LACE and the APRN Consensus Model: Implications for Advancing Nursing Practice.

Understanding the historical context and contemporary trends in advanced practice registered nurse (APRN) education and regulation is pivotal for effective professional advocacy. Until the release of the APRN Consensus Model in 2008, a uniform model for APRN regulation was lacking. Adopting the model's recommendations has implications for APRNs beyond licensure and regulation, including full practice authority, license portability, and patient access to APRN-led care. A comprehensive understanding of APRN education and regulation empowers nurses, APRNs, and stakeholders to drive the profession forward through informed advocacy.

An evaluation of nurse practitioner and physician assistant hiring patterns after implementation of the advanced practice registered nurse consensus model.

ABSTRACT: The Advanced Practice Registered Nurse (APRN) Consensus Model was developed in 2008 by the APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee. This model aims to improve access to APRN care through standardization of licensure, accreditation, certification, and education and has been adopted by many organizations throughout the United States. However, the Consensus Model is not a legislative document, and there is variation in adoption and implementation throughout states and organizations. Since the Consensus Model was developed, little is known about how this change has affected hiring practices for nurse practitioners (NPs) and physician assistants (PAs). There are concerns that the model may place burdensome hiring constraints on NP hires, which could inadvertently lead to preferential hiring of PAs over NPs. We evaluated whether there was a significant association between the proportion of NPs versus PAs hired after the implementation of the APRN Consensus Model in 2017 in a large not-for-profit health system in North Carolina. Our study revealed no association between implementation of hiring practices to align with the APRN Consensus Model and preferential hiring of PAs over NPs.

Planning an implementation science training program for advanced practice registered nurses.

BACKGROUND: A gap exists between scientific discovery and implementation and adoption of research findings in healthcare and public health practice. This gap is due to the fact that research on treatment efficacy and safety in clinical trials ends prematurely with the publication of results, leaving a lack of knowledge of treatment effectiveness in real-world clinical and community settings. Comparative effectiveness research (CER) can facilitate the translation of research findings, reducing the gap between discovery and adoption into practice. Getting CER findings to patients and healthcare providers requires efforts to disseminate and train providers to successfully implement and sustain change in the healthcare setting. Advanced practice registered nurses (APRNs) are instrumental in the implementation of evidence-based research in primary care settings and an important group to target for the dissemination of research findings. There are numerous implementation training programs, but none focus specifically on APRNs. OBJECTIVE: The objective of this article is to describe the infrastructure established to develop a 3-day implementation training program for APRNs and an implementation support system. METHOD: A description of the processes and strategies is provided, including stakeholder engagement through focus groups and the formation of a multistakeholder program planning advisory team, which includes APRNs, organization leaders, and patients. The program also includes curriculum development and program planning as well as the development of an implementation toolkit. RESULTS: Stakeholders were instrumental in shaping the implementation training program, including the content of the curriculum and the program agenda. In addition, the unique perspective of each stakeholder group contributed to the selection of the CER findings disseminated through the intensive training program. CONCLUSION: It is important that strategies to address the lack of implementation training opportunities for APRNs be discussed and disseminated within the healthcare community. This article discusses the plan to address implementation training for APRNs through the development of an implementation curriculum and toolkit for APRNs.

Propuesta de modelo para la enfermera de práctica avanzada / Proposal of a model for advanced practice nurses

La propuesta que se presenta es fruto, por un lado, de los resultados del proyecto “IPACAT22: Consenso sobre los aspectos clave del modelo de la práctica avanzada en Cataluña”, realizado con la participación de 24 enfermeras representantes de asociaciones científicas enfermeras o multidisciplinares de Cataluña. Por otro lado, es también fruto del apasionante, relevante y a veces difícil debate entre los miembros del equipo con diferentes trayectorias profesionales y distintos puntos de vista que enriquecen el objetivo común. Es oportuno presentar los resultados del debate, basados en el rigor, y los resultados de los proyectos de investigación por la mejora y el avance de la enfermera de práctica avanzada. Este debate también desempeña un rol importante en el entorno profesional para ejercer un liderazgo efectivo en las organizaciones y en el sistema de salud. Estamos convencidas de que este documento puede ser un punto de partida para configurar el modelo de la enfermera de práctica avanzada en nuestro contexto.(AU)

The proposal presented is the result, on one hand, of the outcomes of the Project “IPACAT22: Consensus on the key aspects of the model for advanced practice in Catalonia”, prepared with the participation of 24 nurses representing multidisciplinary or nursing scientific associations of Catalonia. On the other hand, it is also the result of the exciting, relevant, and sometimes difficult discussion among the team members with different professional careers and point of views which enhance the common objective. It is appropriate to present the outcomes of this discussion, based on rigour and results of the research projects for the improvement and progress of advanced practice nurses. This discussion also represents a major role in the professional setting, to conduct an effective leadership in organizations and the health system. We are convinced that this document can be a starting point to set up the model for the advanced practice nurse in our setting.(AU)

Program evaluation of a new interprofessional geriatrics curriculum for advanced practice nursing and master of social work learners.

