To address the challenge, a standardized model must be researched and
implemented. Various models have been proven successful in the preparation of other health care professionals, including the one-minutepreceptor (OMP) model and the layered learning practice model in the clinical preparation of pharmacists (Ignoffo et al., 2017). The OMP model has also been successful in clinical preparation of medical doctors (Swartz, 2016). Exploring models, tools, and methods for standardization is a crucial step in addressing one of the challenges in the advanced practice curriculum. The current project represented a step in addressing this documented void. The long-term implications of not addressing this education-to-practice gap could prove detrimental in the ability of new NPS to have a significant, immediate impact on the health care industry and patient population. Exploring use of a standardized tool in the practicum encounter could prove beneficial in the preparation of the NP student for transition to practice.
residency and mentorship program for its NP students. The practice organization supplies the clinical sites and all the preceptors that are employed or affiliated with the practice organization needed to clinically educate all students of the university’s NP program. With this, there is no outside need for more preceptors. Two, the university’s faculty leadership and the practice organization’s executive APN leadership collaborate and co-design the clinical program. They share resources, knowledge, and expertise in order to benefit the clinical program and the NP students. These two key concepts allow for the following to occur. There is an increased involvement of faculty in the student clinical learning experience and at the clinical site. The model includes standardized student clinical education experience including assessments, and standardized preceptor education. The clinical program is focused on mastering competencies. The designed student clinical experiences provide a wide range of clinically immersive experiences rich with professional interdisciplinary collaborative experiences.
The roots of clinical education, which lie in the apprenticeship model of “see one, do one, teach one” have evolved to expanded competencies and increased requirement of hours for NP education (Gaberson, 2012, p. C11). Enrollments of NP students have grown exponentially, resulting in 373 schools that offered NP programs to 68,671 students from Fall 2014 to Fall 2015 (American Association of Colleges of Nursing [AACN], 2016). The recruitment and retention of clinical preceptors for NP students is an awesome challenge for coordinators of NP academic programs. While preceptors have been called “the cornerstone of clinical education” (Marfell, 2011, p. 6), one NP student struggled for months to find her own preceptor, whom she named a “willing mentor” (Farwell, 2009, p. 198). Limited clinical sites and a limited supply of qualified preceptors result in serious concerns for finding placements for NP students (Drayton-Brooks, Gray, Turner, & Newland, 2017; Webb, Lopez, & Guarino, 2015).
As the literatu re indicates, the role of the nurse p ractitioner continues to evolve as it finds the overlap betw een nurse and physician practice. The literature also show s that definitions of role an d scope of practice rem ain am biguous. N urses, physicians, the public, an d even nurse practitioners them selves, rem ain uncertain of the scope of practice. Few recent studies have attem p ted to describe the role. A ttem pts to stan d ard ize prep aratio n and m aintenance of nurse practitioners are currently being m ade w hich may im pact perceptions of the role by nurses, physicians, and patients. W hile some confusion exists reg ard in g educational prep aratio n and scope of the role, nurse practitioners have been found to im prove access to and quality of health, decrease costs and result inclient satisfaction.
If the student does not acknowledge the issue and suggest a resolution, ask if s/he thinks the issue can be resolved. When the student has proposed a resolution, provide your feedback. When you have made a plan, decide how you will both monitor and evaluate improvements. This may be as simple as a plan to improve timeliness to clinical, to provide more thorough documentation or to improve time management. To address more significant or chronic issues, a Learning Plan (template below) may be used. Please remember to include the faculty when a learning plan is used.
New graduates are confronted with significant challenges associated with transitioningfrom the role of studentnurse to licensed professional (Bratt, 2009). Additionally, even experienced nurses transitioning to a new role or facility, face similar challenges. Typically, clinical preceptors are utilized to orient nurses into new roles within the acute care setting. Such experienced nurses are valuable assets to the organization due to their contribute to the overall quality of care delivered (Moore, 2008), but in many cases they receive little or no formal educational preparation regarding role expectations. The problem statement describing this capstone project is: Will (P) Newly Hired Nurses oriented (I) following the implementation of a preceptor educational program when compared to (C) newly hired nurses oriented prior to the preceptor educational program (O) report an increase in self-efficacy at the completion of the nursing orientation period?
