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In recent years, the National Association of Neonatal Nurses and the National Association of Neonatal Nurse Practitioners have been monitoring aspects of neonatal advanced practice nursing and providing leadership and advocacy to address concerns related to workforce, education, competency, fatigue, safety, and scope of practice. This white paper discusses current barriers within neonatal advanced practice registered nurse practice as well as strategies to promote the longevity of the neonatal advanced practice registered nurse roles.

Advanced practice nurses constitute a new professional group within the French health care system. Advanced practice nurses specialise in one of five disciplines including Psychiatry/Mental-Health. This specific discipline is strongly marked by stigmatising representations by healthcare users and other health professionals (including other advanced practice nurses), whose consequences have a deleterious effect. The aim was to highlight all advanced practice nurses representation of Psychiatry/Mental-Health advanced practice nurses. An observational descriptive survey, based on an anonymous online questionnaire was conducted in April 2022 among qualified and student advanced practice nurses from the five specialist disciplines. Overall, 356 advanced practice nurses completed the survey questionnaire. No significant difference in stigmatising representations of Psychiatry/Mental-Health advanced practice nurses versus other advanced practice nurses was observed. Only 3.3% of other advanced practice nurses thought that Psychiatry/Mental-Health advanced practice nurses are often 'strange'. Psychiatry/Mental-Health advanced practice nurses and other advanced practice nurses appeared to have similar representations of the professional roles of advanced practice nurses in general and of advanced practice nurses APN specifically. Unlike other professionals in the psychiatric field (e.g. medical interns, nurses), very little stigmatisation of Psychiatry/Mental-Health advanced practice nurses by their colleagues (i.e. other advanced practice nurses) was observed. This could be partly due to the fact that advanced practice nurses professional identity appeared to be built collectively around the concept of advanced practice. Advanced practice nurses constitute a professional group that is fully involved in contemporary transformations in care and organisational innovation. The very low level of stigmatisation of Psychiatry/Mental-Health advanced practice nurses by other advanced practice nurses in our study suggests that these new healthcare actors could play a crucial role in the improvement of professional health practices, particularly in terms of improved coordination between psychiatric-care and physical-care., (© 2024 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Aim: To report the results of a mapping exercise by the European Federation of Nurses on current advanced practice nursing frameworks and developments across Europe., Design: Online, cross-sectional, questionnaire study., Methods: An online questionnaire was distributed among 35 national nurses' associations across Europe in March 2021. The questionnaire solicited input on 60 items concerning key features of advanced practice nursing, intending to map existing developments and better understand the current state of advanced practice nursing in Europe. Data analysis used descriptive statistics, including counts and percentages, tabulation; open-text responses were handled with thematic synthesis techniques., Results: The definition, sense-making and operationalization of advanced practice nursing vary across Europe. Important variations were noted in the definition and requirements of advanced practice nursing, resulting in different views on the competencies and scope of practice associated with this role. Importantly, the level of education and training required to qualify and practice as an advanced practice nurse varies across European countries. Furthermore, only 11 countries reported the existence of a national legislation establishing minimum educational requirements., Conclusion: Significant variation exists in how countries define advanced practice nursing and how it is regulated at academic and practice levels. More research is needed to clarify whether this variation results from designing models of advanced practice nursing that work in different contexts; and what impact a standardized regulatory framework could have to grow the volume of advanced practice nurses across Europe., Impact: The current paper exposes the lack of clarity on the development and implementation of advanced practice nursing across Europe. We found significant variation in the definition, recognition, regulation and education of advanced practice nurses. Our data are essential to policymakers, professional associations and employers to ensure a coordinated and systematic effort in the consistency and ongoing development of advanced practice nurses across Europe., Patient or Public Contribution: No patient or public contribution applied; the participants were national nurses' associations., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Objective: The objective of this review was to map the literature about the concept of capability in advanced practice nursing education and practice to achieve greater clarity on the concept and its application., Introduction: Advanced practice nursing roles make up a growing segment of the global nursing workforce. Capability has been proposed as an overarching description of the attributes of advanced practice nursing roles within complex workplace environments. Capability includes knowing how to learn, and the ability to creatively integrate prior knowledge, skills, judgment, and experience in both new and familiar situations., Inclusion Criteria: This review looked at the literature about capability applied to advanced practice nursing in any setting globally. We were guided by the International Council of Nurses' definition of advanced practice nursing, which includes nurses with both graduate education and an expanded scope of practice. Drawing from an initial review of the literature, we used a working definition of capability, which was a combination of knowledge, skills, experience, and competencies that enables advanced practice nurses to provide appropriate care for patients in both known and unfamiliar clinical settings. We included literature about individual capability as a concept in any setting related to advanced practice nursing and education., Methods: We searched 18 electronic databases and included qualitative, quantitative, and mixed methods study design methodologies, reviews, and reports. The gray literature search included policy and practice documents from the World Health Organization, the International Council of Nurses, and websites of 48 nursing and health organizations. Two reviewers independently completed title and abstract screening prior to full-text review and data extraction. Conflicts were resolved via discussion or with a third reviewer. Extraction was completed by 2 reviewers using a piloted data extraction tool. Articles published in English from 1975 to the present were included. Sources in languages other than English were not included in the review due to the difficulties in accurately translating the concept of capability., Results: Thirty-five sources were included in the review with publication dates from 2000 to 2023. Most sources originated from Australia, the United Kingdom, and the United States. Sources included frameworks and clinical guidelines, peer-reviewed articles, and gray literature. Capability was discussed in a range of settings, including specialized clinical roles. Applications of capability in educational settings included the use of capability frameworks to guide nurse practitioner education, nursing practice doctorates, and postgraduate nurse practitioner training. Definitions of capability, where provided, were relatively consistent. Capability was proposed as a distinguishing characteristic of advanced practice nursing, as a descriptor of clinical proficiency that moved beyond competency, and as a framework that accounted for complexity in health care settings., Conclusion: Capability was used as a concept and framework to describe advanced practice nursing within complex practice environments that necessitate flexible approaches. Capability frameworks were applied holistically and to specific areas of practice or education, including in pregraduate and postgraduate advanced practice nursing education. Strategies for teaching and learning capability focused on flexibility, student-directed learning, and development of flexible learning pathways., Supplemental Digital Content: A Norwegian-language version of the abstract of this review is available: http://links.lww.com/SRX/A58., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 JBI.)

Aim: Advanced Practice Nurses are expected to provide lifesaving care to patients with complex acute illnesses in emergency and critical care settings. However, little is known about their competencies and barriers to practice in emergency and critical care settings. This review investigated these nurses' competencies to practice., Methods: A scoping review was conducted in accordance with Arksey and O'Malley's framework. Extensive research searches were conducted using seven electronic databases: MEDLINE, CINAHL, Scopus, Web of Science, Ichushi Web, Mednar and GreyNet International. Definitions and explanations of Advanced Practice Nurse competencies were categorized into elements and grouped according to similarity., Results: The database searches identified 2,483 studies, and data were extracted for 23 studies. Analysed studies were published between 2000 and 2021 and conducted in eight countries. Seven competencies were identified: performing advanced practice nursing, acute patient care, diagnostic assessment, interdisciplinary collaboration and consultation, leadership and system management, documenting patient care and supporting patient and family decision-making., Conclusion: This review identified competencies unique to Advanced Practice Nurses in emergency and critical care settings. Further research is required to facilitate understanding of the crucial roles of advanced care nurses among healthcare providers., (© 2023 John Wiley & Sons Australia, Ltd.)

