The development of competency standards for specialist critical care nurses

In defining the contemporary role of the specialist nurse it is necessary to challenge the concept of nursing as merely a combination of skills and knowledge. Nursing must be demonstrated and defined in the context of client care and include the broader notions of professional development and competence. This qualitative study sought to identify the competency standards for nurse specialists in critical care and to articulate the differences between entry-to-practice standards and the advanced practice of specialist nurses. Over 800 hours of specialist critical care nursing practice were observed and grouped into 'domains' or major themes of specialist practice using a constant comparison qualitative technique. These domains were further refined to describe attributes of the registered nurses which resulted in effective and/or superior performance (competency standards) and to provide examples of performance (performance criteria) which met the defined standard. Constant comparison of the emerging domains, competency standards and performance criteria to observations of specialist critical care practice, ensured the results provided a true reflection of the specialist nursing role. Data analysis resulted in 20 competency standards grouped into six domains: professional practice, reflective practice, enabling, clinical problem solving, teamwork, and leadership. Each of these domains is comprised of between two and seven competency standards. Each standard is further divided into component parts or 'elements' and the elements are illustrated with performance criteria. The competency standards are currently being used in several Australian critical care educational programmes and are the foundation for an emerging critical care credentialling process. They have been viewed with interest by a variety of non-critical care specialty groups and may form a common precursor from which further specialist nursing practice assessment will evolve.     

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.     

Advanced nursing practice: policy, education and role development

Aims and objectives. This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. Background. The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. Conclusion. The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. Relevance to clinical practice. In a rapidly changing people‐centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.     

Evidence-based practice and the advanced practice nurse: a curriculum for the future

The concept of evidence-based practice has gained increased attention throughout the 1990s as a strategy for linking the best scientific findings with clinical judgment to improve health outcomes. Because the concept implies finding, evaluating, summarizing, and using research results, a high level of clinical reasoning skills is required. Effective evidence-based practice also requires the incorporation of new practices into clinical and organizational settings, thereby demanding advanced leadership skills. Competencies in clinical reasoning, leadership, and clinical practice are critical for advanced practice nurses. This article describes a master's-level curriculum supportive of evidence-based practice and includes recommendations for developing curricula of this type.     

Teaching in crisis. Patient and family education in critical care

Although the critical care setting is not always a positive teaching environment, it is possible to achieve the goal of optimal patient and family education. The critical care nurse must understand the unique learning needs of patients and families who are experiencing a life crisis a recognize that there are substantial obstacles to overcome to educate in this setting. In addition, it takes experience and resources to develop the teaching skills of the bedside nurse, so that those teachable moments are easily recognized and suitably used to give patients and family members valuable information in small doses. The advanced practice nurse is an essential nursing resource who can spearhead the development of teaching skills for all members of the health care team. In addition, the advanced practice nurse is a clinical expert who can assess the educational needs of patients and their families and provide more detailed and individualized health information from a different perspective. Achieving good patient and family education outcomes is possible when patient care continuity is a priority and the advanced practice nurse is an active part of the nursing team. Exploring the use of new technologies and resources to meet patient and family education needs is absolutely necessary. As hospitals continue to evolve and react to the financial demands placed on them, nursing leadership and critical care nurses will need to articulate clearly all of the essential components of patient care, including patient and family education. In keeping with the rich nursing tradition of patient and family education, critical care nurses and advanced practice nurses have the opportunity to demonstrate their unique teaching skills and continue to promote health education as a priority of patient care.     

A Review of Procedural Skills Performed by Advanced Practice Providers in Emergency Department and Critical Care Settings

Advanced practice providers (physician assistants and nurse practitioners) are part of the interdisciplinary teams integral to successful care and improved outcomes for acutely ill patients in intensive care units and emergency departments. Between physician shortage and increased complexity of patients with often rapidly deteriorating conditions, the addition of advanced practice providers and expansion of acute care provider roles result in positive outcomes including decreased hospital length of stay, improved continuity of care, decreased hospital costs and increase inpatient, physician and staff nurses job satisfaction. This article attempts to examine the role that advanced practice providers (APPs) play in performing diagnostic and therapeutic procedures in acute care settings, education provided in physician assistant (PA) and nurse practitioner (NP) programs, and post-graduate training required to achieve competency and comfort in performing procedures. PA and NP training and credentialing often vary at the state level and by practice site. This article aims to collect information on how these roles compare as well as which procedures are actually being performed by advanced practice providers in the emergency department and critical care settings. Considering the healthcare system move towards team-based care, procedures performed by APPs align with the needs of the patient population served and correspond to the procedures done within the teams by physician providers. Independently billing under national provider identifier is cost effective but can be influenced by the current physician reimbursement system or lack of understanding of APP billing process by health care systems. Though there is limited research in this area, this article serves as a starting point to examining the current utilization and utility of APPs performing procedures in the emergency department and critical care settings.     

