Practice pathways, education, and regulation influencing nurse practitioners' decision to provide primary care: a rapid scoping review.

BACKGROUND/OBJECTIVE: Initially established to improve access to healthcare, particularly for primary care, the full potential of the nurse practitioner role is yet to be realised in most countries. Despite this, most countries are working to meet an ageing population's increasing healthcare needs and reduce healthcare costs and access disparities. Achieving these outcomes requires reform at multiple levels, including nurse practitioner practice pathways, education and regulation, and identifying the barriers and facilitators to optimising their primary care role. METHODS: A rapid scoping review of nurse practitioner practice pathways, education and regulation inclusive of: (1) a systematic search of Medline and CINAHL for peer-reviewed English language articles, including opinion pieces published between January 2015 and February 2022; and (2) a web-based search of nurse practitioner program entry requirements of International Nurse Regulator Collaborative country members with a protected nurse practitioner title and prescribing rights, plus the Netherlands. The individually summarised search data was integrated and synthesised using Popay's narrative approach. RESULTS: Emerging evidence from the included nurse practitioner courses (n = 86) and articles (n = 79) suggests nurse practitioners working in primary care provide safe, effective care and improve healthcare efficiencies. However, different regulatory and educational models are required if the primary care nurse practitioner is to meet growing demand. CONCLUSIONS: International variations in entry criteria, curriculum, and regulation shape the global profile of the nurse practitioner primary care workforce and their practice setting. For countries to grow their primary care nurse practitioner workforce to meet unmet needs, different entry requirements, program content and accredited post-registration transitional programs must be urgently considered.

Trainee ANPs' experiences of having a clinical practice facilitator introduced into a Hospital at Night team.

BACKGROUND: The role of the advanced nurse practitioner (ANP) within Hospital at Night (H@N) teams has emerged in line with the demands of the service and the needs of patients in the out-of-hours period. The majority of ANPs with H@N teams are recruited as trainees. There is a high volume of trainees needing support against a low number of experienced ANPs. Introduction of the clinical practice facilitator (CPF) role is one way of addressing these issues. Within this evaluative study of one H@N service, the CPFs are experienced ANPs who have received additional training in the delivery of practice assessment and learner feedback. AIM: To explore the experiences and perceptions of those trainee ANPs who have had or are currently receiving support and supervision from the CPFs in an H@N service in one Scottish NHS health board. METHOD: The CPFs undertook a service evaluation following introduction of the role. Purposive sampling was undertaken whereby a descriptive questionnaire was sent to 22 eligible participants. RESULTS: 16 questionnaires were returned. Qualitative data from the questionnaire generated several themes from the participants' responses: validation of competencies, supporting wellbeing, accessibility of support, designated prescribing practitioner role and support post-qualification. CONCLUSIONS: CPFs are ideally placed to meet the required needs of trainees. Organisational commitment is key to ensuring ANPs are in optimal positions to provide support and supervision for the next generation of trainees.

Improving Nurse Practitioner Students' Knowledge and Confidence in the Identification and Management of Human Trafficking Victims.

Human trafficking is a global public health problem affecting millions of people worldwide. In the United States, many trafficking victims seek medical care for physical, sexual, and mental health concerns. Unfortunately, many of these individuals go unrecognized by health care providers as being victims of human trafficking and return to their trafficker without interventions for their safety and protection. To provide effective quality care for this patient population, health care providers must be knowledgeable regarding the identification of signs of trafficking, trauma-informed interventions to ensure the safety and protection of the victim(s), and methods to collaborate with interprofessional partners for the provision of appropriate medical and socioeconomic care following the exit from their trafficking situation. The purpose of this pilot study was to evaluate best practices in teaching Family Nurse Practitioner (FNP) students to identify and implement appropriate interventions for victims of human trafficking. The study was conducted in two phases using a mixed-method research design with repeated measures. In the first phase, education was provided through the validated HOPE Training modules produced by the Safe House Project using a pretest, posttest design. In the second phase, the students observed an interprofessional simulation followed by focus groups using a phenomenological approach to explore students' perceptions. Knowledge and confidence increased significantly following the implementation of this study. The results provide essential information regarding incorporating human trafficking education into FNP curricula. This study also contributes to the body of knowledge regarding the vital role that nurse practitioners play in the interprofessional management of human trafficking victims.

Effectiveness of a health education program for people with dementia and their family caregivers: An intervention by nurse practitioners.

