Welcome to the latest key papers and publications focussing mainly on the role of Advanced Nurse Practitioners in the nursing profession.
The British
Journal of Nursing, Nursing Times, British Journal of Healthcare Assistants,
Journal of Perioperative Practice and the British Journal of Midwifery are all
either available in print within the library or online via your OpenAthens
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Evaluation of two academic practice partnerships
for chronic disease management in nursing education
Abstract: More clinical
sites are essential to meeting the learning needs of nursing students who will
care for patients with chronic disease after graduation. Partnerships between
schools of nursing and academic practices can increase clinical training
capacity, allow future nurse practitioners (NPs) to apply knowledge and skills
in the context of care delivery, and potentially improve patient outcomes with
little associated risk. This article describes the experiences of primary care
NP students (n = 37), NP faculty (n = 2), and clinic providers
(n = 2) in an academic practice partnership performing home visits
with complex pediatric asthma and adult heart failure (HF) patients. A 14-item post
experience survey was used to obtain student feedback. Over 75%
(n = 28) of student participants responded. Most respondents, 80%
assigned to pediatric asthma patients and 90% assigned to adult HF patients,
reported the home visit experience prepared them to care for patients with
chronic diseases. Clinic providers indicated the extra attention to both
patient groups reduced barriers to care and improved care continuity. This
partnership offers a model for developing clinical skills in advanced practice
nursing students and enhancing scarce clinical placement resources. Findings
were used to refine the program and expand to include all 150 students in the
subsequent academic year.
Source: Public Health Nursing, 2021; 38(3): 412
Quality improvement: Online resources to support nursing education and practice
Abstract: Background: Quality
improvement (QI) competence is included in the American Association of Colleges
of Nursing Essentials for pre-licensure and graduate degrees and is invaluable
to nurses at all levels of professional practice. Among barriers to integration
of QI competency is insufficient QI knowledge and skills among faculty and
practicing nurses. Many nurses completed their nursing education before the
introduction of the QI competencies in nursing programs, and it is
understandable if they lack QI knowledge, skills, and attitudes.
Purpose: The
purpose of this review is to provide information about QI online resources to
nursing faculty, nurse leaders, and nurses in clinical practice with
educational and training tools and opportunities to broaden their QI
competence.
Methods: The
authors completed a comprehensive review of online resources for learning
and/or teaching QI in health care and explored the websites of eight
organizations.
Results: Within
eight selected websites, the authors chose over 20 online self-study resources
to learn and/or teach QI in health care with content for beginner,
intermediate, and advanced learners.
Conclusion: The QI
online resources are easily accessible and can enable learning and engagement
in QI of nursing faculty, students, and practicing nurses with no or limited
exposure to the discipline.
Source: Nursing Forum; 2021, 56(2): 341
Abstract: Aim: To develop,
implement and evaluate the clinical nurse specialist's role within a specialist
medical healthcare hospital. A secondary aim was to assess the feasibility of
the ‘Clinical Nurse Specialist Conceptualisation, Implementation, and
Evaluation framework’ in the role implementation.
Background: Implementation
of advanced practice nursing roles is an increasing practice around the globe;
however, the implementation of these roles is multidimensional, complex
process. Clear implementation strategies are needed.
Design: Participatory
action research was conducted in Finland between 2017–2018.
Methods: The
researchers adopted an outsider approach to work with staff, considered as
co-researchers, within two participating units. A combination of several
methods, such as focus group interviews, action-learning groups and researcher
reflective field journal, was used to gather data. The ‘Clinical Nurse
Specialist Conceptualisation, Implementation, and Evaluation framework’ was
used to structure the processes undertaken and the Donabedian structure,
process and outcome model was used to structure and analyse the results. The
study was reported using the EQUATOR guideline for participatory action
research.
Results: The
results demonstrated the complexity of the role implementation process. Four
implementation themes of need analysis, role design, role implementation and
role evaluation were examined and described through their structures, processes
and outcomes. The ‘Clinical Nurse Specialist Conceptualisation, Implementation
and Evaluation framework’ was validated for its appropriateness guiding the
role implementation process.
Conclusions: Role
implementation is a complex process which structured, practical guidelines may
facilitate. The examined framework may facilitate the role implementation
process conducted within organisations.
Relevance to
clinical practice: This research provides complimentary information for
individuals and organisations aiming to develop a clinical nurse specialist or
other advanced practice nursing roles. Furthermore, we describe a participatory
action research process, which offers the means for self-reflection and
planning of purposeful actions to improve the conditions of clinical practice.