The Indiana Geriatrics Workforce Enhancement Program (GWEP) implemented a new longitudinal geriatrics curriculum for advanced practice registered nurse (APRN) and master of social work (MSW) learners to prepare them for interprofessional collaborative practice in the care of older adults. This paper reports program outcomes of a novel longitudinal interprofessional geriatrics curriculum involving immersive learning for these learners. Outcomes are described in terms of learner reaction, modification of attitudes/perceptions, acquisition of knowledge/skills, behavior change, impact on the organization, and impact on the patient or client using the Freeth/Kirkpatrick evaluation model. Program participation influenced graduates' knowledge of and their perceived ability to participate in team care and job selection in geriatric-focused positions.

Promoting a culture of reciprocity to build social capital in advanced practice nursing students.

ABSTRACT: A virtual activity integrating the evidence-based Reciprocity Ring model was designed to enhance confidence and skills for building social capital for advanced practice registered nursing (APRN) students. The central objective of the activity was to reduce the stigma of asking for help by providing a framework for the balanced exchange of favors, thus supporting new connections and feelings of trust among APRN students. Students from two APRN practice tracks ( N = 44) participated in a virtual Reciprocity Ring activity where they could post and respond to requests for help. On average, students posted 2.5 requests and received three offers for assistance; 220 connections were made overall with the major theme requests related to stress management. A retrospective survey was administered at the conclusion of the activity. Questions inquired about student confidence before, and then after, the activity for identifying resources, providing help to others, finding personal support when needed, accessing resources related to academic success, and finding solutions to problems. Student mean confidence scores were significantly higher after the activity compared with mean confidence scores before the activity ( p = .01). Additionally, the effect size was large (Cohen d = 0.89). Therefore, we suggest that integrating Reciprocity Ring exercises into nursing curricula and practice can be a useful tool for promoting skills related to productive help-seeking that will support APRN students' academic and professional success.

Advanced Nursing Practice and Advanced Practice Nursing roles within low and lower-middle-income countries.

INTRODUCTION: Population health initiatives rely on the availability and skills of an appropriate workforce to meet required goals. One global workforce initiative with demonstrated ability to expand health care services and improve access to care is the development of Advanced Nursing Practice and Advanced Practice Nursing roles. Given the sparse published information about these roles in Low and Lower-Middle-Income countries, this study seeks to describe their development and application in these countries. DESIGN: The researchers developed a descriptive cross-sectional multilingual survey for online distribution to nursing experts within the targeted countries. Survey questions addressed demographic information on the population served, Advanced Nursing Practice and Advanced Practice Nursing titles, the time frame and rationale for creating the title, and how the roles relate to the International Council of Nurses' Advanced Practice Nursing guidelines characteristics of education, practice, and regulation. RESULTS: Of the 167 responses received, only 24 participants met the inclusion criteria. This represented five low-income countries and nineteen lower-middle-income countries from four World Bank regions. Seventy-one roles were identified. Roles emerged predominantly over the last 20 years, focusing on care for underserved populations, with an almost even spread across primary and acute care settings. There were differences in education, practice, and regulation amongst the roles. Roles that required a master's education or higher with practice-related characteristics had a broader scope of practice, which is consistent with international guidelines. CONCLUSION: This paper describes how Advanced Nursing Practice and Advanced Practice Nursing roles from Low and Lower Middle-Income Countries have been implemented to address gaps in service and highlights disparities in education, practice and regulation compared to international guidelines. Maintaining and increasing support from organizations and universities internationally may be required to assist in developing and expanding educational programs for advanced nursing roles in these countries. CLINICAL RELEVANCE: Understanding how these advanced nursing roles are operationalized in relation to education, practice, and regulation in Low and Lower-Middle-Income countries can provide baseline information that will inform workforce development policies to address healthcare needs in similar jurisdictions.

