Comparing satisfaction and outcomes in on-campus versus virtual education for nurse practitioner students.

ABSTRACT: This article highlights the development and implementation of interactive training experiences for graduate nursing students as part of specialty training in endocrinology. Emphasis was placed on accomplishing the shift from on-campus to virtual training while maintaining fidelity and student satisfaction. A total of 106 graduate nursing students from five cohorts submitted evaluations. Student satisfaction remained high regardless of whether the content was delivered in person or virtually. Most students in the virtual cohorts evaluated the online training positively. Student presentation grades were highest with on-campus delivery. Transitioning in-person training to a virtual environment can be an effective method of delivering nurse practitioner education while promoting student satisfaction. Recommendations for optimizing hybrid learning experiences are offered based on adult learning principles.

Community Health Outside the Exam Room: Extracurricular Learning to Augment Nurse Practitioner Student Practice Readiness.

BACKGROUND: The curricular requirements of nurse practitioner (NP) programs are well established. NP students' clinical practicums provide a context for the extracurricular acquisition of administrative, operational, and systems-focused NP skills. PROBLEM: Acquisition of extracurricular NP skills is variable and highly dependent on a student's clinical placements. The COVID-19 pandemic exacerbated this variability by limiting students' access to traditional clinical rotations. APPROACH: With our practice partners, we inventoried the behaviors that are associated with new graduate NP readiness for practice in community health centers. We then developed an extracurricular seminar series to develop these behaviors. Each seminar in the series was presented by a preceptor. OUTCOMES: Students reported gains in their perceived readiness to practice. The casual format and preceptor presenters were highly valued by students. CONCLUSIONS: NP educators should consider leveraging academic-practice partnerships to standardize students' acquisition of administrative, operational, and systems-focused NP competencies.

Peer patient round table: An innovative approach for evaluating clinical performance for nurse practitioner students.

Clinical performance is a crucial part of evaluation in nurse practitioner education and has traditionally been accomplished through faculty site visits. The evolution of distance learning and on-line programs along with the recent COVID-19 pandemic has further complicated completing site visits, requiring innovative strategies. 'The Peer Patient Round Table (PPRT)' was developed as an innovative evaluation method of student performance. It utilizes the standardized patient simulation concept and shared role-play modality via a telehealth platform. During the PPRT evaluation session, students were involved in a shared role-play of three roles; as a patient, a nurse practitioner student, and a preceptor in individual scenarios. A family nurse practitioner program at Radford University, located in Southwest Virginia, incorporated the PPRT method as the alternative student evaluation method starting May 2020 during COVID-19 pandemic for the last two years. After the first year of implementation of the PPRT, students and faculty were surveyed about the effectiveness of PPRT as a clinical evaluation method as well as their satisfaction with the modality. This article discusses the details of the PPRT procedures, PPRT experiences from faculty and students along with lessons learned.

Identifying barriers and facilitators for nurse practitioners' opioid management of chronic pain.

BACKGROUND: Drug overdose deaths greatly increased during the COVID-19 pandemic, with 100,306 cases occurring in the United States over 12 months from 2020 to 2021, an increase of 28.5% from the year before. Three quarters of these deaths involved opioids, and this epidemic has seriously complicated chronic pain management. The role of nurse practitioners (NPs) in opioid prescription has expanded since Affordable Care Act passage in 2010, but their prescription of opioids for chronic pain management is not well understood. OBJECTIVES: This integrative review aimed to identify barriers, facilitators, and other factors influencing NPs' management of chronic pain with opioids. DATA SOURCES: Five databases were searched for the highest level of evidence in articles published from 2011 to 2021. Search results were refined to focus on NPs' chronic pain management via opioid prescription. CONCLUSIONS: Nine studies were selected for the review. Six identified themes were indicative of barriers, facilitators, and other factors affecting NPs' opioid management: nurse practitioner education, patient subjectivity and patient education, systemic change and alternative treatment access, interprofessional collaboration, nurse practitioner prescriptive authority, and practice environment. States and schools of nursing should modify policy and curricula to better support NPs' opioid management and reduce associated prescription barriers. IMPLICATIONS FOR PRACTICE: NPs' opioid management can best be improved by providing them with current guideline-based education regarding opioid prescription, emphasizing patient education, supplying NPs with systemic support, encouraging interprofessional collaboration, and solving the prescriptive authority issues. Enhancing NPs' opioid prescription and chronic pain management knowledge would help to mitigate the opioid epidemic.

