Pub Date : 2025-04-01DOI: 10.1016/j.jnr.2025.03.005
Elizabeth A. Johnson , Benjamin J. Galatzan
Background
The professional identity of nursing has been rooted in the nursing metaparadigm concepts of person, health, environment, and nursing. These concepts include values and beliefs that guide both clinical and research initiatives to generate new knowledge and the implementation of new approaches that improve patient care and nursing well-being. In the age of technology, complexities have arisen with nonhuman entities, devices, and algorithms informing or overriding traditional pathways of nursing clinical decision-making, which has shed light on legal and ethical challenges not yet addressed in a cohesive regulatory response or framework.
Purpose
The purpose of the present article is to identify critical priorities for nursing education institutions, professional organizations, and regulatory bodies to address through self-advocacy while emphasizing the value proposition of nursing voices in the co-development of technological advancements in healthcare.
Methods
Recommendations for expanded awareness of the impact of technology on nursing practice and professional identity are outlined with examples of local, state, and federal activism and legislation.
Results
Critical priorities are outlined to reimagine a modernized professional identity that integrates technology into the nursing metaparadigm.
Conclusion
Findings affirm the place of the nursing profession as an invaluable leading voice in technology and innovation development.
{"title":"A critical juncture: Reimagining nursing professional identity and regulation in the ethical integration of innovation and technology in healthcare","authors":"Elizabeth A. Johnson , Benjamin J. Galatzan","doi":"10.1016/j.jnr.2025.03.005","DOIUrl":"10.1016/j.jnr.2025.03.005","url":null,"abstract":"<div><h3>Background</h3><div>The professional identity of nursing has been rooted in the nursing metaparadigm concepts of person, health, environment, and nursing. These concepts include values and beliefs that guide both clinical and research initiatives to generate new knowledge and the implementation of new approaches that improve patient care and nursing well-being. In the age of technology, complexities have arisen with nonhuman entities, devices, and algorithms informing or overriding traditional pathways of nursing clinical decision-making, which has shed light on legal and ethical challenges not yet addressed in a cohesive regulatory response or framework.</div></div><div><h3>Purpose</h3><div>The purpose of the present article is to identify critical priorities for nursing education institutions, professional organizations, and regulatory bodies to address through self-advocacy while emphasizing the value proposition of nursing voices in the co-development of technological advancements in healthcare.</div></div><div><h3>Methods</h3><div>Recommendations for expanded awareness of the impact of technology on nursing practice and professional identity are outlined with examples of local, state, and federal activism and legislation.</div></div><div><h3>Results</h3><div>Critical priorities are outlined to reimagine a modernized professional identity that integrates technology into the nursing metaparadigm.</div></div><div><h3>Conclusion</h3><div>Findings affirm the place of the nursing profession as an invaluable leading voice in technology and innovation development.</div></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"16 1","pages":"Pages 10-16"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.jnr.2025.04.001
Tim Porter-O’Grady , Kathy Malloch , Kathy Scott , Joey Ridenour
Background and Purpose
The Arizona Board of Nursing embraced an opportunity to coordinate legislative funding to enhance preceptor training; increase placement of nursing students, new nurses, and nursing assistants in clinical rotations; and increase the number and retention of nurses and nurse assistants.
Methods
The present article describes the grant infrastructure created by 3 appointed national consultants of the grant, the considerations in clarifying the work, the model of change, and the outcomes achieved in the first 18 months of the 3-year grant.
Results
In Year 1, 17 healthcare organizations implemented 27 preceptor training programs in 14 of 15 Arizona counties. Furthermore, 3935 preceptors were trained, 6602 preceptees were partnered with the preceptors, and 802,458 h of preceptorship training occurred. In Year 3, the collaborative group involved in this initiative is creating a statewide network called “NurseNet” to advance this work throughout Arizona.
Conclusion
Overall, this Arizona initiative is a groundbreaking model for addressing workforce challenges and highlights the potential of scalable, standardized approaches to prepare practice-ready nurses and improve retention rates.
