Patient-Centered Care Through Nurse Practitioner-Led Integrated Behavioral Health: A Case Study.

Integrated behavioral health can improve primary care and mental health outcomes. Access to behavioral health and primary care services in Texas is in crisis because of high uninsurance rates, regulatory restrictions, and lack of workforce. To address gaps in access to care, a partnership formed among a large local mental health authority in central Texas, a federally designated rural health clinic, and the Texas A&M University School of Nursing to create an interprofessional team-based health care delivery model led by nurse practitioners in rural and medically underserved areas of central Texas. Academic-practice partners identified 5 clinics for an integrated behavioral health care delivery model. From July 1, 2020, through December 31, 2021, a total of 3183 patient visits were completed. Patients were predominantly female (n = 1719, 54%) and Hispanic (n = 1750, 55%); 1050 (33%) were living at or below the federal poverty level; and 1400 (44%) were uninsured. The purpose of this case study was to describe the first year of implementation of the integrated health care delivery model, barriers to implementation, challenges to sustainability, and successes. We analyzed data from multiple sources, including meeting minutes and agendas, grant reports, direct observations of clinic flow, and interviews with clinic staff, and identified common qualitative themes (eg, challenges to integration, sustainability of integration, outcome successes). Results revealed implementation challenges with the electronic health record, service integration, low staffing levels during a global pandemic, and effective communication. We also examined 2 patient cases to illustrate the success of integrated behavioral health and highlighted lessons learned from the implementation process, including the need for a robust electronic health record and organizational flexibility.

Novice nurse practitioners' employment decisions and role transition experiences during COVID-19.

BACKGROUND: While it is known how the COVID-19 pandemic affected providers already employed and working in health care settings, there is little data about the effect it may have had on novice nurse practitioners (NPs). PURPOSE: The purpose of this study was to describe novice NPs' employment decisions and role transition experiences during the COVID-19 pandemic. METHOD: Via an online survey, novice NPs were asked open-ended questions about how the pandemic influenced the decision to take their first position and their role transition experience, as well as what employers did well or could have done better to facilitate this transition. FINDINGS: Participants described employment challenges that included a difficult job market with limited employment opportunities, decreased pay and benefits, fewer onboarding and mentorship opportunities, and less primary care experience. However, NPs reported the pandemic positively influenced their role transition experiences with decreased patient workload and greater use of telehealth. CONCLUSION: Novice NPs were impacted by the COVID-19 pandemic in making employment decisions and transitioning into the NP role.

Experiences of nurse practitioners working during the COVID-19 pandemic: A metasynthesis of qualitative studies.

BACKGROUND: The impact of the COVID-19 pandemic forced global changes to how nurses practice. Nurse practitioners adjusted their scope, changed how they delivered their service, and worked with limited resources. For some services, patient access was also compromised. OBJECTIVES: To synthesize, combine, and present current evidence on the experiences of nurse practitioners working during the COVID-19 pandemic. DATA SOURCES: CINAHL, Embase, and MEDLINE electronic databases were used to perform a structured search strategy. CONCLUSION: During the COVID-19 pandemic, health care services had to leverage their workforce skills to accelerate COVID-19 identification, treatment, and care. Nurse practitioners rapidly found themselves at the forefront and were concerned about infecting others. They also identified the need for support and were able to adapt to the changing environment. Nurse practitioners also recognized the impact on their well-being. Having insight into nurse practitioner's experiences during the pandemic is valuable for future health care workforce planning. Understanding how they coped will help with critical preparedness and response actions to other health care crises. IMPLICATIONS FOR PRACTICE: Having insight into nurse practitioner's experiences during the pandemic is valuable for future health care workforce planning because, as we know, the nurse practitioner workforce is one of the most rapidly growing professions in primary health care. Any future work in this space will help inform future nurse practitioner education and also help by informing critical preparedness and response actions to future health care crises, whether global or local or clinical or nonclinical.

Comparing satisfaction and outcomes in on-campus versus virtual education for nurse practitioner students.

