American Academy of Nurse Practitioners Certification Board announces changes in the recertification program.

ABSTRACT: The vision of the American Academy of Nurse Practitioners Certification Board (AANPCB) is that nurse practitioners (NPs) meet the highest standards of excellence and competence to support quality care and optimal health outcomes. The highest standards of excellence require monitoring and improving our certification and recertification programs. After conducting a thorough review of the relevant literature and a series of surveys of our certificants, changes were made to the AANPCB recertification requirements that are consistent with continued competency. These changes are (1) maintaining a minimum of 1,000 advanced practice hours as an NP in the role of clinician, educator, administrator, and/or researcher plus obtaining 100 contact hours of qualified professional development credits; (2) allowing completion of the renewal criteria after the certification end date for individuals who have allowed their certification to expire; and (3) retiring the COVID temporary certification extension policy.

Analysis of nurse practitioner practice in US emergency departments: Evidence supporting educational preparation, credentialing, scope of practice, and outcomes.

ABSTRACT: The nurse practitioner (NP) role within emergency care has grown in recent years and now there are an estimated 25,000 NPs employed in diverse emergency care settings. Despite this significant growth and expansion of the NP within emergency care areas, challenges exist. In addition to the pervasive confusion regarding the NP role in emergency care, data and statistics detailing characteristics and outcomes of NP practice in emergency care are either lacking or misrepresented. This article explores barriers and provides current and accurate information describing the current educational preparation, credentialing, scope of practice, and outcomes among NPs in US emergency departments. The totality of available evidence reviewed supports safe, timely, efficient, and patient-centered care provided by NPs in emergency care.

Consideration of the emergency nurse practitioner as a population within the APRN Consensus Model: A SWOT analysis.

ABSTRACT: After adoption of the 2008 Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation, evolution of the nurse practitioner (NP) role and emergency NP (ENP) specialty has outpaced regulatory standards. Lack of uniformity among regulators, health insurance providers, and employers in acknowledging the ENP specialty has created barriers to practice and access to care. This article serves to identify potential outcomes if the ENP specialty was transitioned to a population within the Consensus Model of Regulation. A strengths, weaknesses, opportunities, and threats (SWOT) analysis methodology was used to assess ENP specialty current state, specifically focusing on the licensure, accreditation, certification, and education model for APRN regulation. The data were collected from peer-reviewed literature, clinical subject-matter experts, and academic and advanced practice executive leaders. Variances in ENP licensure, recognition, and acknowledgment among State Boards of Nursing leave the ENP specialty in a precarious position. For each of the strengths and opportunities that could exist in recognizing the ENP at the population level of the Consensus Model, there are abundant weaknesses and threats. Although full acknowledgment of the ENP specialty is lacking, regulatory implications are highly variable, and employers' understanding of the APRN educational model is limited, our findings reveal that the ENP specialty is an evolving role that deserves regulatory legitimization. Although ideal placement for the ENP within the Consensus Model remains to be determined, challenges and opportunities exist with both specialty and population options.

Visual analysis of global comparative mapping of the practice domains of the nurse practitioner/advanced practice nursing role in respondent countries.

BACKGROUND: Internationally, there is increasing demand for nurse practitioner (NP) and advanced practice nursing (APN) roles; however, high variability exists in how NP/APN roles are defined and understood. PURPOSE: The aim of this research was to improve our understanding of how the NP/APN is defined globally by: 1) examining role definitions, competencies, and standards of practice for advanced practice nurses internationally; 2) describing from a global perspective the core concepts and common features of NP/APN associated with practice domains; and 3) exploring the utility of text mining and visual analytics in identifying the clustered core concepts common to NP/APN roles organized around the five advanced practice domains of the Strong Advanced Practice Model. METHODS: This article describes the findings of a secondary analysis of an international NP/APN competency mapping project, using innovative text mining and visual analysis techniques to reexamine and summarize the NP/APN role in 19 countries from Africa, Australia, Asia, Europe, and North America. RESULTS: Although weak aggrupation/associations suggest that further work is needed to define the domains of advanced practice with associated model development, visual analysis points to the identification of common concepts and linkages between concepts for each practice domain of advanced practice outlined in the Strong Model. IMPLICATIONS FOR PRACTICE: The secondary text mining and visual analysis presented in this article allows for comparison of core elements between advanced practice role descriptions, standards, and competencies globally to ultimately provide a global perspective on the common features of NP/APN roles and areas where further delineation is required.

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.

Emergency nurse practitioner practice analysis: Report and implications of the findings.

BACKGROUND AND PURPOSE: A practice analysis of nurse practitioners (NPs) working in emergency care was undertaken to define their job tasks and develop a specialty certification by examination. METHOD: In phase I, clinical experts created a qualitative description of domains of practice, tasks performed, knowledge required, and procedures performed by NPs in emergency care. Phase II involved validating the qualitative description through a national survey (N = 474) of emergency nurse practitioners (ENPs). Evidence from the validation survey was used to create a test content outline for the ENP examination. FINDINGS AND CONCLUSIONS: The delineation of ENP practice validated by the survey (Cronbach alpha = 0.86-0.94 across rating scales) included 5 ENP practice domains: medical screening, medical decision-making/differential diagnoses, patient management, patient disposition and professional, legal and ethical practices. There were 22 job tasks across domains, 10 types of patient conditions/emergency types, 42 knowledge areas, and 68 procedures performed by ENPs. These resulted in a test blueprint providing the foundation for the ENP certification examination content validity. IMPLICATIONS FOR PRACTICE: Beyond certification, the practice analysis has the potential to further inform the scientific basis of emergency specialty practice. Additional uses include refining professional scope and standards of practice, job descriptions, performance appraisals, research, and policy development.

