Expertise in action: The role and reception of advanced practice nurses in clinical settings
DOI:
https://doi.org/10.53713/nhsj.v5i3.536Keywords:
advanced practice nurse services, expectations of physicians and patients, qualitative researchAbstract
Advanced Practice Nurses (APNs) play a crucial and expanding role in modern healthcare by improving patient care quality and outcomes through their specialized knowledge and evidence-based practice. This study aims to explore the expectations and perceptions of both physicians and patients regarding APN services within clinical settings, based on their direct experiences. A phenomenological descriptive qualitative design was employed to capture the lived experiences of participants. Data was collected through semi-structured, face-to-face interviews and analyzed using thematic content analysis to identify key patterns and themes. The analysis revealed four primary themes: the utilization of specialized knowledge and skills, effective communication, problem-solving capabilities, and the importance of increasing the number of APNs working in clinical environments. Participants consistently reported that APN services contributed positively to care quality and patient satisfaction. Patients especially emphasized the need for APNs to apply their advanced expertise in practice and expressed a strong desire for greater APN availability in clinical settings. These findings highlight the essential role of APNs in enhancing healthcare delivery and suggest that healthcare institutions should actively support the growth and integration of APN roles to further improve patient outcomes and clinical effectiveness.
References
American Nurses Association. (2010). IOM report on the future of nursing. https://www.nursingworld.org/practice-policy/iom-future-of-nursing-report/
Aygul, N. S., & Senyuva, E. (2023). Correlation between experiences of clinical nurses in the COVID-19 pandemic with learning agility and readiness level for future pandemics. Journal of Clinical Nursing, 32(5–6), 941–949. https://doi.org/10.1111/jocn.16536
Brennan, C. (2020). Tracing the history of the nurse practitioner profession in 2020, the year of the nurse. Journal of Pediatric Health Care, 34(2), 83–84. https://doi.org/10.1016/j.pedhc.2019.12.005
Chan, T. E., Lockhart, J. S., Schreiber, J. B., & Kronk, R. (2020). Determining nurse practitioner core competencies using a Delphi approach. Journal of the American Association of Nurse Practitioners, 32(3), 200–217. https://doi.org/10.1097/JXX.0000000000000384
Clarke, V., Lehane, E., Mulcahy, H., & Cotter, P. (2021). Nurse practitioners' implementation of evidence-based practice into routine care: A scoping review. Worldviews on Evidence-Based Nursing, 18(3), 180–189. https://doi.org/10.1111/wvn.12510
Creswell, J. W. (2016). Revisiting mixed methods and advancing scientific practices. In S. N. Hesse-Biber & R. B. Johnson (Eds.), The Oxford handbook of multimethod and mixed methods research inquiry (pp. 57–71). Oxford University Press. https://doi.org/10.1093/oxfordhb/9780199933624.013.39
Daly, B. M., Arroll, B., & Scragg, R. K. R. (2019). Diabetes knowledge of primary health care and specialist nurses in a major urban area. Journal of Clinical Nursing, 28(1–2), 125–137. https://doi.org/10.1111/jocn.14684
Dávila, P. Y., Díaz-Narváez, V. P., Montero Andrade, B., López Terán, J. J., Reyes-Reyes, A., & Calzadilla-Núñez, A. (2023). Working nurses’ empathy with patients in public hospitals. Revista Latino-Americana de Enfermagem, 31, e3969. https://doi.org/10.1590/1518-8345.6591.3969
Duignan, M., Drennan, J., & McCarthy, V. J. C. (2024). Work characteristics, job satisfaction and intention to leave: A cross-sectional survey of advanced nurse practitioners. Contemporary Nurse, 60(4), 382–394. https://doi.org/10.1080/10376178.2024.2327353
