Journal of the American Association of Nurse Practitioners最新文献

Background: The neonatal nurse practitioner (NNP) is a pivotal member of the neonatal intensive care unit (NICU) care team. To ensure 24-hour coverage in this high-acuity environment, NNPs often work shifts exceeding 16 hours. However, little is known about how prolonged shifts affect NNP fatigue, clinical performance, and overall well-being.

Methods: A mixed-methods survey was distributed via postcards containing a QR code to board-certified NNPs. The survey assessed demographics, shift practices, and perceptions of fatigue when working shifts greater than 16 hours.

Results: A total of 623 participants initiated the survey; 371 completed all items. Most were experienced NNPs working in level III NICUs. Preferred shift lengths included 24-hour and 12-hour day shifts. Awareness of the National Association of NNP position statement on shift length was high (73%), with 76% agreeing with its recommendations. Over half (51%) supported continuing 24-hour shifts. Eighty-five percent agreed that unit census/acuity contributes to fatigue. Nearly half (49%) reported feeling unsafe driving after shifts >16 hours; among those who did acknowledge feeling unsafe to drive, this occurred an average of 17% of the time. Sixty percent denied ever feeling unable to perform duties after extended shifts; among those who did, the average frequency was 17.4%.

Conclusions: Neonatal nurse practitioners report a preference for extended shifts despite acknowledging associated fatigue-related concerns. Although these findings provided valuable subjective insight, findings are limited by self-reporting and sample representation.

Implications: Additional objective data and qualitative analysis are needed to guide evidence-based strategies that prioritize both provider well-being and patient safety.

Background: Clinician turnover is costly for health care organizations.

Local problem: A retention strategy for newly hired nurse practitioners (NPs) and physician associates (PAs) was needed at our organization.

Methods: A quality improvement project was conducted to determine whether a mentorship program could improve retention and employment experiences of newly hired NPs and PAs.

Interventions: A one-to-one mentorship program was implemented for newly hired NPs and PAs. (a) Retention and productivity data were compared for mentee participants vs. nonparticipants. (b) Mentee and mentor participants completed two program evaluation surveys to examine the program's impact on their employment experiences.

Results: Sixty-eight mentee-mentor pairs completed their mentoring relationship during the first 3 years of the program. Retention was higher among mentee participants vs. nonparticipants during their first (96% vs. 85%, p = .0332) and second year of employment (83% vs. 65%, p = .0480). Productivity during the first year was similar for mentee participants and nonparticipants (38th percentile vs. 37th percentile, p = .84). Most participants (≥69%) believed the program improved onboarding, personal and professional growth, work environment, and NP and PA community connection.

Conclusions: The mentorship program improved first- and second-year retention of newly hired NPs and PAs and employment experiences of program participants. By our estimates, the program helped retain 15 NPs and PAs who would have otherwise left the organization, yielding potential organizational savings of $1.29M-$1.72M. A mentorship program can be an effective retention strategy for reducing health care turnover and related costs.

Abstract: Mobile health units (MHUs) in the United States have grown to over 3,000 nationwide, increasing health care access and equity to underserved communities. Although MHUs have demonstrated improved patient outcomes, there is a lack of literature on partnering with nursing colleges and their faculty. This report will share how a college of nursing and their office of faculty practice and partnerships in a large midwestern state university implemented a nurse-led MHU to deliver reproductive health care to rural communities in central Illinois, incorporating advanced practice registered nurses (APRNs) faculty and graduate nursing students. Point-of-care screening for sexually transmitted infections (STIs) was the focus due to Centers of Disease Control and Prevention reports of more than 2.5 million cases of chlamydia, gonorrhea, and syphilis threatening the health of women and babies. Central Illinois was the selected region due to high rates of poverty, teen pregnancy, crime, and incidence of STIs. With few reported MHUs in this region, there was a health care desert for reproductive care. This partnership between a college of nursing and their APRN faculty, graduate nursing students, and underserved patients offered a mutually beneficial opportunity for improved health equity and access to reproductive care.