{"title":"Arizona board of nursing: Translating policy, transforming practice","authors":"Tim Porter-O’Grady , Kathy Malloch , Kathy Scott , Joey Ridenour","doi":"10.1016/j.jnr.2025.04.001","DOIUrl":"10.1016/j.jnr.2025.04.001","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>The Arizona Board of Nursing embraced an opportunity to coordinate legislative funding to enhance preceptor training; increase placement of nursing students, new nurses, and nursing assistants in clinical rotations; and increase the number and retention of nurses and nurse assistants.</div></div><div><h3>Methods</h3><div>The present article describes the grant infrastructure created by 3 appointed national consultants of the grant, the considerations in clarifying the work, the model of change, and the outcomes achieved in the first 18 months of the 3-year grant.</div></div><div><h3>Results</h3><div>In Year 1, 17 healthcare organizations implemented 27 preceptor training programs in 14 of 15 Arizona counties. Furthermore, 3935 preceptors were trained, 6602 preceptees were partnered with the preceptors, and 802,458 h of preceptorship training occurred. In Year 3, the collaborative group involved in this initiative is creating a statewide network called “NurseNet” to advance this work throughout Arizona.</div></div><div><h3>Conclusion</h3><div>Overall, this Arizona initiative is a groundbreaking model for addressing workforce challenges and highlights the potential of scalable, standardized approaches to prepare practice-ready nurses and improve retention rates.</div></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"16 1","pages":"Pages 37-43"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.jnr.2025.03.001
Jacqueline M. Loversidge , Joyce Zurmehly , Gerene S. Bauldoff
Background
The Evidence-Informed Health Policy (EIHP) model, adapted from an evidence-based practice model, combines the best available evidence with other essential elements to inform and leverage the policymaking dialogue. The EIHP model was first described narratively; a graphic model was later designed but has not yet been evaluated.
Purpose
To ascertain the face validity of the graphic representation of the EIHP model.
Methods
A two-round e-Delphi method survey was emailed to 18 nurse experts in public health policy. The mixed methods survey used a 5-point Likert scale instrument (1, “strongly disagree,” to 5, “strongly agree”) to ask participants their views about the graphic model's structure and function. For any item scored as 3 or lower, the participant was invited to provide additional comments. A final open-ended item requested additional qualitative feedback.
Results
In the first round, 18 participants completed the 14-question survey (7 content-related and 7 process-related), which was accompanied by the graphic model and an explanatory narrative. Seven items achieved a mean score ≥4 (consensus ≥80 %) and were not repeated in the second round. Fifteen individuals completed the second-round survey, which comprised 7 items along with a graphic model that was modified according to first-round quantitative and qualitative feedback; a more detailed model narrative was also included. Fifteen participants completed the second-round survey. Final survey responses revealed that of the 14 items, 12 items reached 80 % consensus. The remaining 2 items reached more than 70 % agreement. Open-ended responses items facilitated a deeper understanding of participants’ perceptions of the graphic model.
Conclusion
The present study provides evidence of consensus to support face validity of this EIHP graphic model. Face validity furnishes the model with credibility and thus provides users with a level of confidence regarding its soundness as a guide to the policymaking process.
