Access to health care in rural communities is challenged by workforce shortages. Nurse practitioners (NPs) have been filling the gap created by physician migration into specialty areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the emergency department with NPs or physician assistants without on-site physicians. NP education often lacks emergency and trauma curriculum, resulting in gaps in education and practice expectations and leading to significant role transition stress and turnover. The purpose of this project was to construct an evidence-based transition-to-practice residency program to support NPs providing emergency department care in the CAH. Theoretical frameworks used to guide the project include rural health theory, novice to expert, and from limbo to legitimacy frameworks. Global outcomes include increased quality of care, patient safety, NP job satisfaction, and decreased turnover. The quality improvement initiative engaged an interprofessional team of institutional and community stakeholders (n = 10) to develop primary products including the residency program, curriculum modules, and the secondary products necessary to implement and evaluate the project. Implementation will consist of a pilot followed by expansion throughout the rural health network. Evaluation will involve the CAH dashboard to monitor patient outcomes, Misener NP job satisfaction scale, and employee turnover rates. The project expands understanding of the on-boarding needs of rural NPs. The results of this project will serve as a guide to publish outcome data and collaborate with higher education to develop programs to award academic credit for paid clinical experiences leading to academic degrees.

In the 1990s, dedicated education units transformed undergraduate preceptorships, but graduate preceptorships remain static. The dyadic nurse practitioner preceptorship model supports an environment where faculty, students, and preceptors may overlook nuances that affect the teaching-learning process. This article describes an innovative clinical education model, Student and Preceptor Advancement in a Dedicated Education Site, designed to improve preceptorships for advanced practice nurses. The focus is on adaptations made to facilitate use in advanced practice nursing programs.

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Introdução: O enfermeiro de prática avançada é o profissional que desenvolveu uma base de conhecimento especializado, habilidades complexas para tomada de decisão, competências clínicas com alto nível de autonomia e integra em sua atuação profissional a pesquisa, a educação, a prática assistencial direta e a gestão. A Atenção Primária à Saúde (APS) brasileira é um cenário com grande potencial para desenvolvimento de práticas avançadas de enfermagem. Objetivo: Construir um perfil de competências para a prática avançada de enfermagem no contexto da Atenção Primária à Saúde brasileira. Método: estudo exploratório e de abordagem qualitativa, que no referencial teórico-metodológico adotou as seis etapas propostas por Zarifian para construção de competências. Foram os sujeitos da pesquisa: egressos do mestrado profissional na Atenção Primária no Sistema Único de Saúde e da residência uniprofissional em Atenção Básica na Saúde da Família, ambos da Escola de Enfermagem da Universidade de São Paulo. Realizou-se uma oficina de trabalho para elencar ações com potencial para prática avançada de enfermagem, a partir de um mapa com ações desempenhadas pelos enfermeiros na APS. O material empírico resultante foi submetido à análise de discurso para posterior construção das competências. Foram seguidos todos os preceitos éticos. Resultados: Participaram do estudo oito sujeitos, sendo dois egressos do mestrado profissional e seis da residência profissional. Os sujeitos reconhecem que a prática avançada de enfermagem amplia as ações e prática clínica dos enfermeiros e que a residência profissional é um modelo potente para formação de práticas avançadas de enfermagem. Foram identificadas 29 ações com potencial para a prática avançada do enfermeiro na APS. As competências construídas com base nessas ações foram: prática clinica ampliada, integralidade do cuidado, autonomia para tomada de decisões complexas, ser referência para a formação continua de profissionais de enfermagem e no desenvolvimento de pesquisa. Conclusão: elaborou-se um perfil de competências para a formação enfermeiros de práticas avançadas para a APS. Estudos posteriores serão necessários para ampliar e aprofundar essas competências, com o envolvimento de outros sujeitos, como gestores, apoiadores técnicos e profissionais da Atenção Primária. / Introduction: Advanced practice nurses are professionals who acquired specialized know-how, complex skills for decision making, and clinical competences with a high level of autonomy. These nurses also incorporate research, education, care practice and management to their professional performance. Brazilian primary health care is a setting with great potential for the development of advanced practice nursing. Objective: To build a profile of competences for advanced practice nursing in the Brazilian primary health care context. Method: This is an exploratory study, using a qualitative approach, whose theoretical-methodological framework adopted the six stages proposed by Zarifian for the construction of competences. The study subjects were graduates of the professional master program in Primary Health Care at the Unified Health System, and the uniprofessional residency program in Primary Health Care at the Family Health Strategy, both in the School of Nursing, at the University of São Paulo. A workshop was conducted to choose actions with a potential for developing advanced practice nursing, based on a map with actions developed by primary health care nurses. The resulting empirical material was submitted to discourse analysis for later construction of the competences. All ethical principles were observed. Results: Eight subjects participated in the study, of whom two had graduated in the professional master program and six in the professional residency program. The subjects recognized that advanced practice nursing improves the actions and clinical practice of nurses and that the professional residency program is a powerful model for teaching advanced practice nursing. A total of 29 actions with a potential for developing advanced practice nursing in primary health care were identified. The following competences were built based on these actions: increased clinical practice, care comprehensiveness, autonomy for making complex decisions, being a reference for the permanent education of nursing professionals and in the development of research. Conclusion: The authors created a profile of competences for the education of advanced practice nursing in primary health care. Further studies are needed to broaden these competences, with the participation of other subjects such as managers, technical supporters and primary health care professionals.

