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Zonneveld D, Conroy T, Lines L. Clinical supervision experience of nurses in or transitioning to advanced practice: A systematic review. J Adv Nurs 2024; 80:3547-3564. [PMID: 38433321 DOI: 10.1111/jan.16126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/05/2024] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
AIMS To systematically explore the clinical supervision (CS) experience for nurses transitioning to advanced practice. DESIGN A qualitative systematic review using Joanna Briggs Institute meta-aggregation following an a priori protocol published on PROSPERO (CRD42023426658). DATA SOURCES Qualitative studies obtained from Medline, CINAHL, PsycINFO, Scopus, Emcare and ERIC databases and ProQuest dissertations and theses for peer-reviewed, published and unpublished studies from inception to July 2023. REVIEW METHODS Two authors conducted data screening and abstraction. Quality was appraised using the Critical Appraisal Skills Programme tool and reporting followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist for systematic reviews. RESULTS Sixteen studies contributed to five synthesized findings: CS that is beneficial requires structure and commitment, trusting relationships are foundational for learning, lifting burdens and preventing burnout, learning through reflection, critical thinking and feedback and barriers to CS. CONCLUSIONS This review provides a meaningful exploration of CS to support nurses transitioning to advanced practice. Well-structured supervision offers a safe space to share work-related concerns and develop an advanced practitioner identity. Sharing experiences helps alleviate work-related burdens and reduce professional isolation and burnout. IMPLICATIONS FOR THE PROFESSION Peer-support networks are vital for successful transition to advanced practice. IMPACT This review highlighted the impact of effective supervisory relationships in forming professional identity and possible links with nursing retention. PUBLIC CONTRIBUTION No direct patient contributions are included as it forms part of a research degree.
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Affiliation(s)
- Debbie Zonneveld
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Lauren Lines
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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2
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Duignan M, Drennan J, Mc Carthy VJC. Work characteristics, job satisfaction and intention to leave: a cross-sectional survey of advanced nurse practitioners. Contemp Nurse 2024; 60:382-394. [PMID: 38489485 DOI: 10.1080/10376178.2024.2327353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/01/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Advanced Nurse Practitioners (ANPs) are highly skilled health care professionals with the potential to play a major role in improving the quality and accessibility of health care services. However, there is emerging evidence of disquiet among nurse practitioners who often work in suboptimal work environments. Therefore, it is important to understand the elements that contribute to ANPs' job satisfaction and retention in healthcare services. AIM To examine the effects of commitment to the workplace, work engagement, and influence at work on job satisfaction and intention to leave of ANPs. METHODS A total of 153 ANP's on the advanced practice section of the Nursing and Midwifery Board of Ireland register completed a web survey between July and August 2020. Independent variables (commitment to the workplace, work engagement, and influence at work) were measured using the Copenhagen Psychosocial Questionnaire (COPSOQ). Multivariable logistic regression models were used to investigate the association between dependent and independent variables. RESULTS Participants who reported higher levels of influence at work and higher levels of commitment to the workplace were also satisfied in their job (OR 1.05, 95% CI 1.01-1.09, p = 0.025), (OR 1.10, 95% CI 1.06-1.14, p < 0.001) respectively. Additionally, ANPs with higher levels of commitment to work were significantly less likely to leave their role (OR 0.94, 95% CI .92-.96, p < 0.001). CONCLUSION Healthcare organisations can improve job satisfaction and decrease intention to leave by creating environments in which ANPs are supported by their colleagues and supervisors, and facilitate their practice to the full extent of their capabilities.
