2011 Adult-Gerontology Primary Care Nurse Practitioner: Role

Transcription

2011
Adult-Gerontology Primary Care Nurse Practitioner
Role Delineation Study
National Survey Results
June 2012
© Copyright 2012 American Nurses Credentialing Center, All Rights Reserved
About this Report
This report pertaining to the practice of adult-gerontology primary care nurse practitioners
was based on the results of a national study of practice of adult-gerontology, family, and pediatric
primary care nurse practitioners.
Table of Contents
ACKNOWLEDGEMENTS................................................................................................................ 3
BACKGROUND ............................................................................................................................... 5
ROLE DELINEATION STUDY OVERVIEW ........................................................................................... 5
UPDATED TEST CONTENT OUTLINES .............................................................................................. 5
ROLE OF THE CONTENT EXPERT PANELS ........................................................................................ 5
SURVEY METHODOLOGY ............................................................................................................. 6
SURVEY CHRONOLOGY .................................................................................................................. 6
SAMPLE SELECTION....................................................................................................................... 6
SURVEY DEVELOPMENT AND MEASURES ........................................................................................ 7
DATA COLLECTION ........................................................................................................................ 8
DATA ANALYSIS ............................................................................................................................ 9
SURVEY RESULTS....................................................................................................................... 11
DEMOGRAPHIC INFORMATION ....................................................................................................... 11
PRACTICE DESCRIPTIONS ............................................................................................................. 12
APPENDICIES
WORK ACTITIVIES STATEMENTS .................................................................................... APPENDIX A
DEMOGRAPHIC DATA SUMMARY .................................................................................... APPENDIX B
WORK ACTIVITIES DESCRIPTIVE STATISTICS .................................................................. APPENDIX C
WORK ACTIVITIES MEAN OVERALL CRITICALITY -- RANK ORDER.................................... APPENDIX D
2011 Role Delineation Study: Adult-Gerontology Primary Care Nurse Practitioner –
2
Acknowledgements
The American Nurses Credentialing Center (ANCC) wishes to thank a number of
content experts who served on the 2011 ANCC Primary Care Nurse Practitioner (AdultGerontology, Family, and Pediatric) Role Delineation Study panels for sustaining this effort and
producing a role delineation study of such high caliber. Without their numerous hours of input
and feedback, the study would not be possible.
Sharon L. Verney, MSN, ANP-BC, GNP-BC
Marianne Shaughnessy, MSN, ANP-BC
Elizabeth B. Esstman, MSN, GNP-BC
Deborah S. Croy, MSN, ANP-BC
Denise Brown, MSN, GNP-BC
April D. Bigelow, PhD, ANP-BC
Kellie L Kahveci, MSN, ANP-BC, GNP-BC
Ronda M. Thompson, MSN, ANP-BC, GNP-BC
Viet H. Nguyen, MN, ANP-BC, GNP-BC
Christine Marie Sabatino, MSN, ANP-BC, GNP-BC
Family Nurse Practitioner
Tammy K. Norman, MSN, FNP-BC
Katharine Arce, MSN, MPH, FNP-BC
Mary Janette A. Betita, MSN, FNP-BC
Mollie E. Aleshire, DNP, FNP-BC, PNP-BC
Melissa M. Ilg, MSN, ANP-BC, FNP-BC
Cheryl A. O'Donnell, Ph.D, FNP, GNP-BC
Diana Kay Fauss, MSN, FNP-BC,GNP-BC
Regina M. Nickelson, MSN, FNP-BC
Carol F. Braungart MS, ACNP-BC, FNP-BC
Carol M. Patton, Ph.D, FNP-BC
Pediatric Primary Care Nurse Practitioner
Mary M. Aruda, PhD, PNP-BC, FNP-BC
Melissa Geist, Ed.D, FNP-BC, PNP-BC
Patricia C. Chatfield, MSN, PNP-BC
Martha Driessnack, Ph.D, PNP-BC
Christine A. Honnick, MSN, PNP-BC
Ann L. Parsons, MN, PNP-BC
Valerie J. Griffin, MSN, FNP-BC, PNP-BC
Rachel L. Anger, MSN, PNP-BC
Bonnie E. Kitchen, MNSc, PNP-BC
Kathryn S. Schartz, MSN, PNP-BC
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We also would like to thank the ANCC staff who also spent numerous hours working to
make this study possible:
Christine DePascale, MS (Project Manager)
David Paulson, PhD, CAE
Chie Ohba, PhD
Cheray Jones
Finally, we would like to thank the ANCC-certified nurse practitioners who supported this
study by completing the survey questionnaire.
The contributions that all of these people made to the study were essential to its success.
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Background
The American Nurses Credentialing Center (ANCC), which was incorporated in 1991 as
a subsidiary of the American Nurses Association, is the largest nursing credentialing organization
in the United States. Its vision is to drive nursing excellence, quality care and improved
outcomes. Currently, ANCC offers 25 examinations at various levels including diploma and
associate degree, baccalaureate, and advanced practice for nurse practitioners, clinical nurse
specialists, and other disciplines. More than 14,000 candidates take an ANCC certification
examination each year. In addition to certification, ANCC provides services such as the Magnet
and Pathways to Excellence recognition programs for hospitals and other facilities that
demonstrate excellence in nursing services, accreditation of continuing education programs,
education and consultation services, and outreach to nursing organizations around the globe.
Role Delineation Study Overview
Role delineation or job analysis studies are typically carried out at the national level with
the goal of describing current practice expectations, performance requirements, and
environments. ANCC has a current goal of conducting a study of nurse practitioners
approximately every three years in order to capture changes in work activities and the knowledge
and skill areas required to perform those activities. The findings are used to update the content
of its respective certification examinations.
The 2011 Primary Care Nurse Practitioner (Adult-Gerontology, Family, and Pediatric)
Role Delineation Study involved two sets of processes or activities that ran more or less
concurrently: a national web-based survey and a linking activity. The national survey was
designed to collect information on the work activities nurse practitioners actually perform in
practice, while the linking activity identifies the major knowledge and skill areas required to
perform the work activities listed in the survey. The results of both of these processes were used
in the updating of the test content outlines for each examination contained within the study.
Updated Test Content Outlines
The results of this role delineation study were used in developing or updating the test
content outline for each examination contained within the study. Examination forms produced
based on the adult-gerontology primary care nurse practitioner test content outline developed
through this study are scheduled to go into effect January 29, 2013. A copy of the test content
outline is available on the American Nurses Credentialing Center website.
Role of the Content Expert Panels
Throughout the study, ANCC invited professionals in practice and educators who teach
courses relevant to nurse practitioners to serve on content expert panels for this study. They
developed the work activities and demographic items for the survey, linked knowledge and skill
areas to the work activities list, and finalized the test content outlines for the respective
certification examinations. All of the content experts serving on the panels were certified by
ANCC in the nurse practitioner population they represented and were invited to serve on the
panels based upon expertise in their specialties.
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Survey Methodology
The purpose of the development and administration of the national survey was to collect
information on the work activities nurse practitioners actually perform in practice. Since the survey
instrument that was used for the purposes of this study would be used across the three primary
care nurse practitioner populations, representatives from each of these three population-based
role delineation study panels were also asked to serve as members of a nine member initial study
workgroup that acted as a sort of steering committee for the panels. This initial workgroup met
for three days May 16-18, 2011 to draft a single pilot version of the survey and to construct the
initial map of knowledge and skill areas relevant to the work activities included in the survey.
Survey Chronology
The survey development and administration timeline was as follows:
May - June 2011
The initial study workgroup along with staff from ANCC drafted the survey
The survey was pilot tested and revised.
July - August 2011
The final survey was administered on the web.
September - November 2011
The survey activity results were analyzed, and activity weights were determined.
Each panel met to review the survey results and activity weights.
Sample Selection
On May 10, 2011, there were a total 18,912 actively certified ANCC adult nurse
practitioners and 4,124 ANCC gerontological nurse practitioners. A random sample of 1,500
adult and gerontological nurse practitioners stratified by region was selected from the ANCC
certification database. Table 1 presents the numbers of ANCC certified adult and gerontology
nurse practitioners that were selected from each region.
Table 1. Number of Surveys Mailed Out per Geographic Region
Number of ANCC
Certified Adult Nurse
Practitioner Selected
(percent of total pop.)
Number of ANCC Certified
Gerontology Nurse
Practitioner Selected
(percent of total pop.)
