A country's efforts toward creating an advanced practice nurse in public health.

AIM: The study goal was to inform the creation of a blueprint for an advanced practice nurse (APN) in public health. BACKGROUND: No internationally accepted standard for an APN in public health exists. Activities of public health nurses (PHN) traditionally have centered on health promotion and disease prevention, but many have added other population-based activities such as chronic and acute disease treatment. INTRODUCTION: An APN in public health is needed to address the global challenges threatening the physical, social, and mental health of populations worldwide. METHODS: This qualitative study was comprised of six focus groups, each containing a different group of stakeholders (n = 40). Study results followed the requirements of the consolidated criteria for reporting qualitative research (COREQ). FINDINGS: Two major themes emerged: the APN role in public health and core expectations. From the APN role theme, four subthemes emerged on APN domains of public health practice and functions. From the core expectations theme, nine subthemes emerged on the APN's qualifications and behaviors. DISCUSSION: Agreement among stakeholders was found in the nine core expectations; however, among the four different visions of an APN in public health, two fit a population-based model rather than the traditional PHN model. CONCLUSIONS: A single APN role in public health is insufficient to address the breadth and complexity of today's global challenges as detailed by the sustainable development goals. Due to the interaction between health and the biopsychosocial environments, we need APNs with different areas of expertise. IMPLICATION FOR NURSING POLICY: Nurses working at universities, in public health services, and as healthcare policymakers are needed to create a multistage strategy that gradually introduces several different types of APNs in public health.

[The world is changing, and so is the world of care]. / Le monde change, l'univers du soin aussi.

In the post-Covid context, which is unstable and changing, what is the role of the team when it is reduced to operating with a growing number of temporary staff? The medical desertification that is gradually taking hold in certain regions is a cause for concern, as is the growing disaffection of nurses throughout France. It is essential to draw up a map that incorporates survival oases, in order to meet the essential need to provide care anyway, while at the same time perpetuating the process of improving care. Advanced practice nursing faces many challenges.

Leveraging Advanced Practice Nursing in Complex Health Care Systems.

The US health care system has seen unprecedented growth in health care cost with only a mediocre return on investment. Achieving sustained quality improvement will require innovation that is effectively integrated into complex systems of care. Complexity leadership has the ability to place value on traditional quality improvement processes, with less focus on rigid structure and more attention on the potential for flexibility and creativity at the point of care. Clinical team leaders, such as nurse practitioners, must nurture adaptability to the constantly changing clinical environment while balancing structured thinking of team members. Nurse practitioners operating in interdisciplinary teams are well positioned to foster adaptive change through rapid cycle improvements at the point of care. As a learning approach to quality improvement, the PDSA (plan-do-study-act) method should be seen as a useful tool for organizations to create an emergent quality improvement process. This article discusses the significance of nurse practitioner leadership using the PDSA method informed by complexity leadership theory and the impact for clinical practice.

Enablers and challenges to advanced nursing and midwifery practice roles.

AIM: To describe the enablers and challenges to the development and implementation of advanced nursing and midwifery practice roles in Ireland. BACKGROUND: Leadership strategies need to be put in place to enhance the development and implementation of advanced nursing and midwifery practice roles. METHOD: A descriptive qualitative approach using semi-structured interviews with key stakeholders (n = 15) was undertaken with nurses and midwives working in specialist and advanced practice roles and participants from other areas such as legislative, regulatory, policy, pharmacy, medicine and education. RESULTS: Participant's perspectives on the enablers and challenges to enacting specialist and advanced practice roles resulted in the generation of three themes: organisational factors; collegial, interprofessional and interpersonal support; and role clarity, economic and regulatory contexts. CONCLUSION: Addressing organisational factors, encouraging collegial and interprofessional support and establishing role clarity contribute to the effective development and implementation of the role of advanced practitioners. IMPLICATIONS FOR NURSING AND MIDWIFERY MANAGEMENT: Managers of nursing services need to provide leadership in developing strategies to enhance the enablers and overcome the challenges to advanced practice role development in their own organisation.