Aims: (1) To identify, evaluate and summarize evidence about the objectives and characteristics of mentoring programmes for specialized nurses (SNs) or nurse navigators (NNs) and advanced practice nurses (APNs) and (2) to identify the effectiveness of these programmes., Design: A systematic review based on PRISMA guidelines., Data Sources: From November 2022 until 7 December 2022, four databases were searched: PubMed, EMBASE, CINAHL and The Cochrane Library., Review Methods: Study selection was performed independently by two researchers. Disagreements were discussed until consensus was reached. Data extraction was undertaken for included studies. Data synthesis was conducted using narrative analysis. Quality appraisal was performed using the Critical Appraisal Skill Programme (CASP) and Mixed Methods Appraisal Tool (MMAT)., Results: Twelve articles were included, all of which focused on mentoring programmes for APNs. Different forms of mentorship (e.g. (in)formal mentorship, work shadowing, workshops) were reported. Studies reported positive outcomes on job retention (n = 5), job satisfaction (n = 6), skills improvement (n = 7), satisfaction with the programme (n = 7) and confidence improvement (n = 4) among participants of mentoring programmes., Conclusion: There is a lack of uniformity and consistency in various elements of mentoring programmes. Further research is needed to develop mentoring programmes for both APNs and SNs/NNs in a systematic and theoretically underpinned manner. It is necessary to establish a thorough evaluation methodology, preferably using a mixed methods design that includes both a qualitative process evaluation and a comprehensive outcome evaluation using validated questionnaires, taking into account the NN/APN, the interprofessional team and organizational level., Impact: The synthesis of evidence may be useful to organizations developing and implementing mentoring programmes for both SN/NN and APN. The development of a mentoring programme for nursing experts should be considered a complex intervention that requires theoretical frameworks and contextual considerations., No Patient or Public Contribution: Not applicable, as no patients or public were involved., (© 2023 John Wiley & Sons Ltd.)

Background: Evidence-based healthcare (EBHC) enables consistent and effective healthcare that prioritises patient safety. The competencies of advanced practice nurses (APNs) are essential for implementing EBHC because their professional duties include promoting EBHC., Aim: To identify, critically appraise, and synthesise the best available evidence concerning the EBHC competence of APNs and associated factors., Design: A systematic review., Data Sources: CINAHL, PubMed, Scopus, Medic, ProQuest, and MedNar., Methods: Databases were searched for studies (until 19 September 2023) that examined the EBHC competence and associated factors of APNs were included. Quantitative studies published in English, Swedish and Finnish were included. We followed the JBI methodology for systematic review and performed a narrative synthesis., Results: The review included 12 quantitative studies, using 15 different instruments, and involved 3163 participants. The quality of the studies was fair. The APNs' EBHC competence areas were categorised into five segments according to the JBI EBHC model. The strongest areas of competencies were in global health as a goal, transferring and implementing evidence, while the weakest were generating and synthesising evidence. Evidence on factors influencing APNs' EBHC competencies was contradictory, but higher levels of education and the presence of an organisational research council may be positively associated with APNs' EBHC competencies., Conclusion: The development of EBHC competencies for APNs should prioritise evidence generation and synthesis. Elevating the education level of APNs and establishing a Research Council within the organisation can potentially enhance the EBHC competence of APNs., Implications for the Profession: We should consider weaknesses in EBHC competence when developing education and practical exercises for APNs. This approach will promote the development of APNs' EBHC competence and EBHC implementation in nursing practice., Registration, and Reporting Checklist: The review was registered in PROSPERO (CRD42021226578), and reporting followed the PRISMA checklist., Patient/public Contribution: None., (© 2024 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Advanced practice nurse (APN) roles bring great added value to health systems. However, their integration into the health workforce and the sustainability of the role depend on contextual factors surrounding their implementation., Aim: To explore the contextual factors that influence the organization, implementation, and performance of clinical practice among oncology APNs in Catalonia (Spain)., Methods: This is a descriptive qualitative study. A framework of contextual factors was applied to explore the perspectives of 14 oncology APNs in public hospitals in Catalonia by means of semistructured interviews. Data were analyzed according to the thematic analysis approach. The COREQ checklist was used to report the study., Results: APNs in cancer care strongly depend on the hospital environment where they are introduced. Recognition by the multidisciplinary team, the existence of mentoring experiences, and networking between APNs are critical factors that can help or hinder the development and autonomy of the APNs. Likewise, support from nursing managers and directors is decisive in defining the professional profile, establishing accountability mechanisms, and securing financial resources, including economic recognition. Factors related to the external environment can also contribute, including a standardized national APN model and scientific societies., Conclusions: Contextual factors around clinical practice, institutional structures, and professional networks are crucial determinants for adequately integrating APNs at the health system level., Implications for Nursing Policy: Professional bodies and national nursing organizations should lay the groundwork for defining standards of practice and advocate for specific regulations. In addition, financial recognition and accountability mechanisms to assess the impact of their contribution should be a priority to ensure sustainability and APN satisfaction., (© 2023 The Authors. International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

Aim: To reflect on the inclusion of an advanced practice nurse (APN) on a clinical leadership team in rural Vermont during the COVID-19 pandemic., Background: During the COVID-19 pandemic, APNs contributed to the reimagining of healthcare delivery. In response to pandemic-related organizational needs, one rural health center in Vermont promoted an APN to a leadership position., Sources of Evidence: This critical reflection describes the experience of one APN promoted to a clinical leadership role during the COVID-19 pandemic in rural Vermont in the United States. We use the four stages of crisis (escalation, emergency, recovery, and resolution) and the healthcare leadership framework proposed by Geerts et al. (2021) to consider how APN leaders can contribute in the "recovery stage" of the pandemic., Discussion: APNs who took on leadership roles during the pandemic may have had fewer opportunities to participate in formal leadership development. However, in the case of our rural health center, an APN was able to seek out mentorship, address operational challenges, and provide representation for advanced practice providers., Conclusion: This article contributes to the literature on APN leadership during the COVID-19 pandemic, by describing a leadership opportunity that helped build APN leadership capability and capacity in our organization., Implications for Nursing Practice: APNs offer a valuable perspective on health leadership teams. As organizations move toward the recovery stage of the pandemic, different leadership styles and skills may be required., Implications for Health Policy: The COVID-19 pandemic provided unexpected leadership opportunities for APNs. Healthcare organizations now have opportunities to reimagine clinical leadership in ways that include APNs., (© 2023 The Authors. International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

Aim: The aim of this study is to contribute to an understanding of the role deployment of advanced practice nurses (APNs) in French healthcare settings., Introduction: The introduction of APNs was formalised in France by the decrees issued on 18 July 2018, which described the areas, activities and training of APNs., Background: A qualitative study on the role implementation of APNs was conducted between July 2021 and May 2022 following a call for projects launched by the Île-de-France Regional Health Agency to evaluate the deployment of APNs in the area., Methods: Data were collected through field observations and semi-structured interviews in order to explore both the APNs deployment processes in nine healthcare structures and the roles played by APN networks and associations with regard to the deployment of APN activities in their working environments., Results: The projects proved to be evolutionary, and their development was marked by various forms of APN isolation and multiple obstacles that were specific to their professional practice settings. Some APNs relied on a variety of forms of mutual assistance and advocacy deployed throughout APN networks and associations., Discussion: The deployment of APNs' role was impacted by diverse configurations of professional power relations and the nature of the obstacles that were structural for APNs in primary care. Their experience of isolation derived from the novelty of their role, the challenge they posed to the cohesion of the nursing profession and a lack of supportive policies for their deployment. Their participation in APN networks and associations enabled them to access advocacy and manage the uncertainties and unknowns related to the deployment of their activities., Conclusion: The results suggest that the formalisation of schemes for mutual assistance among APNs and advocacy should be integrated into the guidelines for the implementation of their role., Implications for Nursing Policy: APN policy should strengthen a bottom-up approach, relying in particular on the development of different forms of collaboration and communication between APN networks and associations on the one hand and the public authorities on the other., (© 2024 The Authors. International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