{"title":"Face validity of an evidence-informed health policy graphic model: An e-Delphi study","authors":"Jacqueline M. Loversidge , Joyce Zurmehly , Gerene S. Bauldoff","doi":"10.1016/j.jnr.2025.03.001","DOIUrl":"10.1016/j.jnr.2025.03.001","url":null,"abstract":"<div><h3>Background</h3><div>The Evidence-Informed Health Policy (EIHP) model, adapted from an evidence-based practice model, combines the best available evidence with other essential elements to inform and leverage the policymaking dialogue. The EIHP model was first described narratively; a graphic model was later designed but has not yet been evaluated.</div></div><div><h3>Purpose</h3><div>To ascertain the face validity of the graphic representation of the EIHP model.</div></div><div><h3>Methods</h3><div>A two-round e-Delphi method survey was emailed to 18 nurse experts in public health policy. The mixed methods survey used a 5-point Likert scale instrument (1, “strongly disagree,” to 5, “strongly agree”) to ask participants their views about the graphic model's structure and function. For any item scored as 3 or lower, the participant was invited to provide additional comments. A final open-ended item requested additional qualitative feedback.</div></div><div><h3>Results</h3><div>In the first round, 18 participants completed the 14-question survey (7 content-related and 7 process-related), which was accompanied by the graphic model and an explanatory narrative. Seven items achieved a mean score ≥4 (consensus ≥80 %) and were not repeated in the second round. Fifteen individuals completed the second-round survey, which comprised 7 items along with a graphic model that was modified according to first-round quantitative and qualitative feedback; a more detailed model narrative was also included. Fifteen participants completed the second-round survey. Final survey responses revealed that of the 14 items, 12 items reached 80 % consensus. The remaining 2 items reached more than 70 % agreement. Open-ended responses items facilitated a deeper understanding of participants’ perceptions of the graphic model.</div></div><div><h3>Conclusion</h3><div>The present study provides evidence of consensus to support face validity of this EIHP graphic model. Face validity furnishes the model with credibility and thus provides users with a level of confidence regarding its soundness as a guide to the policymaking process.</div></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"16 1","pages":"Pages 44-52"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: High turnover and turnover intention rates among nurses exacerbate nursing shortages, reduce care quality, and negatively impact patient outcomes. Existing evidence on these effects needs to be updated to align with current trends, regulations, and policies to enhance organizational capacity and nurses’ well-being.
Purpose: To estimate the turnover rate and prevalence of turnover intention among nurses worldwide and to evaluate moderating factors.
Methods: A meta-analysis was conducted using six databases: CINAHL, Embase, ProQuest, PubMed, Scopus, and Web of Science. Studies published up to January 2024 were eligible for inclusion. Pooled prevalence was analyzed using a generalized linear mixed model and random effects model. Subgroup analysis was performed to explore variations, and heterogeneity was assessed using I 2 and Cochran’s Q statistics. Publication bias was assessed using Egger’s test.
Results: Seventy-five studies involving 3,354,829 nurses were included in this meta-analysis. The pooled turnover rate was 15.2% (95% CI: 12.4%–18.4%), and the pooled prevalence of turnover intention was 38.4% (95% CI: 31.0%–46.4%). The turnover rate of night shift nurses (22.8%) was nearly double that of day shift nurses (14.7%). Night-shift nurses (61.7%) were three times more likely to consider leaving than day-shift nurses (18.7%). Full-time nurses had a higher turnover rate (76.7%) than part-time nurses (20.4%). Among medical-surgical nurses, 57.7% left, while 59.7% planned to leave.
Conclusions: One in seven nurses leave their positions, and two in five intend to leave. Authorities should implement regulations, improve workplace conditions, and provide support systems and career opportunities to reduce turnover.
{"title":"Prevalence and Moderating Factors of Turnover Rate and Turnover Intention Among Nurses Worldwide: A Meta-Analysis","authors":"Dluha Mafula MSN, RN, Hidayat Arifin MSN, RN, Ruey Chen PhD, RN, Chien-Mei Sung PhD, RN, Chiu-Kuei Lee PhD, RN, Kai-Jo Chiang PhD, RN, Kondwani Joseph Banda PhD, RNM, Kuei-Ru Chou PhD, RN","doi":"10.1016/S2155-8256(25)00031-6","DOIUrl":"10.1016/S2155-8256(25)00031-6","url":null,"abstract":"<div><div><strong>Background:</strong> High turnover and turnover intention rates among nurses exacerbate nursing shortages, reduce care quality, and negatively impact patient outcomes. Existing evidence on these effects needs to be updated to align with current trends, regulations, and policies to enhance organizational capacity and nurses’ well-being.</div><div><strong>Purpose:</strong> To estimate the turnover rate and prevalence of turnover intention among nurses worldwide and to evaluate moderating factors.