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Affiliation(s)
- Martin Duignan
- Health Service Executive, Our Lady's Hospital, Navan, Co., Meath, Ireland
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Jonathan Drennan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
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3
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de Lisser R, Dietrich MS, Spetz J, Ramanujam R, Lauderdale J, Stolldorf DP. Psychological safety is associated with better work environment and lower levels of clinician burnout. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae091. [PMID: 39081721 PMCID: PMC11288325 DOI: 10.1093/haschl/qxae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/05/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024]
Abstract
Burnout is attributed to negative work environments and threatens patient and clinician safety. Psychological safety is the perception that the work environment is safe for interpersonal risk-taking and may offer insight into the relationship between the work environment and burnout. In this cross-sectional analysis of survey data from 621 nurse practitioners in California, we found that one-third (34%) experienced high burnout. Four factors in the work environment were negatively associated with burnout and positively associated with psychological safety. Significant mediation effects of psychological safety were observed on the relationships between each work environment factor and both emotional exhaustion and depersonalization. The largest mediation effects were observed on the total effects of Nurse Practitioner-Physician Relations and Practice Visibility on Emotional Exhaustion (37% and 32%, respectively) and Independent Practice and Support and NP-Administration Relations on Depersonalization (32% and 29%, respectively). We found, overall, that psychological safety decreased the strength of the negative relationship between work environment and burnout. We argue that research, practice, and policy efforts to mitigate burnout and improve the work environment should consider psychological safety as a metric for system-level well-being.
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Affiliation(s)
- Rosalind de Lisser
- School of Nursing, Vanderbilt University, Nashville, TN 37240, United States
- School of Nursing, University of California San Francisco, San Francisco, CA 94143, United States
| | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN 37240, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Joanne Spetz
- Philip R. Lee Institute for Policy, University of California San Francisco, San Francisco, CA 94158, United States
| | - Rangaraj Ramanujam
- Owen Graduate School of Management, Vanderbilt University, Nashville, TN 37203, United States
| | - Jana Lauderdale
- School of Nursing, Vanderbilt University, Nashville, TN 37240, United States
| | - Deonni P Stolldorf
- School of Nursing, Vanderbilt University, Nashville, TN 37240, United States
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Zwilling J, O'Reilly-Jacob M. Implementation of Full Practice Authority for Nurse Practitioners in Massachusetts: Impact of Organizational Climate on Practice Change. J Nurs Adm 2024; 54:433-439. [PMID: 39028565 DOI: 10.1097/nna.0000000000001453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between nurse practitioner (NP) organizational climate and the implementation of full practice authority (FPA) for NPs. BACKGROUND In 2021, Massachusetts passed FPA for NPs. Most NPs did not experience changes to their practice. It is unknown whether NP organizational climate impacts implementation of FPA. METHODS A Web-based survey was distributed to NPs in Massachusetts. RESULTS Response rate was 50.3% (N = 147). Practice remained unchanged for most. Organizations with more favorable climates experienced more rapid implementation of FPA, resulting in improved efficiency (P = 0.049) and timeliness (P = 0.007) of care. Nurse practitioners outside hospital systems were more likely to report favorable organizational climates and positive change to their practice after FPA. CONCLUSIONS Organizations that facilitate implementation of FPA are likely to experience improvement in efficiency and timeliness of patient care. Nursing leadership, especially within hospital-based organizations, can help achieve these benefits by improving the organizational climate for NPs.
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Affiliation(s)
- Jana Zwilling
- Author Affiliations: Clinical Associate Professor (Dr Zwilling), University of North Dakota College of Nursing & Professional Disciplines, Grand Forks; and Assistant Professor (Dr O'Reilly-Jacob), Boston College Connell School of Nursing, Chestnut Hill, Massachusetts
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Clarke V, Lehane E, Cotter P, Mulcahy H. Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence-based practice into routine care: An interpretative phenomenological analysis. J Adv Nurs 2024; 80:1559-1573. [PMID: 37950366 DOI: 10.1111/jan.15917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/02/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023]
Abstract
AIM To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care. DESIGN A qualitative interpretative phenomenological analysis. METHODS A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis. RESULTS Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice. CONCLUSION There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care. IMPACT AND IMPLICATIONS The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients. CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care. REPORTING METHOD Consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Vanessa Clarke
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
- Nursing and Midwifery Planning and Development, Health Service Executive North East, Ardee, County Louth, Ireland
| | - Elaine Lehane
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Patrick Cotter
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Helen Mulcahy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Poghosyan L, Liu J, Turi E, Flandrick K, Robinson M, George M, Martsolf G, Carthon JMB, O'Reilly-Jacob M. Racial and ethnic disparities in ED use among older adults with asthma and primary care nurse practitioner work environments. RESEARCH SQUARE 2024:rs.3.rs-3972673. [PMID: 38559202 PMCID: PMC10980142 DOI: 10.21203/rs.3.rs-3972673/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Nurse practitioners (NPs) increasingly deliver primary care in the United States. Yet, poor working conditions strain NP care. We examined whether racial/ethnic health disparities in ED visits among older adults with asthma are moderated by primary care NP work environments. Methods Survey data on NP work environments in six states were collected from 1,244 NPs in 2018-2019. 2018 Medicare claims data from 46,658 patients with asthma was merged with survey data to assess the associations of all-cause and ambulatory care sensitive conditions (ACSC) ED visits with NP work environment and race/ethnicity using logistic regression. Results NP work environment moderated the association of race (Black patients versus White patients) with all-cause (odds ratio [OR]: 0.91; p-value = 0.045) and ACSC (OR: 0.90; p-value = 0.033) ED visits. Conclusions Disparities in ED visits between Black and White patients with asthma decrease when these patients receive care in care clinics with favorable NP work environments.
