Journal of the American Association of Nurse Practitioners最新文献

Abstract: Nurse practitioners demonstrate a moral soundness, unmistakable sincerity, and unquestionable character by embracing the impact of social drivers of health on patient and system outcomes. Opportunities abound to address patients' social drivers of health in clinical and leadership settings. Facilitating patients' access to care navigators and resources can improve the patient's experience and exemplifies the role of the nurse practitioner as a holistic provider.

Background: Despite improved survival, one in five patients with heart failure (HF) is readmitted within 30 days of discharge. Assessing fluid status is challenging, with an estimated 50% accuracy when relying on physical examination alone. Pulmonary congestion is a risk factor for readmission and can manifest weeks before symptoms occur.

Purpose: To conduct a pilot study to assess for pleural effusion with point-of-care ultrasound (POCUS) and to evaluate inferior vena cava (IVC) noncollapsibility as a marker of volume status.

Methods: A convenience sample of adults with HF ( n = 21) were seen in a nurse practitioner (NP)-led postdischarge clinic within 12 days of hospitalization. The setting was a large tertiary care hospital. Inclusion criteria were patients with an HF diagnosis and Medicare insurance. The NP measured IVC diameter, assessed for collapsibility, and examined pleural cavities using a VSCAN POCUS device. Data were analyzed descriptively.

Results: Pleural effusions were identified in three (14.3%) patients with POCUS and referred for thoracentesis. Inferior vena cava was noncollapsible in 5 (23.8%) patients; each of these patients required intervention for volume overload.

Conclusions: Point-of-care ultrasound can be used by NPs to identify patients with pleural effusions who may benefit from thoracentesis. Inferior vena cava noncollapsibility may be a predictor for volume overload.

Implications: Point-of-care ultrasound equips NPs with an extra tool to effectively manage HF.

Abstract: Alzheimer's disease (AD) is a progressive, neurodegenerative disorder that currently affects an estimated 6.9 million people in the United States. Despite the growing prevalence of AD, management of this common condition remains suboptimal. To address knowledge and practice gaps related to cognitive evaluation and Alzheimer's diagnosis and treatment, the American Association of Nurse Practitioners (NPs) developed a 1.5-contact hour NP-focused continuing education (CE) program on AD. Changes in learner knowledge, competence, and confidence were assessed with preactivity and postactivity surveys; qualitative follow-up interviews were conducted to evaluate retention of CE material and behavior changes. In total, 4,793 learners (NPs, 93.6%) who completed the activity and self-reported providing patient care were included in the outcomes analysis. In the pre-activity assessment, notable knowledge and competence deficiencies were identified related to the diagnosis, classification, and pharmacotherapeutic management of AD. The CE activity was associated with significant improvements in knowledge and competence, with a 20-percentage point increase in correct response rate from the pre-activity to post-activity survey ( p < .001). Learner confidence in their ability to perform key clinical tasks related to Alzheimer's management also improved. Twelve NPs participated in follow-up interviews; most reported that the CE activity reinforced their current practices. Despite improvements in knowledge and competence, certain knowledge gaps persisted, and learners identified several ongoing barriers to optimal management, including lack of access to specialists. Given the changing Alzheimer's landscape, ongoing educational interventions targeted to the NP workforce are needed to serve the growing population of adults at risk for AD.

Background: Nurse practitioners (NPs) play a vital role in US nursing homes, providing medical management, improving care coordination, reducing hospitalizations, and addressing physician shortages. Understanding factors influencing NP job satisfaction is essential for workforce retention and sustaining quality care in these complex settings.

Purpose: To describe factors influencing job satisfaction among NPs working in US nursing homes.

Methodology: A descriptive, cross-sectional web-based survey was conducted between April and August 2024 using the Misener Nurse Practitioner Job Satisfaction Scale, a validated 44-item instrument based on Herzberg dual-factor theory. Participants were recruited through the Gerontological Advanced Practice Nurses Association and social media. The survey assessed satisfaction across six domains, including autonomy, collegiality, and professional growth.

