Journal of the American Association of Nurse Practitioners最新文献

Abstract: Professional advancement programs (PAPs) serve as structured pathways for promotion and recognition of clinical contributions among advanced practice registered nurses (APRNs) and physician associates (PAs). Despite the growth of PAPs, there is a lack of identification and standardization of these programs in the literature. This article describes the development and iterative evaluation of a PAP called Advanced Practice Provider Recognition and Incentive Structure (APPRAISE). APPRAISE was created within a large urban academic health system with a multidisciplinary committee of APRN and PA representatives. This paper presents the cycles of evolution from a tiered clinical ladder to a simplified retrospective point-based incentive structure. In addition, this paper outlines key features of APPRAISE and the benefits and challenges between clinical ladders and incentive structures. Benefits of PAPs include increased visibility of APRN and PA contributions, enhanced mentorship, and alignment with organizational goals. Identified challenges include stakeholder turnover and budget constraints. APPRAISE provides a blueprint for sustainable PAP development, emphasizing flexibility, stakeholder collaboration, and fiscal considerations. Future research should assess the impact of PAPs on retention, job satisfaction, and clinical outcomes.

Background: Advance care planning (ACP) is a crucial process that empowers patients to clearly communicate their values, beliefs, and preferences regarding future medical care. This proactive approach ensures that their wishes are respected, particularly when they may be unable to make decisions for themselves. Advance care planning enables patients to articulate their values and preferences for future medical care. It aligns end-of-life care and reduces unnecessary interventions.

Local problem: Despite the well-documented advantages of ACP, its completion rates remain consistently low across various health care settings. This issue is particularly pronounced within underserved and linguistically diverse populations, where systemic barriers, cultural sensitivities, and communication challenges often impede effective ACP engagement and documentation. Addressing this disparity is vital to ensure equitable access to patient-centered care.

Method: Quality-improvement initiative was conducted in a multisite primary care practice. Knowles Adult Learning Theory guided provider education, and Plan-Do-Study-Act cycles supported workflow refinements.

Intervention: Providers and medical assistants received targeted education, used standardized scripts, and engaged patients with multilingual, literacy-appropriate materials. Advance care planning discussions and documentation were monitored through biweekly chart audits over 6 months and analyzed using descriptive statistics.

Result: Seventy-six of 150 chronic care management patients completed ACP documentation, all designating a health care proxy. Completions increased after a booster education session. Multilingual materials, standardized scripts, and workflow adaptations facilitated patient engagement.

Conclusion: Targeted provider education, structured workflows, and culturally sensitive outreach improve ACP completion in primary care. Nurses play a central role in ACP, supporting patient engagement, documentation, and culturally and linguistically appropriate care.

Abstract: Sepsis is one of the leading causes of mortality in the inpatient setting. Despite evolving clinical definitions, regulatory misalignment between Centers for Medicare & Medicaid Services (CMS) SEP-1 measures and Sepsis-3 guidelines creates barriers to optimal care. Advanced practice registered nurses (APRNs) are leaders who promote protocol adherence and policy advocacy. This policy analysis explores how regulatory challenges affect sepsis management and highlights the role of APRNs as change agents in evidence-based practice. A policy analysis was conducted by reviewing CMS SEP-1 regulations, Surviving Sepsis Campaign guidelines, and state-level mandates. A literature search was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Embase to identify systemic barriers and policy inconsistencies affecting sepsis management. Policies were evaluated for clinical alignment, regulatory implications, and their impact on APRN leadership opportunities. Findings were synthesized to develop recommendations to improve APRN-driven sepsis care initiatives. Misalignment between clinical practice and CMS guidelines complicates sepsis management, requiring APRNs to navigate administrative demands while maintaining patient-centered care. Policy reforms must better align SEP-1 with evolving clinical evidence and prioritize early recognition without compromising individualized patient care. Advanced practice registered nurses can lead quality-improvement efforts and legislative advocacy for updated sepsis protocols. Empowering APRNs through leadership in protocol adherence, policy reform, and advocacy initiatives is essential to improving sepsis outcomes. An evidence-based, patient-centered approach will enhance sepsis care delivery and promote health equity across health care settings.

Background: Nurse practitioner (NP)-owned practices play a growing role in primary care, especially in underserved communities. Although states with full practice authority (FPA) have seen increased NP self-employment and improved care access, little is known about the operational realities and challenges of NP-owned, insurance-based practices.

Purpose: This study aims to characterize NP-owned primary care practices, focusing on access, service delivery, financial sustainability, and challenges unique to NP practice ownership.

Methodology: A concurrent mixed-methods design combined survey responses ( n = 19) with electronic health record data from NP-owned practices across six FPA states.

