Procedures taught in family nurse practitioner programs in the United States

Advanced practice providers proficiency-based model of ultrasound training and practice in the ED

Competency in the application of point-of-care ultrasound (POCUS) has come to be an expected fundamental skill set for advanced practice providers (APPs) in the emergency department. Both American College of Emergency Physicians and the Society of Emergency Medicine Physician Assistants approve of and endorse POCUS use by APPs. However, clinical exposure to and practice of ultrasound in this setting is often variable and without structure. POCUS training must be evolved into a system where developed skills are compatible with clinical need and expectations of APPs. At our institution, we developed a formal, structured POCUS training program for emergency medicine (EM) APPs (including physician assistants and nurse practitioners) and evaluated its efficacy quantitatively by means of a proficiency index. This report examines the EM POCUS training most common to physician assistants and nurse practitioners before practicing at our institution and explores the components of our POCUS training program that have affected program development.

Is it time for the 4th P in nurse practitioner education? Physical assessment, pharmacology, pathophysiology, and procedures: A systematic review

BACKGROUND AND PURPOSE

Nurse practitioners (NPs) perform diagnostic and clinical procedure skills in the acute, specialty, urgent, and primary care settings. Nurse practitioners surveyed on readiness for practice report a lack of confidence and education preparation for performing selected advanced diagnostic and skills. As NPs gain independent, full practice scope, it is imperative advanced diagnostic and procedure skills used in practice are taught in nurse practitioner curriculum. The purpose of this review is to document a systematic review of the literature, answering the following question: Among primary care NPs, does current program curriculum align with current procedures and skills in theclinical setting?

METHODS

PubMed, Cochrane, Scopus, CINAHL, and Embase were searched between inception and 2018 using the search terms "advanced practice nursing, clinical competence, diagnostic techniques or procedures, and primary health care." Following the preferred reporting items for systematic reviews and meta-analysis guidelines, nine articles were included in the synthesis.

CONCLUSION

There is scant research regarding NP educational preparation of skills and procedures. Study findings indicate that programs are not teaching all the procedures deemed important. Education should promote improved congruence between the skills and procedures taught in program curricula and those used in clinical practice.

IMPLICATIONS FOR PRACTICE

It is critical to complete an education practice survey measuring skill and procedure preparation and competency at graduation. Survey results will determine whether skill and procedure guidelines are indicated for NP education. A recommendation may include minimal skills and procedure for all nurse practitioner curricula.

Hiring a nurse practitioner: What's in it for the physician?

A solution to the increased demand for primary care providers is to hire a nurse practitioner (NP). Hiring an NP in a primary care practice has numerous advantages for physicians. This article will discuss those advantages and clarify perceived disadvantages to hiring an NP in the primary care setting.

Tympanometry in general practice: use, problems and solutions

OBJECTIVES

The diagnosis in children with middle ear symptoms is often difficult. Tympanometry is recommended as a supplementary diagnostic tool with a high predictive value for fluid or no fluid in the middle ear. The aim of this study was to examine how tympanometry was used in Danish general practice in 2009, to report common problems general practitioners (GPs) and GP nurses encounter in tympanometry and to evaluate the effect of a practical and theoretical course.

METHODS

A 1-year registration of the use of tympanometry in the Danish National Health Service Register in two regions with 40% of all Danish GPs and a survey among 197 participants in a course on diagnosis of otitis media and tympanometry in children were used. The Danish National Health Insurance covers 100% of GPs because they administer reimbursement for their activities, including tympanometry.

RESULTS

During the year 2009, 1433 GPs in 702 clinics were on the list. A total of 417 clinics performed 35 529 tympanometries. Some 285 clinics (40.6%) did not perform tympanometry in 2009. The active clinics performed 42 tympanometries per GP. A 1-day course improved the knowledge and practical skills of the participating GPs and nurses. A majority (70%) stated in a self-reported questionnaire that tympanometry often provided important information, especially about middle ear fluid, and 48% reported that tympanometry several times during the past 2 weeks had changed their management of a middle ear problem. Few had not used their tympanometer during the 2 weeks preceding the survey. The response rate was 72%.

CONCLUSIONS

The use of tympanometry is very skewed. A 6-hour course could improve GPs' care of patients with middle ear problems by using tympanometry.

Tympanometry by nurses--can allocation of tasks be optimised?

OBJECTIVE

Acute otitis media and secretory otitis media are the most common pediatric infectious disease with a substantial impact on especially primary health care. If nurses could perform and interpret tympanometries, family practitioners workload could be reduced. We wanted to investigate the ability of nurses to perform tympanometry and evaluate the amount of training required.

METHODS

Prospective study comparing results from tympanometry with results at myringotomy at a University Central Hospital was conducted. Nurses at the Paediatric Ear, Nose, and Throat Department performed tympanometry prior to myringotomy. Sensitivity and specificity of tympanometries versus myringotomy were calculated. Nurses' opinions about tympanometry and training required were evaluated.

RESULTS

During a 1-year period, 199 children were enrolled in the study and 392 tympanograms were analyzed. Sensitivity of tympanograms to detect middle-ear fluid was 0.54, and specificity 0.82. Secretion occurred in 22.5% of children with type A curves and 45.3% of those with type C curves. Nurses evaluated their training in tympanometry as adequate. CONSCLUSIONS: A single training session in tympanometry is inadequate to qualify nurses to perform tympanometry independently. Thorough research and testing to evaluate the quality of such training is required to produce reliable tympanograms.

How well are nurse practitioners prepared for practice: Results of a 2004 questionnaire study

PURPOSE

The purpose of this study was to evaluate the perceived preparedness of nurse practitioners (NPs) for practice after completing their basic NP educational programs and to evaluate NPs' perceived preparedness in and their perceived importance of select clinical content areas basic to NP education.

DATA SOURCES

This cross-sectional descriptive study used a written questionnaire consisting of 32 items, two of which contained 25 subitems. Subjects were asked to rate their overall level of preparedness when they completed their NP program and both their level of preparation in and the importance of 25 clinical content areas. The questionnaires were administered to attendees at two large national NP conferences in 2004; a total of 562 questionnaires were completed and used in the analysis.

CONCLUSIONS

Ten percent of the sample perceived that they were very well prepared for practice as an NP after completing their basic NP education. Fifty-one percent perceived that they were only somewhat or minimally prepared. Current age, years since graduation from an NP program, and age when attending the NP program did not differ significantly for those who felt prepared versus those who did not. For a number of content areas, subjects did not perceive that they were well prepared in the same areas that they perceived were very important.

IMPLICATIONS FOR PRACTICE

Our results indicate that formal NP education is not preparing new NPs to feel ready for practice and suggests several areas where NP educational programs need to be strengthened. Practicing NPs are the basis of the NP profession, and their views need to be sought, listened to, and reflected upon as we advance toward expanded preparation at the doctoral level.