transition is smooth, the new NP is ultimately responsible for the transition.

Expected roles and utilization of specialist nurses in Japan: the nurse administrators' perspective

AIM

This study explored (1) expected roles for specialist nurses in Japan and (2) nurse administrators' experience-based management strategies for effective implementation of these roles. Background In Japan, specialist nurses have begun to be recognized as valuable human resources. However, managerial issues in utilizing specialist nurses, including unclear roles and lack of reports on effective management strategies, remain.

METHOD

Three focus-group discussions were conducted. Nine nurse administrators participated. Data were analysed using qualitative content analysis techniques.

RESULTS

The expected roles for specialist nurses were: (1) facilitating general nurses' learning; (2) monitoring and improving the patient care standard; and (3) developing new roles for nursing. Two management strategies were: (1) enhancing specialist nurses' influence, and (2) enhancing specialist nurses' motivation.

CONCLUSIONS

Specialist nurses are important human resources able to assume responsibility for process improvement in nursing care. Effective ways to enhance specialist nurses' influence and motivation include developing their management and communication skills, and coordinating their workload and relationships with other health care professionals.

IMPLICATIONS FOR NURSING MANAGEMENT

Process improvement indicators may be useful for evaluating specialist nurses' work. Nurse administrators can contribute to effective implementation of specialist nurses' roles not only by clarifying their roles but also by empowering them to keep up with changing organizational needs.

Determinants of the intention of elementary school nurses to adopt a redefined role in health promotion at school

Background

The quest for greater efficiency in the provision of primary healthcare services and the implementation of a "health-promoting school" approach encourage the optimal redefinition of the role of school nurses. School nurses are viewed as professionals who might be significant actors in the promotion of youth health. The aim of this study was to identify the determinants of the intention of elementary school nurses to adopt a new health-promotion role as a strategic option for the health-promoting school.

Methods

This study was based on an extended version of the theory of planned behaviour (TPB). A total of 251 respondents (response rate of 70%) from 42 school health programs across the Province of Québec completed a mail survey regarding their intention to adopt the proposed health-promotion role. Multiple hierarchical linear regression analyses were performed to assess the relationship between key independent variables and intention. A discriminant analysis of the beliefs was performed to identify the main targets of action.

Results

A total of 73% of respondents expressed a positive intention to accept to play the proposed role. The main predictors were perceived behavioural control (β = 0.36), moral norm (β = 0.27), attitude (β = 0.24), and subjective norm (β = 0.21) (ps < .0001), explaining 83% of the variance. The underlying beliefs distinguishing nurses who had a high intention from those who had a low intention referred to their feelings of being valued, their capacity to overcome the nursing shortage, the approval of the school nurses' community and parents of the students, their leadership skills, and their gaining of a better understanding of school needs.

Conclusions

Results suggest that leadership is a skill that should be addressed to increase the ability of school nurses to assume the proposed role. Findings also indicate that public health administrators need to ensure adequate nurse staffing in the schools in order to increase the proportion of nurses willing to play such a role and avoid burnout among these human resources.

Transitioning a master's of nursing course from campus to on-line delivery: Lessons learned

Distance education continues to expand in nursing programs to service students in urban as well as rural areas in Canada. This article discusses the author's experience with transitioning a master's course in nursing from a traditional seminar format with 7-8 students to one that included distance students joining the classroom in real-time. The course, 'Nursing in Tertiary Health Care' which covers the fall and winter semesters addresses issues and concepts associated with advanced practice nursing for clients of all ages in tertiary care settings. The associated practicum selected by the student with the assistance of the faculty member provides an opportunity to examine the five domains of the Clinical Nurse Specialist role (consultation, education, research, leadership and practice) as one example of advanced practice nursing. The author has taught this course for 12 years in a traditional seminar format. During 2006-2007, a synchronous on-line version of this course was also offered whereby distance students joined the classroom at the same time as the other students in house at the university. This was done using personal computers from home or office, and a bridging program called 'Bridgit'. Lessons learned in making this transition will be discussed.

Cancer nursing: past, present, and future

This article explores the context and nursing care that was provided to people facing the challenges imposed by cancer diagnoses throughout history and issues that influence cancer nursing as it continues to evolve in the twenty-first century. Considerations and potential strategies for the nursing profession to address these issues are offered.