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Affiliation(s)
| | | | - Eleanor Turi
- Perelman School of Medicine, University of Pennsylvania
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Ten Hoeve Y, Drent G, Kastermans M. Factors related to motivation, organisational climate and work engagement within the practice environment of nurse practitioners in the Netherlands. J Clin Nurs 2024; 33:543-558. [PMID: 37864377 DOI: 10.1111/jocn.16914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/04/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
AIM To explore motivation, organisational climate, work engagement and related factors within the practice environment of nurse practitioners. BACKGROUND Motivation in the workplace, organisational climate and work engagement are important to motivate nurse practitioners and prevent early exit. However, little is known about related factors. DESIGN A cross-sectional design using a digital survey with multiple-choice and open-ended questions. Data were collected from 1 November 2019 to 30 March 2020. METHODS The survey contained demographic and job-related data, instruments on motivation in the workplace, organisational climate and work engagement. Three open-ended questions were added to invite respondents to tell about their next career step, (dis)satisfaction with salary and additional comments. Quantitative data were not normally distributed (Kolmogorov-Smirnov test). Kruskal Wallis tests and Mann-Whitney U tests were used to test the relationship between independent and dependent variables. Answers on the open-ended questions were coded and categorised in themes. The STROBE checklist was followed. RESULTS In total 586 questionnaires were completed. The majority of the respondents were female (85%), and their mean age was 47 years (range 26-66 years). Aged 45 or over, more work experience, working in nursing homes, experiencing more autonomy, collaboration with other nurse practitioners, a firmly anchored position, satisfaction with salary and developmental opportunities contributed positively to the practice environment. Answers on the open-ended questions supported the quantitative results. CONCLUSIONS Work motivation, organisational climate and work engagement are positively related to a large variety of personal and work-related factors. Therefore, policymakers and professional organisations should be aware of the impact of these influencing factors to enhance an inspiring work environment. RELEVANCE TO CLINICAL PRACTICE Awareness of factors that influence nurse practitioners' practice environment can be used as a tool to screen and improve the present work environment.