Stakeholder perceptions of the efficacy, barriers, and facilitators of telemental health clinical experiences during COVID for nurse practitioner students.

BACKGROUND: Telemental health services grew during the COVID pandemic, resulting in psychiatric-mental health nurse practitioner students obtaining clinical hours through this modality. Although patient outcome data demonstrate the efficacy of telemental health services, data on the efficacy of learning through telehealth clinical experiences are lacking. PURPOSE: To explore perceptions of learning through telehealth clinical experiences by students, preceptors, and faculty and to identify perceived barriers and facilitators to facilitating telehealth clinical experiences. METHODOLOGY: Mixed-methods exploratory study using web-based, researcher-designed, cross-sectional surveys eliciting perceptions of learning and perceived barriers and facilitators to telemental health clinical experiences sent to current and former PMHNP students and their preceptors of a state university in the southwest along with PMHNP faculty in the National Organization of Nurse Practitioner Faculties. Students and preceptors were offered the option to participate in a semistructured interview. RESULTS: Twenty students (35.7%), 22 preceptors (24.7%), and 19 faculty (25.3%) participated in the surveys. Three preceptors and three students volunteered for interviews. Telemental health clinicals were perceived by students as equivalent to or superior to in-person learning. Preceptors rated the teaching/learning environment through telemental health as equivalent or better as compared with in-person clinicals with two exceptions. Faculty-rated greatest barrier to telemental health clinicals was telephone visits because of technology issues. CONCLUSIONS: Telemental health clinicals can provide a high-quality learning experience for students. IMPLICATIONS: Preceptors should be provided with resources for facilitating telemental health clinicals. Ongoing discussions regarding the number of clinical hours recommended through telehealth are needed.

Promoting understanding of medical decision-making coding for nurse practitioner students.

ABSTRACT: Nurse practitioners (NPs) are often responsible for coding patient encounters for reimbursement. Students should learn the basics of this skill during their educational preparation. On January 1, 2021, the American Medical Association and the Centers for Medicare & Medicaid Services implemented new guidelines to the evaluation and management office appointment documentation and coding. The new medical decision-making (MDM) guidelines created a learning curve for NP students, faculty, and preceptors. An additional obstacle was encountered when on-campus preclinical intensives, which included a coding practice session, were canceled due to the COVID-19 pandemic. The faculty of an NP program identified MDM coding as a difficult concept to teach in an asynchronous learning environment. In response, the faculty developed and implemented synchronous online case study sessions that incorporated active student participation and real-time feedback, thus increasing engagement with peers, faculty, and the MDM concepts. The purpose of this article was to present a synchronous method for teaching MDM coding to NP students, and the outcomes, lessons learned, and implications for nursing education and practice.

Breaking Bad News via Telehealth: Simulation Training for Nurse Practitioner Students.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic demonstrated educators must consider students' future practice will involve patient communication via telehealth, including breaking bad news. METHOD: This mixed-methods analysis was conducted among 33 nurse practitioner (NP) students at two universities. Questionnaires were analyzed before and after a simulation training session with standardized patients to determine students' perceptions, learning satisfaction, confidence, and self-rated preparedness for delivering bad news via telehealth. RESULTS: Students' self-rated levels of preparedness for delivering bad news were higher after participating in the simulation. Students found the teaching methods to be effective, enjoyable, motivating, and suitable to individual learning styles. Two themes emerged that described students' perceptions of the experience: valuable simulation processes and multifaceted learning applicable to future NP practice. CONCLUSION: Breaking bad news via virtual platforms is new and challenging. Findings suggest this simulation experience provided a valuable tool for augmenting didactic training for NP students. [J Nurs Educ. 2022;61(9):528-532.].