ABSTRACT: This article highlights the development and implementation of interactive training experiences for graduate nursing students as part of specialty training in endocrinology. Emphasis was placed on accomplishing the shift from on-campus to virtual training while maintaining fidelity and student satisfaction. A total of 106 graduate nursing students from five cohorts submitted evaluations. Student satisfaction remained high regardless of whether the content was delivered in person or virtually. Most students in the virtual cohorts evaluated the online training positively. Student presentation grades were highest with on-campus delivery. Transitioning in-person training to a virtual environment can be an effective method of delivering nurse practitioner education while promoting student satisfaction. Recommendations for optimizing hybrid learning experiences are offered based on adult learning principles.

Community Health Outside the Exam Room: Extracurricular Learning to Augment Nurse Practitioner Student Practice Readiness.

BACKGROUND: The curricular requirements of nurse practitioner (NP) programs are well established. NP students' clinical practicums provide a context for the extracurricular acquisition of administrative, operational, and systems-focused NP skills. PROBLEM: Acquisition of extracurricular NP skills is variable and highly dependent on a student's clinical placements. The COVID-19 pandemic exacerbated this variability by limiting students' access to traditional clinical rotations. APPROACH: With our practice partners, we inventoried the behaviors that are associated with new graduate NP readiness for practice in community health centers. We then developed an extracurricular seminar series to develop these behaviors. Each seminar in the series was presented by a preceptor. OUTCOMES: Students reported gains in their perceived readiness to practice. The casual format and preceptor presenters were highly valued by students. CONCLUSIONS: NP educators should consider leveraging academic-practice partnerships to standardize students' acquisition of administrative, operational, and systems-focused NP competencies.

Peer patient round table: An innovative approach for evaluating clinical performance for nurse practitioner students.

Clinical performance is a crucial part of evaluation in nurse practitioner education and has traditionally been accomplished through faculty site visits. The evolution of distance learning and on-line programs along with the recent COVID-19 pandemic has further complicated completing site visits, requiring innovative strategies. 'The Peer Patient Round Table (PPRT)' was developed as an innovative evaluation method of student performance. It utilizes the standardized patient simulation concept and shared role-play modality via a telehealth platform. During the PPRT evaluation session, students were involved in a shared role-play of three roles; as a patient, a nurse practitioner student, and a preceptor in individual scenarios. A family nurse practitioner program at Radford University, located in Southwest Virginia, incorporated the PPRT method as the alternative student evaluation method starting May 2020 during COVID-19 pandemic for the last two years. After the first year of implementation of the PPRT, students and faculty were surveyed about the effectiveness of PPRT as a clinical evaluation method as well as their satisfaction with the modality. This article discusses the details of the PPRT procedures, PPRT experiences from faculty and students along with lessons learned.

State Variation in the Utilization of Nurse Practitioner-Provided Home-Based Primary Care: A Medicare Claims Analysis.

Nurse practitioners (NPs) provide an increasing proportion of home-based primary care, despite restrictive scope of practice laws in approximately one half of states. We examined the relationship between scope of practice laws and state volume of NP-provided home-based primary care by performing an analysis of 2018 to 2019 Medicare claims. For each state we calculated the proportion of total home-based primary care visits by NPs and the proportion of all NPs providing home-based primary care. We used the 2018 American Association of Nurse Practitioners classification of state practice environment. We performed chi-square tests to assess the significance between volume and practice environment. We found that 42% of home-based primary care is delivered by NPs nationally, but substantial variation exists across states. We did not find a discernible or statistically significant pattern of uptake of NP-provided home-based primary care across full, reduced, or restricted states. [Journal of Gerontological Nursing, 49(5), 11-17.].

Psychiatric Emergencies and the Potential Role of Psychiatric-Mental Health Nurse Practitioners.

Emergency departments (EDs) are experiencing a worsening crisis of overcrowding, especially during the coronavirus pandemic. Persons experiencing psychiatric emergencies must be evaluated medically and screened for risks of harm to self or others before they can be cleared for transfer to inpatient units or discharged. Severe shortages of inpatient psychiatric beds can lead to hours or even days of costly boarding in the ED. The purpose of this article is to examine the potential role of psychiatric-mental health nurse practitioners in psychiatric ED care, from initial intake and medical clearance, screening for suicide risk, de-escalation, stabilization, and discharge. [Journal of Psychosocial Nursing and Mental Health Services, 59(3), 7-12.].

