Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review.

BACKGROUND: Advanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams. METHODS: We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level). RESULTS: We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs' backgrounds and characteristics, clinical team members' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained. CONCLUSIONS: We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.

Nurse Practitioner Care Environments and Racial and Ethnic Disparities in Hospitalization Among Medicare Beneficiaries with Coronary Heart Disease.

BACKGROUND: Nurse practitioners care for patients with cardiovascular disease, particularly those from racial and ethnic minority groups, and can help assure equitable health outcomes. Yet, nurse practitioners practice in challenging care environments, which limits their ability to care for patients. OBJECTIVE: To determine whether primary care nurse practitioner care environments are associated with racial and ethnic disparities in hospitalizations among older adults with coronary heart disease. DESIGN: In this observational study, a cross-sectional survey was conducted among primary care nurse practitioners in 2018-2019 who completed a valid measure of care environment. The data was merged with 2018 Medicare claims data for patients with coronary heart disease. PARTICIPANTS: A total of 1244 primary care nurse practitioners and 180,216 Medicare beneficiaries 65 and older with coronary heart disease were included. MAIN MEASURES: All-cause and ambulatory care sensitive condition hospitalizations in 2018. KEY RESULTS: There were 50,233 hospitalizations, 9068 for ambulatory care sensitive conditions. About 28% of patients had at least one hospitalization. Hospitalizations varied by race, being highest among Black patients (33.5%). Care environment moderated the relationship between race (Black versus White) and hospitalization (OR 0.93; 95% CI, 0.88-0.98). The lowest care environment was associated with greater hospitalization among Black (odds ratio=1.34; 95% CI, 1.20-1.49) compared to White beneficiaries. Practices with the highest care environment had no racial differences in hospitalizations. There was no interaction effect between care environment and race for ambulatory care sensitive condition hospitalizations. Nurse practitioner care environment had a protective effect on these hospitalizations (OR, 0.96; 95% CI, 0.92-0.99) for all beneficiaries. CONCLUSIONS: Unfavorable care environments were associated with higher hospitalization rates among Black than among White beneficiaries with coronary heart disease. Racial disparities in hospitalization rates were not detected in practices with high-quality care environments, suggesting that improving nurse practitioner care environments could reduce racial disparities in hospitalizations.

Review of advanced practice nurse role in infection throughout the hematopoietic stem cell transplant journey.

BACKGROUND: Prolonged periods of immunosuppression during hematopoietic stem cell transplant (HSCT) can result in serious infectious complications and contribute to transplant-related morbidity and mortality. Adherence to standardized pre and postinfection screening guidelines, prescribed medications, and early identification of infectious symptoms through comprehensive patient and family education are crucial to minimizing infectious complications. Advanced practice nurses (APNs) are key members of the multidisciplinary care team in the HSCT specialty, maintaining a specialized skillset and scope of practice which includes a holistic based, preventative medicine and risk mitigation approach. METHODS: This review sought to describe the role of the APN in HSCT care and to further examine existing APN led models of care which focus on infection prevention and education throughout the HSCT treatment journey. RESULTS: No studies specifically examined the APN role in infectious diseases risk assessment, screening, and management throughout the HSCT journey were identified throughout our review, however, there was considerable evidence to demonstrate the benefits of APN led care in the oncology and solid organ transplantation specialty which led to improvements in continuity of care, overall patient outcomes, and multidisciplinary team collaboration. The key themes identified in our review, were the role of the APN in the delivery of comprehensive patient and family education, the role of the APN in supporting, mentoring, and educating junior medical and nursing teams, the collaboration between the APN and the multidisciplinary care team, and the role of the APN in prompt recognition, triage, and management of treatment related complications, such as infection.

Development and validation of a novel treatment adherence, satisfaction and knowledge questionnaire (TASK-Q) for adult patients with hypothalamic-pituitary disorders.