Northeast – NY, CT, MA, NJ, ME, PA, NH, VT, RI
263 (35.1%)
210 (28.0%)
South – TN, MS, TX, FL, LA, AL, GA, AR, OK, VA, MD, SC, DC, NC,
WV, DE, KY
258 (34.4%)
237 (31.7%)
Midwest – IA, NE, KS, OH, MO, MN, SD, ND, MI, IL, IN, WI
122 (16.3%)
182 (24.3%)
West – WA, AZ, CA, OR, CO, AK, ID, NM, UT, HI, NV, WY, MT
105 (14.0%)
119 (15.9%)
2 (0.3%)
1 (0.1%)
750 (100%)
750 (100%)
Geographic Region
Other – AE, AP, APO
Total
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Survey Development and Measures
On May 16-18, 2011, the initial study workgroup met in Silver Spring, MD in order to draft
the national Primary Care Nurse Practitioner (Adult-Gerontology, Family, and Pediatric) Role
Delineation Study survey for the 2011 role delineation study. The panel members reviewed the
work activities which had been used in the ANCC's 2008 Role Delineation Survey of Nurse
Practitioners as well as the following documents:
Consensus Model for APRN Regulation (APRN Consensus Workgroup and NCSBN
APRN Advisory Council, 2008)
Nurse Practitioner Core Competencies (NONPF, 2011)
Nurse Practitioner Primary Care Competencies in Specialty Area: Family (NONPF, 2002)
Nurse Practitioner Primary Care Competencies in Specialty Area: Pediatrics (NONPF,
2002)
Adult-Gerontology Primary Care Nurse Practitioner Competencies (NONPF, 2010)
The Essentials of Master’s Education in Nursing (AACN, 2011)
Appendix A from The Essentials of Doctorate of Nursing Practice Education for Advanced
Practice Nurses (AACN, 2006)
During the meeting, they discussed any additions, deletions, and changes they would make to
update the 2008 work activity list to reflect current practice of primary care nurse practitioners
working within any of the three population areas. The goal of this process was to create a
comprehensive list of relevant work activities that were potentially performed by nurse
practitioners in any one of the population areas, regardless of whether it was performed in the
others. As a result of this meeting, the panel reached consensus on a list of 100 work activities to
be used in the 2011 survey. These work activities were divided into four domains: Assessment,
Diagnosis, Clinical Management, and Role. The complete text of the work activities list is
presented in Appendix A. The workgroup also identified and finalized a set of 18 demographic
questions. (See Appendix B).
During the same meeting, the workgroup reviewed and approved three scales that
respondents would use to rate the work activities listed in the survey — Frequency (the frequency
with which a work activity is performed), Performance Expectation (how soon on the job the
performance of an activity is expected), and Consequence (the consequence of performing an
activity incorrectly). The performance expectation scale was specifically designed to distinguish
entry-level skills. These three questions and the instructions for answering them are presented in
Table 2.
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Table 2. Survey Questions for Rating Work Activity Statements
Please respond to each activity with three separate responses, one response in each category. When considering a response for
one category, do not consider the other categories. For example: When considering the consequences of incorrect performance of
an activity, do not worry about whether the nurse practitioner performs or is expected to perform the activity; the possibility exists
that an activity has severe consequences, even if it is never performed.
Performance Expectation: When is a newly certified primary care nurse practitioner with a population focus of <<population>> first
expected to perform this activity?
-- Within the first 6 months of working within the role and population.
-- After the first 6 months of working within the role and population.
-- Never expected to perform this activity within the role and population
Frequency: How often does a newly certified primary care nurse practitioner with a population focus of <<population>> perform this
activity (consider within a one year period)?
-- Frequently
-- Often
-- Occasionally
-- Seldom
-- Never
Consequences: Does incorrect performance of this activity cause:
-- No negative consequences
-- Minimal negative consequences
-- Moderate negative consequences
-- Significant negative consequences
The study design included combining each respondent’s responses to each of the three
rating scales in a hierarchical manner into one overall ranking of criticality. To select a procedure
for combining the three scales, importance of each scale to the performance of the work activity
was considered. Performance expectation scale was determined to be regarded as more critical
than the other two scales for representing entry-level practice. The consequence scale was then
regarded as more critical than the frequency scale. Therefore, the scales were combined so that
a particular value on the performance expectation scale would outweigh or outrank all values on
the consequence and frequency scales. This hierarchical scheme emphasized the work activities
that are required of new practitioners immediately on the job and have the greatest impact on
public health or safety. Thus this scheme was selected as the organizing mechanism for
combining the responses from the three survey scales into an overall measure of criticality.
Data Collection
Pilot Testing. Using the same procedures intended for administering the national data
collection, the survey was piloted in June 2011. Twenty-five ANCC certified adult nurse
practitioners and 25 ANCC certified gerontological nurse practitioners randomly selected from
across the nation were included in the sample of 100 ANCC certified nurse practitioners invited to
take the pilot survey. Overall, 34 (34 percent) of the nurse practitioners invited to take the pilot
survey responded; 17 of these respondents were adult or gerontological nurse practitioners.
The respondents of the pilot test in general indicated that the work activities were
appropriate and reflective of the job of the nurse practitioner.
National Survey. In July and August 2011, the 1,500 adult and gerotological nurse
practitioners selected to take the national web-based survey were sent three notifications via the
United States Postal Service: an alert letter, and two follow-up reminders. The alert letter
explained the purpose and importance of the study, the eligibility criteria of the study, and stated
how to access the survey via the internet. The letter indicated that the participant’s responses
would be kept confidential.
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The letter also notified that respondents completing the survey receive a 5 hour reduction
of their continuing education requirement for their ANCC recertification.
The first follow-up reminder letter was sent approximately two-weeks after the alert letter.
It thanked recipients if they had already submitted their completed survey and encouraged them
to do so if they had not already.
The final follow-up reminder letter was sent out only to those who had not yet responded
to the survey and was sent out approximately two-weeks prior to the end of the survey.
Data Analysis
The three rating scales were combined into a single measure of overall criticality using a
hierarchical method. As agreed by the initial study workgroup, the three rating scales were
combined into a single measure in such a manner that a particular value on the performance
expectation scale would outweigh or outrank all values on the consequence and frequency
scales, and that a particular value on the consequence scale would outweigh or outrank all values
on the frequency scale.
Table 3 displays how the values of the overall criticality rating were constructed according
to all the possible survey response patterns that might be given to rate an individual work activity
by its frequency, performance expectation, and consequence. For example, if a respondent
indicated that a particular work activity was expected to be performed within the first six months of
assuming the role of a nurse practitioner, could cause severe harm to the patient if it was
performed incorrectly, and is performed occasionally, the overall criticality rating for that response
pattern would be 39. A score of 32 suggests that a work activity is generally expected to be
performed within the first six months of assuming the role of a nurse practitioner and have
moderate consequences if incorrectly performed. Therefore, work activities with scores of 32 or
higher on the overall criticality variable may be considered as highly critical. When a work activity
was rated as never expected on the performance expectation scale, it would receive an overall
criticality score of 1 as the bottom row in Table 3 indicates.
Table 3. Construction of the Overall Criticality Variable
Survey Response Options
Performance Expectation
Consequence
Within first 6 months
Significant Negative
Consequences
Moderate Negative
Consequences
Minimal Negative
Consequences
No Negative
Consequences
Frequency
Frequently
Often
Occasionally
Seldom
Never
Frequently
Often
Occasionally
Seldom
Never
Frequently
Often
Occasionally
Seldom
Never
Frequently
Often
Occasionally
Seldom
Never
Overall
Criticality Score
41
40
39
38
37
36
35
34
33
32
31
30
29
28
27
26
25
24
23
22
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Table 3. Construction of the Overall Criticality Variable (Continued)
Survey Response Options
Performance Expectation
Consequence
Frequency
After first 6 months
Significant Negative
Frequently
Consequences
Often
Occasionally
Seldom
Never
Moderate Negative
Frequently
Consequences
Often
Occasionally
Seldom
Never
Minimal Negative
Frequently
Consequences
Often
Occasionally
Seldom
Never
No Negative
Frequently
Consequences
Often
Occasionally
Seldom
Never
Never expected
All options
All options
Overall
Criticality Score
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
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Survey Results
The total sample size of the national survey included 1,500 ANCC certified adult and
gerontology nurse practitioners. A total of 156 valid adult nurse practitioner and 217 vaild
gerontology nurse practitioner surveys were returned for an overall response rate of 34.3 percent
and a total usable response rate of 27.4 percent.
Table 4 shows the percent of surveys per population returned in each geographic region
compared to the number of ANCC certified adult and gerontology nurse practitioners selected
within the region.
Table 4. Number of Surveys Returned per Geographic Region
Adult Nurse Practitioner
Number Selected
(percent of total
pop.)
Number Return
(percent of total
pop.)
Northeast – NY, CT, MA, NJ, ME, PA,
NH, VT, RI
South – TN, MS, TX, FL, LA, AL, GA,
AR, OK, VA, MD, SC, DC, NC, WV, DE,
KY
263 (35.1%)
Gerontology Nurse Practitioner
Number Return
(percent of total
pop.)
48 (30.2%)
Number
Selected
(percent of total
pop.)
