Acute care pediatric nurse practitioner: a practice analysis study

Acute Care Pediatric Nurse Practitioner: The 2018 Practice Analysis

INTRODUCTION

Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study informed an update of the Certified Pediatric Nurse Practitioner - Acute Care (CPNP-AC) examination content outline.

METHOD

A descriptive analysis of a survey completed in 2018 by 373 pediatric nurse practitioners (PNP) practicing as an acute care role (AC).

RESULTS

Respondents were primarily females aged 25 to 34 years (35.4%) and formally educated as AC PNPs (84.2%) and held the CPNP-AC credential (98.9%). Most respondents (83.6%) practiced in urban areas and spent 84% of their time in direct patient care with 74% working in inpatient settings. The majority (87%) worked in subspecialty practice such as critical care (18.5%) and cardiac intensive care (12.3%).

DISCUSSION

This is the fourth practice analysis of the AC PNP role that demonstrates continuous evolution in clinical practice, educational preparation, and subspecialty practice distribution.

Alignment of Nurse Practitioner Educational Preparation and Scope of Practice in United States Emergency Departments: A Systematic Review of the Literature

INTRODUCTION

National debate persists surrounding the expanded use of nurse practitioners in the emergency department. Current understanding of the alignment of nurse practitioner educational preparation and practice parameters in United States emergency departments is inchoate. The objective of this review was to seek evidence to support that nurse practitioner education and training align with current practices in the emergency department.

METHODS

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided systematic review of the existing literature was conducted of 4 relevant databases. Level of evidence and quality assignments were made for each article using Grading of Recommendations, Assessment, Development, and Evaluation or Confidence in Evidence from Reviews of Qualitative Research as appropriate.

RESULTS

Nurse practitioners are increasingly staffing emergency departments, providing care to both patients classified as high-acuity and low-acuity. Reports of nurse practitioner scope of practice vary widely. No studies evaluated alignment of educational preparation and training for actual clinical practice.

DISCUSSION

This review of the literature was inconclusive, and the review team we was unable to find evidence that supports the alignment of nurse practitioner educational preparation and training with scope of clinical practice in United States emergency departments. Future research should seek to articulate the landscape of nurse practitioner academic preparation for specialty practice in the emergency department and to specifically examine the alignment of educational preparation with scope of practice and impact on clinical outcomes of patients seen in the emergency department.

Contemporary Practice as a Board-Certified Pediatric Clinical Specialist: A Practice Analysis

PURPOSE

The purpose of the 2019 practice analysis was to identify the elements of contemporary practice as a board-certified pediatric clinical specialist.

METHODS

Consistent with the processes of the American Board of Physical Therapy Specialties (ABPTS), a subject matter expert panel used consensus-based processes to develop a survey to gather information concerning the knowledge areas, professional roles and responsibilities, practice expectations, and practice demographics of board-certified pediatric clinical specialists. The web-based survey was divided into 3 parts and administered to 3 separate groups of board-certified pediatric clinical specialists.

RESULTS

Survey responses from 323 clinical specialists provided data to support confirmation and revision of the Description of Specialty Practice (DSP) for pediatrics.

CONCLUSIONS

The revised DSP will provide contemporary practice information to inform the ABPTS specialist examination blueprint and the curricula of credentialed residency programs in pediatric physical therapy.

American Association of Nurse Practitioners National Nurse Practitioner sample survey: Update on acute care nurse practitioner practice

BACKGROUND AND PURPOSE

Data from national surveys on the practice of nurse practitioners (NPs) provides valuable information on aspects of practice, demographic characteristics of providers and patients, plans for continued employment, and role satisfaction. The American Association of Nurse Practitioners (AANP) has been conducting the AANP Sample Survey since 1988.

METHODS

The most recent AANP Sample Survey was conducted in 2016 with a random stratified survey of 40,000 NPs. Data were collected bimodally, by internet and mail surveys. Responses were received from 3,970 respondents (9.9% response rate), with 335 respondents reporting NP certification in acute care as adult-gerontology acute care and/or pediatric acute care.

RESULTS

Almost all acute care nurse practitioners (ACNPs) reported that they were clinically practicing in 2016 (99.3%), with the top three areas encompassing cardiovascular (20.5%), critical care (12.1%), and hospitalist roles (6.3%). More than 1 in 4 ACNPs worked in a hospital inpatient setting, with 16.1% reporting work in a hospital outpatient clinic, 7.7% in a private group practice, 6.5% at a public university, and some in combined roles covering both inpatient and outpatient care, or on consultation service or specialty-based teams. On average, 34.1% of the patients ACNPs saw were between the ages of 66 and 85 years, and 11.2% were 85 years and older. The top 3 medication classes in which ACNPs regularly prescribe were diuretics (31.9%), analgesic narcotics (31.2%), and antibiotics (27.3%). Majority (88%) report satisfaction with the role, and approximately one third (31.1%) expect to continue to work in their current practice for more than 10 years.