Burnout Among Physicians, Advanced Practice Clinicians and Staff in Smaller Primary Care Practices.

BACKGROUND: Burnout among primary care physicians, advanced practice clinicians (nurse practitioners and physician assistants [APCs]), and staff is common and associated with negative consequences for patient care, but the association of burnout with characteristics of primary care practices is unknown. OBJECTIVE: To examine the association between physician-, APC- and staff-reported burnout and specific structural, organizational, and contextual characteristics of smaller primary care practices. DESIGN: Cross-sectional analysis of survey data collected from 9/22/2015-6/19/2017. SETTING: Sample of smaller primary care practices in the USA participating in a national initiative focused on improving the delivery of cardiovascular preventive services. PARTICIPANTS: 10,284 physicians, APCs and staff from 1380 primary care practices. MAIN MEASURE: Burnout was assessed with a validated single-item measure. KEY RESULTS: Burnout was reported by 20.4% of respondents overall. In a multivariable analysis, burnout was slightly more common among physicians and APCs (physician vs. non-clinical staff, adjusted odds ratio [aOR] = 1.26; 95% confidence interval [CI], 1.05-1.49, APC vs. non-clinical staff, aOR = 1.34, 95% CI, 1.10-1.62). Other multivariable correlates of burnout included non-solo practice (2-5 physician/APCs vs. solo practice, aOR = 1.71; 95% CI, 1.35-2.16), health system affiliation (vs. physician/APC-owned practice, aOR = 1.42; 95%CI, 1.16-1.73), and Federally Qualified Health Center status (vs. physician/APC-owned practice, aOR = 1.36; 95%CI, 1.03-1.78). Neither the proportion of patients on Medicare or Medicaid, nor practice-level patient volume (patient visits per physician/APC per day) were significantly associated with burnout. In analyses stratified by professional category, practice size was not associated with burnout for APCs, and participation in an accountable care organization was associated with burnout for clinical and non-clinical staff. CONCLUSIONS: Burnout is prevalent among physicians, APCs, and staff in smaller primary care practices. Members of solo practices less commonly report burnout, while members of health system-owned practices and Federally Qualified Health Centers more commonly report burnout, suggesting that practice level autonomy may be a critical determinant of burnout.

Profile of advanced nursing practice in Spain: A cross-sectional study.

In this study, we described the profile of advanced nursing practice in Spain. A cross-sectional study design was used to explore the extent and patterns of advanced nursing practice activity within the domains of expert care planning, integrated care, interprofessional collaboration, education, research, evidence-based practice, and professional leadership. Data were collected in 2015/2016. Purposive sampling yielded a sample of 165 specialist and expert nurses employed by a dual tertiary and community hospital in an urban setting. The study included specialist and expert nurses who had a higher practice profile than registered general nurses. The performance of activities according to age, current position, years of experience, nursing grade, and education was compared. Practice domains were more strongly influenced by the predictors of nursing position and professional career ladder. Age and experience predictors were found to be weak predictors of advanced practice domains. This study offers essential information of the nursing workforce, and clarifies both the advanced nursing practice profile and nomenclature in the context of study.

International Nursing: Constructing an Advanced Practice Registered Nurse Practice Model in the UAE: Using Innovation to Address Cultural Implications and Challenges in an International Enterprise.

