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Preparedness for clinical practice is a critical issue for new nurse practitioners (NPs). We assessed new NPs' perceptions of their preparation for and transition into clinical practice. A national sample of 698 licensed NPs who graduated between 2006 and 2011 and were practicing as NPs in the United States completed a survey related to clinical preparation and practice transition. The majority reported feeling generally or somewhat prepared for practice after their NP education. They also expressed interest in receiving assistance as they transition into practice through residencies and mentoring. Specific findings regarding preparedness and transition into practice are described, and recommendations are offered. •New nurse practitioners (NPs) felt most prepared in health assessment, evidence-based practice, and health teaching.•New NPs felt least prepared for procedures, billing, and electrocardiogram/X-ray interpretation.•Registered nurse experience before NP education was not associated with feeling more prepared.•New NPs desire assistance transitioning into clinical practice.•New NPs are interested in postgraduate residency programs.

Objectives To evaluate the effect of training primary care health professionals in behaviour change counselling on the proportion of patients self reporting change in four risk behaviours (smoking, alcohol use, exercise, and healthy eating).Design Cluster randomised trial with general practices as the unit of randomisation.Setting General practices in Wales.Participants 53 general practitioners and practice nurses from 27 general practices (one each at all but one practice) recruited 1827 patients who screened positive for at least one risky behaviour.Intervention Behaviour change counselling was developed from motivational interviewing to enable clinicians to enhance patients’ motivation to change health related behaviour. Clinicians were trained using a blended learning programme called Talking Lifestyles.Main outcome measures Proportion of patients who reported making beneficial changes in at least one of the four risky behaviours at three months.Results 1308 patients from 13 intervention and 1496 from 14 control practices were approached: 76% and 72% respectively agreed to participate, with 831 (84%) and 996 (92%) respectively screening eligible for an intervention. There was no effect on the primary outcome (beneficial change in behaviour) at three months (362 (44%) v 404 (41%), odds ratio 1.12 (95% CI 0.90 to 1.39)) or on biochemical or biometric measures at 12 months. More patients who had consulted with trained clinicians recalled consultation discussion about a health behaviour (724/795 (91%) v 531/966 (55%), odds ratio 12.44 (5.85 to 26.46)) and intended to change (599/831 (72%) v 491/996 (49%), odds ratio 2.88 (2.05 to 4.05)). More intervention practice patients reported making an attempt to change (328 (39%) v 317 (32%), odds ratio 1.40 (1.15 to 1.70)), a sustained behaviour change at three months (288 (35%) v 280 (28%), odds ratio 1.36 (1.11 to 1.65)), and reported slightly greater improvements in healthy eating at three and 12 months, plus improved activity at 12 months. Training cost £1597 per practice.Discussion Training primary care clinicians in behaviour change counselling using a brief blended learning programme did not increase patients reported beneficial behaviour change at three months or improve biometric and a biochemical measure at 12 months, but it did increase patients’ recollection of discussing behaviour change with their clinicians, intentions to change, attempts to change, and perceptions of having made a lasting change at three months. Enduring behaviour change and improvements in biometric measures are unlikely after a single routine consultation with a clinician trained in behaviour change counselling without additional intervention.Trial registration ISRCTN 22495456

The exponential rise in the number of older adults suggests a growing need for geriatricians. Up to 30,000 geriatricians will be needed in the United States by 2030 to care for this aging population and physician supply will be unable to keep up with demand. A potential solution to this shortage could be the addition of advanced practice clinicians within the geriatric specialty. In 2022, a Department of Veterans Affairs (VA) site created a geriatrics nurse practitioner residency program. The residency offers a one-year immersive geriatric clinical experience for new graduate nurse practitioners. Didactic content is an important supplement to clinical education and focuses on topics specific to our patient population, allowing the residents to tailor their care to the needs of patients. This article describes the background, development, and implementation of a geriatrics nurse practitioner residency program, an analysis of the first year program outcomes, and concludes with implications for practice.

