Stronger together: PA and APRN shared governance council drives transformational change

ABSTRACT

Physician associates/assistants (PAs) and advanced practice RNs (APRNs) are a vital part of the healthcare team. As the PA and APRN workforce continues to grow, collaborations can move beyond the bedside. With organizational support, a shared APRN/PA Council allows these clinicians to raise a collective voice on issues that are unique to their practice and to implement meaningful solutions, thus improving the quality of their work environment and clinician satisfaction.

Creating an Advanced Practice Registered Nurse Council Within a Regional Hospital Network

This article describes the development of an advanced practice RN (APRN) council in a large hospital network. Despite obstacles, the council was able to demonstrate positive outcomes, which include standardization of the credentialing and onboarding process, productive networking, and an APRN-oriented education fair. The council has been able to guide workplace culture, establish and support vertical and horizontal interprofessional relationships, provide recommendations to relevant leadership boards, and develop standardized procedures.

Factors influencing the development and implementation of nurse practitioner candidacy programs: A scoping review

BACKGROUND

To meet the growing needs of a diverse population, it is critical that healthcare service provision is underpinned by innovative, cost-effective, and sustainable services and solutions. The role of the nurse practitioner creates an opportunity to meet the increasing demands of complex care and enables greater access to high quality care. Understanding how best to support nurse practitioner candidates to develop into the nurse practitioner role will create greater opportunities to transform service delivery and improve healthcare outcomes.

AIM

To identify key factors that support and positively impact the implementation of nurse practitioner candidacy programs and candidate experiences.

METHODS

A scoping review of research and grey literature was conducted using Joanna Briggs Institute methodology. For the research literature, eight electronic databases (Embase, Medline, CINAHL, Web of Science, Cochrane Library, Joanna Briggs Institute, PubMed and PsycINFO) were searched followed by a hand search of the reference lists of published systematic reviews and relevant topical papers. A review of national and international grey literature sources was completed.

FINDINGS

Identification of a service gap, developing and promoting a clear role for the nurse practitioner candidate, integration into a multi-disciplinary team with strong mentorship/preceptorship support, continuing professional development, and evaluation of the program were identified as key factors in the research and grey literature.

CONCLUSION

A well-designed candidacy program can facilitate transition of the candidate into an autonomous, fully independent nurse practitioner. Recommendations to support the implementation of these roles into the clinical setting have been generated. Tweetable abstract: Key to nurse practitioner candidate programs: Identification of a service gap, clear role, integration, mentorship, training and evaluation.

An integrative review of leadership competencies and attributes in advanced nursing practice

Aim

To establish what leadership competencies are expected of master level‐educated nurses like the Advanced Practice Nurses and the Clinical Nurse Leaders as described in the international literature.

Background

Developments in health care ask for well‐trained nurse leaders. Advanced Practice Nurses and Clinical Nurse Leaders are ideally positioned to lead healthcare reform in nursing. Nurses should be adequately equipped for this role based on internationally defined leadership competencies. Therefore, identifying leadership competencies and related attributes internationally is needed.

Design

Integrative review.

Methods

Embase, Medline and CINAHL databases were searched (January 2005–December 2018). Also, websites of international professional nursing organizations were searched for frameworks on leadership competencies. Study and framework selection, identification of competencies, quality appraisal of included studies and analysis of data were independently conducted by two researchers.

Results

Fifteen studies and seven competency frameworks were included. Synthesis of 150 identified competencies led to a set of 30 core competencies in the clinical, professional, health systems. and health policy leadership domains. Most competencies fitted in one single domain the health policy domain contained the least competencies.

Conclusions

This synthesis of 30 core competencies within four leadership domains can be used for further development of evidence‐based curricula on leadership. Next steps include further refining of competencies, addressing gaps, and the linking of knowledge, skills, and attributes.

Impact

These findings contribute to leadership development for Advanced Practice Nurses and Clinical Nurse Leaders while aiming at improved health service delivery and guiding of health policies and reforms.

Effect of centralized nursing on compliance and quality of life in patients after radical operation for colorectal cancer

AIM

To observe the effect of centralized nursing on the compliance and quality of life (QOF) in patients after radical operation for colorectal cancer.

METHODS

From January 2015 to July 2017, 220 colorectal cancer patients treated at Dajiang East Hospital of Hangzhou were randomly divided into a control group (110 cases) and a study group (110 cases). The control group received traditional nursing, and the study group received centralized nursing. The compliance, including regular examination rate and medication compliance (medication adherence self-efficacy scale, MASES), the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores, the self-nursing (exercise of self-care agency scale, ESCA) score, supportive need (supportive care needs survey short form 34, SCNS-SF34), and QOF (European organization for research on treatment of cancer, EORTC QLQ-C30) were compared between the two groups.