It is ironic that nursing education and practice require so much knowledge and skill to do the job, but very little effort is directed toward developing how to Be while doing the real work of the job. Nurses often become pained and worn down by trying to always care, give, and be there for others without attending to the loving care needed for self. (p. 47) Self-nurturing has been described as an essential prerequisite to being able to give to others (Barratt, 2017). Tools and strategies which help foster an improved sense of wellbeing among those entering or already engaged in NP practice are of utmost significance. In this light, the fostering of mindfulness offers an approach for both student and practicing NPs to better internalize and thereby convey the key nursing principles within Watson’s (2002) theory.
• The publication date of the article/book/module will determine its applicability for your current certification maintenance.
• You are limited to usingone article, book authorship or service as an NCC continuing education reviewer or monograph author per certification maintenance cycle.
Overview of the Guiding Framework
for the Implementation of Nurse Practitioners
in Western Australia
The 9 th of April 2003 marked a major milestone in the history of the nursing profession in Western Australia when the legislation to allow nurse practitioners to practice in designated areas came into effect. This concluded many years of work by the Offi ce of the Chief Nursing Offi cer that transformed a vision for establishing nurse practitioners in Western Australia into a reality. The next phase for the Chief Nursing Offi cer was to focus on handing over the concept of nurse practitioners to the nursing profession to allow the role to be developed in partnership and collaboration within the health services/ organisations and in response to patient needs and service demands. The Offi ce of the Chief Nursing Offi cer is cognisant of the fact that the nursepractitioner role nationally and internationally has developed in many and diverse ways which has subsequently led to a lack of understanding and confusion about the role. In Western Australia, the approach to developing the nursepractitioner framework took into consideration national and international experience, and used it to infl uence the evolution of a clear framework for nursepractitioner practice. This paper outlines the Guiding Framework for the Implementation of Nurse Practitioners in Western Australia (2003) published by the Offi ce of the Chief Nursing Offi cer for the nursing profession and health services/ organisations, detailing the role of nurse practitioners in Western Australia. The Offi ce of the Chief Nursing Offi cer has published the Guiding Framework for the Implementation of Nurse Practitioners in Western Australia (Department of Health, 2003a), which provides essential information for health services/organisations and the nursing profession on the development of nurse practitioners in the State. The guiding framework provides a background on the development of the policy, which led to the legislative changes that now allow registered nurse practitioners to practice in designated areas. It addresses the core concepts and principles, details the educational requirements and opportunities and describes the two distinct processes to establish the new role: registration and designation of an area. In addition, the document outlines an approach to develop the clinical protocols that will defi ne the scope of practice in the designated area and provides the foundation of an evaluation framework.
The examination blueprints for each stream of nursepractitioner practice have been developed in consultation with the educational facilities that offer nursepractitioner education. Each blueprint is based on current statistical information relating to population groups, common health presentations and context of practice as it relates to community based or institutionalized based care.
As soon as NPs began to emerge from the training programs, a body of law emerged governing NP licensure and scope of practice. Idaho was the first state to revise its regulations to allow diagnosis and treatment by nurses.
By the mid-1970s, state legislators began to consider proposed laws regarding prescriptive authority for NPs. In some states, the prescriptive authority was grant- ed through the regulatory process; in others, it was granted through the legislative process. By 2006, NPs had achieved some degree of prescriptive privileges in all states and the District of Columbia. The main legal goal of NPs for 30 years was achieved. The next legal hurdle became evident with the enrollment of a large percentage of the population into managed-care plans. NPs now need the legal authority to handle the primary care of panels of managed-care patients. In some states, NPs have that legal authority. In others, the law is unclear or does not address the issue.
On discussion with Linda Harper, associate director of practice nursing and lead nurse at Gmed, it was apparent that while most of the NPs were experienced nurses in secondary care, few had any experience or concept of working in daytime practice. Being one of the few remaining GPs working between daytime and out of hours general practice, I knew there were generic and transferable skills that could be gained from a clinician working in a dual role. Therefore after negotiation with Linda Harper, and the CHP, it was agreed that the newly recruited 2011 cohort of nurse practitioners would be part of a pilot group and spend a 4-week secondment in General Practice
Patient Rights and Responsibilities: As a member of the Family NursePractitioner profession and The University of Tennessee at Chattanooga, students are held to the ethical standards of ANA and the university. Among these standards are honesty and integrity. These standards are the basis for representation of the profession and the Family NursePractitioner Concentration. This attitude should be conveyed to patients, faculty, and healthcare providers. As a primary care provider, the student must be aware of the patient’s rights and responsibilities.