Background: There is increasing global evidence on the impact of advanced nursing and midwifery practitioners, and Kenya's healthcare system has an excellent opportunity to develop scopes of practice and other regulatory frameworks for the integration of these roles., Objective: The primary purpose of this gap analysis was to explore the existing evidence on opportunities and threats toward the integration of the advanced practice nursing (APN) and advanced practice midwifery (APM) roles in Kenya's healthcare system., Methods: The study team conducted a structured electronic database search of PubMed, CINAHL, Scopus, EBSCOhost Academic Search Complete, and PsycINFO to retrieve articles and credible websites for reports highlighting the opportunities and threats toward the integration of the APN and APM roles in Kenya's healthcare systems. The retrieved articles were screened for relevance and synthesized for reporting using the traditional literature review approach., Results: The Kenya Health Policy Framework 2014-2030, growing population needs, and implementation of universal health coverage provide an opportunity to harness and leverage advanced practice roles in nursing and midwifery. There is also momentum to develop advanced practice because of strategic alliances and global evidence showing the contributions and quality of services offered by advanced practice nurses and advanced practice midwives. However, lack of financial support, structural challenges, and lack of national policies, regulations, and legislation continue to obstruct progress., Conclusion and Implications for Nursing Policy: Developing scopes of practice for APN and APM in Kenya will benefit the professions, the country's healthcare delivery system, and the population. Achieving universal health coverage depends on a health workforce trained and practicing at optimal levels in tandem with education and training to deliver quality care., (© 2024 The Authors. International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

There is a dearth of information on the role of the pediatric palliative advanced practice registered nurse (APRN) reported in the literature, and yet, the role is expanding. Advances in technology and health care are helping children with medical complexity live longer, and the demand for pediatric palliative care is growing. As programs expand to meet this need, there are new opportunities for pediatric palliative APRNs to practice outside acute care consultative models, within large children's hospitals. The aim of this article was to describe the expanding role of the pediatric palliative APRN using a progressive case study that describes how these expanding roles can collaborate using evidence-based practice and expert consensus to define their roles. If pediatric palliative APRNs hesitate to define their practice, others will define it for them., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 by The Hospice and Palliative Nurses Association. All rights reserved.)

Abstract: Meaningful job recognition is a pillar for sustaining healthy work environments and proven beneficial for job satisfaction and retention. However, few dedicated award recognition programs exist for advanced practice registered nurses (APRNs), and no available literature evaluates the impact on professional practice, sense of belonging, and job retention or satisfaction. The purpose of this study was to introduce a novel award recognition program for APRNs and physician associates (PAs) in a large academic medical system and evaluate it's impact on job satisfaction, retention, and sense of belonging. Five awards were created to recognize areas of achievement for clinically practicing APRNs or PAs within an academic health system. Nomination letters were collected, deidentified, and reviewed by an award committee. Winners were announced and received a plaque. A survey was sent to employed APRNs evaluating their response to the program. The survey was sent to both APRNs (83%) and PAs (17%). Survey end points included job satisfaction, willingness to stay in role for 1 and 5 years, sense of community, something to work toward, and increasing recognition of APRNs. Results showed statistical significance in three areas. Advanced practice registered nurses or PAs who were aware of award opportunities and/or nominated for an award showed higher job satisfaction, more likely to stay in job for 1 year, and felt a greater level of recognition. Dedicated APRN award programs may have a positive impact on job satisfaction and retention. This model may be extrapolated to provide greater opportunities for meaningful recognition among clinical APRNs., Competing Interests: Competing interests: The authors report no conflicts of interest., (Copyright © 2023 American Association of Nurse Practitioners.)

Aim: To describe psychometric validation of the newly developed Advanced Practice Nurse Task Questionnaire., Design: Cross-sectional quantitative study., Methods: The development of the questionnaire followed an adapted version of the seven steps described in the guide by the Association for Medical Education in Europe. A nationwide online survey tested the construct and structural validity and internal consistency using an exploratory factor analysis, Cronbach's alpha coefficient and a Kruskal-Wallis test to compare the hypotheses., Results: We received 222 questionnaires between January and September 2020. The factor analysis produced a seven-factor solution as suggested in Hamric's model. However, not all item loadings aligned with the framework's competencies. Cronbach's alpha of factors ranged between .795 and .879. The analysis confirmed the construct validity of the Advanced Practice Nurse Task Questionnaire. The tool was able to discriminate the competencies of guidance and coaching, direct clinical practice and leadership across the three advanced practice nurse roles clinical nurse specialist, nurse practitioner or blended role., Conclusion: A precise assessment of advanced practice nurse tasks is crucial in clinical practice and in research as it may be a basis for further refinement, implementation and evaluation of roles., Impact: The Advanced Practice Nurse Task Questionnaire is the first valid tool to assess tasks according to Hamric's model of competencies independently of the role or the setting. Additionally, it distinguishes the most common advanced practice nurse roles according to the degree of tasks in direct clinical practice and leadership. The tool may be applied in various countries, independent of the degree of implementation and understanding of advanced nursing practice., Reporting Method: The STARD 2015 guideline was used to report the study., Patient or Public Contribution: No patient or public contribution., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

This Research to Practice article is designed to help aid advanced practice registered nurses (APRNs) with up-to-date research guidelines in order to establish evidence-based changes in clinical practice within emergency medical care. The article, "Activated Charcoal and Poisoning: Is It Really Effective?" by Aksay et al. (2022), examines whether the usage of activated charcoal (AC) in current treatment protocols for ingested poisonings adds benefits, given recent controversies in its use. Study variables included clinical findings in relation to the drug being ingested, the frequency and usage of an antidote, the rate of being intubated, and the duration of being hospitalized comparing poisoned patients who received AC with those who did not. APRNs need to be aware of the current guidelines to help establish the appropriateness of use when administering AC and be able to evaluate patients during and after the administering of AC. Improved awareness and education regarding the different treatment modalities for toxicology patients such as AC can help with certain kinds of poisonings in the emergency department., Competing Interests: Disclosure: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Global health challenges demand the optimal use of nurses' professional competence and capability. Competencies related to the roles of advanced practice nurses have been developed, but research on these nurses' capabilities remains limited., Aim: To summarise and compare the literature on the capabilities of advanced practice nurses and the dimensions of these capabilities., Methods: We carried out a mixed methods systematic review, using CINAHL, PubMed, and Scopus to search literature published between 1998 and 2021. The quality of the selected articles was evaluated with the JBI Critical Appraisal Tools. We employed abductive content analysis, including deductive and inductive analysis. The reporting was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement., Results: Eleven articles out of 357 met the inclusion criteria. We identified all five dimensions of Hase and Davis's (1999) capability framework: can apply competencies in familiar as well as unfamiliar situations, is creative, has a high degree of self-efficacy, knows how to learn, and works well in teams. Additionally, we found a new dimension of capability: identifies factors affecting the scope of practice., Limitations: This mixed methods systematic review was conducted about a little-studied topic. Because country-specific differences exist and consensus on advanced practice nursing roles is lacking, the concept of advanced practice nurse capabilities cannot be directly generalised., Conclusions: Capability is a requirement and a necessity in the performance of advanced practice nurses. Identifying and defining the dimensions of advanced practice nurses' capabilities will lead the way in developing the roles, education, and capability assessments of advanced practice nurses. Identification of advanced practice nurses' capability will facilitate role understanding, visibility, and implementation in health care services. This can improve the quality and accessibility of care and improve the cost-effectiveness of the use of health care professionals., (© 2022 Nordic College of Caring Science.)

Abstract: A virtual activity integrating the evidence-based Reciprocity Ring model was designed to enhance confidence and skills for building social capital for advanced practice registered nursing (APRN) students. The central objective of the activity was to reduce the stigma of asking for help by providing a framework for the balanced exchange of favors, thus supporting new connections and feelings of trust among APRN students. Students from two APRN practice tracks ( N = 44) participated in a virtual Reciprocity Ring activity where they could post and respond to requests for help. On average, students posted 2.5 requests and received three offers for assistance; 220 connections were made overall with the major theme requests related to stress management. A retrospective survey was administered at the conclusion of the activity. Questions inquired about student confidence before, and then after, the activity for identifying resources, providing help to others, finding personal support when needed, accessing resources related to academic success, and finding solutions to problems. Student mean confidence scores were significantly higher after the activity compared with mean confidence scores before the activity ( p = .01). Additionally, the effect size was large (Cohen d = 0.89). Therefore, we suggest that integrating Reciprocity Ring exercises into nursing curricula and practice can be a useful tool for promoting skills related to productive help-seeking that will support APRN students' academic and professional success., Competing Interests: Competing interests: The authors report no conflicts of interest., (Copyright © 2022 American Association of Nurse Practitioners.)

