Advanced Practice Nurse-Led Research: Challenges and Approaches to Digital Health Programs' Evaluation Using Big Data.

Advanced practice nurse leaders are in key positions within health systems to provide time and resources for implementation and evaluation of digital health services. As virtual monitoring programs become more embedded within nursing, nurse leaders and educators need to ensure that nurses are prepared to work within interprofessional teams to administer and evaluate them. This article discusses challenges and implementation strategy considerations for data curation and analysis using large datasets from the Medicaid population for research.

A cross-sectional study of United States Academic-clinical research collaborations: Characteristics, resources, benefits and outcomes.

AIMS: The aims of the study were to compare characteristics, resources, benefits and outcomes of academic-clinical collaborations of nursing researcher leaders from academic, clinical and joint-employer sites. BACKGROUND: Few research-based publications addressed academic-clinical research collaborations. New knowledge could increase nursing and multidisciplinary research productivity, including implementation science. DESIGN: An anonymous survey using a 40-item questionnaire. METHODS: Information letters with a link to the questionnaire were emailed to United States nursing research leaders. Data were grouped by institution type: academic, clinical or joint-employer. Analyses included Kruskal-Wallis tests for ordered responses, Pearson's chi-square test or Fisher's exact test for categorical responses and Cohen's Kappa agreement statistic for expected and actual time devoted to research. STROBE guidelines were followed. RESULTS: Of 120 respondents from academic (n = 60; 50.0%), clinical (n = 53; 41.2%) and joint-employer (n = 7; 5.8%) sites, 78.3%, 92.3% and 100%, respectively, were from metropolitan areas. Mean (SD) priority for active collaborations was higher at joint-employer sites; p = .002. Clinical sites were more likely to have directors of evidence-based practice (p = .031) and informatics (p = .008) and librarians (p = .029). Sites with collaborations were more likely to have access to research subjects (p = .008) and post-award research account management (p = .045). By collaboration status, there were no differences in the number of ethics board-approved studies. Collaborating site benefits were perceived to be executive leadership support (p = .003), greater research engagement by clinical nurses (p = .048), more co-authored publications (p = .048) and more abstracts accepted at national meetings (p = .044). Despite more resources and perceived benefits, outcomes did not differ by collaboration status. CONCLUSIONS: Sites with and without academic-clinical research collaborations differed; however, outcomes were similar. Future efforts should focus on nurse scientist collaboration to address important clinical questions aimed at improving clinical outcomes. RELEVANCE TO CLINICAL PRACTICE: Despite some successful outcomes, potential benefits of academic-clinical research collaborations have not been fully actualised.

Access to Care: End-to-End Digital Response for COVID-19 Care Delivery.

The coronavirus disease 2019 pandemic disrupted health care, requiring organizational leaders to act quickly to manage the health-related concerns of individuals and communities. The ability to offer a variety of digitally enabled telehealth services with 24/7 access to nurse practitioners and physician assistants allowed us to care for patients in their homes. It reduced the spread of the virus, protected our employees from further disease spread, and provided early interventions to those in need. The roles of nurse practitioner leaders, the enacted strategies, and patient outcomes demonstrate the impact of an innovative digital care delivery model on care across the continuum.

Medicaid expansion and accessibility to healthcare: The Illinois experience.

OBJECTIVE: The study examined the impact that the Medicaid expansion in Illinois had upon insurance rates, access to medical care, dental care, pharmaceuticals, and mental-health counseling between rural and urban counties. DESIGN AND SAMPLE: A serial cross-sectional design was used to assess the health perceptions of adults living in Illinois. MEASURES: Survey data were collected in 2012 (n = 6,149) before the Medicaid expansion in Illinois and in 2015 (n = 3,532) after the expansion from rural (n = 4) and urban counties (n = 4). INTERVENTION: Medicaid expansion reduced the uninsured rate in both rural (16.39%-4.87%) and urban counties (17.05%-5.2%) and improved self-reported health. It also increased access to all types of healthcare, with the biggest increase in dental coverage. RESULTS: Path analysis indicated that the Medicaid expansion ß = -1.03 (p < .01) and poor versus not poor ß = -1.50 (p < .01) were a significant predictor to no healthcare access. Rural verses urban location was not significant (ß = 0.04); however, race/ethnicity was significantly different (p < .01). CONCLUSION: Findings suggest that although the expansion has increased access to care overall, those who are the most vulnerable are still not benefiting equally from the expansion. Therefore, strategies to assist high-risk adults in enrolling and using their Medicaid coverage need to developed and implemented.

Exploring burnout and job stressors among advanced practice providers.