Partnering to Lead Change: Nurses’ Role in the Redesign of Health Care

Health care has a long-held perception of perioperative nurses as providers who advocate for patients and who carry out physician orders. According to the Institute of Medicine’s 2010 report on the future of nursing, not only must that view evolve, but nurses also must play a leading role, in partnership with physicians and other health care colleagues, if health care reform is to succeed. Several factors will prepare nurses for this new role of partnering to advance health, including advancing their formal education, developing leadership as a core competency, acquiring leadership skills, and being active in new models of leadership (ie, mentorship, volunteering, advocacy).     

Essential professional core competencies for nurses

Core competency is vital to the nursing profession. Such helps guarantee the high quality and effectiveness of delivered care and maintains the social value and status of the nursing profession. This article introduces the definition of nursing core competency and its connotations. The core competency profile for the nursing profession embraces basic behavioral attributes as well as mastery of advanced practice skills. The former include such attributes as gentleness, willingness to serve, keen observation and judgment, efficiency, skillfulness, responsibility and accountability. The latter embraces skills in general care, communication and collaboration, management, self-development, innovation and research, and stress-adjustment. To cultivate competent nurses, academic education should emphasize critical thinking skills, integrate problem-based and evidence-based learning approaches into curricula, and use objective structured clinical examination to evaluate learning outcomes. In the healthcare sector, systematic professional training models such as the clinical ladder with multidiscipline rotation hold the potential to train novice nurses as expert professionals. Meanwhile, to advance the professional capabilities of nurses, nursing administrators should provide a positive work environment to fuel and maintain learning motivation. Education and healthcare systems should work closely together to promote the professional competence of nurses and to strengthen the value of the nursing profession.     

Organizational change strategies for evidence-based practice

Evidence-based practice, a crucial competency for healthcare providers and a basic force in Magnet hospitals, results in better patient outcomes. The authors describe the strategic approach to support the maturation of The Johns Hopkins Nursing evidence-based practice model through providing leadership, setting expectations, establishing structure, building skills, and allocating human and material resources as well as incorporating the model and tools into undergraduate and graduate education at the affiliated university.     

Advanced practice nurses' scope of practice: a qualitative study of advanced clinical competencies

Scand J Caring Sci; 2011; 25; 661–670 Advanced practice nurses’ scope of practice: a qualitative study of advanced clinical competencies Aim To describe and explore Advanced Practice Nurses’ clinical competencies and how these are expressed in clinical practice. Background Discussion concerning advanced clinical practice has been ongoing in the USA since the 1960s and in the UK since the late 1980s. Approximately 24 countries, excluding the USA, have implemented the role of Advance Practice Nurse (APN). In the Nordic countries, especially Sweden and Finland, APNs have been introduced in some organizations but their competency domains have not yet been clearly defined. Theoretical framework The study’s theoretical framework emanates from Aristotle’s three‐dimensional view of knowledge that is epistêmê, technê, and phronesis. Methods Between October 2005 and January 2006, focus group interviews of Clinical Nurse Specialists who provide expert functions in pediatric, internal medicine, and surgical units (n = 26) and APN students (n = 8) were conducted. The data material was analyzed using inductive content analysis. Findings Grouped into five main themes, the study results indicate that APNs possess advanced level clinical competencies in: (A) assessment of patients’ caring needs and nursing care activities, (B) the caring relationship, (C) multi‐professional teamwork, (D) development of competence and nursing care, and (E) leadership in a learning and caring culture. Conclusion Clinical competencies consist of advanced skills, which typify an expanding role that offers new possibilities for holistic patient care practice. APNs’ scope of practice is characterized by responsibility and competence in making autonomous judgments based on expanded clinical competence. On an advanced level, clinical competence consists not merely of advanced skills for assessing and meeting the needs of patients but also the creation of safe and trustful relationships with patients and collaboration with colleagues. APNs can realize advanced skills in their actions through their manner of knowing, doing, and being.     