The characteristics and practice proficiency of nurse practitioners who care for older adults.

Roughly 54 million Americans are 65 years of age or older. Given the number of comorbid diseases reported in older adults, healthcare tailored to the specific needs of this population is imperative. Nurse practitioners (NPs) are uniquely positioned to provide care to older adults; yet little is known about the geriatric-oriented NP workforce. In this study, four professional organizations distributed a survey link to their members who were queried on their demographic, employment, and practice characteristics; one organization's members responded to a previous survey, providing two time points for comparison. Compared with 2016 respondents, there was minimal growth in diversity, fewer who practice in suburban or rural areas, and restrictions on clinical education related to the ongoing pandemic. The findings from this study should alert policymakers of the need to address the development of an adequate workforce of clinicians who specialize in geriatrics.

Measuring the impact of a COVID-19 continuing education program.

ABSTRACT: The COVID-19 pandemic has led to a rapidly shifting health care environment, with frequent changes to best practices, which can lead to knowledge and practice gaps among health care providers, including nurse practitioners (NPs). The purpose of this paper was to describe a continuing education (CE) program developed to address COVID-19 knowledge gaps and to report on the changes in knowledge, competence, and confidence following program completion. The CE program was a 2.5 to 2.67 contact hour webinar delivered in July 2020, October 2020, and February 2021. Content included COVID-19 prevention, diagnosis, and management and was updated before the second and third webinars. Changes in content and webinar audience participation in the question and answer portion were reflected in the CE credit awarded. Preactivity and postactivity knowledge, competence, and confidence levels were assessed among activity completers. Changes between the preactivity and postactivity evaluation were compared. A total of 2,901 learners were included in the analysis, of whom 91.6% were NPs. Overall, baseline knowledge of COVID-19 transmission, diagnosis, and treatment was low. Substantial improvements in knowledge, competence, and confidence were reported from baseline to postactivity evaluation, with increases of 47-73% overall. Furthermore, learner confidence in identifying patients at risk for severe COVID-19 and counseling patients on prevention and transmission significantly increased. Despite plans to implement strategies to improve COVID-19 management, several barriers to uptake were identified. The rapid development of a COVID-19 CE program resulted in substantial gains in NP knowledge related to prevention, diagnosis, and management, with possible implications for nearly 68,000 patient encounters per month.

Innovative Opportunities for Nurse Practitioner Education Uncovered by the Pandemic.

BACKGROUND: The coronavirus disease 2019 pandemic resulted in the abrupt withdrawal of clinical sites for nurse practitioner (NP) students during the Spring semester of 2020. This situation necessitated the identification of innovative clinical opportunities to ensure advanced practice nursing students met course objectives and program requirements. METHOD: This article describes innovative clinical opportunities that met the needs of the community, including those impacted by the pandemic, and enabled NP students' progression toward completing clinical requirements. RESULTS: Participation in these unique opportunities provided more than 130 NP students with meaningful clinical experiences to increase competence in the care of vulnerable populations and communities during a public health crisis. CONCLUSION: Experiences supported competency development in the areas of leadership, clinical management, population health and infection control, policy and advocacy, informatics, telehealth, and ethical considerations while providing essential services to the community. These innovative clinical opportunities may be useful for graduate clinical programs worldwide. [J Nurs Educ. 2022;61(3):153-155.].

Exploring the Effect of COVID-19 on Graduate Nursing Education.