</div><div><strong>Methods:</strong> A meta-analysis was conducted using six databases: CINAHL, Embase, ProQuest, PubMed, Scopus, and Web of Science. Studies published up to January 2024 were eligible for inclusion. Pooled prevalence was analyzed using a generalized linear mixed model and random effects model. Subgroup analysis was performed to explore variations, and heterogeneity was assessed using <em>I</em> 2 and Cochran’s Q statistics. Publication bias was assessed using Egger’s test.</div><div><strong>Results:</strong> Seventy-five studies involving 3,354,829 nurses were included in this meta-analysis. The pooled turnover rate was 15.2% (95% CI: 12.4%–18.4%), and the pooled prevalence of turnover intention was 38.4% (95% CI: 31.0%–46.4%). The turnover rate of night shift nurses (22.8%) was nearly double that of day shift nurses (14.7%). Night-shift nurses (61.7%) were three times more likely to consider leaving than day-shift nurses (18.7%). Full-time nurses had a higher turnover rate (76.7%) than part-time nurses (20.4%). Among medical-surgical nurses, 57.7% left, while 59.7% planned to leave.</div><div><strong>Conclusions:</strong> One in seven nurses leave their positions, and two in five intend to leave. Authorities should implement regulations, improve workplace conditions, and provide support systems and career opportunities to reduce turnover.</div></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"15 4","pages":"Pages 20-36"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143143446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/S2155-8256(25)00032-8
Ai-Leng Foong-Reichert BSc, PharmD, PhD, Kelly A. Grindrod BSc Pharm, PharmD, MSc, Sherilyn K.D. Houle BSP, PhD
Background: Nurse practitioners (NPs) are the fastest growing type of nursing professional in Canada, yet little research exists on NP disciplinary outcomes.
Purpose: To characterize the outcomes of disciplinary action for NPs in Canada by determining the reasons for disciplinary action, penalties issued, and any associations between disciplinary action and demographic characteristics.
Methods: Publicly available regulatory body disciplinary action cases concerning NPs from January 2010 to December 2020 were included. Cases were sought from all 10 provinces and three territories in Canada. If cases could not be accessed online, the nurse regulatory board was contacted via email. The reasons for discipline, penalties applied, and demographic factors were coded independently by two researchers.
Results: Information regarding cases was obtained from six provinces and one territory. A total of 10 cases were included from Manitoba, Ontario, and Newfoundland and Labrador, while British Columbia, Nova Scotia, Prince Edward Island, and Yukon had zero cases during the study period. Cases from Quebec were excluded because we were unable to determine the type of nursing professional being disciplined. Also, case records could not be obtained for the full study period from the remaining jurisdictions (Alberta, Saskatchewan, New Brunswick, Quebec, Northwest Territories, and Nunavut) and were thus excluded. The rate of disciplinary action was low (0.27 cases per 1,000 NPs per year). Professional misconduct was the most common reason for discipline (n = 8), followed by clinical incompetence (n = 7) and dishonest business practices (n = 2). The median number of years licensed as an NP before discipline was 8.5.
Conclusion: To our knowledge, this is the first study to analyze disciplinary outcomes for NPs in Canada. Characterization of disciplinary outcomes is important to develop strategies and educational initiatives to prevent future discipline and support return to practice for those who have been disciplined.
{"title":"A Review of Regulatory Body Nurse Practitioner Disciplinary Action Cases in Canada","authors":"Ai-Leng Foong-Reichert BSc, PharmD, PhD, Kelly A. Grindrod BSc Pharm, PharmD, MSc, Sherilyn K.D. Houle BSP, PhD","doi":"10.1016/S2155-8256(25)00032-8","DOIUrl":"10.1016/S2155-8256(25)00032-8","url":null,"abstract":"<div><div><strong>Background:</strong> Nurse practitioners (NPs) are the fastest growing type of nursing professional in Canada, yet little research exists on NP disciplinary outcomes.</div><div><strong>Purpose:</strong> To characterize the outcomes of disciplinary action for NPs in Canada by determining the reasons for disciplinary action, penalties issued, and any associations between disciplinary action and demographic characteristics.</div><div><strong>Methods:</strong> Publicly available regulatory body disciplinary action cases concerning NPs from January 2010 to December 2020 were included. Cases were sought from all 10 provinces and three territories in Canada. If cases could not be accessed online, the nurse regulatory board was contacted via email. The reasons for discipline, penalties applied, and demographic factors were coded independently by two researchers.</div><div><strong>Results:</strong> Information regarding cases was obtained from six provinces and one territory. A total of 10 cases were included from Manitoba, Ontario, and Newfoundland and Labrador, while British Columbia, Nova Scotia, Prince Edward Island, and Yukon had zero cases during the study period. Cases from Quebec were excluded because we were unable to determine the type of nursing professional being disciplined. Also, case records could not be obtained for the full study period from the remaining jurisdictions (Alberta, Saskatchewan, New Brunswick, Quebec, Northwest Territories, and Nunavut) and were thus excluded. The rate of disciplinary action was low (0.27 cases per 1,000 NPs per year). Professional misconduct was the most common reason for discipline (<em>n</em> = 8), followed by clinical incompetence (<em>n</em> = 7) and dishonest business practices (<em>n</em> = 2). The median number of years licensed as an NP before discipline was 8.5.