Results: Most practices were solo owned, women/minority led, and fee-for-service dominant. Nearly 90% offered telehealth and same-day appointments, with average panel sizes of 867 patients-smaller than national averages. Despite high levels of patient access, challenges included inadequate reimbursement (79%), administrative burden (74%), and limited value-based care (VBC) participation. More than one third reported financial instability, and 84% expressed confidence in long-term sustainability.

Conclusions: Nurse practitioner-owned practices deliver accessible, patient-centered care in underserved areas but face systemic barriers to scalability and financial sustainability.

Implications: Nurse practitioner-owned practices enhance health care access but face financial and administrative barriers. Nurse practitioner-owned practices are well positioned to meet the growing primary care needs, but changes to support equitable reimbursement and expand VBC participation are essential for sustainability.

Abstract: This systematic comparative analysis examines the divergent approaches between the 2025 American College of Cardiology (ACC)/American Heart Association (AHA)/Multisociety (ACC/AHA/Multisociety) and the 2023 European Society of Cardiology guidelines for Acute Coronary Syndrome (ACS) management, with specific focus on implications for Advanced Practice Registered Nurses (APRNs). Despite sharing fundamental principles, these guidelines present significant variations in diagnostic thresholds, risk stratification methodologies, pharmacological interventions, and revascularization strategies that directly influence clinical decision-making processes. As APRNs assume increasingly autonomous roles in cardiovascular care delivery across various settings-from emergency departments to rehabilitation services-understanding these nuanced differences becomes essential for implementing evidence-based practice. This analysis methodically evaluates guideline variations across six domains: diagnostic criteria evolution, risk assessment tools, pharmacological management updates, interventional approaches, secondary prevention recommendations, and technological integration. Each section provides actionable recommendations for translating guideline updates into APRN practice while acknowledging jurisdictional variations in scope of practice. By elucidating these comparative differences, this analysis aims to enhance APRN clinical competency in navigating potentially conflicting international recommendations, ultimately optimizing patient-centered care delivery in accordance with the most current evidence-based standards in ACS management.

Background: California is experiencing a shortage of primary care providers, contributing to delayed access and inappropriate emergency department utilization. Although recent legislation is moving nurse practitioners (NPs) toward full practice authority, public misconceptions about their scope may hinder their effective integration into the primary care workforce.

Purpose: This study aims to assess patient perception of NP care versus physician care, patient understanding of NP scope of practice, and how those perceptions influence provider choice. Findings can help inform legislative and clinical decisions regarding NP autonomy in California.

Methodology: A cross-sectional design gathering quantitative data by a one-time anonymous Qualtrics survey was disseminated.

Results: The sample (N = 24) was predominantly female (75%), aged 30-49 years (50%), White (75%), and non-Hispanic/Latino (66.67%), with 45.83% holding a master's degree or higher. A paired samples t -test showed significantly more favorable perceptions of care by NPs (M = 4.76, SD = 0.33) than MDs (M = 4.42, SD = 0.67), t (22) = -2.85, p = .009, d = 0.59. Regression analyses showed no significant demographic predictors. Substantial gaps in knowledge of NP scope and legislation were identified.

Conclusion: Findings suggest NPs are perceived favorably relative to physicians; however, limited public understanding of NP scope of practice underscores the need for targeted educational initiatives. Although demographic variables were not significant predictors, future longitudinal research with larger, more diverse samples is essential to substantiate these findings and inform evidence-based policy development.

Implication: Expanding public understanding of NP roles is essential to support policy changes and optimize primary care access and delivery.

Background: The nursing profession has evolved from religious caregiving in medieval Europe to the modern nurse practitioner (NP) role. Each historical period shaped the scope, education, and autonomy of nurses, influencing today's advanced practice environment.

Purpose: This historiography examines key developments in nursing from the Middle Ages to the present, highlighting how historical forces shaped NP practice, education, and leadership.

Methodology: A historiographic review was conducted using peer-reviewed literature and historical texts spanning 1,400-2,024. Sources were selected to represent major sociopolitical, cultural, and professional milestones in nursing history, with thematic synthesis tracing the progression from caregiving traditions to advanced practice roles.

Results: Monastic caregiving established early models of organized nursing. In early modern Europe, midwives and female healers navigated shifting professional boundaries amid emerging medical regulation. Wartime service in the 20th century accelerated nursing professionalization, expanded clinical competencies, and catalyzed leadership roles. The 1965 introduction of the NP role addressed primary care shortages and evolved into a nationally recognized, graduate-prepared profession. Today, advanced practice nurses serve as essential providers in an increasingly complex health care system.

Conclusions: The NP role is the product of centuries of adaptation to social needs, political forces, and health care demands.

