What Nurses in Advanced Practice Know.

Integrating valid, reliable, and applicable knowledge into care.

[The manager-IPA pair in mental health: experimenting with a new form of collaboration]. / Le binôme cadre-IPA en santé mentale : expérimenter une nouvelle collaboration.

In 2021, the first advanced practice nurses (APNs) specializing in psychiatry and mental health will have entered the vast field of practice of this discipline. Two years on, the missions entrusted to them within the establishments that have supported the development of their new skills are as varied as ever. While their scope of action remains to be defined in some places, the fact remains that collaboration between the APN and the local health executive is already proving to be a powerful lever for the successful completion of large-scale projects aimed at the continuous improvement of care in their shared field of practice. A look back at the deployment of a quality tool to improve care safety.

[The care team, from roots to new challenges]. / L'équipe soignante, des racines aux nouveaux défis.

The team is a fundamental and structuring dimension of care, founded on the principles of complementarity, interdependence, and shared objectives and responsibilities towards the patient. As a result of the pandemic and the rationalization of public hospitals, teams are faced with changes in the role of supervisors and the arrival of new figures such as advanced practice nurses. While these changes can bring new dynamism and questioning of practices, they can also be destabilizing. The institution must preserve the role of the team and its members.

[The world is changing, and so is the world of care]. / Le monde change, l'univers du soin aussi.

In the post-Covid context, which is unstable and changing, what is the role of the team when it is reduced to operating with a growing number of temporary staff? The medical desertification that is gradually taking hold in certain regions is a cause for concern, as is the growing disaffection of nurses throughout France. It is essential to draw up a map that incorporates survival oases, in order to meet the essential need to provide care anyway, while at the same time perpetuating the process of improving care. Advanced practice nursing faces many challenges.

[Supporting care teams as a lever for improving practices]. / L'accompagnement des équipes de soins comme levier à l'amélioration des pratiques.

Thanks to their guidance and coaching skills, advanced practice nurses (APNs) support teams on a daily basis in improving their practices and developing their reflexivity. Their leadership enables caregivers to question themselves, exchange ideas and think about care from a different angle. Situational analysis sessions provide a space for them to step back, debate and innovate. This meaningful support enabled a newly-qualified IPA to find her place among the teams. Here's a testimonial.

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.

Outcomes of pediatric-focused advanced practice provider fellowship programs: An integrative review.

BACKGROUND: An increased demand for pediatric-focused advanced practice providers (APPs) exists to address the health care needs of children with medical complexity. Postlicensure advanced practice fellowship programs have been developed to help improve novice provider transition to practice, reducing attrition. OBJECTIVES: The objectives of this integrative review are to (1) identify outcome measurements of pediatric-focused advanced practice fellowship programs and (2) evaluate the outcome measures to guide future implications for practice. DATA SOURCES: A systematic integrative literature review was conducted in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses. PubMed, CINAHL, Embase, and Google Scholar were searched in August and September 2022. Articles met inclusion criteria if they included new graduate APPs, reported the intervention of a pediatric fellowship program, and shared outcome measurements. Studies were excluded if they did not directly report on fellowship program outcome measures. Thirteen studies met inclusion criteria and were summarized and appraised for quality using the Johns Hopkins Evidence-Based Practice Model. CONCLUSIONS: Four themes from the literature included the favorable impact of advanced practice fellowship programs on (a) job satisfaction, (b) retention, (c) clinical and professional performance, and (d) financial outcomes. Variable strategies were used to measure outcomes across programs. IMPLICATIONS FOR PRACTICE: Postlicensure pediatric-focused advanced practice fellowship programs seem to improve retention and job satisfaction, increase provider confidence, and bring a favorable return on investment for the organization. Future work should include investment in developing validated, standardized assessment tools to support future development of these programs in the pediatric population.

Sustainable Academic-Clinical Alliance: A Model to Improve Academic-Practice Partnerships.