</div><div><strong>Conclusion:</strong> To our knowledge, this is the first study to analyze disciplinary outcomes for NPs in Canada. Characterization of disciplinary outcomes is important to develop strategies and educational initiatives to prevent future discipline and support return to practice for those who have been disciplined.</div></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"15 4","pages":"Pages 37-42"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/S2155-8256(25)00033-X
Karen L. Weis PhD, RN C-OB, FAAN, Deena Woodall PhD, RN, Teale Ryan PhD, MS, RN, Lisa Larson PhD, RN
Background: The Consolidated Appropriations Act of 2021 (Public Law 116-260) established a Rural Emergency Hospital (REH) designation under the Medicare program. Guidance includes provider staffing requirements, but the nurse staffing recommendations conflict with state boards of nursing scope of practice requirements.
Purpose: To gain a perspective regarding the nurse staffing needed to provide 24/7 emergent care and patient observation for the REH reimbursement model.
Methods: A mixed methods design of ethnography and cross-sectional descriptive data were collected through unstructured field observations, face-to-face interviews, and focus groups to evaluate descriptive data on nurse education, skill mix, and competencies.
Results: Data were collected from nursing personnel and leadership (N = 45) at four critical access hospitals (CAHs) in Kansas. The nursing workforce sample was predominantly registered nurses (87.8%) with associate degrees in nursing (51.3%). Findings reflect the need for a highly skilled, flexible staff with strong critical thinking skills and the ability to function within their full scope of practice.
Conclusions: The REH reimbursement model and associated policies do not address appropriate nurse staffing within the required scope of nursing practice and services. Initial assessment and patient transports are key factors in the REH designation, both of which require the support of registered nurses. The nurse staffing recommended for REHs does not adequately meet the needs of the service model.
{"title":"Nursing Practice Considerations for Medicare’s Reimbursement Model of Rural Emergency Hospitals","authors":"Karen L. Weis PhD, RN C-OB, FAAN, Deena Woodall PhD, RN, Teale Ryan PhD, MS, RN, Lisa Larson PhD, RN","doi":"10.1016/S2155-8256(25)00033-X","DOIUrl":"10.1016/S2155-8256(25)00033-X","url":null,"abstract":"<div><div><strong>Background:</strong> The Consolidated Appropriations Act of 2021 (Public Law 116-260) established a Rural Emergency Hospital (REH) designation under the Medicare program. Guidance includes provider staffing requirements, but the nurse staffing recommendations conflict with state boards of nursing scope of practice requirements.</div><div><strong>Purpose:</strong> To gain a perspective regarding the nurse staffing needed to provide 24/7 emergent care and patient observation for the REH reimbursement model.</div><div><strong>Methods:</strong> A mixed methods design of ethnography and cross-sectional descriptive data were collected through unstructured field observations, face-to-face interviews, and focus groups to evaluate descriptive data on nurse education, skill mix, and competencies.</div><div><strong>Results:</strong> Data were collected from nursing personnel and leadership (<em>N</em> = 45) at four critical access hospitals (CAHs) in Kansas. The nursing workforce sample was predominantly registered nurses (87.8%) with associate degrees in nursing (51.3%). Findings reflect the need for a highly skilled, flexible staff with strong critical thinking skills and the ability to function within their full scope of practice.</div><div><strong>Conclusions:</strong> The REH reimbursement model and associated policies do not address appropriate nurse staffing within the required scope of nursing practice and services. Initial assessment and patient transports are key factors in the REH designation, both of which require the support of registered nurses. The nurse staffing recommended for REHs does not adequately meet the needs of the service model.</div></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"15 4","pages":"Pages 43-50"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/S2155-8256(25)00034-1
Moiz Bhai PhD, Mary Motolenich MS, David T. Mitchell PhD, Danny R. Hughes PhD
Background: In the United States, states are increasingly adopting scope of practice reform to allow full practice authority (FPA) for advanced practice registered nurses (APRNs), such as nurse practitioners (NPs) and certified nurse midwives (CNMs). Little is known about the extent and trends of APRN participation in the care of patients during pregnancy episodes (i.e., the period from a woman’s last menstrual period to birth and resolution of all pregnancy-related outcomes) and whether their involvement changes with FPA.
