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Background Clinician burnout, stress and job dissatisfaction among Advance Practice Registered Nurses (APRNS) may have impacted work-related quality of life (WRQoL) during the COVID-19 pandemic. No studies describe burnout and resilience in APRNs who manage care for patients with HF. Objectives Among APRNs who manage care for patients with HF, study aims included: 1) Describe burnout and WRQoL levels; 2) Determine the relationship between burnout and WRQoL; 3) Examine whether resilience moderates the association between WRQoL and burnout.An online survey of American Association of Heart Failure Nurses and the Heart Failure Society of America APRN members were queried.APRN's who practiced in ambulatory or inpatient cardiology settings at least 8 h weekly.Burnout, WRQoL, and resilience. Results Participants' (N = 101) mean age was 50 (±10) years and 93% identified as female. APRNs worked more than 42 h weekly and reported moderate levels of resilience, high levels of personal (M = 51.7, norm-referenced mean: 35.9) and work-related burnout (M = 50.1, norm-referenced mean: 33.0). Correlations between high levels of burnout and low WRQoL (r range: -0.74 - -0.39 -, p.001) were found. Burnout moderated the relationships among resilience and WRQoL. Conclusion APRNs had high levels of burnout during the COVID-19 pandemic. Patient-related burnout was not high. Level of burnout influenced the relationships among resilience and WRQoL suggesting that burnout is from workplace and personal sources, and that level of resilience could not overcome the effect of burnout. Interventions are needed regarding systems changes to uplift and support our workforce.

Pediatric palliative advanced practice registered nurses (APRNs) leaders are essential in advancing the field of pediatric palliative care. With expertise in pediatrics and strong advocacy skills for children, APRNs are well suited to lead interprofessional clinical teams, educational programs, community hospice and palliative organizations, policy changes, and research initiatives. Despite the prominence of their positions, there is a paucity of literature on pediatric palliative APRNs. This paper explores the leadership roles of the pediatric palliative APRN, offers resources to support leadership development, and showcases the importance of this role in various domains of pediatric palliative care.

Climate change has been labeled one of the most significant threats to patient health. Advanced practice registered nurses must acquire adequate preparatory education to care for patients during climate change. They would benefit from implementing climate change concepts to provide safe and quality care for patients. This article aims to discuss integrating climate change concepts into advanced practice nurses curricula by applying the National Organization of Nurse Practitioner Faculties' competencies.

The Consensus Model specifies distinct education preparations for acute care and primary care nurse practitioners (NP), but incomplete implementation and employer hiring practices risk misalignment of certification and practice.Report the prevalence of acute care certification among NPs working in acute care, investigate the factors associated with alignment, and explore the impact of alignment on nurse outcomes.Using the 2018 National Sample Survey of Registered Nurses, we selected NPs practicing acute care and compared employment, education, and nurse outcomes by certification alignment.A minority of NPs (44.5%) held acute care certification. Controlling for NP characteristics, those practicing in states that restrict a NP's practice to their area of certification had 47% higher odds of acute care certification.Understanding patterns of alignment in the NP workforce and the factors that produce them is critical to an appropriate regulatory framework for advanced practice nursing.

Background Significant growth in advanced practice registered nurse (APRN) student placements for clinical practicums have forced APRN preceptors, hospitals, and clinics to restrict the volume of APRN students they can accommodate. Purpose Describe the experiences and opinions of APRNs regarding their precepting experiences of APRN students in three main areas; placement antecedents, placement postcedents, and preceptor incentives. Methods Quality improvement study conducted via electronic survey that contained quantitative short answer and a qualitative open-ended question of APRNs licensed in the State of REDACTED in June, 2019. Findings A total of 757 surveys were quantitatively analyzed. Qualitative thematic analysis resulted in identifying one overarching theme, the need for shared responsibility and accountability, and six unique primary themes. Discussion Our findings indicate that APRN preceptors recognize their critical role but lack support and preparation to fully execute academic and profession strategic goals and objectives. There is the need for academic and professional ownership of APRN education at every level.

Clinical competency validation is essential for nurse practitioner (NP) education and public accountability. While there has been robust discussion around what constitutes clinical competency and assessment, clear and consistent definitions and measurements remain elusive.This article describes the PRIME-NP clinical competency model that is scalable, reproducible and accurately documents NP student competency across clinical courses.To develop the model, work in 5 discrete domains was necessary: (a) model development, (b) assessment tool to be used in Objective Structured Clinical Exams (OSCE), (c) rubrics to accompany the OSCE exam, (d) faculty education, and (e) evaluating the model use.Faculty and student outcomes reveal that the model and assessment tool acceptability and effectiveness of the model, especially for early identification for at risk students.The PRIME-NP offered faculty the opportunity to identify at-risk students, identify a more nuanced remediation plan, and assess student competency in simulated environments.