PURPOSE: This study assesses the effectiveness of a health education program on caregiving outcomes for people with dementia and their families. METHODS: This quasi-experimental study involved 250 people with dementia and their family caregivers. Behavioral problems in people with dementia were assessed using the Chinese version of the Cohen-Mansfield Agitation Inventory-community form. Family caregiver outcomes were measured using the Agitation Management Self-Efficacy Scale, Caregiver Preparedness Scale, Competence Scale, and Community Resource Awareness and Utilization Assessment. RESULTS: Following the intervention, the experimental group demonstrated significant improvements in terms of self-efficacy, preparedness, competence, and awareness and utilization of community resources among family caregivers. Additionally, the experimental group exhibited lower levels of behavioral problems among people with dementia. CONCLUSIONS: This study helped improve caregiving outcomes for people with dementia and their family caregivers. Therefore, outpatient healthcare providers can utilize these findings to enhance care for this population.

Evaluating the effectiveness of the cardiovascular assessment screening program with nurse practitioners and patients: results of a cluster randomised controlled trial.

BACKGROUND: There is inconsistent utilisation of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by healthcare professionals to identify CVD risk factors early and to intervene using current recommendations. To address this issue, the Cardiovascular Assessment Screening Program (CASP) was developed, implemented, and evaluated. This manuscript reports on the second phase of an exploratory sequential mixed methods study that tested the effectiveness of the CASP with nurse practitioners (NPs) and patients in Canada. METHODS: A two-armed, non-blinded, cluster randomised controlled trial (cRCT) compared the NP-led implementation of CASP with usual care by NPs in community practice clinics across one Canadian province. The NPs were the cluster variable as their screening practices could be affected by their educational training, resources, or other factors. NPs were eligible for inclusion in the study if they were located in different urban and rural community settings and could conduct follow-up visits with patients. NPs recruited and enrolled the patients from their own practices as participants if they were healthy individuals, aged 40-74 years, with no established CVD or vascular disease. Researchers randomly allocated the NPs (n = 10) to the intervention group (IG) or the control group (CG). RESULTS: Eight (8) NPs and 167 patients participated in the cRCT study. Patient participant-level data were analysed by the originally assigned groups IG (n = 68) and CG (n = 99). Utilising GLM (generalized linear modeling) more IG patients (90%; n = 61) received comprehensive CVD screening compared to the CG patients (2%; n = 2), RR = 30.2, 95% CI [8.76, 103.9], p < .0001, controlling for the effect of NP and BP category. CONCLUSION: NP implementation of CASP was effective for comprehensive screening compared to usual care and led to identifying previously unknown CVD risk factors, calculated FRS, heart health priorities and personalised goal-setting. TRIAL REGISTRATION: ClinicalTrial.gov ID#: NCT03170752, date of registration 2017/05/31.

Incorporating a Psychiatric Telehealth Simulation in a Family Nurse Practitioner Curriculum.

The prevalence of mental health disorders in primary care is high and challenges related to the COVID pandemic warrant further training of the family nurse practitioner. A telehealth simulation learning experience that included common primary care diagnoses in mental health-general anxiety, depression, and substance use disorder-was incorporated into a non-clinical behavioral health course. Formative evaluation provided by licensed nurse practitioners confirmed the need for improving interviewing techniques, engaging clients, and promoting safety among this population. Students' confidence during the encounter was measured using the Simulation Effectiveness Tool. Findings suggest a simulation learning experience is an effective resource for training nurse practitioner students to treat mental health disorders.

Interprofessional Post-Graduate Training Model for Nurse Practitioners and Physician Trainees.

CONTEXT: People living with serious illness and their care partners rely on team-based specialty hospice and palliative care (HPC) in order to achieve high quality end of life outcomes. In HPC, physician and nurse practitioner (NP) scope of practice has significant overlap so training together may offer benefits to clinicians and patients. OBJECTIVES: Assessment of clinical competencies in a post-graduate training program consisting of NPs and physicians training and learning side-by-side. METHODS: A crosswalk assured NP and physician HPC clinical competencies were captured in evaluation questions used by interprofessional program faculty to observe and assess trainees. Six clinical competencies were calculated based on aggregated evaluations for each physician and NP HPC post-graduate trainee at 3, 6, 9, and 12 months annually for 3 years. For NPs and physicians, the mean slopes of the best fit lines, the final numeric score, and the mean net change between 12 and three month competencies were compared. Learner experience was captured qualitatively. RESULTS: There was no statistical difference in the change of competency scores, the final competency scores, or the trajectory of improvement in the six competencies between physician to NP trainees. Adding NP trainees was considered by post-graduate trainees as a strength of the program, and did not detract from physician competence achievement. CONCLUSION: Assessing an IPE post-graduate training program in HPC was possible using a shared clinical competency framework, and revealed similar clinical gains for NPs and physicians enrolled in the program.

