A necessity not a luxury: preparing advanced practice nurses to care for older adults.

Of today's 2.7 million registered nurses, less than 1% are certified in gerontological nursing and only 3% of advanced practice nurses (APNs) have specialized training in this area. These statistics indicate that there are not enough gerontological nurse practitioners or geriatric clinical nurse specialists to care for the burgeoning older adult population. Relying solely on certified geriatric APNs to care for older adults is not a viable solution. Educating all APNs with grounding in gerontological nursing care may well be the answer to expanding our nation's capacity to competently care for our rapidly aging population. As part of the 4-year Enhancing Geriatric Nursing Education in Baccalaureate and Advanced Practice Nursing Grant, the American Association of Colleges of Nursing developed a set of core gerontological competencies for graduate APN programs. These competencies, entitled Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care, delineate guidelines for APNs who are not specialists in gerontology but provide care to older adults. This article describes the competency development process, provides an overview of broad categories and examples of competency statements, and highlights model case studies for integrating gerontological content throughout APN curricula to ensure that graduates are equipped to provide competent care to older adults.     

安宁疗护高级实践护士核心能力指标体系的构建

目的:构建安宁疗护专业高级实践护士的核心能力指标体系。方法:通过文献回顾,根据专家协调小组意见,自行设计专家咨询问卷,对全国7个省份15所医院从事临终护理实践、护理管理、姑息医疗以及从事院校安宁疗护教育4个领域的23名资深专家进行两轮德尔菲专家咨询。结果:构建的安宁疗护高级实践护士的核心能力指标体系包括沟通及合作能力、临床实践能力、专业发展能力、文化和灵性照护能力、伦理与法律相关能力、教育教学能力、系统资源管理能力、循证护理及科研能力共8个方面31个二级指标。结论:明确了安宁疗护高级实践护士应具备的核心能力,为培养安宁疗护领域高级实践护士提供依据。     

Scope of practice of an Advanced Practice Nurse at the Swiss Epilepsy Centre

Epilepsy is, after stroke, the second most prevalent neurological disease. The disease has a manifold etiology and symptoms and hence treatment options. From the patients who seek treatment in epilepsy centres, some suffer from psychogenic, non-epileptic seizures. Patient with epileptic seizures have to integrate a medication regimen into their lives, accept symptoms and change their life style to seizure preventing habits. Patients with non-epileptic seizures need psychotherapeutic treatment. Care has to be offered over long periods of time and needs to be tailored to very diverse patients' and family situations. Nurses in this field need broad knowledge about the diseases and treatments as well as enhanced skills in counselling and caring for these patients. Therefore the Swiss Epilepsy Centre in Zurich hired an Advanced Practice Nurse (APN) to increase patients' satisfaction with care and enhance nurses' skills and knowledge. This article analyses the work content of the advanced practice nurse and describes first experiences one year after the implementation of an APN-role. The APN worked half of her time in direct patient and family care. The rest of her work load concerned practice development in coaching and educating the nursing staff, being involved in projects and collaborating with the head nurse on specific topics. In conclusion, implementation of an advanced practice nurse has been shown to be beneficial since patients' feedback were very positive and the increase in nurses' skills and competencies has been assessed as noticeable.     

Advanced practice nurses in emergency care settings: A demographic profile.

INTRODUCTION: Very little is known about clinical nurse specialists and nurse practitioners (advance practice nurses [APNs]) who practice in emergency care settings. The Advanced Practice Committee of the ENA sought to determine a profile of these individuals. METHODS: Surveys were distributed to all registrants at 2 ENA conferences and posted on the ENA Web site. This survey asked 17 questions concerning the demographic characteristics of the APN respondents (eg, education, experience, certification, state recognition, and practice area). The survey was completed by 166 APNs. RESULTS: APNs had considerable experience as ED registered nurses before becoming an APN. They obtained their APN education at the master's degree or post-master's degree level. State recognition was required for 89.2% of the APNs. The majority of APNs (61.4%) obtained their certification through the American Nurses Credentialing Center. Nurse practitioners were predominantly family nurse practitioners (43%), and clinical nurse specialists were either critical care clinical nurse specialists (8.9%) or had other certifications (5.9%). APNs provided services in both the main emergency department and the fast track (45.7%) and were relatively new to their role as an APN. DISCUSSION: Consistent with current educational and certification requirements, the vast majority of APNs held a master's degree. Although relatively new to their role as APNs in emergency care, they were nonetheless very experienced as ED registered nurses. The majority of APNs were certified, even though that is not required for practice in all states. Continued research is needed to identify the most effective utilization of APNs, document their contributions to patient care outcomes, and develop strategies to meet their educational and practice needs.     