The 40th anniversary gemstone is traditionally a ruby – the stone of kings and queens. The Latin derivative is “ruber” which means red (the deep color of the stone). Rubies are thought to have an eternal inner flame or fire that in many global cultures symbolizes nobility, purity, and passion. The ruby is believed to promote health and knowledge as well as love and compassion. It has also been connected to improved energy, creativity, motivation, and goal setting. Does this sound like the GAPNA mission, vision, goals, and experience you know? A gathering of inspired and dedicated gerontological nurses founded this organization in 1981 and it has been growing stronger and burning brighter with recognized influence every year. This article highlights the last decade of work and accomplishments that have occurred from the passion of individuals working with older adults. GAPNA has forged ahead as visionary leaders in the care of older adults; creative in approaches to meeting the needs through certification and leadership opportunities. Health policy is a dedicated advocacy focus for advanced practice nursing and older adults, making the world a better place for aging and quality health care access and equity. This article will remind you or acquaint you with some of the accomplishments in the last decade. The authors hope the outcome of reading the article will delight you, but also motivate you to become actively engaged with the organization in the next years as GAPNA heads toward becoming golden.

The unmet behavioral health treatment needs of children and adolescents have become a public health crisis in the United States, with only 20% of youths obtaining assessment and intervention when indicated. Workforce shortages, including mental health professionals who can provide pharmacologic intervention within an appropriate biopsychosocial context, directly impede our ability to address this crisis. The authors examine the history, education, regulation, and practice of advanced practice psychiatric nurses and consider models of collaborative practice that can be beneficial across treatment settings in order to provide better care of vulnerable youth in ways that foster partnership rather than competition.

Background The COVID-19 pandemic has highlighted the need for nurse leaders who “embrace the interconnection” between medicine and public health. The inequitable impact of COVID-19 on people of color demonstrates the importance of applying expertise from nursing practice and public health systems to work with communities and other professions on complex health issues. Yet, despite a clear need for improved population health, educational programs designed to produce Advanced Public Health Nurses, with skills to address complex system changes, have become increasingly scarce. Purpose We put forward the perspective that the nation needs more advanced practice nurses prepared for leadership roles focused on the health of whole populations, marginalized communities, and the systems and policies that promote their health. Discussion We argue that opportunities should be expanded for nurses to attain education for these roles through increased investments in the Doctor of Nursing Practice model to prepare nurses for advanced public health specialty practice.

Introduction The purpose of this study was to describe the holistic impacts of COVID-19 on pediatric advanced practice registered nurses (APRNs). Method AA convenience sample of APRNs affiliated with the National Association of Pediatric Nurse Practitioners participated in this cross-sectional descriptive study. An investigator-developed survey explored multifocal, holistic impacts of COVID-19. Results A total of 886 participants were provided the survey, with 796 (90%) completing the entire survey. Respondents indicated adverse impacts across personal, clinical, educational, and research foci. Among the most alarming findings, 34% indicated moderate or extreme concern for feeling professionally burned out, 25% feeling nervous or anxious, and 15% feeling depressed or hopeless. Discussion The pediatricAPRN workforce pipeline is at significant risk for provider burnout and compromised mental health. Acknowledgment of pandemic-related trauma on families, children and APRNs is essential. Sustained intentional efforts to cultivate holistic wellness are critically emergent.

Background Advanced practice nursing is recognised globally as central to meeting this community need. Whilst there is increasing recognition that advanced practice nurses should be educated to at least a master degree level, there is scant evidence on the influence of higher education on the practice profile of advanced practice nursing. Aim To investigate the relationship between level of education and domain practice scores of nurses in advanced practice roles. Methods The validated Advanced Practice Nursing Role Delineation (APRD) tool was used to measure the practice profile of advanced practice nurses at different postgraduate education levels, across five domains of nursing practice activities. A cross-sectional electronic survey of nurses was used. Findings APNs with higher degrees performed at a higher level across all five domains of the APRD tool compared to those who did not hold a higher degree. This was highly significant for the domains of Research and Leadership, followed by the Optimising Health Systems and Education domains, but not significant for the Direct Care domain. Discussion Questions are often raised about the benefits of investing in nurses’ education, particularly the need for a higher degree for advanced practice nurses. APNs with higher degrees have a different emphasis in their role activities than those without a higher degree. This difference could be significant given current global health challenges. Conclusion Higher education changes the practice profile of APNs. Those with higher education are more likely to be involved in research and leadership with knowledge integration across all practice domains.

Le Mans general hospital has created an advanced practice nurse position in memory clinics in geriatrics. The activity began in September 2019. During the first year, 189 consultations with the nurse were carried out, despite the difficult health context. Most of the activity has focused on consultations. However, the nurse's other skills have also been deployed. An analysis of the activity enables the areas to improve to be identified in order to continue creating advanced practice nursing positions within the hospital and across the country.

