Perceptions of Physicians, Nurses, and Respiratory Therapists About the Role of Acute Care Nurse Practitioners

Burnout among Respiratory Therapists and Perception of Leadership: A Cross Sectional Survey Over Eight Intensive Care Units

Background

Burnout syndrome (BOS) is a job-related stress disorder featured by three main cardinal manifestations: emotional exhaustion (EE), reduced personal accomplishment (PA), and depersonalization (DP).

Aim

We aimed to report the prevalence of burnout and the impact of leadership and work condition on the burnout among respiratory therapists (RT) are front-line practitioners in many critical settings.

Methods

We surveyed RT in eight intensive care units (ICU) at five tertiary hospitals, under one medical corporation, using three instruments: the Maslach Burnout Inventory Human Services Survey for Medical Personnel, Condition of Work Effectiveness Questionnaire (CWEQ), and Leadership behaviours scale. We used a group of other health care practitioners (ie, physicians and nurses) as the control group.

Results

Of a sampling frame of 1222 ICU practitioners, 445 (36.4%) responded with completed surveys. Eighty-four (17.3%) and 361 (82.7%) participants were in the RT and the control group, respectively. The overall burnout score was significantly lower in the RT group (53.6% vs. 67%, p = 0.02). The EE and DP scores were significantly lower in the RT group [(26.2% vs. 37.7, p = 0.048) and (9.5% vs. 19.9%, p = 0.025), respectively], but the PA score did not show significant difference between the groups. A significant negative relationship was found between CWEQ score and both EE and DP scores (rs = −0. 0.557, p < 0.001) and (rs = −0.372, p < 0.001), respectively, while a significant positive correlation was found between CWEQ and the PA score (rs = 0.225, p < 0.042). A significant negative relationship was found between the leadership attitude and EE scores (rs = −0.414, p < 0.001).

Conclusion

The results of this study suggest a high burnout rate among RT. The reported rate was significantly correlated to work conditions and leadership behaviours. Organizational efforts should be directed to combating burnout through the identification and adequate management of the key precipitating factors.

ClinicalTrials.gov Identifier:

NCT04620005

Preparation and Evolving Role of the Acute Care Nurse Practitioner

Acute care nurse practitioners (ACNPs) are increasingly being employed as members of critical care teams, an outcome driven by increasing demand for intensive care services, a mandated reduction in house officer hours, and evidence supporting the ability of ACNPs to provide high-quality care as collaborative members of critical care teams. Integration of adult ACNPs into critical care teams is most likely to be successful when practitioners have appropriate training, supervision, and mentoring to facilitate their ability to practice efficiently and effectively. Accomplishing this goal requires understanding the educational preparation and skill set potential hires bring to the position as well as the development of an orientation program designed to integrate the practitioner into the critical care team. Pediatric ACNPs are also commonly employed in critical care settings; however, this commentary focuses on the adult ACNP role.

Attitudes toward expanding nurses' authority

BACKGROUND

In recent years, an increasing number of care procedures previously under the physician's authority have been placed in the hands of registered nurses. The purpose of this study was to examine the attitudes of nurses towards expanding nurses' authority and the relationships between these attitudes and job satisfaction facets, professional characteristics, and demographics.

METHOD

A cross-sectional study was conducted between 2010 and 2011 in three major medical centers in Israel. Participants included 833 nurses working in 89 departments. Attitudes toward the expansion of nurses' authority were assessed by self-report questionnaire, as well as job satisfaction facets including perception of professional autonomy, nurse-physician working relations, workload and burnout, perceptions of quality of care, and nursing staff satisfaction at work.

RESULTS

Nurses reported positive attitudes toward the expansion of nurses' authority and moderate attitudes for interpretation of diagnostic tests in selected situations. The results of multivariate regression analyses demonstrate that the nurses' satisfaction from professional autonomy and work relations were the most influential factors in explaining their attitudes toward the expansion of nurses' authority. In addition, professionally young nurses tend to be more positive regarding changes in nurses' authority.

CONCLUSIONS

In the Israeli reality of a nurse's shortage, we are witnessing professional transitions toward expansion of the scope of nurses' accountability and decision-making authority. The current research contributes to our understanding of attitudes toward the expansion of nurses' authority among the nursing staffs. The findings indicate the necessity of redefining the scope of nursing practice within the current professional context.

Nurse practitioners' role perception, stress, satisfaction, and intent to stay at a Midwestern academic medical center

PURPOSE

There is a growing demand for nurse practitioners (NPs) within academic medical centers (AMCs) because of physician shortages and increased need for access to care. In order to retain these NPs, it is important to assess their role perception and satisfaction. The purpose of this study was to evaluate these concepts and their relationships to stress and intent to stay.

DATA SOURCES

A 90-item descriptive survey, including a new role perception scale and the Misener Nurse Practitioner Job Satisfaction Scale, was administered to all NPs at a Midwestern AMC.