Source: Journal of Clinical Nursing; 2021, 30(15-16): 2222
Abstract: Rationale and Aim: Advanced Practice Nurse (APN) is a specialist who has acquired clinical skills
to make complex decisions for a better professional practice. In the United
States, this figure has been developed in different ways, but in some European
countries, it is not yet fully developed, although it may imply a significant
advance in terms of continuity and quality of care in patients with chronic or
multiple pathologies, including cardiac ones and, more specifically, heart
failure (HF). The follow-up of HF patients in many countries has focused on the
medical management of the process, neglecting all the other comprehensive
health aspects that contribute to decompensation of HF, worsening quality
indicators or patient satisfaction, and there are not updated reviews to
clarify the relevance of APN in HF, comparing the results of APN interventions
with doctors clinical practice, since the complexity of care that HF patients
need makes it difficult to control the disease through regular treatment. For
this reason, this systematic review was proposed in order to update the
available knowledge on the effectiveness of APN interventions in HF patients,
analysing four PICO questions (Patients, Interventions, Comparison and
Outcomes): whether APN implies a reduction in the number of hospital
readmissions, if it reduces mortality, if it has a positive cost-benefit
relationship and if it implies any improvement in the quality of life of HF
patients.
Design and
Methods: A systematic review was performed based on the PRISMA statement,
searching at four databases: PubMed, CINAHL, Scopus and Cuiden. Articles were
selected based on the following criteria: English/Spanish language, up to
6 years since publication, and original quantitative studies of
experimental, quasi-experimental or observational character. Papers were
excluded if they do not comply with CONSORT or STROBE checklists, and if they
had not been published in journals indexed in JCR and/or SJR. For the analysis,
two separate researchers used the Cochrane Handbook form for systematic reviews
of intervention, collecting authorship variables, study methods, risks of bias,
intervention and comparison groups, results obtained, PICO question or
questions answered, and the main conclusions.
Results: A total
of 43,754 patients participated in the 11 included studies for the development
of this review, mostly from United States and non-European countries, with a
clearly visible lack of European publications. Regarding the results related to
first PICO question, researches reviewed proved that APN implied a reduction in
the number of hospital readmissions in patients with heart failure (up to 33%).
Regarding the second question, mortality was always lower in groups assisted by
APN versus in control groups (up to 7.8% vs. 17.7%). Regarding the third
question, APN was cost-effective in this type of patient as the cost reduction
was eventually calculated in 1.9 million euros. Regarding the last
question, quality of life of patients who have been cared for by an APN had
notoriously improved, although one of the papers concluded that no significant
differences were found. All the questions addressed obtained a positive answer;
therefore, APN is a practice that reduced hospital readmissions and mortality
in HF patients. The cost-effectiveness is much better with APN than with usual
care, and although the quality of life of HF patients seems to improve with
APN, more studies are needed to support this focused on this.
Source: Nursing Open, 2021; 8(4): 1879
Abstract: Aim: To understand
how advanced nurse practitioners use knowledge to inform their discharge
decision-making in the emergency department.
Background: Advanced
nurse practitioner roles have developed globally in a wide range of healthcare
settings, including the emergency department, over the past few years. The
scope of practice and training vary widely between countries. Little is known
about how they use clinical knowledge in the emergency department.
Design: An
ethnographic study was undertaken in an emergency department in the North of
England.
Method: Data were
collected by observation (n = 5) and semi-structured interviews
(n = 13) between September 2016 and June 2017. Interview transcripts
and field notes were coded using Quirkos software. Thematic analysis was used
to identify key themes.
Findings: In
boundary blurring with medicine, advanced nurse practitioners in the emergency
department need to make timely, autonomous discharge decisions. Knowledge
mobilization is messy and complex; however, shortcuts facilitate autonomous discharge
decision-making. More experienced advanced nurse practitioners rely less on
shortcuts as they draw on experiential knowledge.
Discussion: Boundary
blurring in the advanced nurse practitioner role in the emergency department,
requires reliable knowledge shortcuts. Support from senior colleagues and
accessible smartphone apps enable advanced nurse practitioners to efficiently
make discharge decisions. This study adds to previous research on how knowledge
is managed in boundary blurring.
Conclusion: Advanced
nurse practitioners in the emergency department require timely access to
relevant, up to date knowledge. This study has highlighted their preferred
knowledge sources to inform discharge decision-making. In boundary blurring,
shortcuts enable ANPs to use knowledge efficiently to inform patient care in
the emergency department.
Impact: The
findings increase our understanding of how to equip advanced nurse
practitioners with knowledge to facilitate clinical decision-making. Clinical
managers should provide mentorship and relevant up to date knowledge shortcuts
to ensure efficient, evidence-based discharge decision-making.