The concept of advanced practice nursing and the way it has been adapted to the French context are still poorly understood. It is however rooted in a long history and is based on well-established international notions. After a phase of structuring, advanced practice nurses are now being deployed across the country, with their missions, their association and their own union. Two years after the first graduations, challenges remain but the future is promising.

The first challenge, after graduating as an advanced practice nurse is to establish a new model of care in one's place of practice. The feedback from the creation of an advanced practice nurse position in oncology in Amiens-Picardie university hospital, using a population-based approach, illustrates the roles and skills required in this new health profession.

Use of cannabidiol (CBD) products has become widespread due to the proposed medical benefits without the “high” of marijuana, with recent polling indicating that 1 in 7 Americans report using a CBD product. However, health care professionals have apprehension about whether these treatments are legal, safe, and effective. In this review, we provide a summary of the scientific evidence on CBD oil so that a nurse practitioner can guide patients to the safest and most beneficial products within today’s regulatory environment.

As opioid-related overdose deaths increase across the nation, the need for opioid and naloxone education is of the utmost importance. The metropolitan Chicago area is one of the hardest hit regions regarding opioid use and overdoses. This report focuses on advanced practice nurses’ efforts to provide opioid education and naloxone training to a network of primary care clinics in underserved communities surrounding downtown Chicago. Postsurvey data revealed positive results, showing an increased awareness regarding the opioid crisis and naloxone administration. Utilizing advanced practice nursing skillsets poses as an optimal opportunity to educate interdisciplinary teams, which can positively influence patient outcomes.

Background Internationally, Advanced Practice Nurses (APN) are associated with improvements when measuring results in health care. Advanced Nursing Practice (ANP) refers to an extended nursing care with the aim of meeting the changing conditions in health care systems by providing evidence-based practice. APN outcomes are the endpoints of nursing interventions based on clinical experience, scientific knowledge, and practical skills. Due to the challenges in health care systems, Advanced Practice Nurses have become well established internationally in various fields. Problem In Austria, the first nurses are currently trained in Advanced Nursing Practice on a master's level according to the International Council of Nurses core curriculum (ICN). However, national implementation and evaluation strategies are still missing. Objective The aim of this short report is (i) to show the current situation of APNs in Austria, and (ii) to underline the importance of measuring APN outcomes in implementing this role for future developments in health care. Method A literature search was conducted in CINAHL (Cumulative Index to Nursing and Allied Health), PubMed, and the Cochrane Library in the period 09/2019 to 01/2020. Results With the help of APNs and coordinated, holistic, patient-centered care, a higher quality of care for different patient groups is clearly evident. The cost-effectiveness and the positive experience of both patients and nursing staff have been demonstrated in international studies. In particular, the guidance and educational skills of APNs have been shown to improve health outcomes in vulnerable population groups. Conclusion With regard to the implementation of APNs in the health care system, more focus is needed on the measurement of outcomes in nursing research. Outcome research has been shown to help identify the unique effect of APNs in patient care and to highlight the health-related improvements through Advanced Nursing Practice for health policy and further developments in the health care system.

This article reviews the disparities in human immunodeficiency virus (HIV) incidence, presents evidence on the efficacy of preexposure prophylaxis (PrEP) and nonoccupational postexposure prophylaxis (nPEP), provides an overview of clinical guidelines for prescribing PrEP and nPEP, discusses strategies to promote efficient use of these effective interventions, and reviews best practices in treatment retention for people at high risk for HIV. Nurses are optimally positioned to prevent new HIV infections. When working with sensitive topics such as sexual practices and substance use, nurses excel at building rapport, making shared decisions, and educating about risk reduction with an affirming, nonjudgmental approach.

Background In response to duty hour restrictions, hospitals expanded residency programs and added advanced practice providers. We sought to determine if type of clinical support was associated with emergency general surgery outcomes. Methods As part of our 2015 survey of acute care hospitals, we asked hospitals whether residents and advanced practice providers participate in emergency general surgery care. Data from responding hospitals were linked to patient data (≥18 years old admitted with an emergency general surgery diagnosis) from 17 State Inpatient Databases using American Hospital Association identifiers. Analyses compared emergency general surgery patient and hospital characteristics based on type of providers assisting emergency general surgery surgeons (none, only advanced practice providers, only residents, or both). Multivariable analysis determined if presence of advanced practice providers and/or residents was associated with type of management, mortality, or complications. Results Eighty-three hospitals and 49,271 unique emergency general surgery admissions were included. Hospitals without residents and advanced practice providers were most likely to manage patients operatively. However, hospitals with residents (alone or with advanced practice providers) had reduced odds of systemic complication compared with hospitals without clinical support (adjusted odds ratio 0.77 [95% confidence interval 0.60–0.98] and adjusted odds ratio 0.77 [95% confidence interval 0.62–0.95], respectively), while hospitals with only residents had the lowest odds of operative complication. Conclusion Our findings highlight the positive effect residents (alone or partnering with advanced practice providers) can have on emergency general surgery patient outcomes.

