Clinical decision-making processes among graduate nurses, specialist nurses and nurse practitioners A collaborative international study.

AIM: To explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. BACKGROUND: Clinical decision-making in an emergency department environment is a complex process often occurring in times of crisis. It is an important aspect contributing to the quality of care. However, empirical research is limited regarding the decision-making process in different nursing roles. METHODS: In accordance with the consolidated criteria for reporting qualitative research, a qualitative and observational study was conducted to explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. Six Registered Nurses, six Nurse Specialists and six Nurse Practitioners were observed. A total of 40 hours of observation was made at each setting according to a structured observation guideline, followed by clarifying questions. The data material was analysed by means of a qualitative manifest and latent content analysis. RESULTS: Three themes arose: acting in accordance with routines, previous experience and intuition; considering patient experience; and facilitating new alternatives based on critical thinking. The Registered Nurses mainly used the first approach, the Nurse Specialists used the first and the second approaches, and the Nurse Practitioners used all three approaches. CONCLUSIONS: The results highlight the differences in decision-making processes between these groups. Nurse Practitioners were the only group that facilitated and evaluated new alternatives using their clinical autonomy, such as stepping up and making independent and collaborative decision-making. IMPLICATION: The results can be used in countries developing advanced practice nursing education and defining their scope of practice to inform stakeholders.

Dealing with a case of possible emotional neglect of a child in primary care.

Catherine is an advanced nurse practitioner working in a large general practice in the north of England. She works alongside her medical colleagues and receives and treats patients with undifferentiated complaints. Marcelina is bringing 6-year-old Nathaniel to see her.

Transition of New Graduate Nurses to the Workforce: Challenges and Solutions in the Changing Health Care Environment.

New graduate nurses face a host of challenges that impact successful transition to practice. Health care organizations thus need to understand how changes in the health care landscape impact new graduate nurses who are transitioning to the practice environment. This commentary discusses challenges and possible solutions to successful transition of new graduates into the work environment.

Implementation of a nurse practitioner service in a rural setting: a qualitative analysis of healthcare practitioners' experiences.

BACKGROUND: Nurse Practitioners work independently and collaboratively within multidisciplinary teams to fill unmet service delivery needs. Despite strong evidence of the benefits of the nurse practitioner service model, organisational support for nurse practitioners varies in terms of resources and support from leadership and other healthcare professionals. AIMS: The study aimed to explore healthcare practitioners' experiences of implementation of a NP service in a rural setting. METHODS: Semi-structured interviews were conducted with ten healthcare practitioners to investigate their perspectives of a recently implemented NP service. Data were analysed inductively using thematic analysis. FINDINGS: Themes emerged related to facilitating collaborative practice, person-centred continuity of care and positive health outcomes for the community. Challenges and limitations related to operational role clarity, scopes of practice and leadership. CONCLUSION: Healthcare practitioners were mostly satisfied with the service however challenges caused tension. Change management principles provide a framework to strengthen the effective clinical alignment of the service.

Work characteristics, job satisfaction and intention to leave: a cross-sectional survey of advanced nurse practitioners.

BACKGROUND: Advanced Nurse Practitioners (ANPs) are highly skilled health care professionals with the potential to play a major role in improving the quality and accessibility of health care services. However, there is emerging evidence of disquiet among nurse practitioners who often work in suboptimal work environments. Therefore, it is important to understand the elements that contribute to ANPs' job satisfaction and retention in healthcare services. AIM: To examine the effects of commitment to the workplace, work engagement, and influence at work on job satisfaction and intention to leave of ANPs. METHODS: A total of 153 ANP's on the advanced practice section of the Nursing and Midwifery Board of Ireland register completed a web survey between July and August 2020. Independent variables (commitment to the workplace, work engagement, and influence at work) were measured using the Copenhagen Psychosocial Questionnaire (COPSOQ). Multivariable logistic regression models were used to investigate the association between dependent and independent variables. RESULTS: Participants who reported higher levels of influence at work and higher levels of commitment to the workplace were also satisfied in their job (OR 1.05, 95% CI 1.01-1.09, p = 0.025), (OR 1.10, 95% CI 1.06-1.14, p < 0.001) respectively. Additionally, ANPs with higher levels of commitment to work were significantly less likely to leave their role (OR 0.94, 95% CI .92-.96, p < 0.001). CONCLUSION: Healthcare organisations can improve job satisfaction and decrease intention to leave by creating environments in which ANPs are supported by their colleagues and supervisors, and facilitate their practice to the full extent of their capabilities.