Challenges of advanced practice nursing in pediatric acute and critical care: education to practice

The APN role of the future is dependent on our ability to document through research that NPs, CNSs, and the consolidated role of the NP/CNS plays a critical role in the delivery of high quality cost-effective care. Further information is needed regarding how the APN contributes to and enhances the care delivered by the healthcare team. Cost effectiveness and quality outcome studies are needed including those that describe morbidity and mortality rates, patient satisfaction, and cost effectiveness of models of care that includes APNs. Brooten and Naylor suggest the inclusion of sensitive nursing outcomes, including functional status, mental status, stress level, satisfaction with care, caregiver burden, cost of care. Defining and clarifying the APN functions and qualities of scope of practice is imperative. Perhaps there are populations best served by APNs. Contributions such as continuity, consistency of care, attention to issues such as immobility, skin integrity, and health promotion may have a value added effect. Time motion studies and process logs may add to the information about APNs in pediatric acute and critical care. Professional certification validating competence is essential for the practice of APNs caring for sick children and their families. A disparity exists between the primary care examination now available and the practice of NPs in pediatric acute and critical care. A certification examination is needed with content consistent with the practice of pediatric acute care NP. APNs must possess sufficient knowledge and skill to meet the needs of patients and families in the changing healthcare environment. According to Strodtbeck and colleagues, flexibility, ability to be a self directed learner, critical thinking, relationship skills, and leadership skills including interpersonal insight, interpersonal competence, and ability to stimulate group discussion will serve APNs well as they move into the century. Transitioning brings exciting opportunities along with challenges. Using a blend of abilities, the pediatric acute care APN can provide optimal care to sick children and families.     

Advanced practice nurses core competencies: a framework for developing and testing an advanced practice nurse discharge intervention

The purpose of this paper was to describe evidenced-based interventions as implemented by advanced practice nurses (APNs) conducting intervention research with a vulnerable population of blood and marrow transplant patients. In addition, each of the 6 core competencies of the APN role identified by Hamric are outlined and applied using a patient case study. These competencies are the following: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision making. This article chronicles a typical patient's journey through a post-hospital discharge nursing research study involving APNs as "intervention nurses" and discusses the various aspects of the APN core competencies throughout the process.     

Nurse-sensitive outcomes of advanced practice

Advanced practice nurses (APNs) in the USA are registered nurses who hold masters or doctoral degrees in a specialized area of nursing. They provide advanced clinical care to clients, manage health care systems and influence health care decision-making through expert clinical reasoning and research and theory-based action. APN impact on health care outcomes is supported by studies using physician-focused indicators, although a few studies have identified several that are sensitive to or reflective of advanced practice nursing. A modified Delphi survey was conducted during May 1997-December 1998 to determine the outcome indicators APNs recommend for use in measuring their effect on care delivery outcomes. A convenience sample of 66 APNs attending a statewide outcomes conference identified 27 potential outcome indicators. These indicators were included in a mailed survey sent to APNs working in Tennessee. Respondents were asked to rate each indicator for validity, sensitivity, feasibility, utility and cost. In the second round of the survey, they were asked whether or not they agreed with the rank ordering of indicators, which was determined by the means calculated from responses in the first round. The 10 highest ranked indicators were satisfaction with care delivery, symptom resolution/reduction, perception of being well cared for, compliance/adherence with treatment plan, knowledge of patients and families, trust of care provider, collaboration among care providers, frequency and type of procedures ordered and quality of life. APNs identified both direct and indirect measures of effect on care delivery outcomes. Some of these are currently used as indicators of advanced practice, but many are not. Additional research is needed to determine whether the indicators proposed are valid and sensitive to advanced practice care by nurses.     

