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The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.

Several subgroups of the International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network (ICN NP/APNN) have periodically analyzed APN (nurse practitioner and clinical nurse specialist) development around the world. The primary objective of this study was to describe the global status of APN practice regarding scope of practice, education, regulation, and practice climate. An additional objective was to look for gaps in these same areas of role development in order to recommend future initiatives. An online survey was developed by the research team, and included questions on APN practice roles, education, regulation/credentialing, and practice climate. The study was launched in August 2018 at the 10 Annual ICN NP/APNN Conference in Rotterdam, Netherlands. Links to the survey were provided there and via multiple platforms over the next year. Survey results from 325 respondents, representing 26 countries, were analyzed through descriptive techniques. Although progress was reported, particularly in education, results indicated the APN profession around the world continues to struggle over titling, title protection, regulation development, credentialing, and barriers to practice. APNs have the potential to help the world reach the Sustainable Development Goal of universal health coverage. Several recommendations are provided to help ensure APNs achieve these goals.

Nurses make up the largest segment of the health care profession, with 3 million registered nurses in the United States. Nurses work in a wide variety of settings, including hospitals, public health centers, schools, and homes, and provide a continuum of services, including direct patient care, health promotion, patient education, and coordination of care. They serve in leadership roles, are researchers, and work to improve health care policy. As the health care system undergoes transformation due in part to the Affordable Care Act (ACA), the nursing profession is making a wide-reaching impact by providing and affecting quality, patient-centered, accessible, and affordable care. In 2010, the Institute of Medicine (IOM) released the report The Future of Nursing: Leading Change, Advancing Health , which made a series of recommendations pertaining to roles for nurses in the new health care landscape. This current report assesses progress made by the Robert Wood Johnson Foundation/AARP Future of Nursing: Campaign for Action and others in implementing the recommendations from the 2010 report and identifies areas that should be emphasized over the next 5 years to make further progress toward these goals.

Citing demands for health care that overcomes ageism and promotes sustainable health care, this brief report outlines a model for age-friendly, planet-friendly health care. The model, called the SusQI 5Ms, relies on the premise that what is age friendly is typically planet friendly and vice versa. It aligns the Sustainability in Quality Improvement (SusQI) model with the age-friendly geriatric 5Ms. The SusQI 5Ms model is presented, detailing clinical considerations for the 5Ms while applying the SusQI principles and using clinical examples to illustrate application by advanced practice nurses. •Sustainability in Quality Improvement (SusQI) (sustainable health care) and the 5Ms (age friendly) models combine as SusQI 5Ms.•With the SusQI 5Ms model, nurse practitioners can reshape their practice to be age and planet friendly.•Clinical examples illustrate improved clinical care outcomes for human and planetary health.

Background The phenomenon of missed care has received increasing interest over the past decade. Previous studies have used a missed care framework to identify missed nursing tasks, although these have primarily been within the acute care environment. The aim of this research was to identify missed care specific to the role of the general practice nurse. Methods An integrative review method was adopted, using The Mixed Methods Appraisal Tool to assist in a methodological appraisal of both experimental, theoretical, and qualitative studies. Thematic analysis was then used to analyse and present a narrative synthesis of the data. Data sources: CINAHL, SCOPUS, Web of Science and Google Scholar databases were searched between 2011 and 2022 for empirical research that reported missed care and the general practice nurse. Results Of the 787 papers identified, 10 papers met the inclusion criteria. Three themes identified missed care in relation to primary healthcare nurses: under-staffing and resourcing, communication difficulties, and role confusion. Conclusion Isolating missed care by general practice nurses was challenging because much of the research failed to separate out general practice nurses from community and primary health care nurses. This challenge was exacerbated by disparity in the way that a general practice nurse is defined and presented in the various databases. While some themes such as those related to communication and understaffing and resourcing demonstrate some parallels with the acute sector, more research is required to identify missed care specific to the general practice nurse.

Background Nurse Practitioners (NPs) are pivotal in transforming healthcare by bridging gaps in delivery and improving patient outcomes through advanced clinical expertise. Internationally, NPs often have clear job descriptions and significant autonomy. However, in Norway, the lack of standardized role definitions creates challenges. This study explores the integration of NPs into the Norwegian healthcare system, highlighting variations in practice patterns due to limited regulatory clarity and standardized job descriptions. Establishing national regulatory mechanisms is essential for the consistent development and integration of NPs, ultimately enhancing healthcare service quality. Aim This study aims to explore the demographic and professional characteristics of NPs in Norway and analyse the influencing factors on changes in their practice patterns following the completion of NP education. Methods This study utilized a quantitative, cross-sectional design to collect data over a four-month period, from mid-October 2023 to mid-February 2024. Data analysis was performed using Stata ® 18.0, focusing on demographic, education, work condition, and changes in practice patterns following NP education, and specialist approval. Categorical variables were presented as frequencies with proportions, while continuous variables were presented as means with range. Logistic regression was used to examine associations between changes in practice patterns and factors such as workplace, graduation time, and job description, employing both univariable and multivariable analyses. Results The sample included 95 participants, the majority of whom were educated in the South-Eastern Norway, and 74% had obtained specialist approval. The results show that 66% of participants reported changes in practice patterns after completing NP education, but only 26% had formal job descriptions. Statistical analysis revealed a strong association between having job descriptions and changes in practice patterns (OR 9.5, p  = 0.005). Those who graduated after 2020 were less likely to report changes compared to those who had graduated earlier (OR 0.18, p  = 0.016). Conclusion Job descriptions are critical drivers for changes in practice patterns among NPs, but few participants reported having such descriptions. This underscores the need for the healthcare system to assess and tailor NP job descriptions to meet its needs and maximize competency utilization.