Background: Health care organizations use advanced practice registered nurses (APRNs) to expand patient access and support high-quality care. However, turnover, often exacerbated by inadequate engagement, has steep financial and experiential costs., Local Problem: The project site, a large urban academic institution with quaternary care capabilities, employs more than 300 APRNs to provide patient care. Due to variations in hiring entity, leadership structure, and organizational visibility, efforts to maintain APRN engagement were complex. In addition, inconsistencies in standardization of clinical, credentialing, and privileging procedures created organizational risk., Methods: Quality improvement principles informed the implementation of a shared governance council for APRNs that included nurse practitioners and certified registered nurse anesthetists. Data were collected pre and postintervention using validated engagement questions., Intervention: Implementation of a shared governance council to support the organizational engagement of APRNs through decisional involvement in professional practice issues., Results: Analysis included the percentage of change in aggregate scores and the Wilcoxon rank-sum test to obtain p values of the 2 independent samples. There was an 8.9% increase in aggregate postintervention scores and statistical improvement in measures of quality improvement involvement., Conclusion: Participation in the shared governance council increased APRN engagement through enhanced opportunities to communicate professional and clinical practice issues, decisional involvement, and collaboration. Statistically significant improvements in quality improvement involvement values potentially affirm the council's role in facilitating work environment improvements. Potential long-term gains include improved job satisfaction, retention, and organizational cost savings., Competing Interests: Competing interests: The authors report no conflicts of interest., (Copyright © 2022 American Association of Nurse Practitioners.)

Using a convenience sampling, nurse educators representing 10 countries were surveyed to describe required clinical education for advanced practice beyond basic traditional nursing education. This article explores the many factors currently influencing the structure and diversity of these clinical experiences worldwide.

Aims: To explore Advanced Nurse Practitioners' (ANP) (Emergency) perceptions of their role, positionality and professional identity., Background: Advanced nursing practice was formally established in the Republic of Ireland in 2001 with 336 ANPs currently registered, projection increasing to a critical mass of 750 by 2021. Advanced practitioners (Emergency) give full emergency care for a specific cohort of clients with unscheduled, undifferentiated and undiagnosed conditions., Design: Qualitative narrative inquiry using Bourdieu's concepts of habitus, field and capital as the theoretical framework was undertaken., Methods: Data were collected in 10 in-depth interviews and thematic analysis applied., Results: Five key themes emerged: participants' career pathways, personal and professional transitions, role dimensions and core concepts, and position in the organization and emergent professional identity. Role transitioning and a change in habitus, field and capital revealed the uniqueness of their nursing role. Minimizing waiting times, timely patient care and patient satisfaction were key performance indicators. A heightened awareness regarding higher-level decision-making, autonomy and accountability is integral to advanced practice., Conclusion: This study presents unique insights into the ANP role covering recruitment, organizational culture changes required and support to ease transition emerged., Impact: Better understanding the motivation to undertake the role, the transition experience and use of advanced practice skills sets will inform the targets for the future recruitment and retention of ANPs are met nationally and internationally. Dissatisfaction with previous management roles and wanting to be clinically close to patients were motivations to follow an advanced practice clinical career trajectory. Positionality and emergent professional identity are key enablers ensuring that advanced practitioners' roles demonstrate the attributes of advanced practice. Educators could use the findings to develop recruitment, retention and progression strategies. Disseminating the role and scopes of practice could positively influence collaborative models of service delivery and policy development., (© 2020 John Wiley & Sons Ltd.)

Aim: To formulate, validate, and disseminate policy, modelling nurses' career pathway from registered to advanced practice nurse., Method: The evidence-informed policy and practice pathway framework was utilized. Multiple methods were used, including scoping review of literature, consultation of key informants, survey study, and expert group round-table discussions during 5-year project between 2013 and 2018., Results: Through (a) sourcing, (b) using, and (c) implementing the evidence, the expert group worked systematically to formulate a policy on a career pathway from registered to advanced practice nurse. The formulated career pathway includes three competence levels: registered nurse, specialized nurse, and advanced practice nurse, which includes the roles of nurse practitioner and clinical nurse specialist. In addition, validation and dissemination of the policy, as well as its effective implementation and the process of integrating it into practice, were examined., Conclusion: Evidence-informed policymaking is an effective, interactive way to work collaboratively in achieving consensus and translating knowledge into practice. The formulated policy will contribute to the increased awareness, acknowledgement, and implementation of the registered nurses' traditional and new roles within health care environments. Implementing and integrating the policy in national health care policy, legislation, education, and organizations across the country is a work in progress., (© 2019 John Wiley & Sons Australia, Ltd.)

Aim: To critically appraise and synthesise the current evidence related to the advanced practice nurse (APN) in the children and young people's healthcare setting., Background: A complex landscape of demand and change has influenced the healthcare delivery for children and young people. In the United Kingdom and internationally, governments have endorsed the need for workforce innovation with APN roles introduced to counter these challenges. However, little is known about the impact of these initiatives in the context of children and young people's health care., Design: Systematic review and narrative summary., Data Sources: CINAHL, MEDLINE, DARE, PubMed, Prospero and Cochrane Database of Systematic Reviews were searched for studies published in English language from July 1998 to 2018. Studies were selected based on key search terms and eligibility criteria., Review Methods: The selected studies were appraised using the Effective Public Health Practice Project for quantitative studies. An adapted version of the JBI data extraction tool for experimental/observational studies was used to extract the relevant key findings. This was conducted independently by two researchers., Results: Nine studies were included in the review. The review demonstrated roles were comparable in their clinical practice to medics yet offered higher levels of patient satisfaction, role modelling for staff and led practice initiatives to improve health literacy., Conclusion: This review demonstrates that APN roles in children and young people's health care provide clinical, organizational and professional benefits, with added value to organizations and patients, acting as role models and educators., Impact: The findings from this review indicate further research is required to ascertain contextual issues that may influence the implementation of APNs. This research will impact APNs working with children and young people. Equally, it supports the evidence base for service commissioners outlining areas for future research., (© 2019 John Wiley & Sons Ltd.)

Aim: To outline the development, implementation and evaluation of an alternative combined type 2 diabetes and chronic kidney disease (CKD) care delivery strategy provided in the context of advanced practice nursing informed by co-created knowledge, between patients and healthcare teams to address identified gaps in care provision., Design: This study was informed by the theoretical underpinnings of critical theory and operationalized using a participatory action research (PAR) design. This approach enabled alignment between the theoretical underpinnings and research methodology to respond to practice-level problems and address issues related to healthcare delivery., Methods: The study was undertaken in a series of three cycles of enquiry over a 20 month period (July 2018-February 2020) in five geographically diverse specialist diabetes and nephrology centres. Data collection methods included PAR group minute consensus, retrospective chart review, discovery and focus group interviews. Thematic analysis and descriptive statistics were used to analyse the data., Results: Compared with international standard care outcomes, a higher proportion of patients attending combined care achieved best practice recommendations for blood pressure, Hba1c and lipid management (64.3% vs. <40%). Patients attending combined care experienced improved detection and management of CKD-related anaemia. Additionally, the combined care service experienced significantly lower levels of patient's failure to attend scheduled reviews compared with participating standard care services (0% vs. 7%-23.3%)., Conclusions: Best practice clinical care outcomes and patient attendance improved when a combined type 2 diabetes and CKD care delivery strategy provided in the context of advanced practice nursing was adopted., Impact: This alternative care strategy represented a departure from standard care delivery approaches, in which care for type 2 diabetes and CKD is provided separately and led by physicians. Outcomes demonstrate improved clinical and attendance outcomes which may inform the development of future services led by advanced nurse practitioners., (© 2022 John Wiley & Sons Ltd.)

