research papers on nurse practitioner

Nurse Practitioners and Nurse Anesthetists: The Evolution of the Global Roles pp 103–118 Cite as

The NP and Research: A Global Perspective

• Patricia F. Flannery Pearce 4 , 5 , 6  
• First Online: 06 June 2023

332 Accesses

Part of the book series: Advanced Practice in Nursing ((APN))

Knowledge and skills of nurse practitioners are sought increasingly across the world and the role is migrating extensively. Research publications reflect the diversity of the role, locations, and focus of NP practice, education, advocacy, and leadership and the investment of nurse practitioners in their professional roles. The purpose for this chapter is to present an overview of the many contributions of nurse practitioners internationally to published research, including areas of practice, education, advocacy, policy, and leadership. Published literature was searched and reviewed, retaining for this review 70 published articles, representing NPs in 23 countries and 300 unique authors, most publishing in groups. Recommendations for further research are included.

• Nurse practitioner
• Advanced practice nurse
• International

This is a preview of subscription content, log in via an institution .

Buying options

• Available as PDF
• Read on any device
• Instant download
• Own it forever
• Available as EPUB and PDF
• Durable hardcover edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

American Association of Nurse Practitioners. Nurse practitioner and AANP history. Report. Austin, TX: American Association of Nurse Practitioners; 2018.

Google Scholar  

Ford LC. Reflections on 50 years of change. J Am Assoc Nurse Pract. 2015;27(6):294–5. https://doi.org/10.1002/2327-6924.12271 .

Silver HK, Ford LC. Physicians’ assistants. The pediatric nurse practitioner at Colorado. Am J Nurs. 1967;67(7):1443–4.

International Council of Nurses. Guidelines on advanced practice nursing 2020. Geneva, Switzerland: International Council of Nurses; 2020. Contract No.: ISBN: 978-92-95099-71-5.

Spies LA, Fox-Mccloy H, Kilpatrick K, Habil Máté O, Steinke MK, Leach D, et al. Country-level mentoring for advanced practice nursing: A case study. Int Nurs Rev. 2022;69(March):1–6. https://doi.org/10.1111/inr.12758 .

Bonnel G. Evolvement of French advanced practice nurses. J Am Assoc Nurse Pract. 2014;26(4):207–19. https://doi.org/10.1002/2327-6924.12061 .

Sastre-Fullana P, Gray DC, Cashin A, Bryant-Lukosius D, Schumann L, Geese F, et al. Visual analysis of global comparative mapping of the practice domains of the nurse practitioner/advanced practice nursing role in respondent countries. J Am Assoc Nurse Pract. 2021;33(7):496–505. https://doi.org/10.1097/JXX.0000000000000458 .

Blanck S, Engström M. District nurses’ prescribing practice and its link to structural conditions. J Am Assoc Nurse Pract. 2015;27(10):568–75. https://doi.org/10.1002/2327-6924.12234 .

Kline TV, Savage RL, Greenslade JH, Lock CL, Pattullo C, Bell AJ. Affecting emergency department oxycodone discharge prescribing: an educational intervention. Emerg Med Australas. 2019;31(4):580–6. https://doi.org/10.1111/1742-6723.13261 .

de Wet C, Bowie P, O’Donnell C. ‘The big buzz’: a qualitative study of how safe care is perceived, understood and improved in general practice. BMC Fam Pract. 2018;19(1):1–8. https://doi.org/10.1186/s12875-018-0772-z .

Blackberry ID, Furler JS, Young D, Best JD, Blackberry ID, Furler JS, et al. What does it cost to establish a practice-nursesled clinical trial in general practice? Med J Aust. 2009;191(9):492–5. https://doi.org/10.5694/j.1326-5377.2009.tb02911.x .

Würtz GMF, Jensen CS, Egerod I. International perspectives on the pediatric nurse practitioner role. J Am Assoc Nurse Pract. 2019;31(12):773–81. https://doi.org/10.1097/JXX.0000000000000252 .

Åberg J, Fagerström L. Does the professional role of a specialist nurse correspond to the international ‘nurse practitioner’ profile? Hoitotiede. 2006;18(6):266–76.

Becker DM, DeMong LK, Kaplan P, Hutchinson R, Callahan CM, Fihn SD, et al. Anticoagulation therapy and primary care internal medicine: A nurse practitioner model for combined clinical science. J Gen Intern Med. 1994;9(9):525–7. https://doi.org/10.1007/BF02599227 .

Nzimakwe D. Primary health care in South Africa: private practice nurse practitioners and traditional healers form partnerships. J Am Acad Nurse Pract. 1996;8(7):311–6. https://doi.org/10.1111/j.1745-7599.1996.tb00667.x .

Eklund W. Japan and its healthcare challenges and potential contribution of neonatal nurse practitioners. J Perinat Neonatal Nurs. 2010;24(2):155–66. https://doi.org/10.1097/JPN.0b013e3181db5363 .