Background: National nurse shortages, ongoing nurse faculty retirements, and a dearth of clinical sites make it challenging to prepare advanced practice registered nurses (APRNs) who are ready to transition into independent provider roles, especially in acute care settings. One of the most effective ways to address these experiential learning challenges is for academic institutions and healthcare systems to form collaborative academic-practice partnerships. However, many partnerships between schools of nursing and healthcare institutions have found numerous challenges, including time to devote to the partnership, funding of ideas, competing initiatives and needs, and sustainability. Objective: The University of Maryland School of Nursing (UMSON) set out to expand the traditional academic-clinical partnership approach with a new collaborative model. Methods: Rather than both parties coming to the table with their own goals, the partnership focused on intentional relationship building, transparency, measurable outcomes, and sustainability. This model, further called the Sustainable Academic-Clinical Alliance (SACA), assures that both sides of the partnership benefit. The SACA model was used to create an academic-practice partnership with the University of Maryland Upper Chesapeake Health System in order to increase APRN clinical practice sites and readiness of APRN students to provide care across the continuum in the state of Maryland. Results: Since July 2016, the SACA model has enabled over 40 clinical providers in over 20 different clinical areas to offer 329 different clinical and nonclinical experiences to APRN students from UMSON. At the end of the 5-year alliance, 150 unique UMSON APRN students completed 257 different clinical rotations. Conclusion: The SACA model effectively promotes the development and achievement of sustainable academic-practice partnerships by focusing on (a) intentional relationship building, (b) transparency in goal setting and alliance maintenance, (c) development of outcome measures, and (d) sustainability. Implications for Nursing: The components of the SACA model made sustainability more achievable, which has eluded previous academic-clinical partnerships. This model can serve as a blueprint for other academic and healthcare institutions to establish sustainable academic-practice partnerships.

Developing Political Engagement Competency Among Primary Care Advanced Practice Nursing Students.

Developing political engagement among nurses who care for rural and underserved communities can help mitigate health inequities. An experiential learning opportunity informed by Lobby Day was developed to prepare primary care advanced practice nursing students with the policy skills needed to actively serve as advocates for their patients and communities.

Diabetic foot ulcers: evaluating the role of the specialist advanced practice nurse in complex chronic wounds.

OBJECTIVES: To determine the profile of diabetes patients with neuropathic and neuro-ischaemic lesions who are referred to the advanced practice nurse (APN) in complex chronic wounds; to determine whether a training strategy aimed at primary care nurses and nursing homes that care for patients with diabetic foot disease influences the performance of professionals; and to assess the extent, follow-up and evaluation of diabetic foot disease in patients with neuropathic ulcers and neuro-ischaemic ulcers referred to the specialist APN before and after the training. METHODS: The characteristics of patients referred to the APN over a period of 6.5 years were analysed, as well as the numbers of amputations and deaths pre- and post-training. RESULTS: of the total of 103 patients, 78 were men; across both sexes the average age was 69 years. Fifty patients had neuropathic ulcers and 53 had neuro-ischaemic ulcers, with healing rates of 59%. There were 50 amputations and 37 deaths over the study period. CONCLUSION: Prevention of diabetic foot ulcers depends on having in place a fast, agile, practical clinical pathway between primary care and hospital, with the role of the APN, including the co-ordination of care between primary and secondary settings, being key.

Transforming Advanced Practice RN Compensation: Strategies for Equity in Total Pay.

As the advanced practice RN (APRN) workforce rapidly expands, nursing leaders are grappling with the challenge of establishing equitable and competitive compensation models. This column explores the lessons learned by 2 pioneering APRN leaders who navigated these workforce and compensation challenges within their own healthcare organizations. By sharing their experiences building sustainable APRN infrastructure and addressing pay discrepancies, the authors provide valuable insights and strategies that can help other nursing leaders transform their APRN compensation approaches and ensure their advanced clinicians are appropriately valued and rewarded.