Source: Journal of Advanced Nursing, 2021; 77(7): 3156
Patients' and partners' experiences with prostate cancer and advanced practice nurse counselling
Abstract: Patients with
prostate cancer (PCa) often experience physical and psychological challenges
after diagnosis and therapeutic side effects after radical prostatectomy. To
meet the needs of these patients and their partners, an advanced practice nurse
(APN) support programme was initiated at a Swiss university hospital. The APN
served as a constant contact person and offered psycho-oncological counselling
from the first day after radical prostatectomy to follow-up care in the
outpatient clinic, every third month over the first year and twice in the
second year. Counselling was provided in-person and through the phone. It
focused on coping skills regarding cancer-related distress, hospital stay,
treatment and therapeutic side effects, post-discharge life, and physical
activity. This study aimed to explore the experiences of patients and partners
with the disease, including diagnosis, radical prostatectomy, and follow-up
care. Additionally, their experience with the APN support programme was evaluated.
A qualitative content analysis, according to Mayring, was used. Interviews were
conducted with 10 patients and 8 partners who participated in the APN
counselling programme. Interviews were performed individually in-person or by
telephone. Patients reported a variety of experiences with respect to the
diagnostic process and the final decision for radical prostatectomy. Patients
and spouses also described some unmet information needs during the PCa care
continuum. They wished they received more information about PSA testing,
treatment options, and management of surgically induced side effects such as
incontinence and erectile dysfunction. While most couples mastered the
situation together, some patients did not involve their spouses. During the hospital
stay, patients felt well cared for; the spouses agreed. Urinary incontinence
was the primary challenge after discharge. Later, erectile dysfunction was a
challenge for most participants. While counselling was experienced differently,
patients and spouses valued the trustworthy APN as a constant contact person.
In clinical practice, needs-tailored information should be provided by all
involved healthcare professionals. In addition, a support programme for
patients and partners that includes an APN as a constant contact person over
the PCa continuum is recommended.
Source: International Journal of Urological Nursing, 2021; 15(2): 82
Virtual Interprofessional Learning Due to COVID-19
Abstract: The COVID-19 pandemic necessitated sweeping changes in a neonatal
nurse practitioner (NNP) program's approach to distance-accessible learning.
Prioritizing student learning and safety, we developed a new alternative model
for individualized simulation.
Method: The scenario created for a student to deliver an unexpected diagnosis of trisomy 21, or Down syndrome, to a postpartum mother was redesigned to take place using web-conference technology.
Results: We successfully transitioned the planned in-person individualized simulation for NNP students delivering an unexpected diagnosis to a web-conference environment and added nurse–midwifery (NM) students.
Conclusion: This simulation presented an authentic clinical situation encountered in practice, supporting the specialty-specific competencies for the NNP, NM, and core competencies for interprofessional collaborative practice. The web-conference platform is an effective strategy for simulation. Advanced practice nurses completing individualized simulation through technology are uniquely poised to leverage these skills as telemedicine increasingly influences their future clinical practice.
Source: Journal of Nursing Education, 2021; 60(6): 346
From expert to advanced clinical practitioner and beyond
Abstract: This article
considers the potential development of advanced clinical practitioners (ACPs)
and consultant practitioners, beyond the 'expert' status as defined by Pat
Benner in 1984. The suggested Derby Model: 7 Levels of Practice Advancement,
adapted from Benner's From Novice to Expert, recognises Health Education England's
four pillars of advanced practice and how they can be implemented and enhanced
within these senior roles, and what that means in a 21st century healthcare
system.
Source: British Journal of Nursing, 2021; 30(11): 656-659
Abstract: In October 2018,
President Trump signed into law H.R. 6, the Substance Use-Disorder Prevention
that Promotes Opioid Recovery and Treatment for Patients and Communities Act.
This piece of legislation addresses treatment, prevention, recovery, and
enforcement with particular attention to access in rural areas. It contains
numerous provisions to improve needed access to treat substance use disorders
and especially opioid use disorder (OUD), including mandatory coverage of
medications for OUD, partial elimination of Medicaid payment for inpatient
mental health treatment, and state planning grants to increase provider
capacity. Many of these provisions would be significantly enhanced by removing
barriers to prescriptive authority for Advanced Practice Registered Nurses
(APRNs), including Nurse Practitioners, Clinical Nurse Specialists, Certified
Nurse Midwives, Certified Registered Nurse Anesthetists, and other
state-specific titles for nurses whose scope allows the prescription of
controlled substances. This policy brief includes a history of the role of
APRNs in the delivery of medications for OUD, scope of practice restrictions related
to prescriptive authority as a barrier in their ability to deliver care for
this vulnerable population, and actionable strategies that APRNs can take to
advocate for an increased role in providing care.