Pediatric nurse practitioner salary and practice: results of a Midwest metropolitan area survey

The St. Louis Association of Pediatric Nurse Practitioners has conducted a local biennial salary, practice, and benefits survey since the mid 1990s. This cross-sectional, descriptive study investigated demographic characteristics, salary, benefits, and practice patterns of pediatric nurse practitioners (PNPs) in the St. Louis area in fall, 2005. The survey was sent to 199 PNPs who lived within 100 miles of Saint Louis, with a return rate of 60%. The mean salary for full time PNPs engaged in practice was $72,788, which was a 6.3% increase from the 2003 survey results. PNPs with more years of experience received significantly higher salaries than those with less experience; however, there was no difference in salary based on type of practice (primary versus specialty care) or type of practice setting. Increasing numbers of PNPs are reporting their practice focus as specialty care (53%) rather than primary care (47%) in this region, with 70% of full time PNPs indicating specialty care. PNPs with less than 3 years experience were working equally in primary and specialty care. Practice challenges such as reimbursement and prescriptive issues were identified. Only 37% of PNPs indicated that they were credentialed by insurance plans. Nurse practitioners may find a local survey helpful as they negotiate changes in their salaries and benefits. Members of advance practice nursing organizations and educators may find the survey process useful as they observe local practice trends over time. It is essential that nursing education and continuing education conferences address the basic and continuing education needs of PNPs in both primary care and common specialty practices.

Educating advanced midwife practitioners: a collaborative venture

AIM

To describe the collaborative development of an MSc course preparing Ireland's first advanced midwife practitioners.

BACKGROUND

Ireland has 55 advanced nurse practitioner posts, but, as yet, no advanced midwife practitioners.

METHODS

A consultative, collaborative process involving 38 midwives across Ireland generated the philosophy, aims and content of the course.

RESULTS

Participants stated that candidates should be committed to the conceptual uniqueness of midwifery; the advanced midwife practitioner role should be clearly defined and supported by the candidate's sponsors; programme content should emphasize normal midwifery, be practice led, and encourage reflective, evidence-based, women-centred care.

CONCLUSION

The collaborative process used to develop this programme ensures that it will meet individual students' needs, thus enhancing the education of Ireland's first advanced midwife practitioners. IMPLICATIONS FOR MIDWIFERY MANAGEMENT: The emphasis on normality rather than specialization is a message that could be assimilated by managers in other countries to the benefit of childbearing women across the world.

Review of advanced nursing practice: the international literature and developing the generic features

AIM

The aim of this article is to review the nursing literature on the notion of advanced nursing practice (ANP) and consequently provide clarifications on the concept of advanced nurse practitioner by developing its' generic features.

BACKGROUND

This paper commences by critically reviewing the concept of advanced nursing practice as it is portrayed within the literature. From this review, a series of contradictions emerged in terms of definitions and roles. On further analysis of the literature the core aims and goals of the ANP are revealed.

METHODS

An informative and narrative systematic literature review was undertaken, using specific inclusion and exclusion criteria. The mass of retrieved material was carefully screened and methods of data saturation were used. Consequently, the material was read, re-read and indexed as to develop seven thematic units that formed the generic features of the ANP.

FINDINGS

The generic features that emerged are: (i) the use of knowledge in practice, (ii) critical thinking and analytical skills, (iii) clinical judgement and decision-making skills, (iv) professional leadership and clinical inquiry, (v) coaching and mentoring skills, (vi) research skills and (vii) changing practice.

CONCLUSION

Reviewing the literature on the concept of ANP, a great variety of definitions, conceptualizations and roles emerged. Nonetheless, on a closer reading, a common goal was identified, which was the attainment of practice and professional autonomy via ANP roles for enhanced practice provision. Eventually, from the reviewed literature, seven generic features of the ANP were developed, thus providing clarification to the role and the characteristics of the ANP.

RELEVANCE TO CLINICAL PRACTICE

Clarifying the confusion surrounding advanced nursing practice and gaining an in-depth understanding of its' generic features would facilitate practitioners, practice educators and clinical managers to develop those skills that would allow them or their staff or students to practise at an advanced level.

Case management evolution: from basic to advanced practice role

This article provides an overview of nursing case management as an advanced practice role from a theoretical and practice basis. Not all case managers will, or need to, perform case management duties at the advanced level. However, it has become abundantly clear over the past several years that nurse case managers are performing more complex duties that appear to match the competencies of other advanced practice roles. In this article, the authors will explore the issue in depth and demonstrate the differences between basic and advanced practice nursing case management on the basis of clinical practice, educational level, and research responsibilities for both the basic and advanced levels of case management practice; advanced practice competencies; and examples of advanced practice case management from current practice. Just as there are differences between basic and advanced professional and clinical nursing practice, there is a difference between basic and advanced levels of case management practice.