Introduction Care for many children with medical complexity (CMC) is fragmented, leading to increased family dissatisfaction and stress. We evaluated the impact of an Advanced-Practice Nurse and Care Coordination Assistant model medical care coordination program (MCCP) for CMC at an urban tertiary pediatric hospital on caregivers’ perceptions of several health care indicators. Method A retrospective pre-post survey was administered to parents of CMC enrolled in an MCCP for a minimum of 6 months. Questions were grouped into four domains: quality of life, caregiver satisfaction, care coordination, and caregiver self-efficacy. Mean scores of questions in each domain were compared from before program enrollment with those at the time of survey completion, using paired sample t tests. Result There was an increase in the mean score in all four domains. Discussion Parents of CMC experience an Advanced-Practice Nurse and Care Coordination Assistant model MCCP to be effective in improving the navigation of and satisfaction with their child's health care environment.

Introduction The National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) produces the National Certification Examination (NCE) and grants credentials to registered nurse anesthetists. To provide the profession with adequately prepared practitioners, the NBCRNA gauges anesthetists’ transition from training to practice. A key indicator is the first-time pass on the NCE. Aim The aim of this research was to determine whether success on the NCE’s preparatory Self-Evaluation Examination (SEE) predicts a first-time pass for the NCE. Methods This retrospective analysis consisted of applicants who fulfilled the general requirements for data acquisition and had taken both the SEE and NCE. Each applicant’s SEE information included the SEE total score, SEE domain scores, SEE test date, and the NCE results (pass or fail). Results The applicant’s age and days between SEE and NCE were associated with significant variance in success on NCE at first attempt. Total SEE score predicted performance nearly as well as all the other variables in the final regression model. Conclusion The components of the SEE mirror content areas of the NCE. This research emphasizes the importance of SEE testing as a predictor of students’ successful transition from nurse anesthesia programs to initial certification.

Background In 2004, the American Association of Colleges of Nursing (AACN) called for all nursing schools to phase out master's-level preparation for advanced practice registered nurses (APRNs) and transition to doctor of nursing practice (DNP) preparation only by 2015. Today, five years after the AACN's deadline, nursing has not yet adopted a universal DNP standard for APRN practice entry. Purpose The purpose of this paper is to examine the factors influencing the ability of nursing schools to implement a universal DNP standard for APRNs. Methods Deans from top-ranked nursing schools explore the current state of the DNP degree in the US. The authors draw upon their collective experience as national leaders in academic nursing, long-time influencers on this debate, and heads of DNP programs themselves. This insight is combined with a synthesis of the literature and analysis of previously unpublished data from the AACN on trends in nursing doctoral education. Findings This paper highlights issues such as the long history of inconsistency (in messaging, curricula, etc.) surrounding the DNP, certification and accreditation challenges, cost barriers, and more. The authors apply COVID-19 as a case study to help place DNP graduates within a real-world context for health system stakeholders whose buy-in is essential for the success of this professional transition. Discussion This paper describes the DNP's standing in today's professional environment and advances the conversation on key barriers to its adoption. Insights are shared regarding critical next steps to ensure national acceptance of the DNP as nursing's terminal practice degree.

The aging demographic shift occurring world-wide is creating an opportunity for innovative care models to address the burgeoning care needs of the expanding population of older adults. Nursing and advanced practice nursing as well as interprofessional models past and present hold insights into how to meet the needs of older adults across the continuum of care. A review of past and present models of care is provided. These models across settings emphasize maximizing the role of nurses and advanced practice nurses. The models reviewed include: On LOK and Programs of All-inclusive Care for the Elderly (PACE); Community Aging in Place, Advancing Better Living for Elders (CAPABLE); Teaching Nursing Homes; Interventions to Reduce Acute Care Transfers (INTERACT); Missouri Quality Initiative (MOQI); Evercare/Optum; Nurses Improving Care for Health System Elders (NICHE); Acute Care for the Elderly Unit (ACE Unit); Hospital Elder Life Program (HELP); Age-Friendly Health Systems; and the Transitional Care Model. Each model emphasizes education on the special needs of older adults, providing easy access to evidence-based tools and interventions, as well as strong interprofessional collaboration. Sustainable evidence-based nursing and interprofessional innovations are present across health care settings from the community, long-term care and the acute care setting to address the complex needs of older adults.