PURPOSE: Successful treatment outcomes of adults with hypothalamic-pituitary disorders necessitate the adoption of intricate self-management behaviors, yet current scales for evaluating treatment adherence and satisfaction are inadequate for this patient group. This research introduces a novel treatment adherence, satisfaction and knowledge questionnaire (TASK-Q) developed specifically to identify patients' unmet needs in better assessing and managing these disorders. METHODS: The study was conducted in three phases: (1) generating items and testing content validity, (2) refining these items through a pilot study, and (3) a main study evaluating the psychometric properties of the TASK-Q scale among 262 adults in a Pituitary Nurse-led Clinic, with 152 (58%) patients completing the questionnaire. RESULTS: Exploratory factor analysis was used to test the factor structure and construct validity of the TASK-Q, revealing a 22-item scale divided into Satisfaction and Knowledge (17 items) and Adherence (5 items) subscales, and exhibiting high internal consistency (Cronbach's α = 0.90). Significant correlations were identified between satisfaction and knowledge (r = 0.67, p < 0.001), satisfaction and adherence (r = 0.23, p = 0.005), and knowledge and adherence (r = 0.43, p < 0.001). Complex treatment regimens, like daily growth hormone injections and adjusting glucocorticoids during illness, negatively affected adherence (p < 0.001). CONCLUSION: The TASK-Q is a novel validated scale that can effectively evaluate patients' perspectives on adherence, knowledge and satisfaction. Our findings highlight the significant impact of Advanced Nurse Practitioners in improving patient self-management behaviors, which likely leads to better treatment outcomes for people with hypothalamic-pituitary disorders.

Rural healthcare professionals' participation in Medical Assistance in Dying (MAiD): beyond a binary decision.

BACKGROUND: Medical Assistance in Dying (MAiD) was legalized in Canada in 2016 and amended in 2021. At the time that this study was conducted, the federal government was considering expanding the eligibility criteria to include patients whose death was not reasonably foreseeable. The purpose of this study was to better understand rural healthcare professionals' experiences with assisted dying set against the backdrop of legislative expansion. METHODS: A qualitative exploratory study was undertaken with general rural practice physicians, nurse practitioners, registered nurses, ethicists, patients, and patient families in rural Southern Alberta, Canada. For this paper, data from 18 audio-recorded and transcribed semi-structured interviews with healthcare professionals were analyzed using thematic analysis. Categories and patterns of shared meaning that linked to an overarching theme were identified. RESULTS: Between the binary positions of full support for and conscientious objection to assisted dying, rural healthcare professionals' decisions to participate in MAiD was based on their moral convictions, various contextual factors, and their participation thresholds. Factors including patient suffering; personal and professional values and beliefs; relationships with colleagues, patients and family, and community; and changing MAiD policy and legislation created nuances that informed their decision-making. CONCLUSIONS: The interplay of multiple factors and their degree of influence on healthcare professionals' decision-making create multiple decision points between full support for and participation in MAiD processes and complete opposition and/or abstention. Moreover, our findings suggest evolving policy and legislation have the potential to increase rural healthcare professionals' uncertainty and level of discomfort in providing services. We propose that the binary language typically used in the MAiD discourse be reframed to reflect that decision-making processes and actions are often fluid and situational.

Exploring nurse practitioners' collaboration with general practitioners in Norwegian homecare services: a qualitative study.

OBJECTIVE: Nurse practitioners (NPs) have recently been introduced in Norwegian homecare services. The NP role is still in an early implementation phase without standardized role descriptions. NPs are dependent on collaborating with general practitioners (GPs) in the care and treatment of patients. However, little is known about how NPs in Norway experience this collaboration. This study aims to explore how NPs working in homecare services describe their collaborative experiences with GPs, and what influence this collaboration. DESIGN: The study had a qualitative descriptive design, applying individual, semi structured interviews to generate data from five Norwegian nurse practitioners working in homecare services. Data were analyzed using systematic text condensation. FINDINGS: The NPs had varied experiences regarding the collaboration with GPs. NPs stated their role as unclear, lacking standards and job descriptions. The NPs experienced that some GPs were uncertain about the NPs competence, which inhibited collaboration and restricted the NPs utilization of their full capability.NPs experienced a higher degree of collaboration with GPs they knew, and they indicated that trust was the key to facilitate collaboration. The NPs also noted the challenges of establishing relationships with GPs due to the lack of formal meetings and the physical separation of their workplaces. CONCLUSION: Interpersonal dynamics, organizational structures and systemic frameworks influenced the collaboration between GPs and NPs in homecare services. Trust was identified as an important prerequisite for collaboration.