A narrative review of the training structure,role, and safety profile of advanced critical care practitioners in adult intensive services in the United Kingdom

ObjectiveAdvanced clinical practitioners are a growing part of the National Health Service workforce in the United Kingdom (UK). The concept stems from the progression of skills, knowledge, and experience of healthcare professionals (including nursing, physiotherapists, paramedics, and pharmacists) to a higher level of practice. The addition of advanced critical care practitioners (ACCPs) to the multidisciplinary team of the UK adult critical care is recent; they form part of the fabric of the advanced clinical practitioner workforce. This is a narrative review of the role of ACCPs, considering the evolution of the role, training, accreditation, and evidence supporting the safety profile in adult intensive care in the UK.MethodThis is a narrative review.ConclusionACCPs have evolved from an ad hoc and local training structure, to a UK-wide competency standard and training developed within the Faculty of Intensive Care Medicine. This formed in concert with the advanced clinical practitioner concept. As advanced practice is very much multiprofessional in the UK, a single regulator for multiple base professions is likely neither feasible nor realistic. Over the last 5 years, the UK picture of advanced practice has slowly standardised; an ACCP securely fits under the advanced clinical practitioner umbrella. The ACCP workforce has moved from a handful of early adopters, regional hubs, to a position across most critical care units now have or are developing a team of practitioners. The evidence base for the safety profile of ACCPs is evolving and shows parity in outcomes in the areas currently investigated. The ACCP role provides a vision of a multiprofessional workforce for the future of staffing of critical care services that is diverse and inclusive, not with the intention of competing with our medical colleagues.     

Exploring the contribution and impact of master’s education for leadership development in adult general nursing: A scoping review

AimThe aim of this scoping review was to explore the evidence relating to master’s education for leadership development in adult/general nurses who are not in advanced practice or leadership roles and its impact on practice.BackgroundThe importance of effective, clinical leadership in nursing and health care, has been highlighted following failings reported by Public Inquiries both nationally and internationally. While initiatives have been implemented to address these, the provision of safe, quality care remains problematic. Complex care requires highly skilled professionals to challenge and lead improvements in practice. Master’s education results in graduates with the skills and confidence to make these changes and to become the clinical leaders of the future.MethodsAn a priori scoping review protocol was developed by the review team. This was used to undertake searches across CINAHL Ultimate; Medline (Ovid), Scopus and ProQuest Complete databases, chosen due to their relevance to the subject area. Articles were limited to those in the English Language, peer reviewed and published since 2009. Citation chaining via the reference lists of frequently identified articles were also searched. A further search for relevant grey material using the same relevant keywords and phrases was performed using the limited, Trip Database and Google Scholar.ResultsEight articles were selected for data extraction, and these were published between 2011 and 2019. The articles were predominantly from the UK and Europe, with a focus either on master’s education or on aspects of leadership in nursing and healthcare. Themes identified: a) The need for clinical leadership; b) master’s education for clinical leadership skills; and c) master’s education for professional and organisational outcomes.ConclusionsThe scoping review identified that there is a need for strong clinical leadership in the practice setting. Evidence shows that effective nursing leadership can improve patient outcomes as well as enhancing workplace culture and staff retention. The review has shown that the skills required for clinical leadership are those produced by master’s education. Studies of the impact of master’s education are often self reported and tend to focus on nurses in advanced practice roles. More research is required into master’s education for adult/general nurses not in advanced roles and in examining the link between master’s education and improved patient, professional and organisational outcomes.     

Implementing the clinical nurse specialist role in a regional state psychiatric hospital

Clinical nurse specialists (CNSs) are essential to enhancing psychiatric-mental health nursing within state psychiatric hospital settings. This article presents a project focused on the CNSs in a state psychiatric hospital to expand their clinical role to increase the quality of care to individuals with serious mental illness and their numbers in other state psychiatric hospitals. As the patient population served in these settings becomes more complex, it is critical that advanced practice nurses are provided with appropriate updated state-of-the-art advanced knowledge and skills to collaborate within the interdisciplinary team. Furthermore, because of the complexity of the client and systems characteristics, the CNSs' clinical leadership is critical to promote the best practices in direct care services as well as provide support to various levels of nursing through staff development and training, role modeling, and mentoring of new staff.     

Effective communication and delivery of culturally competent health care

Effective communication between patients and health care providers is a critical element to quality health care. Becoming aware of patients' attitudes, beliefs, biases, and behaviors that may influence patient care can help clinicians improve access to and quality of care. Health care providers should develop a strategic plan for improvement, then implement and evaluate the plan to include structured, continuously improving progress toward achieving cultural competency goals. In this challenging health care environment, health care providers need the skills to explore the meaning of illness, to determine patient's social and family context, and provide patient-centered and culturally competent care.     