Objective: The objective of this review is to examine the current state of the literature regarding wound care provided by advanced practice nurses globally. Specifically, this review will examine the similarities and differences in the wound care practice of advanced practice nurses, including nurse practitioners, clinical nurse specialists, and advanced practice registered nurses., Introduction: Advanced practice nurses have graduate education and advanced scope of practice. The addition of advanced wound care training provides unique opportunities for advanced practice nurses to provide wound care., Inclusion Criteria: This review will consider advanced practice nurses who are nurse practitioners or registered nurses with graduate education and advanced training (certification/education) in wound care. The wound care can be provided independently or as a part of a team, in any setting., Methods: The proposed review will be conducted in accordance with the JBI methodology for scoping reviews. The databases searched will include MEDLINE, CINAHL, ProQuest Nursing and Allied Health, Cochrane Database of Systematic Reviews, and Scopus. To reflect changes in advanced practice nursing scope of practice, searches will be limited to articles published from 2011. Articles in languages other than English will be translated. Titles and abstracts will be independently reviewed by two reviewers, and relevant sources will be retrieved in full and reviewed. Any disagreements will be resolved through discussion or with an additional reviewer. The similarities and differences in wound care practice (type of wound, practice setting, treatments) will be extracted using a data extraction tool. Any modifications will be detailed in the scoping review. Extracted data will be presented in a descriptive format., Competing Interests: There authors declare no conflict of interest., (Copyright © 2022 JBI.)

Aim: To identify and differentiate the practice patterns of generalist, specialist and advanced practice nursing roles in specialist and central hospital contexts., Background: In Finland, as in other Nordic countries, advanced practice nursing roles emerged around 2000. There are over 60,000 registered nurses/midwives in Finland and the clinical career pathway from a registered nurse to advanced practice nurse has been described yet not fully implemented in healthcare organizations. However, the number and activities of nonadvanced and advanced practitioner roles are not well known., Design: A descriptive comparative study., Methods: An online self-report survey was conducted between August and October 2020 using an advanced practice role delineation tool. A census sample of registered nurses, registered midwives, specialist nurses and advanced practice nurses in five university hospitals and one central hospital was recruited. Descriptive statistics were used to summarize the characteristics of participants and group differences were compared using analysis of variance (ANOVA). The STROBE checklist was used as the reporting guideline., Results: A total of 1497 responses were obtained (response rate = 10%). Overall, nurses used comprehensive care and education activities most frequently. The least used activities were research and publication and professional leadership. Univariate analysis of variance test between role effects, when education and grouped age were taken into account, showed statistically significant difference in all of the observed five activities (p < .001)., Conclusion: Identifying activities in different levels of nursing is a crucial first step in delineating nursing roles thus improving the governance of the human resource management., Impact: The study results add to the international literature, delineating nursing roles in the spectrum of generalist to advanced practice nursing. As these roles become more formalized, we may incorporate novel ways of promoting the career development and optimal use and assessment of nursing roles and practice in various career levels., (© 2021 John Wiley & Sons Ltd.)

Background: Stronger healthcare models are increasingly sought to address new population needs, health workforce inefficiencies and nursing shortages. One strategy is to focus on employees' strengths to capitalize on their competencies and maximize their scope of practice., Introduction: Globally, there is an exponential demand for advanced practice nursing services. This study aimed to identify the roles and positions of nurses who align with APN defining criteria at all levels of care in Catalonia, Spain., Methods: The first step of the study included the translation and validation to Catalan of the Advanced Practice Nurse Role Delineation Tool (IDREPA) and step 2 comprised a multicentre cross-sectional study, in which 126 healthcare centres participated: 1209 nurses were included in the study. The STROBE checklist was used to report this study., Results: Transcultural equivalence and validation of the instrument showed a content validity index of 0.958 and the reliability of the questionnaire. The instrument identified 269 nurses who align with international APN defined criteria. They worked in specialized care, mental healthcare and primary and community care, especially in chronic conditions, ageing and end-of-life care., Discussion: Most areas of Catalonia have access to nurses practicing at APN defining criteria. These nurses were developed as an optimal resource to respond to patient needs in the context of study. Both recognition and strategic implementation are necessary to apply their full competencies to solve healthcare problems., Conclusion: Understanding the supply of services delivered by nurses practicing at an advanced level and their scope of practice may lay the foundations for effective workforce planning in a dynamic context. Nurses who align with APN defining criteria are working mainly in large acute services without regulation and recognition., Implications for Nursing: Advanced practice nurses show the value of their role and activities in healthcare services., Implications for Health Policy: Promoting the establishment of APN defining criteria that includes credentialing and a regulatory framework within international guidelines should be a priority to make an impact on healthcare policy., (© 2021 The Authors. International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

Abstract: Advanced practice registered nurse (APRN) programs are challenged to provide clinical learning experiences that prepare graduates with the full continuum of expected competencies. Preparing the APRN in academia, in terms of didactic and clinical application for novice entry, is often a vexing balance between board certification preparedness and the actualities of clinical practice. This article presents an innovative strategy to examine the perplexing reflective question often asked by educators: Does the current approach for simulation development prepare our APRN students sufficiently for entry into practice, and is it current to what is occurring in practice?, Competing Interests: The authors have declared no conflict of interest., (Copyright © 2021 National League for Nursing.)

Aim: This paper describes the characteristics of the new advanced practice nursing roles in France, as well as their challenges and perspectives, and compares the French model with the recommendations of the International Council of Nurses., Background: Advanced practice nursing is particularly well established in English-speaking countries. Since 2018, France has become the second French-speaking region to legalize and regulate advanced practice nurses., Source of Evidence: The International Council of Nurses and French government websites, and scientific databases (PubMed, CINALH, Cochrane Library) were explored. Feedback from French nursing academics was also requested., Discussion: The advanced practice nursing model in France is described according to the scope and conditions of professional practice. The educational program leads to a State diploma with master's degree, which it is mandatory to be a registered nurse. Remuneration depends on the sector of practice in the public hospital, primary care or private sector. Although there is no national strategy for the implementation of advanced practice nursing roles, research projects are being initiated to guide and evaluate the practice. Based on concordance analysis with the recommendations of the International Council of Nurses, the French advanced practice nursing model appears to be similar to the nurse practitioner model., Conclusion: Adjustments in the scope of practice and education can be expected as the implementation of these roles is evaluated., Implications for Nursing Practice: This is a historical evolution of the nursing profession in France, for which communication with patients and healthcare professionals is essential., Implications for Nursing Policy: The implementation of advanced practice nursing roles in clinical settings requires the development of national strategies to support initiatives and ensure the sustainability of these roles., (© 2021 International Council of Nurses.)