Primary care in Northern Ontario for transgender people in the context of the COVID-19 pandemic: A qualitative secondary analysis.

PURPOSE: To examine changes to primary care practice for transgender clients resulting from government mandated public health measures in response to COVID-19 in Northern Ontario. DESIGN: Secondary analysis of qualitative data using interview transcripts from a dataset that included 15 interviews conducted between October 2020 and April 2021. METHODS: The dataset came from a convergent mixed method study exploring the delivery of primary care services to transgender individuals in Northern Ontario. Qualitative interviews with primary care practitioners including nurse practitioners, nurses, physicians, social workers, psychotherapists, and pharmacists providing care for transgender people in Northern Ontario were included in the secondary analysis. RESULTS: Fifteen primary care practitioner providing care to transgender individuals in Northern Ontario participated in the parent study. Practitioners described their understanding of the effect of the early stages of the COVID-19 pandemic changes on their practice and the care experience for their transgender patients. Two themes were identified and described by participants: (1) a change in the delivery of care; and (2) barriers and facilitators to care. CONCLUSIONS: Practitioners' primary care experiences in the early waves of COVID suggest the integral use of telehealth in Northern Ontario transgender care. Nurses working in advance practice and nurse practitioners are essential in providing continuity of care for their transgender clients. CLINICAL RELEVANCE/SIGNIFICANCE: Identification of initial practice changes for the primary care of trans people will illuminate avenues for further research. The urban, rural, and remote practice settings in Northern Ontario provide an opportunity for increasing access for gender diverse people in these areas and for developing increased understanding of uptake of telemedicine practice. Nurses are integral to primary care for transgender patients in Northern Ontario.

The role of leadership in nurses' wellbeing and performance: A cross-sectional survey using a dual motivational pathway model.

AIM: To examine the positive motivational paths from perceived autonomy-supportive leadership, and the negative motivational paths from perceived controlling leadership to satisfaction and frustration of basic psychological needs, work motivation, work performance, work engagement and somatic symptom burden among nurses using Self-Determination Theory. DESIGN: The study used a cross-sectional design mapping nurses' perceptions of the various study variables through a survey. METHODS: Nurses working in the municipal healthcare in Norway were recruited through an electronic questionnaire sent out via a link to their emails between 29th of August and 29th of September 2020. Of them, 219 nurses completed the questionnaire. Study hypotheses were tested using structural equation modelling. RESULTS: Higher levels of perceived autonomy-supportive leadership were associated with reduced levels of somatic symptom burden and increased levels of work performance and work engagement through the satisfaction of basic psychological needs and autonomous motivation, specifically identified regulation and intrinsic motivation. Perceptions of controlling leadership were associated with heightened levels of somatic symptom burden through basic psychological need frustration, amotivation and introjected motivation, along with lower levels of work engagement through need frustration and amotivation. CONCLUSION: This study underscores the positive motivational paths of perceived autonomy-supportive leadership on nurses' work performance and wellbeing through the facilitation of basic psychological need satisfaction and autonomous motivation. Conversely, the study highlights negative motivational paths of perceived controlling leadership on reduced work engagement and heightened ill-being through the basic psychological need frustration, controlled motivation and amotivation. IMPACT: This study provides insights and actionable recommendations for nurses and their leaders, emphasizing the significance of understanding the adverse impact associated with perceived controlling leadership. The findings underscore the importance of addressing these issues to mitigate detrimental effects on motivation and overall work functioning. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence-based practice into routine care: An interpretative phenomenological analysis.

AIM: To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care. DESIGN: A qualitative interpretative phenomenological analysis. METHODS: A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis. RESULTS: Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice. CONCLUSION: There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care. IMPACT AND IMPLICATIONS: The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients. CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY: As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care. REPORTING METHOD: Consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Healthcare professionals' perspectives towards the role of ward-based advanced practice nurses: A cross-sectional study.