210 (28.0%)
258 (34.4%)
59 (37.1%)
237 (31.7%)
71 (32.7%)
Midwest – IA, NE, KS, OH, MO, MN,
SD, ND, MI, IL, IN, WI
122 (16.3%)
29 (18.2%)
182 (24.3%)
55 (25.4%)
West – WA, AZ, CA, OR, CO, AK, ID,
NM, UT, HI, NV, WY, MT
Other – AE, AP, APO
105 (14.0%)
23 (14.5%)
119 (15.9%)
27 (12.4%)
2 (0.3%)
0 (0.0%)
1 (0.1%)
0 (0.0%)
Total
750 (100%)
159 (100%)
750 (100%)
217 (100%)
Geographic Region
64 (29.5%)
Demographic Information
Appendix B details the adult and gerontology nurse practitioners survey respondents’
responses to the survey’s eighteen demographic questions which included inquiry on the
practitioner’s background and practice setting.
Demographic Background
Approximately 92 percent of the respondents were female and 86 percent reported to be
white. Approximately 67 percent of the overall sample fell into the age group of 45-64 years of
age.
Approximately 80 percent of adult and gerontology nurse practitioners indicated that they
held a Masters in Nursing as one of their highest degree. Sixteen percent indicated they held a
Post-Masters Certificate. Two percent of the respondents had doctorate degrees in Nursing
Research (Ph.D., DNS, DNS) and 2 percent indicated they held a Doctorate of Nursing Practice.
Five percent of the respondents indicated they held a degree other than what was listed as their
highest level of education.
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The average number of years of experience the adult and gerontology nurse practitioner
respondents had as a RN was approximately 23 years. The respondents also reported on
average 12 years of experience as a nurse practitioner.
Practice Settings
Approximately 43 percent of the adult and gerontology nurse practitioner respondents
indicated that they practiced in cities with populations between 50,000 and 249,999. Towns with a
population between 2,500 and 49,999 had the second highest percent of respondents (23
percent). Seven percent of the respondents indicated working in a rural (population less than
2,500) practice location.
In terms of practice setting, the highest percentage of adult and gerontological nurse
practitioner respondents indicating they practice in a Nursing home/long-term care setting (34
percent). Private practice came in second with 25 percent of the respondents.
Adult and gerontological nurse practitioners also reported on average 75 percent of their
time was spent providing direct patient care with approximately 17 percent of their time providing
health maintenance, 27 precent of time providing care for acute illnesses, and 37 percent
providing care for chronic illnesses. The adult and gerontological nurse practitioners also
indicated spending on average approximately 2 percent of their time for adolescents ages 13 to
17, 33 percent of their time for Adults ages 18 to 64 years old, and 64 percent of their time
providing care to older adults 65 years old and older. When asked how many hours per week on
average they spent in direct patient care, 61 percent of the adult and geronotological nurse
practitioners reported spending between 30 and 49 hours per week.
Finally, overall 96 percent of the adult and gerontological nurse practitioners indicated
that they have privileges to prescribe medication in their current practice. 86 percent indicated
that they are required to have a physician collaborator or supervisor in their practice setting, and
32 percent reported having hospital privileges.
Practice Descriptions
Descriptive statistics (means, standard deviations, and medians) for the three ratings of
all 100 work activities—performance expectation, consequence, and frequency—and mean
overall criticality are listed in Appendix C. The scales were highly reliable. Cronbach’s
coefficient alpha estimates for the performance expectation, consequence, and frequency scales
when applied to all the data were 0.9866, 0.9476, and 0.9655 respectively. (Cronbach's
coefficient alpha, a measure of internal stability, ranges in value between 0 and 1.)
In Appendix D, the overall criticality statistics are presented in rank order of criticality.
As indicated in Table 5, 44 work activity statements were rated by the adult and gerontology
nurse practitioner respondents as highly critical (with a mean overall criticality rank of 32 or
above). Diagnosis had the highest proportion of items considered highly critical (9 out of 10 work
activities -- 90 percent), Fifty percent (19 out of 38) of the Clinical Management domain work
activites were rated as highly critical. Thirty-six percent of the work activites (9 out of 25) listed
under the Assessment domain had a mean overall criticality ranking of 32 or higher. The lowest
proportion of work activities ranked as highly critical came from the Role Domain (7 out of 27
work activities – 26 percent).
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Table 5. Number of Work Activities by Mean Overall Criticality Range and Population for Adult –Gerontology Primary Care
Nurse Practitioners
Mean Overall Criticality Score
Number of
Work
Activities
37.0 and
above
Between
32.0 and
36.9
Between
27.0 and
31.9
Between
22.0 and
26.9
Between
17.0 and
21.9
Between
12.0 and
16.9
Between
7.0 and
11.9
6.9 and
under
Total
number
above
32.0
3
41
27
13
6
4
6
0
44
Table 6 and 7 displays the 20 highest-ranking and the 20 lowest-ranking work activities
by mean overall criticality respectively. The grey shading in Table 6 indicates the three work
activities that received criticality ratings of 37 and above. Two of these three tasks, Prescribe
medications and Monitors the safety and effectiveness of interventions fell into the domain
Clinical Management. The highest rank task, Maintains Confidentiality and privacy according to
regulatory standards (e.g., HIPAA) fell into the domain Role.
The three lowest ranked work activities that received criticality rankings of 11 or less are
highlighted in Table 7. All three of these work activities fell within the Role domain. The focus of
these work activities centered on analyzing the impact of globalization on health, engaging in
scholarly activites and engaging in policy-making external to the organization.
Table 6. Top 20 Work Activities Ranked by Mean Overall Criticality
Work Activity Number and Name
96
43
44
63
25
20
49
27
24
85
2
62
31
67
33
21
93
1
26
29
Maintains confidentiality and privacy according to regulatory standards
(e.g., HIPAA)
Prescribes medications
Monitors the safety and effectiveness of interventions
Evaluates effectiveness of pharmacologic regimen
Performs a focused physical exam
Assesses patient for acute pain
Reports suspected abuse, exploitation and/or neglect
Orders diagnostic tests
Performs a comprehensive physical exam
Identifies and refers patient with conditions beyond scope of practice
Obtains a focused health history
Evaluates patient responses to interventions
Develops differential diagnoses
Evaluates treatment outcomes related to acute pain
Formulates diagnoses
Assesses patient for chronic pain
Documents in accordance with regulatory process and payor source
Obtains a comprehensive health history
Differentiates between normal physiologic changes and abnormal/atypical
findings
Interprets results from diagnostic tests
Mean
Overall
Criticality
38.3
37.3
37.2
36.7
36.6
36.5
35.9
35.9
35.9
35.8
35.8
35.7
35.5
35.4
35.3
35.3
35.2
35.1
35.0
34.9
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Table 7. Bottom 20 Work Activities Ranked by Mean Overall Criticality
Work Activity Number and Name
10
60
19
77
81
99
74
82
15
79
41
97
16
78
86
12
95
98
84
87
Performs a spiritual assessment
Counsels on family planning, sexuality, and/or reproductive health
Assesses patient for development delays/impairment, learning disabilities
Advocates for improved access, quality, and cost-effective health care
Identifies opportunities for quality improvement
Plans for potential crisis and/or disaster situations
Fosters collaboration with multiple stakeholders (e.g. patients,
community, integrated health care teams, and policy makers) to improve
health care
Implements patient and provider safety and quality improvement
initiatives
Performs a community risk assessment
Serves as an interprofessional resource for patient care
Develops population-focused plan of care based on epidemiologic data
Evaluates the impact of health care delivery on providers, stakeholders
and the environment
Performs a population risk assessment
Conducts peer review to promote a culture of excellence
Engages in policy-making internal to the organization
Performs a genetic assessment
Precepts students, novice nurse practitioners, and/or other health
professionals
Analyzes the impact of globalization on health
Engages in scholarly activities (e.g., give presentations, publish
professional article, engage in research activities)
Engages in policy-making external to the organization
Mean
Overall
Criticality
23.2
23.0
23.0
22.5
20.8
20.0
19.3
19.2
19.1
18.6
16.8
16.1
15.2
14.7
11.8
11.7
11.3
10.8
10.0
9.0
14
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Appendix A
Work Activities Statements
Task List for Final Survey
I.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Assessment
Obtains a comprehensive health history
Obtains a history regarding sexual and reproductive health and behaviors
Performs age-appropriate screenings (e.g., developmental, hearing, vision, oral health, genetics)
Determines health status of patient using primary and secondary sources of data (e.g., epidemiological, social,
environmental)
Performs a psychosocial evaluation
Performs a lifestyle assessment (e.g., sleep, exercise, BMI)
Performs a nutritional assessment
Performs a cultural assessment
Performs an individual risk assessment, including safety
Performs a mental health assessment
Performs a family/caregiver risk assessment
Performs a functional assessment, including mobility and cognition
Assesses patient’s capacity for decision-making
Assesses patient for development delays/impairment, learning disabilities
Assesses for advance care planning/advanced directives
Assesses family dynamics and communication patterns
Performs a comprehensive physical exam
II.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
Diagnosis
Differentiates between normal physiologic changes and abnormal/atypical findings
Performs diagnostic tests
Synthesizes data to inform clinical reasoning
Prioritizes differential diagnoses
Prioritizes diagnoses
Develops a comprehensive problem list
III.