BACKGROUND: Minimal research exists on how engagement, burnout, work-family balance, and job stressors impact advanced practice nurses and physician assistants, collectively referred to advanced practice providers (APPs). PURPOSE: To investigate the interrelationships among burnout, job stressors, work-family balance, and engagement with APPs. METHODS: An online questionnaire was distributed to APPs working in four healthcare systems. A total of 1,216 APPs completed the survey. A hypothesized model was tested using structural equation modeling. FINDINGS: There was a high correlation of job stressors with development of burnout. A significant negative effect between job stress and work engagement was supported; however, indirect effects of stress through job burnout had a stronger impact on work engagement. Higher levels of work-family balance contributed to a lower level of stress experienced by providers. DISCUSSION: Organizational leaders desiring to improve employee engagement and reduce burnout need to focus on the significance of work-family balance to job stressors.

Fostering Academic-Clinical Research Partnerships.

Academic-clinical research partnerships can benefit academic and clinical partners when goals are clearly articulated and mutually determined and include increased research dissemination and lower research costs. This article explores the history of academic-clinical research partnerships and discusses the drivers of collaborative academic-clinical research relationships, resources from academia and clinical sites, and sustainability of collaborative partnerships. Through collaboration, academic-clinical partners can improve clinical outcomes and reduce healthcare costs.

Human Trafficking Education: An Asynchronous Approach to Improve Nurses' Knowledge and Application.

Nurses as healthcare professionals are in key positions to identify trafficked persons. Assessment of nurse knowledge shows the benefit of using asynchronous human trafficking education as a means for learning. Recommendations from this study for professional development educators include garnishing nurse executive support and use of case-study, evidence-based approaches. Support for state-mandated human trafficking education requirements for initial and ongoing licensure of nurses is necessary as human trafficking knowledge may decrease over time.

Implementing the COPA model in nursing education and practice settings: promoting competence, quality care, and patient safety.

The Competency Outcomes and Performance Assessment Model (COPA) prepares learners for effective role performance in the workplace by delineating comprehensive, core clinical behaviors that provide evidence of competence. This article explores the experiences of COPA model implementation in two nursing programs and a statewide nurse internship program. The article describes the challenges and benefits of implementation, discusses the transition from a traditional to an outcomes- and competency-based curriculum, and examines the process of assessment, with a focus on the faculty role. The influences of outcomes-based learning strategies and evaluation on competence, confidence, learning, and practice are discussed. In the statewide internship program, with 10 years of implementation experience in practice environments across the continuum of care, the COPA framework has provided significant benefits for preceptors, new nurse graduates, employers, and patient safety.

Perceptions of Role Transition into Practice among Advanced Practice Providers and Physicians.

This study sought to examine the experiences of advanced practice providers (APPs) as an approach to inform the development of formalized programs for transition into practice and to compare APP (N = 122) and physician (N = 84) perceptions of the novice practitioners' acclimation into a provider role within the first year of practice. Using a cross-sectional survey design, two separate web-based questionnaires were distributed to APPs and physicians. The APPs' perspectives echoed findings of earlier studies with regard to perceived confidence, feelings of anxiety/fear, and inadequacy. In 16 of 23 paired items, physicians and APPs had similar perspectives about confidence/competence after orientation. Significant differences in their perceptions included amount of physician support, time management, length of time to become a fully functional APP, and independence. Better understanding of the perceptions of APPs and physicians can augment APP preparation for a shifting workforce composition and team-based, interprofessional practice designed to meet the population's health care needs.

Investigating practice-level and individual factors of advanced practice registered nurses and physician assistants and their relationship to resilience.

BACKGROUND: Gaps in research persist related to practitioners' resilience, although much has been written about the need for strategies to strengthen personal resilience. PURPOSE: The study's purpose was to examine practice-level (quality of physician relationship, physician presence, and autonomy) and individual factors and how they affect resilience. METHODOLOGY: An online survey invited advanced practice registered nurses (APRNs) and physician assistants (PAs) from four states to participate in a cross-sectional study. Hierarchical ordinary least squares regression was used to test the impact of main effect variables in the context of identified control variables. SAMPLE: A sample of 1,138 APRNs and PAs completed the survey questions. RESULTS: Findings from the covariate model (model 1) and the main effect model (model 2) show that both models were significant at the p < .01 level, with the adjusted R2 differing from 0.02 to 0.13, respectively. Regression results show a significant positive association between quality of the physician relationship and APRN/PA resilience (b = 0.09, p < .01). A negative association between the lack of autonomy and higher levels of resilience (b = -0.14, p < .01) was also demonstrated. CONCLUSIONS: Advanced practice registered nurse/PA resilience is affected by both practice-level and personal factors, suggesting that workplace interventions could increase resilience. IMPLICATIONS FOR PRACTICE: Work environments allowing APRNs and PAs to function autonomously and with professional support from physician colleagues are favorable contributors to their resilience. Future studies need to investigate the meaning of physician presence/availability and organizational interventions that extend beyond individual resilience.

