Dynamics and processes influencing role integration of advanced practice nurses and nurse navigators in oncology teams

[Experience with the implementation of advanced practice nurses specializing in oncology and hematology-oncology in a hospital setting]

INTRODUCTION

Advances in oncology have altered the prognosis of certain cancers, transforming care pathways. In France, the emergence of the advanced practice nurse profession offers an innovative response to the new needs of patient support. However, the role transition for these nurses is sometimes a complex phase. This study explores the experiences of nurses who chose to train in advanced practice.

METHODS

This qualitative research was conducted through five semi-structured interviews based on theoretical sampling with advanced practice nurses specialized in oncology, who are currently working in hospital settings. A thematic analysis with double coding was carried out.

RESULTS

The role transition was described as a challenging period for some nurses, with a detrimental impact on their well-being, questioning of their professional identity, and a sense of isolation. Identified barriers to this transition included incomplete training and poor understanding of the new responsibilities by colleagues. Conversely, factors such as the development of a role aligned with the nurse's expectations, hierarchical and medical team support were perceived positively.

DISCUSSION

The implementation of a peer mentoring program, medical mentorship, or enhanced communication about this new profession could serve as tools to facilitate the integration of advanced practice nurses and promote a positive role transition experience.

Burnout and work engagement in advanced practice cancer nurses: A scoping review

PURPOSE

To explore the job demands, resources and outcomes of burnout and work engagement in advanced practice cancer nurses.

METHODS

A scoping review guided by Arksey and O'Malley's methodological framework. Six databases, including CINAHL (EBSCO), Cochrane Library, MEDLINE (Ovid), PsycINFO (Ovid), Scopus, and ProQuest Dissertations and Theses database and grey literature were searched for studies published in English between January 2000 and January 2024. A descriptive analysis and qualitative content analysis were conducted to analyse the data.

RESULTS

A total of 2344 articles were screened for eligibility, and 28 were selected for inclusion. Four broad themes were identified: (i) job demands, (ii) job resources, (iii) negative outcomes and (iv) positive outcomes in relation to the advanced practice cancer nurses' work environment and practices. A total of 31 job demands, 22 job resources, 9 negative and 12 positive outcomes were identified. Three studies reported higher burnout among advanced practice cancer nurses, while no studies provided data on work engagement.

CONCLUSION

Higher job demands lead to negative outcomes, which could affect advanced practice cancer nurses' overall performance and well-being. The evidence for the relationship of job demands and resources with burnout and work engagement is inconclusive. Further research is needed to address the influence of job demands and resources on burnout and work engagement of advanced practice cancer nurses.

Nurse-Led Service Model for Outpatient Pain-Free Management Under Anesthesiologist Supervision: A Single Center, Observational Study in China

BACKGROUND

The efficacy of establishing an intensification outpatient center for diagnostic and treatment endoscope services has been documented, but its practical implementation remains limited. Presently, there are two models for outpatient endoscope care services: the clinical specialty-based model and the solitary outpatient model. However, each model has its limitations.

AIMS

In this study, we introduce a nurse-led service model that offers comprehensive care throughout the entire journey for patients undergoing painless endoscopic treatment procedures outside the operating room overseen by anesthesiologist and report its implementation in an university-affiliated hospital.

DESIGN

A single-center observational study.

METHODS

Data was collected all of 2013 and 2022 at a tertiary medical hospital center. A total of 168,100 patients undergoing endoscopic anesthesia were included in the analysis. Patients receiving endoscopic diagnosis and treatment were divided into two groups: the Model-2013 (clinical specialty endoscopy service model, from January to December 2013) and the Model-2022 (nurse-led service model under the supervision of anesthesiologists, from January to December 2022). We conducted a retrospective analysis of workload data and compared the nursing quality management index of endoscopy center between Model-2013 and Model-2022.

RESULTS

In 2013, the workload for digestive endoscopy was 28,864 procedures, while in 2022, it had significantly increased to 139,236 procedures. Patient satisfaction had risen from 93.99% to 95.25%, and the satisfaction of the collaborative team increased from 91.77% to 98.10%. The endoscopic cancellation rate dropped from 13.56% to 8.75%. The quality indicators for anesthesia nursing and endoscopy nursing had improved significantly without an increase in equipment and nursing costs (p < .05).

CONCLUSION

The nurse-led service model for patients undergoing painless endoscopic procedures outside the operating room can enhance service efficiency and patient safety and satisfaction, and can serve as a viable alternative to the traditional models based on clinical specialty and independent single endoscopy department.

Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review

BACKGROUND

Advanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams.

METHODS

We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level).

RESULTS

We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs' backgrounds and characteristics, clinical team members' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained.

CONCLUSIONS

We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.

