Attitudinal barriers to buprenorphine prescription and former waiver training.

OBJECTIVE: Opioid use disorder (OUD) can be effectively treated with buprenorphine maintenance. Recent changes in federal policy have removed the requirement for physicians to complete additional training to apply for a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine. At that time, few primary care providers (PCPs) had completed the training for a DEA waiver to prescribe buprenorphine. Our goal was to identify addressable barriers that may persist despite updates to federal legislation. DESIGN: A 42-item survey was distributed to 662 physicians and nurse practitioners at two academic medical centers with 100 respondents. SETTING: The survey was sent via email and administered anonymously through SurveyMonkey. PATIENTS AND PARTICIPANTS: All participants were PCPs, and all PCPs at the two academic medical centers were eligible to participate. INTERVENTIONS: PCPs responded to the survey by answering questions online. MAIN OUTCOME MEASURES: PCPs answered questions regarding previous buprenorphine waiver training status, local OUD prevalence, the effectiveness of OUD treatment modalities, and previous barriers to training. RESULTS: Respondents were compared using descriptive statistics and logistic regression. Of the 100 respondents (response rate: 15 percent), 69 percent had not completed the training. Ninety-nine percent of PCPs agreed that OUD was an issue in their area, 94 percent saw patients with OUD, and 91 percent rated buprenorphine maintenance as a very effective treatment for OUD. Previously waivered and nonwaivered providers did not differ in their responses to these questions. Those who had been waivered were less likely to say they did not see enough patients with OUD to justify training (odds ratio [OR] 0.267, p = 0.005) and were less likely to express concern about allowing patients with OUD into their practice (OR 0.348, p = 0.020) than PCPs who had applied for the DEA waiver. CONCLUSIONS: Despite nonwaivered PCPs recognizing OUD's prevalence, they were concerned about allowing patients with OUD into their practice and said there were not enough patients to justify training. This suggests that attitudinal barriers are the most appropriate target for current intervention.

Collaborative nursing education between advanced practice registered nurses.

The surge in healthcare demands due to the explosion of growth in the aging adult population demands that academic institutions address enhanced education of Advanced Practice Registered Nurses (APRNs). This is particularly challenging amidst nurse faculty shortages in specialty areas, stemming from factors such as lack of pay competitiveness with clinical positions, and doctoral-prepared nurses seeking faculty positions. Despite efforts to address the shortages, recruitment challenges persist, necessitating innovative approaches. This article explores the interprofessional collaborative teaching between Nurse Anesthesia (NA) and Adult Gerontology Nurse Practitioner (NP) programs, focusing on airway management, sedation techniques, chest X-ray interpretation, and ultrasound skills. To date, this collaboration between NA and NP faculty has proven effective. Both synchronous and online asynchronous teaching have received overwhelmingly positive student feedback. Ongoing communication and collaborations between NA and NP faculty facilitate teaching and educational strategies across programs, sharing faculty expertise, and mitigating reduced faculty numbers. This innovative model benefits faculty and students and provides a platform for firsthand interprofessional collaboration, fostering mutual respect and preparing students for effective interdisciplinary healthcare teamwork.

The National Organization of Nurse Practitioner Faculties Leadership Mentoring Program: Ten years of positive outcomes.

BACKGROUND: Nursing leadership programs can have a positive impact on organizations and communities. Health equity in nursing requires leaders who parallel the population demographics. PURPOSE: This work evaluated the National Organization of Nurse Practitioner Faculties Leadership Mentoring Program (LMP) 10 years from its inception. Lessons learned from this evaluation can inform leadership initiatives in nursing and other health professions. METHOD: This cross-sectional evaluation applied the Context, Inputs, Process, and Products model to gauge effectiveness of the LMP. All 48 participants were invited to participate. RESULTS: Thirty-two survey respondents, a 67 % response rate, demonstrated a 767 % increase in extramural scholarship collaborations and promotion to associate and full professor at 43 % and 90 %, respectively. Academic leadership positions to department chair, assistant/associate dean, and dean increased 200 %, 167 %, and 100 %, respectively. Seventy-seven percent of program participants are engaged on boards and committees at local, state, national, and international levels. These roles significantly impact legislative, policy, advocacy, and regulatory efforts, signifying the LMP's influence on broader societal and professional domains. CONCLUSION: Identifying clear program outcomes and metrics for leadership program evaluation can advance diversity, equity, and inclusion efforts. Sustainable funding models for leadership development will have a high return on investment for health professions.

