Empowering Nurses for High-Value Healthcare: A Call for Legislative and Systemic Change.

ABSTRACT: Recognizing the positive impact of clinical data outcomes and patient care experiences, coupled with the growing preference for advanced practice RNs among patients, it is imperative that nurse leaders propel legislative reforms and infrastructure support from health systems. This strategic approach is crucial for maximizing the potential of nurses in improving patient care experience and outcomes, as well as increasing accessibility to healthcare in every community.

Health System and University Leader Learning Collaboratives: Advancing Education, Regulation, and Advanced Practice Nursing Care Across the World.

ABSTRACT: This month's column proposes advanced practice nurse (APN), health system, and university leader roundtable discussions to understand and address global healthcare challenges and the evolving role of the APN. Forming international learning collaboratives focused on gaining a comprehensive understanding of the use of APNs and related education, regulatory frameworks, and models for practice can lead to greater utilization and impact to global healthcare. The "PEPPA" framework is discussed as 1 tool to enhance discussion in these collaboratives.

Health System-Academic Partnerships: Essential to Increasing the APRN Workforce.

This month's column highlights the importance of established health system academic partnerships in strengthening the advanced practice RN workforce.

Supporting Advanced Practice Nurses to Work at the Top of Their License: A Partnership With Nurse Executives.

This month's column highlights the value of nurse executive leaders in leveraging their experience, role, and partnership in empowering advanced practice RNs to work at the top of their education, clinical training, and license, optimizing the triple aim, even quadruple aim, in healthcare.

Analysis of nurse practitioner practice in US emergency departments: Evidence supporting educational preparation, credentialing, scope of practice, and outcomes.

ABSTRACT: The nurse practitioner (NP) role within emergency care has grown in recent years and now there are an estimated 25,000 NPs employed in diverse emergency care settings. Despite this significant growth and expansion of the NP within emergency care areas, challenges exist. In addition to the pervasive confusion regarding the NP role in emergency care, data and statistics detailing characteristics and outcomes of NP practice in emergency care are either lacking or misrepresented. This article explores barriers and provides current and accurate information describing the current educational preparation, credentialing, scope of practice, and outcomes among NPs in US emergency departments. The totality of available evidence reviewed supports safe, timely, efficient, and patient-centered care provided by NPs in emergency care.

Nurse Practitioners Are Stepping Up to Meet Access to Primary Care Services Across the United States: A Time for Policy Change.

This month's column highlights the need for access to primary care services across the United States and how nurse practitioners (NPs) have risen to meet this need. The authors discuss the modernization of licensure laws that will remove unnecessary barriers to full and direct access to NP healthcare services.

PEARL: Keeping Focus on Practice, Education, Advocacy, Research, and Leadership for Nurse Practitioners in 2023.

This column highlights 5 key categories in which nurse practitioners continually strive for excellence: practice, education, advocacy, research, and leadership, also known as "PEARL."

Promoting Adaptation in Female Inmates to Reduce Risk of Opioid Overdose Post-Release Through HOPE.

The purpose of the project was to develop a sustainable pre-release education program to reduce the risk of opioid overdose post-release in female inmates in a rural county jail in Middle Tennessee. The project was supported and guided using Roy's adaptation model. Content analysis resulted in common themes (initiation, moral failure, ineffective strategies, supportive environment, new beginnings, and adaptive domains), identified within the pre- and post-implementation surveys. The implementation of a successful reentry program for the vulnerable female incarcerated population has the potential to reduce the risk of opioid overdose death and negative health outcomes post-release.

Nurse Practitioner Leadership Essential: Ensuring a Positive Onboarding Experience for New Nurse Practitioners.

This month's column highlights the importance of a comprehensive employee onboarding program for newly hired nurse practitioners and 6 essential components for a successful program.

Encouraging and Facilitating Research Opportunities for Advanced Practice Registered Nurses: The Role of the Chief Nursing Officer.

ABSTRACT: This month's column highlights the value contribution of advanced practice registered nurses (APRNs) to research and the importance of chief nursing officer development of health system infrastructure to engage APRNs in research.

Choosing the Ideal Advanced Practice Leader for Your Organization.

This month's column highlights the attributes, competencies, and qualifications for consideration when selecting the ideal advanced practice leader, one that is collaborative and skilled in providing leadership at the executive or health systems level.

Beyond the Pandemic: Top 10 Priorities for Health System Advanced Practice Leadership.

This month's column highlights health system priorities for advanced practice leaders and advanced practice infrastructure and support.

Patients are Choosing Nurse Practitioners as Their Primary Care Provider in Many Communities Across the US.

This month's column highlights why patients are choosing to see nurse practitioners (NPs) as primary care providers, for both urgent and chronic care needs. Nurse practitioners are 1 type of advanced practice RN. Advanced practice RNs are inclusive of NPs, nurse midwives, nurse specialists, and nurse anesthetists. Primary care NPs see patients in the ambulatory and community settings, focusing on disease prevention and health maintenance. Primary care NPs often work in rural communities, providing access to care for many underserved populations.

Today's Advanced Practice Leader: Value Contribution to Healthcare Systems and Delivery of Accessible, High-Quality Patient Care.

This month's column highlights organizational, practice, and patient care advantages to adding advanced practice leaders to health systems' leadership teams and ideal characteristics of effective, executive advanced practice leaders.

Origin and Outcomes of Acute Care Nurse Practitioner Practice.

Acute care nurse practitioners (NPs) are educated, clinically trained, and board certified to care for acutely and critically ill patients, largely in hospital settings. Acute care NPs can positively impact patient care outcomes and are often added to acute care teams to drive optimal, reliable, efficient, and safe care, often referred to as "high value" care.