Abstract: The white coat has become a contested symbol in nursing-a garment once exclusive to medicine that now reflects deeper tensions about professional identity, legitimacy, and visual authority. Although some nurses wear it out of practicality or institutional policy, its broader adoption risks reinforcing hierarchies that devalue nursing's distinct epistemology, which emphasizes relational, experiential, and embodied care. Drawing from critical theory, poststructuralism, and postmodernism, this essay explores how the white coat perpetuates colonial mimicry and epistemic violence by aligning nursing with a model of clinical detachment and scientific supremacy. Through both historical analysis and personal reflection, the author examines how uniform symbolism affects nurse-patient dynamics, role clarity, and self-perception. Practical counterarguments-including hygiene, patient trust, and professional image-are acknowledged and addressed. The essay ultimately advocates for context-specific attire and meaningful professional rituals, such as pinning ceremonies and value-based tokens. These alternatives better align with nursing's pluralistic philosophy and can empower nurses to define their visual and symbolic identity on their own terms. Letting go of the white coat is not a dismissal of professionalism but an invitation to reimagine it through the lens of care, justice, and authenticity.

Background: Preceptors are an integral part of nurse practitioner (NP) education; they mentor students and facilitate experiential learning in the clinical setting. Understanding factors that motivate clinicians to serve as preceptors can inform recruitment and retention of preceptors.

Purpose: To understand factors that motivate and challenge clinicians to choose to precept NP students.

Methodology: A survey was emailed to preceptors of NP students asking them to rate the importance of factors on a scale from not at all important (1) to extremely important (5) in influencing their decision to precept. Factors were categorized into five domains: university process, finance/time/productivity, recognition, certification/education, and intrinsic/other. Descriptive statistics were calculated.

Results: Seventy-three of 224 preceptors responded (33% response rate). Highly rated motivating factors included having the role of preceptor clearly defined (mean = 4.00, SD = 1.01), coworkers support (mean = 4.07, SD = 0.91), and enjoying precepting NP students (Mean = 4.32, SD = 0.72). Lowest rated motivating factors include faculty presence during site visit (Mean = 2.74, SD = 1.11), financial renumeration (M = 2.13, SD = 1.38), and receiving gifts (mean = 1.66, SD = 0.98).

Conclusion: Our findings indicate having coworkers who are supportive of their role as a preceptor, and clearly defined roles are more important than financial renumeration and faculty site visits.

Implications for practice: Building relationships with staff, administrators, and preceptors could strengthen academic-clinical partnerships resulting in an environment supportive of precepting NP students. Faculty may be able to reduce travel to clinic sites by communicating more frequently through email or telephone.

Background: This study explored nurse practitioner (NP) recall relative to men's urology/sexual/reproductive health content in NP educational programs, which often require separate women's health content.

Purpose: This study explored practicing NPs' recall of (1) curricula content relative to men's urology/sexual/reproductive health topics and (2) specific physical examination and laboratory interpretation content relative to men's urology, sexual, and reproductive health topics.

Methodology: This exploratory study used a cross-sectional, descriptive design. A convenience sample of NPs working with adult male patients were recruited among attendees of the 2023 American Association of Nurse Practitioners (AANP) National Conference. Respondents completed a one-time, anonymous, online survey assessing recall of the amount of time dedicated to learning about various men's urologic/sexual/reproductive health issues.

Results: Ninety NPs completed the survey, averaging 9.9 ± 6.9 years in practice. 84% of participants felt that their NP program offered more content focused on women's health care needs compared with men's health content. Using a 0 (not prepared) to 10 (thoroughly prepared) Likert scale for a response to "How well do you feel your NP program prepared you to manage the specific health care needs of," the average was 4.1 for men and 6.9 for women.

Conclusions: This is the first project to quantify men's health topics as part of the NP curriculum, creating groundwork for discussion of apparent disparity in gender-specific curricula content and a potential gap in NP knowledge relative to men's urologic/sexual/reproductive health issues.

Implications: These results suggest a need for a formalized men's health curriculum to complement the women's health curriculum present in most NP programs.

Abstract: Concurrent bronchoesophageal fistulas (BEF) and spinal-esophageal fistulas (SEF) are exceedingly rare complications of esophageal perforation, particularly in cancer patients undergoing multimodal therapies. This report describes a patient with metastatic papillary thyroid cancer who developed BEF and SEF following thyroidectomy, radiotherapy, and systemic antineoplastic therapies. Despite multiple interventions, including esophageal stenting, nutritional support, and antifungal therapy, the patient's condition deteriorated due to recurrent infections and progressive organ dysfunction. This case highlights the complex interplay between oncologic treatments and their complications, underscoring the need for early recognition, multidisciplinary management, and novel therapeutic strategies for high-risk patients.

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.