Assessing outcomes in advanced practice nursing practice: the use of quality indicators and evidence-based practice

Advanced practice nurses (APNs) impact both patient care and healthcare systems on a daily basis. Tracking and documenting the outcomes of APN practice have become essential, due partly to the emphasis on outcomes that has become a component of the majority of healthcare initiatives. This article outlines important aspects related to assessing outcomes and discusses the use of quality indicators to demonstrate outcomes of APN practice. Examples from clinical practice are provided in order to demonstrate that assessing the outcomes of APN practice can be incorporated into daily practice as part of ongoing initiatives. In delineating the outcomes of APN care, the value of APNs can be formally acknowledged.     

Mentoring advanced practice nurses in research: recommendations from a pilot program

Advanced Practice Nurses (APNs) need research skills to develop and advance their practice and, yet, many have limited access to research training and support following completion of their advanced degree. In this paper we report on the development, delivery, and evaluation of an innovative pilot program that combined research training and one-to-one mentorship for nine APNs in conducting research relevant to their practice. The program was organized within an academic institution and its affiliated hospitals in Toronto, Canada. Our experience with this program may assist those in other organizations to plan and deliver a similar program for APN research mentorship.     

Advanced practice in pediatric nursing: blending roles

In the past, pediatric advanced practice nurse's roles were the Clinical Nurse Specialist (CNS) in the inpatient setting and the Nurse Practitioner (NP) in the outpatient setting. With health care system changes, such as the shifting and blurring boundaries between inpatient and outpatient care, changes were required in the graduate curricula to blend the CNS and NP roles into an advanced practice nurse (APN) role. This article describes the model at Rush University, the advantages of the CNS/NP blended role, the revised APN curriculum, and examples of blended-role APNs in action. The curriculum change to blend the CNS/NP roles addresses the need for the blended APN role in changing health care systems.     

The Development of Advanced Nursing Practice Globally

Purpose: To examine the development of advanced nursing practice globally.
Methods: Data were collected from documentary resources available in the International Nurse Practitioners/Advanced Practice Nurse Network (INP/APNN) of the International Council of Nurses. The areas examined were guided by the "key informant survey on advanced nursing practice self-administered questionnaire." Two core members of the INP/APNN who have rich experience in global advanced nursing development analyzed the data. A total of 14 countries and three regions from five continents were included in the analyses. The development of advanced nursing practice in these areas is facilitated by a need for better access to care in a cost-containment era and the enhancement of nursing education to postgraduate level. The mechanism for regulation of practice is in place in some countries.
Conclusions: Confirms the development of advanced practice in nursing is a global trend.
Clinical Relevance: APNs can improve global health with points to enhanced education in nursing and regulation of advanced practice.     

An innovative approach to peer review for the advanced practice nurse--a focus on critical incidents

Purpose: To provide an overview of the development and implementation of a peer review process for advanced practice nurses (APNs) based on critical incidents that provide meaningful evaluation of practice and meets the needs of APNs across multiple care specialties and practice situations.
Data sources: A review of the literature and evaluation of the existing peer review process currently in place at a large tertiary care facility.
Conclusions: Peer review is central to self-regulation and professional practice for APNs. It has been proposed that APNs of similar rank and clinical expertise should participate in peer review. APN peer review and evaluation have traditionally existed as a component of performance evaluation, evaluation of practice patterns, and compliance monitoring, and to evaluate quality indicators. We found no examples of peer review in the context of evaluating a critical incident in the literature. The APN Peer Review Committee and the review process were developed at our institution to provide peer input and communication to all credentialed APNs in incidents regarding appropriateness of care and scope of practice.
Implications for practice: APNs must assure that they have a voice in the peer review process. Representation by peers of similar specialty and rank is an important component in the peer evaluation process. The establishment of the APN Peer Review Committee served this purpose for our institution.     

