Preceptor rewards: How to say thank you for mentoring the next generation of nurse practitioners

Purpose: To answer the question how do faculty nurture and reward clinical preceptors and what supports do preceptors require? Data sources: Data came from the literature and from surveying a purposive sample of 26 faculty members teaching clinical courses and arranging precepted experiences for nurse practitioner (NP) students at 26 public and private institutions across the United States. The vehicles for the survey were personal contact and e-mail.Conclusions: Schools offer preceptor rewards varying widely in their monetary value, from tuition and continuing education vouchers, verification of hours toward recertification, access to services and events on campus, reduced price or free admission to museums, cultural and sports events, and lectures. Faculty nurture preceptors by nominating them for awards, providing letters of reference, editing manuscripts, and collaborating on research projects. Supports for preceptors from the literature reflected National Organization of Nurse Practitioner Faculties guidelines (2000), and the policies of schools and clinical agencies, such as providing copies of program objectives and student credentials.Implications for practice and education: As NP programs have proliferated, there is increased pressure on faculty to find, nurture, reward, and retain good preceptors. Faculty must continue to work with program and agency administrators to comply with policies and create preceptor rewards to recognize their gifts to us, to our schools, and to the profession

Simulation as a Disruptive Innovation in Advanced Practice Nursing Programs: A Report from a Qualitative Examination

Simulation as a pedagogy is used extensively to educate healthcare professionals in both academic and clinical arenas with the intent to improve the delivery of care and patient outcomes. Advanced practice nursing (APN) programs use simulation as a pedagogy even though APN accreditation and certification organizations prohibit substituting simulation hours for the minimum 500 clinical hours. The purpose of this qualitative study was to explore faculty perceptions of educating APN students using simulation. Focus groups were conducted with a convenience sample of APN simulation faculty. Disruptive innovation theory was used by the researchers to guide the data analysis. Themes emerging during analysis included: 1) extrinsic tension and pressure in the midst of chaos, 2) internal vulnerability, and 3) passion and tenacity to remain resilient. The study results provide clarity to understand integration of APN simulation in the current environment, and introduce the impact of simulation as a disruptive innovation

Creating effective advisory boards for schools of nursing

Increasingly, a significant priority for the dean and faculty in schools of nursing is fundraising. Raising financial resources is highly competitive and requires sophisticated approaches to building relationships with individual donors, government agencies, private foundations, and corporations. Fundraising efforts need to be designed to cultivate alumni, parents, and friends as key leaders educated in the work of the school, its vision for the future, and the nursing profession. Advisory boards, with an emphasis on development, can effectively nurture such leaders who are fully versed in the strategic vision of the school and who are willing to provide financial support and access to a broad community of interest. An integrated approach that capitalizes on the expertise and knowledge of the dean, the faculty, advancement officers, and a carefully selected board chair forms the foundation of a successful model for development-focused advisory boards. Advisory board implementation is discussed from the perspective of a clearly articulated board charge, selection and recruitment, board retreat, assessment of interest and inclination through an annual board-planning process, engagement in priority project planning with the faculty, and careful cultivation toward deepened relationships and funding

Are genetic tests exceptional? Lessons from a qualitative study on thrombophilia

Policy makers have suggested that information about genetic risk factors, which are associated with low risk and for which preventive strategies exist, should not be considered “exceptional” and should not warrant special safeguards, such as data protection or specialist pre-test counselling. There is scant research on how such risk factors are perceived, and to explore this we conducted qualitative interviews with 42 participants who had undergone testing in the South West of England for a low risk genetic susceptibility to deep vein thrombosis (DVT). Generally the participants, who were mostly women, thought the test was less serious than a genetic test for a predisposition to breast cancer or a non-genetic, diagnostic test for diabetes. They had used the genetic information to reduce their risk of DVTs by avoiding oral contraceptives and hormone replacement therapy but had not changed their lifestyle. Many considered pre-test genetic counselling unnecessary. However, a subgroup of participants, who were often less educated or at a high risk, were distressed and/or confused about thrombophilia and thought pre-test counselling would have been helpful. The findings indicate an emerging interpretation of genetics not as revealing exceptional or “in depth” knowledge about one's health and identity but as occasionally relevant surface information, which participants use to make specific health decisions but not to transform their everyday lives. However, the views of the subgroup indicate that some participants interpret thrombophilia as serious and/or need special support

