Investigating practice-level and individual factors of advanced practice registered nurses and physician assistants and their relationship to resilience

BACKGROUND

Gaps in research persist related to practitioners' resilience, although much has been written about the need for strategies to strengthen personal resilience.

PURPOSE

The study's purpose was to examine practice-level (quality of physician relationship, physician presence, and autonomy) and individual factors and how they affect resilience.

METHODOLOGY

An online survey invited advanced practice registered nurses (APRNs) and physician assistants (PAs) from four states to participate in a cross-sectional study. Hierarchical ordinary least squares regression was used to test the impact of main effect variables in the context of identified control variables.

SAMPLE

A sample of 1,138 APRNs and PAs completed the survey questions.

RESULTS

Findings from the covariate model (model 1) and the main effect model (model 2) show that both models were significant at the p < .01 level, with the adjusted R2 differing from 0.02 to 0.13, respectively. Regression results show a significant positive association between quality of the physician relationship and APRN/PA resilience (b = 0.09, p < .01). A negative association between the lack of autonomy and higher levels of resilience (b = -0.14, p < .01) was also demonstrated.

CONCLUSIONS

Advanced practice registered nurse/PA resilience is affected by both practice-level and personal factors, suggesting that workplace interventions could increase resilience.

IMPLICATIONS FOR PRACTICE

Work environments allowing APRNs and PAs to function autonomously and with professional support from physician colleagues are favorable contributors to their resilience. Future studies need to investigate the meaning of physician presence/availability and organizational interventions that extend beyond individual resilience.

An exploration of perceived neonatal nurse practitioner authority in a restricted practice setting

BACKGROUND

Perceptions of autonomy in practice affect Neonatal Nurse Practitioner (NNP) job satisfaction, retention, and motivation to pursue NNP roles. However, Novice to Expert theory describes the processes for transitioning to nurse practitioner roles are not in relationship with NNP practice autonomy.

PURPOSE

Relationships between Advanced Practice Registered Nurse (APRN) practice authority, state restrictions, APRN volume, and health care access exist. However, do APRN perceptions of autonomy relate to motivation to pursue practice authority? This study provides an exploration of perceptions of NNP practice autonomy in this context.

METHODOLOGY

Semistructured interviews conducted with NNPs and neonatologists practicing in a restricted setting explored perceptions of practice expertise and autonomy, based on Patricia Benner's Novice to Expert theoretical framework. Laddered methodology organized survey questions, and the Framework Method was used for analysis of results.

RESULTS

The majority of eligible NNPs (n = 12, 67%) and neonatologists (n = 8, 67%) agreed to study participation. Identified themes were grouped into larger concepts, including "NNP practice authority," "NNP expertise," and "NNP autonomy." For example, "NNP expertise" included the theme "determining NNP expertise" and associated factors included "procedural skills," "years and acuity of practice level," and "confidence in management plan and emergent situations."

CONCLUSIONS

Both neonatologists and NNPs perceived neonatologists as a practice authority with support for NNP autonomy. Factors indicating NNP expertise correlated with domains in Benner Novice to Expert theory.

IMPLICATIONS

These findings support previous work concerning the evolution of expertise and transition to practice. More inquiry to understand perspectives of APRNs in restricted practice settings is indicated.

Developing the advanced practice nursing role in Slovakia: Perception, education, and practice

BACKGROUND

Advanced practice nursing (APN) is a modern and effective nursing role that has a positive impact on health care systems around the world. Guiding principles are advanced education, expanded scope of practice, and policies supportive of the role.

PURPOSE

The aim of this study was to find out the perception of APNs of their own practice in the context of the current legislative conditions in Slovakia and to identify related factors.

METHODS

A quantitative exploratory design was selected. From 5,067 APN, 584 were conveniently selected. The adapted and modified SCAPE study questionnaire was used for data collection. Data were processed using SPSS 25.

