Nurse Practitioner Post-Graduate Residency Program: Best Practice

This review aims to better understand the novice nurse practitioner (NP) transition to practice, while providing content from organizations focused on quality transitional programs. A major problem is the shortage of NPs in primary care. This is related to high turnover due to the difficult transition from expert RN to novice NP. To better understand this transition, Duchscher’s Transition Shock Theory was examined and used to support the importance of residency programs. This review provides support for the use of NP residencies to positively impact the transition to practice for the novice NP. The Community Health Center Inc. NP Residency Program promotes quality NP residencies and is used as an exemplar. The article also addresses the concern with residency variability and the cost associated with these programs.     

Clinical nurse specialist and nurse practitioner core curricula survey results

The American Nurses' Association's Council of Clinical Nurse Specialists and Council of Primary Health Care Nurse Practitioners conducted a survey of all graduate nursing programs in the United States that prepare nurse practitioners and/or clinical nurse specialists. One hundred eight schools responded (73.5 percent), yielding data on 317 programs that could be further analyzed. For the 60 NP and 195 CNS programs analyzed, information was obtained on the following: required courses, number of hours of the required courses, students' clinical training settings and graduates' employment settings. Findings revealed marked similarity between the core curricula of NP and CNS graduate programs. The only significant differences found were that NP programs placed greater emphasis on pharmacology, primary care, physical assessment, health promotion, nutrition and history-taking in their curricula. In both the student clinical settings and graduate employment settings, NPs focused on primary care settings while CNSs focused on secondary or tertiary care settings. Based on the marked similarities between the core curricula of NP and CNS graduate programs, it is suggested that further investigations be conducted to determine whether objectives and/or teaching methods differ, and to further investigate the effects of practice setting on role development. Further, it is suggested that NPs and CNSs continue to interact through forums and conferences to continue the evolution and definition of graduate nursing education and advanced practice.     

A review of graduate nurse transition programs in Australia.

BACKGROUND: Despite nearly two decades of experience with graduate transition programs in Australia little evidence exists regarding the effectiveness of these programs as interventions that enhance the transition from nursing student to professional practitioner. There is general acknowledgement that this is a crucial time for people entering the profession and yet there is little agreement on what constitutes best practice for nurses' transition to the workforce. AIM: This paper challenges the status quo through a review of current programs and questions whether primacy should be given to formal transition programs or to the development of educationally supportive clinical learning environments. CONCLUSION: There is sufficient doubt in the efficacy of formal transition programs to at least investigate potential alternatives such as concentration on the development of a supportive practice culture conducive to learning. Indeed, the type of learning environment suitable for graduate nurses is likely to be one that will also facilitate the continued development and enhanced job satisfaction of the rest of the nursing team.     

Physician Perceptions of Advanced Practice Providers on Hospitalist Teams

Little is known about physician perceptions of nurse practitioners (NPs) and physician assistants (PAs) on hospitalist teams and the factors that impact their perceptions. Academic physician hospitalists were surveyed to better understand those factors, focusing on NP/PA experience, training, and physician experience with NPs/PAs. Perceptions by hospitalist physicians of NPs/PAs were strongly positive. Notable findings include the perceived positive impacts of NPs/PAs on clinical care provided, practice efficiency, and physician satisfaction. Most respondents prefer working with NPs and PAs with multiple years of clinical experience, particularly those who have participated in training beyond NP/PA graduate programs of study.     

Report from the Council of Emergency Medicine Residency Directors Subcommittee on Graduate Medical Education Funding: Effects of Decreased Medicare Support

INTRODUCTION: Recent changes by the Health Care Financing Administration (HCFA) have resulted in decreased Medicare support for emergency medicine (EM) residencies. OBJECTIVE: To determine the effects of reduced graduate medical education (GME) funding support on residency size, resident rotations, and support for a fourth postgraduate year (PGY) of training and for residents with previous training. METHODS: A 36-question survey was developed by the Council of Emergency Medicine Residency Directors (CORD) committee on GME funding and sent to all 122 EM program directors (PDs). Responses were collected by the Society for Academic Emergency Medicine (SAEM) office and blinded with respect to the institution. RESULTS: Of 122 programs, 109 (89%) responded, of which 78 were PGY 1-3 programs, 19 were PGY 2-4, and 12 were PGY 1-4. The PDs were asked specifically whether there were changes in program size due to changes in Medicare reimbursement. Although few programs (12%) decreased their size or planned to decrease their size, 39% had discussions regarding decreasing their size. Thirty percent of the PDs responded that other programs at their institution had already decreased their size; 26% of the PDs had problems with financing outside rotations; and 24% had a decrease in off-service residents in their emergency departments (EDs). Only seven (6%) of programs paid residents from practice plan dollars, while most (82%) were fully supported by federal GME funding. Nearly all four-year programs (97%) received full resident salary support from their institutions and 77% of programs accept residents with previous training. CONCLUSIONS: Nearly all EM programs are fully supported by their institutions, including the fourth postgraduate year. Most programs take residents with previous training. Although few programs have reduced their size, many are discussing this. Many programs have had difficulty with funding off-service rotations and many have had decreased numbers of off-service residents in their EDs. Recent GME funding changes have had adverse effects on EM residency programs.     