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

OBJECTIVE: The objective of this review was to map the literature about the concept of capability in advanced practice nursing education and practice to achieve greater clarity on the concept and its application. INTRODUCTION: Advanced practice nursing roles make up a growing segment of the global nursing workforce. Capability has been proposed as an overarching description of the attributes of advanced practice nursing roles within complex workplace environments. Capability includes knowing how to learn, and the ability to creatively integrate prior knowledge, skills, judgment, and experience in both new and familiar situations. INCLUSION CRITERIA: This review looked at the literature about capability applied to advanced practice nursing in any setting globally. We were guided by the International Council of Nurses' definition of advanced practice nursing, which includes nurses with both graduate education and an expanded scope of practice. Drawing from an initial review of the literature, we used a working definition of capability, which was a combination of knowledge, skills, experience, and competencies that enables advanced practice nurses to provide appropriate care for patients in both known and unfamiliar clinical settings. We included literature about individual capability as a concept in any setting related to advanced practice nursing and education. METHODS: We searched 18 electronic databases and included qualitative, quantitative, and mixed methods study design methodologies, reviews, and reports. The gray literature search included policy and practice documents from the World Health Organization, the International Council of Nurses, and websites of 48 nursing and health organizations. Two reviewers independently completed title and abstract screening prior to full-text review and data extraction. Conflicts were resolved via discussion or with a third reviewer. Extraction was completed by 2 reviewers using a piloted data extraction tool. Articles published in English from 1975 to the present were included. Sources in languages other than English were not included in the review due to the difficulties in accurately translating the concept of capability. RESULTS: Thirty-five sources were included in the review with publication dates from 2000 to 2023. Most sources originated from Australia, the United Kingdom, and the United States. Sources included frameworks and clinical guidelines, peer-reviewed articles, and gray literature. Capability was discussed in a range of settings, including specialized clinical roles. Applications of capability in educational settings included the use of capability frameworks to guide nurse practitioner education, nursing practice doctorates, and postgraduate nurse practitioner training. Definitions of capability, where provided, were relatively consistent. Capability was proposed as a distinguishing characteristic of advanced practice nursing, as a descriptor of clinical proficiency that moved beyond competency, and as a framework that accounted for complexity in health care settings. CONCLUSION: Capability was used as a concept and framework to describe advanced practice nursing within complex practice environments that necessitate flexible approaches. Capability frameworks were applied holistically and to specific areas of practice or education, including in pregraduate and postgraduate advanced practice nursing education. Strategies for teaching and learning capability focused on flexibility, student-directed learning, and development of flexible learning pathways. SUPPLEMENTAL DIGITAL CONTENT: A Norwegian-language version of the abstract of this review is available: http://links.lww.com/SRX/A58.

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 global perspective of advanced practice nursing research: A review of systematic reviews.

INTRODUCTION: The World Health Organization (WHO) called for the expansion of all nursing roles, including advanced practice nurses (APNs), nurse practitioners (NPs) and clinical nurse specialists (CNSs). A clearer understanding of the impact of these roles will inform global priorities for advanced practice nursing education, research, and policy. OBJECTIVE: To identify gaps in advanced practice nursing research globally. MATERIALS AND METHODS: A review of systematic reviews was conducted. We searched CINAHL, Embase, Global Health, Healthstar, PubMed, Medline, Cochrane Library, DARE, Joanna Briggs Institute EBP, and Web of Science from January 2011 onwards, with no restrictions on jurisdiction or language. Grey literature and hand searches of reference lists were undertaken. Review quality was assessed using the Critical Appraisal Skills Program (CASP). Study selection, data extraction and CASP assessments were done independently by two reviewers. We extracted study characteristics, country and outcome data. Data were summarized using narrative synthesis. RESULTS: We screened 5840 articles and retained 117 systematic reviews, representing 38 countries. Most CASP criteria were met. However, study selection by two reviewers was done inconsistently and language and geographical restrictions were applied. We found highly consistent evidence that APN, NP and CNS care was equal or superior to the comparator (e.g., physicians) for 29 indicator categories across a wide range of clinical settings, patient populations and acuity levels. Mixed findings were noted for quality of life, consultations, costs, emergency room visits, and health care service delivery where some studies favoured the control groups. No indicator consistently favoured the control group. There is emerging research related to Artificial Intelligence (AI). CONCLUSION: There is a large body of advanced practice nursing research globally, but several WHO regions are underrepresented. Identified research gaps include AI, interprofessional team functioning, workload, and patients and families as partners in healthcare. PROSPERO REGISTRATION NUMBER: CRD42021278532.

Lessons learned: Why study-abroad remains a critical component of nursing curriculums.

BACKGROUND: Caring for an increasingly older and multicultural patient population requires nurses and APNs who are able to integrate cultural competency in meeting the needs of their patients while decreasing health care disparities. A study-abroad immersion experience is one way to instill deep learning and cultural competency. PURPOSE: The purpose of this study was to understand the lived experience of baccalaureate nursing students and APN students working together in a study-abroad, service-learning experience. METHOD: Using Interpretive Phenomenological Analysis (IPA) (Smith & Osborn, 2003), we explored the lived experience of Baccalaureate and Advanced Practice Nursing Students in a service-learning, study-abroad experience in Belize. RESULTS: Emergent themes derived from students' journal transcripts were: (1) Allowing learning to take place; (2) Practicing nursing with limited resources (3) A different take on culture; and (4) Kinship with peers. From this theme two sub themes emerged: 1) students' connection with the people and the country, and 2) students' connection with each other. CONCLUSION: Cultural immersion prepared students to work in Belize with different patient groups, having varied perspectives related to their health. Students learned that the core values of dignity and caring require that we, as nurses, go where the patient is-not where we want the patient to be. This is tested when students are confronted with a culture not their own.