Clinical Management
36. Develops a mutually agreeable individualized plan of care
37. Evaluates patient, family and/or caregiver’s knowledge of plan of care
38. Educates patient, family and/or caregiver regarding plan of care include testing, diagnosis, treatments and/or
implications.
39. Facilitates the development of advance care planning/advance directives
40. Prioritizes plan of care considering safety, risk reduction, and comorbidities
41. Develops population-focused plan of care based on epidemiologic data
42. Implements plan of care that incorporates cultural, spiritual, psychosocial considerations
43. Prescribes medications
44. Monitors the safety and effectiveness of interventions
45. Prescribes non-pharmacologic interventions
Appendix A– Work Activities Statements
A-2
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
Manages health maintenance status and health promotion interventions
Immunizes based on current recommendations
Counsels regarding nutrition and weight status
Reports suspected abuse, exploitation and/or neglect
Facilitates transitions in levels of care
Facilitates transitions of care between health care providers
Plans follow-up care
Manages episodic disease
Manages chronic disease
Selects evidence-based technological interventions
Provides palliative care
Provides end of life care
Performs primary care procedures (e.g., wart removal, suturing, cerumen)
Coaches patient, family, and/or caregiver regarding lifestyle and behavioral changes
Counsels on family planning, sexuality, and/or reproductive health
Counsels patient and/or family through grief, dying, and death
Evaluates patient responses to interventions
Evaluates effectiveness of pharmacologic regimen
Evaluates effectiveness of nonpharmacologic interventions
Evaluates adherence to treatment plan
Evaluates the impact of diagnosis and treatment on patient, family, and caregiver
Evaluates treatment outcomes related to acute pain
Evaluates treatment and educational outcomes related to chronic pain
Evaluates treatment and educational outcomes related to nutrition
Evaluates plan of care considering safety, risk reduction and comorbidities
Modifies plan of care to meet the needs of patient, families, and/or caregivers
Modifies plan of care based on patient response to interventions
Maintains a comprehensive problem list
IV.
Role
74. Fosters collaboration with multiple stakeholders (e.g. patients, community, integrated health care teams, and policy
makers) to improve health care
75. Collaborates with other professionals
76. Advocates for individual patient needs
77. Advocates for improved access, quality, and cost-effective health care
78. Conducts peer review to promote a culture of excellence
79. Serves as an inter-professional resource for patient care
80. Creates a climate of patient-centered care (definition of patient-centered care -- care based on a partnership between the
patient and the healthcare provider that is focus on the patient’s values, preferences and needs)
81. Identifies opportunities for quality improvement
82. Implements patient and provider safety and quality improvement initiatives
83. Engages in professional development activities
84. Engages in scholarly activities (e.g., give presentations, publish professional article, engage in research activities)
85. Identifies and refers patient with conditions beyond scope of practice
86. Engages in policy-making internal to the organization
87. Engages in policy-making external to the organization
88. Identifies ethical dilemmas and seek resources for resolution
89. Identifies legal dilemmas and seek resources for resolution
90. Promotes the role of the nurse practitioner
91. Integrates theory, current evidence, professional standards, and clinical guidelines to improve practice
92. Documents daily patient related activities
A-3
93.
94.
95.
96.
97.
98.
99.
100.
Documents in accordance with regulatory process and payor source
Bills for services according to level of care
Precepts students, novice nurse practitioners, and/or other health professionals
Maintains confidentiality and privacy according to regulatory standards (e.g., HIPAA)
Evaluates the impact of health care delivery on providers, stakeholders and the environment
Analyzes the impact of globalization on health
Plans for potential crisis and/or disaster situations
Integrates informatics and/or health care technology into practice
A-4
Appendix B
Demographic Data Summary
1. Primary place of work
Primary Place of Work: Recruitment
Pool
(N = 1498)
West
N = 267,
17.82%
Primary Place of Work: Respondents
(N = 390)
West
N = 58,
14.87%
Northeast
N = 260,
17.36%
Northeast
N = 70,
17.95%
Midwest
N = 76,
19.49%
Midwest
N = 326,
21.76%
South
N = 642,
42.86%
Other
N =3,
0.20%
Other
N = 0,
0.00%
South
N = 186,
47.69%
GNP: Primary Place of Work Recruitment Pool N = 750
West
N = 119,
15.87%
Other
N = 1, 0.13%
Northeast
N = 210,
28.00%
Midwest
N = 182,
24.27%
South
N = 238,
31.73%
Appendix B– Demographic Data Summary
B-2
2. Which nurse practitioner certification are you using as a reference point to complete this
survey?
Count
Percent
Adult Nurse Practitioner
Gerontological Nurse
Practitioner
Total
195
51.9%
181
48.1%
376
2. What is your gender?
Female
Male
Total
(Missing
Count
Percent
344
29
92.3%
7.8%
373
3
3. What is your age?
Under 25 years old
25 - 34 years old
35 - 44 years old
45 - 54 years old
55 - 64 years old
65 and older
Total
Count
Percent
0
35
68
116
134
23
0.0%
9.3%
18.1%
30.9%
35.6%
6.1%
376
100%
B-3
4. What is your race/ethnic background?
White
Black or African American
American Indian and Alaska Native
Asian
Native Hawaiian and other Pacific Islander
Hispanic or Latino
Middle Eastern
Other
Total
(Missing
Count
Percent
319
19
1
17
0
9
1
6
85.8%
5.1%
0.3%
4.6%
0.0%
2.4%
0.3%
1.6%
372
4
100%
5. Indicate the highest educational level you have completed:
Count
Percent
302
20
61
9
8
7
19
80.3%
5.3%
16.2%
2.4%
2.1%
1.9%
5.1%
Count
Percent
56
87
95
101
31
2
15.1%
23.4%
25.5%
27.2%
8.3%
0.5%
Masters in Nursing
Masters in field other than Nursing
Post-Masters Certificate
Doctorate in Nursing Research (e.g., Ph.D., DNS, DSN)
Doctorate in Nursing Practice (DNP)
Doctorate in field other than Nursing
Other
*The percentage is computed using "Total = 376," however, the total count is larger
than 376, as this question asks the respondents to choose all that apply
6a. How many years of experience do you have as a registered nurse?
Number of Years
0 to 9
10 to 19
20 to 29
30 to 39
40 to 49
50 to 59
Total
(Missing
372
4
B-4
6b. How many years of experience do you have as a nurse practitioner?
Number of Years
0 to 9
10 to 19
20 to 29
30 to 39
40 to 49
50 to 59
Total
(Missing
Count
Percent
140
172
47
16
0
0
37.3%
45.9%
12.5%
4.3%
0.0%
0.0%
375
1
7. Which one best characterizes your current clinical practice location(s)?
(Mark all that apply)
Rural (population less than 2,500)
Town (population between 2,500 - 49,999)
City (population between 50,000 - 249,999)
Metropolitan (population between 250,000 - 999,999)
Greater Metropolitan (population greater than 999,999)
Count
Percent
22
87
160
76
56
7.2%
23.1%
42.6%
20.2%
14.9%
*The percentage is computed using "Total = 376," however, the total count is larger
than 376, as this question asks the respondents to choose all that apply
B-5
8. Estimate the percentage of time (during an average week) that you provide direct patient care in each of the age groups listed below.
Percent of Time
Infant
Preschool
School age
Adolescent
Adult
(birth to 1 years)
(2 to 4 years)
(5 to 12 years)
(13 to 17 years)
(18 to 64 years)
Count
Percent
Count
Percent
Count
Percent
Count
Percent
Count
Percent
Below 1%
364
96.8%
363
96.5%
357
94.9%
294
78.2%
52
13.8%
1% to 19%
12
3.2%
13
3.5 %
19
5.1%
70
18.6%
92
24.5%
20% to 39%
0
0.0%
0
0.0%
0
0.0%
9
2.4%
84
22.3%
40% to 59%
0
0.0%
0
0.0%
0
0.0%
2
0.5%
62
16.5%
60% to 79%
0
0.0%
0
0.0%
0
0.0%
1
0.3%
40
10.6%
80% to 100%
0
0.0%
0
0.0%
0
0.0%
0
0.0%
46
12.2%
376
100%
376
100%
376
100%
376
100%
376
100%
Total
Mean percent spent with
each age group
B-6
(Continue to the next page)
Infant
Preschool
School age
Adolescent
Adult
(birth to 1 years)
(2 to 4 years)
(5 to 12 years)
(13 to 17 years)
(18 to 64 years)
0.1%
0.2%
0.4%
1.8%
33.2%
8. Estimate the percentage of time (during an average week) that you provide direct patient care in each of the age groups listed below. (Continued)
Young-Old
Middle-Old
Oldest-Old
(65 to 74 years)
(75 to 84 years)
(85 years and older)
Count
Percent
Count
Percent
Count
Percent
16
4.3%
28
14.9%
56
14.9%
1% to 19%
105
27.9%
117
31.1%
197
52.4%
20% to 39%
183
48.7%
141
37.5%
81
21.5%
40% to 59%
60
16.0%
73
19.4%
24
6.4%
60% to 79%
10
2.7%
12
3.2%
28
7.4%
80% to 100%
2
0.5%
5
1.3%
0
0.0%
376
100%
376
100%
376
100%
Percent of Time
0%
Valid Responses
Missing
Mean percent spent with
each age group
Young-Old
Middle-Old
Oldest-Old
(65 to 74 years)
(75 to 84 years)
(85 years and older)