AIMS: 1. To explore the perceptions of physicians, registered nurses (RN) and allied health professionals (AHP) towards the role of ward-based advanced practice nurse (APN). 2. To examine healthcare professionals' perception of APN role expansion in inpatient care. DESIGN: Cross-sectional study. METHODS: A 43-item survey comprising of five domains was conducted on healthcare professionals' perceptions towards ward-based APNs in five medical wards of a tertiary hospital from November 2022 to February 2023. The participants were recruited using convenience sampling via email and cross-platform messaging service. RESULTS: A total of 181 completed respondents including 26 physicians, 102 nurses and 45 AHPs. Statistical analysis was performed with IBM SPSS Version 28.0. APNs were perceived to be spending a great extent of time across all five domains, namely, 'direct comprehensive care', 'support of systems', 'research', 'education' and 'publication and professional leadership'. Significant differences were noted in perceptions based on prior experience with APNs and between different healthcare professions. The majority recognized APNs' positive impact on patient safety, efficiency and patient-centeredness. CONCLUSION: This study offers valuable insights into ward-based APNs' practice patterns, roles and impact, revealing a positive shift in their acceptance and expanding roles within inpatient general wards. It also highlights the valuable roles and impact of ward-based APNs in direct patient care, system support, research, education and leadership, despite ongoing challenges in role clarity, particularly in treatment planning and ward rounds. IMPLICATIONS FOR THE PROFESSION: APNs are highly regarded as competent and a consistent personnel in the wards. However, there are divided views on clinical activities that APNs undertake. IMPACT (ADDRESSING): What problem did the study address? ○ Role ambiguity for ward-based APNs. ○ Healthcare professionals' readiness and acceptance of APNs. What were the main findings? ○ APNs are perceived to have a strong involvement in direct patient care, support of system, research, education and leadership. ○ APNs are recognized for their significant impact on patient safety, efficiency and patient-centredness, but there were varied perceptions on the extent of time they spend in different practice domains. ○ The critical roles of APNs participating in daily ward rounds and initiating discharge plans were highlighted, emphasizing their importance in timeliness and continuity of care. Where and on whom will the research have an impact? ○ It will affect healthcare professionals including physicians, nurses, allied health professionals and healthcare administrators by providing insights into the roles and contributions of ward-based APNs. ○ The findings will guide policymakers and nurse leaders in making informed decisions about the implementation and development of APN roles, ultimately improving patient care and outcomes. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

What is nursing in advanced nursing practice? Applying theories and models to advanced nursing practice-A discursive review.

AIM: This article appraises models and theories related to advanced nursing practice. It argues that while the role of the advanced nurse practitioner builds on and extends beyond traditional nursing, it remains firmly grounded in 'caring'. BACKGROUND: The stereotype that nurses 'care' and doctors 'cure' is fading. Increasingly, nurses have crossed boundaries and conducted independent assessment, diagnosis, prescribing and consultation, which used to be the doctor's role. Confusion and argument have arisen due to the higher-level practice of the advanced nurse practitioner, as many questions where these 'doctor nurses' stand. DESIGN: A literature review. DATA SOURCES: Databases, including CINAHL, Medline and Google Scholar, were searched. METHOD: Databases were searched, and relevant studies and review articles from 1970 to 2023 were identified using the following keywords: 'advanced nurse practitioner', 'nurse practitioner', 'advanced nursing', 'advance practice', 'nurse practitioner', 'nursing theory' and 'nursing model'. RESULTS: Although advanced nurse practitioners identify themselves as nurses, there is limited use of nursing theory to conceptualize this new level of practice and to define their contribution to the multi-disciplinary team. It is noted that a holistic approach to personalized patient care, based on therapeutic relationships and effective communication, may help us identify the unique contribution of the advanced nurse practitioner. CONCLUSIONS: The development of advanced nursing theory needs to capture this holistic approach and its caring element to recognize the value and strengthen the identity allegiance of this hybrid role. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Holistic approach and patient-centred care, effective communication and the therapeutic relationship are strong characteristics relating to ANP practice, the latter of which is yet to be clearly defined and captured in nursing theories. Conceptualizing ANP practice and capturing their valuable nursing care will enable better understanding and clarity for the role to realize its full potential.