Telehealth is an acknowledged strategy to meet patient healthcare needs. In critical care settings, Tele-ICU's are expanding to deliver clinical services across a diverse spectrum of critically ill patients. The expansion of telehealth provides increased opportunities for advanced practice providers including advanced practice nurses and physician assistants; however, limited information on roles and models of care for advanced practice providers in telehealth exist. This article reviews current and evolving roles for advanced practice providers in telehealth in acute and critical care settings across 7 healthcare systems in the United States. The health system exemplars described in this article identify the important role of advanced practice providers in providing patient care oversight and in improving outcomes for acute and critically ill patients. As telehealth continues to expand, additional opportunities will lead to novel roles for advanced practice providers in the field of telehealth to assist with patient care management for subacute, acute, and critically ill patients.

Introduction Across the United States, unintentional shootings involving toddlers are on the rise. Pediatric nurses and nurse practitioners encounter families with toddlers regularly, allowing them the opportunity to make assessments and implement safety measures. The purpose of this study was to assess gun safety knowledge levels, health promotion strategies, and preventive interventions of advanced practice registered nurses (APRNs) Methods This quantitative study used an anonymous, online survey e-mailed to pediatric-focused APRNs using the National Association of Pediatric Nurse Practitioners e-mail list. Results The sample included 54 APRNs. The majority, 70.3%, reported asking parents about guns in the home; this was most often done with a new patient (62.3%, p = .05). APRNs were more likely (88.7%, p = .05) to believe that well-child practice standards should include questions about gun safety, but 56.4% (p = .033) responded that their workplace does not have a teaching plan or policy about gun safety. In addition, APRNs who are gun owners were more likely to screen for guns (62.5%, p = .05) and teach about safe gun storage (75.0%, p = .02). Discussion Overall, APRNs feel knowledgeable enough to assess and inform patients about safe gun storage, as well as interventions. One obstacle to effective promotion of gun safety may exist at the broader systemic level, as most of the practice settings do not have pertinent policies and resources for families of toddlers. Findings suggest that most APRNs are including gun safety teaching without an identified policy.

Purpose To explore how Epilepsy Specialist Nurses in the Republic of Ireland enacted their clinical role. Methods Qualitative descriptive design that involved individual and focus group interviews, observation and documentary analysis. Data were collected from 12 Epilepsy Specialist Nurses working in five hospital-based epilepsy services in Ireland, 24 multidisciplinary team members, and 35 people with epilepsy and their family members were involved. Data were analysed in NVivo using an inductive and deductive approach. Results Epilepsy Specialist Nurses work out of a value base that gives primacy to collaboration. active participation, relationship-based care, and respect for the voices of PWE and family members. They are key players in empowering people to self-manage their illness, Core dimensions of their clinical role includes: performing a comprehensive assessment to inform care and treatment; providing person-centred education; monitoring the impact of care and treatment; providing education to family members and significant others; providing psychosocial care to optimise psychological wellness; co-ordinating care to enhance patients’ journey; and quality assuring patient information. Conclusion Findings from this study highlight the key role ESNs played as members of the MDT in building and supporting PWE’s capacity to self-manage their illness. However, they also indicate deficits in the provision of information on sudden unexpected death in epilepsy and how to disclose a diagnosis of epilepsy by the ESN, as well deficits in their knowledge and confidence in supporting people experiencing significant mental health morbidities.

Learning interpretation of the 12-lead electrocardiogram is a critical component of health care curricula. Collaborative, multidisciplinary instruction provides an approach to teaching complex skills such as electrocardiographic (ECG) interpretation. Faculty from advanced practice nursing, pharmacy, emergency medicine, and cardiology collaborated to produce a 5-module podcast series on the fundamentals of 12-lead ECG interpretation for use with health care students. Students from multiple health care professional education programs at different universities worked together to learn ECG interpretation.

The prevalence of stress, anxiety, and depression have increased during the coronavirus disease (COVID-19) pandemic across age groups. Older adults may additionally be experiencing accelerated cognitive decline and increased behavioral and psychological symptoms of dementia related to the pandemic and associated isolation precautions. The advanced practice nurse has an opportunity to holistically intervene to mitigate the negative effects of isolation and promote older adults' wellbeing during challenging times.