24.6%
24.3%
15.4%
B-7
9. Estimate the percentage of time (during an average week) spent in direct patient care.
Health maintenance
Percent of Time
Count
Maternity care
Percent
Count
Acute illness care
Percent
Count
Chronic illness care
Percent
Count
End-of-life care
Percent
Count
Percent
0%
1% to 19%
20% to 39%
40% to 59%
60% to 79%
80% to 100%
51
183
102
25
8
7
13.6%
97.3%
27.1%
6.6%
2.1%
1.9%
358
14
4
0
0
0
95.2%
3.7%
1.1%
0.0%
0.0%
0.0%
27
103
148
69
18
11
7.2%
27.4%
39.4%
18.4%
4.8%
2.9%
16
48
128
122
45
17
4.3%
12.8%
34.0%
32.4%
12.0%
4.5%
130
191
40
6
5
4
34.6%
50.8%
10.6%
1.6%
1.3%
1.1%
Total
376
100%
376
100%
376
100%
376
100%
376
100%
Mean percent spent
with each type of direct
care
Health maintenance
Maternity care
Acute illness care
Chronic illness care
End-of-life care
16.8%
0.4%
26.6%
37.2%
8.8%
B-8
9. The percentage of time (during an average week) that you provide patients with (continue)
Mental health care
Percent of Time
Count
Other
Percent
Count
Percent
0%
1% to 19%
20% to 39%
40% to 59%
60% to 79%
80% to 100%
109
209
45
8
1
4
29.0%
55.6%
12.0%
2.1%
0.3%
1.1%
333
36
5
1
1
0
88.6%
9.6%
1.3%
0.3%
0.3%
0.0%
Total
376
100%
376
100%
Mean percent spent
with each type of
direct care
Mental health care
Other
37.2%
1.3%
B-9
10. Which of the following best or most accurately describes your practice setting? (Mark all that apply.)
Community/Public Health (city/county/state/federal agency)
Home Health Care
Hospice Facility
Hospital, Inpatient
Hospital, Outpatient
Managed care (HMO, Blue Cross/Blue Shield)
Medical school
Nursing home/long-term care
Independent nurse practitioner practice
Occupational Health
Private Practice
Retail based clinic
School or College Health
School/College of nursing
VA/Armed forces
Other
Count
Percent
28
25
15
59
54
26
3
129
14
10
93
3
16
10
35
55
7.4%
6.6%
4.0%
15.7%
14.4%
6.9%
0.8%
34.3%
3.7%
2.7%
24.7%
0.8%
4.3%
2.7%
9.3%
14.6%
*The percentage is computed using "Total = 376," however, the total count is larger than 376, as this question asks the respondents
to choose all that apply
11. On average, how many hours per week do you spend in direct patient care?
Number of Hours
0 to 9
10 to 19
20 to 29
30 to 39
40 to 49
50 or more
Total
(Missing
(Invalid
Count
Percent
12
23
56
123
94
47
3.4%
6.5%
15.8%
34.6%
26.5%
13.2%
355
17)
4)
100%
B-10
12. Approximately what percentage of your average work week is spent in each of the following activities?
Management,
supervision, and
administration
Direct
patient care
Percent of Time
Teaching
Research
Consultation
Other
Count
Percent
Count
Percent
Count
Percent
Count
Percent
Count
Percent
Count
Percent
0%
1% to 19%
20% to 39%
40% to 59%
60% to 79%
80% to 100%
5
10
22
35
77
227
1.3%
2.7%
5.9%
9.3%
20.5%
60.4%
197
125
35
11
4
4
52.4%
33.2%
9.3%
2.9%
1.1%
1.1%
171
157
36
6
6
0
45.5%
41.8%
9.6%
1.6%
1.6%
0.0%
302
63
7
3
0
1
80.3%
16.8%
1.9%
0.8%
0.0%
0.3%
204
136
21
9
3
3
54.3%
36.2%
5.6%
2.4%
0.8%
0.8%
329
35
10
2
0
0
87.5%
9.3%
2.7%
0.5%
0.0%
0.0%
Total
376
100%
376
100%
376
100%
376
100%
376
100%
376
100%
Mean percent spent
with each activity
Direct
patient care
Management,
supervision, and
administration
Teaching
Research
Consultation
Other
75.2%
7.8%
7.3%
1.9%
6.3%
1.6%
B-11
13. On average, what percentage of your patient visits are pertaining to conditions related to each of the body systems listed below.
Head, Eyes, Ears
Nose and Throat
Percent of Time
Respiratory
System
Cardiovascular
System
Gastrointestinal
System
Genitourinary
System
Musculoskeletal
System
Count
Percent
Count
Percent
Count
Percent
Count
Percent
Count
Percent
Count
Percent
Below 1%
1% to 19%
20% to 39%
40% to 59%
60% to 79%
80% to 100%
93
254
21
4
3
1
24.7%
67.6%
5.6%
1.1%
0.8%
0.3%
48
314
108
9
2
0
12.8%
83.5%
28.7%
2.4%
0.5%
0.0%
34
181
124
17
5
15
9.0%
48.1%
33.0%
4.5%
1.3%
4.0%
69
285
20
1
1
0
18.4%
75.8%
5.3%
0.3%
0.3%
0.0%
80
272
14
2
3
5
21.3%
72.3%
3.7%
0.5%
0.8%
1.3%
66
247
51
5
5
2
17.6%
65.7%
13.6%
1.3%
1.3%
0.5%
Total
376
100%
376
100%
376
100%
376
100%
376
100%
376
100%
Mean percent spent
treating conditions
within each body
system
Head, Eyes, Ears
Nose and Throat
Respiratory
System
Cardiovascular
System
Gastrointestinal
System
Genitourinary
System
Musculoskeletal
System
7.2%
14.1%
19.1%
8.1%
8.0%
11.3%
B-12
13. On average, what percentage of your patient visits are pertaining to conditions related to each of the body systems listed below. (Continued)
Endocrine System
(including metabolic
disorders)
Neurological
System
Percent of Time
Hematopoietic
System
Immune
System
Integumentary
System
Count
Percent
Count
Percent
Count
Percent
Count
Percent
Count
Percent
0%
1% to 19%
20% to 39%
40% to 59%
60% to 79%
80% to 100%
69
265
20
6
4
12
18.4%
70.5%
5.3%
1.6%
1.1%
3.2%
84
231
47
8
2
4
22.3%
61.4%
12.5%
2.1%
0.5%
1.1%
166
205
4
0
0
1
44.1%
54.5%
1.1%
0.0%
0.0%
0.3%
200
170
3
1
0
2
53.2%
45.2%
0.8%
0.3%
0.0%
0.5%
119
243
8
2
1
3
31.6%
64.6%
2.1%
0.5%
0.3%
0.8%
Total
376
100%
376
100%
376
100%
376
100%
376
100%
Mean percent spent
treating conditions
within each body
system
Neurological
System
Endocrine System
(including metabolic
disorders)
Hematopoietic
System
Immune
System
Integumentary
System
10.5%
10.3%
3.1%
2.6%
5.7%
B-13
14. Consider your patient visits within the past year. Estimate the percent of patients for which you prescribed/managed
medications within each of these drug agent categories.
Number/Percent of Respondents
Who Prescribed or Managed
Medications within the Drug
Agent Category during one or
more percent of patient visits
Count
Percent
Antiinfective
Antiinflammatory
Autonomic Nervous System
Cancer
Cardiovascular
Emergency
Endocrine
Gastrointestinal
Herbal
Immunologic
Neurologic and Neuromuscular
Pain
Psychiatric
Reproductive and Gender-Related
Respiratory
Urologic
352
344
240
79
331
191
313
339
163
158
296
351
312
170
331
296
93.6%
91.4%
63.8%
21.0%
88.0%
50.8%
83.2%
90.2%
43.4%
42.0%
78.7%
93.4%
83.0%
45.2%
88.0%
78.7%
Count
Percent
362
14
96.3%
3.7%
376
100%
Count
Percent
320
54
85.6%
14.4%
*The percentage is computed using "Total = 376."
15. Do you have privileges to prescribe medications in your current practice setting?
Yes
No
Total
16. Are you required to have a physician collaborator/supervisor?
Yes
No
Total
Missing
374
2)
B-14
17. Do you have hospital privileges in your current practice setting?
Yes
No
Total
Missing
Count
Percent
119
251
32.2%
67.8%
370
6)
18. Do you: (Mark all that apply)
Admit patients to the hospital
Manage patients during hospitalization
Discharge patients from the hospital
Count
Percent
94
83
58
25.0%
22.1%
15.4%
*The percentage is computed using "Total = 376."
