“Power” is a concept that has been discussed by nurse scholars and leaders within the nursing literature. The literature surrounding power concurs that power is necessary within the practice of nursing so that nurses are able to support patients and move the profession of nursing forward. There is a scarcity of research, however, regarding nurses’ perception of power within their own practices. Advanced practice nurses (APNs) are in positions in which they apply graduate education, specialized knowledge, and expertise to improve health care outcomes. Therefore, a qualitative study using an interpretive hermeneutic phenomenological approach was undertaken to discover APNs’ lived experience of power within their practices. In-depth, tape-recorded interviews were conducted with eight APNs from a large tertiary care facility. All of the participants agreed to a follow-up interview to review the summary of the study results. van Manen’s (1990) approach was used to analyze the data by subjecting the transcripts to a thematic analysis and reflective process. The overarching theme of the interviews is “building to make a difference” and the APNs’ perceived that this happened by “building on,” building with,” and “building for.” The APNs built on their knowledge and expertise, built with others in relationships and built for the capacity to make a difference. Power was a part of the everyday practices of these APNs and was described as “soft power,” a power that they shared to bring about change for the better. This shared power was reflected back on them resulting in increased power within their practices, a process described by the APNs as power creep.

This is the first primary care dermatology reference written by and for nurses. It focuses on approximately 60 skin conditions that are commonly seen in primary care settings and provides unique decision trees to assist in accurate diagnosis. Organized for quick access, the book presents conditions alphabetically and includes evidence-based treatment and management strategies along with full-color photos taken during actual office visits. Dermatologic diagnostics cover skin assessment, specimen collection procedures, and use of mechanical devices, along with relevant evidence-based topical, systemic, and surgical treatment options. The resource provides an overview of dermatology basics including skin anatomy and physiology and skin terminology. Illustrations, graphs, and skin terminology help to accurately document descriptions of rashes, lesions, and diseases during diagnostic evaluations. The book also defines risk factors in relation to skin conditions and diseases and delineates conditions common to specific populations. A broad range of management strategies is presented along with alerts for when expert follow-up is indicated. To promote rapid identification of skin conditions, each is presented in a consistent organization that includes overview, epidemiology, pathology/histology, clinical presentation, differential diagnosis, treatment/management, special considerations and appropriate referrals, and patient education. The Clinical Pearls feature captures the authors" expertise. Additional photos are available from the website as a digital photo archive. Key Features: Focuses on approximately 60 common dermatological conditions with high-quality, full-color photos Presents four unique decision trees to foster accurate diagnosis and clinical decision making Delivers evidence-based protocols for diagnosis, treatment, and management Uses a consistent format to promote quick access to information Written by advanced-degree nurse practitioners with nurses" informational needs in mind / https://dc.etsu.edu/etsu_books/1221/thumbnail.jpg

Asthma is a leading cause of pediatric hospital admissions. Parents of children under the age of 18 with asthma require education to recognize and manage the signs and symptoms of the disease. Parent education has shown to decrease their children's hospital admission and readmission rates. The purpose of this pilot project was to develop an asthma educational module for the parents of children with asthma and obtain parent feedback on the content. Families with children under the age of 18 who had been admitted to the hospital with a diagnosis of asthma, an asthma exacerbation, or status asthmaticus were invited to participate. A nurse practitioner provided three parents with information on the signs, symptoms, and medication management of asthma, as well as hands-on demonstration of inhaler use. Twenty-eight staff nurses provided verbal feedback on module content, including educational benefit and readability for parents. Parent and staff verbal feedback indicated the module was both a useful and effective tool for asthma education. Clinical leaders plan to expand the pilot study on two additional pediatric units using the same module used in the pilot program with intent to analyze readmission rates. The project promotes social change through parent empowerment to care for their child in the home environment.

The recent study by Goossens et al. (2012) concluded that, “By means of an Advanced Practice Nursing (APN) team, malfunctions can be effectively managed, giving staff nurses more time but less stress in their daily care for patients with TIVADs [totally implantable venous access devices]”. However, that conclusion is not supported by their study because there was not a control group and no data was provided that had any bearing on whether the malfunctions were effectively managed or whether the staff nurses had more time or less stress.

