Advertisement

Educators’ Perceptions of the Development of Clinical Judgment of Direct-Entry Students and Experienced RNs Enrolled in NP Programs

      Background

      Nurse practitioner (NP) education was originally reserved for experienced nurses, but it has gradually opened to nurses with little to no clinical experience at the registered nurse (RN) level as well as to non-nurses. The existence of multiple paths to NP training and practice raises questions about the role of generalist RN experience in learning clinical decision-making and other aspects of the NP role.

      Purpose

      To describe educators’ perceptions of the role of prior nursing experience in the development of clinical judgment during NP graduate education.

      Methods

      In this qualitative descriptive study, 27 NP faculty from four universities participated in individual interviews. Transcripts were analyzed using a thematic approach.

      Results

      According to participants, previous nursing experience—or any relevant experience—can either be helpful or detrimental in the development of NP students’ clinical judgment. Three themes were generated: variations in students’ baseline knowledge and skills, different frames of reference to grasp new content and skills, and challenges related to professional identity. In addition, participants described factors that they believe can affect the impact of different types of experience.

      Conclusion

      Students with and without prior nursing experience face distinct challenges in learning NP-level clinical decision-making and judgment, but they reach similar end-of-program competence. Educators are confronted with contradictions between generally held wisdom, their professional socialization, and first-hand observations regarding the role of experience (inside and outside nursing) in preparing students to become NPs.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Nursing Regulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. American Academy of Physician Assistants. (n.d.). Become a PA. https://www.aapa.org/career-central/become-a-pa/

      2. Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. Journal for Nurse Practitioners, 11(2), 178–183. https://doi.org/10.1016/j.nurpra.2014.11.004

      3. Beckstead, J. W., & Stamp, K. D. (2007). Understanding how nurse practitioners estimate patients’ risk for coronary heart disease: A judgment analysis. Journal of Advanced Nursing, 60(4), 436–446. https://doi.org/10.1111/j.1365-2648.2007.04406.x

      4. Bélisle, M., Lavoie, P., Pepin, J., Fernandez, N., Boyer, L., Lechasseur, K., & Larue, C. (2021). A conceptual framework of student professionalization for health professional education and research. International Journal of Nursing Education Scholarship, 18(1), 20200104. https://doi.org/10.1515/ijnes-2020-0104

      5. Bradshaw, C., Atkinson, S., & Doody, O. (2017). Employing a qualitative description approach in health care research. Global Qualitative Nursing Research, 4, Article 2333393617742282. https://doi.org/10.1177/2333393617742282

      6. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

      7. Brown, G., Imel, B., Nelson, A., Hale, L. S., & Jansen, N. (2013). Correlations between PANCE performance, physician assistant program grade point average, and selection criteria. Journal of Physician Assistant Education, 24(1), 42–44. https://doi.org/10.1097/01367895-201324010-00006

      8. Burman, M. E., Stepans, M. B., Jansa, N., & Steiner, S. (2002). How do NPs make clinical decisions? Nurse Practitioner, 27(5), 57–64. https://doi.org/10.1097/00006205-200205000-00010

      9. Cayton, H., & Webb, K. (2014). The benefits of a ‘right-touch’ approach to health care regulation. Journal of Health Services Research & Policy, 19(4), 198–199. https://doi.org/10.1177/1355819614546031

      10. Chen, S.-L., Hsu, H.-Y., Chang, C.-F., & Lin, E. C.-L. (2016). An exploration of the correlates of nurse practitioners’ clinical decision-making abilities. Journal of Clinical Nursing, 25(7/8), 1016–1024. https://doi.org/10.1111/jocn.13136

      11. Crosby, F. E., Dunn, J. D., Fallacaro, M. D., Jozwiak-Shields, C., & MacIsaac, A. M. (2003). Preadmission characteristics of advanced practice nursing students. Journal of the American Academy of Nurse Practitioners, 15(9), 424–431. https://doi.org/10.1111/j.1745-7599.2003.tb00417.x

      12. Cusson, R. M., & Strange, S. N. (2008). Neonatal nurse practitioner role transition: The process of reattaining expert status. The Journal of Perinatal & Neonatal Nursing, 22(4), 329–337. https://doi.org/10.1097/01.jpn.0000341365.60693.39

      13. Downey, K. M., & Asselin, M. E. (2015). Accelerated master’s programs in nursing for non-nurses: An integrative review of students’ and faculty’s perceptions. Journal of Professional Nursing, 31(3), 215–225. https://doi.org/10.1016/j.profnurs.2014.10.002