B-15
Appendix C
Work Activities Descriptive Statistics
Appendix C– Work Activities Descriptive Statistics
Survey Order
Performance
Expectation
Consequence
Frequency
Overall Rank
N
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
1 Obtains a comprehensive health history
376
2.0
0.1
2.0
2.0
0.9
2.0
3.4
0.6
3.0
35.1
5.0
2 Obtains a focused health history
376
2.0
0.1
2.0
2.1
0.9
2.0
3.7
0.5
4.0
35.8
5.3
376
1.9
0.4
2.0
1.4
0.9
1.0
2.5
1.0
3.0
29.9
8.1
376
1.9
0.3
2.0
1.6
0.9
2.0
3.1
0.8
3.0
31.5
8.1
376
1.8
0.5
2.0
1.5
0.9
1.0
3.0
0.9
3.0
28.3
10.6
376
1.9
0.4
2.0
1.6
0.9
2.0
3.1
0.7
3.0
30.8
8.3
376
1.9
0.3
2.0
1.4
0.8
1.0
3.1
0.8
3.0
30.5
7.5
376
1.9
0.4
2.0
1.5
0.8
1.0
2.9
0.9
3.0
29.4
8.9
376
1.8
0.5
2.0
1.2
0.8
1.0
2.5
1.0
2.0
26.3
10.1
10 Performs a spiritual assessment
376
1.6
0.7
2.0
0.9
0.8
1.0
2.1
1.1
2.0
23.2
11.2
11 Performs an individual risk assessment, including
safety
12 Performs a genetic assessment
376
1.9
0.3
2.0
1.9
1.0
2.0
3.1
0.8
3.0
33.3
7.9
376
0.8
0.8
1.0
0.9
0.9
1.0
1.0
1.1
1.0
11.7
13.0
376
1.8
0.4
2.0
1.9
0.9
2.0
3.0
0.8
3.0
31.5
9.2
3 Obtains a history regarding sexual and
reproductive health and behaviors
4 Performs age-appropriate screenings (e.g.,
developmental, hearing, vision, oral health,
genetics)
5 Determines health status of patient using primary
and secondary sources of data (e.g.,
epidemiological, social, environmental)
6 Performs a psychosocial evaluation
7 Performs a lifestyle assessment (e.g., sleep,
exercise, BMI)
8 Performs a nutritional assessment
9 Performs a cultural assessment
13 Performs a mental health assessment
C-2
Performance expectation response options: 0 = never, 1 = after first 6 months, 2 = within the first 6 months; Consequences response option: 0 = no negative
consequences, 1 = minimal, 2 = moderate, 3= significant; Frequency response options: 0 = never, 1 = seldom, 2 = occasionally, 3 = often, 4 = frequently
Survey Order
Performance
Expectation
Consequence
Frequency
Overall Rank
N
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
376
1.8
0.4
2.0
1.6
0.9
2.0
2.7
0.9
3.0
29.0
10.1
376
1.4
0.8
2.0
1.1
0.9
1.0
1.8
1.1
2.0
19.1
13.5
376
1.1
0.8
1.0
0.9
0.8
1.0
1.4
1.2
1.0
15.2
13.5
17 Performs a functional assessment, including
mobility and cognition
18 Assesses patient’s capacity for decision-making
376
1.9
0.3
2.0
2.0
0.9
2.0
3.2
0.8
3.0
33.5
8.2
376
1.8
0.4
2.0
2.1
1.0
2.0
3.1
1.0
3.0
32.1
10.0
19 Assesses patient for development
delays/impairment, learning disabilities
20 Assesses patient for acute pain
376
1.5
0.8
2.0
1.4
1.0
1.0
2.1
1.3
2.0
23.0
14.1
376
2.0
0.1
2.0
2.2
0.9
2.0
3.6
0.6
4.0
36.5
5.4
21 Assesses patient for chronic pain
376
2.0
0.2
2.0
2.1
0.9
2.0
3.6
0.6
4.0
35.3
5.8
376
1.9
0.4
2.0
1.7
1.0
2.0
3.0
0.9
3.0
30.9
9.8
376
1.7
0.5
2.0
1.4
0.9
1.0
2.7
0.9
3.0
27.0
10.7
14 Performs a family/caregiver risk assessment
15 Performs a community risk assessment
16 Performs a population risk assessment
22 Assesses for advance care planning/advanced
directives
23 Assesses family dynamics and communication
patterns
24 Performs a comprehensive physical exam
376
2.0
0.1
2.0
2.2
0.9
2.0
3.3
0.6
3.0
35.9
5.6
25 Performs a focused physical exam
376
2.0
0.1
2.0
2.3
0.9
3.0
3.6
0.5
4.0
36.6
5.1
26 Differentiates between normal physiologic
changes and abnormal/atypical findings
27 Orders diagnostic tests
376
1.9
0.3
2.0
2.4
0.9
3.0
3.7
0.5
4.0
35.0
8.3
376
2.0
0.2
2.0
2.2
0.9
2.0
3.4
0.5
3.0
35.9
5.8
28 Performs diagnostic tests
376
1.7
0.6
2.0
2.0
1.0
2.0
2.6
1.1
3.0
29.0
12.0
C-3
Survey Order
Performance
Expectation
29 Interprets results from diagnostic tests
30 Synthesizes data to inform clinical reasoning
Consequence
Frequency
Overall Rank
N
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
376
1.9
0.3
2.0
2.4
0.9
3.0
3.4
0.6
3.0
34.9
8.7
376
1.8
0.4
2.0
2.3
1.0
3.0
3.6
0.6
4.0
33.5
9.8
31 Develops differential diagnoses
376
1.9
0.2
2.0
2.2
0.9
2.0
3.7
0.5
4.0
35.5
7.0
32 Prioritizes differential diagnoses
376
1.9
0.4
2.0
2.1
0.9
2.0
3.7
0.5
4.0
33.1
9.1
33 Formulates diagnoses
376
1.9
0.3
2.0
2.3
0.9
3.0
3.7
0.5
4.0
35.3
7.9
34 Prioritizes diagnoses
376
1.9
0.4
2.0
2.1
0.9
2.0
3.7
0.5
4.0
33.6
8.8
376
1.9
0.3
2.0
1.9
0.9
2.0
3.6
0.6
4.0
32.5
8.6
376
1.9
0.3
2.0
1.8
0.9
2.0
3.5
0.6
4.0
31.9
8.3
376
1.9
0.3
2.0
1.9
0.9
2.0
3.5
0.7
4.0
32.3
8.3
376
1.9
0.3
2.0
2.0
0.9
2.0
3.6
0.5
4.0
34.1
7.3
376
1.7
0.5
2.0
1.7
0.9
2.0
2.7
1.0
3.0
26.9
11.4
376
1.8
0.4
2.0
1.9
0.9
2.0
3.4
0.7
4.0
31.4
9.3
376
1.2
0.7
1.0
1.2
0.9
1.0
1.9
1.3
2.0
16.8
13.4
35 Develops a comprehensive problem list
36 Develops a mutually agreeable individualized
plan of care
37 Evaluates patient, family and/or caregiver’s
knowledge of plan of care
38 Educates patient, family and/or caregiver
regarding plan of care include testing, diagnosis,
treatments and/or implications.