Graduate nursing students are both nurses and adult learners. During the COVID-19 pandemic, many found themselves working on the frontlines while maintaining their studies and confronting challenges in their professional, educational, and personal lives. Changes in work environments, including redeployments, increased hours, and furloughs, challenged their work-study balance. The rapid pivot to virtual instruction allowed graduate nursing students to continue their coursework, but asynchronous delivery of course content increased their isolation and stress. Academic institutions supported graduate nursing students through innovations such as regular town hall meetings and flexible attendance policies, while the widespread closure of clinical learning sites became one of their biggest challenges. A minimum of 500 hours of supervised direct patient care is required to prepare a student to practice as a nurse practitioner, but there is no formal, financed clinical placement system for nurse practitioner students-leaving this clinical learning requirement particularly vulnerable to disruption during the pandemic. Some of the clinical learning alternatives employed included occupational health work, tele-precepting, and simulation. Since telehealth will be a part of the future of health care delivery, tele-precepting practices should be further developed, but simulation was underused and not an acceptable replacement for supervised direct patient care. A postpandemic future needs to limit gaps in the development of safe, competent health care providers by viewing graduate nursing students as essential workers and ensuring their access to the robust didactic and clinical learning opportunities that will best position them as leaders in health care.

Rapid Curricular Innovations During COVID-19 Clinical Suspension: Maintaining Student Engagement with Simulation Experiences.

Health care education programs were faced with the need to quickly adapt to a new reality during the coronavirus disease 2019 pandemic. Students were temporarily suspended from campus and clinical sites, requiring prompt changes in structure to their didactic and clinical learning. This article describes the rapid adjustments that one midwifery and women's health nurse practitioner education program created using both synchronous and asynchronous simulation experiences to promote student learning and ongoing engagement. Flexibility and reflexivity were needed by faculty and students alike in the face of the multiple changes wrought by the pandemic. Curricular changes were made simultaneously in many courses. Objective structured clinical examinations simulate telehealth experiences that assess knowledge, clinical reasoning, and professional behaviors via a scripted scenario and an actor patient. On-call simulations mimic telephone triage and provide students the opportunity to build listening, assessment, and management skills for prenatal and intrapartum scenarios. Students are provided equipment and virtual instruction in an intrauterine device insertion session, which promotes skill acquisition and self-confidence. Trigger films are used to visualize real-life or scripted clinical encounters, leading to discussion and decision-making, particularly in the affective domain. Bilateral learning tools, similar to case studies, provide students an opportunity to demonstrate their knowledge and critical thinking with a mechanism for faculty feedback. Web-based virtual clinical encounter learning tools using patient avatars prompt additional student learning. Suturing skills introduced in live remote group sessions are augmented with video-guided individual practice. This article describes each of these adapted and innovative simulation methods and shares lessons learned during their development and implementation.

Critical juncture: The doctor of nursing practice and COVID-19.

ABSTRACT: The year 2020 was one of tremendous challenge and change for our communities and our profession. As the next decade unfolds, the doctor of nursing practice (DNP) will be required for entry to practice as a nurse practitioner (NP), and we will all continue to recover individually and as a nation from the experiences of the year 2020. Doctor of nursing practice-prepared NPs need to be equipped to take the lead in post-COVID recovery and the challenges the US health care system faces through an increased emphasis on curricula and clinical experiences focused on health disparities, community health, and health promotion.

Nurse practitioner students as an essential workforce: The lessons of coronavirus disease 2019.

BACKGROUND: The coronavirus disease 2019 (COVID-19) disrupted the education and clinical training of nursing students. Clinical sites shut out students over low equipment supplies, physical distancing requirements, and redeployment of staff. PURPOSE AND METHODS: The purpose of this paper is to highlight a progressive solution to engage nurse practitioner students as part of the COVID-19 response given the disruption of their traditional clinical training environments so that student could continue to matriculate and graduate in a timely manner. FINDINGS: Nurse practitioner students swiftly responded and were deemed an essential part of the nursing workforce. DISCUSSION: Policy implications for advanced nursing practice and education for telehealth and simulation research moving forward is also provided.

In the time of COVID .

ABSTRACT: JAANP Fellow Dr. Leslie-Faith Morritt Taub, NYU Adult-Gerontology Primary Care Program Director, describes the emotional, political, and social impact of COVID-19 on one graduating cohort of nurse practitioner (NP) students at New York University and one incoming cohort of students. Through the lens of a seasoned professor she describes the changes to her teaching methods because she leads these students through the course work and clinical work required to take on the role of the NP in the midst of a global pandemic in the heart of New York City.

