NPs are qualified to lead the charge for improvement in the U.S. According to the American Association of Nurse Practitioners (AANP), NPs render care that is safe, effective, patient-centered, timely, efficient, equitable and evidence-based. Moreover, NP care is of the same standard as physicians' care.
Growth and advancement in the 21st century APRNs are extremely valuable to today's healthcare system. They hold critical roles in addressing the rise in chronic medical conditions, expanding access to healthcare and meeting population health needs, especially for aging or underserved populations.
APRNs treat and diagnose illnesses, advise the public on health issues, manage chronic disease, and engage in continuous education to remain ahead of any technological, methodological, or other developments in the field.
Research is important to the practice of the APNs because it provides the evidence that has been tested and can be used which then can be applied in patient care. Research is very important to the nursing profession, for it helps to set the standards, guidelines, policies and procedures.
Research has found that patients under the care of NPs have fewer unnecessary hospital readmissions, fewer potentially preventable hospitalizations, higher patient satisfaction and fewer unnecessary emergency room visits than patients under the care of physicians.
Abstract. Nurse leaders face a myriad of challenges in the 21st century such as nursing workforce shortages, negative affectivity, generation workforce concerns, changing delivery systems, and increasing clinical practice complexity, to name a few.
NPs provide individual and family-focused clinical care with an emphasis on health promotion, illness prevention, and the diagnosis and management of chronic and episodic disease. The NP role represents a significant opportunity to improve the accessibility of rural communities to a full range of PHC services.
How can nurses help with preventative health care efforts?Providing general education. According to Hospital News, one of the most fundamental ways that nurses assist inpreventative health efforts is through education. ... Identifying at-risk patients. ... Helping facilitate access to care. ... Educating the community.
Community health centers provide comprehensive primary care and preventive services to some of the most vulnerable and underserved Americans, reducing the need for more costly forms of care, such as hospitalizations and emergency department visits, down the line.
These roles include coordinating, consolidating, conducting, consulting, and committing to nursing research. Because of their specialized clinical experience and graduate-level academic education, APNs are needed to participate in these five roles.
APRNs provide patient assessments, diagnose diseases and conditions, order tests, prescribe medications and direct patient care. Some states allow APRNs to dispense medications under certain conditions and others permit APRNs to provide drug samples to patients.
They can diagnose common medical problems, order tests, prescribe medication and make referrals. “It's cost-effective and high-quality care,” Jones-Schubart said. “They are key members of the health care team.”
According to the U.S. Bureau of Labor Statistics, the job outlook for advanced practice registered nurses (APRNs), including nurse practitioners, nurse anesthetists, and nurse midwives, is projected to grow 26 percent from 2018 to 2028, much faster than the average for all occupations.
Typical activities for health promotion, disease prevention, and wellness programs include: Communication: Raising awareness about healthy behaviors for the general public. Examples of communication strategies include public service announcements, health fairs, mass media campaigns, and newsletters.
The prevalence of chronic illness and multimorbidity rises with population aging, thereby increasing the acuity of care. Consequently, the demand for emergency and critical care services has increased. However, the forecasted requirements for physicians have shown a continued shortage. Among efforts underway to search for innovations to strengthen the workforce, there is a heightened interest ...
Aim: The aim of this paper is to discuss six issues influencing the introduction of advanced practice nursing (APN) roles: confusion about APN terminology, failure to define clearly the roles and goals, role emphasis on physician replacement/support, underutilization of all APN role domains, failure to address environmental factors that undermine the roles, and limited use of evidence-based ...
There have been several changes to healthcare services in the UK over recent years, with rising NHS costs and increasing demands on healthcare professionals to deliver high-quality care. Simultaneously, public inquiries have identified suboptimal leadership throughout the NHS, which has been linked …
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Excluded from the review were studies that examined both adult and pediatric patients requiring emergency or critical care services. Excluded from the review were also studies that examined services provided by physician assistants. This review included studies with interventions which compared the outcomes of the APN-/NP-directed emergency or critical care services with those of the physician-directed care. This review also included studies with interventions which compared the physician-only model of care with APN-physician or NP-physician collaborative model of care.
Capitalizing on nurses in advanced practice to increase patients’ access to emergency and critical care is appealing . This review suggests that the implementation of advanced practice nursing roles in the emergency and critical care settings improves patient outcomes. The transformation of healthcare delivery through effective utilization of the workforce may alleviate the impending rise in demand for health services. Nevertheless, it is necessary to first prepare a receptive context to effect sustainable change.
The nomenclature varies internationally. The “NP” title is used in Australia, Belgium, Canada, Sweden, the United Kingdom (UK), and the USA whereas the “APN” title is used in Switzerland, Singapore, and South Korea [10]. Nonetheless, NPs and APNs (NP/APNs) are registered nurses “who acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice” ([4], p. 26) and enter the workforce with a master’s degree [11].