The New York State COVID-19 Healthcare Personnel Study: One-Year Follow-up of Physicians, Nurse Practitioners, and Physician Assistants, 2020-2021.

OBJECTIVES: The COVID-19 Healthcare Personnel Study is a longitudinal survey to assess the changing impact of the COVID-19 pandemic on the New York State health care workforce. We analyzed results from a follow-up survey of physicians, nurse practitioners, and physician assistants on the availability of equipment and personnel, work conditions, physical and mental health of participants, and impact of the pandemic on commitment to their profession. METHODS: We conducted an online survey of all licensed New York State physicians, nurse practitioners, and physician assistants in April 2020 (N = 2105) and a follow-up survey in February 2021 (N = 978). We analyzed changes in item responses from baseline to follow-up. We calculated survey-adjusted paired t tests and odds ratios (ORs) using survey-adjusted generalized linear models controlling for age, sex, region of practice, and hospital versus non-hospital-based practice. RESULTS: Twenty percent of respondents expressed continuing concern about personnel shortages at both baseline and follow-up. Respondents reported working approximately 5 more hours on average during a 2-week period at follow-up compared with baseline (78.1 vs 72.6 hours; P = .008). For 20.4% (95% CI, 17.2%-23.5%) of respondents, mental health issues had become persistent. More than one-third (35.6%; 95% CI, 31.9%-39.4%) of respondents reported that they thought about leaving their profession more often than once per month. The association between persistent mental and behavioral health issues and contemplating leaving one's profession was significant (OR = 2.7; 95% CI, 1.8-4.1; P < .001). CONCLUSIONS: Interventions such as decreasing the number of hours worked, ensuring health care professionals do not work directly with patients while ill, and addressing shortages of personal protective equipment can help address concerns of the health care workforce.

Nurse practitioner/physician collaborative models of care: a scoping review protocol.

BACKGROUND: Before the COVID-19 pandemic, many long-term care (LTC) homes experienced difficulties in providing residents with access to primary care, typically delivered by community-based family physicians or nurse practitioners (NPs). During the pandemic, legislative changes in Ontario, Canada enabled NPs to act in the role of Medical Directors thereby empowering NPs to work to their full scope of practice. Emerging from this new context, it remains unclear how NPs and physicians will best work together as primary care providers. NP/physician collaborative models appear key to achieving optimal resident outcomes. This scoping review aims to map available evidence on existing collaborative models of care between NPs and physicians within LTC homes. METHODS: The review will be guided by the research question, "What are the structures, processes and outcomes of collaborative models of care involving NPs and Physicians in LTC homes?" This scoping review will be conducted according to the methods framework for scoping reviews outlined by Arksey and O'Malley and refined by Levac et al., Colquhoun et al., and Daudt et al., as well as the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Statement. Electronic databases (MEDLINE, Embase + Embase Classic, APA PsycInfo, Cochrane Central Register of Controlled Trials, AMED, CINAHL, Ageline, and Scopus), grey literature, and reference lists of included articles will be searched. English language studies that describe NP and physician collaborative models within the LTC setting will be included. DISCUSSION: This scoping review will consolidate what is known about existing NP/physician collaborative models of care in LTC homes. Results will be used to inform the development of a collaborative practice framework for long-term care clinical leadership.

Contemporary adult gerontology acute care nurse practitioner (AGACNP) practice: Findings from the 2020 American Association of Critical Care Nurses AGACNP practice analysis survey.