Growing the Neonatal Nurse Practitioner Workforce Through Mentoring: A Scoping Review.

OBJECTIVE: The purpose of this article is to highlight evidence specific to the neonatal nurse practitioner (NNP) workforce related to successful mentoring programs. Specifically, the authors of this article explored recent evidence of mentorship to improve job satisfaction and retention of the NNP workforce. BACKGROUND: NNPs are valuable members of neonatal healthcare team. Because of the aging NNP workforce, methods to recruit, train, mentor, develop, and retain new NNPs are imperative. METHODS: Using a quality appraisal tool from the PRISMA extension for scoping reviews, articles were identified through electronic database searches using search terms related to mentoring, nurse practitioners, recruitment, and retention. Studies published in English between 2013 and 2023 were included. Peer-reviewed quantitative and qualitative articles were synthesized and critically appraised by 4 reviewers. RESULTS: The authors identified 46 articles with a focus on mentoring in nursing of which 12 articles include mentoring for nurse practitioners. Research indicates that mentoring relationships are valuable in many healthcare roles and professions. Evidence is limited indicating the impact of mentoring in the highly specialized role of the NNP. CONCLUSION: Mentoring is an invaluable component of professional nursing and counters incivility while advancing competency, job satisfaction, and retention. Additional research is needed regarding NNP-specific mentoring programs.

Peer feedback: A tool to improve PA, NP, and physician collaboration and clinical practice.

ABSTRACT: The increasing use of physician associates/assistants (PAs) and NPs on clinical teams creates an opportunity for colleagues to provide feedback that can drive growth and improvement in PA and NP clinical skills. Through a needs assessment, month-long pilot, and buy-in from our academic hospital medicine group, we initiated a peer feedback platform that sought to highlight individual faculty strengths, facilitate thoughtful and constructive feedback, and create effective collaboration among colleagues. Three months after implementation, results indicated that the platform provided important information on clinical skills and identified areas for growth and opportunities for additional training. Peer feedback can also improve working relationships among PAs, NPs, and physicians by highlighting the clinical skill sets and value of all team members.

Supporting Nurse Professional Development Practitioners Through an Academic-Practice Pilot Initiative.

BACKGROUND: Nurse professional development practitioners (NPDPs) support licensed nurses as they transition into practice. The NPDPs themselves benefit from opportunities to grow professionally in their role as educators. METHOD: A nursing school and hospital leadership pilot initiative was conducted to support staff development for NPDPs at a Midwestern health system. Four sessions were developed by academic educators and presented to NPDPs: educational theory, backward curricular design, active learning strategies, and assessment and evaluation principles. RESULTS: The NPDPs who attended the seminar indicated that the program objectives were met and identified at least one change they planned to make in planning, course design, or evaluation. In addition, they requested future professional development opportunities. Planning and implementation of this pilot educational seminar provided valuable content for NPDPs. CONCLUSION: This pilot model can strengthen academic-practice partnerships and support ongoing staff development. [J Contin Educ Nurs. 2024;55(5):253-256.].

How Implementing a Digital Competency Management System Reduced Nurse Training Cost and Improved NPD Practitioner Satisfaction in a Pediatric Hospital.

BACKGROUND: Traditional competency evaluations and manual tracking created a problem within one organization. Subjective competency assessments and inconsistent recordkeeping resulted in increased organizational costs. These factors increased the workload of nursing professional development (NPD) practitioners, leading to job dissatisfaction and turnover. METHOD: The project lead evaluated how implementing a digital competency management system (CMS) affected nurse training costs and assessed NPD practitioners' satisfaction after the digital CMS conversion. RESULTS: A cost analysis compared training costs before and after implementation of a digital CMS. A pre- and postsurvey compared NPD practitioners' satisfaction before and after digital implementation. A digital CMS provided a centralized repository and educational platform, which saved $500,000 in training costs and increased NPD practitioners' job satisfaction by decreasing workload and creating meaningful mechanisms to accurately assess staff knowledge and skills. CONCLUSION: The NPD practitioners showed tangible outcome measures and return on investment by combining adult learning and technology. [J Contin Educ Nurs. 2024;55(5):239-245.].

A systematic review: Clinical education and preceptorship during nurse practitioner role transition.

