Developing Nurse Practitioners for Hospitalist Roles: Lessons Learned From an Academic Practice Partnership

Background: There are numerous benefits to academic practice partnerships. While there is great emphasis on the new graduate nurse transition to practice, there is less intention placed on the new nurse practitioner (NP) role transition. In a rural teaching hospital, leadership perceived a need for more support to successfully transition NPs into hospitalist practice roles. Objective: One academic practice partnership developed and implemented a grant-funded program to support advanced practice registered nurses (APRNs) transition to practice at a rural teaching hospital. Methods: Informed by the results of a needs assessment, faculty and practice partners delivered lecture content in a face-to-face setting during scheduled hours. Results: Although the content was well received, attendance to and engagement with the program were suboptimal. Conclusions: Upon reflection, the program team gained valuable lessons regarding role expectations, intentional interdisciplinary collaboration, timing, alignment, delivery format, and the need for a dedicated program coordinator. Implications for nursing: APRN transition programs can provide much-needed support with dedicated structure, clear communication, and individualized content. It can also be a recruitment and retention strategy for healthcare organizations.

Managing DNP projects in student/faculty groups to facilitate learning with large cohorts

Despite the initial intent of the 2004 American Association of Colleges of Nursing (AACN) position statement to move all advanced nursing practice education to the doctoral level, many schools remain at the master's degree level. Many schools successfully transitioned their programs but struggled with adequate resources for the growing number of students and the faculty, staff, and preceptor workload associated with the Doctor of Nursing Practice (DNP) project courses. The AACN 2015 taskforce made many recommendations related to quality of DNP projects, but there is little in the literature on best operational practices. The goal of this paper is to describe how one school modified the DNP project courses from a traditional chair and committee driven format to a class driven format with multiple smaller sections to successfully manage large numbers of DNP students across nine specialties. Specifically, a new model with its successes and challenges is described as well as details regarding finances, course coordination, project advisors, project team, annual offerings and grouping of students.

Survey of Nursing Faculty Preparation for Guiding DNP Quality Improvement Projects

BACKGROUND

Quality improvement (QI) projects comprise the majority of University of Maryland School of Nursing (UMSON) Doctor of Nursing Practice (DNP) projects.

METHODS

An online survey was completed by 51% (n = 38) of faculty, who teach or mentor DNP students, and was analyzed using quantitative and descriptive methods.

RESULTS

Faculty were somewhat or not familiar with developing a QI charter 68.4%, human error theory and error proofing 63.2%, driver diagrams 60.5%, characteristics of high-reliability organizations 60.5%, and Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines 55.3%. The faculty were most interested in learning more about (n = 97 responses) were human error theory and error proofing (28.9%), SQUIRE guidelines (26.3%), statistical process control (21.1%), and implementation strategies and tactics (21.1%). The most commonly identified challenges included identifying QI projects (24%), project time constraints (16%), keeping up-to-date on QI concepts, methods, and tools (12%), and balancing professional workload (10%).

CONCLUSIONS

Gaps in self-reported QI knowledge indicate there is a need for further development of DNP and PhD prepared faculty at the UMSON.

THE EFFECTS OF BRANCHIAL CHLORIDE CELL PROLIFERATION ON RESPIRATORY FUNCTION IN THE RAINBOW TROUT ONCORHYNCHUS MYKISS

The objectives of this study were to induce chloride cell (CC) proliferation on the gill lamellae of rainbow trout Oncorhynchus mykiss and to evaluate the consequences for respiratory function. Chronic elevation of hormone levels was used to induce CC proliferation; fish were injected with a combination of cortisol (8 mg kg-1 intramuscularly every day for 10 days) and ovine growth hormone (2 mg kg-1 intraperitoneally every second day for 10 days). The extent of CC proliferation was quantified using scanning electron microscopy and a two-dimensional analysis. An extracorporeal preparation in combination with environmental hypoxia was used to assess the effects of CC proliferation on respiratory function. Arterial blood was routed from the coeliac artery through an external circuit in which pH (pHa), partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) were monitored continuously. Environmental hypoxia was imposed by gassing a water equilibration column supplying the experimental chamber with N2. The hormone treatment increased the average CC surface area by 2.7-fold and CC density by 2.2-fold; the combined effect was a fivefold increase in CC fractional area. While the PaO2 values of hormone-treated and control fish were similar at PwO2>12.0 kPa, the arterial O2 tensions of treated fish were significantly lower than those of the control group for PwO2¾12.0 kPa. In comparison with control fish at all environmental O2 tensions, the hormone-treated fish exhibited elevated PaCO2 values and a significant acidosis. The effects of CC proliferation on blood gas variables in hormone-treated fish were accompanied by a significantly elevated ventilation amplitude and a lowered ventilation frequency. The results of this study demonstrated (i) that impairment of respiratory gas transfer coincides with CC proliferation, (ii) that O2 and CO2 transfer are influenced differently and (iii) that partial compensation is achieved through physiological adjustments.