Activities Performed by Acute and Critical Care Advanced Practice Nurses: American Association of Critical-Care Nurses Study of Practice

Description and Evaluation of the AACN Synergy Model for Patient Care Employing the Critique Frameworks of Chinn and Kramer (2011) and Fawcett and DeSanto-Madeya (2013)

This study describes and evaluates the AACN Synergy Model for Patient Care that aligns nurses' competencies with the needs of patients and their families, developed by the American Association of Critical-Care Nurses. The description focuses on objectively explaining the theory, while the evaluation is based on established standards to determine its viability for application in nursing practice. This study applies Chinn and Kramer's (2011) theoretical description method and Fawcett and DeSanto-Madeya's (2013) theory analysis method to evaluate the AACN Synergy Model for Patient Care. Focusing on the patient-nurse relationship, the theory is appropriate for various nursing applications.

Practice Analysis: Adult-Gerontology Acute Care Nurse Practitioner and Clinical Nurse Specialist

BACKGROUND

Standards for advanced practice registered nurse (APRN) licensure in the United States require certification programs to analyze practice in order to document the knowledge and skills necessary for entry-level adult-gerontology acute care nurse practitioners (AGACNPs) and wellness-through-acute-care clinical nurse specialists (AGCNSs). The practice analysis done every 5 years by the AACN Certification Corporation provides research data for use in establishing test plans for certification of APRNs.

OBJECTIVES

To describe the development of a survey to collect information on the current practice of AGACNPs and AGCNSs, and to compare the results from practitioners in the 2 roles.

METHODS

In 2016, a task force of subject matter experts created a survey of the practice activities and competencies of AGACNPs and AGCNSs. Respondents rated activities and competencies according to their applicability and significance to APRN practice. The subject matter experts analyzed the ratings to determine which patient care problems, skills and procedures, and competencies would be included in the updated certification test plans.

RESULTS

After analyzing the survey responses, subject matter experts retained 135 patient care problems, 45 skills and procedures, and all national competencies for AGACNPs and 123 patient care problems, 56 skills and procedures, and all national competencies for AGCNSs. Both roles involve several of the same patient care problems, skills and procedures, and competencies.

CONCLUSIONS

Data from practice analysis surveys formed the basis for developing reliable and valid certification examinations for entry-level APRNs. The information from such studies of practice should inform practicing nurses and students, as well as educators, accreditors, legislators, and regulators, about the work of AGACNPs and AGCNSs.

Time use of advanced practice nurses in hospitals: A cross-sectional study

AIMS

To examine the use of time by advanced practice nurses and time use differences according to type of healthcare organization, work experience, and supervisor.

DESIGN

A cross-sectional, observational study.

METHODS

Non-participant observations were executed in Belgium (October 2015-January 2016). Time use was categorized in domains (patient/family, team, healthcare organization) and roles (clinical expert, educator/coach, change agent/innovator, researcher, leader, collaborator, and ethical decision-making facilitator). Proportional working time in domains and roles was calculated. Chi-squared tests identified differences in time use according to type of healthcare organization, number of years of work experience, and type of hierarchical/functional supervisor.

RESULTS

Participants mainly devoted time to the patient/family domain (30.78%) and the clinical expert role (34.19%). The role of leader and ethical decision-making facilitator covered, respectively, 4.84% and 0.07% of participants' time. Time distribution in domains and roles differed between participants in university and peripheral hospitals.

CONCLUSION

Activities were executed in all domains and roles, except for the ethical decision-making facilitator role. Further research could uncover barriers and facilitators for role execution, especially about leadership and ethical decision-making.

IMPACT

Advanced practice nurses, supervisors and policymakers could act to optimize advanced practice nurses' scope of practice.

Hiring appropriate providers for different populations: acute care nurse practitioners

Acute care nurse practitioners, prepared as providers for a variety of populations of patients, continue to make substantial contributions to health care. Evidence indicates shorter stays, higher satisfaction among patients, increased work efficiency, and higher quality outcomes when acute care nurse practitioners are part of unit- or service-based provider teams. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education outlines detailed guidelines for matching nurse practitioners' education with certification and practice by using a population-focused algorithm. Despite national support for the model, nurse practitioners and employers continue to struggle with finding the right fit. Nurse practitioners often use their interest and previous nursing experience to apply for an available position, and hospitals may not understand preparation or regulations related to matching the appropriate provider to the work environment. Evidence and regulatory guidelines indicate appropriate providers for population-focused positions. This article presents history and recommendations for hiring acute care nurse practitioners as providers for different populations of patients.