Nurse Practitioner Education: Recommending Theories and Frameworks for Simulation-Based Experiences and Research.

Simulation-based education is an evidence-based strategy to address learning and evaluation of outcomes in the updated American Association of Colleges of Nursing Essentials. Currently, there is a dearth of rigorous research on nurse practitioner education simulation. Studies on the topic often neglect a sound theoretical or conceptual framework beyond the National League of Nursing Jeffries Simulation Theory. This article aims to explore and distinguish the implementation of various theories and frameworks to determine how these elements can be stand-alone or used in combination to explore simulation-based experience competency outcomes. Specific recommendations for simulation research are (a) to include learning theories, (b) level learning and track competency progression using a framework, and (c) use a framework for measuring outcomes. Simulation science for nurse practitioner education can be advanced through united and consistent use of established theories and frameworks. These efforts will inform emerging best practices of simulation-based learning to address competition-based learning initiatives, validity of high-stakes simulation evaluation, and how to credit learners for simulation activities.

Collaborative framework to assess achievement of American Association of Colleges of Nursing and National Organization of Nurse Practitioner Faculties patient-centered competencies using evolving case studies.

BACKGROUND: The American Association of Colleges of Nursing (AACN) and National Organization of Nurse Practitioner Faculties (NONPF) emphasize the role of clinical reasoning in nurse practitioner (NP) competencies. Evidence-based clinical reasoning is vital to patient safety. Collaborative technology tools can aid in assessing progress towards achieving clinical reasoning competency. PURPOSE/AIMS: The purpose of this article is to describe an electronic, collaborative learning framework to teach and assess second year NP students in systematically selecting and eliminating diagnoses and forming treatment plans. DESIGN/METHODS: Post gap analysis, the collaborative learning framework was created. This visual, collaborative resource was scaffolded across two sequential advanced NP second year clinical synthesis courses and embedded with evolving case studies. Students identified pertinent positives and negatives from the history, physical, and diagnostic findings. Each student developed a unique differential diagnosis and plan of care and critiqued their peers. RESULT/FINDINGS: The tool exceeded expectations. Faculty were able to visualize data, provide clarification on interpretation of data and pharmacology, and grade in small groups. CONCLUSION: The collaborative learning framework provided real-time visualization of students' work in clinical reasoning. It was easy to use and integrate into second year NP courses to meet learning objectives and assess clinical reasoning competency.

Barriers to learning and performing point-of-care ultrasound (POCUS): An integrative review.

BACKGROUND: Point-of-care ultrasound (POCUS) is a valuable adjunct to traditional imaging and physical exam. Adult-Gerontology Acute Care Nurse Practitioners (AGACNPs) serve as primary providers for acutely ill patients across the country, yet there is limited literature to describe the AGACNP experience with POCUS training and clinical application. PURPOSE: This integrative review was to describe barriers to learning and performing POCUS that AGACNP's experience, identify necessary components of a successful POCUS curriculum, and synthesize evidence to propose solutions. METHOD: CINAHL, PubMed, and Ovid databases were systematically searched for publications. Two reviewers completed the quality appraisal of the 12 articles identified during the literature search. RESULTS: Common barriers include: formal training; access to ultrasound machines; quality assurance; time to perform exams; inability to use findings in documentation/decision making. Low confidence may be an underrepresented barrier. Successful training programs include an introductory class with mixed didactic and hands-on training, training with live models, direct supervision and image review by experts, and longitudinal training. CONCLUSION: Adult-Gerontology Acute Care Nurse Practitioners are capable of learning and incorporating POCUS use into clinical practice. Broad solutions can be instituted to remove barriers, but more research is needed to describe necessary components of a successful POCUS training program.