39 Facilitates the development of advance care
planning/advance directives
40 Prioritizes plan of care considering safety, risk
reduction, and comorbidities
41 Develops population-focused plan of care based
on epidemiologic data
C-4
Survey Order
Performance
Expectation
Consequence
Frequency
Overall Rank
N
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
42 Implements plan of care that incorporates
cultural, spiritual, psychosocial considerations
43 Prescribes medications
376
1.7
0.5
2.0
1.4
0.8
1.0
2.9
1.0
3.0
26.4
11.1
376
1.9
0.3
2.0
2.6
0.8
3.0
3.5
0.6
4.0
37.3
6.4
44 Monitors the safety and effectiveness of
interventions
45 Prescribes non-pharmacologic interventions
376
2.0
0.2
2.0
2.4
0.9
3.0
3.8
0.4
4.0
37.2
5.8
376
2.0
0.2
2.0
1.7
0.9
2.0
3.3
0.6
3.0
33.1
6.0
376
1.9
0.3
2.0
1.7
0.9
2.0
3.4
0.7
3.0
31.9
8.3
376
1.9
0.3
2.0
1.8
0.9
2.0
3.3
0.9
3.0
33.2
8.1
48 Counsels regarding nutrition and weight status
376
1.9
0.3
2.0
1.6
0.8
2.0
3.1
0.7
3.0
31.6
7.3
49 Reports suspected abuse, exploitation and/or
neglect
50 Facilitates transitions in levels of care
376
1.9
0.3
2.0
2.5
0.9
3.0
2.9
1.3
4.0
35.9
8.1
376
1.7
0.5
2.0
1.8
0.9
2.0
2.8
0.9
3.0
28.2
10.6
51 Facilitates transitions of care between health care
providers
52 Plans follow-up care
53 Manages episodic disease
376
376
1.8
1.9
0.4
0.2
2.0
2.0
1.8
2.0
0.9
0.9
2.0
2.0
2.9
3.5
0.9
0.6
3.0
4.0
29.6
34.1
9.7
7.1
376
1.9
0.2
2.0
2.1
0.9
2.0
3.4
0.6
3.0
34.9
6.9
376
1.9
0.3
2.0
2.2
0.9
2.0
3.6
0.5
4.0
34.8
7.4
376
1.7
0.5
2.0
1.8
0.9
2.0
3.0
0.9
3.0
28.4
11.2
46 Manages health maintenance status and health
promotion interventions
47 Immunizes based on current recommendations
54 Manages chronic disease
55 Selects evidence-based technological
interventions
C-5
Survey Order
Performance
Expectation
Consequence
Frequency
Overall Rank
N
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
376
1.6
0.6
2.0
1.8
1.0
2.0
2.4
1.1
2.0
26.1
12.5
57 Provides end of life care
376
1.5
0.7
2.0
1.8
1.0
2.0
2.3
1.1
2.0
24.8
13.2
58 Performs primary care procedures (e.g., wart
removal, suturing, cerumen)
376
1.5
0.6
2.0
1.6
0.9
2.0
2.2
1.0
2.0
23.8
12.2
59 Coaches patient, family, and/or caregiver
regarding lifestyle and behavioral changes
376
1.9
0.4
2.0
1.5
0.8
1.0
2.9
0.8
3.0
29.8
8.3
376
1.5
0.8
2.0
1.3
1.0
1.0
1.8
1.2
2.0
23.0
13.6
376
1.7
0.5
2.0
1.6
0.9
2.0
2.5
0.9
2.0
26.4
11.4
376
2.0
0.2
2.0
2.1
0.9
2.0
3.7
0.5
4.0
35.7
5.7
376
2.0
0.2
2.0
2.3
0.9
3.0
3.8
0.4
4.0
36.7
6.0
376
2.0
0.2
2.0
1.8
0.9
2.0
3.5
0.6
4.0
33.7
6.2
376
2.0
0.2
2.0
2.0
0.9
2.0
3.6
0.6
4.0
34.6
6.3
376
1.8
0.4
2.0
1.7
0.9
2.0
3.2
0.8
3.0
30.7
9.0
376
2.0
0.2
2.0
2.1
0.9
2.0
3.5
0.7
4.0
35.4
6.0
376
1.9
0.3
2.0
2.0
0.9
2.0
3.4
0.7
3.0
33.0
8.2
56 Provides palliative care
60 Counsels on family planning, sexuality, and/or
reproductive health
61 Counsels patient and/or family through grief,
dying, and death
62 Evaluates patient responses to interventions
63 Evaluates effectiveness of pharmacologic
regimen
64 Evaluates effectiveness of nonpharmacologic
interventions
65 Evaluates adherence to treatment plan
66 Evaluates the impact of diagnosis and treatment
on patient, family, and caregiver
67 Evaluates treatment outcomes related to acute
pain
68 Evaluates treatment and educational outcomes
related to chronic pain
C-6
Survey Order
Performance
Expectation
69 Evaluates treatment and educational outcomes
related to nutrition
70 Evaluates plan of care considering safety, risk
reduction and comorbidities
71 Modifies plan of care to meet the needs of
patient, families, and/or caregivers
72 Modifies plan of care based on patient response
to interventions
73 Maintains a comprehensive problem list
Consequence
Frequency
Overall Rank
N
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
376
1.8
0.4
2.0
1.6
0.8
2.0
2.8
0.9
3.0
29.2
9.4
376
1.9
0.3
2.0
1.9
0.9
2.0
3.2
0.7
3.0
32.3
8.3
376
1.9
0.3
2.0
1.8
0.9
2.0
3.2
0.7
3.0
31.7
8.3
376
1.9
0.3
2.0
2.0
0.9
2.0
3.5
0.7
4.0
34.0
7.3
376
1.9
0.3
2.0
1.8
0.9
2.0
3.6
0.6
4.0
32.7
7.8
74 Fosters collaboration with multiple stakeholders
(e.g. patients, community, integrated health care
teams, and policy makers) to improve health care
376
1.4
0.6
1.0
1.4
0.9
1.0
2.3
1.1
2.0
19.3
12.7
75 Collaborates with other professionals
376
2.0
0.2
2.0
1.9
0.9
2.0
3.4
0.6
3.0
33.8
6.8
76 Advocates for individual patient needs
376
1.9
0.2
2.0
1.9
0.9
2.0
3.4
0.8
4.0
33.8
7.2
376
1.5
0.6
2.0
1.5
1.0
2.0
2.6
1.0
3.0
22.5
12.3
376
1.2
0.6
1.0
1.2
0.9
1.0
2.0
1.0
2.0
14.7
10.8
376
1.4
0.5
1.0
1.2
0.9
1.0
2.6
0.9
3.0
18.6
11.9
376
1.8
0.4
2.0
1.7
1.0
2.0
3.4
0.8
4.0
29.6
10.8
77 Advocates for improved access, quality, and costeffective health care
78 Conducts peer review to promote a culture of
excellence
79 Serves as an interprofessional resource for
patient care
80 Creates a climate of patient-centered care
(definition of patient-centered care -- care based
on a partnership between the patient and the
C-7
Survey Order
Performance
Expectation
Consequence
Frequency
Overall Rank
N
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
81 Identifies opportunities for quality improvement
376
1.5
0.5
1.0
1.4
0.9
1.0
2.7
0.9
3.0
20.8
12.2
82 Implements patient and provider safety and
quality improvement initiatives
376
1.4
0.6
1.0
1.4
0.9
1.0
2.5
0.9
2.0
19.2
12.4
376
1.7
0.5
2.0
1.4
1.0
1.0
2.9
0.8
3.0
25.7
11.6
376
1.1
0.5
1.0
0.7
0.8
1.0
1.8
0.9
2.0
10.0
8.8
376
1.9
0.3
2.0
2.4
0.9
3.0
3.3
0.9
4.0
35.8
7.8
376
1.1
0.5
1.0
1.0
0.9
1.0
1.8
0.9
2.0
11.8
9.9
376
0.9
0.6
1.0
0.8
0.9
1.0
1.3
1.0
1.0
9.0
8.7
376
1.7
0.5
2.0
1.7
1.0
2.0
2.2
1.1
2.0
25.8
12.6
376
1.7
0.5
2.0
1.8
1.0
2.0
2.1
1.2
2.0
27.0
12.7
376
1.8
0.4
2.0
1.4
1.1
1.0
3.5
0.7
4.0
28.7
10.4
healthcare provider that is focus on the patient’s
values, preferences and needs)
83 Engages in professional development activities
84 Engages in scholarly activities (e.g., give
presentations, publish professional article,
engage in research activities)
85 Identifies and refers patient with conditions
beyond scope of practice
86 Engages in policy-making internal to the
organization
87 Engages in policy-making external to the
organization
88 Identifies ethical dilemmas and seek resources
for resolution
89 Identifies legal dilemmas and seek resources for
resolution
90 Promotes the role of the nurse practitioner
C-8
Survey Order
Performance
Expectation
91 Integrates theory, current evidence, professional
standards, and clinical guidelines to improve
practice
92 Documents daily patient related activities
93 Documents in accordance with regulatory process
and payor source
94 Bills for services according to level of care
95 Precepts students, novice nurse practitioners,
and/or other health professionals
96 Maintains confidentiality and privacy according to
regulatory standards (e.g., HIPAA)
97 Evaluates the impact of health care delivery on
providers, stakeholders and the environment
98 Analyzes the impact of globalization on health
99 Plans for potential crisis and/or disaster
situations
10 Integrates informatics and/or health care
0 technology into practice
Consequence
Frequency
Overall Rank
N
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
Median
Mean
Std
Dev
376
1.8
0.4
2.0
1.8
1.0
2.0
3.5
0.8
4.0
30.4
10.9
376
1.9
0.3
2.0
1.9
1.0
2.0
3.4
1.0
4.0
33.4
9.1
376
1.9
0.3
2.0
2.1
1.0
2.0
3.8
0.6
4.0
35.2
8.1
376
1.9
0.4
2.0
2.1
1.0
2.0
3.7
0.8
4.0
34.3
9.1
376
1.1
0.3
1.0
1.1
1.0
1.0
2.1
0.9
2.0
11.3
7.8
376
2.0
0.1
2.0
2.5
0.9
3.0
4.0
0.3
4.0
38.3
4.9
376
1.2
0.6
1.0
1.2
0.9
1.0
2.1
1.2
2.0
16.1
12.5
376
0.9
0.7
1.0
0.9
0.9
1.0
1.4
1.2
1.0
10.8
11.1
376
1.3
0.7
1.0
1.7
1.1
2.0
1.8
1.1
2.0
20.0
13.6
376
1.7
0.5
2.0
1.5
0.9
1.0
3.1
1.0
3.0
27.3
11.8
C-9
Appendix D
Work Activities Mean Overall Criticality – Rank Order
Rank Order
N
96
Overall Rank
Mean
Std Dev
Maintains confidentiality and privacy
according to regulatory standards
(e.g., HIPAA)
Prescribes medications
Monitors the safety and effectiveness
of interventions
Evaluates effectiveness of
pharmacologic regimen
376
38.3
4.9
376
376
37.3
37.2
6.4
5.8
376
36.7
6.0
376
36.6
5.1
Reports suspected abuse, exploitation
and/or neglect
376
376
36.5
35.9
5.4
8.1
376
35.9
5.8
Performs a comprehensive physical
exam
Identifies and refers patient with
conditions beyond scope of practice
376
35.9
5.6
376
35.8
7.8
376
35.8
5.3
376
35.7
5.7
376
376
35.5
35.4
7.0
6.0
33
Evaluates patient responses to
interventions
Evaluates treatment outcomes related
to acute pain
376
35.3
7.9
21
376
35.3
5.8
93
Documents in accordance with
regulatory process and payor source
Obtains a comprehensive health
history
Differentiates between normal
physiologic changes and
abnormal/atypical findings
Manages episodic disease
Manages chronic disease
376
35.2
8.1
376
35.1
5.0
376
35.0
8.3
376
376
376
34.9
34.9
34.8
8.7
6.9
7.4
43
44
63
25
20
49
27
24
85
2
62
31
67
1
26
29
53
54
Appendix D– Work Activities Mean Overall Criticality – Rank Order
D-2
Rank Order
N
Overall Rank
Mean
Std Dev
65
Evaluates adherence to treatment plan
376
34.6
6.3
94
Bills for services according to level of
care
Educates patient, family and/or
caregiver regarding plan of care
include testing, diagnosis, treatments
and/or implications.