Self-reported quality of care for older adults from 2004 to 2011: a cohort study

Background: little is known about changes in the quality of medical care for older adults over time. Objective: to assess changes in technical quality of care over 6 years, and associations with participants' characteristics. Design: a national cohort survey covering RAND Corporation-derived quality indicators (QIs) in face-to-face structured interviews in participants' households. Participants: a total of 5,114 people aged 50 or more in four waves of the English Longitudinal Study of Ageing. Methods: the percentage achievement of 24 QIs in 10 general medical and geriatric clinical conditions was calculated for each time point, and associations with participants' characteristics were estimated using logistic regression. Results: participants were eligible for 21,220 QIs. QI achievement for geriatric conditions (cataract, falls, osteoarthritis and osteoporosis) was 41% [95% confidence interval (CI): 38–44] in 2004–05 and 38% (36–39) in 2010–11. Achievement for general medical conditions (depression, diabetes mellitus, hypertension, ischaemic heart disease, pain and cerebrovascular disease) improved from 75% (73–77) in 2004–05 to 80% (79–82) in 2010–11. Achievement ranged from 89% for cerebrovascular disease to 34% for osteoarthritis. Overall achievement was lower for participants who were men, wealthier, infrequent alcohol drinkers, not obese and living alone. Conclusion: substantial system-level shortfalls in quality of care for geriatric conditions persisted over 6 years, with relatively small and inconsistent variations in quality by participants' characteristics. The relative lack of variation by participants' characteristics suggests that quality improvement interventions may be more effective when directed at healthcare delivery systems rather than individuals

Clinical lactation practice: 20 years of evidence

Lactation consultants depend on a vast multidisciplinary knowledge base to support their practices. To coincide with the 20-year anniversary of the International Lactation Consultant Association, the authors sought to highlight the knowledge base to demonstrate how practice has been affected. Using standard databases, they extracted English-language scientific literature related to breastfeeding and maternal and infant health outcomes; factors associated with breastfeeding initiation, exclusivity, and duration; lactation physiology; common breastfeeding challenges; breastfeeding practices within vulnerable populations; health professional support of breastfeeding; and breastfeeding practices in developing countries of Africa. Summaries of research are provided to demonstrate scientific method and knowledge evolution. As the knowledge of the biological, behavioral, and environmental factors that affect breastfeeding continues to grow, researchers and lactation consultants will identify additional research areas. Thus, the cycle of describing and explaining phenomena, testing interventions to improve practice, and ultimately improving breastfeeding outcomes worldwide will continue

Mentoring Graduate Students to Become Effective Teaching Assistants: Developing and Implementing a Student-Centred Program for Nursing

Teaching in the health professions, including nursing, requires specialized educational strategies that meet the needs of the current generation of learners. Currently there is a shortage of experienced post-secondary educators in nursing, possibly exacerbated by inadequate Teaching Assistant (TA) professional development programs. Most literature describes TA professional development programs that involve undergraduate students employed as TAs, and few consider how programs can mentor graduate students to develop their instructional skills, contribute to courses, and enhance their careers. There are limited reports in the Canadian context. In this article we outline the rationale, development, and implementation of a Graduate Teaching Assistant (GTA) mentorship program for graduate students at a school of nursing located in western Canada. Our aim is to provide mentorship and experience in educational strategies to graduate students, to help mentor and educate future nursing educators who are experienced post-secondary teachers. We discuss the rationale for offering the GTA mentorship program, followed by a description of the GTA mentorship program components. We highlight the role of the Senior TA, an experienced GTA who takes a leadership role in coordinating the program. Importantly, we discuss how knowledge related to cultural safety is presented, and how it has been adapted over time to meet GTAs’ needs. Finally, we discuss the evolution of a school of nursing GTA mentorship program, located in western Canada and we describe future changes to the program in order to remain relevant to the needs of graduate students in nursing, faculty and administration, and undergraduate nursing students. L’enseignement dans les professions de la santé, y compris les sciences infirmières, nécessite des stratégies pédagogiques répondant aux besoins de la génération actuelle d’apprenantes. Nous connaissons actuellement une pénurie d’enseignantes en sciences infirmières, possiblement aggravée par l’inadéquation des programmes de développement professionnel pour les auxiliaires d’enseignement (Teaching Assistant; TA). La littérature sur le sujet décrit surtout les programmes de développement professionnel pour les étudiantes de premier cycle qui sont embauchées comme auxiliaires d’enseignement; peu considèrent la façon dont les programmes peuvent soutenir les étudiantes des cycles supérieurs pour leur permettre de développer leurs habiletés d’enseignement, de contribuer aux cours, et d’améliorer leurs perspectives de carrière. Peu de rapports font état du contexte canadien. Dans cet article, nous justifions et exposons brièvement l’élaboration et la mise en œuvre d’un programme de mentorat pour les auxiliaires d’enseignement qui sont étudiantes aux cycles supérieurs (Graduate Teaching Assistant; GTA) dans une école de sciences infirmières de l’Ouest canadien. Notre objectif est d’offrir du mentorat ainsi qu’une expérience permettant à des étudiantes des cycles supérieurs de pratiquer des stratégies pédagogiques, afin de contribuer à la formation de nouvelles enseignantes chevronnées en sciences infirmières. Nous présentons le rationnel pour offrir un tel programme de mentorat pour les étudiants des cycles supérieurs et en décrivons les composantes. Nous soulignons le rôle de l’auxiliaire sénior, une auxiliaire expérimentée jouant un rôle de leader dans la coordination du programme. Chose importante, nous discutons de la manière de présenter les connaissances sur la sécurité culturelle, ainsi que de l’adaptation au fil du temps pour répondre aux besoins des auxiliaires d’enseignement. Enfin, nous abordons l’évolution du programme de mentorat pour les étudiantes des cycles supérieurs d’une école de sciences infirmières de l’Ouest du Canada; nous décrivons également les changements qui seront apportés au programme, afin qu’il réponde toujours aux besoins des étudiantes des cycles supérieurs en sciences infirmières, du corps professoral, de la direction et des étudiantes du premier cycle

Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial

Background: Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. However, limited evidence exists of the challenges GP practices face in implementing telephone triage. We conducted a qualitative process evaluation alongside a UK-based cluster randomised trial (ESTEEM) which compared the impact of GP-led and nurse-led telephone triage with usual care on primary care workload, cost, patient experience, and safety for patients requesting a same-day GP consultation. The aim of the process study was to provide insights into the observed effects of the ESTEEM trial from the perspectives of staff and patients, and to specify the circumstances under which triage is likely to be successfully implemented. Here we report perspectives of staff. Methods: The intervention comprised implementation of either GP-led or nurse-led telephone triage for a period of 2-3 months. A qualitative evaluation was conducted using staff interviews recruited from eight general practices (4 GP triage, 4 Nurse triage) in the UK, implementing triage as part of the ESTEEM trial. Qualitative interviews were undertaken with 44 staff members in GP triage and nurse triage practices (16 GPs, 8 nurses, 7 practice managers, 13 administrative staff). Results: Staff reported diverse experiences and perceptions regarding the implementation of telephone triage, its effects on workload, and on the benefits of triage. Such diversity were explained by the different ways triage was organised, the staffing models used to support triage, how the introduction of triage was communicated across practice staff, and by how staff roles were reconfigured as a result of implementing triage. Conclusion: The findings from the process evaluation offer insight into the range of ways GP practices participating in ESTEEM implemented telephone triage, and the circumstances under which telephone triage can be successfully implemented beyond the context of a clinical trial. Staff experiences and perceptions of telephone triage are shaped by the way practices communicate with staff, prepare for and sustain the changes required to implement triage effectively, as well as by existing practice culture, and staff and patient behaviour arising in response to the changes made. Trial registration: Current Controlled Trials ISRCTN20687662. Registered 28 May 2009

The effect of nurses' preparedness and nurse practitioner status on triage call management in primary care: a secondary analysis of cross-sectional data from the ESTEEM Trial

Background: Nurse-led telephone triage is increasingly used to manage demand for GP consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings. Objective: To investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition. Design: Questionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage. Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a GP or nurse. Settings: : 15 General Practices and 7012 patients receiving the nurse triage intervention in four regions of the U.K. Participants: : 45 Nurse Practitioners (NPs) and Practice Nurse (PNs) trained in the use of CDSS. Methods: We investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling. Results: Valid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio (OR) 0.19, 95% confidence interval (CI) 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more likely to recommend patients for follow-up (OR 3.17, 95% CI 1.18; 5.55). Conclusion: Nurse characteristics were associated with disposition of triage calls to within practice follow-up. Nurse practitioners or those who reported feeling ‘more prepared’ for the role were more likely to manage the call definitively. Practices considering nurse triage should ensure that nurses transitioning into new roles feel adequately prepared. While standardised training is necessary, it may not be sufficient to ensure successful implementation

Telephone triage for management of same-day consultation requests in general practice (the ESTEEM trial): A cluster-randomised controlled trial and cost-consequence analysis

Telephone triage is increasingly used to manage workload in primary care; however, supporting evidence for this approach is scarce. We aimed to assess the effectiveness and cost consequences of general practitioner-(GP)-led and nurse-led telephone triage compared with usual care for patients seeking same-day consultations in primary care