Competency-based Professional Advancement Model for Advanced Practice RNs

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.

Level of clinical competency and associated factors of nursing students in Ethiopia: systematic review and meta-analysis

BACKGROUND

Assessing the clinical level of competency in nursing students is crucial as it represents the ultimate goal of nursing education. Poor competency result in low performance and can be affected by various factors. Thus, the aim of this study was to identify level of clinical competency and associated factors of nursing students in Ethiopia.

METHODS

systematic review and meta-analysis was employed. Searching strategy was conducted from January up to march 2024 from Web of Science, PubMed and Google Scholar. The quality of studies was assessed using PRISMA checklist. A meta-analysis was performed using R Studio with the meta package Version 1.4.1106.

RESULTS

in total, 145 studies were identified through database search, and only 7 studies were included in the meta-analysis representing 1937 nursing students. The pooled effect size of clinical competency of nursing students was 28%. Three factors were found to be associated with clinical competency: a positive clinical learning environment, student confidence in performing procedures, and effective staff-student interaction. The effect sizes of these factors were 6.30, 2.23, and 7.76, respectively.

CONCLUSION AND RECOMMENDATION

The clinical competency of nursing students was 28%, and it was associated with clinical learning environment, student confidence in performing procedures, and staff-student interaction. Nursing education programs should focus on enhancing students' competency levels by addressing specific factors. (PROSPERO) INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS: CRD42022367057.

Continuum of nursing education and practice: Time to close the chasm between academia and practice

Nurses play a key role in the health of Americans. Unfortunately, the nation is expected to experience an increasing nursing shortage due to nurses retiring or leaving the profession and growing healthcare needs. In this context, it is important to prepare nursing students to be practice-ready graduates. To accomplish this goal, students must learn domain knowledge that is reflective of current nursing practices and have ample experiential learning opportunities, which require close collaboration between academia and practice in nursing education. Traditionally, faculty members who have developed nursing curriculum and the course content are mainly from within academia. The aims of the article are to describe prior efforts in academia-practice collaboration for baccalaureate-level nursing education and to propose the innovative Nursing Education and Practice Continuum model, which expands our team's successful collaborative projects. The model conceptualizes nursing education as a continuum between academia and practice, which constantly interact and evolve, and facilitates co-building and co-implementing nursing education courses for both students and practicing nurses. Nursing practice is also a continuum between experiential learning and practice after graduation. This continuum model can be implemented by aligning baccalaureate-level nursing education with the Nurse Residency Program curriculum. This article also addresses potential challenges and strategies during implementation.

Invisible Work: Advanced Practice Providers' Role in the Education of Surgeons

OBJECTIVE

As the composition and work of surgical teams evolve, the role of advanced practice providers (APPs) has expanded. We explored how APPs influence the training experience of surgeons from the perspectives of faculty, residents, and APPs.

DESIGN

Qualitative data were obtained from semi-structured open-ended interviews. A codebook was developed blending deductive and inductive logics. Dyads independently coded the transcripts using a constant comparative approach; differences were reconciled by consensus.

RESULTS

During 2-day site visits to 15 general surgery programs, 393 individual and small focus group interviews were conducted with residents, faculty, staff, and program leadership. Forty transcripts representing 51 interviewees (15 APPs, 23 residents, 13 faculty) were collected. We identified 4 major themes:¹ APP as Educator: APPs play a significant role in resident education to ensure seamless patient care while allowing trainees room for clinical growth.² Canary in the Coal Mine: APPs often are the first to notice a surgical trainee's mood and provide support to improve wellness.³ Division of Labor: Distribution of clinical workload has a direct impact on surgical trainees' educational experience and APP job satisfaction.⁴ Second-Class Citizen: APPs described experiences in which their expertise was disrespected, and their contributions were unrecognized.

CONCLUSIONS

APPs have an active and essential role in the well-being and education of surgeons during training. Surgical residency programs and hospitals have an opportunity to decrease the "invisibility" of the work of APPs through increased recognition of these roles and elevation of APP expertise through formal career development pathways.

Telehealth Competencies: Leveled for Continuous Advanced Practice Nurse Development

BACKGROUND

The COVID-19 pandemic spurred a rapid uptake of telehealth utilization, with advanced practice registered nurses (APRNs) at the forefront of telehealth care delivery. To advance training of nurse practitioners and support curricular development, essential APRN student competencies in telehealth were developed.

PROBLEM

Although telehealth competencies have been developed, little is understood about their evaluation across the curricula. Moving to competency-based nursing education involves leveling broad competencies into subcompetencies, including those for telehealth. Subcompetencies support frequent, multimodal evaluation of student progress across APRN curricula.

APPROACH

Adapting Benner's Novice to Expert Theory, faculty experts in telehealth and graduate nursing education used an iterative process to develop and level subcompetencies aligned with the Four Ps of Telehealth framework.

OUTCOMES

Telehealth subcompetencies were leveled for preclinical and clinical rotations and for readiness for practice.

CONCLUSIONS

The leveled subcompetencies, aligned with the Four Ps of Telehealth framework, will support APRN faculty in diverse programs as they implement competency-based education in telehealth.

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.

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.

Active teaching strategies improve nursing knowledge and skills to assist burn victims

OBJECTIVE

to evaluate the impact of an educational intervention, on nurses' self-perception, about knowledge and skills for initial care for burn victims.

METHODS

a quasi-experimental study of the type before and after, with 18 nurses who assist burn victims. The intervention was carried out for 11 days in face-to-face meetings and online activities, and comprised active case-based learning strategies, simulation training, concept maps and digital portfolio. A structured instrument was used to collect sociodemographic data, and another one related to the knowledge and essential skills to the initial care for burn victims.

RESULTS

The average scores found before the intervention ranged from 2.78 to 3.33 and, after the intervention, they ranged from 3.89 to 4.72. Relevant statistical differences (p <0.005) were found in all questions addressed.

CONCLUSION

this educational intervention, based on innovative teaching methods, showed a positive impact on nurses' knowledge and skills on initial care for people with burns.

Competence, challenges and attitudes of bedside nurses caring for patients with left ventricular assist devices

OBJECTIVES

We aimed to describe the bedside registered nurses perceived competence, attitudes, and challenges surrounding the management of patients with left ventricular assist devices (LVAD) in the intensive care unit (ICU) and stepdown unit (SDU).

RESEARCH METHODOLOGY/DESIGN

An exploratory research was employed using a survey.

SETTING

Bedside participants were recruited via an electronic recruitment flyer circulated in online professional and social networking sites.

MAIN OUTCOME MEASURES

Items consisted of a numeric rating scale, measuring competence and attitudes related to the management of patients with left ventricular assist devices. The one open-ended question asked the participants to write responses regarding challenges in left ventricular assist device care. Data were analysed using quantitative and qualitative analytics software.

RESULTS

A total of 36 intensive care unit and 35 stepdown unit bedside nurse (n = 71) from six regions of the United States responded. Overall mean scores for competency and attitude domains were ≥ 7.0. Intensive care nurses scored higher in competence and attitude when compared to stepdown unit nurses care of short-term left ventricular assist devices. Competence and attitude were positively associated with years of experience. Five themes related to challenges in care were identified.

CONCLUSION

Overall, bedside nurses had satisfactory competence and attitudes surrounding the care of hospitalised left ventricular assist device patients.

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.