Highlights • APRNs stand ready and willing to improve access to care across. • Federal HHS Secretary calls for lifting restrictions during COVID-19. • The Southeast U.S. remains the most restricted area for APRNs. • Now is the time to push forward on permanently removing APRN practice barriers. • Increased engagement of nurses in professional advocacy is needed., Advanced Practice Registered Nurses (APRNs) stand ready and willing to improve access to care across the United States, both during the COVID-19 pandemic and beyond. Yet, their practice remains restricted in certain states due to long outdated regulations, even as many other healthcare regulatory changes have occurred via executive order (e.g., allowing for telehealth reimbursement and expediated licensing). For instance, the APRN Compact has been on standby since 2015. When the Federal HHS Secretary called upon all governors to lift restrictions on APRNs during the public health crisis, seven of the 28 restricted states took no action, and the Southeast remained the most restricted area of the country. Now—in the Year of the Nurse and Midwife, during the COVID-19 pandemic—is the time to push forward on permanently removing APRN practice barriers. Nationwide, this can be accomplished by increased engagement of nurses, who may, in turn, engage the public, physician champions, and other pro-nursing organizations.

Background Advanced practice registered nurses (APRN) are expected to contribute to improved patient outcomes. Traditionally, clinical nurse specialists (CNS) have been the APRN role that led system-level nursing practice initiatives to advance care for specialty populations. Little is known about the work processes used by CNSs to achieve outcomes. Purpose This study identified common processes used by CNSs working in a variety of practice settings and specialties to advance nursing practice and achieve improved clinical outcomes. Methods Qualitative descriptive methods were used; a purposeful sample of CNSs with completed system-level projects participated in focus groups. Data were analyzed using standard content analysis process. Findings CNSs engaged in intricate interactions identified as articulation work involving the management of intersections between people, technology and organizations. This expert work is largely invisible. Self-agency, trust, and influence are a nexus upon which CNS work processes revolve. Discussion The findings provide insight into CNS work processes, lend credibility to the CNS's leadership abilities, and help explain why the CNS role and practice is often considered invisible and ambiguous.

Extensive research results show quality improvements associated with advanced cancer nursing roles. Despite this, these roles are not implemented in many countries. The aim of this cross-sectional, population-based study was to compare patients' perception of care, before and after the introduction of a new advanced nursing role, the coordination contact nurse (CCN), in a region in Sweden.All patients (with gynaecological, haematological, HeadNeck, upper gastrointestinal cancers) diagnosed in the region the year prior and one-year post introducing the new CCN role were identified from the Swedish Cancer Register. Data were collected using the European Organization of Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire (QLQ-C30 and QLQ-INFO25) and a study specific questionnaire.The results, based on baseline (n = 869) and follow-up data (n = 1003), show statistically significant patient-reported improvements after the introduction of the CCN role, regarding health-related patient information (EORTC QLQ- INFO25 global mean score increased from 41.23 to 44.16, p = 0.0006). We found statistically significant improvements related to availability of supportive care resources, e.g. increased reported access to contact nurse (from 53% to 66%, p ≤ 0.0001) and individual written care plans (from 40% to 54%, p 0.0001). We also found some improvements related to patient involvement and care coordination, but also room for further developments.The implementation of the new advanced cancer nursing role may have contributed to important improvements, but it has also identified areas in need of development. Further research with long-term evaluations of CCN roles in other contexts, are both needed and on-going.

Nurse practitioners (NPs) across the country are gaining full practice authority that includes authorization to prescribe legend and controlled drugs. Unrestricted prescriptive authority is necessary for NPs to practice to the full extent of their education and training. We reviewed the literature, state requirements, and accreditation criteria related to teaching advanced pharmacology content to NP students for preparation for prescribing. Nursing educators and advanced practice nursing leaders might consider establishment of standardized content for teaching advanced pharmacology to NP students to ensure graduates meet prescribing requirements for full practice authority.

Introduction The struggle to maintain quality education in the online environment has brought about the redesign for the family nurse practitioner courses. Background The family nurse practitioner program uses graduate Health Education Systems Incorporated examination as a quality indicator and program benchmark. A downward trend in Health Education Systems Incorporated examination scores stimulated a need for change. Two strategies were implemented to enhance engagement and improve synthesis of clinical information. Case-based learning and gamification involves the use of game thinking and game mechanics in non-game contexts to engage users in solving problems while the case-based discussions act as formative assessment tool, providing information on student's progress and development. Objectives To assess the implementation of innovative strategies on the Health Education Systems Incorporated examination scores and to enhance students engagement and synthesis of clinical information. Method Case presentations were created in the Learning Management System an online program, for every module. Interwoven throughout the module are various game elements. The game elements include voluntary participation with immediate feedback that can be both positive and negative and provides a social connection. The student has the freedom to fail and the freedom to choose without significant repercussions. Results The results showed examination scores increased significantly. Using a one-way analysis of variance to compare Health Education Systems Incorporated examination scores between semester cohorts of students, followed by a post hoc pairwise comparison a statistically significant difference (p Conclusion Although there are many approaches for online learning, using case presentations can mirror different social and cultural situations to challenge the learner. Case-based discussion and gamification strategies are effective in engaging students in a challenging environment. Student responded positively to case-base presentation with game elements. Using this approach is designed to challenge and add value to the learning experience.