Integrating nurse practitioners into primary healthcare to advance health equity through a social justice lens: An integrative review.

AIM: To develop a framework to guide the successful integration of nurse practitioners (NPs) into practice settings and, working from a social justice lens, deliver comprehensive primary healthcare which advances health equity. DESIGN: Integrative review. METHODS: The integrative review was informed by the Whittemore and Knafl's framework and followed the Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. Quality was assessed using the Johns Hopkins Research Evidence Appraisal Tool. Findings were extracted and thematically analysed using NVivo. A social justice lens informed all phases. DATA SOURCES: Databases, including CINAHL, PubMed, Scopus and Web of Science, were searched for peer-reviewed literature published in English between 2005 and April 2022. RESULTS: Twenty-eight articles were included. Six themes were identified at the individual (micro), local health provider (meso), and national systems and structures (macro) levels of the health sector: (1) autonomy and agency; (2) awareness and visibility; (3) shared vision; (4) leadership; (5) funding and infrastructure; and (6) intentional support and self-care. The evidence-based framework is explicitly focused on the components required to successfully integrate NPs into primary healthcare to advance health equity. CONCLUSION: Integrating NPs into primary healthcare is complex and requires a multilevel approach at macro, meso and micro levels. NPs offer the potential to transform primary healthcare delivery to meet the health needs of local communities. Health workforce and integration policies and strategies are essential if the contribution of NPs is to be realized. The proposed framework offers an opportunity for further research to inform NP integration. IMPACT STATEMENT: Nurse practitioners (NPs) offer the potential to transform primary healthcare services to meet local community health needs and advance health equity. Globally, there is a lack of guidance and health policy to support the integration of the NP workforce. The developed framework provides guidance to successfully integrate NPs to deliver comprehensive primary healthcare grounded in social justice. Integrating NPs into PHC is complex and requires a multilevel approach at macro, meso and micro levels. The framework offers an opportunity for further research to inform NP integration, education and policy. SUMMARY STATEMENT: What problem did the study address: The challenges of integrating nurse practitioners (NPs) into primary healthcare (PHC) are internationally recognized. Attempts to establish NP roles in New Zealand have been ad hoc with limited research, evidence-informed frameworks or policy to guide integration initiatives. Our review builds on existing international literature to understand how NPs are successfully integrated into PHC to advance health equity and provide a guiding framework. What were the main findings: Six themes were identified across individual (micro), local health provider (meso) and national systems and structures (macro) levels as fundamental to NP integration: autonomy and agency; awareness and visibility of the NP and their role; a shared vision for the direction of primary healthcare utilizing NP scope of practice; leadership in all spaces; necessary funding and infrastructure; and intentional support and self-care. Where and on whom will the research have an impact: Given extant health workforce challenges together with persisting health inequities, NPs provide a solution to delivering comprehensive primary healthcare from a social justice lens to promote healthcare access and health equity. The proposed evidence-informed framework provides guidance for successful integration across the health sector, training providers, as well as the NP profession, and is a platform for future research. REPORTING METHOD: This integrative review adhered to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) method. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Development of a competency framework for advanced practice nurses: A co-design process.