Background New healthcare professions are emerging due to scarce medical resources. The appearance of a new healthcare profession, advanced practice nurses (APNs), has raised questions about how general practitioners interrelate with them as primary care providers. The objective of this study was to explore the perceptions general practitioners have towards the services rendered by APNs to patients, to general practice and the role they play in the healthcare system. Methods A survey-based, cross-sectional study was conducted throughout the Grand Est region of France which covers 57,333km 2 and has a population of approximately 5,562,651. The survey was compiled using pre-existing questionnaires and was carried out from July to September 2022 via email. Variables collected were rate of acceptability and socio-demographic characteristics. Results In total, 251 responses were included. The mean age of general practitioners was 41.7 years, most were women (58.2%) and worked in rural areas of the region (53.8%). Over 80% of respondents practiced in group structures (defined as either multi-professional health centers (n = 61) or in group practices (n = 143)). Most respondents (94.0%) were familiar with the APN profession and did not consider that APNs improved access to care (55.8%, percent of responders with score ≤ 3/10). Moreover, most did not believe that APNs were useful as a primary care provider for patients (61.8%). However, being a member of a territorialized healthcare community, known as Communautés Professionnelles Territoriales de Santé (CPTS ) , was associated with a positive appraisal of APNs’ services (OR = 2.116, 95%CI: 1.223 to 3.712; p  = 0.007). Conclusions Encouraging shared and networked practice within a healthcare community may promote a positive perception of new actors. Further studies need to be conducted to show whether the integration of APNs into healthcare networks improves quality of care.

Background . According to projections based on current trends, it can be anticipated that from 2024 onward, approximately 70% of all cancer cases will be diagnosed in individuals 65 years and older. Given this complex intersection between population ageing and cancer incidence, it is of great importance to address this issue from a comprehensive care perspective. Here comes the importance of advanced practice nurse into play. However, this figure is still not sufficiently valued in many countries. Its roles are also not clearly defined at the international level. For this reason, a systematic review of the scientific literature was carried out to analyze the impact of advanced practice nurse on the quality of life of older adults with cancer. Methods . Searches were carried out in PubMed, Web of Science (WoS), Scopus, CINAHL, LILACS, and ScienceDirect databases. They were limited to studies conducted in the last 7 years. Only open‐access articles were selected. To analyze the chosen articles and assess their quality, the criteria of the PRISMA and CASPe statements were applied. All authors participated in both the selection of the articles and their analysis. Results . Of the initial 58 articles selected, a total of 10 articles were finally included, as they met the eligibility criteria established after further analysis. The results show a positive relationship between the advanced practice nurse intervention and quality of life in older adults with cancer. Conclusions . Advanced practice nurse (APN) plays a key role in the care of older adults with cancer, significantly improving their quality of life and contributing to the comprehensive care of these patients. The findings evidenced in this work support the integration of APNs in cancer care teams to improve patient experience and overall well‐being.

Over the past 15 years, the emergency nurse practitioner has been recognized as a nursing specialty role with dedicated scope and standards of practice. However, a paucity of objective data exists to validate the actual practice of emergency nurse practitioners in the emergency care setting. The purpose of this pilot study was to describe the initial acuity of patients assigned to emergency nurse practitioners, actions, decisional complexity, and disposition decisions of advanced practice nurses as they function in emergency departments in a single system. This descriptive exploratory study used retrospective chart data to gain understanding. The most common Emergency Severity Index level seen by emergency nurse practitioners was Emergency Severity Index 3. Of 8513 encounters with Emergency Severity Index level data, 21% were triaged at Emergency Severity Index 2, 56% at Emergency Severity Index 3, 21% at Emergency Severity Index 4, and only 2% at Emergency Severity Index 5. Half of encounters resulted in a Current Procedural Terminology code of 99825 or higher and 94% were coded at 99824 or higher. There were a high percentage of admissions including intensive care unit admissions. Although descriptive, this study is highly illustrative of the broad scope of complex skills and clinical decision making required to perform as an advanced practice nurse in the emergency department. Further examination of education and training is warranted.

Cervical cancer screening programs in Australia have been developed to detect early precancerous changes in women with a cervix aged between 25 and 74. Yet, many barriers remain to the uptake of cervical screening. Barriers include a lack of culturally appropriate service provision, physical access, poor health literacy, emotional difficulties, socio-economic disadvantage and not having access to a female service provider. In remote and very remote areas of Australia, additional barriers experienced by Aboriginal or Torres Strait Islander peoples include a distrust of healthcare providers and a lack of services, resulting in a much higher rate of diagnosis and death from cervical cancer. General practice nurses (GPNs) are well placed to conduct cervical screening tests (CSTs) after they have undertaken additional education and practical training. GPNs’ increase in scope of practice is beneficial to general practice as it helps to remove some barriers to cervical screening. In addition, GPNs conducting CSTs reduce GP workload and burnout and increase teamwork. GPNs working in metropolitan clinics have greater access to training facilities, whereas those working in rural and remote clinics are required to travel potentially long distances to complete practical assessments. This highlights the need for training to be made available in rural and remote areas. The aim of this forum paper is therefore to generate further discussion on the need for training programs to be made available in rural and remote areas to aid the upskilling of GPNs.