Despite utilization of the advanced practice registered nurse (APRN) in the United States health care system, there is little information about the introduction, utilization, and challenges of the APRN role globally, especially in the Middle East. This article will look at how one hospital in the United Arab Emirates introduced the APRN role to a health care environment of a country where it has not been recognized historically. Cultural challenges and barriers for the implementation of the role include regulatory, societal, and institutional. Innovation and collaboration are necessary to address these challenges and barriers and to pave the way for a successful advanced practice model pilot, as well as for the future use of the role. Innovation is also one of the key performance indicators for the country's health care. However, the idea of advanced practice is a new concept that has been outside the mainstream health care practice for the United Arab Emirates. To help with the implementation, a road map was developed to outline the steps necessary to provide a safe practice environment. The plan included aligning with the ministry of health nursing and midwifery council, as well as the Health Authority of Abu Dhabi, to help them learn more about the US model of advanced practice, along with benefits, and outcomes of the role. Developing the role of the APRN will benefit the future state of the health care infrastructure for not only the United Arab Emirates but throughout the Middle East.

Pioneering a National Advanced Practice Leadership Council to Enhance Care Delivery in a Large 19-State Health System.

This article describes an innovative approach to enhancing the capacity of advanced practice clinicians (APCs) in a large faith-based health system consisting of multiple markets across the United States. With the challenges in health care today, promotion of advanced practice is vital to increasing quality and access to care while maintaining cost-effectiveness. The development of a national Advanced Practice Leadership Council led by the Vice President of Advanced Practice at Catholic Health Initiatives has been a progressive approach in mitigating the challenges facing APCs in today's health care arena. The success of the Council has led to its inclusion on the health system's national clinical governance structure. The authors discuss development of the Council along with specific information regarding various committee work, including APC state regulations, delineation of privileges, quality measures, and total compensation.

The Future of Neonatal Advanced Practice Registered Nurse Practice: White Paper.

In recent years, the National Association of Neonatal Nurses and the National Association of Neonatal Nurse Practitioners have been monitoring aspects of neonatal advanced practice nursing and providing leadership and advocacy to address concerns related to workforce, education, competency, fatigue, safety, and scope of practice. This white paper discusses current barriers within neonatal advanced practice registered nurse practice as well as strategies to promote the longevity of the neonatal advanced practice registered nurse roles.

Educational Changes to Support Advanced Practice Nursing Education.

Educational factors limit the number of advanced practice registered nurse (APRN) graduates to meet the growing workforce demands. Healthcare dynamics are necessitating a shift in how nursing education envisions, creates, and implements clinical learning opportunities. The current clinical education model in APRN programs continues to be the same as it was 45 years ago when the student numbers were much smaller. New approaches in graduate nursing education are needed to address the shortage of APRNs in primary and acute care areas. Determining competency based on the number of clinical hours can be inefficient, ineffective, and costly and limits the ability to increase capacity. Little research exists in graduate nursing education to support the effectiveness and efficiency of current hours of clinical required for nurse practitioner students. Simulation and academic-practice partnership models can offer innovative approaches to nurse practitioner education for clinical training, with the goal of producing graduates who can provide safe, quality care within the complex practice-based environment of the nation's evolving healthcare system.

[Towards universal access to health care: incorporation of advanced practice nurses in primary care]. / Atención primaria de salud en Chile: enfermería de práctica avanzada contribuye al acceso universal de salud.

To move towards universal access to health, the Pan American Health Organization recommends strengthening primary health care (PHC). One of the strategies is to increase the number qualified professionals, both medical and non-medical, working in PHC. In Chile there is a lack of professionals in this level of care, hampering the provision of health. Physicians still prefer secondary and tertiary levels of health. International experience has shown that advanced practice nurses (APN), specialists in PHC are cost-effective professionals able to deliver a complete and quality care to patients. Strong evidence demonstrates the benefits that APN could provide to the population, delivering nursing care that incorporates medical tasks, for example in patients with chronic diseases, allowing greater availability of medical hours for patients requiring more complex management. The success in the implementation of this new role requires the support of the health team, especially PHC physicians, endorsing and promoting the benefits of the APN for the population.

Advanced or advancing nursing practice: what is the future direction for nursing?