RESULTS

The regular examination rate and MASES score in the study group were significantly higher than those in the control group (t = -8.815, -26.387; P = 0.000, 0.000). There was no significant difference in SAS or SDS score between the two groups before nursing care (P > 0.05). SAS and SDS scores were significantly decreased after nursing care in both groups (P < 0.05), and the two scores in the study group were significantly lower than those in the control group (t = 11.912, 10.599, P = 0.000, 0.000). There was no significant difference in ESCA or SCNS-SF34 score between the two groups before nursing care (P > 0.05). ESCA and SCNS-SF34 scores were significantly increased after nursing care in both groups (P < 0.05), and the two scores in the study group at 3 and 6 months were significantly higher than those in control group (ESCA: t = -6.119, -7.931, P = 0.000, 0.000; SCNS-SF34: t = 6.822, 10.717, P = 0.000, 0.000). There was no significant difference in EORTC score between the two groups before nursing care (P > 0.05). After 6 mo of nursing care, the functional domain score in the EORTC was significantly increased in both groups (P < 0.05), and the score in the study group was significantly higher than that in the control group (P < 0.05). The symptom domain score in the EORTC was significantly decreased in both groups (P < 0.05), and the score in the study group was significantly lower than that of the control group (P < 0.05).

CONCLUSION

Centralized nursing can significantly improve compliance and QOF in patients after radical operation for colorectal cancer.

Effective professional networking

The reasons for nurse practitioners to develop a professional network are boundless and are likely to change over time. Networking opens doors and creates relationships that support new opportunities, personal development, collaborative research, policy activism, evidence-based practice, and more. Successful professional networking involves shared, mutually beneficial interactions between individuals and/or individuals and groups, regardless of whether it occurs face to face or electronically. This article combines nuggets from the literature with guidance based on the authors' combined experience in networking activities at the local, national, and international levels.

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.

Building leadership capacity in advanced nurse practitioners - the role of organisational management

AIM

To highlight the organisation-level management's role in building leadership capacity in advanced nurse practitioners and the need for appropriate supports to increase their becoming leaders.

BACKGROUND

Little is published about the role of organisation-level management in building leadership capacity and in developing the next generation of nurse leaders. In times of economic constraint, organisations need to focus their efforts on targeted leadership initiatives. Advanced nurse practitioners are ideally positioned to act as leaders both within and beyond the health care organisation.

EVALUATION

From the available research evidence, several support structures and mechanisms are identified as enablers for advanced nurse practitioners to enact their leadership role.

CONCLUSION

Health care organisations need to include building leadership capacity as a priority in their strategic plan and take action to build-up the level of advanced nurse practitioner leadership.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse executives have a vital role in influencing the organisation's strategic plan and making a business case for prioritising leadership capacity building within advanced nurse practitioners. A challenge for nurse executives faced with competing service and leadership development demands, involves strategic decision-making regarding whether the advanced nurse practitioner's role is limited to service delivery or its potential in leading health care reforms is realised.

Barriers and enablers to advanced practitioners' ability to enact their leadership role: A scoping review

BACKGROUND

Advanced roles such as nurse practitioner, nurse consultant and advanced nurse or midwife practitioner are increasing across the world. In most countries, clinical practice, education, leadership and research are the four components that define the advanced practitioner's role. Of these, leadership is perhaps the most important part of the role, but its study has largely been neglected. There is a risk that failure to identify and respond to barriers to enacting the advanced practitioners' leadership role will limit the extent to which they can become strategic leaders for professional development, and jeopardise the long-term sustainability of the role.

OBJECTIVES

To identify the barriers and enablers to advanced practitioner's ability to enact their leadership role.

DATA SOURCES

A search of the research literature was undertaken in electronic databases (PubMed, CINAHL, PsycINFO, ProQuest Dissertation and Theses, from inception to 4-6th June 2015), unpublished research in seventeen online research repositories and institutes, and hand search of 2 leadership journals (March/April 2010-4th June 2015).

REVIEW METHODS

Using pre-set inclusion criteria, the 1506 titles found were screened by two authors working independently. The 140 full text reports selected were reviewed by two authors separately and 34 were included, and data extracted and cross-checked. Any disagreements were discussed by the scoping team until consensus was reached. Using content analysis, the barriers and enablers relating to leadership enactment were sorted into themes based on their common characteristics, and using a Structure-Process-Outcome conceptual framework were categorised under the four structural layers: (1) healthcare system-level, (2) organisational-level, (3) team-level, and (4) advanced practitioner-level.

RESULTS

Thirteen barriers to, and 11 enablers of, leadership were identified. Of these a majority (n=14) were related to organisational-level factors such as mentoring, support from senior management, opportunity to participate at strategic level, structural supports for the role, and size of clinical caseload. Advanced practitioner-level factors relating to personal attributes, knowledge, skills and values of the advanced practitioner were identified.

CONCLUSIONS

Although building leadership capabilities at advanced practitioner-level and team-level are important, without key inputs from healthcare managers, advanced practitioners' leadership enactment will remain at the level of clinical practice, and their contribution as change agents and innovators at the strategic level of service development and development of the nursing profession will be not be realised.