Suzuki M, Harada N, Honda K, Koda M, Araki R, Kudo T, et al. Facilitators and barriers in implementing the nurse practitioner role in Japan: A cross sectional descriptive study. Int Nurs Rev 2022:1–8. https://doi.org/10.1111/inr.12790 .

Mills AC, McSweeney M, Lavin MA. Characteristics of patient visits to nurse practitioners and physician assistants in hospital outpatient departments. J Prof Nurs. 1998;14(6):335–43.

Mundinger MO, Kane RL, Lenz ER, Totten AM, Tsai W, Cleary PD, et al. Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. JAMA. 2000;283(1):59–68. https://doi.org/10.1001/jama.283.1.59 .

Ball C, Cox CL. Part one: restoring patients to health—outcomes and indicators of advanced nursing practice in adult critical care. Int J Nurs Pract. 2003;9(6):356–67. https://doi.org/10.1046/j.1440-172x.2003.00444.x .

DiCenso A, Martin-Misener R, Bryant-Lukosius D, Bourgeault I, Kilpatrick K, Donald F, et al. Advanced practice nursing in Canada: Overview of a decision support synthesis. Nurs Leadersh (Tor Ont). 2010;23:15–34. https://doi.org/10.12927/cjnl.2010.22267 .

MacLellan L, Higgins I, Levett-Jones T. Medical acceptance of the nurse practitioner role in Australia: a decade on. J Am Assoc Nurse Pract. 2015;27(3):152–9. https://doi.org/10.1002/2327-6924.12141 .

Aaron EM, Andrews CS. Integration of advanced practice providers into the Israeli healthcare system. Isr J Health Policy Res. 2016;5:7. https://doi.org/10.1186/s13584-016-0065-8 .

Cooper M, Rasmussen P, Magarey J. Regulation, migration and expectation: internationally qualified health practitioners in Australia-a qualitative study. Hum Resour Health. 2020;18(1):74. https://doi.org/10.1186/s12960-020-00514-7 .

Espinoza P, Troncoso B, Jacobson L, Schober M. Advanced practice nursing in Chile and the role of the registered nurse: Integrating 2 realities through continuous education. Clin Nurse Spec. 2021;35(5):264–70. https://doi.org/10.1097/NUR.0000000000000622 .

Chang W, Mu P, Tsay S. The experience of role transition in acute care nurse practitioners in Taiwan under the collaborative practice model. J Nurs Res (Taiwan Nurses Association). 2006;14(2):83–92. https://doi.org/10.1097/01.jnr.0000387566.34318.b2 .

Chiu HJ, Tsay SL, Tung HH. Scope of practice and legislation for nurse practitioners in Taiwan. J Am Assoc Nurse Pract. 2015;27(9):497–500. https://doi.org/10.1002/2327-6924.12248 .

Goodyear R. The nurse practitioner/advanced practice role in Taiwan. J Nurse Pract. 2012;8(10):841–2. https://doi.org/10.1016/j.nurpra.2012.09.008 .

Wei C-W, Tung H-H, Tsay S-L, Lin C-W. Nurse practitioners in Taiwan: Today and tomorrow. J Am Acad Nurse Pract. 2012;24(3):138–42. https://doi.org/10.1111/j.1745-7599.2011.00707.x .

Ho L-H, Chang S-C, Kau K, Shiu S-Y, Huang S-S, Wang Y-J, et al. The impact of organizational support on practice outcomes in nurse practitioners in Taiwan. J Nurs Res (Lippincott Williams & Wilkins). 2021;29(3):e148. https://doi.org/10.1097/JNR.0000000000000425 .

Chen YJ, Lin KP. Association among work characteristics, role transition, and job burnout in nurse practitioners in Taiwan. Inquiry. 2022;59:1–10. https://doi.org/10.1177/00469580221081403 .

Wei C-W, Tung H-H, Lin C-F, Sun C-C, Shih S-N. Self-role perception of nurse practitioners in northern Taiwan. J Nurs. 2011;58(2):22–30.

Poot B, Nelson K, Zonneveld R, Weatherall M. Potentially inappropriate medicine prescribing by nurse practitioners in New Zealand. J Am Assoc Nurse Pract. 2020;32(3):220–8. https://doi.org/10.1097/JXX.0000000000000239 .

Chang AM, Gardner GE, Duffield C, Ramis MA. A Delphi study to validate an advanced practice nursing tool. J Adv Nurs. 2010;66(10):2320–30. https://doi.org/10.1111/j.1365-2648.2010.05367.x .

Carryer J, Gardner G, Dunn S, Gardner A. The core role of the nurse practitioner: Practice, professionalism and clinical leadership. J Clin Nurs. 2007;16(10):1818–25. https://doi.org/10.1111/j.1365-2702.2007.01823.x .

Scanlon A, Cashin A, Watson N, Bryce J. Advanced nursing practice hours as part of endorsement requirements for nurse practitioners in Australia: A definitional conundrum. J Am Acad Nurse Pract. 2012;24(11):649–59. https://doi.org/10.1111/j.1745-7599.2012.00761.x .