Results: Among 157 participants, 75.1% held a master's degree and 22.9% a Doctor of Nursing Practice. The mean global satisfaction score was 4.4 (SD = 1.0) on a 6-point scale. Nurse practitioners reported the highest satisfaction with autonomy, challenge in work, and professional relationships with supervisors and colleagues. Areas of lower satisfaction included compensation for duties outside regular responsibilities, involvement in research, time for professional service, and administrative support.

Conclusions: Nurse practitioners reported moderate to high satisfaction, especially with clinical autonomy and patient care. Addressing gaps in compensation, administrative support, and professional development could strengthen retention and improve care quality in nursing homes.

Implications: Health care leaders should prioritize supportive work environments and expand professional growth opportunities to retain NPs and ensure quality care for aging populations.

Background: Nurses' contributions are central to health care but are often shaped and constrained by structural, cultural, and policy forces that limit how their value is understood. During the COVID-19 pandemic, Australian Nurse Practitioners (NPs) faced heightened demands for leadership and adaptability, yet many reported a lack of recognition and sustained visibility. This tension between contribution and recognition raises questions about how NP value is defined and legitimized.

Purpose: This article explores the emergent concept of value as perceived and embodied by NPs during the pandemic. It offers an interpretive discussion of this existential theme, drawn from a broader phenomenological study of Australian NPs' lived experiences. Although based on that study, this article presents a focused philosophical and contextual analysis.

Methodology: Guided by qualitative phenomenology, 16 hospital-based NPs were interviewed. Although three themes were identified in the broader study, this article centers on the interpretive thread of value.

Findings: Participants described feeling systemically undervalued, with recognition frameworks narrowly focused on clinical productivity. They described how this conditional visibility affected their identity and perceived sustainability. Despite this, the participants expressed a deeper sense of value through their leadership, adaptability, and ability to cope under pressure, contributions that they felt were often overlooked or unacknowledged.

Conclusions and implications: Current frameworks overlook the full scope of NP contribution. A broader understanding of value, beyond productivity and inclusive of the integrative nature of practice, is essential to enhance recognition, support sustainability, and enable meaningful system integration.

Background: Major depressive disorder (MDD) remains challenging to diagnose due to reliance on subjective clinical assessments, sparking interest in objective biological markers. Complete blood count (CBC) parameters reflect underlying biological processes, such as inflammation and oxygen transport dysfunction, both of which are implicated in MDD pathophysiology.

Objectives: The purpose of this systematic review is to explore the potential role of CBC parameters as biomarkers for diagnosing and assessing the severity of MDD.

Data sources: The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, analyzing studies published between 2014 and 2024. Databases searched included PubMed, CINAHL Complete, Scopus, PsycINFO, and Web of Science. A total of 22 studies met the inclusion criteria.

Conclusions: The majority of studies (approximately 17 out of 22) found that low red blood cell indices and elevated neutrophil-to-lymphocyte ratio were associated with symptoms such as fatigue, cognitive impairment, and chronic inflammation. Although individual CBC parameters showed moderate diagnostic utility, composite CBC scores demonstrated promise in identifying patients with higher MDD severity. However, only a small number of longitudinal studies (5 of 22) examined CBC changes over time or in response to treatment, and findings were mixed. Therefore, although CBC parameters show potential for clinical integration, their predictive value for treatment outcomes remains inconclusive and warrants further investigation.

Implications for practice: Standardizing CBC biomarker thresholds and further exploring the role of inflammation in MDD are essential for clinical integration. Complete blood count biomarkers hold promise for enhancing early detection and enabling personalized treatment approaches in primary care and psychiatric settings.

Background: Acute care comprises a significant amount of health care delivery, and demand for hospital care is forecasted to grow. Nurse practitioner (NP) roles evolved from primary care to meet patients' acute care needs. Nurse practitioners increasingly assume inpatient roles. Yet, growth of the acute care NP workforce is not widely described, and this knowledge can inform future workforce growth.

Purpose: To describe the growth in the inpatient, acute care NP workforce.

