An exploration of perceived neonatal nurse practitioner authority in a restricted practice setting.

BACKGROUND: Perceptions of autonomy in practice affect Neonatal Nurse Practitioner (NNP) job satisfaction, retention, and motivation to pursue NNP roles. However, Novice to Expert theory describes the processes for transitioning to nurse practitioner roles are not in relationship with NNP practice autonomy. PURPOSE: Relationships between Advanced Practice Registered Nurse (APRN) practice authority, state restrictions, APRN volume, and health care access exist. However, do APRN perceptions of autonomy relate to motivation to pursue practice authority? This study provides an exploration of perceptions of NNP practice autonomy in this context. METHODOLOGY: Semistructured interviews conducted with NNPs and neonatologists practicing in a restricted setting explored perceptions of practice expertise and autonomy, based on Patricia Benner's Novice to Expert theoretical framework. Laddered methodology organized survey questions, and the Framework Method was used for analysis of results. RESULTS: The majority of eligible NNPs (n = 12, 67%) and neonatologists (n = 8, 67%) agreed to study participation. Identified themes were grouped into larger concepts, including "NNP practice authority," "NNP expertise," and "NNP autonomy." For example, "NNP expertise" included the theme "determining NNP expertise" and associated factors included "procedural skills," "years and acuity of practice level," and "confidence in management plan and emergent situations." CONCLUSIONS: Both neonatologists and NNPs perceived neonatologists as a practice authority with support for NNP autonomy. Factors indicating NNP expertise correlated with domains in Benner Novice to Expert theory. IMPLICATIONS: These findings support previous work concerning the evolution of expertise and transition to practice. More inquiry to understand perspectives of APRNs in restricted practice settings is indicated.

Perceptions of disaster management knowledge and skills among advanced practice registered nurses.

BACKGROUND AND PURPOSE: Disaster management experts around the world agree that nurses play a vital role in disaster preparation, response, and recovery. The Joint Commission on Accreditation of Health care Organizations requires biannual disaster drills for accredited facilities, and there are numerous training resources and educational materials on disaster management topics. Multiple federal and state laws govern health care provider activities during a disaster. However, there is a lack of guidance and evidence surrounding the specific roles and responsibilities of advanced practice registered nurses (APRNs) in a disaster setting. This project assesses APRNs knowledge of disaster management roles and responsibilities and the training for these roles. METHODS: Using a cross-sectional survey research design, a 68-item survey was distributed via e-mail and social media to members of Texas APRN professional organizations. A convenience sample of those responding and meeting inclusion criteria (Texas-licensed APRN) was analyzed using SPSS to perform descriptive and nonparametric statistics. RESULTS: Thirty-one percent of responding APRNs considered themselves prepared for the management of disasters. A majority of statements (29/47, 61.7%) evaluating APRN knowledge and skills were significantly different (p < .05) across three training and experience categories: post-APRN program education, workplace/community drills or exercises, and planning or disaster response. IMPLICATIONS FOR PRACTICE: More clearly defined roles and readily available training and resources will improve APRNs preparation for disaster situations. Recurrent training and professional experience increase knowledge and confidence related to advanced practice disaster management competencies.