Work characteristics, job satisfaction and intention to leave: a cross-sectional survey of advanced nurse practitioners.

BACKGROUND: Advanced Nurse Practitioners (ANPs) are highly skilled health care professionals with the potential to play a major role in improving the quality and accessibility of health care services. However, there is emerging evidence of disquiet among nurse practitioners who often work in suboptimal work environments. Therefore, it is important to understand the elements that contribute to ANPs' job satisfaction and retention in healthcare services. AIM: To examine the effects of commitment to the workplace, work engagement, and influence at work on job satisfaction and intention to leave of ANPs. METHODS: A total of 153 ANP's on the advanced practice section of the Nursing and Midwifery Board of Ireland register completed a web survey between July and August 2020. Independent variables (commitment to the workplace, work engagement, and influence at work) were measured using the Copenhagen Psychosocial Questionnaire (COPSOQ). Multivariable logistic regression models were used to investigate the association between dependent and independent variables. RESULTS: Participants who reported higher levels of influence at work and higher levels of commitment to the workplace were also satisfied in their job (OR 1.05, 95% CI 1.01-1.09, p = 0.025), (OR 1.10, 95% CI 1.06-1.14, p < 0.001) respectively. Additionally, ANPs with higher levels of commitment to work were significantly less likely to leave their role (OR 0.94, 95% CI .92-.96, p < 0.001). CONCLUSION: Healthcare organisations can improve job satisfaction and decrease intention to leave by creating environments in which ANPs are supported by their colleagues and supervisors, and facilitate their practice to the full extent of their capabilities.

Relationship between work-related psychosocial factors and self-leadership in advanced nurse practitioners: A cross-sectional study.

AIM: The aim of this study was to investigate the relationship between advanced nurse practitioners' self-leadership and commitment to the workplace, work engagement and influence at work. BACKGROUND: The concept of self-leadership is particularly suited to ANPs, who are required to take responsibility for their work roles. An optimum balance between the ANPs' psychosocial work environment and self-leadership may positively impact work ability in this group and can be compromised by interactions between and among these variables. DESIGN: A cross-sectional correlational study was conducted from July 2020 to August 2020 on 153 ANPs across a national health service. METHODS: The survey was distributed to respondents online. The revised self-leadership questionnaire was used to measure self-leadership, and three scales from the Copenhagen Psychosocial Questionnaire were used to measure commitment to the workplace, work engagement and influence at work. Multiple linear regression was used to examine the association between self-leadership and the psychosocial variables. RESULTS: ANPs with high levels of self-leadership reported high levels of work engagement and commitment to the workplace. No relationship was found between self-leadership and influence at work. CONCLUSION: Improving self-leadership among ANPs by involving them in strategic leadership activities at an organizational level could be an effective strategy for optimizing the role and facilitating ANPs to contribute at an organizational level beyond the clinical interface. However, organizational support is required to ensure that ANPs practise to the full potential of their training and capability. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. IMPACT: This study provided new evidence of a relationship between ANPs' self-leadership and psychosocial factors. This study found that ANPs with high levels of self-leadership reported high levels of work engagement and commitment to the workplace. Policymakers and organizational leaders can optimize the ANP role and facilitate ANPs to contribute strategically to improve care systems. This study identifies a relationship between ANPs' self-leadership and specific psychosocial variables.

Impact of clinical leadership in advanced practice roles on outcomes in health care: A scoping review.

