Louise Kaplan

The State of Evidence-Based Practice in US Nurses Critical Implications for Nurse Leaders and Educators

This descriptive survey assessed the perception of evidence-based practice (EBP) among nurses in the United States. Although evidence-based healthcare results in improved patient outcomes and reduced costs, nurses do not consistently implement evidence-based best practices. A descriptive survey was conducted with a random sample of 1015 RNs who are members of the American Nurses Association. Although nurses believe in evidence-based care, barriers remain prevalent, including resistance from colleagues, nurse leaders, and managers. Differences existed in responses of nurses from Magnet® versus non-Magnet institutions as well as nurses with master’s versus nonmaster’s degrees. Nurse leaders and educators must provide learning opportunities regarding EBP and facilitate supportive cultures to achieve the Institute of Medicine’s 2020 goal that 90% of clinical decisions be evidence-based.

The contribution of physicians, physician assistants, and nurse practitioners toward rural primary care: findings from a 13-state survey.

Background:Estimates of the relative contributions of physicians, physician assistants (PAs), and nurse practitioners (NPs) toward rural primary care are needed to inform workforce planning activities aimed at reducing rural primary shortages. Objectives:For each provider group, this study quantifies the average weekly number of outpatient primary care visits and the types of services provided within and beyond the outpatient setting. Methods:A randomly drawn sample of 788 physicians, 601 PAs, and 918 NPs with rural addresses in 13 US states responded to a mailed questionnaire that measured reported weekly outpatient visits and scope of services provided within and beyond the outpatient setting. Analysis of variance and &khgr;2 testing were used to test for bivariate associations. Multivariate regression was used to model average weekly outpatient volume adjusting for provider sociodemographics and geographical location. Results:Compared with physicians, average weekly outpatient visit quantity was 8% lower for PAs and 25% lower for NPs (P<0.001). After multivariate adjustment, this gap became negligible for PAs (P=0.56) and decreased to 10% for NPs (P<0.001). Compared with PAs and NPs, primary care physicians were more likely to provide services beyond the outpatient setting, including hospital care, emergency care, childbirth attending deliveries, and after-hours call coverage (all P<0.001). Conclusions:Although our findings suggest that a greater reliance on PAs and NPs in rural primary settings would have a minor impact on outpatient practice volume, this shift might reduce the availability of services that have more often been traditionally provided by rural primary care physicians beyond the outpatient clinic setting.

Prescriptive authority and barriers to NP practice.

For decades, nurse practitioners (NPs) have faced a myriad of difficulties as they attempted to provide comprehensive patient care, including pharmacologic therapies. NPs have also struggled to remove constraints on their ability to practice to the full extent of their potential. Intensive legislative and regulatory work has been necessary to advance autonomous NP practice. This article examines issues surrounding removing barriers to practice. 1

DOCTOR OF NURSING PRACTICE Program Evaluation and Beyond: Capturing the Profession's Transition to the DNP

&NA; The Doctor of Nursing Practice (DNP) educational preparation for advanced practice nursing and DNP role development are innovations that require intense scrutiny through formative and summative evaluation. It is imperative to move beyond standard curriculum evaluation approaches to capture the transformation of advanced nursing practice and the profession.The University of Washington School of Nursing designed a comprehensive DNP evaluation plan that focuses on both program effectiveness and the experience of transition as described by faculty and students.The evaluation plan is outlined, and lessons learned regarding data collection, student and faculty participation, and institutional review board approval are discussed. Examples of instruments are included.

Faculty perspectives about the DNP: a study of advocacy, ambivalence, & antagonism.

This article describes research about faculty perspectives at the time of and 2 years after the Doctor of Nursing Practice program was launched at the University of Washington School of Nursing.

Opening doors: The practice degree that changes practice.

Abstract:This descriptive, qualitative research study describes the educational experience and preparation for future practice of the initial three cohorts of DNP graduates of a Northwest university. “Opening doors: The practice degree that changes practice” was the overarching theme identified. Five additional themes included students and faculty as colearners; explaining the DNP; thinking differently about practice; navigating the capstone; and building bonds/collegial connections.

A primer on Medicare and changes resulting from the Patient Protection and Affordable Care Act.

The Patient Protection and Affordable Care Act (PPACA) included changes to Medicare aimed at cost containment, improving quality and health system performance, increasing preventive services, lowering prescription drug costs, and other enhancements. Many nurse practitioners (NPs) provide care to Medicare patients. This article provides an overview of the Medicare program and how changes to Medicare by the PPACA act may affect NP practice.

Faculty supervision of NP program practicums: A comparison of rural and urban site differences.

Abstract:Results of a survey of NP education programs were analyzed to describe factors influencing clinical placement of students in rural clinical rotations, methods used to evaluate NP students in their clinical rotations, and whether the frequency and type of faculty evaluations differed by urban or rural clinical sites.

Medical marijuana: Legal and regulatory considerations.

Nearly half of the United States has legalized medical marijuana. Advanced practice registered nurses (APRNs) in six states can authorize patients for medical marijuana use. Knowledge of legal and regulatory aspects of medical marijuana laws will protect an APRNs license and the public.

Internal audit advice for nurse practitioner advocacy groups.

In February 2013, a former program director for a nurses’ association pled guilty in a U.S. District Court to mail fraud and money laundering. Between 2005 and 2009, the director and the chapter treasurer diverted more than