A simulation educational intervention to enhance preclinical family nurse practitioner student preparation.

ABSTRACT: Simulation has been shown to improve communication and psychometric skills in advanced practice nursing students. Little is known about the impact of a simulation educational intervention with a faculty-facilitated debriefing on the preparation of novice nurse practitioner students for their first clinical practicum. This article describes the development of an educational intervention to accomplish this. The simulation education intervention was implemented with preclinical nurse practitioner students designed to improve their preparation for their first precepted clinical experience. Students were surveyed preintervention and postintervention to explore their self-perception of confidence and preparation for clinicals looking at six domains: health history, physical examination, diagnostics, differentials, final diagnosis, and plan of care. Quantitative results were statistically significant for each domain. Qualitative findings gave deeper insight into the students' perceptions of how the intervention prepared them for clinicals. Advanced practice educators can use educational interventions such as this to prepare students for their first clinical practicums.

Individual values, the social determinants of health, and flourishing among medical, physician assistant, and nurse practitioner students.

The purpose of this study is to explore how demographics and individual values, qualities, and personality traits are associated with perceptions of flourishing among medical (MD), physician assistant (PA), and nurse practitioner (NP) students. Current MD, PA, and NP students from two academic medical centers were recruited to participate in this cross-sectional study between August 6 and October 9, 2023. Participants completed the Secure Flourish Index (traditional SFI) and then applied a percentage weight to each of the six flourishing domains based on perceived relative importance to their overall flourishing. Additional survey questions included demographics and multiple validated instruments: WellRx, 2 Question Maslach Burnout Inventory, Brief COPE Inventory, the Short Grit Scale, and Duke University Religion Index. Descriptive statistics, ANOVA, correlation, and regression analyses were performed with an alpha of 0.05. A total of 393 of 1820 eligible students began the survey (21.6%) while 280, (15.4%) were included in the analysis. Traditional SFI scores were higher with higher grit (r = .368, p < .001). Traditional SFI scores were lower with higher WellRx (r = -.336, p < .001), burnout (r = -.466, p < .001), or avoidant (r = -.453, p < .001) coping style. Scores were about 10 points lower for students who had considered leaving training in the past 6 months (M = 75.3, SD = 16.2) than those who had not (M = 85.6, SD = 14.4; p < .001). The SFI domain of physical and mental health had the highest relative percentage weight (20.2% (SD 8.4)) but was second to lowest in mean domain flourishing score (mean 6.5, SD 1.7). While participants placed high value on physical and mental health, they reported relatively low flourishing in this area. Targeted interventions to improve the ability for students to cope with the hardships of training and life, as well as supports structured to address the social and structural determinants of health may improve flourishing among students with similar values.

Advancing Nurse Practitioner proficiency and confidence: An evaluation of postgraduate training in rural and medically underserved communities.

BACKGROUND: Nurse practitioners (NPs) are critical in delivering primary health care, especially in underserved and rural areas. Transitioning from academic training to practical application poses challenges, highlighting the need for structured post-licensure training (PLT). PURPOSE: To address the knowledge gap regarding the impact of PLT programs on the clinical development, confidence, and care delivery of NPs using an innovative evaluative approach. METHODOLOGY: Using a mixed-methods approach, this study engaged 19 NP fellows in quantitative and qualitative evaluations. Assessments of clinical skills and feedback were collected using the REDCap platform, focusing on mentorship and the practical application of skills. RESULTS: Quantitative analysis showed improvements in several domains: patient-centered care (median score increase from 8 to 10, p = .005), knowledge of evidence-based practice (median score from 8 to 9, p = .028), and health systems (median score from 8 to 9, p = .014). Qualitative feedback underscored the benefits of the program's structured support and practical learning experiences while revealing the need for improvements in mentor preparedness. CONCLUSIONS: The PLT program effectively advanced NP proficiency across various domains, particularly in patient-centered care and evidence-based practice. However, it also highlighted a crucial need for focused mentorship in developing leadership skills. The study's limited scope, dependence on self-reported measures, and specific statistical methods constrain the broader applicability of its findings. Future research should aim to validate these results across diverse settings and explore long-term outcomes. IMPLICATIONS: This study provides new perspectives on NP workforce development, emphasizing the importance of structured mentorship and training, especially in medically underserved communities.