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Affiliation(s)
- Yvonne Ten Hoeve
- Health Sciences-Nursing Research, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerda Drent
- Master Advanced Nursing Practice, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Marijke Kastermans
- Master Advanced Nursing Practice, Hanze University of Applied Sciences, Groningen, The Netherlands
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Nahari A, Alhamed A, Moafa H, Aboshaiqah A, Almotairy M. Role delineation of advanced practice nursing: A cross-sectional study. J Adv Nurs 2024; 80:366-376. [PMID: 37449552 DOI: 10.1111/jan.15797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
AIMS To identify the roles and activities of nurses, including advanced practice nursing (APN), and to determine nursing practice patterns across health facilities in Saudi Arabia. METHODS A descriptive cross-sectional design was used to collect data from 207 nurses working in the Saudi health sector between November 2021 and March 2022 through an online questionnaire. The Advanced Practice Role Delineation tool was used to measure and delineate nursing practice patterns and activities. Data were analysed using descriptive statistics and analysis of variance. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. RESULTS Findings showed that participants, regardless of their current role, reported high scores across all domains of practice. The highest average score was obtained for the Clinical Care domain. Except for the leadership domain, findings showed that those reported working as advanced practice nurses had higher average scores across all domains than those working as staff nurses or being in managerial/administrative positions. There were significant differences in the average Clinical Care scores between advanced practice nurses and staff nurses. CONCLUSION Advanced practice nursing roles and activities are being practised in Saudi Arabia; however, there is no clear delineation of these roles and activities according to a unified and national-level APN scope of practice. IMPACTS Advanced practice nursing roles are evolving in Saudi Arabia; however, no study has examined the existing patterns of APN activities in Saudi Arabia. This study highlights the practice patterns of advanced practice nurses and adds to the international evidence base on the need for delineating APN activities under a unified scope of practice. The findings of this study are beneficial to practitioners, researchers, and stakeholders as well as the legislative and regulatory bodies. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Ahmed Nahari
- Department of Medical-Surgical Nursing, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Arwa Alhamed
- College of Nursing, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hamza Moafa
- Department of Community and Psychiatric Mental Health Nursing, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Aboshaiqah
- Department of Nursing Administration and Education, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Monir Almotairy
- Department of Nursing Administration and Education, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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Chang HY, Lee IC, Tai SI, Ng NY, Shiau WL, Yu WP, Cheng TCE, Teng CI. Professional engagement: Connecting self-efficacy to actual turnover among hospital nurses. J Adv Nurs 2023; 79:4756-4766. [PMID: 37334431 DOI: 10.1111/jan.15737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 06/20/2023]
Abstract
AIMS To examine how nurses' self-efficacy impacts professional engagement (professional opportunities exploration and workplace improvement participation), nurses' turnover intention and further on actual turnover. BACKGROUND The problem of nursing shortage has become a common global issue. Nurses' self-efficacy could reduce nurses' turnover intention. However, whether professional engagement could connect nurses' self-efficacy and their actual turnover remains unknown. DESIGN This study adopts a three-wave follow-up design. METHODS This study uses proportionate random sampling to survey nurses in a large medical centre in Taiwan. Totally, 417 participants were enrolled from December 2021 to January 2022 (first wave) and followed up from February 2022 to March 2022 (second wave). The data of nurses' actual turnover (or not) were traced in May 2022 (third wave). STROBE statement was chosen as the EQUATOR checklist. RESULTS Self-efficacy was positively linked to outcome expectation, which is positively linked to professional opportunities exploration. Self-efficacy was positively linked to career interest and workplace improvement participation. Professional engagement was negatively linked to nurses' intention to leave the target hospital, which was positively linked to actual turnover. CONCLUSION This study uniquely finds that professional engagement is the key to the mechanism underlying the influence of nurse' self-efficacy on their actual turnover. IMPACT Our findings impact nursing management that professional engagement is as well important as nurses' self-efficacy, with an aim to maintain the professional nursing workforce. PATIENT OR PUBLIC CONTRIBUTION Nurses complete the questionnaires, return them to the investigators and permit investigators to check their personnel data.
