neonatal nurse practitioner

Neonatal nurse practitioner ethics knowledge and attitudes

Background: Neonatal nurse practitioners have become the front-line staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described.

Research aim: To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is reflected in attitudes toward ethical dilemmas in the neonatal intensive care unit.

Research design: This was a prospective cohort study that examined decision making at the threshold of viability, life-sustaining therapies for sick neonates, and a ranking of the five most impactful ethical issues.

Participants and research context: All 47 neonatal nurse practitioners who had an active license in the State of Mississippi were contacted via e-mail. Surveys were completed online using Survey Monkey software.

Ethical considerations: The study was approved by the University of Mississippi Medical Center Institutional Review Board (IRB; #2015-0189).

Findings: Of the neonatal nurse practitioners who completed the survey, 87.5% stated that their religious practices affected their ethical decision making and 76% felt that decisions regarding life-sustaining treatment for a neonate should not involve consultation with the hospital’s legal team or risk management. Only 11% indicated that the consent process involved patient understanding of possible procedures. Participating in the continuation or escalation of care for infants at the threshold of viability was the top ethical issue encountered by neonatal nurse practitioners.

Discussion: Our findings reflect deficiencies in the neonatal nurse practitioner knowledge base concerning ethical decision making, informed consent/permission, and the continuation/escalation of care.

Conclusion: In addition to continuing education highlighting ethics concepts, exploring the influence of religion in making decisions and knowing the most prominent dilemmas faced by neonatal nurse practitioners in the neonatal intensive care unit may lead to insights into potential solutions.

Keywords: Decision making; ethics consultation; informed consent; parental permission; religion; threshold of viability.

Nurse practitioner integration: Qualitative experiences of the change management process

Aim: The aim of this qualitative research was to explore perceptions of organisational change related to the integration of nurse practitioners from key nursing stakeholders.

Background: The ongoing delivery of effective and efficient patient services is reliant upon the development and sustainability of nurse practitioner roles. Examination of the factors contributing to the under-utilization of nurse practitioner roles is crucial to inform future management policies. A change management theory is used to reveal the complexity involved.

Method: Qualitative interviews were undertaken using a purposive sampling strategy of key stakeholders. Thematic analysis was undertaken and key themes were correlated to the theoretical framework.

Results: The results confirm the benefits of nurse practitioner roles, but suggest organisational structures and embedded professional cultures present barriers to full role optimization. Complicated policy processes are creating barriers to the integration of nurse practitioner roles.

Conclusion: The findings increase understanding of the links between strategic planning, human resource management, professional and organisational cultures, governance and politics in change management. Effective leadership drives the change process through the ability to align key components necessary for success. Sustainability of nurse practitioners relies on recognition of their full potential in the health care team.

Implications for nursing management: The results of this study highlight the importance of management and leadership in the promotion of advanced nursing skills and experience to better meet patient outcomes. The findings reinforce the potential of nurse practitioners to deliver patient centred, timely and efficient health care.

Keywords: change management; health care reform; human resource management; nurse practitioners; organisational culture; organisational structure.

Transformational leadership to promote nurse practitioner practice in primary care

Aim: This study investigated transformational leadership from the perspectives of primary care nurse practitioners.

Background: The growing workforce of nurse practitioners in the United States could play a critical role in meeting the increasing demand for primary care. Little is known about how leadership within primary care practices could promote nurse-practitioner care. Transformational leadership is a widely recognized leadership style that affects clinician practice and outcomes.

Method: A cross-sectional survey design was used to collect data from nurse practitioners in New York state in 2012. The online survey containing measures of nurse practitioners and leadership relationships was completed by 278 nurse practitioners.

Results: The four factors of transformational leadership-idealized influence, inspirational motivation, intellectual stimulation, and individual consideration-were recognized by nurse practitioners. Almost half of nurse practitioners reported that leadership did not share information equally between nurse practitioners and physicians (idealized influence), and 45.9% reported that nurse practitioners were not represented on important organisational committees (intellectual stimulation).

Conclusion: Transformational leadership can be applied to promote nurse practitioner practice in primary care. Future research should explore how transformational leadership affects nurse practitioner care and outcomes.

Implications for nursing management: Leaders in primary care practices should consider applying transformational leadership principles to promote nurse practitioner practice.

Keywords: nurse practitioner; primary care; transformational leadership.

Predictors of nurse practitioner retention

Background and purpose: Increased utilization of nurse practitioners (NPs) has been proposed to reduce the shortage of primary care providers, so identifying factors related to retention of NPs is important for health care organizations. The purpose of this study was to examine the relationship of Misener Nurse Practitioner Job Satisfaction Scale factors and nurse demographic characteristics with NP retention, as defined by the number of years at the current position and intention to leave the current position within 5 years.

Methods: A survey was distributed via email to members of the Texas NP Organization.