Content and characteristics of evidence in the use of standardized patients for advanced practice nurses: A mixed-studies systematic review.

OBJECTIVES: The use of Standardized Patients (SPs) as a supplement to traditional clinical experience is of interest in the advanced practice nursing curriculum. Yet, evidence exploring this area is limited. This systematic review aims to consolidate and synthesize findings on the available evidence of using standardized patients (SPs) on advanced practice nurse (APN) students' learning and assessment experiences. DESIGN: Mixed-studies systematic review. DATA SOURCES: PubMed, EMBASE, Cochrane Library, CINAHL, Scopus, PsycINFO, and ProQuest Dissertations and Theses from the inception of each database to May 2022. REVIEW METHODS: Quantitative, qualitative, and mixed-method studies involving the use of SPs for education and assessments among APN students were included in this review. RESULTS: Twenty studies were included. Three themes were identified through thematic synthesis: (1) Benefits associated with standardized patients, (2) Uniqueness of standardized patient experience, and (3) Preference and way forward. Overall, these students benefited from refining knowledge, clinical skills, and communication skills, and perceived a boost in confidence in their nursing competencies through SP simulations. More studies with rigorous methodology are needed to ascertain the causal relationships between SP simulations and APN students. Future studies should evaluate the cost-effectiveness of SP, especially in low-income countries. Inter-professional SP simulations and hybrid simulations should be explored further. Considerations for improvements include allocating more sessions for multisource feedback, offering dyadic or group support, and providing assessments that are more formative during simulations. CONCLUSIONS: SP simulation can complement traditional clinical experience in providing APN students with the knowledge, clinical skills, and communication skills in the real-world context.

Expanding the theoretical understanding in Advanced Practice Nursing: Framing the future.

AIM: We aimed to discuss the importance of the integration of nursing theories in advanced nursing to meet future demands. BACKGROUND: Nursing studies reporting a lack of professional care have increased in recent years and indicate a global complex socioecological problem. The lack of a clear theoretical understanding in education, research and practice makes Advanced Practice Nursing invisible and vulnerable. DESIGN: A theoretical paper was selected to stimulate vital reflexion and debate about the importance of theory integration. METHODS: The selection of nursing theories represents the position of some theorists based on our experiences with national and international research and personal leadership in a master's degree program. IMPLICATIONS FOR NURSES: For nurses to continue to make a difference in the lives of their patients, practitioners, and researchers need to practice and expand theoretical understanding within their fields. This would enable them to be visible and at the forefront of the wider changes in health care owing to their central position and connection to health organizations. CONCLUSION: Nursing theories are essential to the continuing evolution of the discipline of nursing. Postgraduate programs in nursing and research must be encouraged to use and further develop nursing theories to facilitate the advancement of nursing care in education, research, and practice.

Creating an Advanced Practice Registered Nurse Council Within a Regional Hospital Network.

This article describes the development of an advanced practice RN (APRN) council in a large hospital network. Despite obstacles, the council was able to demonstrate positive outcomes, which include standardization of the credentialing and onboarding process, productive networking, and an APRN-oriented education fair. The council has been able to guide workplace culture, establish and support vertical and horizontal interprofessional relationships, provide recommendations to relevant leadership boards, and develop standardized procedures.

Capability as a concept in advanced practice nursing and education: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify and map how the concept of capability in advanced practice nursing and education is described in the literature. INTRODUCTION: Advanced practice nursing and education is often described in terms of the achievement of competencies. The concept of capability has been proposed as a more accurate description of the attributes of advanced practice nursing. Definitions of capability in advanced practice nursing vary, but often focus on the integration of prior knowledge, skills, resources, judgment, and experience when solving unanticipated problems or working in new situations. INCLUSION CRITERIA: This review will consider studies addressing the concept of individual capability in any setting related to advanced practice nursing education and practice. The working definition of capability in this review is a combination of knowledge, skills, experience, and competencies that enables advanced practice nurses to provide appropriate care for patients in both familiar and unfamiliar clinical settings. Advanced practice nurses will include nurses with both graduate education and an expanded scope of practice. METHODS: Eight academic databases will be searched for qualitative, quantitative, and mixed methods study designs. The gray literature search will include policy and practice documents from nursing and health organization websites. Two reviewers will independently complete title and abstract screening prior to full-text review and data extraction. Articles published in English from 1975 to the present will be included. Other languages will be included if translations are available.

Educating APRN Students About Telehealth Credentialing, Licensing, and Billing.

