Journal of the American Association of Nurse Practitioners最新文献

Abstract: Use of genome sequencing as a screening tool for newborn screening has been an area of considerable interest worldwide. Genomic-based screening offers opportunities for identifying many more conditions for which new, transformative treatments are emerging, especially for conditions without biomarkers. The current newborn screening system lacks capacity to meet the demand that is only growing and modernization is needed. But many challenges exist regarding building the infrastructure needed for large-scale implementation of genome sequencing in newborn screening, such as cost, workforce needs, scientific and technical issues, coordination across state programs, privacy issues, ethical and legal concerns, and uncertain federal leadership. Numerous pilot studies and national initiatives both in the U.S. and internationally focused on genome sequencing in newborn screening are contributing data about feasibility, acceptability and health, behavioral and economic outcomes. As this experience and knowledge evolves, the changes to newborn screening practices will likely develop over time. It will be important for advanced practice nurses to participate as members of the community of stakeholders to help shape the evolution of newborn screening which has long been regarded as a major public health success.

Abstract: Nurse practitioners (NPs) and physician assistants (PAs) play a vital role in health care delivery. To meet growing health care demands, NPs and PAs have increased levels of autonomy, face early productivity expectations, and care for increasingly complex patients. This paper aims to describe, define, and standardize the role of the advanced practice education and professional development specialist across organizations. Using survey methodology, an anonymous survey was emailed to an informal group of advanced practice educators. The survey was sent out three times over approximately 8 weeks, with the last survey sent after the annual National Association of Pediatric NPs meeting. Of the 24 survey respondents, there were 13 different titles. Most respondents (75%) had worked as an APP for over 10 years. Most providers in educator roles were new to the position; 33% had been in the role for less than 1 year, and 29% for 1-3 years. Fifty percent of respondents were matrixed to the entire health system, whereas 42% stated their work is delineated to a specific department. Only 17% of survey respondents felt that leaders at their organization understood their role as advanced practice educators. As advanced practice leadership roles become more formalized with focused initiatives, including onboarding, student placement, and professional development, the educator and professional development role must be clearly defined. Standardizing the title and role responsibilities of the educator and professional development specialist is crucial to supporting a robust, engaged, and expert workforce, thus improving provider and family satisfaction and quality of care.

Background: There is a growing demand for intensive care unit (ICU) providers at the time of physician shortages, increased provider burnout, and attrition. Evidence supports safe utilization of nurse practitioners (NPs) and physician assistants (PAs) in the ICU.

Local problem: An ICU team using intensivists (medical doctors) and doctors of osteopathic medicine, NPs, and PAs experiencing staffing challenges because of staff shortages and increased clinical responsibilities.

Methods: An evidence-based pre-post quality improvement project.

Intervention: Utilization of NPs and PAs overnight instead of intensivists in a community medical/surgical ICU with electronic ICU support. Primary measures were mortality, procedural complications, central line-associated bloodstream infection, and catheter-associated urinary tract infections preimplementation and postimplementation. Secondary measure was qualitative data on facilitators and barriers to implementation.

Results: Catheter-associated urinary tract infection rates preimplementation and postimplementation were zero. Central line-associated bloodstream infection rates decreased from one pre to zero post. Procedural complication rate decreased by 0.4% ( p = .687). The survey had an 80% response rate, with >90% answering that implementation positively affected quality and communication. Communication, collaboration, focus on quality care, and increased accessibility were identified as facilitators. Role understanding, acceptance, and communication with other services were identified as barriers.

Conclusion: A collaborative model of care using NPs and PAs overnight in a community ICU is a feasible, safe, and effective staffing solution. The hybrid model provided additional support for NPs, PAs, and nursing staff, which helped with transition and overall satisfaction. Further research on NP and PA implementation in a hybrid model is needed on a national, multisite scale.

Background: Nurse practitioners (NPs) have become indispensable to clinical care. However, few studies have used qualitative research designs to explore health care providers' perspectives on the roles played by NPs in clinical care.

Purpose: Investigating health care providers' perspectives on the roles played by NPs in clinical care in Taiwan.

Methodology: A qualitative research design was employed in a single medical center in Taiwan. A semistructured interview guide was used to conduct face-to-face interviews with medical-surgical health care providers in groups. A total of nine participants, including physicians, nursing supervisors, and NPs, were interviewed in this study.

Results: The findings of this study highlight three themes concerning the roles played by NPs in clinical care in Taiwan: (1) guardian of care: NPs are keen observers, caregivers, and strong advocates for patients; (2) bridge for communication: NPs are persuasive communicators and effective mediators who use resources effectively; and (3) promoter of improvement in the quality of care: NPs are experienced and dedicated professionals.

Conclusions: The themes of guardian of care, bridge for communication, and promoter of improvement in the quality of care characterized the roles played by NPs in clinical care from the perspectives of health care providers. Future researchers could further examine these roles from the perspective of patients and investigate the impacts of NPs' role characteristics on clinical outcomes.

Implications: The role characteristics of keen observers, meticulous caregivers, and advocators could be incorporated into cultivating and training NPs.

Abstract: TikTok, a widely popular video-sharing platform, is increasingly being recognized as a valuable educational tool in nursing and health education. This platform supports delivery of engaging, concise and visually rich content, through a microlearning pedagogy, which can enhance learning and retention of health-related concepts in small, manageable units. This format caters to the preferences of digital-native learners, making it an enticing educational medium, especially for teaching adolescents and young adults. However, the brevity of the content may lead to superficial understanding of complex topics. Despite its popularity, TikTok faces criticism and regulatory challenges, including concerns over misinformation and data privacy. This study explores the advantages and disadvantages of using TikTok in nursing and health education, including examples of successful implementation. The authors advocate for the responsible use of TikTok-style videos, distributed through other social media platforms, to maximize the educational benefits, while navigating the challenges posed by the platform's current regulatory landscape.