CONCLUSIONS

The response rate was 62.4% (n = 181). Overall, the NPs had moderate role perception (M = 4.30, SD = 1.23) and were somewhat satisfied (M = 4.23, SD = 0.74). Over a third (39.4%) reported they were unsure about staying or did not intend to stay in their position. Intent to stay and stress were moderately correlated with overall satisfaction and weakly correlated with role perception. There were significant differences in the intrapractice and professional aspects of job satisfaction based on their supervisor.

IMPLICATIONS FOR PRACTICE

With increased NP needs, it is crucial for AMCs and NP supervisors to assess role perception, satisfaction, and stress among NPs in order to ensure a stable, satisfied, and productive workforce.

The tortuous journey of introducing the nurse practitioner as a new member of the healthcare team: a meta-synthesis

The aim of this study was to explore the obstacles to and the opportunities for achieving optimal interprofessional team collaboration with the introduction of the nurse practitioner (NP). A team approach can contribute importantly to sustainable and safe patient care, and NPs have been added to the healthcare team in many countries. Following the international trend towards the development of the acute care NP, the role has recently been initiated in surgical care in Sweden. The introduction of an advanced nursing role into existing organisations raises questions about how the role will be developed and what its effects will be on collaboration between the different professions. We conducted a systematic review of qualitative studies using the meta-ethnographic approach developed by Noblit and Hare. Literature in the field of nursing was searched on PubMed and CINAHL, and empirical qualitative studies from outpatient and inpatient care in seven countries were included. The studies were appraised according to national guidelines and templates and were analysed and synthesised according to the meta-ethnographic approach. A total of 26 studies were included in the synthesis. The analysis revealed four themes: (i) a threat to professional boundaries, (ii) a resource for the team, (iii) the quest for autonomy and control, and (iv) necessary properties of a developing interprofessional collaboration. Based on these themes, the synthesis was created and presented as a metaphorical journey. The implementation of a new nursing role in a traditional healthcare team is a complex process influenced by many factors and can be described as "a tortuous journey towards a partially unknown destination". The synthesised obstacles and opportunities drawn from international studies may help healthcare organisations and new NPs prepare for, and optimise, the implementation of a new nursing role.

Conceptual framework of acute care nurse practitioner role enactment, boundary work, and perceptions of team effectiveness

AIM

This article describes a new conceptual framework for acute care nurse practitioner role enactment, boundary work and perceptions of team effectiveness.

BACKGROUND

Acute care nurse practitioners contribute positively to patient care by enacting an expanded scope of practise. Researchers have found both positive and negative reactions to the introduction of acute care nurse practitioners in healthcare teams. The process of role enactment, shifting role boundaries, and perceptions of team effectiveness has been studied disparately. A framework linking team structures and processes to desirable outcomes is needed.

DATA SOURCES

Literature was obtained by searching CINAHL, PsycInfo, MedLine, PubMed, British Nursing Index, Cochrane Library, JSTOR Archive, Web of Science, and Google Scholar from 1985-2010. A descriptive multiple-case study was completed from March 2009-May 2009.

DISCUSSION

A new conceptual framework describing how role enactment and boundary work affect perceptions of team effectiveness was developed by combining theoretical and empirical sources. The framework proposes proximal indicators used by team members to assess their team's performance.

IMPLICATIONS FOR NURSING

The framework identifies the inter-related dimensions and concepts that different stakeholders need to consider when introducing nurse practitioners in healthcare teams. Further study is needed to identify team-level outcomes that reflect the contributions of all providers to quality patient care, and explore the patients' and families' perceptions of team effectiveness following the introduction of acute care nurse practitioners.

CONCLUSION

The new framework can guide decision-making and research related to the structures, processes, and outcomes of nurse practitioner roles in healthcare teams.

The neuroscience acute care nurse practitioner: role development, implementation, and improvement

As the number and opportunities for acute care nurse practitioners (ACNPs) continue to increase, the successful integration of these providers into the health care setting becomes more of a challenge. This article outlines strategies for role development, implementation, and evaluation to optimize the performance of the neuroscience ACNP role. The concepts presented are applicable across all acute-care specialties that use ACNPs.

The expanding role of the nurse practitioner in an academic medical center and its impact on graduate medical education

PURPOSE

Academic medical centers (AMCs) have used nurse practitioners (NPs) for the provision of direct patient care for many years. However, as more NPs are hired to fill in the void created by both the 80-hour work week and the increased demands on attendings' time, their role has evolved in terms of patient care and graduate medical education. We sought to evaluate the expanded role of the NP in our large tertiary AMC to help clarify the interrelationships with the patient care delivery model and GME.

METHODS

Data were collected through interviews of NPs, nurses, attendings, and residents. Data were analyzed to identify trends contributing to successful models of practice and their impact on patient care and graduate medical education (GME).

RESULTS

Interviews were completed with 58/74 (78%) NPs employed at our medical center. Anonymous written surveys were completed by 41 (55%) providers. In terms of perceived impact on the role NPs played in GME, 77% of NPs surveyed felt that their role complimented the resident training; 9% felt that their role competed with resident training; and 14% felt that their role had no impact on resident training.