Source: Policy, Politics & Nursing Practice, 2021; 22(2): 85
The Significance of the NP Preceptorship Shortage
Abstract: Keywords: nurse practitioner, advanced practice registered nurse,
preceptor matching, preceptorship, preceptor shortage, nursing education,
clinical rotation, clinical experience, clinical hours, clinical contract,
clinical placement, pay for preceptors, Sawyer Initiative, COVID-19 pandemic
Imagine being a graduate nursing student, freshly minted with a degree plan,
financial aid, supportive family, and books in hand.
The 2016 report of the National Task Force on Quality NP Education, (National Task Force on Quality Nurse Practitioner Education. 20161 states that students must complete a graduate program that corresponds to the certification, role, and population.
According to a report by the National Task Force on Quality NP Education, one problem noted in NP education is a lack of standardized preceptor guidelines and educational policies (National Task Force on Quality Nurse Practitioner Education. 20161.
Comparison of
Clinical Education Models The Medical Student Medical students have
predetermined clinical rotations, called clerkships, while in medical school
fHowlev. 20201.
Source: Online Journal of Issues in Nursing; 2021; 26(2): 1
Abstract: Aim: To undertake
a scoping review of the literature exploring the impact of clinical leadership
in advanced practice roles in relation to patient, staff and organisational
outcomes.
Background: An
increasing number of publications as well as job specifications have identified
clinical leadership as a cornerstone of advanced practice roles. However, it is
unclear whether embedding clinical leadership in such roles has led to
improvements in patient, staff or organisational outcomes. Therefore,
identifying the extent to which clinical leadership in advanced practice roles
relates to patient, staff and organisational outcomes is needed.
Method: A scoping
review examining the relationship between clinical leadership in advanced
practice roles and health care outcomes. Searching in SCOPUS, PubMed, Psychinfo
and CINAHL Plus and Web of Science identified 765 potential articles.
Independent selection, data extraction tabulation of findings and analysis were
completed.
Results: Seven
studies were identified that met the inclusion criteria. Only studies reporting
on nurses in advanced practice roles were included; no studies were identified
that reported on the advanced practice roles of allied health professionals.
The results indicate that there is no objective evidence of the impact of
advanced practitioners’ clinical leadership on patient, staff or organisational
outcomes.
Conclusion: There
is a paucity of objective evidence to identify the extent to which clinical
leadership is enacted in advanced practice roles. The review indicates a need
for closer alignment of AP clinical leadership policy aspirations and formal
operational leadership opportunities for APs.
Implications for
Nursing Management: Nurse managers have a key role in supporting and equipping
APs with leadership competencies and opportunities to enable both capability
and capacity building of such roles. Nurse managers should involve APs in
health care leadership at an organisational level to maximize their
contribution to health, quality practice environments and health care reform.
Additionally, a distinct involvement in staff development, change, operational
strategic decisions and policy development should be part of the AP role, which
is facilitated by management.
Source: Journal of Nursing Management, 2021; 29(4): 613
Don’t forget the leadership in advanced practice
Abstract: Although the
advanced practice role primarily focuses on delivering the clinical aspects of
patient care, the other pillars of advanced practice (research, education and
leadership/management) should not be overlooked as they are key to the success
of the advanced practice role. Interestingly, the International Council of
Nursing definition of nurse practitioners includes the importance of certain
characteristics, ‘expert knowledge base, complex decision-making skills and
clinical competencies’, but does not include the other pillars of advanced
practice (International Council of Nurses, 2020).
Source: Journal of Nursing Management, 2021; 29(4): 607
The emerging role of the advanced practice epilepsy nurse: A comparative study between two countries
Abstract: Aims and
objectives: The aim of the study was to compare advanced practice in epilepsy
nurses in Spain and United Kingdom, identifying differences in the domains of
standard advanced practice.
Background: Europe
has recently faced the challenge of providing high-quality care for patients
with epilepsy, a disease that generates many health demands. In some countries,
such as the United Kingdom, advanced practice nursing is well established and
could serve as a guide for implantation in countries where it is still in
development, as is the case of Spain.
Design: A
multicentre cross-sectional descriptive cohort study compared differences in
the roles of advanced practice nurses in Spain and the United Kingdom.