BACKGROUND: National standards for nurse practitioner licensure require certification programs to conduct practice analyses to ensure that certified nurse practitioners possess the necessary knowledge for entry-level practice. The practice analysis for the American Association of Critical Care Nurses Certification Corporation (AACN Cert Corp) adult-gerontology acute care nurse practitioner (AGACNP) credential is performed every five years by the AACN Certification Corporation. PURPOSE: The AACN Cert Corp conducted a practice analysis to confirm that current AGACNP practice is reflected in the ACNPC-AG test plan, and the examination is congruent with 2008 consensus model guidelines. This work describes findings from the 2020 AACN Cert Corp practice analysis and changes in AGACNP practice and academic preparation based on the survey data. METHOD: In 2020, AACN Cert Corp volunteer subject matter experts (SMEs) developed a survey of practice activities and competencies relevant to AGACNP practice. Patient care activities and competencies were rated by AGACNP respondents for criticality and frequency. AACN SMEs reviewed criticality and frequency ratings to determine the patient care problems, skills/procedures, and competencies to include in the updated AACN Cert Corp ACNPC-AG test plan. RESULTS: The 2020 AGACNP practice analysis survey and subsequent review resulted in the retention of 33 skills and procedures, 165 patient care problems, and all national competencies in the final ACNPC-AG test plan. CONCLUSIONS AND IMPLICATIONS: The 2020 AACN Cert Corp AGACNP practice analysis survey describes possible changes in AGACNP practice and academic preparation that have occurred since the 2016 survey, findings that may be associated with the ongoing COVID-19 pandemic.

Nurse practitioner job preference: A discrete choice experiment.

BACKGROUND: Nurse practitioners play a critical role in improving the access to care and in meeting the needs for health care. However, prior to the COVID-19 pandemic, the average turnover rate of nurse practitioners was 10 % with associated total direct cost that ranged from $85,832 to $114,919 for each episode of turnover in the United States. Little is known about the job preference of nurse practitioners and the cost savings to an organization that provides jobs with characteristics attractive to nurse practitioners. OBJECTIVE: The aim of this study was to identify the preferred job characteristics that are associated with nurse practitioners' job choices; and to determine the extent to which nurse practitioners would need to be compensated for practicing without these characteristics. DESIGN: A two-stage design using a mixed method approach. SETTING(S): The state of Georgia in the United States. PARTICIPANTS: 2757 nurse practitioners who were actively licensed were invited to participate. Of the 412 participants, 372 actively employed in Georgia were included in the analysis. METHODS: A 2-stage discrete choice experiment was designed. Stage-1 was a qualitative design using a focus group to identify nurse practitioners' preferred job characteristics. Stage-2 was a quantitative design using survey distribution and analysis. A mixed logit model was used for ranking nurse practitioners' preferred job characteristics and the extent to which they would need to be compensated. RESULTS: On average nurse practitioners were 47.4 years of age; the majority were female (90 %), white (75.3 %), and educated at the master's level (88.7 %). Participants did not value teams that were not very cohesive (ß = -1.50); administration that was not very responsive and supportive (ß = -1.04); being supervised by a physician (ß = -0.58); not having their own panel of patients (ß = -0.42); and not billing under their own National Provider Identifier (ß = -0.18). Participants would need an increase in annual income of USD$21,780 for practicing in a not very cohesive team; USD$15,280 for practicing with a not very responsive administration; and USD$21,450 for being supervised by a physician. CONCLUSIONS: A cohesive, responsive, and supportive working environment and being able to practice independently are important characteristics for nurse practitioners when choosing a job. Healthcare managers should provide a workplace culture that reflects these preferred job characteristics to attract and retain nurse practitioners. Policymakers should consider reforming the scope of practice legislation to promote the independent practice of nurse practitioners.

Burnout Syndrome in Nursing Professionals in COVID -19 Intensive Care / Síndrome de Burnout em Profissionais de Enfermagem na Terapia Intensiva de COVID-19 / Síndrome de Burnout en Profesionales de enfermería en Terapia Intensiva de COVID-19

Abstract The COVID-19 pandemic evidenced a scenario of increased demands on health professionals that can lead to professional burnout. This study aimed to investigate Burnout Syndrome (BS) and associated factors in nursing professionals working in intensive care units (ICU) of the public service during the COVID-19 pandemic. 157 professionals were evaluated regarding sociodemographic, occupational and working conditions variables, and the Maslach Burnout Inventory (MBI) was used. The prevalence of BS was 45.2%, with some professionals suffering from more than one factor of the syndrome: emotional exhaustion (28.7%), depersonalization (3.8%) and low professional fulfillment (24.8%). Logistic regression analysis in the final model showed that female gender, not having children, statutory bond, professionals who had COVID-19 and declared wanting to leave the ICU environment had a higher risk of BS. The results showed BS in nursing professionals and that new risk factors were added with the advent of the pandemic.

