Evaluation of the implementation of advanced practice nursing roles in France: A multiple case study

[Barriers and facilitators to integrating academic nursing roles into psychiatric practice: Partial results of the AkaPP study]

INTRODUCTION

The integration of academically qualified nurses into psychiatric care is crucial to the quality of patient care and the professional satisfaction of nurses. Despite its increasing importance and political demand, the integration of academic nursing roles into (psychiatric) care practice appears to be progressing slowly. This study therefore examines how academically qualified nurses who work in direct psychiatric nursing practice, practice development or nursing research perceive the integration of their academic nursing role into psychiatric care practice and which contextual factors promote or inhibit the integration of academic nursing roles into psychiatric nursing and care practice.

METHODS

Data collection for the nationwide AkaPP study took place between August and November 2020 using a specially developed online questionnaire. The target population of the study was academically qualified nurses working in psychiatric settings (n = 185). The subgroup of academically qualified nurses working in direct psychiatric nursing practice, practice development or nursing research (n = 100) was analyzed as part of this sub-study. Data analysis was performed using descriptive statistical methods as well as appropriate statistical procedures to test the correlation between certain variables of role development or role integration and the rating of role integration (Chi-square test, Cramer's V, Spearman's rank correlation). Qualitative data (free text data) were analyzed using qualitative content analysis. Reporting was based on the STROBE checklist.

RESULTS

Overall, role integration is rated as less successful (MV = 2.62; SD = 1.309). The results show that time resources for extended tasks (V = .554, p < .000) and for exchange and networking (V = .570, p < .001) correlate significantly with satisfaction with role integration. A specific description of tasks and activities (V = .522, p < .000) and for research activities (V = .453, p < .001) are also moderately to strongly associated with a positive assessment of role integration. On the other hand, induction concepts, trainee programs, and specific training courses do not show a strong statistical correlation with role integration. The use of systematic concepts such as the PEPPA framework was described by only a small group but tended to show a higher level of satisfaction. The main obstacles to successful role integration were lack of acceptance by members of one's own discipline (68.2%) or lack of appropriate differentiation of tasks and activities (60.5%).

CONCLUSION

In order to successfully integrate academically qualified nurses into psychiatric nursing practice, nursing management, educational institutions, and policy makers should pay more attention to the provision of time resources, clear role descriptions and the promotion of research activities. The implementation of systematic approaches to role development could also improve nurses' integration and satisfaction.

Advanced practice nursing implementation in France: A mixed-method study

AIM(S)

To describe advanced practice nursing (APN) in the French healthcare landscape and to provide insights on how the role is defined and implemented and how the role is perceived by physicians.

DESIGN

A mixed-method approach incorporating qualitative and quantitative data to offer a global understanding of APN implementation in France was used.

METHODS

Data were collected through questionnaires and interviews with APNs and physicians in diverse healthcare settings in France. The questionnaire assessed the roles, relationships with physicians and patients and the perceived implementation success of APNs. In-depth interviews explored experiences, definitions, challenges and perspectives of APNs. A thematic analysis was applied to the qualitative data to complete the quantitative exploration. Descriptive analyses were performed for quantitative data.

RESULTS

A total of 41 APNs and 12 physicians were involved in this study between December 2022 and March 2023. The findings underscore APN as a pivotal, independent profession integrating advanced clinical expertise and interprofessional skills. The challenges encountered by APNs include role ambiguity, ongoing resistance and the need to address institutional barriers. Despite the fact that 73.2% of APNs reported that their role was well implemented, only 17.1% had clearly defined roles at the outset.

CONCLUSION

This study revealed the dynamic and evolving nature of APN in France, highlighting its challenges and opportunities. Despite facing role ambiguity and resistance, APNs play a crucial role in the healthcare system.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The results highlight the need for specific interventions to tackle challenges and facilitate successful integration of APN. These insights lay a foundation for future research and interventions aimed at boosting the impact and acceptance of APN in France, potentially influencing policy modifications and professional development.

IMPACT

Problem Addressed: The study aimed to enhance comprehension of the implementation and role of advanced practice nursing (APN) in France. It focused on defining APN in the French context, identifying barriers and facilitators to its implementation and evaluating its impact.

MAIN FINDINGS

The study revealed that APN in France is evolving with expanded competencies and clinical autonomy, but faces challenges like role ambiguity and professional resistance. Key findings include the successful integration of APNs in healthcare settings, positive relationships with medical doctors and patient satisfaction. However, the study also highlighted the necessity to resolve role ambiguity and to improve the understanding and acceptance of APN roles among healthcare professionals for successful APN integration. Impact of the research: This research will primarily impact healthcare systems and policy-making in France, guiding the future development and integration of APN roles. It is also relevant for healthcare professionals, particularly nurses and physicians, by providing information about the evolving nature of APN and its benefits in patient care. Globally, the study contributes to the broader discourse on APN, offering insights that could inform APN implementation strategies in other countries facing similar healthcare challenges.

REPORTING METHOD

COREQ-STROBE.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

[University hospital nurse: the challenges of this new status]

Combining hospital and university activities encourages the professionals involved in these missions to innovate, to overcome divisions and energize career paths for the benefit of all: patients, students, teachers, researchers, caregivers and supervisors.

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.