Methods: The
Advanced Practice Role Delineation Tool and its validated Spanish version were
administered using an online questionnaire in a cohort of advanced practice
epilepsy nurses in both countries. A convenience sample was recruited between
January to December 2019. The study complied with the Strengthening the
Reporting of Observational Studies in Epidemiology (STROBE) checklist.
Results: Most
United Kingdom nurses in our sample came from community environments, in
contrast to Spanish nurses who worked in hospital. All domains analysed in the
survey had significantly higher scores in the United Kingdom than in the
Spanish cohort, especially in the research and leadership domains.
Conclusions: The
advanced practice role in Spain is underdeveloped compared with the United
Kingdom. Differences in the settings of advanced roles in epilepsy nurses may
be explained by greater community practice in the United Kingdom and differences
in organisational and health systems.
Relevance to
clinical practice: Our study showed the need to implement specific policies to
develop advance practice nurse roles in Spain to improve the quality of care of
patients with epilepsy.
Source: Journal of Clinical Nursing, 2021; 30(9-10): 1263
Abstract: Aim: This study
aimed to explore the role and impact of advanced practice nurses (APNs) in care
of patients following fragility hip fracture by systematically reviewing the
available evidence.
Review Design: Systematic
review.
Data sources: A
search of the databases Ovid Medline, CINAHL, Embase, Emcare, Cochrane Library,
and Google Scholar was conducted from January–February 2019.
Method: This
systematic review adhered to The PRISMA Statement. Study selection was managed
using the Covidence software platform and quality was assessed using JBI
Critical appraisal tools. Studies included adults >18 years and
described the role and impact of APNs in care of patients following fragility
hip fracture on clinical and non-clinical outcomes.
Results: There
were 19 papers identified that met the inclusion/exclusion criteria. Quality
was graded as moderate to low risk of bias. Six characteristics of APNs were
identified: (1) coordination; (2) collaboration; (3) education; (4) assessment,
investigation and treatment recommendations; (5) discharge planning, support
and follow up; and (6) documentation. Overall mortality and LOS improved when
characteristics of the APN role were present.
Conclusion: Key
findings from this systematic review showed: (1) The APN title and role are not
clearly defined, but characteristics of the APN role are evident; (2)
characteristics of APNs promote the delivery of best practice hip fracture care
and have a positive impact on mortality and LOS; and (3) innovative service
delivery models involving APNs should be considered to address future
projections of hip fracture rates and improve outcomes.
Impact: This
systematic review provides evidence of the role characteristics of APNs in
fragility hip fracture and the impact of the role on outcomes. Findings from
this research could be used to develop service delivery models using APNs to
care for patients following fragility hip fracture and to inform practice where
APN roles may improve outcomes for other patient cohorts.
Source: Journal of Advanced Nursing, 2021; 77(5): 2166
Nurse practitioner students as an essential workforce: The lessons of coronavirus disease 2019
Abstract: • Nursing students are an essential workforce during a pandemic. •
The coronavirus disease 2019 pandemic provides opportunities for nurse leaders
to identify creative solutions. • Future policies need to focus on the role of
advanced practice simulation training and telehealth. The coronavirus disease
2019 (COVID-19) disrupted the education and clinical training of nursing
students. Clinical sites shut out students over low equipment supplies,
physical distancing requirements, and redeployment of staff. The purpose of
this paper is to highlight a progressive solution to engage nurse practitioner
students as part of the COVID-19 response given the disruption of their
traditional clinical training environments so that student could continue to
matriculate and graduate in a timely manner. Nurse practitioner students
swiftly responded and were deemed an essential part of the nursing workforce.
Policy implications for advanced nursing practice and education for telehealth
and simulation research moving forward is also provided.
Source: Nursing Outlook, 2021; 69(3): 333-339
Abstract: Increasing
prevalence in breast cancers, workforce shortages and technological
advancements have increased the need to further develop advanced practice in
breast diagnosis. The Advanced Clinical Practitioner training programme has
been introduced to support this need. The aim of this work was to
systematically review studies that explore advanced practice in mammography to
assess the potential impact of the introduction of a specific Advanced Clinical
Practitioner training programme in breast diagnosis within the UK. A systematic
PRISMA review of the literature published between 1999 and January 2020 was
carried out. A total of 17 studies were included in the review. Four themes
were identified in the literature in relation to advanced practice in breast
imaging: multidisciplinary practice; roles and responsibilities associated with
advanced practice; development and progression; embedding and sustaining
advanced practice. It was evident across all themes that advanced practice is
vital in supporting better care for patients attending breast imaging in light
of workforce shortages. Although advanced practice and its benefits are well
established in breast imaging, persistent barriers were acknowledged such as
role ambiguity, recruitment issues, lack of support from some radiologists and
poor funding. Findings suggest that introducing a more formalised pathway to
advanced practice into breast imaging through the implementation of a specific
Advanced Clinical Practitioner apprenticeship training programme may overcome
many of the challenges evidenced in this review. The findings of this review
will help inform the development of the Advanced Clinical Practitioner
apprenticeship programme specific to breast diagnosis.