Implications: Understanding nursing's historical trajectory reinforces the profession's resilience and informs advocacy for expanded NP practice authority. This perspective equips clinicians, educators, and policymakers to align future NP growth with evolving population health needs and global primary care demands.

Background: Newborn screening (NBS) is one of the most significant public health achievements, traditionally using biochemical and physiologic tests to detect rare but treatable conditions. The emergence of genomic sequencing technologies, including whole-genome sequencing (WGS), now offers the ability to identify thousands of variants underlying pediatric disorders. These advances create new opportunities to transform NBS but also raise important clinical, ethical, and policy challenges.

Purpose: This article explores the implications of genomic NBS for advanced practice nursing, with a focus on lessons from the NIH-funded BabySeq Project and the policy precedent set by Florida's 2025 Sunshine Genetics Act, the first statewide, publicly funded WGS-NBS program in the United States.

Discussion: BabySeq demonstrated that genomic sequencing can identify actionable variants in approximately 9% of infants, yet it also exposed ethical tensions regarding disclosure of adult-onset findings and the contested concept of "family benefit." Florida's Sunshine Genetics Act expands NBS beyond the federal Recommended Uniform Screening Panel, aiming to reduce diagnostic odysseys and promote equity of access. However, unresolved issues persist, including informed consent, return of uncertain or adult-onset findings, and data stewardship. For nurse practitioners, the integration of genomic sequencing into NBS underscores new roles in parental education, consent counseling, care coordination, and long-term follow-up. Ensuring equity, cultural sensitivity, and alignment with professional guidelines will be essential to implementation.

Conclusions: WGS in NBS has the potential to improve outcomes for children and families by enabling earlier diagnosis and intervention. Nurse practitioners, as frontline providers in primary care and pediatrics, are uniquely positioned to support families through genomic education, ethical decision making, and care navigation. Building workforce genomic competency and advocating for equitable policies are critical to realizing the promise of genomic NBS in clinical practice.

Abstract: Artificial intelligence (AI) is transforming health care delivery and education, offering both opportunities and challenges. Because AI tools become more integrated into clinical practice, educators are exploring their potential to enhance learning, improve decision making, and prepare future providers for technology-rich environments. However, the use of AI in health care education raises concerns about academic integrity, overreliance, and the risk of AI-generated misinformation, known as "hallucinations." These inaccuracies pose significant challenges for students building foundational knowledge. Additionally, practical issues such as implementation costs, Health Insurance Portability and Accountability Act compliance, data privacy, and inherent biases in AI systems must be addressed. This article discusses the integration of AI into advanced practice nursing education using the Technological Pedagogical Content Knowledge (TPACK) framework. This framework emphasizes the interconnectedness of technology, pedagogy, and content knowledge, guiding educators in designing assignments that promote critical thinking and prepare students for real-world clinical practice. The evolution of an AI-based assignment for advanced practice nursing students is detailed, highlighting ethical considerations, interdisciplinary collaboration, and the development of clinical reasoning skills. By integrating AI into nursing education, we can ensure that advanced practice registered nurses (APRNs) are well-prepared to meet the demands of modern health care environments. This integration supports essential competencies, aligns with the 2021 American Association of Colleges of Nursing Essentials, and addresses the increasing complexity of patient care. Moreover, it equips APRNs with the skills needed to leverage AI effectively, fostering a culture of continuous learning and adaptation.

Background: Successful use of nurse practitioner (NP) and physician assistant (PA) care models is vital to delivering optimal patient care, maintaining financial stability, and reducing staff burnout and turnover.

Local problem: A large cardiovascular surgery practice experienced substantial growth, leading to an obsolete NP and PA care model. Consequently, workplace satisfaction scores were reduced, and the NP and PA turnover rate in 2018 was unacceptably high.

Methods: A multidisciplinary redesign team was formed to address gaps in the care model through a quality-improvement initiative. The team analyzed current workflows, collected external and internal survey data, conducted patient tracers, and observed staff. Seventeen collaborative care models were proposed by frontline staff members and presented to their peers for feedback. This feedback was used to select the best aspects of the proposed models to create a new model.

Interventions: The updated care model consisted of several key changes, which included reducing NP- and PA-to-patient ratios, eliminating redundant tasks, shifting from location-based to surgical team-based coverage, ensuring top-of-scope practice, developing specialty service lines, and separating inpatient and outpatient practices.

Results: After implementation of the new care model, NP and PA turnover rates decreased from baseline by an average of approximately 74% per year. Departmental work culture scores concomitantly increased from 68% to 85% after implementation of the new care model.

Conclusions: Adapting care models in conjunction with departmental growth is crucial to enhancing staff satisfaction and reducing burnout.