Evaluating a Virtual Flipped Classroom Approach to Nurse Practitioner Telehealth Competency Development.

BACKGROUND: Evidence supports the use of multi-modal approaches to develop nurse practitioner (NP) students' telehealth competency. METHOD: A virtual flipped classroom approach that included eLearning, interactive webinars, and virtual standardized patient (SP) simulations was implemented and evaluated to teach NP students to use telehealth and other connected health technologies to improve care for underserved populations. RESULTS: Analysis of data from multiple-choice quizzes, surveys, and SP evaluations indicated students achieved high levels of knowledge, met the learning objectives, demonstrated above-average competency during telehealth simulations that improved over time, and were highly satisfied with the learning experiences. CONCLUSION: The educational benefits of a flipped classroom can be realized within a fully online learning experience. Future research should examine the effects of repeated simulation opportunities on telehealth competency development. [J Nurs Educ. 2024;63(8):546-551.].

Exploring a pilot alcohol and other drug (AOD) nurse practitioner mentoring program: Empirical research mixed methods: A pilot nurse practitioner mentoring program.

AIM: To explore the effectiveness and acceptability of a pilot mentoring program for alcohol and other drug (AOD) nurse practitioners (also known globally as addiction nurse practitioners). DESIGN: Mixed method evaluation. METHODS: Two-phase evaluation comprising survey (demographics, pre- and post-program perceived competency and confidence) with 15 participants completing the pre survey and 10 participants completing the post survey, and qualitative interviews after the program with 10 participants. RESULTS: The quantitative results indicate statistically significant increases in some domains of perceived competence and confidence in treatment. Qualitative findings indicate that participants valued peer support and mentoring from experienced nurse practitioners. Where formal residency or internship programs for nurse practitioners do not exist, informal mentoring programs may address issues inherent in nurse practitioner transition that may impact retention. We recommend further exploration of mentoring programs with larger sample sizes to determine if self-reported clinical improvements are noted. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE: Nurse practitioners are a vital part of the healthcare system; their advanced skills and knowledge place them in an ideal position to address prescriber shortages and access to care for populations underserved by healthcare. However, literature indicates that they are often underutilised, and transition to autonomous practice remains a challenge. Our exploration of a pilot mentoring program for nurse practitioners shows that their knowledge and perceived skills are high, yet peer assistance is valued in transitioning from advanced practice registered nurse to autonomous nurse practitioner. We recommend further trialling and evaluation of nurse practitioner mentoring programs to both increase supply of nurse practitioners and provide greater access to quality healthcare for underserved populations. IMPACT: What problem did the study address? The ability of nurse practitioners to offer advanced practice interventions such as diagnosis and medication management potentially provides a solution to healthcare resource shortages. However, current literature indicates that advanced nurses transitioning to nurse practitioner roles suffer transition shock, leading to burnout and poor retention. What were the main findings? Although this pilot mentoring program shows significant improvements in survey responses on confidence and capability, qualitative data shows that neophyte nurse practitioners value peer support and mentoring from more experienced practitioners. Participants described maintaining ongoing connections with both mentors and fellow mentees, which aided transition to the role of autonomous nurse practitioner. Where and on whom will the research have an impact? The results of this pilot mentoring program indicate that there is benefit to these programs for neophyte nurse practitioners in many specialties. This paper indicates that mentoring programs for nurse practitioners may provide a community of practice and may have a positive impact on transition shock. REPORTING METHOD: Good Reporting of a Mixed Methods Study (GRAMMS) checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

NP student knowledge and perceptions of medical marijuana.