Source: Radiography, 2021; 27(2): 654-662
Academic–Service Partnerships: Increasing the Advanced Nurse Workforce
Abstract: Background: Clinical education placement for advanced practice
registered nurse (APRN) students is challenging for most graduate schools of
nursing. This study describes the experiences of hospitals that formed
academic–service partnerships to facilitate clinical education placement for
APRN students.
Method: Hospital staff, schools of nursing administration and
clinical faculty staff, clinical preceptors, and APRN students participated in
the focus group and interview sessions during the evaluation of the Graduate
Nurse Education demonstration project.
Results: Content analysis resulted in seven themes: APRN Student
Enrollment, Clinical Placements/Process, Clinical Education Sites, Clinical
Preceptors, Communication and Collaboration, Sustainability, and Funding
Process.
Conclusion: Future partnerships between hospitals, schools of
nursing, and clinical education sites should consider collaborating in multiple
regions to increase enrollment and clinical education placement opportunities
for APRN students.
Source: Journal of Nursing Education, 2021; 60(4): 190-195
Undertaking consultations and clinical assessments at advanced level
Abstract: Once deemed the
reserve of doctors, ‘the medical interview’ has since transitioned across
professional boundaries and is now a key part of the advanced clinical
practitioner (ACP) role. Much of the literature surrounding this topic focuses
on a purely medical model; however, the ACPs’ use of consultation and clinical
assessment of complex patient caseloads with undifferentiated and undiagnosed
diseases is now a regular feature in healthcare practice. This article explores
how knowledge of the fundamental principles surrounding ACP–patient communications,
along with the use of appropriate consultation frameworks and examination
skills, can provide a deeper insight and enhance the existing skills of the
ACP. A comprehensive guide to undertaking patient consultations, physical
examination and diagnostic reasoning on a body systems basis is explored in
future issues of this Advanced Clinical Practice series.
Source: British Journal of Nursing, 2021; 30(4): 238-243
The ascent to advanced practice: challenges, support and opportunities
Abstract: The article
presents the discussion on considering the importance of clinical supervision,
mentorship, and supporting mechanisms assisting in developing advanced clinical
practice. Topics include nurses practicing with greater autonomy providing a
wider clinical service to patients; and affecting service provision and helping
in enhancing the development of advanced clinical practice.
Source: British Journal of Nursing, 2021; 30(2): 106-108
A day in the life of an advanced clinical practitioner in older people's care
Abstract: AUTH Why you
should read this article: • To learn about the requirements for becoming an
advanced clinical practitioner • To understand the day-to-day work of an
advanced clinical practitioner • To recognise how advanced clinical practitioners
fit within the current NHS workforce Advanced clinical practitioners (ACPs) are
master's-level educated, experienced and competent nurses or allied healthcare
professionals who practise a high degree of autonomy and undertake complex
decision-making. This article offers a reflective account of advanced clinical
practice in an older person's unit specialising in rehabilitation and complex
discharge planning. It illustrates how ACPs work autonomously with medical
colleagues to provide patient-focused care, enhance the multidisciplinary team
and provide safe, high-quality care. The article also describes various aspects
of the role for nurses or allied healthcare professionals who might consider
this career path.
Source: Nursing Older People, 2020; 32(5): 12-15
A Statewide Survey of Clinical Nurse Specialist Practice: Opportunities and Challenges
Abstract: Clinical nurse
specialists are the second largest advanced practice nursing role in the United
States and remain underused in many states. Expanding access to care to improve
patient outcomes is a national priority, which prompted this state clinical nurse
specialist association to identify practice barriers, identify opportunities
for practice expansion, differentiate registered nurse from clinical nurse
specialist practice, and describe differences in those who have practiced in
other states. This study was composed of a 15-question online survey, including
demographic information, collected over a 4-week period in 2016. Sixty-one
respondents (7% of eligible clinical nurse specialists in the state) completed
the survey. Regulations limiting the scope of practice in the state were
identified by 75% of participants as a practice barrier. Work environment,
educational factors, and organizational support contributed to limitations in
practice as delineated in the Consensus Model for Advanced Practice Registered Nurses.