BACKGROUND: The demand for nurse practitioners (NP) is growing; however, the NP role transition is difficult. NP role transition starts with NP student entering the program and can last for as long as two years post-graduation. NP clinical education and preceptorship model is outdated and is in need of restructuring. PURPOSE: The purpose of this literature review was to describe and explain the issues and resources within the NP clinical education and preceptorship that is used to support NPs' role transition both before and after graduation. METHODS: The search years included 2010-2022. The following search terms were used: graduate nurse, advanced nursing, nurse practitioner, APRN, masters prepared, advanced nurse, nursing student, practicum, residency programs, residencies, school, program, clinical, clinical education, nursing education, health education, training, clinical site, student, preceptor, preceptorship, apprenticeship, mentor, mentorship, transition, role transition, role change, nurse's role, primary care, qualitative research, collaboration, and clinical competence. RESULTS: In this review pre-graduation persistent issues with availability of clinical sites and preceptors as well as lack of consistency in competency based clinical education assessment practices were identified. Difficult transition to practice post-graduation showed inconsistent and limited support available to further develop the newly graduated entry level NPs' clinical skills. CONCLUSION: Restructuring the old clinical education and preceptorship model used during the pre-graduation NP role transition stage is necessary to improve NP role transition process and graduate the required number of practice ready NPs.

PRIME-nurse practitioner competency model validation and criterion based OSCE rubric interrater reliability.

The PRIME-NP (Professional-Reporter-Interpreter-Manager-Educator/Evaluation-Nurse Practitioner) Model is adapted from the RIME (Reporter-Interpreter-Manager-Educator) model used in medical education to guide medical student and resident education. The Delphi technique was used to validate the PRIME-NP Model. After two rounds of review by a group of experts in NP curriculum, the model was determined to be valid based on expert consensus. Agreement percent increase from the first round to the second round in all categories. Interrater reliability (IRR) was assessed using interclass correlation after instrument validation was completed for each of the five levels of the PRIME-NP model. Overall, the IRR of the instrument was found to be acceptable with some notable exceptions. No variance was noted in professional behaviors at any level. Variance was increased in management and educator/evaluator behaviors in higher/later course levels. The PRIME-NP Model and PRIME-NP OSCE Rubric is a valid and reliable instrument to assess NP student progression in objective structured clinical examinations. This instrument has the potential for adaptation for use in other types of health sciences education and settings.

Game-based learning to improve diagnostic accuracy: a pilot randomized-controlled trial.

OBJECTIVES: Perform a pilot study of online game-based learning (GBL) using natural frequencies and feedback to teach diagnostic reasoning. METHODS: We conducted a multicenter randomized-controlled trial of computer-based training. We enrolled medical students, residents, practicing physicians and nurse practitioners. The intervention was a 45 min online GBL training vs. control education with a primary outcome of score on a scale of diagnostic accuracy (composed of 10 realistic case vignettes, requesting estimates of probability of disease after a test result, 0-100 points total). RESULTS: Of 90 participants there were 30 students, 30 residents and 30 practicing clinicians. Of these 62 % (56/90) were female and 52 % (47/90) were white. Sixty were randomized to GBL intervention and 30 to control. The primary outcome of diagnostic accuracy immediately after training was better in GBL (mean accuracy score 59.4) vs. control (37.6), p=0.0005. The GBL group was then split evenly (30, 30) into no further intervention or weekly emails with case studies. Both GBL groups performed better than control at one-month and some continued effect at three-month follow up. Scores at one-month GBL (59.2) GBL plus emails (54.2) vs. control (33.9), p=0.024; three-months GBL (56.2), GBL plus emails (42.9) vs. control (35.1), p=0.076. Most participants would recommend GBL to colleagues (73 %), believed it was enjoyable (92 %) and believed it improves test interpretation (95 %). CONCLUSIONS: In this pilot study, a single session with GBL nearly doubled score on a scale of diagnostic accuracy in medical trainees and practicing clinicians. The impact of GBL persisted after three months.

The psychiatric-mental health nurse practitioner as coordinating practitioner in the Netherlands: A multiple case study.

BACKGROUND: Psychiatric-mental health nurse practitioners (PMHNPs) in the Netherlands have been allowed to perform the role of coordinating practitioner (CP) since 2018. This role is reserved for mental health care specialists who are trained and qualified at the master's degree level. Earlier studies have not addressed how PMHNPs perform that role and what mechanisms and contextual factors determine their performance. This understanding could help optimize their performance in this role and promote effective deployment of PMHNPs in mental health care. PURPOSE: To understand how PMHNPs perform this role and what mechanisms and contextual factors underlie that performance. METHODOLOGY: A multiple case study involving PMHNPs who work in various settings as CPs. Data were collected and analyzed using the realistic evaluation approach. RESULTS: We identified four mechanisms related to the performance of PMHNPs in the role of CP: (1) autonomous performance; (2) unique expertise; (3) accessibility, availability, and professional involvement; and (4) additional roles. The extent to which these mechanisms are present is largely determined by organizational factors, team factors, and individual factors. CONCLUSIONS: Psychiatric-mental health nurse practitioners are seeking to identify and interpret the role of CP. This study helps to elucidate the mechanism of role performance by PMHNPs and what they should focus on to deliver effective and patient-centered mental health care. IMPLICATIONS: Policymakers, health care professionals, and educators should consider the mechanisms and contextual factors to facilitate and support PMHNPs' employment and training in the role of CP.