AIMS: The aim of the study was to develop a comprehensive competency framework for advanced practice nurses in Belgium. DESIGN: A co-design development process was conducted. METHODS: This study consisted of two consecutive stages (November 2020-December 2021): (1) developing a competency framework for advanced practice nurses in Belgium by the research team, based on literature and (2) group discussions or interviews with and written feedback from key stakeholders. 11 group discussions and seven individual interviews were conducted with various stakeholder groups with a total of 117 participants. RESULTS: A comprehensive competency framework containing 31 key competencies and 120 enabling competencies was developed based on the Canadian Medical Education Directions for Specialists Competency Framework. These competencies were grouped into seven roles: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator and health promoter. CONCLUSION: The developed competency framework has resemblance to other international frameworks. This framework emphasized the independent role of the advanced practice nurse and provided guidance in a clear task division and delegation to other professionals. It can provide a solid foundation for delivering high-quality, patient-centred care by advanced practice nurses in the years to come. IMPLICATIONS FOR THE PROFESSION: This competency framework can guide further development of advanced practice nursing education in Belgium and represents a starting point for future evaluation of its feasibility and usability in education and clinical practice. Advanced practice nurses and healthcare managers can also use the framework as an instrument for personal and professional development, performance appraisal, and further alignment of these function profiles in clinical practice. Finally, this framework can inform and guide policymakers towards legal recognition of advanced practice nursing in Belgium and inspire the development of advanced practice nursing profiles in countries where these profiles are still emerging. IMPACT: What problem did the study address? The absence of a detailed competency framework for advanced practice nurses complicates legal recognition, role clarification and implementation in practice in Belgium. A rigorously developed competency framework could clarify which competencies to integrate in future advanced practice nursing education, mentorship programs and practice. What were the main findings? The competency framework outlined seven roles for advanced practice nurses: clinical expert and therapist, organizer of quality care and leader in innovation, professional and clinical leader, collaborator, researcher, communicator, and health promoter. Differentiation from other expert nursing profiles and clinical autonomy of advanced practice nurses were pivotal. Where and on whom will the research have impact? The comprehensive competency framework for advanced practice nurses and the collaborative methodology used can inspire other countries where these profiles are still emerging. The competency framework can be used as an instrument for role clarification, performance appraisals, continuous professional development, and professional (e-)portfolios. The competency framework can guide policymakers when establishing Belgian's legal framework for advanced practice nurses. REPORTING METHOD: The authors have adhered to CONFERD-HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution in the design of the study. A patient advisory panel commented on the developed competency framework.

PRIME-nurse practitioner competency model validation and criterion based OSCE rubric interrater reliability.

The PRIME-NP (Professional-Reporter-Interpreter-Manager-Educator/Evaluation-Nurse Practitioner) Model is adapted from the RIME (Reporter-Interpreter-Manager-Educator) model used in medical education to guide medical student and resident education. The Delphi technique was used to validate the PRIME-NP Model. After two rounds of review by a group of experts in NP curriculum, the model was determined to be valid based on expert consensus. Agreement percent increase from the first round to the second round in all categories. Interrater reliability (IRR) was assessed using interclass correlation after instrument validation was completed for each of the five levels of the PRIME-NP model. Overall, the IRR of the instrument was found to be acceptable with some notable exceptions. No variance was noted in professional behaviors at any level. Variance was increased in management and educator/evaluator behaviors in higher/later course levels. The PRIME-NP Model and PRIME-NP OSCE Rubric is a valid and reliable instrument to assess NP student progression in objective structured clinical examinations. This instrument has the potential for adaptation for use in other types of health sciences education and settings.

Nurse practitioners' use of diagnostic imaging: A scoping review.

AIM: To explore the nature and extent of peer-reviewed literature related to the use of diagnostic imaging by nurse practitioners (NPs) to inform future practice and research. BACKGROUND: Nurse practitioners undertake advanced assessment, diagnosis, and management of patients, including requesting and interpretation of diagnostic imaging. It is unclear what evidence exists related to the quality use of radiological investigations by NPs in recent years. DESIGN: A scoping review based on the steps suggested by the Joanna Briggs Institute. METHODS: A structured review of the databases Medline, CINAHL and Embase was undertaken using the keywords and MESH terms 'nurse practitioner', 'medical imaging', 'diagnostic imaging', 'scan' and 'radiography'. Only English language articles were included, and no date limit was applied. Database review was completed on 30 May 2021. RESULTS: Eight themes were identified-country and clinical context, requesting diagnostic imaging, performing diagnostic imaging, image-guided interventions, interpreting diagnostic imaging, training education and knowledge, impact on resource usage and comparison with medical practitioners. There were more studies across a greater breadth of clinical specialties and imaging modalities in the United States than in other countries. Nurse practitioner practice is frequently benchmarked against that of medical colleagues. There is a paucity of studies focusing on educational preparation and the lack of relevant university curricula for NPs around diagnostic imaging. CONCLUSION: There are significant gaps in the evidence outside of the United States across several of the identified themes. Further studies are needed to explore NP access to and use of diagnostic imaging and to understand the barriers and facilitators to this. RELEVANCE TO CLINICAL PRACTICE: Studies from four countries were included in this review. The evidence suggests that, where studied, nurse practitioners (NPs) can safely and appropriately request and interpret plain x-rays in the emergency and minor injuries setting. Further research is needed to evaluate the educational needs of NPs in relation to diagnostic imaging and their use of advanced imaging techniques, particularly outside of the United States. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Interprofessional teams with and without nurse practitioners and the level of adherence to best practice guidelines in cardiac surgery: A retrospective study.