What clinical activities do advanced-practice registered dietitian nutritionists perform? Results of a Delphi study

Activities performed by advanced-practice registered dietitian nutritionists (RDNs) have yet to be clearly elucidated. The study aimed to gain consensus on the practice activities of advanced-practice RDNs who provide direct clinical nutrition care. A three-round Delphi study was conducted. Purposive sampling identified 117 RDN experts working as clinicians and/or managers in direct care settings that met inclusion criteria for advanced-level practice. In Round 1, 85 experts provided open-ended advanced-level practice activities linked to the Nutrition Care Process sections. Using content analysis, the responses were coded into activity statements. In Round 2, experts rated the essentiality of these activities. In Round 3, experts re-rated statements not reaching consensus while viewing their previous rating, the group median, and comments. Median ratings of 1.0 to 3.0 were defined as essential, 4.0 were neither essential nor nonessential, and 5.0 to 7.0 were nonessential. Consensus was reached when the interquartile range of responses to each question was <2.0. Seventy-six (89.4%) experts completed all rounds. From 770 comments, 129 activity statements were generated. All statements reached consensus: 97.7% as essential; 0.8% as nonessential; and 1.5% as neither. Of essential activities, 67.5% were highly essential with limited variability (median=1.0; interquartile range≤2.0). Advanced-practice RDNs' tasks are patient-centered and reflect complex care; involve a comprehensive and discriminating approach; are grounded in advanced knowledge and expertise in clinical nutrition; include use of advanced interviewing, education, and counseling strategies; and require communication with patient, families, and the health care team. The high-level of consensus from experts suggest advanced-level clinical nutrition practice exists and can be defined.

Acute care pediatric nurse practitioner: a practice analysis study

INTRODUCTION

It is the responsibility of certification organizations to provide psychometrically sound and legally defensible examinations. Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study describes the practice of the acute care pediatric nurse practitioner (ACPNP) since the inception of the certified pediatric nurse practitioner-acute care (CPNP-AC) examination in 2005.

METHOD

A descriptive analysis of the 2009 practice survey of U.S. ACPNPs (291 respondents) was performed.

RESULTS

Most ACPNP respondents were White women; the mean age was 40 years, and 47.9% had been formally educated as ACPNPs. More than 40% practiced in the Midwestern United States. Most respondents (86.2%) practiced in urban areas. Respondents reported spending 71% of practice time in inpatient settings. The most frequently cited areas of practice were critical care (27.5%), followed by emergency department (10.7%) and specialty practices.

DISCUSSION

In light of recent advanced practice regulatory role distinctions, this re-examination of the ACPNP practice 5 years after initiation of the CPNP-AC certification examination demonstrates changes in clinical practice and educational preparation requirements.

Reporting relationships of clinical nurse specialists in acute care

Reporting relationships between clinical nurse specialists (CNSs) and administrators (ADMs) can facilitate or constrain CNS practice and affect patient outcomes. Limited information is available comparing reporting relationships and perspectives of CNSs and ADMs.

PURPOSE

The purpose of the present study was to describe CNS and ADM reporting relationships and compare their perspectives about the activities and outcomes of CNS practice in acute care settings.

DESIGN

The present study uses a descriptive survey.

SETTING

Four healthcare organizations in the midwestern United States.

SAMPLE

Clinical nurse specialist participants (n = 30) were master's degree prepared and employed in an acute care setting. Administrator participants (n = 7) were responsible for supervision and evaluation of CNSs in their organization.

METHODS

Questionnaires were developed from literature and content review by experts. The CNS and ADM questionnaires contained separate sections for CNS and organization information with parallel construction of questions about CNS activities and outcomes.

FINDINGS

There was variability across organizations related to reporting relationships and structure of CNS work. No significant differences were found when comparing CNS and ADM perspectives of work activity proportions and the importance of 10 activities and 7 outcomes. The most important CNS activities included developing clinical protocols and guidelines, quality improvement, and coordination of care. The most important outcomes included evidence-based nursing care and skilled and competent nursing staff.

CONCLUSION

Comparing perspectives of work activity time, priority activities, and outcomes provides a basis for collaboration between CNSs and ADMs in reporting relationships.

IMPLICATIONS

Clinical nurse specialists should develop positive interactions and shared understanding with ADMs to improve effectiveness and enhance patient outcomes.