Discovering resources--making global connections, international networking

PURPOSE: To describe the key objectives, aims, activities and vision for the International Nurse Practitioner/Advanced Practice Nursing Network (INP/PNN). DATA SOURCES: Selected publications and documents, personal experience, and commentary. CONCLUSIONS: Advanced practice nursing and NP roles are prevalent in the United States and are now emerging in numerous countries throughout the world. There is a heightened interest among APNs and NPs internationally to share knowledge, expertise, and resources to enhance the presence of nursing in primary healthcare worldwide. The INP/APNN proposes to be an option for supporting the diversity of international networking in this field. IMPLICATIONS FOR PRACTICE: Nurse practitioner and APN roles are emerging globally. Globalization and global health issues impact all health care practitioners. Collaboration, partnering, and networking have the potential of enhancing and advancing practice for both experienced practitioners and countries that are initiating APN roles.     

Positioning advanced practice nurses for financial success in clinical practice

Advanced practice nurses (APNs) are well prepared for patient care, but not for the financial aspects of clinical practice. A lack of reimbursement knowledge and skills limits the prospects for APNs to be key players in business and practice ventures. Faculty are challenged to strengthen the advanced practice reimbursement component of the financial management core to promote the reimbursement competency of APNs. The author discusses 4 primary content categories that are critical to financial success in clinical practice.     

Advancing practice inquiry: research foundations of the practice doctorate in nursing

The University of Washington Doctor of Nursing Practice program entails 3 curricular dimensions: advanced practice, leadership, and practice inquiry. In this article, the practice inquiry dimension is discussed and defined as a type of clinical investigation that closely aligns with the realities and complexities of everyday practice by advanced practice nurses (APNs). The advancement of APNs' practice inquiry competencies is timely for its interfaces with the national scientific agenda's emphasis on translating science to clinical practice, health care delivery systems and policy. A framework for conceptualizing a practice inquiry curriculum and competencies is proposed. In addition, the divergent and convergent comparisons with Doctor of Philosophy (PhD) nursing programs are discussed, with emphasis placed on potential collaborative clinical research endeavors.     

A survey of oncology advanced practice nurses in Ontario: profile and predictors of job satisfaction

The purpose of this study was to examine role structures and processes and their impact on job satisfaction for oncology advanced practice nurses (APNs) in Ontario. APNs caring for adult, paediatric or palliative patients in integrated regional cancer programs, tertiary care hospitals or community hospitals and agencies were invited to complete a mailed self-report questionnaire. A total of 73 of 77 APNs participated in the study. Most APNs (55%) were acute care nurse practitioners employed by regional cancer programs or tertiary care hospitals. Adult patients with breast or haematological cancers and those receiving initial treatment or palliative care were the primary focus of APN roles. APN education needs related to specialization in oncology, leadership and research were identified. Overall, APNs were minimally satisfied with their roles. Role confidence (beta = .404, p = .001) and the number of overtime hours (beta = -.313, p = .008) were respective positive and negative predictors of APN job satisfaction. Progress in role development is described, and recommendations for improving role development and expanding the delivery of oncology APN services are provided.     

Evaluating the cutoff score of the advanced practice nurse certification examination in Korea

AimThis study aimed to evaluate the cutoff score of the Advanced Practice Nurse (APN) certification examination determined using two standard-setting methods and to compare it with the current score.BackgroundThe APN qualification is established by passing a certification examination. However, the method of determining the passing criterion is different among countries. In Korea, the passing criterion has been predetermined as 60% of the total score or above without any theoretical or empirical basis.DesignIn this study, two typical and popular standard-setting methods, the modified Angoff and Bookmark methods, were used to determine the passing criterion of the APN certification examination.MethodsThe performance data of a gerontological APN certification examination were used to conduct standard setting with both the modified Angoff and Bookmark methods. The total number of examinees in the dataset was 121. Item analysis with a 2-parameter logistic model was performed based on the item response theory using the Bilog-MG3.0 program. A total of 5 raters in APN education and clinical nursing practice were selected.ResultsThe modified Angoff and Bookmark methods gave cutoff scores of 113 and 110.5 with passing ratios of 52.9% and 57.0%, respectively. These results were different from the conventional cutoff score of 90 with a passing ratio of 93.4%.ConclusionThe present arbitrary fixed cutoff score should be reconsidered to improve the robustness of the APN qualification and standard-setting methods should be employed to determine an adequate cutoff score for the APN certification examination to ensure the competency of APNs in providing advanced care.