Purpose/objectives: Children in our nation are experiencing the social, emotional, and physical impacts of an unprecedented time in history. Advanced practice nurses prepared as psychiatric clinical nurse specialists and nurse practitioners bring therapeutic interventions, psychopharmacologic management, and systems thinking to clinical environments of care. Insight into the mental health of youth and families and how clinical nurse specialists may provide solutions for forthcoming challenges is discussed., Description of the Project/program: Barriers to mental healthcare such as the invisibility of nurses at state and federal levels must be eradicated to mitigate the mental health challenges that youth, families, and communities endure. Contemporary issues such as effects of social media, stigma, and suicide present burdens that can be moderated through nursing interventions., Outcome: The psychiatric clinical nurse specialist provides evidence and community-based nursing interventions that, through early identification and advocacy, contribute to positive mental health outcomes for youth and families., Conclusion: The need for well-educated advanced practice nurses has never been greater for our vulnerable populations of children, adolescents, and families with mental health challenges. Nurse-delivered programs demonstrate that interventions are necessary for communication, psychoeducation, and prevention of consequences from unacknowledged social media, stigma, and suicide problems., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Gaps in research persist related to practitioners' resilience, although much has been written about the need for strategies to strengthen personal resilience., Purpose: The study's purpose was to examine practice-level (quality of physician relationship, physician presence, and autonomy) and individual factors and how they affect resilience., Methodology: An online survey invited advanced practice registered nurses (APRNs) and physician assistants (PAs) from four states to participate in a cross-sectional study. Hierarchical ordinary least squares regression was used to test the impact of main effect variables in the context of identified control variables., Sample: A sample of 1,138 APRNs and PAs completed the survey questions., Results: Findings from the covariate model (model 1) and the main effect model (model 2) show that both models were significant at the p < .01 level, with the adjusted R2 differing from 0.02 to 0.13, respectively. Regression results show a significant positive association between quality of the physician relationship and APRN/PA resilience (b = 0.09, p < .01). A negative association between the lack of autonomy and higher levels of resilience (b = -0.14, p < .01) was also demonstrated., Conclusions: Advanced practice registered nurse/PA resilience is affected by both practice-level and personal factors, suggesting that workplace interventions could increase resilience., Implications for Practice: Work environments allowing APRNs and PAs to function autonomously and with professional support from physician colleagues are favorable contributors to their resilience. Future studies need to investigate the meaning of physician presence/availability and organizational interventions that extend beyond individual resilience., Competing Interests: Competing interests: The authors report no conflicts of interest., (Copyright © 2021 American Association of Nurse Practitioners.)

Abstract: Scholarship forms the scientific basis of advanced practice registered nurse (APRN) practice. Although the number of manuscripts from APRNs has grown, the vast majority of APRNs do not publish works that affect practice, education, research, or policy. Many APRNs are unaware of resources, such as a writing coach and an editor, that facilitate producing publishable scholarship. This article describes the similarities and differences of the two resources., Competing Interests: Competing interests: The author reports no conflicts of interest., (Copyright © 2021 American Association of Nurse Practitioners.)

Aim: This study aims to report on the actions and incident management of the advanced practice nurses of a disaster operation team who were deployed in response to the COVID-19 outbreak, and to explore how it illustrated the Core Competencies in Disaster Nursing Version 2.0 delineated by the International Council of Nurses in 2019., Methods: This is a descriptive study. The participants (responders) communicated and reported their actions in the operation with headquarter on a popular social media platform in China (WeChat), established specifically for the three-rescue teams., Results: The response approach of advanced nurses to COVID-19 encompassed six of the eight domains of the competencies outlined in ICN CCDN V2.0, namely on preparation and planning, communication, incident management systems, safety and security, assessment and intervention., Conclusions: The response teams of advanced practice nurses in this study clearly demonstrated their competencies in disaster rescue, which fulfilled most of the core competencies set forth by the ICN., Implications for Nursing Management: The findings of this study contributed to understand the roles played by advanced practice nurses and nurse managers in disaster management and how these relate to the competencies set forth by the ICN., (© 2020 John Wiley & Sons Ltd.)

Aim: To critically appraise and synthesize evidence of integrated care stemming from advanced practice nursing in elderly primary care settings throughout the United States and Thailand., Background: Advanced practice nurses are key to accelerating integrated elderly care in the community. Yet, their scope and capacity vary greatly across countries, making impact measurement highly challenging., Methods: A systematic search of PubMed, CINAHL, Scopus and ThaiJo databases was performed. Full-text articles in English or Thai language were reviewed using an inductive thematic approach from the integrated people-centred Health Services framework, adopted by the World Health Organization., Results: A total of 42 articles were appraised according to framework strategies: (1) people and community empowerment/engagement; (2) governance and accountability strengthening; (3) model of care reorientation; (4) service coordination; and (5) enabling environment creation. Collaborative roles and empowerment of older people were associated with higher quality of care. Thai nurses empowered individuals through community networks and resources, incorporating care models (strategy 1). In contrast, US nurses adopted a quality improvement and safety approach, incorporating technology into nursing interventions (strategy 5)., Conclusion: Advanced practice nurses employ an array of strategies and approaches in caring for older people. Although their role varies from mostly substitute (US) to supplemental (Thailand), nurses in both countries contribute towards integrated person-centred care., Implication for Nursing Practice and Nursing Policy: Preparing advanced practice nurses to work in the community is a prerequisite for meeting ageing population health needs in a sustainable manner. Education, professional development and leadership training opportunities should focus on capacity building in: a) strengthening mutual accountability, b) reorienting the work environment through innovative care models and c) coordinating services through partnerships to achieve universal health and ensure healthy ageing., (© 2021 International Council of Nurses.)

Aim: To describe the practice doctorate scholarly approach to assess advanced nursing practice in Ireland to address healthcare and nursing policy initiatives., Background: A global team from Ireland and the United States collaborated with stakeholders, using a practice doctorate approach to identify geographic healthcare needs, the current state of the education and the evolving roles of advanced nursing practice. In Ireland, current policy initiatives call for expanding the capacity for advanced nurse practitioners to meet healthcare needs in community settings., Sources of Evidence: Further assessment data were required from stakeholders to inform graduate nursing education to prepare advanced practice nurses to fulfil increasingly complex healthcare needs. The practice doctorate approach included review of literature, current policy and assessment with interviews, dialogue and the development of working relationships with policymakers, academics and practitioners., Discussion: The current state and future vision of graduate nursing education are evolving. A force field analysis identified promoting and restraining factors to the desired state of development of the primary care advanced practice role. Relationship building with stakeholders and sharing of expertise was key to engage academia and policymakers to address identified restraining forces. Short-term outcomes included development of collaborative relationships between practice, academia and policymakers, curricular development for the primary care nurse practitioner and intentionally shared dissemination to promote community graduate nursing education., Implications for Nursing Practice: This innovative practice scholarship approach was used to assess and promote advanced nursing practice impact and promote the nursing profession globally., Implications for Policy: Successful collaboration between two global partners was achieved to promote policy objectives for both nursing and health care, with the ultimate goal of improving health outcomes and population health., (© 2020 International Council of Nurses.)

Background: Stroke prevalence is rising internationally. Advanced practice nursing is established across many jurisdictions; however, its contribution to stroke services is under research., Aim: To gain insights into the future scope and role of future advanced nurse practitioners in stroke care from the perspectives of key stakeholders., Design: A qualitative descriptive approach., Methods: Interviews were conducted in 2019 with a purposive sample of 18 participants, comprising stroke nurses, stroke unit managers, stroke survivors and their family carers, recruited in one UK healthcare trust. The research is reported in line with COREQ. Data were analysed in accordance with an inductive content analysis approach., Results: The abstraction process generated four main themes. These were 'The lynchpin of the acute stroke service', 'An expert in stroke care', 'Person and family focussed' and 'Preparation for the role'., Conclusion: These findings offer new perspectives on the potential scope and role of advanced nurse practitioners in stroke service delivery. Further research should focus on how to address the challenges confronted by advanced nurse practitioners when endeavouring to engage in autonomous clinical decision-making., Impact: Study findings may advance postregistration education curricula, clinical supervision models and research directions., Relevance to Clinical Practice: There is support for the implementation of advanced practice nursing in the hyperacute and acute stroke phases of the care pathway. An interprofessional model of clinical supervision has potential to support the developing advanced nurse practitioner in autonomous clinical decision-making., (© 2020 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Aims and Objectives: To consider the relationship between professional nursing identity and advanced practice by exploring intra-professional relationships between advanced nurse practitioners (ANPs) and nursing colleagues., Background: Advanced nursing practice continues to develop internationally. Previous studies suggest advanced practice may lack support within nursing, which may lead to underutilisation, retention and patient safety issues. However, the relationship between the wider nursing profession and advanced practice is poorly understood and the theory that professional identity creates cultural barriers to advanced practice has received little empirical attention., Design: Ethnographic methodology was used., Methods: Fieldwork methods were participant observation and semi-structured interviews. Participants were ANPs (n = 9) and nursing colleagues (n = 5) across two primary care general practice organisations. Data were analysed thematically using framework analysis, underpinned a priori by professional identity theories. Reporting was guided by COREQ., Results: Three themes were identified which indicated how intra-professional relationships were conducted: Conciliating Nursing, where ANPs took responsibility for developing positive relationships with other nurses; Vertical Discounting, where nursing colleagues were dismissive and undermined ANPs, who themselves behaved similarly towards other nurses; and Lateral Othering, where ANPs undermined other ANPs. Vertical Discounting and Lateral Othering destabilised advanced practice., Conclusion: Intra-professional relationships, and the broader nursing profession, shape advanced practice. We theorise this is underpinned by threats to professional identity, while weak professional identity amongst even established advanced practitioners exacerbates lack of support. Highlighting these issues allows space to develop alternative strategies to negotiate intra-professional relationships, informed by professional identity theories, which support rather than inhibit advanced practice., Relevance to Clinical Practice: As advanced practice expands throughout primary and secondary care, and across allied health professions, the impact of professional identity and relationships on health care will likely increase and the importance of strong advanced practice identity will become increasingly relevant., (© 2019 John Wiley & Sons Ltd.)