Supporting new graduate registered nurse transition for safety: A literature review update

BackgroundReports suggest higher incidence of medical errors occur during times of transition for new practitioners, in part due to general staff disruption in the health services and inexperience of those entering the workplace. NGRNs experience a range of challenges on transition to professional practice and their transition experience will impact their ability to provide high quality patient care.AimThe aim of this review was to critically appraise the contemporary literature concerning the transition of new graduate registered nurses (NGRNs) and their patient safety knowledge and practices.DesignA scoping review of research literature.MethodsThe review used key terms and Boolean operators to search literature from 2015 to September 2018. A search of CINAHL, PsycINFO, Scopus and Medline databases and a manual search of references conducted to identify any other literature not previously detected.FindingsThis review acknowledges NGRNs have varied experiences during initial transition to practice. Transition programs are valuable for the structure and support provided during the first 12-months of practice. Ward culture influences safety practices while disparity between readiness and expectations remains.DiscussionPractical and emotional support necessary to help new nurses successfully navigate the turbulent early months of transition to clinical practice will ultimately enhance NGRNs’ clinical safety.ConclusionsNew graduate nurses require a supportive culture to translate knowledge and skills into safe practice and alleviate stressors. There remains little literature regarding patient safety knowledge and practices of new graduate registered nurses.     

Intensive care nurse practitioners in Australia: A description of a service model in an adult tertiary intensive care unit

BackgroundAlthough well-established internationally, nurse practitioners (NPs) in Australian adult intensive care units (ICUs) are rare. Australian literature clearly highlights the importance of creating ICU NP roles to meet emerging demands. An ICU NP model of care at a metropolitan hospital in Sydney provides care in four core practice areas: complex case management, vascular access, tracheostomy management, and intrahospital transport of critically ill patients. The ICU NPs also provide training and assessment for ICU nurses and medical officers in these same core practice areas and can efficiently meet service gaps in crisis such as the most recent COVID-19 pandemic.ResultsThe ICU NP program described is an innovative model of care that has demonstrated potential benefits to patients and their families. Potential benefits to the healthcare system including supporting advanced practice nursing development in regional and rural Australia and in addressing future ICU workforce issues are also identified. This model of care provides a clear role and structure for the integration of NPs in the adult ICU. Research to evaluate the impact of the role is required and is underway.ConclusionsThis model is being used to develop a national adult ICU NP fellowship training program for ICU transitional NPs preparing for endorsement or endorsed NPs who require additional ICU-specific training. This immersive clinical training program combined with didactic learning modules offers a framework to support the implementation of the adult ICU NP role as well as a framework for NP fellowship programs in other specialties.     

How do we pass NP autonomy legislation?

NP practice autonomy means prescribing medication and treatment based on graduate nursing education and credentials, without physician supervision. NP advancement and optimal professional practice depends on autonomy. NP researchers conducted a study to describe legislative initiatives in states where NPs practice and prescribe autonomously. This article outlines the strategies NPs used to pass autonomy legislation in South Carolina. NPs in other states can use these strategies to pursue autonomy legislation.     

Recruitment and retention of primary care nurse practitioners in underserved areas: A scoping review

BackgroundThe growing nurse practitioner (NP) workforce plays a critical role in primary care delivery in the United States. However, better recruitment and retention of the robust NP workforce in underserved areas are needed; evidence to inform such effort is limited.PurposeThis scoping review aimed to examine the findings, scope, and knowledge gaps of available literature on factors associated with NP recruitment and retention in underserved areas.MethodsThis review was guided by Joanna Briggs’ Scoping Review Methodology and PRISMA-SCR reporting standards. Literature search for peer-reviewed and gray literature was conducted in six databases.FindingsA total of 22 studies met inclusion criteria. Factors associated with NP recruitment and retention in underserved areas were mapped into five themes, including factors related to: the individual NP, NP education programs/financial aid, organizations employing NPs, the communities NPs work in, and autonomous practice. Majority of the included studies were published before 2010; few used rigorous study designs and analysis methods; and few exclusively studied NPs and unique challenges facing the NP workforce.DiscussionAvailable studies demonstrate that NP recruitment and retention can be addressed by various stakeholders (e.g., educators, policy makers); however, up-to-date, methodologically rigorous, and NP-focused studies are needed.     