Few patients with opioid use disorder receive medication for addiction treatment. In 2017 the Comprehensive Addiction and Recovery Act enabled nurse practitioners (NPs) and physician assistants (PAs) to obtain federal waivers allowing them to prescribe buprenorphine, a key medication for opioid use disorder. The waiver expansion was intended to increase patients' access to opioid use treatment, which was particularly important for rural areas with few physicians. However, little is known about the adoption of these waivers by NPs or PAs in rural areas. Using federal data, we examined waiver adoption in rural areas and its association with scope-of-practice regulations, which set the extent to which NPs or PAs can prescribe medication. From 2016 to 2019 the number of waivered clinicians per 100,000 population in rural areas increased by 111 percent. NPs and PAs accounted for more than half of this increase and were the first waivered clinicians in 165 [corrected] rural counties with 5.7 million residents. In rural areas, broad scope-of-practice regulations were associated with twice as many waivered NPs per 100,000 population as restricted scopes of practice were. The rapid growth in the numbers of NPs and PAs with buprenorphine waivers is a promising development in improving access to addiction treatment in rural areas.

Colorectal cancer (CRC) is a significant contributor to cancer-related burden, ranking second in cancer mortality in France. Despite the proven survival benefits of systematic CRC screening, uptake remains suboptimal, particularly among people with limited health literacy (HL) and lower socioeconomic position. This study aimed to assess the acceptability of an e-learning training programme on HL and CRC screening among general practitioners (GPs) in deprived areas while also exploring strategies for its promotion and scale-up. A qualitative study nested within the DECODE cluster-randomised controlled trial (NCT04631692) across four French regions was conducted. Semi-structured interviews (phone or online) were carried out to capture opinions, experiences, and recommendations of GPs in the intervention arm. Thematic analysis, employing manual and NVivo coding, was performed. The majority of 22 GPs (16/22) found the training acceptable, informative, tailored to their knowledge needs and offering great flexibility of use. The module on HL garnered more interest than the one on CRC screening, as it addressed a relatively new area for many GPs. It facilitated reflection on patient communication techniques and identified areas for improvement in physician-patient interaction. A perceived gap in the training was the insufficient interactivity in both didactic and virtual group sessions. The findings of this study show high acceptability of the e-learning training by participants, indicating a potential for implementation, if kept concise, self-paced, asynchronous, and with a stronger focus on HL. The training helped GPs reflect on their practices, enhance HL knowledge, and improve patient communication strategies, leading some to adopt new techniques in daily interactions with low HL patients, beyond just screening.

Eating disorders (EDs) are a significant public health concern, yet men remain underrepresented in research and care, partly due to stigmatization. This stigmatization contributes to reduced help-seeking and recognition of ED symptoms in men. To address this, targeted interventions for healthcare professionals are needed. The iSMEsH intervention aims to sensitize general practitioners (GPs) in Germany to EDs in men, impart relevant knowledge and skills, and counter the perception of EDs as \"women's diseases\". We will evaluate the iSMEsH intervention regarding its effects on biased attitudes, knowledge, and self-efficacy among GPs. A sequential explanatory mixed-methods design (QUAN → qual) will be applied in three steps: (1) pre-implementation focus groups and a panel discussion with individuals with lived ED experience and GPs to design the intervention, (2) conduction of a randomized, wait-list controlled trial of the online training trial with GPs and medical students, and (3) post-implementation qualitative interviews with GPs. Quantitative data (step 2) will be analyzed using mixed-measures ANOVAs and contrast analyses (per-protocol) as well as corresponding 2 × 3 linear mixed models with fixed and random effects (intention-to-treat). Qualitative data from step 3 will be analyzed using thematic analysis as outlined by Braun and Clarke (2006). Ethical approval was granted by the Ruhr-University Bochum Ethics Committee (AZ 2023-1106). Participants will provide written or digital informed consent. The intervention seeks to reduce stigma against men with EDs in primary care by improving GPs' and medical students' knowledge, attitudes, and self-efficacy. Strengths include the comprehensive mixed-methods approach and involvement of people with lived experience. Limitations are reliance on self-report and short-/intermediate-term outcomes. If effective, iSMEsH may offer a foundation for future stigma-reduction strategies in healthcare.