Development of an advanced practice preceptor evaluation tool.

BACKGROUND: Preceptors are essential in advanced practice registered nurse (APRN) and physician assistant (PA) fellowships; however, no tools exist for fellows to evaluate their preceptor. PURPOSE: The study's purpose was to examine the use of a modified preceptor evaluation tool (PET) in a new population APRNs and PAs who participated in a formalized postgraduate fellowship program. METHODOLOGICAL ORIENTATION: A qualitative study involving cognitive interviewing methods was used to evaluate original and modified items of the PET as a means to determine face validity. Over a period of 19 months, five different focus groups were conducted. Study participants completed an independent analysis of the tool prior to engaging in a focus group discussion. Further testing of new items was performed using the last two focus group cohorts and achieved data saturation. SAMPLE: The sample included 23 fellows who had completed an acute, ambulatory, or primary care yearlong fellowship. More than half of the fellows ranged in age from <30 to 40 years. CONCLUSIONS: All original 19 items were retained, with the majority (79%) requiring slight modifications. Using feedback from fellows, 10 items were added to the final version, including two open-ended questions. The new items added a focus on preceptors' ability to foster domains of professional growth in the fellows' provider role. IMPLICATIONS FOR PRACTICE: This newly developed tool with face validity provides a new mechanism for preceptor evaluation by APRN and PA fellows. Additional research is needed with larger groups of fellows as a means to establish the tool's psychometric properties.

Transitioning an Advanced Practice Fellowship Curriculum to eLearning During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 global pandemic brought mandatory shelter-in-place orders, disrupting traditional face-to-face teaching methods for advanced practice fellowship programs nationally, creating a challenge for fellowship program directors to preserve curriculum using nontraditional methods. METHOD: Using a variety of both web-based and app-based virtual platforms, a nationally accredited fellowship program converted traditional in-seat learning modalities to elearning platforms using both synchronous and asynchronous education. RESULTS: Preliminary data indicate that knowledge acquisition and perceived fellow satisfaction are preserved despite the abrupt change to program delivery. Programmatic modifications were submitted to the American Nurse Credentialing Center for compliance and deemed as creative, innovative, and collaborative. CONCLUSION: Curriculum for advanced practice fellowship programs can be favorably converted to elearning using virtual platforms during a crisis. Through prompt reevaluation and restructuring, virtual platforms can replace in-seat didactic lectures, patient case studies, mentoring, and even simulation, while ensuring program continuation and compliance with accreditation standards. [J Nurs Educ. 2020;59(9):514-517.].

Advanced Practice Provider Perspectives on Organizational Strategies for Work Stress Reduction.

Unresolved work stress contributes to burnout, compassion fatigue, disengagement, and other work-contextualized factors. The impact of occupational stressors extends to the organization in a negative fashion as well. In 2017, advanced practice providers (APPs) from four health systems, including nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, and physician assistants, participated in a quantitative online cross-sectional survey; 754 participants responded to a free-text question related to work stress and work-family balance. Suggested organizational strategies were ordered into 29 codes, 10 subthemes, and four main themes: "reduce job stressors," "improve leadership and operations," "promote APP well-being," and "maintain the status quo." Findings are consistent with other research related to occupational stress with many of the reported strategies considered as evidence-based. Targeted interventions for reducing job stress will need to include improved autonomy for APPs, role delineation, support for work-family balance, and better communication as part of management practices.

Strategies of Advanced Practice Providers to Reduce Stress at Work.

Background: High levels of stress and burnout, documented among healthcare professionals, result in high levels of job turnover. However, little is known about personal strategies employed by advanced practice providers (APPs) to mitigate stress. Methods: 3,939 APPs were invited to complete an online, anonymous, cross-sectional survey to examine work stress and burnout among APPs using quantitative and qualitative analyses. The Maslach Burnout Inventory (MBI) served as the measure for burnout. Work-stress reduction strategies were identified by an open-ended question. Findings: 854 APPs (70% of 1,218 respondents) (nurse practitioners, physician assistants, nurse midwives, anesthetists, and clinical nurse specialists) from four different United States health systems completed the free text portion of the survey. Qualitative analyses revealed that almost all of the APPs (94%) reported at least one stress reduction strategy. Four main themes were derived from the free-text responses: "Self-focused" (67.5%), "relational-focused"(16.1%), "job-focused" (11.5%) and "nothing" (4.9%). Quantitative results from the MBI revealed high levels of burnout among APPs with insignificant differences between those who provided a response to the qualitative question and those who did not: emotional exhaustion (p = .188); depersonalization (p = .265); personal accomplishment (p = .213). Conclusion/Application to Practice: Qualitative results highlighted strategies, many evidence-based, that APPs use to mitigate stress. Further research is needed to determine the frequency and consistency of APPs' enactment of personal strategies. These initial findings provide insights for occupational health practitioners and researchers planning primary prevention and secondary interventions for improving workplace health, enhancing personal wellness, and reducing job-related stressors.