Purpose: To examine the participation of APRNs in office-based prenatal care between states that allow APRN FPA and those that do not.
Methods: Using a retrospective commercial insurance claims database, we identified continuously enrolled females undergoing a pregnancy test and constructed comprehensive care information of each pregnancy episode. We then identified the proportion of episodes in which at least one prenatal office-based evaluation and management visit was performed by an APRN (i.e., involvement) and the share of these visits within a pregnancy episode performed by APRNs (i.e., intensity of involvement) for each year from 2008 to 2014 and compared intertemporal and geospatial trends. Statistical tests of differences in means and proportions were used to examine differences in APRN involvement and intensity between states that allow APRN FPA and those that do not.
Results: Between 2008 and 2014, NP involvement increased 304% and CNM involvement increased 134%. Involvement increased in both FPA (NPs: 267%, CNMs: 106%) and non-FPA (NPs: 307%, CNMs: 156%) states over the sample period. Involvement was higher in FPA states (p < 0.001) for NPs and CNMs in all years. Intensity exhibited little variation across the sample.
Conclusion: APRN involvement in care during pregnancy episodes has increased over time, although considerable variation exists between states.
{"title":"Advanced Practice Registered Nurse Involvement in Pregnancy Episodes: U.S. Trends From 2008–2014","authors":"Moiz Bhai PhD, Mary Motolenich MS, David T. Mitchell PhD, Danny R. Hughes PhD","doi":"10.1016/S2155-8256(25)00034-1","DOIUrl":"10.1016/S2155-8256(25)00034-1","url":null,"abstract":"<div><div><strong>Background:</strong> In the United States, states are increasingly adopting scope of practice reform to allow full practice authority (FPA) for advanced practice registered nurses (APRNs), such as nurse practitioners (NPs) and certified nurse midwives (CNMs). Little is known about the extent and trends of APRN participation in the care of patients during pregnancy episodes (i.e., the period from a woman’s last menstrual period to birth and resolution of all pregnancy-related outcomes) and whether their involvement changes with FPA.</div><div><strong>Purpose:</strong> To examine the participation of APRNs in office-based prenatal care between states that allow APRN FPA and those that do not.</div><div><strong>Methods:</strong> Using a retrospective commercial insurance claims database, we identified continuously enrolled females undergoing a pregnancy test and constructed comprehensive care information of each pregnancy episode. We then identified the proportion of episodes in which at least one prenatal office-based evaluation and management visit was performed by an APRN (i.e., involvement) and the share of these visits within a pregnancy episode performed by APRNs (i.e., intensity of involvement) for each year from 2008 to 2014 and compared intertemporal and geospatial trends. Statistical tests of differences in means and proportions were used to examine differences in APRN involvement and intensity between states that allow APRN FPA and those that do not.</div><div><strong>Results:</strong> Between 2008 and 2014, NP involvement increased 304% and CNM involvement increased 134%. Involvement increased in both FPA (NPs: 267%, CNMs: 106%) and non-FPA (NPs: 307%, CNMs: 156%) states over the sample period. Involvement was higher in FPA states (<em>p</em> < 0.001) for NPs and CNMs in all years. Intensity exhibited little variation across the sample.</div><div><strong>Conclusion:</strong> APRN involvement in care during pregnancy episodes has increased over time, although considerable variation exists between states.</div></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"15 4","pages":"Pages 51-59"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号