AIM: To undertake a scoping review of the literature exploring the impact of clinical leadership in advanced practice roles in relation to patient, staff and organisational outcomes. BACKGROUND: An increasing number of publications as well as job specifications have identified clinical leadership as a cornerstone of advanced practice roles. However, it is unclear whether embedding clinical leadership in such roles has led to improvements in patient, staff or organisational outcomes. Therefore, identifying the extent to which clinical leadership in advanced practice roles relates to patient, staff and organisational outcomes is needed. METHOD: A scoping review examining the relationship between clinical leadership in advanced practice roles and health care outcomes. Searching in SCOPUS, PubMed, Psychinfo and CINAHL Plus and Web of Science identified 765 potential articles. Independent selection, data extraction tabulation of findings and analysis were completed. RESULTS: Seven studies were identified that met the inclusion criteria. Only studies reporting on nurses in advanced practice roles were included; no studies were identified that reported on the advanced practice roles of allied health professionals. The results indicate that there is no objective evidence of the impact of advanced practitioners' clinical leadership on patient, staff or organisational outcomes. CONCLUSION: There is a paucity of objective evidence to identify the extent to which clinical leadership is enacted in advanced practice roles. The review indicates a need for closer alignment of AP clinical leadership policy aspirations and formal operational leadership opportunities for APs. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers have a key role in supporting and equipping APs with leadership competencies and opportunities to enable both capability and capacity building of such roles. Nurse managers should involve APs in health care leadership at an organisational level to maximize their contribution to health, quality practice environments and health care reform. Additionally, a distinct involvement in staff development, change, operational strategic decisions and policy development should be part of the AP role, which is facilitated by management.

GPs' opinions of discharge summaries generated by advanced nurse practitioners in emergency care settings.

AIM: Clinical handover at the point of discharge is critically important. It generally occurs through a written document, usually in the form of a discharge summary. Hospital discharge summaries contribute to continuity of care for patients who leave hospital and who may require care in the community provided by their GP. They must be accurate, valid, reliable, timely, legible and complete. The aim of this study was to investigate GPs' perceptions of the content of discharge summaries generated by emergency advanced nurse practitioners (EANPs). METHOD: A cross-sectional descriptive survey design was used and a questionnaire was distributed to 120 GPs. Raw statistical data were analysed using SPSS v22 while the qualitative data from the open-ended questions were manually analysed. FINDINGS: Most GPs were satisfied with the EANPs' discharge summary letters. However, this study supports previous papers that identified deficits in communication between secondary care and GPs. CONCLUSION: There is a need to refine discharge summaries to create an enhanced structured discharge summary template that can be used by all disciplines.

Physical activity: is it time for emergency department nurses to step up?

Physical inactivity seems to be reaching pandemic proportions. People are becoming more obese and less physically active at an alarming rate, and physical inactivity is a significant societal and personal burden in terms of economic and health costs. Nurses are ideally placed to motivate patients and promote physical activity. This article examines the benefits of physical activity, and explores emergency nurses' role in promoting regular exercise. It also outlines physical activity recommendations and suggests a starting point for promoting healthy exercise to patients who attend emergency departments.

Patellar dislocation: Not the bees knees.

BACKGROUND: Patellar dislocations are common, particularly in the adolescent polulation. Registered Advanced Nurse Practitioners are healthcare professionals who can appropriately manage these injuries to minimise the risk of chronicity. METHODS: This is a case study which uses a clinical examplar from the authors practice focusing on the assessment, diagnosis and managment of patellar dislocations. Particular reference is made of the significance of the MPFL. RESULTS: This paper highlights the importance of recognition of appropriate management of patellar dislocations in the ED setting. Discussion points include the role of the MDT and the role of exercise prescription in the injury management. CONCLUSION: The diagnosis of patellar dislocation is heavily dependant on eliciting a comprehensive history and conducting an appropriate clinical exam. Patient outcomes may be optimised by adopting an MDT approach.

Congruence of pain assessment between nurses and emergency department patients: a replication.

AIM: To ascertain congruence between patients' self-report of pain intensity and nurses' assessment of their pain intensity. METHODS: This study adopted a replication methodology which aimed to ascertain congruence between patients' self-report of pain intensity and nurses' assessment of their pain intensity. Raw statistical data was analysed using SPSS for windows. RESULTS: This study supports the findings of the original US study that emergency nurses frequently underestimate patients' pain intensity. However, this study also found incidents where nurses accurately assessed their patients' pain intensity, and incidences of overestimation. CONCLUSIONS: This study illustrates underestimation of patients' pain intensity by emergency nurses which is both clinically and statistically significant. RELEVANCE TO CLINICAL PRACTICE: Implications for nursing practice include a need for assessment of patients' pain intensity, the development of pain management protocols, and increased emphasis on education in both undergraduate and postgraduate nursing curricula. Also there needs to be continued clinical audit of pain management standards.