Quality of Life and Compassion Satisfaction in Clinicians: A Pilot Intervention Study for Reducing Compassion Fatigue.

BACKGROUND: Compassion fatigue (CF) is prevalent in healthcare professionals, particularly in those caring for chronic, acutely ill, and/or those patients who might be moving toward comfort care. Over time, CF can lead to burnout (BO) and secondary traumatic stress and an overall decrease in professional quality of life. In this pilot study, participants completed a resiliency program focused on education about CF and self-awareness of its individualized impact and were expected to develop ongoing self-care practices to prevent/address the untoward effects. METHODS: Healthcare professionals ( N = 15) participated in a formalized educational program consisting of three 90-minute educational sessions held 2 weeks apart. Preassessment and postintervention data were collected electronically in survey format. A postprogram evaluation was also offered. RESULTS: Upon completion of the program, participants noted an increase in compassion satisfaction (CS) and a small reduction in BO. Secondary traumatic stress remained unchanged. Feedback about the program was positive, and participants reported the impact on their clinical practice and life to be moderately high. At 6 months, over half of the participants continued to report positive impact on their personal/professional lives. CONCLUSION: While the small sample size of this pilot study limits the generalizability of the findings, there were positive effects for CS and BO in participants over time, indicating possible benefits of providing self-care education to healthcare providers. Additional research with a larger sample size is needed to address how healthcare providers might further benefit from resiliency education and interventions to improve professional quality of life.

Expanding RN Scope of Knowledge-Genetics/Genomics: The New Frontier.

Introducing a new competency into nursing practice requires the support of nursing leadership. A knowledge survey was used to assess nurses' knowledge following a yearlong genomics education initiative. Findings indicate that nurses benefit from repeated exposure to genetics-related content. Recommendations from this study include development and implementation of strategies that can be used to prepare nurses at all levels for the application of genetics and genomics. Clinical nurses with knowledge of genetics will be able to implement evidence-based interventions to manage acute and chronic illnesses. These nurses will then be able to engage patients more fully, thereby helping them to understand the relationship of genetics to healthy outcomes.

Linking competency-based assessment to successful clinical practice.

Competence is essential for health care professionals; graduates must meet the responsibilities associated with a particular position. At one community college, nursing faculty have used a competency-based approach to educate and evaluate associate degree nursing students. The nursing curriculum is designed to allow for the inclusion of laboratory experiences for each nursing course and requires students to complete a clinical performance examination before advancing to the next level. The examination is designed as a clinical scenario with three to four responsibilities completed in random order. Critical elements developed by faculty are used to assess student competence. The increase in graduates' abilities to complete these skills has been valuable to both employers and graduates. Since 1992, with the implementation of a competency-based curriculum, the program's NCLEX-RN pass rates (98%) have been consistently above the national and state averages.

An investigation of nursing competence and the competency outcomes performance assessment curricular approach: senior students' self-reported perceptions.

This study was designed to measure the construct of competence as perceived by nursing students in different programs of study. An exploration of a competence-based curricular model was undertaken to determine if there are distinguishing differences between schools that have formally adopted Dr. Carrie Lenburg's Competency Outcomes Performance Assessment (COPA) model as a curricular guide and those who have do not have a formal competence model guiding the curriculum. The Six-Dimension Scale of Nursing Performance (6-D Scale) was used to evaluate nursing competence. Using a purposive sample, senior nursing students (N = 391) from three different types of nursing programs (baccalaureate, associate [ADN], and diploma) were surveyed. Students completed a two-part questionnaire that included the 6-D Scale, demographic questions, and a researcher-generated questionnaire designed to measure competency-based learning and evaluation. Faculty (n = 101) from these same programs were also surveyed. The results revealed that students from COPA and non-COPA schools reported slightly lower scores in three subscales: teaching/collaboration, critical care, and leadership. Significant curricular differences as defined by the Klein Scales were found between COPA and non-COPA senior students, with 17% to 30% of the variance explained for the COPA students. The findings reflect that baccalaureate students reported significantly lower 6-D Scale scores in multiple areas when compared to diploma and ADN students. Enhancement of student learning and curricular revisions designed to improve leadership and technical expertise are suggested by the findings of this study.