AIM: To examine the level of adherence to best-practice guidelines of interprofessional teams with acute care nurse practitioners (ACNPs) compared to interprofessional teams without ACNPs. DESIGN: A retrospective observational study was conducted in 2023. METHOD: A retrospective cohort was created including 280 patients who underwent a coronary artery bypass graft and/or a valve repair and hospitalised in a cardiac surgery unit of a university affiliated hospital in Québec (Canada) between 1 January 2019 to 31 January 2020. The level of adherence to best-practice guidelines was measured from a composite score in percentage. The composite score was created from a newly developed tool including 99 items across six categories (patient information, pharmacotherapy, laboratory tests, post-operative assessment, patient and interprofessional teams' characteristics). Multivariate linear and logistic regression models were computed to examine the effect of interprofessional teams with ACNPs on the level of adherence to best-practice guidelines. RESULTS: Most of the patients of the cohort were male and underwent a coronary artery bypass graft procedure. Patients under the care of interprofessional teams with ACNP were 1.72 times more likely to reach a level of adherence higher than 80% compared to interprofessional teams without ACNPs and were 2.29 times more likely to be within the highest quartile of the scores for the level of adherence to best-practice guidelines of the cohort. IMPACT: This study provides empirical data supporting the benefits of ACNP practice for patients, interprofessional teams and healthcare organisations. RELEVANCE FOR PRACTICE: Our findings identify the important contributions of interprofessional teams that include ACNPs using a validated instrument, as well as their contribution to the delivery of high quality patient care. REPORTING METHOD: This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Practice patterns, role and impact of advanced practice nurses in stroke care: A mixed-methods systematic review.

AIM(S): To undertake a systematic review of the practice patterns and roles of advanced practice nurses (APNs) in inpatient and outpatient stroke-care services; and to evaluate the impact of APN-led inpatient and outpatient stroke-care services on clinical and patient-reported outcomes. DESIGN: A mixed-methods systematic review. METHODS: A systematic search was conducted across six electronic databases for primary studies. Data were synthesised using a convergent integrated approach. DATA SOURCES (INCLUDE SEARCH DATES) *FOR REVIEWS ONLY: A systematic search was conducted across PubMed, CINAHL, Cochrane Library, Embase, PsycInfo and ProQuest Dissertations & Theses Global, for primary studies published between the inception of the databases and 3 November 2022. RESULTS: Findings based on the 18 included primary studies indicate that the APNs' roles have been implemented across the continuum of stroke care, including pre-intervention care, inpatient care and post-discharge care. Practicing at an advanced level, the APNs engaged in clinical, operational and educational undertakings across services and disciplines. Positive clinical and patient-reported outcomes have been attributed to their practice. CONCLUSION: The review highlights the critical role of APNs in improving stroke care, especially in the pre-intervention phase. Their clinical expertise, patient-centered approach and collaboration can transform stroke care. Integrating APNs into stroke care teams is essential for better management and outcomes in light of the increasing stroke burden. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Healthcare institutions should integrate APNs to enhance pre-intervention stroke care, improve diagnostic accuracy and expedite treatment. APNs can prioritise patient-centric care, including assessments, coordination and education. Medication reconciliation, timely rehabilitation referrals and lifestyle modifications for secondary stroke prevention are crucial. Implementing advanced practice nursing frameworks ensures successful APN integration, leading to improved stroke care and better patient outcomes in response to the growing stroke burden. IMPACT (ADDRESSING): What problem did the study address? Poor clarity of the role of advanced practice nurses among patients, physicians, healthcare professionals, health policymakers and nurses. What were the main findings? Advanced practice nurses practise across the continuum of stroke care, mainly in pre-intervention care which takes place before initiating treatment, inpatient care and post-discharge care. The implementation of the advanced practice nurse role in stroke care has contributed positively to clinical and patient-reported outcomes. Where and on whom will the research have an impact? Insights from the review are envisioned to inform healthcare policymakers and leaders in the implementation and evaluation of the APN role in stroke care. REPORTING METHOD: Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. TRIAL AND PROTOCOL REGISTRATION: https://figshare.com/ndownloader/files/41606781; Registered on Open Science Framework osf.io/dav8j.