      14. El-Banna, M. M., Briggs, L. A., Leslie, M. S., Athey, E. K., Pericak, A., Falk, N. L., & Greene, J. (2015). Does prior RN clinical experience predict academic success in graduate nurse practitioner programs? Journal of Nursing Education, 54(5), 276–280. https://doi.org/10.3928/01484834-20150417-05

      15. Faraz, A. (2016). Novice nurse practitioner workforce transition into primary care: A literature review. Western Journal of Nursing Research, 38(11), 1531–1545. https://doi.org/10.1177/0193945916649587

      16. Fleming, E., & Carberry, M. (2011). Steering a course towards advanced nurse practitioner: A critical care perspective. Nursing in Critical Care, 16(2), 67–76. https://doi.org/10.1111/j.1478-5153.2011.00448.x

      17. Hegmann, T., & Iverson, K. (2016). Does previous healthcare experience increase success in physician assistant training? Journal of the American Academy of Physician Assistants, 29(6), 54–56. https://doi.org/10.1097/01.JAA.0000483097.66394.45

      18. Heitz, L. J., Steiner, S. H., & Burman, M. E. (2004). RN to FNP: A qualitative study of role transition. Journal of Nursing Education, 43(9), 416–420. https://doi.org/10.3928/01484834-20040901-08

      19. Higgins, R., Moser, S., Dereczyk, A., Canales, R., Stewart, G., Schierholtz, C., Ruback, T. J., McDaniel, J., Van Rhee, J., & Arbuckle, S. (2010). Admission variables as predictors of PANCE scores in physician assistant programs: A comparison study across universities. Journal of Physician Assistant Education, 21(1), 10–17. https://doi.org/10.1097/01367895-201021010-00002

      20. Honda, T., Patel-Junankar, D., Baginski, R., & Scott, R. (2018). Admissions variables: Predictors of physician assistant student success. Journal of Physician Assistant Education, 29(3), 167–172. https://doi.org/10.1097/JPA.0000000000000212

      21. International Council of Nurses. (2020). Guidelines on advanced practice nursing. https://www.icn.ch/system/files/documents/2020-04/ICN_APN%20Report_EN_WEB.pdf

      22. Jackson, M., & Marchi, N. (2020). Graduate-entry education for nonnurses: Preparation, pathways, and progress. Nursing Education Perspectives, 41(1), 30–32. https://doi.org/10.1097/01.NEP.0000000000000510

      23. Kelly, N. R., & Mathews, M. (2001). The transition to first position as nurse practitioner. Journal of Nursing Education, 40(4), 156–162. https://doi.org/10.3928/0148-4834-20010401-05

      24. Kim, H., Sefcik, J. S., & Bradway, C. (2017). Characteristics of qualitative descriptive studies: A systematic review. Research in Nursing & Health, 40(1), 23–42. https://doi.org/10.1002/nur.21768

      25. Kosowski, M. M., & Roberts, V. W. (2003). When protocols are not enough: Intuitive decision making by novice nurse practitioners. Journal of Holistic Nursing, 21(1), 52–72. https://doi.org/10.1177/0898010102250275

      26. Ljungbeck, B., Sjögren Forss, K., Finnbogadóttir, H., & Carlson, E. (2021). Content in nurse practitioner education—A scoping review. Nurse Education Today, 98, Article 104650. https://doi.org/10.1016/j.nedt.2020.104650

        • Lolar S.
        • Pilat M.J.
        • Welch R.D.
        Impact of type of healthcare experience before physician assistant school admission on PANCE score.
        Journal of Allied Health. 2020; 49: 176-180
      27. Mark, H. D., Twigg, R. D., Barber, L., & Warren, N. (2019). Entry-level master’s programs in nursing: Review of programmatic features. Journal of Nursing Education, 58(9), 525–529. https://doi.org/10.3928/01484834-20190819-05

      28. Martsolf, G. R., Nguyen, P., Freund, D., & Poghosyan, L. (2017). What we know about postgraduate nurse practitioner residency and fellowship programs. Journal for Nurse Practitioners, 13(7), 482–487. https://doi.org/10.1016/j.nurpra.2017.05.013

      29. National Task Force on Quality Nurse Practitioner Education. (2016). Criteria for evaluation of nurse practitioner programs (5th ed.). https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/Docs/EvalCriteria2016Final.pdf

      30. Offredy, M. (2002). Decision-making in primary care: Outcomes from a study using patient scenarios. Journal of Advanced Nursing, 40(5), 532–541. https://doi.org/10.1046/j.1365-2648.2002.02410.x