This article presents a general analysis about academic training of Advanced Practice Nurses at international level. Firstly, some essential and global characteristics of advanced practice training, the core competencies and the difficulties found in the implementation of the academic training programs for these figures are presented. Secondly, the reality of advanced practice training in our country is explained, with emphasis on some university programmes at Masters, level and the expansion of the official nursing specialties. Then the European situation is addressed, showing a great variability among countries in the implementation of these roles, as well as an important heterogeneity in the academic training associated with their performance. Lastly, continuing with the international perspective, the academic training for advanced practice nurses in the USA, Latin America, Africa, Asia and Oceania is described.

In a context of aging of the population, increased prevalence of chronic diseases and increasing complexity, it is necessary to define new professional roles that can meet the health needs of the population. Added to this is the certainty that variability in clinical practice, as well as in health management, makes it necessary to use best evidence as the basis for decision-making. But the application of clinical practice based on evidence in a specific context implies a broad mastery of the available evidence, its applicability and limitations, as well as a deep understanding of the particular characteristics of the area where it is to be applied, from the "macro" (health policies, framework regulations, strategic lines, social values, etc.) to the "micro" level (local culture, user preferences, etc.). The "Health Service of the Balearic Islands", in collaboration with the Faculty of Nursing and Physiotherapy from the University of the Balearic Islands, proposes the development of new advanced practice nursing roles that focus their efforts on the planned implementation of evidence in clinical settings. Advanced practice nurses have managed naturally, thanks to their competence development, to exercise the role of promoting organizational and attitudinal changes that facilitate the implementation of evidence in organizations and complex environments.

Aim To determine the impact of advanced practice nurses in chronic wound care in the adequacy of treatments for patients with chronic wounds and the consumption of dressings in the districts where they have been implemented. Method A quasi-experimental pre-poststudy without a control group with 3 measurements: pre-implementation in 2015, one year after implementation in 2016, and 2 years post-implementation in 2017, in the health districts (HD) where the role of the advanced practice nurse in chronic wound care was piloted in Andalusia. The main variables were trained professionals, consultancies, prevalence of chronic wounds, adequacy of treatments and economic cost in materials for the participating HD. Results The training of a total of 2717 health teams with a total of 95,095 teaching hours was achieved. In addition, a total of 3871 consultancies were performed. The prevalence of patients with injuries in the home care (HC) programme and in care homes diminished significantly, to almost half. The adequacy of the treatments increased to 90% and savings of more than 250,000€ in dressings were achieved in just 2 years. Conclusion The prevalence of chronic wounds during the 2 years of implementation decreased by almost half. Adequacy of training and consultancy was achieved, rationalising health expenditure and ensuring efficient care for patients with chronic wounds.

The socio-demographic and epidemiological changes of our environment are characterized by an increase in aging, chronic illness, comorbidities and with it, a progressive escalation of the demand for care. These new demands and expectations of citizenship are accompanied by an evolution of health systems (technological advances, complexity of the healthcare network, limited resources), the need to develop new roles and competence in care, together with the opportunity that full academic development implies: Nursing undergraduate and posgraduate degrees. This is why, at present, it is necessary to reorient care models in order to achieve health care for more agile, efficient and better quality care processes, adapted to the needs and expectations of citizens and to the sustainability of health systems. The Public Health System of Andalusia (SSPA) has developed, in recent decades, different nursing roles that include new competences, with the aim of responding to the needs of citizens. The objective of this article is to present how the competences development framework of nurses has been configured in the SSPA, which also integrates advanced skills in care and advanced practice profiles (Clinical Nurse Specialists and Advanced practice nurses).

Advanced Practice Nursing has been a reality in the international context for several decades and recently new nursing profiles have been developed in Spain as well that follow this model. The consolidation of these advanced practice roles has also led to of the creation of tools that attempt to define and evaluate their functions. This study aims to identify and explore the existing instruments that enable the domains of Advanced Practice Nursing to be defined. A review of existing international questionnaires and instruments was undertaken, including an analysis of the design process, the domains/dimensions defined, the main results and an exploration of clinimetric properties. Seven studies were analysed but not all proved to be valid, stable or reliable tools. One included tool was able to differentiate between the functions of the general nurse and the advanced practice nurse by the level of activities undertaken within the five domains described. These tools are necessary to evaluate the scope of advanced practice in new nursing roles that correspond to other international models of competencies and practice domains.

Advanced practice nurses are in a key position to meet the increasing demand for health care providers in North America, but the lack of clinical sites, qualified nursing faculty, and small preceptor pools hinder advanced practice nursing program expansion. Simulation is a pedagogical methodology that is used in advanced practice nursing education, yet regulatory agencies do not allow simulation to replace direct patient care experiences. Simulation enhances clinical experiences and allows for better learning and assessment. This article invites dialogue regarding the role of simulation in providing quality clinical educational experiences for the advanced practice nursing student.