Characteristics and effectiveness of mentoring programmes for specialized and advanced practice nurses: A systematic review

AIMS

(1) To identify, evaluate and summarize evidence about the objectives and characteristics of mentoring programmes for specialized nurses (SNs) or nurse navigators (NNs) and advanced practice nurses (APNs) and (2) to identify the effectiveness of these programmes.

DESIGN

A systematic review based on PRISMA guidelines.

DATA SOURCES

From November 2022 until 7 December 2022, four databases were searched: PubMed, EMBASE, CINAHL and The Cochrane Library.

REVIEW METHODS

Study selection was performed independently by two researchers. Disagreements were discussed until consensus was reached. Data extraction was undertaken for included studies. Data synthesis was conducted using narrative analysis. Quality appraisal was performed using the Critical Appraisal Skill Programme (CASP) and Mixed Methods Appraisal Tool (MMAT).

RESULTS

Twelve articles were included, all of which focused on mentoring programmes for APNs. Different forms of mentorship (e.g. (in)formal mentorship, work shadowing, workshops) were reported. Studies reported positive outcomes on job retention (n = 5), job satisfaction (n = 6), skills improvement (n = 7), satisfaction with the programme (n = 7) and confidence improvement (n = 4) among participants of mentoring programmes.

CONCLUSION

There is a lack of uniformity and consistency in various elements of mentoring programmes. Further research is needed to develop mentoring programmes for both APNs and SNs/NNs in a systematic and theoretically underpinned manner. It is necessary to establish a thorough evaluation methodology, preferably using a mixed methods design that includes both a qualitative process evaluation and a comprehensive outcome evaluation using validated questionnaires, taking into account the NN/APN, the interprofessional team and organizational level.

IMPACT

The synthesis of evidence may be useful to organizations developing and implementing mentoring programmes for both SN/NN and APN. The development of a mentoring programme for nursing experts should be considered a complex intervention that requires theoretical frameworks and contextual considerations.

NO PATIENT OR PUBLIC CONTRIBUTION

Not applicable, as no patients or public were involved.

Advanced Practice Nursing Titles and Roles in Cancer Care: A Scoping Review

OBJECTIVES

Advanced practice nursing roles in cancer care are diverse and exist across the cancer care continuum. However, the titles used and the scope of practice differ across countries. This diversity is likely to be misleading to patients and influence nurses' contribution to health care. An understanding of the current state of advanced practice nursing roles in cancer care internationally is needed to inform opportunities for future role development and enhance cancer nursing career pathways.

METHODS

This scoping review included a systematic search of four databases: MEDLINE, CINAHL, PsycINFO, and Academic Search Complete. Independent screening for papers meeting the review's inclusion criteria was undertaken using online screening software. Data extraction, coding, and mapping were undertaken in NVivo 12.

RESULTS

Of the 13,409 records identified, 108 met the review's inclusion criteria. A variety of roles in cancer care settings were described. The United States and the United Kingdom had the most titles for advanced practice nursing roles. Tumor-specific roles were described and integrated into different phases of the cancer care continuum. Trends in continuing professional development for advanced practice nurses in cancer care included the rise in Fellowship programs in the United States and practice-based education in the United Kingdom.

CONCLUSIONS

The differences in advanced practice nursing roles in cancer care allow regional and institutional variation to meet the needs of patient populations and health care system demands. However, a lack of clarity surrounding titles and roles results in confusion and underutilization of these nurses' highly specialized skill sets.

IMPLICATIONS FOR NURSING PRACTICE

Incongruence in titles and scope of practice internationally will ultimately result in a merging of roles. There is a need for international agreement on education requirements for advanced practice nursing roles to promote career pathways.

The use of written guides to empower breast cancer survivors in their management of chronic pain: A realist evaluation

OBJECTIVE

Many breast cancer survivors experience long-term complaints following treatment, such as pain, which are often not addressed in a sufficient way. To empower survivors in talking about their pain and related complaints and in searching for appropriate support when needed, we developed two written guides. With this study, we aimed to pilot test the guides and gain insight into the implementation process and influencing mechanisms through the perspective of a realist evaluation.

METHODS

Nine survivors were interviewed at two time points (i.e., post-intervention and at three-month follow-up). The data were thematically analysed and categorized into a context-implementation-mechanisms-outcomes hypothesis.

RESULTS

The guides empowered the participants to discuss pain with medical specialists and initiate support-seeking behaviour through underlying mechanisms such as awareness, acknowledgment, hope, reduced isolation, and motivation. Nonetheless, mechanisms and outcomes differed according to a survivor's unique context.

CONCLUSION

Written guides can offer a feasible way to empower survivors in their management of chronic pain. However, a one-size-fits-all approach is not desirable and other strategies might be necessary.

PRACTICE IMPLICATIONS

It is pivotal to engage survivors as well as professionals in adopting new interventions. As such, the role of nurses in introducing and endorsing the guides should be further explored.