← Becker’s Healthcare Podcast
Loading summary
Transcript16 lines
- [00:00]
A
This is Laura Dardo with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. Marcelie Ainslie, assistant professor of nursing at UNH School of Nursing, and Dr. Tracy Chan, assistant professor and Interim Nurse Practitioner Program Director at Oakland University School of nursing in Rochester, Michigan. Dr. Ainslie, Dr. Chan, thank you so much for joining us today.
- [00:21]
B
Thank you. So excited to be here and have the opportunity to connect.
- [00:26]
A
Fantastic. Now I know you're really focused on NP population, educational preparation and figure out how we're going to be working with the nursing workforce of the future. So for hospital leaders, what's the practical problem that you're trying to solve here? How are you really defining the NP population and preparation as they show up on the clinical agencies?
- [00:47]
C
So hospitals experience real variability in what a new graduate NP is prepared to do. Even within the same population certification. NPs have eight different certification populations that they can work in. It's not an issue of whether NPs are capable, it's that the educational preparation has been described broadly but not consistently bounded to so institutions interpret preparation differently. It can lead to hiring based on assumptions, onboarding that's longer or less targeted than it needs to be, and uneven transition to practice outcomes. This work provides a clearer shared model of educational preparation so clinical agencies can align hiring orientation and early role assignment with what graduates were educated to do, improving efficiency and patient safety.
- [01:53]
A
That's really helpful to understand. And you know, it's so critical right now, especially to have those nurses in the workforce that's prepared to improve efficiency as well as patient safety, thinking about how the patient population is changing and shifting. Now, in the paper that you've recently written, you argue that the NP education is fundamentally different from the medical model because it's population based and holistic. I'm curious, Dr. Ainslie, if you could talk a little bit more about what do hospital administrators most often misunderstand about this model and what misalignment does it create when NPs are placed into roles based on the medical model assumptions?
- [02:36]
B
Yeah, thanks. That's a great question. We see this a lot in health systems. Most health systems operate in a medical model lens and have a lot of administrative higher level C suite administrators who are physicians. And it's assumed that the NPs coming in have the same parameters of scope of practice. But NP education, like Dr. Chan was saying, is really grounded in this holistic biopsychosocial model and it's organized by patient populations and patient needs, the population span, the wellness illness continuum but the emphasis and implementation of this vary. So what this means is that when hospitals apply a medical model assumption to NP roles, sometimes they might expect readiness for specific patient groups, a severity level or visit type that aren't central to the NP population's educational preparation. What our work helps to do is translate this population based model which is unfamiliar to a lot of hospital system administrators and human resources department, and it translates it into practical parameters that hospitals could use to reduce the mismatch between the educational preparation of the new hire and the clinical environment in which they're being hired into. And this could build just more predictable transitions into practice and create a smoother onboarding process.
- [04:23]
A
I love that. I think it makes a lot of sense to really use the information we have and have that model then shifted for that onboarding process to really get people up to speed as quickly as possible. I really appreciate that. Now, Dr. Chan, what did the National Organization of Nurse Practitioner Faculty's national work Group actually produce that's new? Can you describe some of the population specific narratives and visual depictions and how they can set clear educational boundaries using age, severity and visit content?
- [04:58]
C
Sure. Yes. That's exactly what our article was on. And NAMFC is the acronym for our organization, the National Organization of Nurse Practitioner Faculties. And we convened an inclusive consensus based national work group that had representation from all NP populations and collaborated with population specific nursing organizations. So there is specifically the pediatric nurse practitioners, there's women's health, neonatal. So we worked with those groups as well. And it expanded to being 81 experts who work together to produce an outline of population specific narrative descriptions as well as visual depictions that define the educational preparation using the patient centered categories of age, severity of presentation and visit content. So this really gave more clearer educational parameters to help reduce regional and institutional variability and create a more predictive model for transition into practice. So looking at what ages have been defined in the consensus model, there was confusion out there on what age range fell for the adult gerontology. It said that it begins with young adult. Well, when we talk to programs within within this group of experts, we found that the definition was defined as 12 years old in some institutions and as 21 years of age in others. So this variable interpretation resulted in adult Gero NPs receiving either full adolescent curriculum, some receiving just medical components and not the behavior or social components, and some receiving no adolescent curriculum. So this document helps to define that better so that hospital systems and employers understand what their NP that they're hiring has been educated to be able to provide care for that makes a lot
- [07:43]
A
of sense and you know, it is so helpful to see some of those variations and you know, really being able to get to the bottom of how patients are treated and where, you know, they have the best results. Now I know overlapping between NP populations can be somewhat confusing, especially for workforce planning. Dr. Ainslie, what are some of the most important overlap versus distinction takeaways for hospitals? Especially the idea that some populations may stabilize and refer or consult RA rather than provide that full spectrum of care for certain ages and severity levels?