Advanced nursing practice roles have emerged over the last 25 years in response to two major challenges: first, the significant reduction in available doctors; and, second, the rise in numbers of patients with complex health needs. It is suggested that, with a major drive to respond to the first problem, with its emphasis on the development of medical skills, the development of advanced nursing practice (which has the potential to have a significant impact on the second challenge of the rise in long-term conditions) has very much taken second place. Moreover, advanced nursing practice roles have become so medically focused that not only is advanced nursing practice not evident, but neither are the recognised sub-roles that are fundamental to advancing practice. These include innovation, education, research and clinical leadership. This article argues that in the current climate it is essential that advanced nurse practitioners not only demonstrate advanced practice, but also actively embrace the concept of 'advancing' nursing practice as the dominant feature of new roles.

The future of the clinical nurse specialist role in Finland.

PURPOSE: To identify and examine the expert panelists' visions on the future implementation of the clinical nurse specialist (CNS) role in Finland. DESIGN AND METHODS: A policy Delphi design was conducted in 2013. A purposive sampling method was used to recognize expert panelists in the areas of advanced practice nursing (APN), healthcare management, and advanced practice nurse education. Three iterative Web-based survey rounds were conducted (n = 25, n = 22, n = 19). Both qualitative and quantitative methods were used to analyze the data. FINDINGS: The expert panelists envisioned the future of the CNS role in Finland. This study portrayed the CNS role in Finland as generally consistent with the international role. CNS have comprehensive skills and knowledge that they use to guide and develop nursing practice; however, several threats may affect their role achievement. The existing national consensus, contradiction, and ambivalence related to CNS roles were revealed through the examination of the results, thus pointing out the areas for consideration when further developing these roles and role policies. CONCLUSIONS: This is the first national study to examine the implementation of the CNS role in Finland. Expert panelists' views regarding the CNS role will be valuable in the forthcoming national policy formulation process. Although the policy Delphi design is not often utilized, this study reveals that it is very well suited to guide and inform national and international APN policy development. CLINICAL RELEVANCE: This study contributes to CNS role development and describes the methods facilitating the essential policy formulation process.

[How to develop advanced practice nursing in complex health care systems?]. / Comment développer la pratique infirmiére avancée dans des systemès de soins de santé complexes ?

Over the last few decades, advanced nursing practitioners (ANP) have developed new roles in health care systems and this tendency is continuing to grow. Postgraduate trainedANP interact directly with the person, i.e. the individual and his/her family - in many fields of practice and in a context of collaboration withfellow nurses and other health care professionals. The potential benefits of ANP interventions have been demonstrated in many fields. In particular, ANP are public health actors, able to participate in the interdisciplinary response to supportive care ofpatients with chronic diseases. However, the development of advanced practice nursing (APN) in a complex health care system requires a systemic approach coordinated with the various levels of training of nursing practitioners and other health care professionals. This is an essential prerequisite to allow ANPs to develop new roles adapted to their capacities (legal qualification, high level, specialist training, modalities of collaboration, etc.). To achieve an added value for patients, for the health care system in terms ofresults and to ensure adequate nursing conditions, the authors emphasize the importance of structured development of APN and propose an awareness phase comprising adoption of a conceptual model of APN and the establishment of a structured list of existing nursing practices in order to prepare a methodical implementation strategy.

An investigation of barriers and enablers to advanced nursing roles in Australian general practice.

Over the past decade, there has been substantial increase in nurses' roles in primary health care, particularly in general practice settings. Simultaneously, there has been an expansion of advanced roles for nurses across a range of clinical environments. This paper draws upon findings from a study that sought to develop a framework to support development of advanced nursing roles in general practice. It presents findings from one part of that study that explored barriers and facilitators to the development of these roles. Twenty-three key leaders from nursing, general practice and professional organisations participated in semi-structured interviews. Data were analysed using thematic analysis. A range of factors was identified as key to developing advanced roles in general practice. These included increasing awareness and attractiveness of practice nursing, health reform activities, practice limitations, education and professional development. Understanding complex systems and workforce issues is required to promote active intervention that can facilitate development of advanced nursing roles in Australian general practice.