Analysis of education and previous nursing experience of certified PNPs in the United States.

BACKGROUND: Educational programs to prepare nurse practitioners (NPs) were historically built upon foundational nursing experience. Originally prepared as certificate programs in 1965, the educational requirements for nurse practitioners (NPs) rapidly shifted from certificate programs to the Master's degree (DellaBella, 2015; Fairman, 2008). As Doctor of Nursing Practice (DNP) degree programs increase in number, it is unknown whether this foundational nursing experience has changed, or if it differs by certification type for pediatric nurse practitioners (PNPs). This study aimed to evaluate the educational preparation and prior nursing experience of primary care and acute care certified PNPs. METHODS: A national survey of members of the Pediatric Nurse Practitioner Certification Board (N = 17,530) was completed (Mudd et al., 2022). A sub-analysis of this data was conducted (n = 1974). RESULTS: There was no statistical evidence among either primary or acute care PNPs of an association between previous nursing experience and type of degree preparation (Master's or DNP). There was only a weak association between educational preparation and experience among acute care nurse practitioners. Most respondents were prepared at the Master's level, and 85% of all respondents had >1 year of nursing experience prior to returning for additional PNP education. DISCUSSION: This study adds to the literature as it describes the educational preparation and foundational nursing experience of primary and acute care PNPs. It can serve as a benchmark as the move to the DNP continues for Advanced Practice Registered Nurse preparation.

Nurse practitioners' degrees and associations with time use, functional autonomy, and job outcomes.

BACKGROUND: Doctorate of Nursing Practice preparation is recommended for entry to nurse practitioner (NP) practice but there are few comparative studies, and their designs conflate educational pathways. PURPOSE: To investigate time use, functional autonomy, and job outcomes among NPs without a doctorate, NPs whose initial NP preparation and doctorate were separated by 2 or more years, and NPs whose NP preparation and doctorate were concurrent. METHOD: We selected all NPs from the 2018 National Sample Survey of Registered Nurses, except those whose doctorates focused on research. We controlled for confounding and applied sample weights to produce nationally representative results. DISCUSSION: NPs' educational pathways are associated with distinct practice roles and, moving forward, policy should be informed by evidence that accounts for their differences. CONCLUSION: Concurrent NPs had higher levels of functional autonomy compared with NPs without a doctorate, but patterns of time use were essentially the same. Separate doctoral education was associated with teaching and administration.

Burnout, job satisfaction, and turnover intention among primary care nurse practitioners with their own patient panels.

BACKGROUND: Nurse practitioners (NPs) can enhance NP care and improve access to care by autonomously managing their patient panels. Yet, its impact on workforce outcomes such as burnout, job satisfaction, and turnover intention remains unexplored. PURPOSE: To estimate the impact of NP panel management on workforce outcomes. METHODS: Structural equation modeling was conducted using survey data from 1,244 primary care NPs. NP panel management was categorized into co-managing patients with other providers, both co-managing and autonomously managing, and fully autonomous management. DISCUSSION: Fully autonomous management led to more burnout than co-managing (B = 0.089, bias-corrected 95% bootstrap confidence interval [0.028, 0.151]). Work hours partially (27%) mediated this relationship. This findings indicate that greater autonomy in panel management among NPs may lead to increased burnout, partially due to longer work hours. CONCLUSION: Interventions to reduce work hours could help NPs deliver quality care without burnout.