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This article discusses the challenge that educators have in assessing competency in APRN students, particularly with simulation.

This is an article from The Journal of Nurse Practitioners. The IOM is recommending a transition to practice (residency program) for new graduate nurse practitioners; along with a competency tool to assess the effectiveness of such program.

Pediatric NP's began training in 1965 in order to enhance the role of the pediatric nurse; however, since then PNP's are seeking increased autonomy from MD's in order to work to the full extent of the knowledge and skills. The article describes how PNP's are aptly trained to assess kid's who are abused, exploited, neglected, or need immunizations. As a result, PNP's have a unique role, separate from MD's, to enhance any practice.

This article asks the question: "Compared to other providers (physicians or teams without APRNs), are APRN patient outcomes of care similar?" The study is specific to USA and includes data regarding NPs, CNRAs, and CNMs. Outcomes were determined by the following: patient satisfaction with provider/care, patient self-assessment of perceived health status, functional status, blood glucose, serum lipids, blood pressure, emergency department visits, hospitalization, duration of ventilation, length of stay, and mortality (p9).

I really liked this article because it focused on crisis resource management in Emergency Medicine. Seven perceived barriers to effective team performance in the ED were listed with the number one barrier being communication between disciplines. Further, of 81 (nurses, physicians, and residents) 100% felt that effective communication and effective leadership were very important team management skills that could effect the outcome of a resuscitation. Additionally, the number one contributing factor to adverse resuscitation outcomes was poor communication (96.2% out of 79 participants). Though other barriers and contributing factors to adverse outcomes were identified, communication was reported as the most contributory. Coming from an emergency room myself, I totally love the aspect of interdisciplinary collaboration. In resuscitation you are working with the physician, the nurses, the techs, pharmacy, the lab, the radiology department--and following a successful resuscitation, you are collaborating with the intensivist/pulmonolgist, cardiologist, and potentially other specialists, as well as the ICU staff members. The patient is relying on effective communication and collaboration to obtain the best outcome possible. And this communication and collaboration is not the sole responsibility of the provider, but EVERYONE on the team!

This report summarizes the current understanding of teamwork, describes interventions designed to improve teamwork, and makes practical recommendations for hospitals to assess and improve teamwork-related performance. Examples of interventions that have successfully improved teamwork include the following: localization of physicians, daily goals-of-care forms and checklists, teamwork training, and interdisciplinary rounds.

This 2016 article provides a brief overview of progress made in expanding APRN scope of practice to utilize a practitioner's education to the fullest extent. Although the removal of barriers to scope of practice is progressing, there is still much work ahead. This article recommends that to meet our goals, we must encourage other HCPs, policy makers, etc. that investing in our profession, i.e. becoming stakeholders, is a necessity to optimize health care practice.

An article examining the effectiveness of high fidelity simulation on preparing APRN students for practice.