Resumo A pandemia de COVID-19 evidenciou um cenário de acréscimo de demandas aos profissionais de saúde que pode levar ao esgotamento profissional. Este estudo teve como objetivo investigar a Síndrome de Burnout (SB) e fatores associados em profissionais de enfermagem nas unidades de terapia intensiva (UTI) durante a pandemia de COVID-19. Foram avaliados 157 profissionais em relação às variáveis sociodemográficas, ocupacionais e condições de trabalho, e o Maslach Burnout Inventory (MBI) foi utilizado. A prevalência da SB foi de 45,2%, com alguns profissionais em mais de um fator da síndrome: exaustão emocional (28,7%), despersonalização (3,8%) e baixa realização profissional (24,8%). Análise de regressão logística no modelo final mostrou que o gênero feminino, não ter filhos, vínculo estatutário, profissionais que tiveram COVID-19 e que declararam querer sair do ambiente de UTI tiveram maior risco de presença da SB. Os resultados evidenciaram SB nos profissionais de enfermagem e que novos fatores de risco foram acrescidos com o advento da pandemia.

Resumen La pandemia de la COVID-19 evidenció un escenario de mayores exigencias a los profesionales de la salud que puede derivar en desgaste profesional. Este estudio tuvo como objetivo investigar el Síndrome de Burnout (BS) y factores asociados en los profesionales de enfermería en las unidades de cuidados intensivos (UCI) durante la pandemia. Los 157 profesionales fueron evaluados con relación a las variables sociodemográficas, ocupacionales y condiciones de trabajo, y se utilizó el Maslach Burnout Inventory (MBI). La prevalencia de SB fue del 45,2%, con algunos profesionales que sufren de más de un factor del síndrome: agotamiento emocional (28,7%), despersonalización (3,8%) y baja realización profesional (24,8%). El análisis de regresión logística mostró que el sexo femenino, no tener hijos, la relación laboral reglamentaria, los profesionales que contrajeron COVID-19 y que declararon querer salir del entorno de la UCI tuvieron un mayor riesgo de presencia de SB. Los resultados mostraron SB en profesionales de enfermería y que se agregaron nuevos factores de riesgo con el advenimiento de la pandemia.

Identifying barriers and facilitators for nurse practitioners' opioid management of chronic pain.

BACKGROUND: Drug overdose deaths greatly increased during the COVID-19 pandemic, with 100,306 cases occurring in the United States over 12 months from 2020 to 2021, an increase of 28.5% from the year before. Three quarters of these deaths involved opioids, and this epidemic has seriously complicated chronic pain management. The role of nurse practitioners (NPs) in opioid prescription has expanded since Affordable Care Act passage in 2010, but their prescription of opioids for chronic pain management is not well understood. OBJECTIVES: This integrative review aimed to identify barriers, facilitators, and other factors influencing NPs' management of chronic pain with opioids. DATA SOURCES: Five databases were searched for the highest level of evidence in articles published from 2011 to 2021. Search results were refined to focus on NPs' chronic pain management via opioid prescription. CONCLUSIONS: Nine studies were selected for the review. Six identified themes were indicative of barriers, facilitators, and other factors affecting NPs' opioid management: nurse practitioner education, patient subjectivity and patient education, systemic change and alternative treatment access, interprofessional collaboration, nurse practitioner prescriptive authority, and practice environment. States and schools of nursing should modify policy and curricula to better support NPs' opioid management and reduce associated prescription barriers. IMPLICATIONS FOR PRACTICE: NPs' opioid management can best be improved by providing them with current guideline-based education regarding opioid prescription, emphasizing patient education, supplying NPs with systemic support, encouraging interprofessional collaboration, and solving the prescriptive authority issues. Enhancing NPs' opioid prescription and chronic pain management knowledge would help to mitigate the opioid epidemic.

Stakeholder perceptions of the efficacy, barriers, and facilitators of telemental health clinical experiences during COVID for nurse practitioner students.