Methods: This study used a repeated cross-sectional design to analyze data from the US National Sample Survey of Registered Nurses (1988-2022) and the National Sample Survey of NPs (2012) to describe acute care NP workforce size, demographic, education, and practice characteristics. Descriptive statistical analyses accounted for the complex survey design and weighting and generated national workforce estimates.

Results: The acute care NP workforce increased 836% (3,243-30,368 NPs) from 1988 to 2022. Yet, a growing proportion of inpatient NPs are not acute care certified. The workforce became more demographically diverse with advanced education. They also provide care in more wide-ranging clinical practice areas.

Conclusion: Over the past 3 decades, a novel acute care NP role evolved into an essential role in inpatient settings. However, there are opportunities to increase the utilization of acute care NPs.

Implications: This research highlights growth in the acute care NP workforce and opportunities for acute care NPs to improve access to care in inpatient settings. Educators, employers, and policymakers can support the ongoing integration of acute care NPs in inpatient care.

Introduction: The Centers for Medicare & Medicaid Services Open Payments Database (OPD) reports industry payments to health care providers, promoting transparency in financial relationships. In 2021, the OPD expanded to include nurse practitioners (NPs), who now number over 385,000 in the United States.

Purpose: This study analyzed general industry payments to NPs from 2021 to 2022, focusing on payment nature, amounts, companies involved, and geographic distribution.

Methodology: We queried the OPD for NPs identified as "Nurse Practitioner" under relevant taxonomy categories, analyzing data on payment nature, amount, company, covered product, and recipient location. Descriptive statistics summarized the data.

Results: Between 2021 and 2022, 207,732, US NPs received $182,275,340 in 4,866,831 general payments. The median payment was $16.47. Most payments were for food and beverage (97%), which accounted for the highest dollar total ($102,218,684; 56%). Other payments included services other than consulting ($48,325,438; 27%) and travel/lodging ($11,478,596; 6%). Five companies-AbbVie, Allergan, Janssen, Novo Nordisk, and AstraZeneca-accounted for 32.6% of payments. Florida, Texas, and California received the highest payments.

Conclusions: Nurse practitioners received substantial nonresearch payments, predominantly for food and beverage. Future research should explore factors like certification area and state practice authority that influence payment trends.

Implications: Understanding industry payments to NP highlights areas of potential influence, emphasizing the importance of transparency and policies to mitigate conflicts of interest.

Abstract: Genomic advances are rapidly transforming the understanding of health and illness, making it essential for the nursing workforce and faculty to be equipped to teach and deliver genomic-informed care. The Translation and Integration of Genomics is Essential to Doctoral NuRsing (TIGER) program, supported by the National Human Genome Research Institute, utilizes a "train-the-trainer" model to prepare doctoral nurse educators to integrate genomic content into nursing curricula, practice, and research. The TIGER program aims to build capacity among doctoral-prepared nursing faculty to champion genomics integration across education and clinical practice. Translation and Integration of Genomics is Essential to Doctoral NuRsing includes a kickoff workshop held every January in conjunction with the annual American Association of Colleges of Nursing (AACN) Doctoral Education Conference, followed by monthly webinars (February-December) with national genomic experts. The program incorporates asynchronous and synchronous learning, with evaluation through pre/post knowledge assessments, satisfaction surveys, and progress on individual Specific Measurable, Achievable, Relevant, Time-bound (SMART) goals. To date, TIGER has engaged 61 participants from 24 US states, representing 5.48% (48/875) of AACN-accredited nursing schools. Participants include Doctor of Nursing Practice (DNP) (n = 30), Doctor of Philosophy (PhD) (n = 29), and DNP/PhD (n = 2) faculty. Translation and Integration of Genomics is Essential to Doctoral NuRsing is building national capacity in genomic nursing education. Participants report increased knowledge and access to resources for faculty development, curriculum integration, pharmacogenomics, simulation, and research. Continued expansion is needed to reach more AACN member schools and strengthen national impact. Genomics is foundational to precision health, and nurse practitioners (NPs) must be prepared to integrate genomic science into clinical care. This manuscript describes the background, structure, challenges, lessons learned, and future directions of TIGER with implications for nursing faculty and the future NP workforce.