Conclusions: Three hundred fifteen NPs participated in the study. Years of experience (p < .001), salary (p = .018), and benefits (p = .007) were significantly associated with longer duration of employment at the current position, after controlling for the other variables in the linear regression model. After adjusting for the other variables in the logistic regression model, higher challenge/autonomy factor scores (p = .016) and higher annual salary (p = .032) were associated with significantly lower odds of intention to leave the current position within 5 years.

Implications for practice: Interventions to increase NP autonomy and facilitate employment in positions with more competitive salaries are likely to improve NP retention.

Appraisal of the emergency nurse practitioner specialty role

The role of the Emergency Nurse Practitioner (ENP) has evolved as a specialty and is appreciated within the context of the 2008 Consensus Model document (APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee, 2008). The first in a series of five articles, this article describes the appraisal of the ENP role as well as the specialty and the distinctive role of the ENP. The second article, Emergency Nurse Practitioner Practice Analysis: Report and Implications of the Findings, presents research to support the scientific basis of emergency specialty practice and content validity for a national certification program. Article 3, Beyond Competencies; Practice Standards for Emergency Nurse Practitioners: A Model for Clinicians, Educators, and Employers, introduces a new conceptual model that defines the specialty of emergency care’s knowledge, skills, and abilities identified by the ENP practice analysis as practice standards not traditional competencies. In Article 4, Proposed Standardized Educational Preparation for the Emergency Nurse Practitioner, essential content for ENP preparation within graduate, postgraduate, and doctoral programs. The fifth article, Envisioning the Future for ENPs: Implications for Clinical Practice, Education, Research, and Health Policy, describes how ENPs are envisioning and impacting the future of emergency care and how their evolution can serve as a model for development of other advanced practice nursing specialties.

Mentoring New Graduate Nurse Practitioners

There is a critical shortage of neonatal nurse practitioners (NNPs) in the United States. The NNP shortage increases workload and negatively affects job satisfaction, which ultimately impacts patient safety. Therefore, it is imperative to identify strategies to improve job satisfaction and retention. Authors of current evidence supported the connection between mentoring and role transition, job satisfaction, and intent to stay. Mentorship is key to the success of new graduate nurse practitioners as they develop confidence in the nurse practitioner (NP) role. The aim of this integrative review is to examine the existing evidence regarding mentoring of advanced practice nurses and the potential impact on the NNP workforce.

Keywords: intent to stay; job satisfaction; mentor; neonatal nurse practitioner; role transition.

Development of Nurse Practitioner Competencies for Advance Care Planning

This article describes the development of nurse practitioner (NP) competencies for advance care planning. Nurse practitioners are well positioned to implement advance care planning with their patients; however, very few patients have an advance care plan. A modified Delphi method was used to engage NPs in achieving consensus for advance care planning competencies. In round 1, draft competencies were developed from the findings of a survey of NP beliefs, knowledge, and level of implementation of advance care planning. In round 2, 29 NPs participated in the evaluation of the draft competencies and their components. Revisions were made, and a final round was conducted where 15 of the original NP participants confirmed their consensus with the final document. The final document includes 4 competencies, each with several elements: (1) Clinical Practice, (2) Consultation and Communication, (3) Advocacy, and (4) Therapeutic Management. Advance care planning competencies will provide NPs with a guide that can be used to ensure that they are able to clearly identify their distinct role in advance care planning. These competencies may inform the integration of advance care planning in a variety of health care settings and with other health care providers.

Professional organization membership: Advancing the nurse practitioner role

With a paucity of literature on professional organization membership by nurse practitioners (NPs), the authors base the discussion of the personal benefits associated with membership on literature focusing on clinicians other than NPs and their personal experiences as members of multiple organizations. Membership is described as related to NP socialization, engagement, networking, mentorship, advocacy, policy, leadership development, research dissemination, professional development, and volunteerism. In addition to encouraging active participation in one or more professional organizations, the need for research into factors influencing the degree to which NPs participate in organizations and the associated benefits is identified.

Keywords: Advanced practice nurse (APN); leadership; nurse practitioners; professionalism.

 

Sources:

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Lowe G, Plummer V, Boyd L. Nurse practitioner integration: Qualitative experiences of the change management process. J Nurs Manag. 2018;26(8):992-1001. doi:10.1111/jonm.12624
Poghosyan L, Bernhardt J. Transformational leadership to promote nurse practitioner practice in primary care. J Nurs Manag. 2018;26(8):1066-1073. doi:10.1111/jonm.12636
Hagan J, Curtis DL Sr,. Predictors of nurse practitioner retention. J Am Assoc Nurse Pract. 2018;30(5):280-284. doi:10.1097/JXX.0000000000000049
Hoyt KS, Evans DD, Wilbeck J, et al. Appraisal of the emergency nurse practitioner specialty role. J Am Assoc Nurse Pract. 2018;30(10):551-559. doi:10.1097/JXX.0000000000000134
Moss C, Jackson J. Mentoring New Graduate Nurse Practitioners. Neonatal Netw. 2019;38(3):151-159. doi:10.1891/0730-0832.38.3.151
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