Participants support increasing public awareness of clinical nurse specialists
as advanced practice nurses. Survey results confirm the need for a multifaceted
approach in removing clinical nurse specialist practice barriers and improving
access to their care by aligning state law and regulation with the National
Council of State Boards of Nurses' Model Nurse Practice Act.
Source: Clinical Nurse Specialist: The Journal for Advanced Nursing
Practice, 2020; 34(6): 290-294
Advanced Practice Provider Perspectives on Organizational Strategies for Work Stress Reduction
Abstract: Unresolved work
stress contributes to burnout, compassion fatigue, disengagement, and other
work-contextualized factors. The impact of occupational stressors extends to
the organization in a negative fashion as well. In 2017, advanced practice
providers (APPs) from four health systems, including nurse practitioners,
clinical nurse specialists, nurse midwives, nurse anesthetists, and physician
assistants, participated in a quantitative online cross-sectional survey; 754
participants responded to a free-text question related to work stress and
work–family balance. Suggested organizational strategies were ordered into 29
codes, 10 subthemes, and four main themes: "reduce job stressors,"
"improve leadership and operations," "promote APP
well-being," and "maintain the status quo." Findings are
consistent with other research related to occupational stress with many of the
reported strategies considered as evidence-based. Targeted interventions for
reducing job stress will need to include improved autonomy for APPs, role
delineation, support for work–family balance, and better communication as part
of management practices.
Source: Western Journal of Nursing Research, 2020; 42(9): 708-717
Safeguarding high-quality evidence-based care through advanced clinical practice
Abstract: The author
discusses the first multi-professional definition of advanced clinical practice
developed by Health Education England, suggesting that such practice relates to
the high level of autonomy and complex decision-making responsibility that the
practitioner is accountable for.
Source: British Journal of Cardiac Nursing, 2020; 15(7): 1-3
Overcoming the challenges of role transition for trainee advanced clinical practitioners
Abstract: Advanced clinical
practitioners (ACPs) are being recruited in England to improve care continuity
and safety, meet complex needs and ease workforce pressures. These roles are
open to experienced, registered health professionals from a variety of
backgrounds. This significant career change typically involves a transitional
training programme. This article explores the challenges presented by this
transition and how they can be overcome. Attaining the postgraduate
qualification can be daunting for those who have been outside academic
education, especially the initial degree module. The generalist ACP role can be
confused with that of clinical nurse specialist, and an ambiguous role identity
can cause problems for management, expectations and morale. Trainee ACPs gain
wide experience from ward rotations, although they can specialise in some
areas. Thus, trainees experience de-skilling as they go from being an expert in
one role to a novice in another, as well as potentially developing imposter
syndrome. Trainees may be anxious about being expected to fulfil the
competencies of a qualified ACP, and their trainee status should be evident in
their uniform. Those entering advanced practice can face interpersonal
hostility and institutional resistance. Any bullying should be addressed
directly, and potential misconceptions should be clarified. There is no
overarching national regulatory body for ACPs, and relevant guidelines can
diverge. While a clinical supervision assesses a trainee's performance, a
separate mentor should support their learning and develop their competence and
confidence, especially in the first year. Mentorships should be defined and
structured. Trainees can be supported by experienced qualified ACPs. Flexible
individual induction plans, with information spaced throughout the year, can
help overcome these challenges, and these should make the most of the trainee's
achievements in their previous role.
Source: Gastrointestinal Nursing, 2020; 18(5): 35-41
Abstract: Aims and
objectives: To explore patients' understanding of the role of an advanced
practice nurse (APN). Background: The increasing prevalence of multimorbidities
among people living with cardiovascular disease (CVD) has increased the
complexity of their clinical care. Implementing the role of APNs in new models
of care has been shown to improve outcomes in the CVD population. However, the
CVD population's understanding of and
experiences with the APN role have not been examined in Singapore. Methods: An
exploratory descriptive qualitative design using semi-structured face-to-face
individual interviews was undertaken (November 2017–March 2018). Fourteen
participants were purposively sampled from an outpatient clinic in one of
Singapore's national heart centres. Thematic analysis was undertaken. The COREQ
guidelines were adhered to. Findings: The multi-ethnic sample included ten
males and four females. Two main themes were identified: (1) APNs play a
complementary role to doctors and (2) the acceptance of the APN role takes
time. Each theme was supported by three subthemes to further elucidate the role
and acceptance of APNs. Conclusion: A lack of understanding of the role of APNs
is present, thereby causing the less than optimal patient acceptance of APNs.