CONCLUSION

We believe that the presence of an experienced NP on a care deliver team can enhance the educational experience of residents as well as provide continuity of patient care in the era of the 80-hour work week.

Role stress and job satisfaction for nurse specialists

AIM

This paper is a report of a study to illustrate the unique relationship between role stress and job satisfaction and provide recommendations for advanced nursing practice in Taiwan.

BACKGROUND

International literature has shown that work role-related stress experienced by staff nurses predicts role strain, which in turn influences job satisfaction and intention to leave the job. In this study, the direct relationship between role stress and job satisfaction of nurse specialists was examined after controlling for personality trait and personal characteristics.

METHOD

In 2004 a convenience sample of 129 nurse specialists from five acute care teaching hospitals in Taiwan participated. They completed a questionnaire (response rate 81%) focusing on personal characteristics, the Five Factor Model of personality traits, role stress (i.e. ambiguity, conflict, overload, incompetence) and job satisfaction (i.e. professionalism, interaction, demand/reward, control/recognition). Data were analysed using hierarchical regression models.

RESULTS

After controlling for personality traits and personal characteristics, role stress variables predicted 24.8% of the variance in job satisfaction. Role ambiguity (P < 0.001) and role overload (P < 0.01) were the best predictors, but role conflict was not statistically significant. Role stress explained statistically significant proportions of the variance for each component of job satisfaction: professionalism (10.6%), interaction (16.7%), demand/reward (27.1%) and control/recognition (18.5%). Role ambiguity predicted all four satisfaction components, role overload predicted demand/reward and role incompetence predicted interaction.

CONCLUSION

Organizational restructuring and administrative support are recommended to address the issues raised. Appropriate training, sufficient communications and supportive legislation are required. Future research should be conducted to evaluate the impact of these interventions.

Innovations in Care: The Nurse Practitioner in the PACU

Recognizing the advantages of the advanced practice nurse (APN), an urban medical center of 500+ beds created an innovative position. The decision was made to hire a nurse practitioner to manage patients seen in the busy PACU. This article is a description of the program. The article includes background, objectives, qualifications of the practitioner, collaborative practice agreement, delineation of privileges, and educational plan. The role description and daily practice plan of the practitioner are also discussed.

Acute care nurse practitioners: the role in neuroscience critical care

In order to meet the needs of the high acuity population in today's critical care environment, the role of the Acute Care Nurse practitioner (ACNP) has been adopted by many intensive care units (ICU's) across the country, including specialized neurocritical care units. In this chapter we will provide a brief historical review of the ACNP as well as their function in various ICU settings. Lastly, we will describe the current role of the ACNP in the Neurosciences Critical Care Unit at the Johns Hopkins Hospital as well as future plans and challenges of the role.

The evolving role of the acute care nurse practitioner in critical care

PURPOSE OF REVIEW

The newest nurse practitioner role is the acute care nurse practitioner. This paper presents the latest data on the role from both a US and international perspective.

RECENT FINDINGS

Now present in the USA for at least 15 years, the acute care nurse practitioner role has become well established in critical care settings and is moving into international healthcare. The few outcome studies conducted to date demonstrate the acute care nurse practitioner provides quality patient and family care, improves patient satisfaction, is cost effective, and is an answer to the hospital's shortage of medical residents with new restrictions on working hours.

SUMMARY

The role of acute care nurse practitioners in critical care is increasing worldwide. Most countries are experimenting with this latest nurse practitioner as an extended-role healthcare provider with many potential benefits to patients and their families, as well as the healthcare system.

Trauma Case Management

The care of a critically ill trauma patient is complex and requires the expertise and skill of many healthcare providers. Delays in injury identification and the development of a treatment plan without considering comorbid conditions impede the patient's resuscitation and recovery from the acute injury, delay the rehabilitative phase, and increase the costs. This article will discuss a strategy using an advanced practice nurse as a case manager to assist in prompt identification of the patients' pathologic and physiologic changes and psychosocial and rehabilitative needs and to orchestrate a comprehensive and consistent plan through the continuum of care.

Strategies for success in the acute care nurse practitioner role

This article reviews issues related to development of the role of the acute care nurse practitioner (ACNP). Strategies for ensuring success in the role are outlined, including the importance of communication about the role, maintaining competency, forming collaborative relationships, and the value of networking. The ACNP represents an innovative role in advanced practice nursing. Demonstrating the outcomes of ACNP practice ensures recognition of the impact and value of this unique role.

Acute Care Nurse Practitioner Practice: Results of a 5-Year Longitudinal Study

The role of acute care nurse practitioners (ACNPs) has developed in capacity. More than 3500 advanced practice nurses have been certified as ACNPs, and the number of practice settings where these professionals work is continually expanding. Beginning in 1996, a series of surveys were conducted of nurse practitioners seeking national certification as ACNPs. What started as an attempt to gather information on the role of ACNPs evolved into a national 5-year longitudinal survey of ACNP practice. The cumulative results of the project are reported, and how the role of the ACNP was established in advanced practice nursing is discussed.