Aim: To evaluate the implementation of advanced practice nursing in emergency care in Norway for patients with orthopaedic injuries, including hip fractures. The outcomes relate to quality of care and patient trust., Design: A non-inferiority study comparing an advanced practice nursing care model with a standard (physician-led) care model., Methods: Data will be collected from patient records and through the Patient Trust Questionnaire, completed by patients. The data will be analysed by descriptive and inferential statistics. Funding for the research was granted in 2015 and the regional ethical committee approved the current study in February 2019., Discussion: In Norway and the other Nordic countries, advanced practice nursing is still in its infancy, especially in the emergency care context. This study will evaluate advanced practice nursing in this new context., Impact: The study will add to knowledge on the quality of care provided for orthopaedic patients with minor orthopaedic injuries or hip fractures as delivered by advanced practice nurses and physicians, respectively. It will also evaluate how well-advanced practice nursing is accepted by patients in this new context., (© 2019 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aim: To review published literature descriptions of advanced practice nurses' roles in low- and lower middle-income countries., Background: Advanced practice nurse roles have the potential to address insufficient healthcare resources in low- and lower middle-income countries., Introduction: This integrative review highlights advanced practice nurses' roles in the delivery of healthcare services in low- and lower middle-income countries., Methods: Three electronic databases PubMed, CINAHL complete and ProQuest Health & Medicine were searched. No limits by year or language were set. The names for low- and lower middle-income countries and combinations 'related to advanced practice nurses' titles were used to identify papers. In addition, a review of publication type was performed. Themes found within the publications were assessed against the advanced practice nurses' International Council of Nurses' characteristics. An integrative review facilitated an appraisal of the papers identified., Results: The initial search identified 5778 publications in 16 languages. This number was reduced to 23, from 18 low- and lower middle-income once exclusion criteria were applied. Six publications were from 1977 to 1999, and six between 2000 and 2010, with the remaining 11 from 2011 to 2018. Zambia had the most publications. Notably, 63 countries were not represented. Of those meeting inclusion criteria, the majority addressed education with a lesser extent focusing on practice and regulation of advanced practice nurse's roles. The majority were published during the last decade., Discussion: This review of the published literature identified advanced practice nurses' roles and function within some healthcare systems. However, not all components were reported. Examination of the grey literature could provide additional information about the actual and potential benefits of advanced practice nurses' in low- and lower middle-income countries., Conclusion: The published literature that referred to advanced practice nurses' identified their contribution to positive impacts on health care over the last 40 years. However, with only 11 publications identified in the last 7 years, further review is required to understand the advanced practice nurses' roles in these countries., Implications for Nursing And/or Health Policy: Further development of advanced practice nurses' in low- and lower middle-income countries is supported by the lack of published literature., (© 2019 International Council of Nurses.)

Aims and Objectives: (a) To describe and analyse advanced practice nursing students' self-assessment of their clinical competence and need for further training and (b) to analyse the possible predictive variables in their self-assessment., Background: The self-assessment of clinical competence in nursing education is important for identifying professional development and educational needs to improve patient care., Design: A cross-sectional survey following STROBE guidelines was used., Methods: Ninety-nine students from three universities/university colleges in Norway participated in the study, and data were collected using a revised version of the Professional Nurse Self-Assessment Scale II. Descriptive, correlation and regression analyses were performed., Results: The students gave the highest self-assessment ratings for their clinical competence in taking full responsibility and for their need for further training in medication effects and interactions. Although the students gave themselves low ratings for the use of electronic devices, they assessed their need for further training in this area as average. Clinical work experience as a registered nurse and previous higher education level were not significant predictors of clinical competence nor the need for further training., Conclusion: The findings indicate that self-assessment is appropriate for students in advanced practice nursing programmes. This study implies that programmes in advanced practice nursing need to familiarise students with the possibilities of information technology. It questions the entry requirement that stipulates that prospective students must have several years of clinical work experience as registered nurses before entering advanced practice nursing programmes. These programmes need to communicate that competencies other than direct clinical practice are also needed for students' future roles., Relevance to Clinical Practice: The study contributes to the exploration of how students self-assess own clinical competence and need for further training in advanced practice nursing programmes. Further research should evaluate the development of clinical competence., (© 2019 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.)

Aims: To identify associations among agency, community, personal and attitudinal factors that affect advanced practice nurses' uptake of HIV pre-exposure prophylaxis, an intervention consists of emtricitabine/tenofovir once-daily pill, along with sexual risk reduction education., Design: Cross-sectional., Methods: During March-May 2017, randomly selected Indiana advanced practice nurses were invited to complete an online survey, consisted of several validated self-rating measures (N = 1,358; response = 32.3%). Final sample (N = 369) was predominantly White, non-Hispanic, female advanced practice nurses in urban practices (mean age = 46). Conceptual model for structural equation model included 29 original/composite variables and five latent factors., Results: Final model consisted of 11 variables and four factors: agency, community, HIV prevention practices (including screening) and motivation to adopt evidence-based practices overall. Community had direct effects on HIV prevention practices (estimate = 0.28) and agency (estimate = 0.29). Agency had direct effects on HIV prevention practices (estimate = 0.74) and motivation to adopt evidence-based practices (estimate = 0.24). Community had indirect effects, through agency, on the two remaining factors., Conclusion: Barriers exist against pre-exposure prophylaxis implementation, although practice guidelines are available. HIV prevention practices must be integrated across organizational structures, especially in high-risk communities, whereas practice change is more effective when focused on changing providers' attitudes towards intervention. When planning a pre-exposure prophylaxis intervention, advancing inputs from healthcare professionals, organizational leadership and community members, is crucial to success., Impact: In settings where advanced practice nurses are primary contact points for health care, they may be best positioned to have an impact on implementation of HIV risk reduction strategies. Further research is needed to optimize their contributions to pre-exposure prophylaxis implementation., (© 2019 John Wiley & Sons Ltd.)

Background and Purpose: The Advanced Practice Registered Nurse (APRN) Compact was approved at the National Council of State Boards of Nursing Delegate Assembly in May 2015. Since that date, only three states have been successful in the legislative adoption of the compact. Thus, the purpose of this study was to explore the experiences and perceptions of nursing regulatory leaders involved with the individual state adoption of the APRN Compact., Methods: This qualitative study followed a phenomenological-hermeneutic methodology approach., Conclusions: Four themes emerged from within the data: legislative political environment; professional organizational barriers; strategies to push past barriers; and moving forward. An overarching theme of consistent communication was evident., Implications for Practice: This study identifies barriers experienced in the legislative state adoption process and successful strategies to overcome these barriers to move the APRN compact forward.