Beyond competencies: Practice standards for emergency nurse practitioners-A model for specialty care clinicians, educators, and employers.

BACKGROUND/PURPOSE: The growth of advanced practice nursing specialties requires additional expertise for practice that goes beyond entry-level competencies, knowledge, skills, and abilities. A practice standards model for specialty nurse practitioners (PSMSNPs) is introduced that differentiates entry-to-practice population foci competencies from advanced specialty practice standards. OBJECTIVES: (a) Differentiate competencies and practice standards in context to specialty NPs using the emergency specialty as the exemplar, (b) articulate the process to develop the PSMSNP that evolved from an evidence-based practice analysis of NPs working in emergency care, (c) apply the PSMSNP for adaptation to other specialties, and (d) provide implications for the utilization of the PSMSNP by educators, clinicians, and employers. DATA SOURCES: American Academy of Nurse Practitioners Certification Board's Practice Analysis of Emergency Nurse Practitioners, Consensus Model for APRN Regulation, Future of Nursing report, Peer Nursing Report, Strong Model of Advanced Practice, Entrustable Professional Activities, Emergency Medicine Milestones Project, and the Advancing Healthcare Transformation: A New Era for Academic Nursing report. CONCLUSIONS: The PSMSNP has been defined and adapted to other specialties and threaded through other models of practice for educators, clinicians, and employers. The adaptability of this model differentiates the core population foci and unique practice variables of specialty NPs. National boards of nursing, hospital credentialing committees, colleges, and universities can use this model to establish standards for specialty evaluation and guide clinical practice. IMPLICATIONS FOR PRACTICE: The implementation of the PSMSNP will support the delineation of the specialty. This model will fulfill the American Nurses Association and Consensus Model specialty constructs.

Proposed standardized educational preparation for the emergency nurse practitioner.

The dynamic climate within health care policy-making and academia, in conjunction with updated Emergency Nurse Practitioner (ENP) competencies and a recent role delineation study, supports development of standardized curricula to ensure appropriate preparation for practice. Emergency NP curricular content should align with the updated ENP Practice Standards and National Organization of Nurse Practitioner Faculties' competencies for the Core and Family NP. This article provides rationale for establishing standardized educational curricula for ENP programs, delineates core specialty curricular content for inclusion, and discusses applicability of ENP specialty competencies within graduate academic education and postgraduate fellowship programs. As national ENP program curricula are standardized, clarity of the ENP specialty role will be enhanced and educational outcomes can be uniformly evaluated.

Embracing the future for emergency nurse practitioners and specialty practice: Implications for research, clinical practice, education, and health policy.

The emergency nurse practitioner (ENP) specialty has grown rapidly, responding and adapting to changes within emergency care. Designation and advancement of nurse practitioner (NP) specialties follows a systematic process as defined by the profession. This includes establishment of scope and standards of practice, educational standards, and policy initiatives to ensure quality and safety within the profession. This article describes how the ENP specialty has used evidence to meet health system needs and chart a transformational future. Current recommendations for advancing health care transformation, as described by the American Association of Colleges of Nursing-Manatt Report, inform and frame the processes by which the ENP specialty has collaborated with diverse stakeholders to create a research and policy agenda to ensure that ENPs are appropriately prepared to lead and provide access to safe, affordable, quality health care. These processes provide a future-oriented model that promotes advancement of the NP profession through provision of new NP specialty designations as they emerge to meet changing health care system needs.

Issues that impact type-2 diabetes self-management in rural communities.

PURPOSE: To evaluate and synthesize the evidence related to issues that impact type-2 diabetes self-management in rural communities. DATA SOURCES: A systematic review of the literature from 2008 to 2013 was conducted using the following health science databases: CINAHL, PubMed, Cochrane Library, and OVID. Other databases searched included the clearinghouses of the Centers for Disease Control (CDC); National Rural Health Association (NRHA), State Offices of Rural Health (SORH), and Rural Health Research & Policy Centers (RHRPC). Keywords used to obtain relevant articles included rural, type-2 diabetes self-management, health disparities, and nursing. CONCLUSION: Three themes emerged from the literature examined: barriers to type-2 diabetes self-management, provider tools and education enhance type-2 diabetes self-management, and recommendations and guidelines for diabetes self-management efficacy. IMPLICATIONS FOR PRACTICE: The information presented here will support healthcare providers in improving preventative care, providing optimal disease management, and assisting with successful type-2 diabetes self-management in rural populations.

Myasthenia gravis: diagnosis and treatment.

PURPOSE: To provide information about myasthenia gravis (MG), including pathophysiology, differential diagnosis, treatments, diagnostic work up, patient teaching, and diagnostic algorithms for ptosis and weakness related to MG. DATA: Clinical and research journal articles, medical textbooks, and a patient with MG. CONCLUSIONS: Myasthenia Gravis is a very complex disease with many different signs and symptoms, which may be quite noticeable or vague. The presenting symptoms of ptosis and/or diplopia should cause the clinician to consider a work-up for MG. IMPLICATIONS FOR PRACTICE: Because of the low incidence MG (1 in 10,000) has in the U.S., a delay in diagnosis of one to two years is not uncommon. It is vital to diagnose this disease and begin treatment as soon as possible to decrease the signs and symptoms.