Development and psychometric testing of the EverCare Nurse Practitioner Role and Activity Scale (ENPRAS)

PURPOSE: To develop and test an instrument measuring the frequency of the performance of role activities by EverCare nurse practitioners (NPs), who provide primary care to nursing home residents. DATA SOURCES: One hundred thirty-one EverCare Nurse Practitioner Role and Activity Scale (ENPRAS) activities were identified through telephone interviews (n= 11), participant observation (n= 5), and a focus group (n= 4). CONCLUSIONS: Two content validity tests (n= 11; n= 15) (Content Validity Index > or = .78 for all retained items) and internal consistency reliability testing (n= 127; Cronbach's alpha = .78-.96) yielded 99 activities arranged in six role subscales-Collaborator, Clinician, Care Manager/Coordinator, Counselor, Communicator/Cheerleader, and Coach/Educator. IMPLICATIONS FOR PRACTICE: The ENPRAS can be used to measure similarities and differences in NP practice activities performed by EverCare NPs working at different EverCare program sites and to compare practice activities performed by EverCare NPs and other NPs. The EverCare program is sponsored by United Health Care, which leads the field in collaborative NP/MD primary care in nursing homes. Future studies should be directed toward testing the generalizability of the ENPRAS with NPs working in other collaborative models, as well as NPs in noncollaborative models of care delivery in the long-term care setting.     

Satisfaction with Nurse Practitioners and Intent to Adhere to Plan

This study explored perceptions of satisfaction with care from nurse practitioners (NPs) and intent to adhere to health plan. A convenience sample of 118 participants was included. The Perception of Satisfaction with Care from NP instrument was used to measure components of satisfaction and overall satisfaction after the visit. Most participants intended to adhere to the plan by the NP. The clients’ perceptions of overall satisfaction with care and intent to adhere to health recommendations were high. Nursing implications include to develop benchmarks for quality of care and promote care provided by NPs. The adapted instrument, Perception of Satisfaction with Care from NP, is reliable and can be useful for students.     

Spiritual care practices of nurse practitioners in federally designated nonmetropolitan areas of North Carolina

PURPOSE: The purpose of this study was to explore if and then how nurse practitioners (NPs) living in federally designated nonmetropolitan areas of North Carolina integrated spiritual care into their practices. Participants identified the frequency in which they utilize spiritual care practices, specific spiritual interventions, and their definitions of spiritual care. DATA SOURCES: A sample of 101 NPs was chosen through systematic sampling from 507 eligible NPs. Each participant was mailed a demographic data sheet and the Nurse Practitioner Spiritual Care Perspective Survey (NPSCPS). The NPSCPS was modified from the Oncology Nurse Spiritual Care Perspective Scale developed by Taylor and colleagues. Of the 101 mailings, 65 were returned and included in the analysis. CONCLUSIONS: Although most of the NPs in this study felt that spiritual care was an important part of nursing practice, 73% did not routinely provide spiritual care to their patients. Barriers and limitations to the provision of spiritual care must be explored. IMPLICATIONS FOR PRACTICE: As providers of holistic care, NPs should be proficient and comfortable in providing spiritual care to their patients. Educational programs should provide NPs and NP students with knowledge and skills to provide spiritual care.     

Attitudes of registered nurses toward nurse practitioners

PURPOSE: Registered nurses (RNs) work closely with nurse practitioners (NPs) in all facets of patient care and often have a direct influence on the patient's perception of the professional who is directing the care, and a patient's perceptions may affect clinical outcomes. However, few studies have been conducted to measure RN acceptance of the NP. The authors surveyed RNs in southern Illinois to assess their attitudes concerning the level of care provided by NPs. Southern Illinois was chosen because of the limited number of NPs in the area and because of concerns that limited exposure might negatively influence RN attitudes about the NP role. DATA COLLECTION: A 26-item research questionnaire, previously used with school nurses, was modified to reflect RNs in general. Seven items related to demographic information, and 19 items created a five-response Likert-formatted scale (r = .93). The questionnaire was mailed to 500 randomly selected RNs from the 11 southernmost counties of Illinois. CONCLUSIONS: The results showed support of the NP role. RNs believed that NPs were knowledgeable, competent health care providers. RNs were also comfortable working with NPs and often consulted them for advice and information. They saw the role of the NP as a positive addition to the health care team. IMPLICATIONS FOR PRACTICE: One identified concern was that scores indicated RNs felt that they received limited respect from NPs. Although the scores were high in this category, some RNs had concerns that NPs might not respect or understand the difficulty of the RN role in providing patient care. NPs need to recognize their collegial and professional ties to RNs and should take time to provide positive feedback to RNs as they collaborate to provide health care. Such behavior would only solidify the health team approach.     