development. Sexual health is an area where Australian nurse practitioners have tested this level of service and reported favourable outcomes. Hooke and others explored sexual health service provision by nurse practitioners as part of the New South Wales nursepractitioner trial (Hooke, Bennett et al. 2001). This was an early model to be tested and some barriers to implementation were identiﬁ ed. The authors stated that development of competencies was a difﬁ cult task because these were still being developed at national level and had not yet been ratiﬁ ed by special interest groups. The team developing this model made an explicit decision to use standing orders rather than prescribing rights. Later, in the ACT, a sexual health nursepractitionermodel provided effective clinical management, patient education and health promotion and referral services for patients with a variety of health issues. The nursepractitioner was able to intervene in an opportunistic fashion, providing accessible and acceptable service in multiple settings including to marginalised and at risk groups (O’Keefe and Gardner 2003/2004). This model developed a limited formulary of medications that were recommended for the role. The differing scope of practice of these two models (albeit in the same clinical ﬁ eld) speciﬁ cally around use of limited formularies (and therefore prescribing rights) or use of standing orders arises in Australian and New Zealand literature as well as engaging some of the international assumptions about nursepractitioner level of service. A more thorough examination of the role of prescribing is probably warranted at this juncture. New Zealand is in a period of evolution in terms of prescribing education and practice. All students in current masters’ degrees leading to nursepractitioner endorsement will take pharmacology and all applicants for nursepractitioner endorsement will have to have completed advanced pharmacology education.
2. Communicate with adolescents in their own venues; put messages where adolescents are and make it fashionable to get immunized. Communicate with families in multiple venues, multiple languages, and multiple literacy levels; in newsletters and text messages; on websites; at school functions; and at sporting events. School nurses/nurse practitioners can play an important role in providing information and encouraging full immunization of all students. Consider communicating with adolescents through social network websites (eg, Facebook, MySpace) and on their cell phones. Adolescents can program their follow-up immunizations into their cell phones right in your office. Have adolescents use peer-to-peer language and communication styles to encourage immunizations. Create an environment that values adolescent immunizations and makes it fashionable to be immunized.
Canada’s population is aging. It is estimated that by the year 2011, 16 percent of the population will be over age 65, with these numbers increasing to 24 percent by the year 2031 (Statistics Canada, 2003). Life expectancy is also on the rise. Canada ranks within the top 3 developed countries in the world in relation to life expectancy. Canadian women have an average life expectancy of 81.4 years compared to men at 75 years (Statistics Canada, 2003). Ontarians 60 years and older will account for half of the projected population growth of 3 million by 2021, even though they make up only 17% of the population (Thompson, Gow & Associates, 2000). With increased life expectancy comes the inevitability that many of the elderly will have one or more medical conditions requiring the care of a geriatrician.
The American Cancer Society (ACS) estimates that 1,444,920 new cases of cancer will be diagnosed and that 559,650 Americans will die of cancer in 2007 (ACS, 2007). Although survival rates continue to climb, cancer remains the second most common cause of death in the United States, exceeded only by heart disease. Those who survive cancer often continue to receive treatment and require close follow-up care and surveillance. The National Cancer Institute (NCI) estimates that approximately 10.5 million Americans with a history of cancer were alive in 2003. Some were cancer-free, whereas others still had evidence of cancer and may have been undergoing treatment (ACS). A significant number of advanced practice registered nurses (APRNs) provide care to patients with a past, current, or potential diagnosis of cancer, and very distinct competencies are required to provide this care. As of May 2007, the membership of the Oncology Nursing Society (ONS) included 2,024 oncology nurse practitioners (ONPs).
Evaluation of Student Learning by Preceptors
Preceptors assist course responsible faculty and are practitioners who provide direct teaching to students appropriate to the course and program objectives. Preceptors for clinical specializations may include both advanced practice nurses (APRNs) and non-nurse practitioners (usually physicians). Each preceptor must be credentialed and state licensed to practice in his/her specialization. National certification is highly