Journal of the American Association of Nurse Practitioners
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J Am Assoc Nurse Pract · Nov 2020
Characteristics and perceptions of the US nurse practitioner hospitalist workforce.
The use of nurse practitioners (NPs) as hospitalists has grown over the last two decades. Based on current educational preparation, certification, and scope of practice, the acute care NP is considered by professional standards the best prepared to care for the needs of acutely and critically ill patients. Little is known about this sector of the NP workforce. ⋯ The prevalence of on-the-job training as the most common preparation for the hospitalist role suggests a need to evaluate the effectiveness and outcomes of NPs not initially educated as acute care NPs who work as hospitalists. Nurse practitioner educators should address the evolving workforce needs of both primary and acute care practice when planning and implementing educational programs.
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J Am Assoc Nurse Pract · Aug 2020
ReviewEducation initiatives in cognitive debiasing to improve diagnostic accuracy in student providers: A scoping review.
The high prevalence of diagnostic errors by health care providers has prompted medical educators to examine cognitive biases and debiasing strategies in an effort to prevent these errors. The National Academy of Medicine hypothesized that explicit diagnostic reasoning education of all health care professionals can improve diagnostic accuracy. ⋯ There are myriad debiasing strategies student providers may use to mitigate cognitive bias. Structured reflection and education initiatives demonstrated the most consistent improvements in diagnostic accuracy. Future studies on debiasing strategies must include NP students to understand their response to these initiatives.
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J Am Assoc Nurse Pract · Jun 2020
Driving high-functioning clinical teams: An advanced practice registered nurse and physician assistant optimization initiative.
Rapid changes in the health care marketplace are driving health care systems to modify operations by which the advanced practice registered nurse (APRN) and physician assistant (PA) clinicians serve patients. By identifying more effective and efficient utilization workflows, organizations can meet these demands resulting in high-functioning clinical teams. ⋯ Several recommendations were presented to department leaders regarding NP/CNM/CNS/PA practice. Those departments who implemented several of the recommendations showed positive outcomes. This was evidenced by increased financial gain (increased relative value units, increase in revenue generated), increased patient access (increased clinic densities), and overall NP/CNM/CNS/PA satisfaction.
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J Am Assoc Nurse Pract · May 2020
Reducing chest radiography utilization in the medical intensive care unit.
Daily chest radiographs (CXRs) have long been a routine part of care. However, evidence as well as changing technology has promoted on-demand CXRs as beneficial to patient care. We found that a substantial number of routine daily CXRs were being ordered, with some of the orders staying active even after extubation. ⋯ By an orchestrated process that included creating awareness and desire to change CXR ordering practices, we were able to decrease routine CXRs and increase on-demand utilization while maintaining counterbalance measures.
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J Am Assoc Nurse Pract · Apr 2020
ReviewUnmet needs in the acute treatment of migraine attacks and the emerging role of calcitonin gene-related peptide receptor antagonists: An integrative review.
Migraine is a prevalent and chronic disease associated with high rates of disability and significant financial and socioeconomic burden. Current acute treatments for migraine attacks include both migraine-specific (e.g., triptans, ergotamines) and nonspecific (e.g., nonsteroidal anti-inflammatory drugs) medications; however, significant unmet treatment needs remain. ⋯ The availability and use of CGRP receptor antagonists may help reduce the extent of unmet needs in the treatment of migraine attacks, resulting in more patients receiving treatment and better outcomes for people with migraine. Nurse practitioners are well positioned to increase rates of migraine diagnosis/treatment (another key unmet need), using consensus guidelines to guide their approach.