An Innovative Approach for Graduate Education for Psychiatric Nurse Practitioners

A major transformation in nurse practitioner (NP) education is the emergence of post graduate residencies; their foci include (a) educating NPs in population health; (b) increasing clinical proficiency; and (c) incorporating quality and safety into practice. We describe a psychiatric NP residency program supported by an academic-practice partnership, known as the Veterans Affairs Nursing Academic Partnership for Graduate Education (VANAP-GE) between the Birmingham Veterans Administration Medical Center (BVAMC) and the University of Alabama at Birmingham (UAB) School of Nursing (SON) for a population of Veterans with complex mental and physical health needs. Topics which are covered include risks of suicide among Veterans, post-traumatic stress disorder, depressive and anxiety disorders, and substance use disorders. During this one-year traineeship during the first year after NP certification, residents engage in development of crucial skills for improving the future of U.S. health care. All residents are newly licensed PMHNPs, but some are also pursuing DNP degrees. For residents who are simultaneously enrolled in BSN to DNP programs, the additional clinical training afforded by NP residency education provides a natural laboratory for their projects with foci of quality and safety, leadership, and clinical scholarship. Reduction in NP turnover as well as cost savings of orientation and recruitment are significant benefits for the practice partner with zero vacancies since the partnership's inception. These multiple successes predict increased establishment of residencies as viable post graduate pathways for NPs.     

Changing Nurse Practitioner Students’ Perceptions Regarding Substance Use Disorder

Nurse practitioners (NPs) are in a key position to provide services to persons with substance use disorder and decrease marginalization and stigmatization. There is a paucity of evidence on interventions to affect NPs’ attitudes/beliefs, confidence/preparedness, concerns/barriers, and ability to treat substance use disorder. The presented research demonstrated significant positive changes (P < .05) in 33 of 44 items on the Substance Use Disorder, Knowledge, Attitudes and Beliefs Survey, after NP students were provided a targeted educational program on the treatment of opioid use disorder. The research supports educational programs positively impacting NPs’ knowledge, attitudes, and beliefs regarding persons with substance use disorder.     

Residency programs for primary care nurse practitioners in federally qualified health centers: a service perspective

A number of social forces are converging to shape the coming health care and professional practice environment for nurse practitioners (NPs) and the public they serve. Two major innovations of the 1960s, NPs and community health centers, have reached their fourth decade since their inception. These forces have traveled parallel and overlapping paths in their mission to provide high quality health care. Today the current federally qualified community health centers (FQHCs) are a major component of the nation's safety net for the medically underserved, special populations, and the uninsured throughout the United States. Nurse practitioners in the FQHC settings are responsible for highly complex care across lifecycles, with a focus on the treatment and management of disease along with prevention and health promotion. The author suggests that FQHC-based formal residency programs in primary care at either the post-master's or post-doctoral level are the next step in the evolution of both FQHCs and NP preparation. Possible funding mechanisms through changes in federal graduate medical education legislation are explored.     

Identifying and aligning expectations in a mentoring relationship

The mentoring relationship between a scholar and their primary mentor is a core feature of research training. Anecdotal evidence suggests this relationship is adversely affected when scholar and mentor expectations are not aligned. We examined three questions: (1) What is the value in assuring that the expectations of scholars and mentors are mutually identified and aligned? (2) What types of programmatic interventions facilitate this process? (3) What types of expectations are important to identify and align? We addressed these questions through a systematic literature review, focus group interviews of mentors and scholars, a survey of Clinical and Translational Science Award (CTSA) KL2 program directors, and review of formal programmatic mechanisms used by KL2 programs. We found broad support for the importance of identifying and aligning the expectations of scholars and mentors and evidence that mentoring contracts, agreements, and training programs facilitate this process. These tools focus on aligning expectations with respect to the scholar's research, education, professional development and career advancement as well as support, communication, and personal conduct and interpersonal relations. Research is needed to assess test the efficacy of formal alignment activities.     