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Affiliation(s)
- Hao-Yuan Chang
- School of Nursing, National Taiwan University, Taipei, Taiwan
| | - I-Chen Lee
- Department of Industrial and Business Management, Chang Gung University, Taoyuan City, Taiwan
- Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- Department of Business and Management, Ming Chi University of Technology, Taipei, Taiwan
| | - Shih-I Tai
- Graduate Institute of Management, Chang Gung University, Taoyuan City, Taiwan
| | - Nga Yan Ng
- Department of Industrial and Business Management, Chang Gung University, Taoyuan City, Taiwan
| | - Wen-Lung Shiau
- Department of Information Management, Chang Gung University, Taoyuan City, Taiwan
| | - Wen-Pin Yu
- Department of Nursing, Chang Gung Medical Foundation, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - T C E Cheng
- Faculty of Business, Department of Logistics and Maritime Studies, The Hong Kong Polytechnic University, Hong Kong SAR, PRC
| | - Ching-I Teng
- Department of Business and Management, Ming Chi University of Technology, Taipei, Taiwan
- Graduate Institute of Management, Chang Gung University, Taoyuan City, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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Osakwe ZT, Liu B, Ankuda CK, Ritchie CS, Leff B, Ornstein KA. The role of restrictive scope-of-practice regulations on the delivery of nurse practitioner-delivered home-based primary care. J Am Geriatr Soc 2023; 71:2256-2263. [PMID: 36855242 PMCID: PMC10363209 DOI: 10.1111/jgs.18300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Nurse practitioners (NPs) are the largest group of providers delivering home-based primary care (HBPC) in the U.S. We examined the association of scope-of-practice regulations and NP-HBPC rates. METHODS Using the Centers for Medicare and Medicaid Services Provider Utilization and Payment Data Public Use File for 2019, we conducted a state-level analysis to examine the impact of scope-of-practice regulations on the utilization of NP-HBPC. Healthcare Common Procedure Coding System codes were used to identify the HBPC visits in private residences (99341-99,345, 99,347-99,350) and domiciliary settings (99324-99,328, 99,334-99,337). We used linear regression to compare NP-HBPC utilization rates between states of either restricted or reduced scope-of-practice laws to states with full scope-of-practice, adjusting for a number of NP-HBPC providers, state ranking of total assisted living, the proportion of fee-for-service (FFS) Medicare beneficiaries and neighborhood-level socio-economic status and race and ethnicity. RESULTS Nearly half of NPs providing HBPC (46%; n = 7151) were in states with a restricted scope of practice regulations. Compared to states with full scope-of-practice, states with restricted or reduced scope-of-practice had higher adjusted rates of NP-HBPC per 1000 FFS Medicare beneficiaries. The average level of the utilization rate of NP-HBPC was 89.9, 63, and 49.1 visits, per 1000 FFS Medicare beneficiaries in states with restricted, reduced, and full- scope-of-practice laws, respectively. The rate of NP-HBPC visits was higher in states with restricted (Beta coefficient = 0.92; 95%CI 0.13-1.72; p = 0.023) and reduced scope-of-practice laws (Beta coefficient = 0.91; 95%CI 0.03-1.79; p = 0.043) compared to states with full scope-of-practice laws. CONCLUSION Restricted state NP scope-of-practice regulations were associated with higher rates of FFS Medicare NP-HBPC care delivery compared with full or reduced scope-of-practice. Understanding underlying mechanisms of how scope-of-practice affects NP-HBPC delivery could help to develop scope-of-practice regulations that improve access to HBPC for the underserved homebound population.
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Affiliation(s)
- Zainab Toteh Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claire K. Ankuda
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA
| | - Bruce Leff
- Center for Transformative Geriatric Research, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katherine A. Ornstein
- Center for Equity in Aging, Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Erickson M, Yee AM, Krauter R, Hoffmann T. The impact of a structured onboarding program for newly hired nurse practitioners and physician assistants. J Am Assoc Nurse Pract 2023; 35:265-271. [PMID: 36857535 DOI: 10.1097/jxx.0000000000000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/23/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND The return on investment for onboarding programs and their effect on attrition and engagement within health systems across the United States are unclear. LOCAL PROBLEM The existing onboarding program for nurse practitioners (NPs) and physician assistants (PAs) at a hospital on the west coast was varied and lacked a clinician focus. A structured onboarding program was created to standardize their entry to our workforce. METHODS A needs assessment was completed with a stakeholder focus group, for which an onboarding curriculum was then created. Participants completed presurveys/postsurveys during the data collection period as the primary outcome. A Plan-Do-Study-Act approach was used to revise session content and improve participant experience. Onboarding costs and attrition were tracked as secondary outcomes. INTERVENTIONS From July 2017 through June 2019, newly hired NPs and PAs were invited to participate in the program. Six quarterly cohorts attended five in-person 2-hour onboarding sessions over 12 months. RESULTS One hundred twenty-nine eligible NPs and PAs completed an anonymous pre/post Qualtrics survey. The aggregate responses were significantly improved using Fisher exact test. Measured onboarding value was not significantly changed. Mean pre-onboarding attrition was 10.3% compared with 4.5% for onboarding participants. The annual cost for onboarding participants was $63,470 versus $256,826 as the estimated mean cost of one separation within their first year. CONCLUSIONS Workforce engagement, standardized knowledge, and participant attrition revealed an improving trend with this structured onboarding program. The investment to formalize onboarding newly hired NPs and PAs was modest, and the findings suggest that an onboarding program has financial and engagement merit.