RESULTS

There were differences between newly introduced competencies for the APN role in Slovakia and the general concept of the role that could influence practice. The level of APNs' perception of their own practice is low. Years of practice was significantly and positively related to the perception. The results in each region were significantly different. Community nurses/outpatient nurses assessed their practice at a significantly higher level. The educational curriculum lacks the subject of APN. Competencies, remuneration, and satisfaction with the status are insufficient.

IMPLICATIONS FOR PRACTICE

To understand, implement, and practice the concept of APN, it is essential to change policies related to competencies, education, remuneration, and status. Creation of an educational model that includes the subject area of advanced practice nursing in the postgraduate curriculum is essential. Education and practice conditions for advanced practice nurses should be uniform in all regions of the country.

Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: A scoping review

BACKGROUND

Workload and workforce issues in primary care are key drivers for the growing international trend to expand nursing roles. Advanced nurse practitioners are increasingly being appointed to take on activities and roles traditionally carried out by doctors. Successful implementation of any new role within multidisciplinary teams is complex and time-consuming, therefore it is important to understand the factors that may hinder or support implementation of the advanced nurse practitioner role in primary care settings.

OBJECTIVES

To identify, appraise and synthesise the barriers and facilitators that impact implementation of advanced practitioner roles in primary care settings.

METHODS

A scoping review conducted using the Arksey and O'Malley (2005) framework and reported in accordance with PRISMA-ScR. Eight databases (Cochrane Library, Health Business Elite, Kings Fund Library, HMIC, Medline, CINAHL, SCOPUS and Web of Science) were searched to identify studies published in English between 2002 and 2017. Study selection and methodological assessment were conducted by two independent reviewers. A pre-piloted extraction form was used to extract the following data: study characteristics, context, participants and information describing the advanced nurse practitioner role. Deductive coding for barriers and facilitators was undertaken using a modified Yorkshire Contributory Framework. We used inductive coding for barriers or facilitators that could not be classified using pre-defined codes. Disagreements were addressed through discussion. Descriptive data was tabulated within evidence tables, and key findings for barriers and facilitators were brought together within a narrative synthesis based on the volume of evidence.

FINDINGS

Systematic searching identified 5976 potential records, 2852 abstracts were screened, and 122 full texts were retrieved. Fifty-four studies (reported across 76 publications) met the selection criteria. Half of the studies (n = 27) were conducted in North America (n = 27), and 25/54 employed a qualitative design. The advanced nurse practitioner role was diverse, working across the lifespan and with different patient groups. However, there was little agreement about the level of autonomy, or what constituted everyday activities. Team factors were the most frequently reported barrier and facilitator. Individual factors, lines of responsibility and 'other' factors (i.e., funding), were also frequently reported barriers. Facilitators included individual factors, supervision and leadership and 'other' factors (i.e., funding, planning for role integration).

CONCLUSION

Building collaborative relationships with other healthcare professionals and negotiating the role are critical to the success of the implementation of the advanced nurse practitioner role. Team consensus about the role and how it integrates into the wider team is also essential.

Understanding the Roles, Responsibilities, and Competencies of Advanced Practice Registered Nurses: Instrument Development and Psychometric Testing

BACKGROUND AND PURPOSE

Demand for primary care providers increases value for advanced practice registered nurses (APRNs) to assume more independent roles. The purpose was to develop a reliable, valid instrument to measure roles, responsibilities, and competencies reflective of autonomous practice for APRNs.

METHODS

Conceptual literature motivated development of a new instrument. Validity was initially evaluated through expert content review. Reliability of proposed scales was evaluated and possible underlying constructs were identified through factor analysis using data from a pilot study.

RESULTS

Content validity for the instrument was high (content validity index [CVI] 88). The 16-item instrument is highly reliable (Cronbach's alpha of 0.81). Cronbach's alphas for subscales ranged from 0.60 to 0.75. Factor analysis identified four components.

CONCLUSIONS

The Petersen Sieloff Assessment of Advanced Practice (PSAAP) demonstrated initial reliability. Additional examination is warranted to further improve the factor structure.