Yes / The diversification of nursing and allied health profession (AHP) roles has seen unprecedented growth as organizations have sought to optimize limited health care resources. Within the UK health care system, the nonmedical consultant is viewed as the pinnacle of the clinical career ladder. Yet, nearly 15 years after their introduction, recruitment to these positions remains slow. Criticisms of nonmedical consultant practice include a lack of role clarity, a failure to work across the four domains of consultant practice, a lack of suitable applicants, and poor preparedness of new appointments. Although there is evidence exploring the nature and effectiveness of established consultant roles, little research addresses the development phase of aspiring consultants. Objectives To explore the transitional journey experienced by trainee consultant radiographers as they move from advanced to consultant practitioner within a locally devised consultant development programme. Design Longitudinal qualitative enquiry. Methods and Settings Five trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees. Results A challenging journey was recounted involving five key emotional stages that occurred in a consistent and predictable order (ie, elation, denial, doubt, crisis, and recovery). The identified stages had close parallels with Hopson's Life Events model, suggesting that transition to consultant practice is a significant life event rather than a straightforward job promotion. Conclusions Current emphasis on the four domains of practice, although providing a clear framework for expected external role outcomes, overlooks the importance of the internal or subjective career development on the perceived success or failure of the role. Employers, educators, and professional bodies have a responsibility to facilitate aspirational consultants to explore and enhance their internal career development, offering more time to define themselves and their role with support to guide them through the transition journey.

Interest in the influence of emotions on behaviour, decision making, and leadership has accelerated over the last decade. Despite this, the influence of emotions on career advancement and behaviour within radiography and radiotherapy has largely been ignored. The ease of transition from one work role to another within an individual's career may be influenced by previous experience, personal characteristics, organizational environment, culture, and the nature of the role itself. Consequently, the transition from the often well-defined role of advanced or specialist practitioner to the more fluid role of consultant practitioner is associated with changing emotions as reported in the first part of this two-part series. What remains unexplored are the emotional triggers that pre-empt each stage in the transition cycle and how our understanding of these might support the successful implementation of consultant practitioner roles. To explore the emotional triggers that pre-empted each stage in the transitional journey of trainee consultant radiographers as they moved from advanced to consultant practitioner within a locally devised consultant development program. Five trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees. Although all trainee consultant radiographers experienced the emotional events described in the first part of this two-part series in a predictable order (ie, elation, denial, doubt, crisis, and recovery), the timing of the events was not consistent. Importantly, four emotional triggers were identified, and the dominance of these and the reaction of individuals to them determined the emotional well-being of the individual over time. This study provides a unique and hitherto unexplored insight into the transition journey from advanced or specialist practitioner. Importantly, the findings suggest that commonly adopted supportive change interventions may, in fact, trigger the negative emotions they are intended to alleviate and disable rather than enable role transition.

No / Advanced practice roles are emerging in all disciplines at a rapid pace and reporting radiographers are ideally placed to work at such level. Advanced practitioners should demonstrate expert practice and show progression into three other areas of higher level practice. Most existing literature has focussed on the image interpretation aspect of the role, however there is little evidence that plain film reporting radiographers are undertaking activities beyond image interpretation and fulfilling the role of advanced practitioner. Letters were posted to every acute NHS trust in the UK, inviting reporting radiographers to complete an online survey. Both quantitative and qualitative information was sought regarding demographics and roles supplementary to reporting. A total of 205 responses were analysed; 83.3% of reporting radiographers describe themselves as advanced practitioner, however significantly less are showing progression into the four core functions of higher level practice. A total of 97.0% undertake expert practice, 54.7% have a leadership role, 19.8% provide expert lectures and 71.1% have roles encompassing service development or research, though most of these fall into the service development category. 34.5% felt that they were aware of the differences between extended and advanced practice though much less (9.3%) could correctly articulate the difference. Few individuals are aware of the difference between extended and advanced practice. Though the majority of plain film reporting radiographers identify themselves as advanced practitioners, significantly less evidence all four core functions of higher level practice. The number of individuals undertaking research and providing expert-level education is low.