Nurse practitioner faculty attitudes about interprofessional education.

BACKGROUND: Nurse practitioner (NP) faculty attitudes toward interprofessional education (IPE) can be barriers to the shift in culture and successful implementation of IPE into nursing curricula. A paucity of studies exist comparing faculty attitudes of IPE with different educational modalities. PURPOSE: The purpose of this research is to compare NP faculty attitudes toward IPE between IPE experiences and educational modalities in NP academic programs. METHODOLOGY: A quantitative cross-sectional comparative design was used. An electronic survey was advertised to approximately 3,000 members of the National Organization of NP Faculties by email blasts to assess their attitudes toward IPE in the academic setting. RESULTS: Participating NP faculty ( n = 208) completed the survey, with a response rate of 6.9%. The results showed that NP faculty reported positive attitudes toward IPE ( M = 4.33). Nurse practitioner faculty attitudes toward IPE and participation in IPE experiences were not statistically significant ( p = .126). Nurse practitioner faculty attitudes toward IPE did not differ with the educational modality. The main effect of the NP degree program educational modality was not statistically significant, F (2, 172) = 0.74, p = .479. CONCLUSIONS: Nurse practitioner faculty are optimistic about IPE in multiple educational modalities but still have some reservations about how to implement IPE activities successfully. IMPLICATIONS: The NP faculty attitudes and barriers to IPE curricular development in all educational modalities must be addressed to prepare NP students to be competent collaborative practice-ready providers on graduation.

Perceptions of the advanced nurse practitioner role in a hospital setting.

AIM: To explore perceptions of junior doctors, nurses and advanced nurse practitioners (ANP) in relation to the role of the ANP. METHOD: A qualitative cross-sectional design was used, embedded in an interpretative philosophy. A non-probability sample of six junior doctors, six ward nurses and six ANPs took part in focus groups and individual semi-structured interviews. A mixture of phenomenological and grounded theory approaches were used to collect the data. FINDINGS: Four major themes were identified - diverse definitions of the ANP role between medical and surgical wards in the hospital at day compared to hospital at night work; role vagueness and ambiguity; communication and education needs; and constraints and barriers. The study found varied perceptions and understanding of the role of the ANP within the hospital at day. Conversely, the hospital at night concept seemed correctly perceived - the role appeared well-established, organised and orchestrated the appropriate responses as required in both medicine and surgery. During the hospital at day, nurses on medical wards were more inclined to use the medical staff as their first responders. The absence of the bleep filtering system in medicine during the day was identified as one of the main barriers. A definitive understanding of the role during the hospital at day has been recognised as the second main barrier. A constraint well known to the ANP team was the inability to provide a bleep filter system in medicine during the day. CONCLUSION: The study finds the need for improved education, clinical support and system management during the hospital at day, with more of an emphasis within medical wards.

Staying alert to ethical challenges.

Please replace the abstract with: Nurse practitioners (NPs) are faced with many ethical challenges. It requires moral courage to stand up for ones' beliefs and resolve ethical issues. Ethical challenges of NPs are discussed including some specific disciplinary situations involving a state board of nursing. Solutions that may help NPs stay alert to ethical challenges include ethics courses and lifelong mentoring. In this "Year of the Nurse and Midwife," NPs and other nurses should ensure that we maintain the designation of most trusted profession.

A UK Military nurse practitioner on Exercise SAIF SAREEA 3: the first Overseas deployment.

As the Queen Alexandra's Royal Army Nursing Corps celebrates its 70th Anniversary, army nursing continues to advance patient care delivery to new levels. Advanced level nursing practice has moved from the relatively 'calm' confines of the NHS to the austere desert of Oman. This article will provide a personal account of the first deployment of a military nurse practitioner since it was formally introduced in 2012 to frontline medicine, leading an armoured prehospital treatment team.