Background: Nurse Practitioners (NPs) are integral to addressing the evolving demands of health care, delivering high-quality, cost-effective care across diverse settings. Despite their critical role, research exploring the impact of organizational belonging on NPs' job satisfaction, burnout, and retention remains limited.

Purpose: The purpose of the study was to explore the association between organizational practice environment and organizational belonging for NPs who work across all practice environments.

Methodology: This is a cross-sectional, descriptive study surveying NP's across primary, acute, and specialty care areas. Multiple validated instruments were used to scale organizational practice environment, NP organizational belonging, provider comanagement, burnout, job satisfaction, mental health, and intention to leave one's job.

Results: Among 73 respondents, organizational climate significantly influenced NP belonging (β = 1.14, p = .001) and job satisfaction (β = -2.06, p = .002). Organizational belonging was associated with job satisfaction (β = -2.06, p = .010), comanagement (β = 1.87, p = .045), and burnout (β = -3.45, p = .001).

Implications: To enhance NP job satisfaction, health care organizations should prioritize fostering a sense of belonging. Key strategies include promoting role clarity, supporting collaborative practice, and involving NPs in leadership and decision-making processes.

Conclusions: The lack of institutional belonging among NPs is a complex issue influenced by workplace dynamics, role recognition, and organizational culture. Addressing these factors is essential for improving NP retention, job satisfaction, and overall workforce well-being.

Abstract: Postgraduate education for advanced practice team members has emerged as a viable way of gaining critical experience needed for specialty practice. Residency and fellowship training programs have been part of the landscape for medical education for decades but have only recently become available to advanced practice team members. Most programs provide a year of structured learning, but there are few published reports of their value. We provide a description and outcome data of our specialty practice fellowship at an academic medical center over a 5-year period. A fellowship advisory board with representation from numerous specialties defined entry criteria, curriculum, and clinical site placement. Participant and preceptor experience was measured monthly to optimize rapid acquisition of skills. The curriculum was modified through rapid cycle quality improvement in response to scores lower than 70%. In total, 30 fellows have participated in the advanced practice nurse practitioner and physician assistant fellowship program between 2019 and 2023, among 8 specialty tracks. Of the participants from 2019 to 2023, 28 fellows graduated with successful program completion. Ninety-six percent were employed in specialty care settings at the time of graduation or within six months post program completion. The overall postfellowship retention rate at the training site was 79%. This outcome data supported the return on investment. This article provides data and insight into postgraduate fellowship programs with 5 years of cohort data, long-term outcomes, retention rates, and return on investment. In addition, it informs educators and employers with insight into programmatic design, evaluation, and outcomes in transition to practice programs.

Background: Provider handoff communication is essential to the continuity of care and safety of patients. The illness severity, patient information, action list, situational awareness and contingency plans, and synthesis (I-PASS) tool is an evidence-based resource that has been effective in handoffs between providers in a variety of settings. The tool was selected to improve provide communication in efforts to reduce surgical interventions and procedures in a gastroenterology inpatient setting.

Local problem: In an inpatient gastroenterology unit, there was no standardized handoff in place between gastroenterologist and nurse practitioners (NPs). Therefore, there were gaps in patient information, which would further delay procedures.

Methods: Using a plan-do-study-act framework, a quality improvement project was implemented to evaluate the effectiveness of I-PASS handoff implementation among NPs serving in a busy inpatient gastrointestinal setting.

Intervention: The standardized I-PASS handoff was implemented between gastroenterologist and NPs in an inpatient gastroenterology setting in an effort to reduce same-day cancellations of gastroenterology procedures.

Results: More than half (60%) fully adopted the standardized I-PASS handoff tool. Some seasoned providers resisted adopting a new standardized handoff. Monthly gastroenterology procedural cancellation rates steadily declined after the implementation of the standardized handoff tool.

Conclusions: Standardized provider handoff tools are effective in reducing communication errors and improving health care efficiency. The I-PASS tool is a useful handoff tool for inpatient gastroenterology teams and should be considered for implementation among other health delivery teams that care for complex patients and those that use resources such as a surgical suite or procedural laboratory.

Background: Chronic wounds represent a significant health care burden, particularly among under-resourced people, due to limited access to care, social determinants, and untreated comorbidities. These factors contribute to delayed healing, complications, reduced quality of life, and increased costs.

Purpose: This study examined the types of chronic wounds, barriers to care, and clinical outcomes among under-resourced individuals treated at a nurse practitioner-led (NP-led) wound care clinic, to inform targeted interventions for improving access and continuity.

Methodology: This retrospective cohort study analyzed medical records of 493 patients treated at a NP-led clinic on the west coast between 2020 and 2024, focusing on wound types, care barriers, and clinical outcomes.

Results: The most common diagnoses were nonpressure chronic ulcers (17.6%) and pressure injuries (16.6%), with lower extremities as the main location (20.49%). A strong correlation was found between number of appointments and follow-up (r = 1.0). No significant relationship was seen between referral source and clinic visit status (χ2 = 2.67, p = .26). Overall, 91.9% of wounds healed, whereas 16.8% of patients experienced persistent wound issues, reflecting barriers such as inaccessibility (17%) and refusal of care (5.7%).

Conclusions: NP-led wound clinics are essential for under-resourced populations but face systemic challenges in patient follow-up and engagement. Findings highlight the need for interventions, improved continuity, and strategies addressing health care and social determinants.

Implications: Enhancing continuity, fostering patient trust, and addressing social determinants through remote monitoring, community outreach, and tailored approaches are vital to optimize outcomes for under-resourced individuals with chronic wounds.