As patients with CVD experience improvements to their health through APN-led
services, they may gain confidence in APNs' skills and knowledge. Relevance to
clinical practice: When introducing new roles, fully explaining these roles to
the target population is pertinent as it will be facilitative to patient
engagement and optimisations of care. The findings support the call for APNs to
explain the value and essence of advanced practice nursing more effectively.
There should be a greater emphasis on teaching APNs to introduce and explain
the role of APNs through APN preparatory education and incorporating this
practice in APN practice standards, especially in contexts where APN
development is premature.
Source: Journal of Clinical Nursing, 2020; 29(9/10): 1623-1634
Abstract: Aims and objectives:
To consider the relationship between professional nursing identity and advanced
practice by exploring intra-professional relationships between advanced nurse
practitioners (ANPs) and nursing colleagues. Background: Advanced nursing
practice continues to develop internationally. Previous studies suggest
advanced practice may lack support within nursing, which may lead to
underutilisation, retention and patient safety issues. However, the
relationship between the wider nursing profession and advanced practice is
poorly understood and the theory that professional identity creates cultural
barriers to advanced practice has received little empirical attention. Design:
Ethnographic methodology was used. Methods: Fieldwork methods were participant
observation and semi-structured interviews. Participants were ANPs (n = 9) and
nursing colleagues (n = 5) across two primary care general practice
organisations. Data were analysed thematically using framework analysis,
underpinned a priori by professional identity theories. Reporting was guided by
COREQ. Results: Three themes were identified which indicated how
intra-professional relationships were conducted: Conciliating Nursing, where
ANPs took responsibility for developing positive relationships with other nurses;
Vertical Discounting, where nursing colleagues were dismissive and undermined
ANPs, who themselves behaved similarly towards other nurses; and Lateral
Othering, where ANPs undermined other ANPs. Vertical Discounting and Lateral
Othering destabilised advanced practice. Conclusion: Intra-professional
relationships, and the broader nursing profession, shape advanced practice. We
theorise this is underpinned by threats to professional identity, while weak
professional identity amongst even established advanced practitioners
exacerbates lack of support. Highlighting these issues allows space to develop
alternative strategies to negotiate intra-professional relationships, informed
by professional identity theories, which support rather than inhibit advanced
practice. Relevance to clinical practice: As advanced practice expands
throughout primary and secondary care, and across allied health professions,
the impact of professional identity and relationships on health care will
likely increase and the importance of strong advanced practice identity will
become increasingly relevant.
Source: Journal of Clinical Nursing, 2020; 29(7/8): 1195-1208
Advanced practice for children and young people: A systematic review with narrative summary
Abstract: Aim: To
critically appraise and synthesise the current evidence related to the advanced
practice nurse (APN) in the children and young people's healthcare setting.
Background: A
complex landscape of demand and change has influenced the healthcare delivery
for children and young people. In the United Kingdom and internationally,
governments have endorsed the need for workforce innovation with APN roles
introduced to counter these challenges. However, little is known about the
impact of these initiatives in the context of children and young people's
health care.
Design:
Systematic review and narrative summary.
Data sources:
CINAHL, MEDLINE, DARE, PubMed, Prospero and Cochrane Database of Systematic
Reviews were searched for studies published in English language from July 1998
to 2018. Studies were selected based on key search terms and eligibility
criteria.
Review methods:
The selected studies were appraised using the Effective Public Health Practice
Project for quantitative studies. An adapted version of the JBI data extraction
tool for experimental/observational studies was used to extract the relevant
key findings. This was conducted independently by two researchers.
Results: Nine
studies were included in the review. The review demonstrated roles were
comparable in their clinical practice to medics yet offered higher levels of
patient satisfaction, role modelling for staff and led practice initiatives to
improve health literacy.
Conclusion: This
review demonstrates that APN roles in children and young people's health care
provide clinical, organizational and professional benefits, with added value to
organizations and patients, acting as role models and educators.
Impact: The
findings from this review indicate further research is required to ascertain
contextual issues that may influence the implementation of APNs. This research
will impact APNs working with children and young people. Equally, it supports
the evidence base for service commissioners outlining areas for future
research.
Source: Journal of Advanced Nursing, 2020; 76(1): 135-146
Abstract: The article
informs about 32nd annual Advanced Practice Registered Nurse (APRN) legislative
update, which describes legislative and regulatory changes to practice,
reimbursement, and prescriptive authority that have impact on Nurse
practitioners and other advanced practice registered nurses in the issues.
Topics include securing a clinical training preceptor is challenging given
number of healthcare provider student learners; and APRNs are included in the
definition of health care professional.