The use of national collaborative to promote advanced practice registered nurse-led high-value care initiatives.

BACKGROUND: High-value healthcare focuses on improving healthcare to produce cost effective care, however limited information on the role of advanced practice registered nurses (APRNs) exists. PURPOSE: This descriptive report describes APRN-led initiatives implemented as part of a national collaborative promoting the Choosing Wisely® campaign and high-value care measures. METHOD: An APRN national collaborative focuses on developing and implementing high-value care initiatives. Monthly calls, podcasts, and a file sharing platform are used to facilitate the work of the national collaborative. FINDINGS: A total of 16 APRN teams from 14 states are participating and have implemented a number of initiatives to reduce unnecessary testing and treatments, promote appropriate antibiotic use, and promote optimal clinical practices such as mobility for hospitalized elderly patients, among others. DISCUSSION: A national collaborative has proven to be a successful way to engage APRN teams to focus on targeting high-value care and promoting evidence-based practices in clinical care.

Development and testing of an advanced practice clinical advancement program within an academic medical center.

BACKGROUND: Faculty advanced practice registered nurses (APRNs) and physician assistants (PAs) employed by Vanderbilt University Medical Center (VUMC) have historically participated in rank promotion tracks for recognition of professional accomplishments in education, practice, and research. However, there has not been a clinical advancement program for nonfaculty practitioners. Satisfaction, engagement, and health surveys indicated VUMC APRNs and PAs were seeking opportunities for professional growth and development. Many health care organizations have incorporated clinical advancement programs as key recruitment and retention strategies. With a growing number of nonfaculty APRNs and PAs, VUMC began to explore the development, implementation, and evaluation of a clinical advancement program. PURPOSE: A VUMC Clinical Advancement Task Force was created to explore, develop, implement, and evaluate an advanced practice clinical advancement pilot. METHODS: Two teams were selected to participate in a 6-month pilot. Presurveys and postsurveys were conducted, and postpilot focus groups were held with participating practitioners. A 9-square tool was developed as a rubric for evaluating the practitioner's progress. Applications, leader assessments, and recommendations were housed in a secure database for a selected advancement committee to evaluate. RESULTS: Of 23 participants, 47% indicated satisfaction with professional development opportunities, when compared with 84% postpilot. Postpilot focus groups further improved the tool and the process for the program. IMPLICATIONS FOR PRACTICE: Opportunities for advancement/professional development positively influence APRN and PA perceptions of job satisfaction. This program could be tested with other APRN and PA teams for impact on job satisfaction, engagement, and retention.

Assessing and addressing practitioner burnout: Results from an advanced practice registered nurse health and well-being study.

BACKGROUND: Numerous nursing and physician studies have reported the effects of workload, environment, and life circumstances contributing to burnout. Effects may include job dissatisfaction, poor quality of life, and associated negative patient outcomes. Although assessing clinician burnout to determine effective interventions has become a topic of great importance, there are minimal studies specific to advanced practice registered nurses (APRNs). PURPOSE: This single-center study was conducted to assess the prevalence and impact of APRN burnout and to recommend targeted interventions toward improvement of overall health and well-being. METHODS: A cross-sectional, mixed methods design was used. The voluntary, anonymous survey examined perceptions of wellness, inclusion, social support, personal coping mechanisms, and status of burnout. RESULTS: The 78-question survey was sent to 1,014 APRNs (94%) and PAs (6%), with a 43.6% response rate (n = 433); 76.4% were nurse practitioners. Participants were identified as currently experiencing burnout, formerly burned out, or never having experienced burnout. Profiles were developed, and similarities and differences between each group were compared. Of 433 respondents, 40.4% (n = 175) reported having never experienced burnout, 33.3% (n = 144) reported they had formerly experienced burnout, and 26.3% (n = 114) reported they were currently experiencing burnout. IMPLICATIONS FOR PRACTICE: The results of the study identified that some APRNs report experiencing burnout at different times in their careers. Recommendations by participants to mitigate burnout included self-care, organizational promotion of health and well-being, career development, and leadership support. This study is one of the first to report on burnout among APRNs and potential interventions to build resilience; however, additional research is warranted.

Nurse Practitioners and Physician Assistants in Acute and Critical Care: A Concise Review of the Literature and Data 2008-2018.

OBJECTIVES: To provide a concise review of the literature and data pertaining to the use of nurse practitioners and physician assistants, collectively called advanced practice providers, in ICU and acute care settings. DATA SOURCES: Detailed search strategy using the databases PubMed, Ovid MEDLINE, and the Cumulative Index of Nursing and Allied Health Literature for the time period from January 2008 to December 2018. STUDY SELECTION: Studies addressing nurse practitioner, physician assistant, or advanced practice provider care in the ICU or acute care setting. DATA EXTRACTION: Relevant studies were reviewed, and the following aspects of each study were identified, abstracted, and analyzed: study population, study design, study aims, methods, results, and relevant implications for critical care practice. DATA SYNTHESIS: Five systematic reviews, four literature reviews, and 44 individual studies were identified, reviewed, and critiqued. Of the research studies, the majority were retrospective with others being observational, quasi-experimental, or quality improvement, along with two randomized control trials. Overall, the studies assessed a variety of effects of advanced practice provider care, including on length of stay, mortality, and quality-related metrics, with a majority demonstrating similar or improved patient care outcomes. CONCLUSIONS: Over the past 10 years, the number of studies assessing the impact of advanced practice providers in acute and critical care settings continue to increase. Collectively, these studies identify the value of advanced practice providers in patient care management, continuity of care, improved quality and safety metrics, patient and staff satisfaction, and on new areas of focus including enhanced educational experience of residents and fellows.