A systematic review of the effectiveness of simulation-based education on satisfaction and learning outcomes in nurse practitioner programs

BackgroundHigh-fidelity simulation (HFS) is becoming an integral component in healthcare education programs. There is considerable evidence demonstrating the effectiveness of HFS on satisfaction and learning outcomes within undergraduate nursing programs; however, there are few studies that have investigated its use and effectiveness within nurse practitioner (NP) programs.ObjectiveTo synthesize the best available evidence about the effectiveness of HFS within NP education programs worldwide. The specific review question was: what is the effect of HFS on learner satisfaction, knowledge, attitudes, and skill performance in NP education?MethodsJoanna Briggs Institute systematic review methodology was utilized. The following databases were searched: MEDLINE, CINAHL, EMBASE, Epistemonikos, PROSPERO, HealthSTAR, AMED, Cochrane, Global Health and PsycINFO. Studies were included if they were quantitative in nature and reported on any aspect HFS within a NP program.ResultsTen studies were included in the review. All studies were conducted in the United States and published between 2007 and 2014. Outcomes explored included: knowledge, attitudes, skills and satisfaction. The majority of studies compared HFS to online learning or traditional classroom lecture. Most study scenarios featured high acuity, low frequency events within acute care settings; only two studies utilized scenarios simulated within primary care.ConclusionsThere is limited evidence supporting the use of HFS within NP programs. In general, HFS increases students' knowledge and confidence, and students are more satisfied with simulation-based teaching in comparison to other methods. Future studies should explore the effectiveness of simulation training within NP programs in reducing the theory to practice gap, and evaluate knowledge retention, transferability to real patient situations, and impact of simulation on patient outcomes.     

Transition to mental health nursing through specialist graduate nurse programs in mental health: a review of the literature

Specialist graduate nurse programs (GNPs) in psychiatric/mental health nursing have been widely implemented across public healthcare services throughout Victoria, Australia. Broadly, these programs aim to assist newly graduated nurses during the transition from nursing student to registered nurse. This paper presents a review of the literature relevant to GNPs; specifically focusing on graduate transition. An adequate orientation to clinical areas and ongoing support throughout the transition process were identified as significant determinants of new graduates" satisfaction with the initial post-qualification period. However, the literature suggests that the inadequacy of psychiatric/mental health nursing content in undergraduate nursing courses creates additional difficulties within this specialty area of practice. Moreover, the current literature review emphasises the need for further research to evaluate the effectiveness of GNPs for nursing in general and for psychiatric/mental health nursing in particular.     

我国护理专业学位硕士培养现状的调查与分析

目的:了解我国护理专业学位研究生培养状况,为开展老年护理专业学位研究生培养方案的构建提供依据。方法:以能力本位理论为理论基础,采用自编问卷以方便抽样方法,对全国15所高校的84名护理专业学位研究生和26名护理研究生导师进行问卷调查。结果:调查对象中,88.1%护理专业学位研究生和96.2%的护理研究生导师认为护理研究生在临床实践中最应具备的能力是护理专科技能,84.5%护理专业学位研究生和88.5%导师认为其次是沟通与协调能力;护理专业学位研究生和导师在临床实践期间应具备的主要素质中选择专业素质、人文关怀、思想道德分别占比94.1%、90.5%、86.9%和100%、100%、100%;仅有26.2%的护理专业硕士希望将来从事临床高级护理实践工作;有9.5%的护理专业学位研究生有专职的临床指导医生。结论:护理专业学位研究生应该重视思想道德、人文关怀方面的培养,在临床护理实践中要着重培养学生的专科技能和沟通与协调能力,具备条件的医院要配备专门的高水平临床指导教师以提高学生专科技能,做到专业技能和人文关怀同步发展。     

Evidence-based and occupational perspective of effective interventions for older clients that remediate or support improved driving performance.

To assess the effectiveness of person-related interventions on driving ability in older adults, this literature review was completed as a part of the Evidence-Based Literature Review Project of the American Occupational Therapy Association. Nineteen articles were incorporated into the systematic review and include interventions in the following areas: visual, cognitive, and motor; educational; passengers; and medical. The results provide inconclusive evidence for the use of interventions such as the Useful Field of View training, home exercise programs, and passenger interactions. Conclusive evidence shows that older adults respond positively to programs stressing self-awareness of driving skills and that some medical interventions affect the ability to drive. Despite limitations, the studies reviewed provide useful information that deserves further exploration. Reading the literature provides therapists with knowledge that might improve client care. Learning about cutting-edge interventions and educating peers and students about evidence-based interventions may lead to safer community mobility for older adults.