International service learning enhances nurse practitioner students' practice and cultural humility.

Academic and health care institutions are charged with improving quality-of-care outcomes by creating culturally educated health care professionals to practice in a global health care environment. International short-term service learning experiences provide nurse practitioner students an opportunity to meet clinical competency skills aligned with course curricula. Faculty can directly observe students' clinical practice, and students broaden diagnostic reasoning skills while earning credit for clinical hours. As project and research ideas are formulated, students develop system-level thinking to implement evidence-based practices and disseminate their knowledge and experience of caring for the underserved. Students who participate in service-learning opportunities foster their awareness of cultural humility, easing transition into practice. Some academic institutions established short-term service-learning opportunities for students, and evidence supports faculty and students' sense of well-being after participation. We describe an example of a short-term, international service-learning opportunity in Haiti where students work with an interprofessional team and experience the effect of social determinants of health on delivering quality care.

Addressing transgender patients' barriers to access care.

The transgender population faces several barriers to accessing quality medical care in the US healthcare system. This article examines the challenges that prevent this marginalized group from obtaining high-quality healthcare services and discusses how NP advocacy can help create a welcoming environment for transgender patients.

Fellowship Programs: Reflections of an Advanced Practice Nurse Fellow.

Newly graduated advanced practice nurses (APNs) often accept positions equipped only with brief, limited training and are expected to primarily learn on the job. APN fellowship programs, such as the oncology fellowship program at Sylvester Comprehensive Cancer Center (SCCC) in Florida, may be a solution to this problem; they provide in-depth training to APNs, offer support through open communication with preceptors, grant APNs opportunities to develop skills and confidence, and allow APNs the time to earn the trust of others at the institution and take on additional responsibilities. This article discusses such programs and focuses on the author's experiences as a fellow at SCCC.

Understanding employment contracts: What to know before you sign.

NPs are conscientious providers, but when it comes to their own careers, they may not be as careful to apply the same prevention strategies, monitoring, and hypervigilance that they use with their patients to avoid poor outcomes. This article identifies potential risks in employment contracts and offers suggestions for avoiding disputes.

Application Strategies and Tips for Using the Nursing Professional Development Practice Model.

In the past year since the 3rd edition of the Nursing Professional Development: Scope and Standards of Practice was released, many Nursing Professional Development departments across the nation have incorporated this foundational document into their practice. In this column, we continue to describe the activities of our colleagues to integrate the scope and standards into practice.

Learning from the Third World: health care in Nicaragua.

PIP: In this article, Candace Kugel, a family nurse practitioner in Pennsylvania who visited Nicaragua as part of an exchange program, describes her impressions of the country's health care system. Kugel is a member of the Project Gettysburg/Leon, a sister-city program that promotes cultural exchanges. She arrived in Nicaragua less than 2 weeks after the newly elected UNO government assumed power. In Leon, Kugel visited seven rural and urban clinics, the city's hospital, the health education organization, and the medical, dental, and nursing schools. In all health facilities, she discovered politically energized and committed health care workers. It is this determination that allows then to continue working in spite of perpetual shortages of even the most basic supplies. The hospital was out of insulin, and was having to reuse bulb syringes for newborns. One clinic lacked water supply. Kugel also found nurses to be in short supply. As she explains, the physicians outnumber professional nurse 3-1. Because of low salaries, 1 6-day work schedule, and staffing shortages, few are interested in becoming nurses. Furthermore, the nursing school is severely ill-equipped. Nonetheless, Nicaragua's health care system has accomplished health: immunization, family planning, prenatal care, well-child screening, health education, and treating open water for malaria and dengue-bearing mosquitoes. From 1979-88, infant mortality dropped from 93/1000-62/1000, and life expectancy increased from 56-63.3 years. Additionally, Nicaraguans now consider health care a right, not a privilege. Kugel hopes that with the end of the US embargo and the renewal of US aid, Nicaragua will accomplish even more.^ieng

The role of nurse practitioners in primary care groups.

The author of this article is a newly elected member of the Hammersmith primary care group. She describes how she developed the role, learned new responsibilities and discovered opportunities to improve her work with patients.