OBJECTIVE: This study aimed to measure NP students' knowledge and perception of medical marijuana (MM) and determine whether they need additional education on the topic. METHODS: A cross-sectional, descriptive study was implemented. NP students were asked to complete a survey that assessed their knowledge of MM, including adverse reactions and medical indications. Perceptions of recreational marijuana and MM were assessed through a 5-point Likert-scale questionnaire. RESULTS: Of the 230 NP students who completed all or part of the questionnaire, 115 met inclusion criteria and were included in results. Most students (94%) felt that MM should be legalized in all US states. Likewise, 97% felt that MM education should be included in NP program curricula; however, only 30% reported receiving in-depth education on the topic. Participants were asked to identify, among 18 provided medical conditions, those which were approved indications for MM use; accurate response rate was low, though cancer, pain, cachexia, nausea/vomiting, posttraumatic stress disorder, and epilepsy were identified correctly as indications by more than half of participants. Previous MM use and religious affiliation had an impact on knowledge and perceptions of MM. CONCLUSION: With an increasing number of states legalizing MM, NP programs must evaluate their current curricula and integrate content that addresses the gap in knowledge of MM mechanism of action, indications, and adverse reactions.

Psychotherapy Skills for Psychiatric Mental Health Nurse Practitioner Students in the Age of Competency-Based Education.

ABSTRACT: As the field of nursing moves toward competency-based education, faculty need to adapt teaching and learning strategies to meet standards for assessing core behaviors of graduate psychiatric mental health nurse practitioner students. This article reviews a psychotherapy skills-based learning assignment at Frontier Nursing University that was adapted to meet developing competency-based learning standards. The assignment utilizes prerecorded video scenarios to provide students with opportunities to reinforce psychotherapy skills during didactic coursework. Assessment is conducted via an analytic rubric and specific feedback is given to each student in writing.

Developing a comprehensive curriculum program for nurse practitioners delivering primary care in the long-term care setting.

In the Long-Term Care (LTC) setting, comprehensive primary care is often provided by Nurse Practitioners (NPs). NPs are uniquely positioned to meet the evolving primary care needs of LTC residents. However, caring for this population requires additional education and training due to its special considerations. To meet the learning needs of NPs entering the LTC workplace, a Certificate Program was designed to enhance primary care competencies within the LTC setting. The aim of the program is to increase knowledge, capacity, and confidence of NPs to deliver quality, evidence-based, integrated, and interprofessional primary care to LTC residents. This curriculum is anticipated to address the growing need for LTC services and improve the delivery of high-quality primary care.

Determining the Effects of Complex Education on Primary Care Nurse Practitioners' Self-efficacy in Advance Care Planning for Healthy Adults.

Advance care planning is a process in which capable adults communicate their preferences for medical care in case of incapacitation. Regardless of health status, most adults are interested in advance care planning conversations and prefer providers to initiate these discussions. Primary care nurse practitioners are ideally positioned to lead these conversations but lack knowledge, confidence, and communication skills to do so. This project aimed to develop, implement, and evaluate an educational program for primary care nurse practitioners regarding leading advance care planning conversations with healthy adults. This evidence-based practice project used the Advance Care Planning Self-Efficacy Scale to measure primary care nurse practitioners' self-efficacy after completing a complex educational program. The educational program was developed based on a nationally recognized program incorporating didactic, observational, and role-play learning. The findings of this project indicated that providing complex education was an effective intervention immediately and after 3 months ( P = .018 and P = .023, respectively). The results indicate that educating nurse practitioners is an effective intervention for increasing their self-efficacy in leading advance care planning conversations with healthy adults over 3 months, recommending additional intervention at least earlier than 6 months.

Restoring Psychiatric Mental Health APRN Roles: A Report of Innovations in Workforce Development Design Supported by Salutogenic Solutions and an Enduring Educational Frame, Part One.