      31. Offredy, M., & Meerabeau, E. (2005). The use of ‘think aloud’ technique, information processing theory and schema theory to explain decision-making processes of general practitioners and nurse practitioners using patient scenarios. Primary Health Care Research & Development, 6(1), 46–59. https://doi.org/10.1191/1463423605pc228oa

      32. Patzer, B., Lazzara, E. H., Keebler, J. R., Madi, M. H., Dwyer, P., Huckstadt, A. A., & Smith-Campbell, B. (2017). Predictors of nursing graduate school success. Nursing Education Perspectives, 38(5), 272–274. https://doi.org/10.1097/01.NEP.0000000000000172

      33. Pellico, L. H., Terrill, E., White, P., & Rico, J. (2012). Integrative review of graduate entry programs in nursing. Journal of Nursing Education, 51(1), 29–37. https://doi.org/10.3928/01484834-20111130-01

      34. Rich, E. R. (2005). Does RN experience relate to NP clinical skills? The Nurse Practitioner, 30(12), 53–56. https://doi.org/10.1097/00006205-200512000-00009

      35. Richard-Eaglin, A. (2017). Predicting student success in nurse practitioner programs. Journal of the American Association of Nurse Practitioners, 29(10), 600–605. https://doi.org/10.1002/2327-6924.12502

      36. Ritter, B. J. (2003). An analysis of expert nurse practitioners’ diagnostic reasoning. Journal of the American Academy of Nurse Practitioners, 15(3), 137–141. https://doi.org/10.1111/j.1745-7599.2003.tb00270.x

      37. Salisu, W. J., Dehghan Nayeri, N., Yakubu, I., & Ebrahimpour, F. (2019). Challenges and facilitators of professional socialization: A systematic review. Nursing Open, 6(4), 1289–1298. https://doi.org/10.1002/nop2.341

      38. Sharu, D. (2012). From nurse to advanced nurse practitioner: Mid-career transitions. In A. Mc Kee & M. Eraut (Eds.), Learning trajectories, innovation and identity for professional development (pp. 175–192). Springer. https://doi.org/10.1007/978-94-007-1724-4_9

      39. Silver, H. K., Ford, L. C., & Day, L. R. (1968). The pediatric nurse-practitioner program: Expanding the role of the nurse to provide increased health care for children. JAMA, 204(4), 88–92. https://doi.org/10.1001/jama.1968.03140170014003

        • Slavinsky A.T.
        • Diers D.
        Nursing education for college graduates.
        Nursing Outlook. 1982; 30: 292-297
      40. Stamp, K. D. (2012). How nurse practitioners make decisions regarding coronary heat disease risk: A social judgment analysis. International Journal of Nursing Knowledge, 23(1), 29–40. https://doi.org/10.1111/j.2047-3095.2011.01196.x

      41. Steiner, S. H., McLaughlin, D. G., Hyde, R. S., Brown, R. H., & Burman, M. E. (2008). Role transition during RN-to-FNP education. Journal of Nursing Education, 47(10), 441–447. https://doi.org/10.3928/01484834-20081001-07

        • Sullivan-Bentz M.
        • Humbert J.
        • Cragg B.
        • Legault F.
        • Laflamme C.
        • Bailey P.H.
        • Doucette S.
        Supporting primary health care nurse practitioners’ transition to practice.
        Canadian Family Physician. 2010; 56: 1176-1182
      42. Thompson, A. (2019). An educational intervention to enhance nurse practitioner role transition in the first year of practice. Journal of the American Association of Nurse Practitioners, 31(1), 24–32. https://doi.org/10.1097/JXX.0000000000000095

      43. Thompson, S., Moorley, C., & Barratt, J. (2017). A comparative study on the clinical decision-making processes of nurse practitioners vs. medical doctors using scenarios in a secondary care environment. Journal of Advanced Nursing, 73(5), 1097–1110. https://doi.org/10.1111/jan.13206

      44. Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042

      45. Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing & Health Sciences, 15(3), 398–405. https://doi.org/10.1111/nhs.12048

      46. Vasileiou, K., Barnett, J., Thorpe, S., & Young, T. (2018). Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period. BMC Medical Research Methodology, 18(1), Article 148. https://doi.org/10.1186/s12874-018-0594-7

      47. Wolf, C., Ahmed, A. Z., Schmidt, G., & Winter, S. (2020). Predictors of attrition among accelerated and traditional physician assistant students. Journal of Physician Assistant Education, 31(4), 204–206. https://doi.org/10.1097/JPA.0000000000000334

      48. Wood, S. K. (2020). Keeping the nurse in the nurse practitioner: Returning to our disciplinary roots of knowing in nursing. Advances in Nursing Science, 43(1), 50–61. https://doi.org/10.1097/ANS.0000000000000301