Since the inception of advanced nursing practice in primary care, its role has extended to other healthcare settings such as the acute care. Acute care provides short-term restorative stabilization to patients in unstable chronic conditions and with complex acute and critical illnesses. Acute care encompasses emergency and critical care [15]. Emergency and primary care advanced nursing practice do share similarities in that they serve as first-contact access to healthcare, but the acuity of the patient manifestations delineates the two. Unlike in primary care NP/APNs, emergency NP/APNs are trained to manage patients with acute life- or limb-threatening conditions [15]. In the past decade, greater practice autonomy has been given to NP/APNs in emergency and critical care. This expanded practice allows nurses to assume some medical tasks typically performed by physicians, aiming at not only increasing the access to healthcare and service efficiency but also eventually mitigating the cost of health services.
The selection of studies was done independently by two of the authors (BW and JL) based on the eligibility criteria. Disagreement during selection was resolved by discussion with a third-party arbiter (WT). The selection process is illustrated in the flow diagram in Fig. 1.
Therefore, the main objective of this systematic review is to present, critically appraise, and synthesize the best available evidence on the impact of advanced nursing practice on patients’ length of stay, time to treatment or consult, mortality, patient satisfaction, and cost in emergency and critical care settings.
Medical licensing is a state function and APRN scope-of-practice (SOP) laws vary from state to state. 5In 16 states, APRNs have the authority to practice without a written agreement with a supervising physician, 9 states require physician involvement to prescribe but not to diagnose and treat, and in 24 states physician oversight is required to prescribe, diagnose, and treat.6The definition of “oversight,” however, varies by state, and most states allow collaboration or supervision to occur remotely.7There is also variation in SOP laws regarding APRNs' authority to supervise clinical staff. For example, one article notes a requirement in sections 2069–71 of the California Business and Professions Code that doctors and selected other professions— but not registered nurses—may supervise California medical assistants.8
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Today, most NPs practice in primary care. Autonomy or independence has always been central to the concept of a nurse practitioner as a primary care provider.2The National Council of State Boards of Nursing defines “independence” as practicing with “no requirement for a written collaborative agreement, no supervision, [and] no conditions for practice.”3Although the authority to diagnose and prescribe are the most frequently mentioned aspects of independence, the concept encompasses other dimensions including entry into practice; authority to bill for services independently; access to diagnostic services and hospital admitting privileges; and recognition as primary care providers.4
Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses
Recent publications promoting over-riding state scope-of-practice laws argue that a large body of evidence shows APRNs working independently provide the same quality of care as medical doctors. We found scarce long-term evidence to justify this position.
The National Governors Association10and the Institute of Medicine (IOM)11have criticized variation in SOP regulations among the states, and both argue that nurses should be able to practice to the “full extent of their education and training” in order to adapt to the changing health care system after the implementation of the Affordable Care Act (ACA), which authorizes nurse-managed health clinics and other innovations. In March, 2014, a report from the Federal Trade Commission, relying in large part on the IOM report, argued that physician supervision or collaborative practice agreement requirements “may sometimes restrict competition unnecessarily, which can be detrimental to health care consumers and have broader public health consequence,” that is, “decreased access to health care services, higher health care costs, reduced quality of care, and less innovation in health care delivery.”12In the context of the ACA, one emergent issue is whether some patient care teams should be led by a nurse practitioner instead of only a medical doctor. Other advocates for change argue that, nationally, removing restrictions on NP practice would improve access to primary care and allow NPs to emerge as leaders of the integrated teams that are an important component of new models for delivering primary care.8,13,14
Strong conclusions or policy changes relating to extension of autonomous APRN practice cannot be based solely on the evidence reviewed here. Although no differences in 4 outcome measures (health status, quality of life, mortality, hospitalizations) were detected, the evidence cannot rule out such differences. Published evidence about performance measures, satisfaction, resource use, and considerations of access to care—as well as the track record of VA facilities that use this model—should be considered.
The purpose of this course is to provide clinicians with the information necessary to choose the appropriate opioid agents for their patients, with a resultant improvement in patients' quality of life and compliance with prescribed treatments.
This course fulfills the Michigan requirement for 2 hours of continuing education in pain and pain symptom management. This activity is designed to comply with the requirements of California Assembly Bill 1195, Cultural and Linguistic Competency.
In support of improving patient care, NetCE is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Because APRNs are expected to be leading members of healthcare teams, formal training is essential to the transition process. 20 Clinical readiness, leadership skills, communication, and professional identity are key components to the development of new APRNs.
1 One of the greatest challenges is the shift in experience level APRNs encounter when they leave their positions as seasoned RNs to begin practice as new APRNs. 1 Through personal communication and published literature, new APRNs resoundingly express a lack of self-confidence as they begin their new practitioner roles. Research indicates that the quality of this career adjustment can impact APRNs' development in their new roles and their decisions to remain in the profession or not. 2 A recent literature review, spanning from 2009 through 2019, yielded 155 articles related to APRN transition to practice. An additional 34 articles specifically explored transition programs. Many of these articles discuss various specific transition programs, emphasize the challenges faced by new graduate APRNs entering practice, and share research reporting the challenges of this transition.