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Affiliation(s)
- Mitchel Erickson
- Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California
- Division of Geriatrics University of California, San Francisco Health, San Francisco, California
| | - Alisa M Yee
- University of California, San Francisco Health, San Francisco, California
- Department of Gastrointestinal Surgery Oncology, University of California San Francisco Health, San Francisco, California
| | - Roseanne Krauter
- University of California, San Francisco Health, San Francisco, California
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco Health, San Francisco, California
- Department of Family Health Care Nursing, University of California San Francisco School of Nursing, San Francisco, California
| | - Thomas Hoffmann
- Department of Epidemiology and Biostatistics Office of Research, University of California San Francisco School of Nursing, San Francisco, California
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Poghosyan L, Liu J, Schlak A, Courtwright S, Flandrick K, Nantsupawat A, Martsolf GR. Primary Care Nurse Practitioner Burnout and ED Use and Hospitalizations Among Chronically Ill Medicare Beneficiaries. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231219108. [PMID: 38146179 PMCID: PMC10752115 DOI: 10.1177/00469580231219108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023]
Abstract
Nurse practitioners (NPs) represent the fastest-growing workforce of primary care clinicians in the United States. Their numbers are projected to grow in the near future. The NP workforce can help the country meet the rising demand for care services due to the aging population and increasing chronic disease burden. Yet, increased burnout among these clinicians may affect their ability to deliver high-quality, safe care. We investigated how NP burnout in primary care practices affects patient outcomes, including emergency department (ED) use and hospitalizations, among older adults with chronic conditions. In 2018-2019, we collected survey data from 1244 primary care NPs from 6 geographically diverse states on their burnout and merged the survey data with data from Medicare claims on ED use and hospitalizations among 467 466 older adults with chronic conditions. 26.3% of NPs reported burnout. Using logistic regression models, we found that with a 1-unit increase in the standardized burnout score, the odds of an ED visit increased by 2.8% (OR = 1.028; P-value = .035); Ambulatory Care Sensitive Conditions (ACSC) ED visit by 3.2% (OR = 1.032; P-value = .019); hospitalization by 3.9% (OR = 1.039; P-value = .001); and ACSC hospitalization by 6.2% (OR = 1.062; P-value = .001). Our findings indicate that if chronically ill older adults receive care in primary care practices with higher NP burnout rates they are more likely to use EDs and hospitals. Policy and practice efforts, such as improving NP working conditions, should be undertaken to reduce NP burnout in primary care practices to potentially prevent acute care use.
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Affiliation(s)
| | | | - Amelia Schlak
- Department of Veteran’s Affairs, Office of Research and Development, Washington, DC, USA
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Schimschal SE, Visentin D, Kornhaber R, Cleary M. Achieving Long-term Goals Amidst Uncertainty: An Integrative Model for the Psychological Resources of Grit. J Contin Educ Nurs 2022; 53:355-363. [PMID: 35914275 DOI: 10.3928/00220124-20220706-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article proposes an integrative model for the psychological resources of grit. The growing body of work in nursing on the topic of grit indicates considerable interest in achieving long-term goals, especially amidst uncertainty from the COVID-19 pandemic. Motivational behaviors are thought to influence engagement in continuing education in nursing, thereby improving clinical practice and patient outcomes. The model was informed by a comprehensive review of the literature. Sixteen attributes for acquiring and strengthening four psychological resources of grit were identified. Each attribute is discussed along with interrelationships and implications for professional nursing development. Given the complex demands placed on health professionals, this model is both timely and relevant for all nurse and education providers interested in enhancing personal characteristics that may mitigate against stress and build capabilities for goal achievement. [J Contin Educ Nurs. 2022;53(8):355-363.].
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