Revolutionizing assessment in a clinical skills environment--a global approach: the recorded assessment

Assessment is an essential component of education and a key element of the student experience. This is never more apparent than in the assessment of student nurses competency in practice skills. The use of clinical skills centres to facilitate the acquisition of nursing skills continues to gain popularity, nonetheless the methods used to develop and assess competency within these environments remains diverse with contemporary literature suggesting that the objective structured clinical examination (OSCE) is predominantly used. This paper presents an innovative approach used within a skills environment to summatively assess nursing students at the end of their first year; one that seeks to cultivate clinical competency through a process of self-appraisal and appreciation of evidence-based literature. The recorded assessment is a unique strategy that endeavours to make the learning experience more meaningful for the students, through the use of an audio-visual tool and written critique. The critique is crucial to the learning process by encouraging the student to adopt a critical and holistic view of their practice; essential skills for future practitioners.     

'Back to the bedside': graduate level education in critical care

The need for post registration education for nurses practising at specialty level in critical care environments is widely acknowledged in nursing and educational literature. There is also clear consensus that the ultimate aim of educational preparation and practice development is to improve the delivery of nursing care to patients who are critically ill and provide support for their families. Yet the 'right' approach to educational delivery and evaluation is less clear and stimulates considerable debate amongst nursing educators, care providers, learners and regulatory bodies. The need for critical care nurses to apply advanced knowledge and technical skills to complex and dynamic practice situations necessitates the development of critical thinking and a problem-solving approach to clinical practice that can be fostered through education and experience. This paper explores the relationships within teaching, learning and practice development in critical care nursing and questions the popular assumption that 'post graduate (Master's level) education fits all'. Discussion focuses on the successful development and implementation of graduate level education for critical care nurses in the South Island of New Zealand and how this development is challenging existing approaches to the provision and evaluation of formal critical care education in New Zealand.     

The clinical leadership role of the CNS in the identification of nursing-sensitive and multidisciplinary quality indicator sets

Within a team-oriented approach to healthcare, the demonstration of quality is challenging. Multidisciplinary quality indicators ideally represent all pertinent stakeholders and are preferred when evaluating the quality of care for specific patient populations. Recently, however, nursing-sensitive indicators have been developed that reflect the unique contribution of nursing to patient outcomes. Because nursing-sensitive quality indicators reflect nursings' accountability for patient care, they must also be considered when identifying indicators sets. Controversy exists concerning the appropriate definition, number, and approach to indicator identification. Many organizations are attempting to measure everything to ensure that all appropriate indicators are represented. To incorporate both nursing-sensitive and multidisciplinary quality indicators, a phased organization-wide approach is advocated. Through clinical leadership skills combined with the advanced practice roles of consultant, educator, and researcher, the clinical nurse specialist can facilitate the inclusion of relevant indicators, preserve both multidisciplinary and nursing-sensitive approaches, and maintain efficiency during the process. The clinical nurse specialist, with clinical expertise and advanced education has a unique leadership role in the identification of the resultant critical indicator matrix.     

护理硕士研究生的护士核心能力调查分析

目的调查护理硕士研究生中注册护士的核心能力水平,为研究生的培养提供依据。方法采用注册护士核心能力量表对82名护理硕士研究生进行问卷调查。结果本组核心能力各维度得分从高至低为评判性思维和科研能力、专业发展、临床护理、教育与咨询、人际关系、伦理与法律实践和领导;不同职称护理硕士研究生核心能力总分和各维度得分差异有统计学意义(P0.01)。结论护理硕士研究生核心能力处于中上水平,但应加强对低职称护理硕士研究生核心能力的培养,以提高护理研究生的竞争力。     

Pain management in the culture of critical care

Pain of critically ill patients is undertreated. Undertreatment of pain may be related, in part, to the culture of critical care practice, where nurses are challenged to meet competing patient demands. Implementation of appropriate pain management strategies is within the critical care nurse's scope of practice and must be a priority when delivering patient care. Although the multidisciplinary team can make the best holistic pain management plan, nurses have extensive independence and latitude in administration of pharmacologic and nonpharmacologic interventions. It is, in fact, "primarily the nurses' responsibility to administer the proper drug and dose at the proper time". Fostering a culture within critical care units that promotes optimal pain management is influenced by unit leadership, the values held by the staff, nurse competency, and an effective quality program that includes process and outcome indicators of pain management.