BACKGROUND: Telemental health services grew during the COVID pandemic, resulting in psychiatric-mental health nurse practitioner students obtaining clinical hours through this modality. Although patient outcome data demonstrate the efficacy of telemental health services, data on the efficacy of learning through telehealth clinical experiences are lacking. PURPOSE: To explore perceptions of learning through telehealth clinical experiences by students, preceptors, and faculty and to identify perceived barriers and facilitators to facilitating telehealth clinical experiences. METHODOLOGY: Mixed-methods exploratory study using web-based, researcher-designed, cross-sectional surveys eliciting perceptions of learning and perceived barriers and facilitators to telemental health clinical experiences sent to current and former PMHNP students and their preceptors of a state university in the southwest along with PMHNP faculty in the National Organization of Nurse Practitioner Faculties. Students and preceptors were offered the option to participate in a semistructured interview. RESULTS: Twenty students (35.7%), 22 preceptors (24.7%), and 19 faculty (25.3%) participated in the surveys. Three preceptors and three students volunteered for interviews. Telemental health clinicals were perceived by students as equivalent to or superior to in-person learning. Preceptors rated the teaching/learning environment through telemental health as equivalent or better as compared with in-person clinicals with two exceptions. Faculty-rated greatest barrier to telemental health clinicals was telephone visits because of technology issues. CONCLUSIONS: Telemental health clinicals can provide a high-quality learning experience for students. IMPLICATIONS: Preceptors should be provided with resources for facilitating telemental health clinicals. Ongoing discussions regarding the number of clinical hours recommended through telehealth are needed.

Assessing the impact of the COVID-19 pandemic on nurse practitioners' professional quality of life.

BACKGROUND: The COVID-19 global pandemic has put health care professionals under immense pressure and hindered their ability to provide quality services. PURPOSE: This study aimed to examine the professional quality of life (ProQOL) among Georgia nurse practitioners during the COVID-19 global pandemic. METHODOLOGY: The ProQOL survey was distributed to nurse practitioners in Georgia by the professional organization's listserv. Multiple analysis of variance (ANOVA) analyses were performed to assess differences between employment settings, geographic location, and other relevant demographic qualifiers and levels of compassion satisfaction, burnout, and secondary traumatic stress. RESULTS: Hundred nurse practitioners (NPs) (n = 100) responded to the survey. Ninety-one percent were female and ages 25-35 years. Male NPs showed higher rates of compassion fatigue and secondary traumatic stress. CONCLUSIONS: A ProQOL survey demonstrated increased burnout and secondary traumatic stress among frontline practitioners in Georgia due to increased workloads, feelings of inadequacy, fear of being infected by the virus, and prolonged exposure to deaths. IMPLICATIONS: Ensuring effective communication, team collaboration, emotional, adequate staffing, and psychological support can help reduce compassion fatigue among NPs.

Nurse practitioner practice under the COVID-19 public health emergency: Did policy change persist?

ABSTRACT: The COVID-19 public health emergency (PHE) offers opportunities to study legislative and policy changes to nurse practitioner (NP) practice limitations, including factors that affect persistence. We evaluated states with restricted or reduced practice as identified by the American Association of Nurse Practitioners. This analysis 1) identified and correlated key changes in policy during the PHE with state regulatory, governmental, and practice variables; 2) modeled predictive characteristics that facilitate or impede policy persistence; and 3) explored the lived experience of NPs working in eligible states with policy changes during the PHE. Focus group interviews with NP leaders and bivariate correlations with regression analysis from the 2019 to 2021 legislative sessions were conducted. Nurse practitioner identified three types of persistence during the PHE: the power differential between MDs and NPs; the existing day-to-day environment; and barriers to change. In 2019, significantly more legislation was passed in states with sunset laws (Spearman rho: -0.38; p -value = .046). During 2020, 15 states introduced a total of 22 bills focused on NP practice, although only four passed one bill each. In 2021, states with an independent board structure introduced more NP legislation than did those states with a nonindependent board structure (Spearman rho: -0.406; p -value = .032). Few PHE policies persisted, despite robust predictions that this was likely to occur. Independent board structure and sunset laws were associated with legislation introduction and passage. Policy persistence is complex and based on multiple state and environmental variables. We urge persistence in NP advocacy strategies.