BACKGROUND: An essential component of advanced practice nursing (APRN) education includes how to facilitate and adopt telehealth into practice, which includes becoming familiar with what is needed to practice telehealth and how to effectively bill for this service. This article describes the integration of telehealth credentialing, licensing, and billing into a preexisting APRN Role Practicum course. METHOD: Participants consisted of two cohorts (n = 129) of APRN students enrolled in a role preparation course within a Doctor of Nursing Practice curriculum. Students' knowledge and perceptions regarding the content of a prerecorded lecture were assessed using a pretest/posttest design. The posttest also included optional module assessment questions. RESULTS: Student knowledge regarding the information presented increased, and overall student feedback was positive. CONCLUSION: Telehealth content was successfully integrated into a preexisting APRN Role Practicum course. Students found the information relevant to future practice and became knowledgeable regarding telehealth laws and regulations. [J Nurs Educ. 2022;61(7):413-416.].

Integrating Climate Change Concepts into Advanced Practice Registered Nurses Curricula with the Application of the National Organization of Nurse Practitioner Faculties Competencies.

Climate change has been labeled one of the most significant threats to patient health. Advanced practice registered nurses must acquire adequate preparatory education to care for patients during climate change. They would benefit from implementing climate change concepts to provide safe and quality care for patients. This article aims to discuss integrating climate change concepts into advanced practice nurses curricula by applying the National Organization of Nurse Practitioner Faculties' competencies.

Pandemic response: The identification of alternative clinical hours to ensure advanced practice nursing students meet program requirements.

ABSTRACT: The coronavirus (COVID-19) pandemic resulted in the abrupt withdrawal of clinical sites for advanced practice nursing students which worsened an already challenging placement process. Few studies to date have analyzed the use of alternative clinical practice experiences used to facilitate the completion of program requirements by advanced practice nursing students beyond direct hour requirements. The faculty team from one university decided to track and analyze their use of alternative clinical practice experiences for advanced practice nursing students actively enrolled during the first semester of the pandemic. The team collated student alternative hour entries within the clinical courses for review and statistical analysis. Data included input from advanced practice nursing students in family, pediatric primary care, adult gerontology primary care, adult gerontology acute care nurse practitioner concentrations, and nursing education, doctor of nursing practice, and nurse anesthesia programs. A total of 569 advanced practice nursing students participated in 15 distinct alternative clinical activities. There was a significant effect of students' program concentration on total number of virtual case study hours logged, F (6, 562) = 9.45, p < .0001, and a significant effect of students' program concentration on total number of continuing education hours logged, F (6, 562) = 7.79, p < .0001. Results can inform the use of concentration-specific alternative activities for advanced practice nursing students to address gaps in clinical experiences.

Breaking Down Institutional Barriers to Advanced Practice Registered Nurse Practice.

Advanced practice registered nurses (APRNs) significantly contribute to health promotion, disease prevention, and disease management. Yet, barriers to APRN practice exist, including regulatory, state, and institutional barriers, that hinder their ability to practice to the full extent of their education, licensure, and certification. Nurse leaders can play an important role in helping reduce unnecessary institutional barriers to APRN practice.

Introducing the DNP Projects Department.

In 2004, to advance the credibility and education of the advanced practice nurse, member schools affiliated with the American Association of Colleges of Nursing (AACN) began a process to endorse a position statement on the practice doctorate in nursing. With this endorsement of advanced clinical practice nursing education at the doctoral level-an alternative to research-focused doctoral programs-the credential of doctor of nursing practice (DNP) began.

Perceptions of competency in advanced clinical practice.

BACKGROUND: Historically, there has been limited research carried out on the competency of individuals undertaking advanced clinical roles. AIMS: To research advanced clinical practitioner (ACP) perceptions of the term competency, and how they evidence their competency in practice. METHODS: A cross-sectional, qualitative study used semi-structured interviews, which were analysed by content analysis. Six participants were recruited to the study. FINDINGS: There is disparity in the definitions of 'trainee' and 'qualified' ACP in clinical practice as well as disparity and ambiguity regarding being able to work in a supernumerary capacity during training and master's level study. There is a lack of agreement over the benchmark for qualified ACP status and the road to getting there. CONCLUSION: ACPs should be employed in a supernumerary capacity while training and work towards a full MSc in advanced clinical practice. They should maintain a portfolio of their competency. Work must also be carried out nationally to identify both generic and specialist curricula for ACPs to benchmark against.