IMPLICATIONS FOR PRACTICE

The findings of the 2016 AANP National NP Sample Survey data related to ACNP practice identify expansion of work settings, practice consistent with acute care scope of practice, role satisfaction, and intent to continue working. Continued monitoring of practice components and employment is indicated to track ACNP workforce trends.

Nurse Practitioners and Interdisciplinary Teams in Pediatric Critical Care

Objective:

To describe the members of pediatric intensive care unit interdisciplinary provider teams and labor inputs, working conditions, and clinical practice of pediatric intensive care unit nurse practitioners.

Methods:

A national, quantitative, crosssectional, descriptive postal survey of pediatric intensive care unit medical directors and nurse practitioners was administered to gather information about provider-team members, pediatric intensive care unit nurse practitioner labor inputs, working conditions, and clinical practice. Descriptive statistics, cross-tabulations, and χ2 tests were used.

Results:

Responses from 97 pediatric intensive care unit medical directors and 59 pediatric intensive care unit nurse practitioners representing 126 institutions were received. Provider-team composition varied between institutions with and without nurse practitioners. Pediatric intensive care units employed an average of 3 full-time nurse practitioners; the average nurse practitioner-to-patient ratio was 1 to 5. The clinical practice reported by medical directors was consistent with practice reported by nurse practitioners.

Conclusion:

Nurse practitioners are integrated into interdisciplinary pediatric intensive care unit teams, but institutional variation in team composition exists. Investigating models of care contributes to the understanding of how models influence positive patient and organizational outcomes and may change future role implementation.

Hiring appropriate providers for different populations: acute care nurse practitioners

Acute care nurse practitioners, prepared as providers for a variety of populations of patients, continue to make substantial contributions to health care. Evidence indicates shorter stays, higher satisfaction among patients, increased work efficiency, and higher quality outcomes when acute care nurse practitioners are part of unit- or service-based provider teams. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education outlines detailed guidelines for matching nurse practitioners' education with certification and practice by using a population-focused algorithm. Despite national support for the model, nurse practitioners and employers continue to struggle with finding the right fit. Nurse practitioners often use their interest and previous nursing experience to apply for an available position, and hospitals may not understand preparation or regulations related to matching the appropriate provider to the work environment. Evidence and regulatory guidelines indicate appropriate providers for population-focused positions. This article presents history and recommendations for hiring acute care nurse practitioners as providers for different populations of patients.

How to report professional practice in nursing? A scoping review

BACKGROUND

Nursing professional practice in different contexts of care has been widely described in evidence-based literature. Currently, there is no consensus on a common structure for these descriptions. Understanding and comparing similar practices is made difficult by the varying nature of descriptions provided in scientific literature.

PURPOSE OF THE STUDY

1) to report research methods found in the scientific literature that were used to describe the practice of different health professionals; 2) to report on the main concepts used to describe the practice of these health professionals; 3) to propose a structure for the description of the practice in nursing.

METHODS

A scoping review following a five-stage approach: 1) identifying the research question; 2) identifying relevant studies; 3) selecting studies; 4) charting data; 5) reporting results. The Medline, CINAHL, psychARTICLES, psyCRITIQUES, psycEXTRA, Psychology and Behavioral Science Collection and psycINFO databases were searched. Each study was analyzed and extracted data were classified by categories and structures used to describe the health professional practices.

RESULTS

Forty-nine studies were included. In these studies, quantitative, qualitative or mixed methods were used to describe professional practice in different health disciplines. Three major concepts were reported most frequently in describing professional practice: roles, domains and activities. The concepts varied greatly among authors. We found that to define roles or to characterize a professional practice, activities must be described and organized on the basis of different domains.

CONCLUSIONS

A promising structure for describing nursing professional practice is proposed by the authors of this review. The structure facilitates the accurate description of all domains and activities performed by nurses in different contexts of practice, and will contribute to the development of knowledge about nursing practice in different contexts based on shared concepts.

Acute Care Pediatric Nurse Practitioner: The 2014 Practice Analysis

INTRODUCTION

Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study describes the current practice of the acute care pediatric nurse practitioner (AC PNP) to inform an update of the Certified Pediatric Nurse Practitioner-Acute Care (CPNP-AC) examination content outline.

METHOD

A descriptive analysis was performed of the responses of 319 pediatric nurse practitioners, practicing in an acute care role, who completed a practice survey in 2014.

RESULTS

Respondents were primarily White women with a mean age of 40 years; 75% had been formally educated as AC PNPs, compared with 48% in 2009. Regional practice was most heavily concentrated in the Southeast (28%) and Midwest (27%). Most respondents (81%) practiced in urban areas. Respondents reported spending 75% of practice time in inpatient settings. The most frequently cited areas of practice were critical care (36%), followed by emergency department (9%) and subspecialty practices.

DISCUSSION

This third analysis of AC PNP practice 10 years after initiation of the CPNP-AC certification examination demonstrates changes in clinical practice and educational preparation.