Annual costs per APRN trainee are estimated at as much as $100,000, with two-thirds of this expense supporting the cost of the new APRN and the rest supplementing lost preceptor productivity. 2 Justifying a program based on cost will be a key factor for incumbent APRNs interested in developing a transition to practice program at their organization. This is the first step in the process. To understand a particular organization's financials, meet with a nurse recruiter to determine turnover of new first-year APRNs and the costs associated with this turnover. Other sources include the literature from regional or national employment agencies that collect data on these statistics. Tracy has estimated the cost to replace an APRN has been as high as twice that of the APRN's annual salary. 11 Additionally, employment turnover rates for NPs, as discussed by both Barnes and Hoff and colleagues, have been reported twice as high as for physicians. 2,6 According to Nursing Solutions, Inc., annual turnover levels for acute care NPs were found in one national survey to be between 8% and 11%. 13 Smaller organizations may know their turnover rates and be able to calculate the cost. Tracy states that 83% of hospitals do not report these rates or the reasons for turnover. 11 Working on a tracking process will be key to understanding the turnover rates before and after program implementation and will help determine successful metrics related to cost.
Five factors emerged as being perceived as facilitating the transition to practice. These include mastery of self-efficacy and confidence, expert mentoring and guidance, supportive work environment, peer support, and previous experience as a student nurse anesthetist. Here, Tracy brings forward the student experience prior to moving into a licensed APRN role. This is the only study reviewed that reveals the importance of clinical experiences as a student.
Because APRNs are expected to be leading members of healthcare teams, formal training is essential to the transition process. 20 Clinical readiness, leadership skills, communication, and professional identity are key components to the development of new APRNs. Creating a well-designed transition program that offers a structured path to independent practice will undoubtedly have an overall positive impact on the bottom line, productivity, and patient outcomes. Understanding current internal data, reviewing resources provided by organizations that are developing standards for these programs, and connecting with colleagues from around the country are all great assets available toward developing a successful program.
These include the GraduateNursingEDU.org website repository for fellowship programs, The American Nurses Credential Center (ANCC), the CCNE, and finally, the National Nurse Practitioner Residency and Fellowship Training Consortium, which was founded in 2018. 15,22,23
The Nurse Practitioner Role Transition Scale (NPRTS) is another potential tool. It is a self-report survey designed to measure NPs' perceptions of the role. It has been tested for content validity and reliability. This 16-item, 5-point Likert scale survey, published in 2015 by Strange, measures self-perceptions of the role transition experience in three dimensions: developing comfort and building competence, understanding the role, and collegial support. 21
Excluded from the review were studies that examined both adult and pediatric patients requiring emergency or critical care services. Excluded from the review were also studies that examined services provided by physician assistants. This review included studies with interventions which compared the outcomes of the APN-/NP-directed emergency or critical care services with those of the physician-directed care. This review also included studies with interventions which compared the physician-only model of care with APN-physician or NP-physician collaborative model of care.
Capitalizing on nurses in advanced practice to increase patients’ access to emergency and critical care is appealing . This review suggests that the implementation of advanced practice nursing roles in the emergency and critical care settings improves patient outcomes. The transformation of healthcare delivery through effective utilization of the workforce may alleviate the impending rise in demand for health services. Nevertheless, it is necessary to first prepare a receptive context to effect sustainable change.
The nomenclature varies internationally. The “NP” title is used in Australia, Belgium, Canada, Sweden, the United Kingdom (UK), and the USA whereas the “APN” title is used in Switzerland, Singapore, and South Korea [10]. Nonetheless, NPs and APNs (NP/APNs) are registered nurses “who acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice” ([4], p. 26) and enter the workforce with a master’s degree [11].
Since the inception of advanced nursing practice in primary care, its role has extended to other healthcare settings such as the acute care. Acute care provides short-term restorative stabilization to patients in unstable chronic conditions and with complex acute and critical illnesses. Acute care encompasses emergency and critical care [15]. Emergency and primary care advanced nursing practice do share similarities in that they serve as first-contact access to healthcare, but the acuity of the patient manifestations delineates the two. Unlike in primary care NP/APNs, emergency NP/APNs are trained to manage patients with acute life- or limb-threatening conditions [15]. In the past decade, greater practice autonomy has been given to NP/APNs in emergency and critical care. This expanded practice allows nurses to assume some medical tasks typically performed by physicians, aiming at not only increasing the access to healthcare and service efficiency but also eventually mitigating the cost of health services.
The selection of studies was done independently by two of the authors (BW and JL) based on the eligibility criteria. Disagreement during selection was resolved by discussion with a third-party arbiter (WT). The selection process is illustrated in the flow diagram in Fig. 1.
Therefore, the main objective of this systematic review is to present, critically appraise, and synthesize the best available evidence on the impact of advanced nursing practice on patients’ length of stay, time to treatment or consult, mortality, patient satisfaction, and cost in emergency and critical care settings.