Adult-Gerontology Nurse Practitioners: A Discussion of Scope and Expertise

Adult-gerontology primary care nurse practitioners (NPs) deliver longitudinal primary care in outpatient settings from adolescence to older adulthood, and adult-gerontology acute care NPs provide care to critically ill adults and older adults. Family NP programs vastly outnumber adult-gerontology NP programs nationwide, despite a rapidly aging population. This report discusses the differences in education and scope of practice of adult-gerontology primary care NPs, adult-gerontology acute care NPs, and family NPs and highlights the crucial and unique assets adult-gerontology NPs bring to any health care system or practice. Differences in competencies, certification examinations, and practice settings are discussed in depth.     

Theory of Nurse Practitioner Job Satisfaction

Nurse practitioner (NP) job satisfaction was evaluated qualitatively to enhance understanding of relevant processes and concepts. A constructivist grounded theory study was undertaken. The study population included NPs working in rural and urban primary health care in Northern Ontario, Canada. An original theory to explain NP job satisfaction and intent to leave was developed. This report focuses on the concept of NP job satisfaction within the broader theory and explores all relevant findings.     

A National Study of Australian Nurse Practitioners’ Organizational Practice Environment

The nurse practitioner (NP) workforce in Australia plays a vital role in helping the country meet the current demand for health care. Data from Australian NPs using the Nurse Practitioner Primary Care Organizational Climate Questionnaire demonstrated that one-seventh of the overall Australian NP population completed the study. The response was overwhelmingly positive in the area of practice; 71.6% of NPs had no restriction on their practice and felt valued by their organization. The results of this study enable a benchmark for ongoing national evaluations in addition to international comparative data.     

The role of nurse practitioners in hospital settings: implications for interprofessional practice

Expansion of the nurse practitioner (NP) role worldwide indicates a need to understand how the role functions in interprofessional healthcare teams. Through the adoption of a mixed methods approach that gathered on-site tracking and observation, self-recorded logs of consultations and focus group interviews of team members and NPs, we describe the extent of role activity and the nature of interprofessional practices of 46 NPs and their team members in nine hospital sites across the province of Ontario, Canada. Findings outline the nature of the NP role activities, which largely focused on providing clinical care, with the support of their team, to a range of patients across the study settings. We discuss how ‘embedding’ the NP in this way appears to contribute to utilization of expertise of all professions as well as enabling team members to promote evidence-based practices. We argue that the use of NPs augments interprofessional role utilization through their desire to consult with a range of professionals and the capacity to perform holistic care for patients that is not limited to traditional nursing boundaries.     

The Nurse Practitioner in Saudi Arabia: Potentials and Threats

The provision of the nurse practitioner (NP) began in the mid-1960s and is defined more clearly nowadays in many developed countries, such as the United States, Canada, United Kingdom, and Australia. Their scope of practice is legally well defined in these nations. However, the countries of the Middle East, including Saudi Arabia, face the problem of lack of enough numbers of NPs and even lack well-defined NPs’ roles and duties. Several challenges face the effective adoption of the NP title and roles in Saudi Arabia, where it cannot be identified successfully without a clear recognition, definition, scope, legislation, or a regulatory framework     

Pioneering a Primary Care Adult Nurse Practitioner Interprofessional Fellowship

The Department of Veterans Affairs Office of Academic Affiliations funded 5 Centers of Excellence in Primary Care Education. The West Haven site pioneered the first post-master's adult nurse practitioner (NP) interprofessional fellowship to address the gap in NP education. The experiences of the initial cohort were captured through semistructured interviews. Qualitative analysis revealed 4 common themes: (1) bridging into professional practice, (2) expanded appreciation of health professionals' roles, (3) commitment to interprofessional teamwork, and (4) the necessity of mentorship. The initial findings suggest that post-master's adult NP interprofessional fellowship programs are an essential “next step” for new NPs.     