Drury, A., Sulosaari, V., Sharp, L., Ullgren, H., Munter, J., & Oldenmenger, W. (2023). The future of cancer nursing in Europe: Addressing professional issues in education, research, policy and practice. European Journal of Oncology Nursing, 63, 102271. https://doi.org/10.1016/j.ejon.2023.102271
Ford, L. C., & Gardenier, D. (2015). Fasten your seat belts—It’s going to be a bumpy ride. The Journal for Nurse Practitioners, 11(6), 575–577. https://doi.org/10.1016/j.nurpra.2015.03.012
Goh, M. I., Ang, E. N. K., Chan, Y. H., He, H. G., & Vehvilainen-Julkunen, K. (2016). A descriptive quantitative study on multiethnic patient satisfaction with nursing care measured by the revised humane caring scale. Applied Nursing Research, 31, 126–131. https://doi.org/10.1016/j.apnr.2016.02.002
Gray, A. (2016). Advanced or advancing nursing practice: What is the future direction for nursing? British Journal of Nursing, 25(1), 8–13. https://doi.org/10.12968/bjon.2016.25.1.8
Hickman, L. D., DiGiacomo, M., Phillips, J., Rao, A., Newton, P. J., Jackson, D., & Ferguson, C. (2018). Improving evidence-based practice in postgraduate nursing programs: A systematic review: Bridging the evidence practice gap (bridge project). Nurse Education Today, 63, 69–75. https://doi.org/10.1016/j.nedt.2018.01.015
Hudspeth, R. S., & Klein, T. A. (2019). Understanding nurse practitioner scope of practice: Regulatory, practice, and employment perspectives now and for the future. Journal of the American Association of Nurse Practitioners, 31(8), 468–473. https://doi.org/10.1097/JXX.0000000000000268
Htay M, Whitehead D. (2021). The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review. Int J Nurs Stud Adv, 17(3), 100034. https://doi.org/10.1016/j.ijnsa.2021.100034
Institute of Medicine (IOM) Committee for the Evaluation of the Impact of the Institute of Medicine Report the Future of Nursing. (2015). The future of nursing: Leading change, advancing health. https://www.nursingworld.org/practice-policy/iom-future-of-nursing-report/
International Council of Nurses (ICN). (2020). Guidelines on advanced practice nursing. https://www.icn.ch/system/files/documents/2020-04/ICN_APN%20Report_EN_WEB.pdf
Karaca, A., & Durna, Z. (2019). Patient satisfaction with the quality of nursing care. Nursing Open, 6(2), 535–545. https://doi.org/10.1002/nop2.237
Kersu, O., Mert Boga, S., Kosgeroglu, N., Aydın Sayilan, A., Ilter, G., & Baydemir, C. (2020). Determination of the relationship between perception of nursing quality and satisfaction status of patients hospitalized in surgical services. Journal of Education and Research in Nursing. https://doi.org/10.5222/head.2020.032
Kim, Y. A., & Sim, O. I. (2020). Communication skills, problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism among clinical nurses: A structural equation model analysis. International Journal of Environmental Research and Public Health, 17, 4896. https://doi.org/10.3390/ijerph17134896
Kim, Y., Oh, Y., Lee, E., & Kim, S. J. (2022). Impact of nurse–physician collaboration, moral distress, and professional autonomy on job satisfaction among nurses acting as physician assistants. International Journal of Environmental Research and Public Health, 19(2). https://doi.org/10.3390/ijerph19020661
Kisacik, O. G., & Sonmez, M. (2020). Pressure ulcers prevention: Turkish nursing students’ knowledge and attitudes and influencing factors. Journal of Tissue Viability, 29(1), 24–31. https://doi.org/10.1016/j.jtv.2019.11.003
Loke, J., Colquhoun, D., & Lee, K. W. (2015). A Foucauldian analysis on the professionalisation effort of nursing in Singapore. Working Papers in the Health Sciences, 1(12). https://www.researchgate.net/publication/281319456
Machado, K. P. M., Lysakowski, S., Araujo, B. R., Caregnato, R. C. A., & Blatt, C. R. (2022). Modelo técnico-assistencial de cuidados de enfermagem ao paciente de transplante renal. Revista Eletrônica de Enfermagem, 24, e66892. https://doi.org/10.5216/ree.v24.66892