- [08:19]
B
Yeah, that's great. So I think I want to answer this in two levels because the first issue around overlap is a misinterpretation about RN prior work experience and NP education. Also different from the medical model is that our students have pre existing experience in the healthcare care system. So we may receive ICURNs or acute care practicing registered nurses into a family practice nurse practitioner program where the educational curriculum is grounded in a primary care environment, not acute care. And then when that student graduates and if they want to go work some where in an inpatient setting, the capacity of their scope of practice is limited to their NP educational parameters. It is not dependent on their prior registered nurse experience. Now that registered nurse experience creates more depth of knowledge. It grounds and facilitates transition into back into the health system in a new role. The prior RN experience creates value in hiring nurse practitioners because they have that depth of experience already and they're not coming out as brand new healthcare practitioners. That being said, within the NP populations there is also this second layer of overlap and distinction. So the first one being not to confuse their registered nurse experience with their nurse practitioner educational preparation, those are distinct. And the second layer is within nurse practitioner populations themselves. So when we did this work, we found that NP populations really share more foundational educational preparation than even most educators assumed to be real. But when we drilled down into what students needed to know and how we engage in the healthcare system, the behaviors and the knowledge and the skills are very similar across NP roles. And it's really the context and setting that changes based on the NP population. And it's key to name this overlap accurately and define the boundaries of preparation so that hospitals aren't relying on guesswork in their hiring or in the alignment of the new hire with the clinical area in which they're being assigned. So it's a critical nuance in some scenarios. And students may be educated to stabilize and refer or provide consult for certain aspects of care, but not have the full spectrum delivery of care. So if you think about like in the Primary care setting, you know, patients inappropriately present to settings and you may have a chest pain showing up to a primary care office. Right. And primary care is going to want to assess, stabilize and refer to the next level of care. So the scope of dealing with that within the primary care setting is not full spectrum of care, but how to move the patient through the system effectively to receive the most appropriate level of care. And this full spectrum of care aligns with the biopsychosocial model for the age and severity range identified for each NP population. So why is this important for hospitals? It supports smarter staffing models, creates clearer role expectations and safer assignment decisions, especially in the high acuity and complex settings that represent our current healthcare system.
- [12:40]
A
That's helpful to understand and I think especially looking at the complexity of healthcare today, knowing all of these different areas of variation and then being able to zero in on what is the patient, where the patient is, and how you can address some of those gaps makes a big difference. Now, before we wrap up here, Dr. Chan, I was curious if an AHA member hospital wanted to act on this tomorrow, what would you advise?
- [13:10]
C
Thank you. So the first part really is looking at, you know, the document that shows what the educational preparation of MP populations by age and severity are reading, looking at both that visual depiction as well as the narrative descriptions and using those to write your job descriptions and make them more explicit that reflect the age range, the typical severity your service expects. Then secondly would be looking at your onboarding process and transition to practice pathways, make sure they're targeted by based on the predictable educational preparation in the actual clinical environment, and then engaging your clinical leaders and academic partners. So student clinical placements, precepting expectations and early career role assignments align. The payoff is going to be reduced variability and readiness, more efficient onboarding investment, a stronger team integration, and ultimately improved patient safety.
- [14:28]
B
Yeah, so I just wanted to add that as soon as this work published and the table that Dr. Chan's referencing is in the preamble to the Competency Implementation Guide for Nurse Practitioner Faculty, that nonprofit put out in 2024. There's also a peer reviewed article that I provided the reference for. I hope the citation can make it where the podcast is listed. And as soon as it's published, we receive contact from the Veteran Health affairs appreciating the work that has been done and coaching them through appropriate interpretation of the work so that they were able to do a workforce assessment for NP alignment and really work on improving some of their hiring processes. We know from working with VHA that this is something that's meaningful and desired by health systems, so we appreciate the opportunity to bring it to your group today.
- [15:33]
A
Absolutely. And we so appreciate your time and energy in spending with us and sharing with us a bit deeper into the work that you're doing. We can certainly make sure this citation and link is appearing within the podcast notes and make sure that any listeners are able to easily access it, which will be fantastic. Dr. Chan, Dr. Ainslie, thank you so much for joining us again, and I truly appreciate your expertise and look forward to continuing the conversation in the future.
- [15:59]
B
Thank you.
- [16:00]
C
Thank you.