BACKGROUND: The change from a clinical nurse specialist to nurse practitioner model has significantly affected graduate education and practice because of emphasis on the dominant biomedical prescriber role, marginalizing the nurse-psychotherapy and consultation-liaison roles fundamental to quality psychiatric advanced practice nursing practice. AIM/METHOD: We report on a four-year Workforce Development Project supported by an academic-practice partnership to restore formation and skill building of the marginalized roles. Part One focuses on program design, the curriculum for nine specialty courses, and the teaching and learning community approach that promotes engagement, faculty commitment, and preceptor recruitment and retention; the creative faculty staffing model is described. RESULTS: The educational frame described includes highlights of teaching/learning strategies drawn from the history of professional formation curriculum rooted in salutogenesis and belonging science, existentialism, solution-focused therapy, modeling and role modeling theory, and Peplau's Interpersonal Relations . CONCLUSION: There is significant interest and commitment to learning the nurse-psychotherapist and consultation-liaison roles.

Restoring Psychiatric Mental Health APRN Roles: A Report of Innovations in Workforce Development Design Supported by Salutogenic Solutions and an Enduring Educational Frame, Part Two.

BACKGROUND: The change from clinical nurse specialist to nurse practitioner model with emphasis on the biomedical prescriber role significantly affected graduate education/practice. AIM/METHOD: This article reports solutions, lessons learned, and insights from faculty in a four-year Workforce Development Project supported by an academic-practice partnership. Lessons learned that are shared as administrative and clinical practice insights include use of experiential learning platform and interaction process recordings, confirmation of the state of nurse psychotherapy blocks to clinical placements, movement toward a salutogenic psychosocial nursing process, changing student evaluation language of preceptors, and implementation of an Advanced Practice Nursing model for clinical supervision. RESULTS: The educational hypothesis that in-person experiential learning in a workshop format with live simulations is critical to the professional development of psychiatric mental health advanced practice nursing is supported. Resistance to the cultural change operationalized through the curriculum is described. Five student reflections exemplify progress made as a result of this program. CONCLUSION: This program with its enduring educational frame was an opportunity to regain a historical momentum as nurse leaders in mental health care. There is significant interest and commitment to learning the nurse-psychotherapist and consultation-liaison roles.

Super-Mentors to Train Multiple Neonatal Advanced Practice Providers: Pros and Cons.

BACKGROUND: Despite available training programs for neonatal advanced practice providers (Neo APP), including neonatal nurse practitioners and physician assistants, it is difficult to meet the demand for these providers. There are no publications regarding training models with greater than 1 Neo APP learner per mentor. PURPOSE: To create and measure outcomes of a 12-month program to educate Neo APP "Super-Mentors" able to train 2 Neo APP learners simultaneously. METHODS: Super-Mentors were selected and attended monthly classes to learn mentorship concepts and receive support. Learners received didactic content and support through a Fellowship program. Quantitative data regarding recruitment and retention, as well as Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) results were compared pre- and postprogram. Qualitative satisfaction measures via survey from 21 stakeholders were analyzed through a phenomenological approach. RESULTS: Six Super-Mentors trained 14 Neo APPs, as compared to 7 in the previous year. One Neo APP left after training. Summative preprogram MNPJSS scores were better (5.1 ± 0.37) than postprogram (4.7 ± 0.47) ( P < .001). The most important preprogram subscale item was "vacation" versus "quality of assistive personnel" postprogram. Both pre- and postprogram scores reflected positive job satisfaction so differences may not be clinically significant. Qualitative program benefits included faster and increased onboarding, stronger relationships, and dedicated time. Challenges included role clarity among other stakeholders, learning culture, and spacial/technological logistics. IMPLICATIONS FOR PRACTICE: Super-Mentors can train twice the number of Neo APP learners, with optimal preparation and support of all stakeholders, adequate space, and appropriate technology.

A reflection on the value of participating in a journal club: Early findings from a transition to practice program.

ABSTRACT: The column describes the intersection of a transition to practice program for advance practice providers and incorporating monthly journal club activities. Reflections on the value of the journal club highlight opportunities for education, clinical care, and system-level care.