Plans follow-up care
376
34.3
9.1
376
34.1
7.3
376
34.1
7.1
376
34.0
7.3
76
Modifies plan of care based on patient
response to interventions
Advocates for individual patient needs
376
33.8
7.2
75
Collaborates with other professionals
376
33.8
6.8
64
Evaluates effectiveness of
nonpharmacologic interventions
Prioritizes diagnoses
Performs a functional assessment,
including mobility and cognition
Synthesizes data to inform clinical
reasoning
Documents daily patient related
activities
Performs an individual risk
assessment, including safety
Immunizes based on current
recommendations
376
33.7
6.2
376
376
33.6
33.5
8.8
8.2
376
33.5
9.8
376
33.4
9.1
376
33.3
7.9
376
33.2
8.1
32
Prioritizes differential diagnoses
376
33.1
9.1
45
Prescribes non-pharmacologic
interventions
Evaluates treatment and educational
outcomes related to chronic pain
376
33.1
6.0
376
33.0
8.2
Maintains a comprehensive problem
list
Develops a comprehensive problem
list
Evaluates patient, family and/or
caregiver’s knowledge of plan of care
Evaluates plan of care considering
safety, risk reduction and
376
32.7
7.8
376
32.5
8.6
376
32.3
8.3
376
32.3
8.3
38
52
72
34
17
30
92
11
47
68
73
35
37
70
D-3
Rank Order
N
Overall Rank
Mean
Std Dev
comorbidities
18
36
46
71
48
4
13
40
22
6
66
7
91
3
59
51
Assesses patient’s capacity for
decision-making
Develops a mutually agreeable
individualized plan of care
Manages health maintenance status
and health promotion interventions
Modifies plan of care to meet the
needs of patient, families, and/or
caregivers
Counsels regarding nutrition and
weight status
376
32.1
10.0
376
31.9
8.3
376
31.9
8.3
376
31.7
8.3
376
31.6
7.3
Performs age-appropriate screenings
(e.g., developmental, hearing, vision,
oral health, genetics)
Performs a mental health assessment
376
31.5
8.1
376
31.5
9.2
Prioritizes plan of care considering
safety, risk reduction, and
comorbidities
Assesses for advance care
planning/advanced directives
Performs a psychosocial evaluation
376
31.4
9.3
376
30.9
9.8
376
30.8
8.3
Evaluates the impact of diagnosis and
treatment on patient, family, and
caregiver
Performs a lifestyle assessment (e.g.,
sleep, exercise, BMI)
376
30.7
9.0
376
30.5
7.5
Integrates theory, current evidence,
professional standards, and clinical
guidelines to improve practice
Obtains a history regarding sexual and
reproductive health and behaviors
376
30.4
10.9
376
29.9
8.1
Coaches patient, family, and/or
caregiver regarding lifestyle and
behavioral changes
Facilitates transitions of care between
health care providers
376
29.8
8.3
376
29.6
9.7
D-4
Rank Order
N
80
Overall Rank
Mean
Std Dev
Creates a climate of patient-centered
care (definition of patient-centered
care -- care based on a partnership
between the patient and the
healthcare provider that is focus on
the patient’s values, preferences and
needs)
Performs a nutritional assessment
376
29.6
10.8
376
29.4
8.9
69
Evaluates treatment and educational
outcomes related to nutrition
376
29.2
9.4
14
Performs a family/caregiver risk
assessment
Performs diagnostic tests
376
29.0
10.1
376
29.0
12.0
Promotes the role of the nurse
practitioner
Selects evidence-based technological
interventions
Determines health status of patient
using primary and secondary sources
of data (e.g., epidemiological, social,
environmental)
Facilitates transitions in levels of care
376
28.7
10.4
376
28.4
11.2
376
28.3
10.6
376
28.2
10.6
100
Integrates informatics and/or health
care technology into practice
376
27.3
11.8
89
Identifies legal dilemmas and seek
resources for resolution
376
27.0
12.7
23
Assesses family dynamics and
communication patterns
Facilitates the development of
advance care planning/advance
directives
Implements plan of care that
incorporates cultural, spiritual,
psychosocial considerations
Counsels patient and/or family
through grief, dying, and death
376
27.0
10.7
376
26.9
11.4
376
26.4
11.1
376
26.4
11.4
Performs a cultural assessment
376
26.3
10.1
8
28
90
55
5
50
39
42
61
9
D-5
Rank Order
N
Overall Rank
Mean
Std Dev
56
Provides palliative care
376
26.1
12.5
88
Identifies ethical dilemmas and seek
resources for resolution
Engages in professional development
activities
Provides end of life care
376
25.8
12.6
376
25.7
11.6
376
24.8
13.2
Performs primary care procedures
(e.g., wart removal, suturing, cerumen)
376
23.8
12.2
376
23.2
11.2
60
Counsels on family planning, sexuality,
and/or reproductive health
376
23.0
13.6
19
Assesses patient for development
delays/impairment, learning
disabilities
Advocates for improved access,
quality, and cost-effective health care
Identifies opportunities for quality
improvement
376
23.0
14.1
376
22.5
12.3
376
20.8
12.2
Plans for potential crisis and/or
disaster situations
Fosters collaboration with multiple
stakeholders (e.g. patients,
community, integrated health care
teams, and policy makers) to improve
health care
Implements patient and provider
safety and quality improvement
initiatives
376
20.0
13.6
376
19.3
12.7
376
19.2
12.4
376
19.1
13.5
79
Serves as an interprofessional resource
for patient care
376
18.6
11.9
41
Develops population-focused plan of
care based on epidemiologic data
376
16.8
13.4
97
Evaluates the impact of health care
delivery on providers, stakeholders
376
16.1
12.5
83
57
58
10
77
81
99
74
82
15
D-6
Rank Order
N
Overall Rank
Mean
Std Dev
and the environment
16
78
86
12
95
98
84
87
Conducts peer review to promote a
culture of excellence
Engages in policy-making internal to
the organization
376
376
15.2
14.7
13.5
10.8
376
11.8
9.9
376
11.7
13.0
Precepts students, novice nurse
practitioners, and/or other health
professionals
Analyzes the impact of globalization on
health
376
11.3
7.8
376
10.8
11.1
Engages in scholarly activities (e.g.,
give presentations, publish
professional article, engage in research
activities)
Engages in policy-making external to
the organization
376
10.0
8.8
376
9.0
8.7
D-7
This page is left intentionally blank
D-8
The mission of the American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses
Association (ANA), is to promote excellence in nursing and health care globally through credentialing
programs. ANCC’s internationally renowned credentialing programs certify and recognize individual
nurses in specialty practice areas. It recognizes healthcare organizations that promote nursing excellence
and quality patient outcomes, while providing safe, positive work environments. In addition, ANCC
accredits health care organizations that provide and approve continuing nursing education. It also offers
educational materials to support nurses and organizations as they work toward their credentials.
ANCC’s Certification Program enables nurses to demonstrate their specialty expertise and validate
their knowledge to employers and patients. Through targeted exams that incorporate the latest nursingpractice standards, ANCC certification empowers nurses with pride and professional satisfaction.
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2011 Adult-Gerontology Primary Care Nurse Practitioner: Role

Transcription

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