Innovative Approach to Procedure Skills: A Nurse Practitioner Educator's Response to COVID-19.

BACKGROUND: The The Neonatal Nurse Practitioner program at The Ohio State University transitioned from a traditional face-to-face program to a distance-enhanced hybrid model providing course content online with campus visits for procedural skills and simulation in 2017. Although the 2020 COVID-19 pandemic necessitated cancellation of all in-person events across the university, the neonatal nurse practitioner students' learning needs remained the same. METHOD: The onsite experience was redesigned for virtual delivery. Procedural content was accomplished through student-led small-group collaborative critical thinking activities surrounding procedural complications, and other faculty-led scenario discussions. RESULTS: Students collaborated for a Complications Rounds activity (1-day) that promoted learning about procedural skills from a global perspective including safe techniques, monitoring, risks, and troubleshooting complications. CONCLUSION: Procedural content can be achieved when in-person learning is not possible. The Complications Rounds approach can mitigate delays or gaps in practical experiences. Examining complications in-depth increases preparedness, promoting greater awareness of harm prevention when these present in future practice. [J Nurs Educ. 2020;59(12):692-696.].

Introducing telehealth skills into the Doctor of Nursing Practice curriculum.

ABSTRACT: Telehealth training was important for nurse practitioner (NP) students prior to the COVID-19 pandemic, but now it is essential. Training in telehealth allows access to health care for vulnerable populations in rural health areas and beyond. As the future of health care delivery changes, providers will be required to use this technology. Therefore, it is imperative that such training become part of NP education to prepare students to be technologically competent providers in the 21st century. The objective of this educational pilot project was to educate Doctor of Nursing Practice nurse practitioner students to conduct patient interviews and provide interprofessional collaboration using telehealth. The project addressed a gap in the literature on planning for simulations from varying NP specialties and provided feedback from standardized patients on their experiences. A total of 83 students from four specialty tracks received telehealth education. Students then interviewed simulated patients and provided a collaborating report. The students and patients were asked to complete questionnaires to assess the modules and the experience itself. Quantitative descriptive data were gathered, and qualitative themes were obtained from open-ended questions. Both the students and simulated patients indicated that they appreciated the ease and convenience of interviewing patients through technology. Both struggled with issues related to the technology and the need to have backup systems available. The students demonstrated that they were very capable of using telehealth and were generally very positive about the experience.

Exploring Readiness for Teleprecepting in Psychiatric Mental Health Nurse Practitioner Training.

OBJECTIVE: Telehealth offers a solution to many challenges in health care, including the shortage of psychiatric providers. Recently the need to limit patient and provider exposure to coronavirus disease 2019 (COVID-19) has escalated implementation of telehealth across the globe. As telehealth utilization expands, its role in nursing education and training requires systematic evaluation. Since publication of the National Organization of Nurse Practitioner Faculty white paper supporting telehealth in health care delivery and nurse practitioner education, several studies have demonstrated successful didactic instruction and training in telehealth. However, a recent literature review found no studies evaluating the use of telehealth technology as a means of precepting in clinical training. METHODS: This small-scale qualitative study investigates the readiness of one behavioral health clinic to provide teleprecepting to psychiatric mental health nurse practitioner students. Two preceptors and one student were interviewed using a peer-reviewed semistructured interview guide using video chat. Responses were reviewed, coded, and categorized into themes. RESULTS: Thematic analysis of the interviews revealed three categories for consideration in establishing teleprecepting. Clinical factors, logistics, and comparison with traditional precepting are discussed. Interviewees viewed teleprecepting as a viable method of increasing access to clinical training. CONCLUSIONS: This project supports teleprecepting as a feasible strategy for improving access to clinical training and as a technological resource that merits systematic evaluation. Practice guidelines are needed for teleprecepting of advanced practice registered nurse students, and both preceptors and students may benefit from training to support best practices prior to implementation.