Studier visar att en god och säker vård har ett nära samband med en hög grad av omvårdnadskompetens hos personalen. Trots att specialistsjuksköterskor har ansvar för att initiera och tillämpa evidensbaserad vård samt att driva utvecklingen inom vården saknas en tydlig beskrivning av vad detta faktiskt innebär samt hur kompetensen bäst kan komma till användning. Syftet är att belysa specialistsjuksköterskors kompetens och dess betydelse för vårdkvalitet och vårdutveckling. För att kunna besvara syftet utfördes en litteraturöversikt. Arton artiklar, varav tolv med kvalitativ metod och sex med kvantitativ metod inkluderades i resultatet. Samtliga artiklar kvalitetsbedömdes med modifierade granskningsmallar. Därefter gjordes en tematisk analys av artiklarnas resultat. Specialistsjuksköterskors avancerade kompetens visade sig ha en viktig betydelse för flera patientgrupper såväl som för andra vårdprofessioner. Den avancerade kompetensen gjorde skillnad i både vårdkvalitet och vårdutveckling. Ett flertal utmaningar i form av organisatoriskt motstånd och otydligheten i rollbeskrivningar kan leda till brist på utvecklingsmöjligheter och att kompetensen som specialistsjuksköterskor har inte används fullt ut. Att sjukvårdsorganisationer tar tillvara på specialistsjuksköterskors kompetens behöver ses som en förutsättning för vårdens förbättringsarbete och för utvecklingen av vårdkvaliteten. / Research has proven that a care of high quality is connected with a high degree of nursing competence. Although nurse specialists with advanced education have responsibilities to implement evidence-based research in practice, in addition to improve the quality of nursing care, there is a lack of a comprehensive and clear description of what this actually means and how their skills best should be applied. The purpose of this study is to examine the roles of nurse specialists and the impact their professional knowledge has on quality of care and health care development. A literature review was performed. Eighteen articles, of which twelve with qualitative method and six with quantitative method, were included in the result. A thematic analysis was made of the results of the articles. The skills of specialist nurses proved to be important for several patient groups as well as for other healthcare professions. The advanced competence made a difference for both quality of care and healthcare improvement. Thus, several challenges like organizational resistance and ambiguity in role descriptions can lead to a lack of development opportunities and that the competence of specialist nurses are not being fully utilized. The skills of nurse specialists need to be seen by healthcare organizations as a prerequisite for the improvement of care and for the development of care quality.