Objectives: The literature highlights the importance of an interprofessional approach in palliative care to improve the quality of care, favoring an effective use of resources. Members of the interprofessional team include all professionals involved in patient care; in some contexts, the advanced practice nurse (APN) has a clearly defined role. This study aimed to define the possible role of the APN within the interprofessional palliative care team in our context., Data Sources: A focused ethnographic approach was taken involving participant observation and semistructured interviews., Conclusion: From the participant observations, interaction of the participants, discussion content, and styles of meeting management were described. From the thematic analysis of the interviews, 15 themes emerged, grouped into four macro-themes: interprofessional collaboration, the interprofessional meeting, nurse's role, and developments., Implications for Nursing Practice: The study has identified current nursing practice within the interprofessional palliative care team and areas where interprofessional collaboration can be improved. These are both organizational (role definition and team meeting management) and professional (development of nursing culture, expanded nursing role, and introduction of the APN within the team). Nurses must develop advanced skills to ensure more effective care for patients and caregivers. The introduction of an APN could be appropriate to address this need., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aim: The aim of the study was to identify the nature and extent of scientific research addressing continuing education for advanced practice nurses., Design: A scoping review., Review Methods: The Joanna Briggs Institute's methodology for scoping reviews., Data Sources: Electronic search was conducted on 17 September 2023 via CINAHL, PsycINFO, PubMed, Scopus, Web of Science, Cochrane Library and the Joanna Briggs Institute's Evidence-Based Practice Database for research articles published between 2012 and 2023., Results: Nineteen papers were included in this review. Scientific research on continuing education for advanced practice nursing roles (i.e. nurse practitioner, clinical nurse specialist) has primarily been conducted in the United States and mostly addresses online-delivered continuing education interventions for clinical care competency. Most of the interventions targeted nurse practitioners., Conclusion: Continuing education has a pivotal role in supporting advanced practice nursing competency development. In addition to clinical care, future continuing education research should focus on other advanced practice nursing competencies, such as education, leadership, supporting organizational strategies, research and evidence implementation., Implications for the Profession And/or Patient Care: Continuing education programmes for advanced practice nurses should be rigorously developed, implemented and evaluated to support the quality and effectiveness of patient care., Impact: Continuing education for advanced practice nursing roles is an understudied phenomenon. This review highlights future research priorities and may inform the development of continuing education programmes., Reporting Method: PRISMA-ScR., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Objective: To discuss the opportunities and challenges of implementing patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) within advanced practice nursing services in cancer care., Methods: This discussion paper has been informed by an environmental scan of evidence from systematic reviews and primary studies evaluating the use and implementation of PROMs and PREMs. Literature from the contexts of cancer and chronic disease, including nursing and multidisciplinary supportive care literature, has been included., Results: Advanced practice nurses are well-positioned to evaluate and respond to PROMs and PREMs data; several studies have highlighted improved patient outcomes concerning quality of life, symptom distress, and functional status within nurse-led services. Nevertheless, the implementation of PROMs and PREMs in cancer care and nurse-led services is variable. Previous studies have highlighted implementation challenges, which can hinder comparability and generalizability of PROMs and PREMs instruments. Advanced practice nurses should consider these challenges, including ways to use standardized PROM instruments. Electronic PROMs, while efficient, may exclude individuals at risk of inequity. Complex, lengthy, and frequent administration of PROMs may also overburden people living with or after cancer, with people affected by cancer expressing preference for flexible use in some studies. Therefore, the involvement of people affected by cancer in planning for PROMs/PREMs implementation may overcome this challenge. Finally, organizational considerations in implementation should address financial investments, including initial costs for technology and training and consideration of the operationalization of PROMs within existing infrastructure for the seamless utilization of PROMs data., Conclusion: Despite the potential of advanced practice nursing services to enhance patient-reported outcomes and experiences, variability in the implementation of PROMs and PREMs poses challenges. Use of validated measures, electronic or paper-based instruments, and the preferences of people affected by cancer for the use of PROMs and PREMs must be carefully considered in consultation with end users for successful implementation., Implications for Practice: In planning for the implementation of PROMs and PREMs within nurse-led services, implementation risks may be mitigated through establishing clear guidelines for their use, investment in the development of the required infrastructure, user education, and rigorous implementation processes, including patient involvement in PROMs/PREMs selection., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Maura Dowling is a guest editor for the “Advanced Oncology Nursing Roles” special issue of Seminars in Oncology Nursing. As a coauthor of this article, she did not participate in any editorial process or decision-making, which was handled by another editor., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Advanced practice nursing roles in cancer care are diverse and exist across the cancer care continuum. However, the titles used and the scope of practice differ across countries. This diversity is likely to be misleading to patients and influence nurses' contribution to health care. An understanding of the current state of advanced practice nursing roles in cancer care internationally is needed to inform opportunities for future role development and enhance cancer nursing career pathways., Methods: This scoping review included a systematic search of four databases: MEDLINE, CINAHL, PsycINFO, and Academic Search Complete. Independent screening for papers meeting the review's inclusion criteria was undertaken using online screening software. Data extraction, coding, and mapping were undertaken in NVivo 12., Results: Of the 13,409 records identified, 108 met the review's inclusion criteria. A variety of roles in cancer care settings were described. The United States and the United Kingdom had the most titles for advanced practice nursing roles. Tumor-specific roles were described and integrated into different phases of the cancer care continuum. Trends in continuing professional development for advanced practice nurses in cancer care included the rise in Fellowship programs in the United States and practice-based education in the United Kingdom., Conclusions: The differences in advanced practice nursing roles in cancer care allow regional and institutional variation to meet the needs of patient populations and health care system demands. However, a lack of clarity surrounding titles and roles results in confusion and underutilization of these nurses' highly specialized skill sets., Implications for Nursing Practice: Incongruence in titles and scope of practice internationally will ultimately result in a merging of roles. There is a need for international agreement on education requirements for advanced practice nursing roles to promote career pathways., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Advanced practice nursing in cancer care is a research priority of the European Oncology Nursing Society (EONS). Five authors are members of the EONS research working group (Maura Dowling, Eva Pape, Paz Fernández-Ortega, Cherith Semple, Amanda Drury). Maura Dowling, Eva Paper, and Denise Bryant-Lukosius were Guest Editors for the “Advanced Oncology Nursing Roles” Special issue of Seminars in Oncology Nursing. As authors of this article, they did not participate in any editorial process or decision-making, which was handled by another editor., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Aim: This paper aims to highlight the vital importance of investing in advanced practice nursing (APN) for enhancing emergency care throughout Africa., Background: APN's role is increasingly recognized as pivotal in optimizing healthcare, particularly in emergency settings in Africa. It offers improved patient care quality and strengthens the healthcare workforce., Sources of Evidence: Evidence is drawn from successful implementations of APN in various healthcare environments. This includes the development of APN-specific curricula and training, mentorship initiatives, clinical supervision, and defining advanced nursing roles within healthcare organizations. Investing in APNs in emergency care in Africa can lead to improved quality and access to care, cost-effectiveness, enhanced patient outcomes and satisfaction, and opportunities for professional development and career advancement in the healthcare workforce., Discussion: Despite facing barriers in implementation, APN in emergency care presents innovative solutions. Investing in APN can help healthcare entities and policymakers surmount these challenges, providing specialized patient care and improving health outcomes. The discussion emphasizes the benefits such as enhanced access to care, reduced healthcare costs, and improved patient outcomes, alongside bolstering the healthcare workforce., Conclusion: The necessity and benefits of investing in APN for emergency care in Africa are clear. It is crucial for improving healthcare delivery and outcomes., Implications for Nursing Practice: APN investment leads to a more competent and efficient nursing workforce, capable of addressing complex emergencies and improving patient care., Implications for Nursing Policy and Health/social Policy: The paper advocates for policies that support APN development and integration into the healthcare system, emphasizing the need for research to assess APN's long-term impact and establish best practices for its implementation in emergency care across Africa., (© 2024 The Authors. International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)