Background: An increasing number of patients with an oncology diagnose will be seen in the future. The oncology care is complex and in great need of nurses with a high level of competence. There is a lack of previous research in the specialist oncology nurses competence and therefore knowledge of their skills can reveal an understanding of their competence. Aim: The aim of the study was to describe the competence of the specialist oncology nurse. Method: Four oncology nurses and two directors of oncology care were interviewed. The interview text was analyzed using qualitative content analysis. Results: The result showed that the oncology nurses had developed six different competences within different areas. These competence areas were assertiveness, patient-centered care, ethical and moral-, pedagogical-, to lead and develop- and theoretical competence. They described their competences in a way of feeling more confident and they had a deeper theoretical knowledge. They also described that the needs of the patient as central. They found it easier to communicate and to give information and had a greater ambition to develop the oncology care. Conclusion: Deeper theoretical knowledge is a necessity to develop new competence. Theoretical knowledge seems essential in order to develop new competence. To be able to use their new competences, time, opportunities and support must be given to the specialist oncology nurse. It is also important for the specialist oncology nurse to claim and believe in her competence.

Background: Cardiology is but one of the many clinical foci available to certified Advanced Practice Registered Nurses (APRNs). In fact, more acute care APRNs choose cardiology as their focus than any other. With such strong interest in cardiac advanced practice nursing, it is imperative to assess the adequacy of preparation for those who wish to follow this career path. Known barriers exist in the educational and clinical preparation of this APRN population, however, there is little research detailing the specifics of those barriers. Purpose: This study describes the needs of APRNs who plan to specialize in cardiology. Method and Sampling: A qualitative design was used to describe the motivation of APRNs specializing in cardiology, tools they currently utilize to achieve their specialization, and their needs based on the current approach. I recruited participants, APRNs specializing in cardiology, through meetings at a local cardiology practice. Seven APRNs specializing in cardiology with experience ranging from 10 months to 15 years, and currently working in a cardiac setting, participated in the study. Structured interviews were conducted to describe the needs of APRNs who plan to specialize in cardiology. The interviews were audiotaped and analyzed to reveal commonalities. Findings: After analyzing the audio recordings three major commonalities emerged: APRNs specializing in cardiology must overcome limited educational opportunities, APRNs specializing in cardiology require a higher level of skill than their formal training and licensing requirements provide, and the need to validate APRNs specializing in cardiology knowledge. Additional commonalities included availability and the type of degree programs, and a lack of cardiac focus in educational preparation. Conclusion: The findings showed the needs of APRNs who plan to specialize in cardiology are rooted in their educational preparation. There is a vast amount of variability among degree programs and a severe lack of cardiac focus in their educational preparation. In order to achieve competency, 100% of study participants secured a mentorship with an expert cardiac clinician for a minimum of one year post-graduation and without assistance from their educational programs. Additionally, APRNs specializing in cardiology believe a national certification or examination requirement would be beneficial to their practice.

Background: Due to arduous demands of graduate education, advanced practice nursing (APN) students who are classified as adult learners are at risk for suffering sleep deprivation. Factors contributing to sleep deprivation include stress, expected academic challenges, and everyday life stressors. Purpose: This study investigated if APN students’ grade-point average (GPA), gender, and employment status predicted levels of daytime sleepiness. Theoretical Framework. The psychological well-being model selected for this study was consistent with the theory that sleep is a resource essential to well-being; adequate sleep is the resource needed to optimally manage stressful life demands. Methods. Bivariate and multiple regression were employed to examine the relationship between GPA, gender, and employment status with daytime sleepiness on a sample of APN students (N = 123) in their second academic year. The Epworth Sleepiness Scale and a demographic questionnaire were used to record data on GPA, gender, and employment status. Results. Results showed ESS and GPA were negatively correlated and statistically significant (r = -.24, p < .05). This indicates that as the tendency for sleepiness increased, GPA decreased, thereby supporting the alternative hypothesis. Although not statistically significant, employed participants reported greater daytime sleepiness, as did women. Conclusions: When GPA, gender, and employment were combined, multiple correlation showed a statistically significant shared variance of 8% with daytime sleepiness, due primarily to the correlation between GPA and daytime sleepiness. The effect size of shared variance was between small and medium with respect to magnitude of importance.