Path to bariatric nurse certification: the practice analysis

BACKGROUND

In 2005, the American Society for Metabolic and Bariatric Surgery (ASMBS) nursing membership embarked on a journey to develop a specialty certification program for nurses caring for morbidly obese and bariatric surgical patients. In keeping with the certification industry best practices, a practice analysis study was conducted to create an empirically sound foundation for the new nursing specialty certification examination.

METHODS

Task force meetings, subject-matter expert interviews, and an external review process were implemented to create a definition of the specialty in terms of 4 domains of practice, 45 nursing tasks, and 54 knowledge areas. The definition encompassed the work of bariatric nurse coordinators, bariatric program directors, and floor nurses caring for morbidly obese and bariatric surgical patients. A survey was administered to 1084 nurses practicing in the specialty to validate the domains, tasks, and knowledge.

RESULTS

Some differences in the time spent in each of the domains and tasks were noted for the survey respondents in the different job roles. Nevertheless, the respondents for all job roles rated the domains and tasks moderately or highly important in optimizing the outcomes for morbidly obese and bariatric surgery patients. In addition, most respondents agreed that the 54 knowledge areas were acquired during the first 2 years of practice in the specialty.

CONCLUSION

The survey results validated a specialized body of nursing knowledge rooted in the tasks that define professional practice. The results are being used to guide the development of a certification program for nurses practicing in the specialty and to provide guidance for education and training initiatives.

Acute care nurse practitioner: an advanced practice role for RN first assistants

Acute care nurse practitioners (ACNPs) are advanced practice RNs who are educationally prepared to provide advanced nursing care to patients with complex acute, critical, and chronic illness. The education of advanced practice nurses should prepare them for the setting in which they practice; ACNPs are well prepared for hospital and specialty practice, particularly if they have experience as RN first assistants (RNFAs). This article provides a brief overview of the ACNP opportunity for RNFAs and the importance of additional training for ACNPs without OR experience who may be first assisting.

Development of a pediatric intensive care unit nurse practitioner program

The use of acute care nurse practitioners in the adult critical care environment is well established. In the last several years, nurse practitioners are being used in the pediatric intensive care unit as well. Consequently, an increasing number of pediatric nurse practitioners have moved from primary care to the acute care environment. The recent development of the national acute care pediatric nurse practitioner certification examination provides validation of the education and standards of care provided by this subset of advanced practice nurses. The authors describe the highly successful pediatric critical care nurse practitioner program and its outcomes in a pediatric intensive care unit.

Discrimination of educational outcomes between differing levels of critical care programmes by selected stakeholders in Australia: a mixed-method approach

OBJECTIVE

This study was designed to prioritise educational outcomes for three levels of postgraduate speciality critical care nursing programmes.

BACKGROUND

Postgraduate speciality education has proliferated within Australia over the past 20 years. However, there is little agreement regarding the expected characteristics, or relevant priorities, of these characteristics of graduates successfully completing these programmes of study.

METHOD

This study used a mixed-method approach comprising two phases. Initially a survey was mailed to volunteers between March and June 2005 to obtain priorities in educational outcomes for graduates of critical care programmes. This was followed by a stakeholder focus group in May 2006 to refine expected outcomes.

RESULTS

Survey respondents rated educational outcomes that described professional and legal aspects of practice to ensure safe patient care as highest priority for programme graduates. Although most educational outcome statements were considered important for graduates from all levels of courses, increasing levels of practice was described for increasingly higher levels of programmes from Graduate Certificate to Masters Degree.

CONCLUSION

This study provides an emerging description of the priorities of critical care nursing programmes, with priority given to professional and legal aspects of practice. Further delineation of priorities is necessary to inform ongoing educational development.

Synergy and peripheral percutaneous transluminal angioplasty

Peripheral percutaneous transluminal angioplasty with endovascular stent is a procedure to improve the symptoms of claudication caused by peripheral vascular disease. There is evidence to show that upward of 30% of patients seek further intervention for recurring symptoms in 1 year. This high rate of recidivism necessitates nursing intervention postprocedure in the hospital to promote a lifestyle change. The Synergy Model is useful to develop a relationship between the patient and the nurse that promotes a lifestyle change. The outlined patient who underwent peripheral percutaneous transluminal angioplasty and the nurse characteristics within the Synergy Model lend themselves to frame a short, intense hospital stay inclusive of thorough, patient-centered teaching.

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.