Gaining experience in the provider role: Exploration of a novel simulation intervention to prepare nurse practitioner students to detect and manage skin cancer.

BACKGROUND: The high prevalence and negative outcomes associated with skin cancer demand effective strategies to prepare nurse practitioner students to detect cancerous lesions and manage patient care. However, few studies have examined dermatologic simulations to prepare nurse practitioner students to detect and manage skin cancer. PURPOSE: An exploratory-descriptive qualitative approach was used to examine nurse practitioner students' experiences with simulations involving standardized patients wearing three-dimensional (3-D) prosthetic skin lesions, perceptions of ability to apply the simulations to clinical practice, and preferences for learning dermatologic care. METHODOLOGY: A convenience sample of 39 nurse practitioner students participated in simulations with standardized patients wearing 3-D skin lesions. Focus groups were conducted following simulation participation, and thematic analysis was performed by two researchers. RESULTS: Four themes emerged: Simulation provides a safe place to practice , Dermatology should be an integral part of education , Realism makes a difference , and Improved confidence and preparation for practice . CONCLUSIONS: Simulations with standardized patients wearing 3-D skin lesion prosthetics provided students the opportunity to assess, diagnose, and manage the care of patients with cancerous skin lesions. Participants valued the realistic practice with dermatologic care and reported improved confidence and preparation for practice. IMPLICATIONS: Faculty can use simulations to provide experiential learning about the provider role in general and as it pertains to skin cancer care. Attention to realism is important to aid in building students' confidence and preparation for practice.

Telehealth Simulation: Effect on Nurse Learner Knowledge, Confidence, and Attitudes.

ABSTRACT: Limited research explores the effectiveness of educational interventions in meeting telehealth technology competencies. A combined didactic and simulation intervention was implemented with 66 prelicensure and 15 nurse practitioner students. Telehealth knowledge, confidence, and attitudes were evaluated using the Telemedicine Objective Structured Clinical Exam survey. Results were analyzed using descriptive and inferential strategies, and responses to an open-ended question were content analyzed. Survey scores significantly increased from pre- to post-intervention. Learners recognized the value of telehealth and the educational intervention. This effective and well-received intervention can be used by schools of nursing to facilitate student attainment of telehealth competencies.

Use of Simulation to Integrate Behavioral Health Into Primary Care Nurse Practitioner Programs.

BACKGROUND: Identifying and treating acute and chronic behavioral health conditions is integral to primary care practice, yet primary care nurse practitioner (NP) training models do not meet the demand for integrated behavioral health practices. Simulation offers an effective pedagogical tool for integrating behavioral health training in primary care. METHOD: With support from federal funding and external consultants, new didactic and complementary simulation curricula in integrated behavioral health care were introduced in the primary care and psychiatric mental health NP programs at a school of nursing. Two rounds of this curricular innovation were implemented and evaluated across specialties. RESULTS: Ninety-seven students participated in the training and reported enhanced behavioral-health assessment and hand-off skills, greater confidence in applying core content, and improved communication skills. CONCLUSION: Thoughtfully designed simulation offers an important tool for developing integrated behavioral health competencies that will help prepare future primary care clinicians meet the needs of patients and communities. [J Nurs Educ. 2024;63(2):128-133.].

Nurse practitioner education: Uniting the 2021 essentials with The Core Competencies on Disability Health Care Education.

ABSTRACT: People with disabilities (PWD) are the largest minority group in the world, making up 16% of the world's population, an estimated 1.3 billion people. People with disabilities die earlier, have poorer health outcomes, and are more affected by emergencies and natural disasters. Factors contributing to health inequities can be characterized as socioeconomic, political, involve social determinants of health, include higher risk factors, and display a wide spectrum of health system barriers. Too often, health care training programs exclude specific standards for disability training. By mapping the new American Association of Colleges of Nursing (AACN) The Essentials: Core Competencies for Professional Education with The Core Competencies for Disability Health Care Education , we can provide a synergistic relationship that will prepare future advanced practice nurses to provide effective care to people with disabilities across the lifespan and in every delivery care system.