Students who participate in the Vanderbilt Program for Interprofessional Learning are required to attend Immersion, our program of orientation for teams of interprofessional students. Medical, advanced practice nursing, pharmacy, and social work students coming from different institutions are required to complete the 4 day “Immersion” before beginning in their respective academic programs, as a way to decrease the development of professional bias. Many of the students are also new to the Nashville area, and the Immersion program introduces the students to the community and the populations they will be serving in professional school and beyond. Immersion includes a range of activities, including community tours, poverty simulations, creation of life maps, personality identification, team building, patient storytelling, and introduction to professional life. Each day has a specific theme: Self, Community, Professions and the Patient. Student evaluations for Immersion are overwhelmingly positive. The focus of this paper is to describe the curricular design of the Immersion week, report student feedback, and discuss lessons learned that might provide guidance for other educational programs.

To describe the profile of patients evaluated by Nurse Care Management in an Emergency Department and identify the type of alternative healthcare resource assigned and report the results of clinical practice.Prospective follow-up, on admission to the Emergency Department in an acute hospital and on discharge from the alternative healthcare resource, of patients assessed by Nurse Care Management, from July to December 2015. The patient characteristics, social environment and results of clinical practice were studied.190 patients were included of whom 13 were readmitted (6.8%). 122 (59.8%) cases from the Emergency Department were referred to to intermediate care facilities, 71 (34.8%) cases for domiciliary care, 10 (4.9%) cases were referred to an acute care hospital and 1 (0.5%) died. Patients referred to intermediate care were more complex, presented geriatric syndromes as their reason for admission and diagnosed with dementia, while those referred to home care presented more respiratory and cardiovascular illnesses (p0.05). The mean Barthel Index and polypharmacy before emergency admission were higher than at the time of discharge from the alternative healthcare resource (p0.05).Patients presenting with advanced age, complexity, comorbidity, are referred to intermediate care facilities or domiciliary care, they are admitted to acute care hospitasl and are readmitted less than other patients. After being discharged from the alternative resource, they lose functional capacity and present less polypharmacy.

MANAGING THE TRANSITION FROM NURSE TO ADVANCED PRACTICE NURSE Qualified nurses who go on to undertake further training often find the transition difficult. This phenomenon has been studied more specifically in the field of advanced practice nursing. As France prepares to train and deploy state registered advanced practice nurses, it is essential to incorporate the learnings arising from research, in order to facilitate their training programme and their integration into their first role. Taking these elements into account will have a direct impact on the clinical results for which they will be accountable and their quality of working life.

Purpose The development of advanced nursing practices (ANP) can meet challenges presented by evolving needs of health care. We aimed at describing the approach taken to implement ANP in a pediatric oncology-hematology unit. Method The Participatory, Evidence-informed, Patient-centered Process for Advanced practice was considered as a conceptual framework for the development, implementation and evaluation of the nursing role. Successive steps were taken for identifying patients and family needs, defining the health care priorities, and establishing a new health care model. Results The seven steps of the PEPPA framework were carried out over a year and contributed to the identification of the tasks and the role of the advanced nurse practitioner in the patient care pathway. The implementation of ANP was gradually achieved with the development of new evidenced-based health care procedures. The subsequent approval of a contract specification for advanced nurse practitioners facilitated the onset of a specific consultation, which facilitated a holistic approach. Conclusion The impact of the implementation can be appreciated at different levels: i) the patient and his or her family, with improvement of communication and continuity of care; ii) the interdisciplinary team, with development of a dynamic and greater motivation of the health care providers; and iii) the profession, with a greater recognition of the competencies and conceptualization of the new role. An assessment of the process, the structure and the results should be carried out to validate the role of the advanced nurse practitioner throughout the long journey of a child with leukemia.

Purpose Staff nurse turnover is a costly problem for healthcare managers, which has been extensively studied. Now, managers are facing a new challenge attributed to nurses leaving their current positions to become advanced practice nurses. We aimed to identify factors associated with new nurses' career choice as advanced practice nurses. Methods We used descriptive comparative design to analyze data from 946 nurses who reported working as new staff nurses in 2006 and 10 years later reported working as advanced practice nurses. Results We add to the topic of nurses' turnover by identifying the factors associated with nurses leaving their jobs to become advanced practice nurses. The factors include being younger, not married, enrolled into a formal education program, and having a bachelor's degree at entry into nursing practice. Conclusions To better manage staff nurse turnover due to nurses becoming advanced practice nurses, managers should monitor educational policy trends on bachelor's entry into practice, new nurses' enrollment status into formal education program upon hire, and new nurses' demographics.