Background The rapid evolution of the epidemiological picture and the recent SARS-COV-2 pandemic has expressed the vulnerabilities of health systems and focuses attention on the population’s needs. The nurse’s figure in the care teams is universally identified; however, the implementation of the role within some care settings turns out to be complex and challenging. This integrative review aims to identify the barriers and facilitators in implementing the role of the nurse in primary care settings. Methods An integrative review was conducted on the Medline and Cinahl databases until 9 June 2020. Qualitative, quantitative, and Mixed-method research studies were selected to identify studies related to the barriers and facilitators of the nurse’s role in nursing facilities’ primary care. For the extraction of the results, the Consolidating Framework for Research Implementation (CFIR) was used to identify the factors that influence implementation in health care. Results Following the duplicates’ removal, the search identified 18,257 articles, of which 56 were relevant to the inclusion criteria; therefore, they were included in the summary. The selected studies were conducted in thirteen countries, most from Oceania, Europe, North America, Latin America, and the Caribbean. The barriers reported most frequently concern the nursing profession’s regulatory and regulatory aspects within the contexts of care, cultural and organizational aspects, training, and the transfer of specific skills, which were previously designated to doctors. The facilitators are mainly linked to the nurse’s adaptability to the various contexts of care, recognizing the patient’s role, and the desire to develop multidisciplinary and effective working groups to respond to the health needs of the population in primary care contexts. Conclusion This review highlighted the main barriers and facilitators in implementing the nurse’s role in primary care settings. These results offer useful elements for stakeholders to identify effective strategies in preparing programs and activities for implementing the nurse’s role, acting on the elements identified as barriers and favouring the aspects that emerge as facilitators.

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.

Background Patients with advanced chronic non-malignant conditions often experience significant symptom burden. Therefore, overcoming barriers to interprofessional collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams is essential to facilitate the timely integration of palliative care elements. The KOPAL trial aimed to examine the impact of case conferences between GPs and SPHC teams on symptom burden and pain in patients with advanced chronic heart failure, chronic obstructive pulmonary disease, and dementia. Methods The cluster-randomised controlled trial compared a structured palliative care nurse visit followed by an interprofessional case conference to usual care. Data were collected from GPs at baseline and 48 weeks, while standardised patient interviews were conducted at baseline, 6, 12, 24, and 48 weeks. Results We analysed 172 patients from 49 German GP practices. Both groups showed marginal improvement in symptom burden; however, no statistically significant between-group difference was found ( =-0.561, 95% CI: -3.201–2.079, p  = .68). Patients with dementia experienced a significant pain reduction ( =2.187, 95% CI: 0.563–3.812, p  = .009). Conversely, the intervention did not have a significant effect on pain severity ( =-0.711, 95% CI: -1.430 − 0.008, p =.053) or pain interference ( =-0.036, 95% CI:-0.797 − 0.725, p =.926) in other patient groups. Conclusions The intervention showed promise in the timely introduction of palliative care elements to address pain management in patients with dementia. Further studies are needed to identify and effectively address symptom burden and pain in other patient groups. Trial registration German Clinical Trials Register: https://www.drks.de/DRKS00017795 (Registration date: 9th January 2020).

Social determinants of health (SDOH) knowledge and skills are crucial to improving health outcomes and achieving health equity. Yet, many barriers exist including gaps in training for nurse practitioner (NP) faculty, challenges in curricular integration, and translation of SDOH skills to NP practice. With the pedagogical shift to competency-based education, SDOH can be integrated throughout NP education utilizing a structured approach. To improve NP faculty knowledge of SDOH and enhance curricular inclusion, a team of NP educators developed a faculty enrichment initiative that consisted of a comprehensive toolkit and 3-part webinar series. As a result, the toolkit provides evidence-based strategies for SDOH curricular integration as well as assignment exemplars to streamline the process for NP faculty. The webinar series, structured using evidence-based teaching strategies, faculty engagement, and competency-driven learning objectives, focuses on disseminating knowledge, skills, and the practical application of SDOH principles in NP curricula. In conclusion, with successful faculty enrichment initiatives, existing barriers can be overcome resulting in knowledgeable faculty, robust curricular integration, and practice-ready NPs that improve health outcomes and promote health equity.