Matusov, Y., Matthews, A., Rue, M., Sheffield, L., & Pedraza, I. F. (2022). Perception of interdisciplinary collaboration between ICU nurses and resident physicians during the COVID-19 pandemic. Journal of Interprofessional Education & Practice, 27, 100501. https://doi.org/10.1016/j.xjep.2022.100501
Mayo, A. M., Ray, M. M., Chamblee, T. B., Urden, L. D., & Moody, R. (2017). The advanced practice clinical nurse specialist. Nursing Administration Quarterly, 41(1), 70–76. https://doi.org/10.1097/NAQ.0000000000000201
McMullan, J. (2023). Patient perspective. In H. Kerr & J. De Munter (Eds.), The role of the clinical nurse specialist in cancer care (pp. 32–42). John Wiley & Sons Ltd. https://doi.org/10.1002/9781119867029.ch3Queen's University Belfast
Mojaradi, Z., & Rad, S. (2022). Hospitalized patients’ satisfaction with health services and nursing index at a private general hospital in Mashhad. Razavi International Journal of Medicine, 10(3), 1075. https://doi.org/10.30483/RIJM.2021.254232.1075
Monahan, L., Sparbel, K., Heinschel, J., Wirtz Rugen, K., & Rosenberger, K. (2018). Medical and pharmacy students shadowing advanced practice nurses to develop interprofessional competencies. Applied Nursing Research, 39, 103–108. https://doi.org/10.1016/j.apnr.2017.11.012
Neal-Boylan, L. (2020). PhD or DNP? That is the question. The Journal for Nurse Practitioners, 16(2), A5–A6. https://doi.org/10.1016/j.nurpra.2019.11.015
Panchapakesan, P., Sai, L. P., & Rajendran, C. (2015). Customer satisfaction in Indian hospitals: Moderators and mediators. Quality Management Journal, 22(1), 10–29. https://doi.org/10.1080/10686967.2015.11918416
Parker, J., & Hill, M. (2017). A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong Special Administrative Region (SAR), China. International Journal of Nursing Sciences, 4(2), 196–204. https://doi.org/10.1016/j.ijnss.2017.01.002
Rautiainen, E., & Vallimies-Patomäki, M. (2016). A review of the organization, regulation, and financing practices of postgraduate education in clinical nursing in 12 European countries. Nurse Education Today, 36, 96–104. https://doi.org/10.1016/j.nedt.2015.08.004
Russell, R. S., Johnson, D. M., & White, S. W. (2015). Patient perceptions of quality: Analyzing patient satisfaction surveys. International Journal of Operations & Production Management, 35(8), 1158–1181. https://doi.org/10.1108/IJOPM-02-2014-0074
Saygili, M., & Celik, Y. (2020). An evaluation of palliative care service effect in patients with cancer diagnosis: Comparison in terms of the symptom level and care satisfaction. Agri, 32(2), 61–71. https://doi.org/10.14744/agri.2019.95770
Schober, M. (2019). Development of advanced practice nursing (APN): The international context. Enfermería Clínica (English Edition), 29(2), 63–66. https://doi.org/10.1016/j.enfcle.2018.08.006
Sharifnia, A. M., Green, H., Fernandez, R., & Alananzeh, I. (2023). Empathy and ethical sensitivity among intensive and critical care nurses: A path analysis. Nursing Ethics. https://doi.org/10.1177/09697330231167543
Tanaka, M., Taketomi, K., Yoshikazu, Y., & Rieko, K. (2017). The current status of nursing professionalism among nursing faculty in Japan. Journal of Nursing Research, 25(1), 7–12. https://doi.org/10.1097/jnr.0000000000000155
Vermeir, P., Degroote, S., Vandijck, D., Mariman, A., Deveugele, M., Peleman, R., Verhaeghe, R., Cambré, B., & Vogelaers, D. (2017). Job satisfaction in relation to communication in health care among nurses: A narrative review and practical recommendations. SAGE Open, 7(2). https://doi.org/10.1177/2158244017711486
Yangyang, C., Shuai, L., Jingjing, R., & Ying, L. (2021). Satisfaction degree and related factors of community health services among residents in Zhejiang province. Chinese Journal of Health Policy, 14(6), 79–83.
Yuan, X., Wan, S., Chen, Y., & Qin, W. (2022). Competency expectations of nurses in rapid response teams: An interview-based qualitative study. Annals of Palliative Medicine, 11(6), 2043–2049. https://doi.org/10.21037/apm-22-566