New Nurse Practitioner Competencies: Skill Development and Reflective Writing Rubrics

New nurse practitioners (NPs) must be safe and effective in their first job. Some new NPs have reported that they feel unprepared for transition to the NP role and that not all physicians and employers understand the NP role. Rubrics (scoring tools specifying expectations for successful performance) help ensure successful transitions to practice. Rubrics clarify performance expectations and can reduce confusion around role. Two rubrics for assessing NP performance, 1 focused on established NP role competencies and 1 on reflective writing, were developed using the novice-to-expert framework for skill development to facilitate successful transition of new NPs into practice.     

A Scoping Review of Nurse Practitioner Roles in Immigrant Health

The provision of adequate health care services to immigrants continues to be an issue in many countries. The objective of this scoping review is to examine the extent, range, nature, and characteristics of the literature for the nurse practitioner (NP) role in immigrant health. A search of 5 databases was completed, yielding 440 studies. After reviewing the abstracts and eliminating studies based on the inclusion and exclusion criteria, only 5 studies qualified for the scoping review. Given that scope of NPs’ roles is expanding, this review reveals how NP care can improve immigrants’ health. Barriers to the utilization of NPs in immigrant health include language, the development of therapeutic relationships, and cultural beliefs. Overall, this review shows that there is a need for more research on the role of NPs in immigrant health, especially from the perspective of service recipients.     

Tort reform: an issue for nurse practitioners

PURPOSE: To inform nurse practitioners (NPs) about the issues related to tort reform and its relationship to malpractice insurance costs. DATA SOURCES: Current journals, newspapers, professional newsletters, and Internet sites. CONCLUSIONS: NPs are paying more for their malpractice premiums, and many are losing their places of employment as clinics close due to the increased cost of premiums. One method proposed for curbing the flow of monies spent on premiums and litigation is tort law reform. California serves as an example; its Medical Injury Compensation Reform Act (MICRA) tort reform law was passed 25 years ago, and it has maintained stable malpractice premiums. Other states have proposed similar laws, but some have not had similar success. To curb litigation costs, not only should tort laws be reformed, but NPs and physicians should keep abreast of current practice standards in order to provide quality medical care. IMPLICATIONS FOR PRACTICE: Like physicians, NPs are affected directly by tort laws. These laws hold NPs accountable at the same level as physicians. In addition, many states limit NPs' practice to delegation of authority by a physician. Liability is therefore transferred from the NP to the physician and vice versa in cases of injury or wrongful act. In addition, many NPs are finding it increasingly difficult to locate insurers who will write policies for medical liability.     

Nurse Practitioner Role,Independent Practice,and Teamwork in Primary Care

Primary care nurse practitioner (NP) workforce represents a substantial supply of primary care providers able to meet the demand for care. However, many barriers influence NP practice and care. This study conducted a survey of NPs in New York state to better understand NPs' role, independent practice, and teamwork in primary care organizations. Overall, 278 NPs completed the online survey. Forty-two percent of NPs had their own patient panel. The mean score of the Autonomy and Independent Practice scale was higher than that of the Teamwork scale. These scales were positively correlated, suggesting that NP independent practice may improve teamwork.     

Supporting Nurse Practitioner Preceptor Development

Increases in the number of nurse practitioners (NPs) completing their educational programs create a challenge for universities as well as health care organizations. More clinical preceptors are needed to support students and new professionals transitioning to clinical practice. Although preceptors are critical in the evolution from new NP to competent provider, there is a lack of information available to NP preceptors related to developing effective clinical teaching skills. This comprehensive literature review evaluates current, evidence-based strategies for preceptor development. The findings in the literature show improvement in clinical reasoning when structured preceptor methods are incorporated into clinical practice.