Parker R, Forrest L, McCracken J, McRae I, Cox D. What primary health-care services are Australian consumers willing to accept from nurse practitioners? A national survey. Health Expect. 2014;17(5):733–40. https://doi.org/10.1111/j.1369-7625.2012.00800.x .

Parker R, Forrest L, Ward N, McCracken J, Cox D, Derrett J. How acceptable are primary health care nurse practitioners to Australian consumers? Collegian. 2013;20(1):35–41. https://doi.org/10.1016/j.colegn.2012.03.001 .

Carryer J, Wilkinson J, Towers A, Gardner G. Delineating advanced practice nursing in New Zealand: A national survey. Int Nurs Rev. 2018;65(1):24–32. https://doi.org/10.1111/inr.12427 .

Halász BG, Makerníková L, Obroćníková A, Hudáková A, Vojteková M. Developing the advanced practice nursing role in Slovakia: Perception, education, and practice. J Am Assoc Nurse Pract. 2021;33(11):916–23. https://doi.org/10.1097/JXX.0000000000000460 .

Deshefy-Longhi T, Swartz MK, Grey M. Characterizing nurse practitioner practice by sampling patient encounters: An APRNet study. J Am Acad Nurse Pract. 2008;20(5):281–7. https://doi.org/10.1111/j.1745-7599.2008.00318.x .

Luo P-Y, Tung H-H, Huang S-S, Kau K, Chang S-C, Shiu S-Y, et al. Organizational empowerment and practice outcomes of acute care nurse practitioners in Taiwan: A national survey. J Am Assoc Nurse Pract. 2022;34(1):89–99. https://doi.org/10.1097/JXX.0000000000000592 .

Sloand E, Groves S. A community-oriented primary care nursing model in an international setting that emphasizes partnerships. J Am Acad Nurse Pract. 2005;17(2):47–50. https://doi.org/10.1111/j.1041-2972.2005.00010.x .

Ryder M, Jacob E, Hendricks J. An inductive qualitative approach to explore Nurse Practitioners views on leadership and research: an international perspective. J Clin Nurs. 2019;28(13/14):2644–58. https://doi.org/10.1111/jocn.14853 .

Chao AM, Zhou Y, Wei X, Wisdom-Goulbourne T, Dowd M, Compher C. Nutrition education in primary care adult and family nurse practitioner programs. Nurse Educ. 2022;47(1):47–50. https://doi.org/10.1097/NNE.0000000000001050 .

Mboineki JF, Changying C, Zhang W. Health care providers’ perceptions regarding fundamental issues to consider prior to launching nurse practitioner training in Tanzania. J Am Assoc Nurse Pract. 2018;30(11):621–9. https://doi.org/10.1097/JXX.0000000000000085 .

MacLellan L, Gardner G, Gardner A. Designing the future in wound care: the role of the nurse practitioner. Primary Intention: Aus J Wound Manag. 2002;10(3):97–106.

MacLellan L, Higgins I, Levett-Jones T. An exploration of the factors that influence nurse practitioner transition in Australia: A story of turmoil, tenacity, and triumph. J Am Assoc Nurse Pract. 2017;29(3):149–56. https://doi.org/10.1002/2327-6924.12423 .

Allen J, Fabri AM. An evaluation of a community aged care nurse practitioner service. J Clin Nurs. 2005;14(10):1202–9. https://doi.org/10.1111/j.1365-2702.2005.01199.x .

Asimus M, MacLellan L, Li P. Pressure ulcer prevention in Australia: The role of the nurse practitioner in changing practice and saving lives. Int Wound J. 2011;8(5):508–13. https://doi.org/10.1111/j.1742-481X.2011.00824.x .

Thrasher C, Purc-Stehenson R. Patient satisfaction with nurse practitioner care in emergency departments in Canada. J Am Acad Nurse Pract. 2008;20(5):231–7.

Cole FL, Kleinpell R. Expanding acute care nurse practitioner practice: Focus on emergency department practice. J Am Acad Nurse Pract. 2006;18(5):187–9. https://doi.org/10.1111/j.1745-7599.2006.00126.x .

Considine J, Martin R, Smit D, Jenkins J, Winter C. Defining the scope of practice of the emergency nurse practitioner role in a metropolitan emergency department. Int J Nurs Pract. 2006;12(4):205–13. https://doi.org/10.1111/j.1440-172X.2006.00570.x .

Li J, Westbrook J, Callen J, Georgiou A, Jeffrey B. The impact of nurse practitioners on care delivery in the emergency department: A multiple perspectives qualitative study. BMC Health Serv Res. 2013;13:356. https://doi.org/10.1186/1472-6963-13-356 .

Boeijen ERK, Peters JWB, van Vught AJAH. Nurse practitioners leading the way: An exploratory study on the added value of nurse practitioners in outpatient care in the Netherlands. J Am Assoc Nurse Pract. 2020;32(12):800–8. https://doi.org/10.1097/JXX.0000000000000307 .

Coventry LL, Pickles S, Sin M, Towell A, Giles M, Murray K, et al. Impact of the orthopaedic nurse practitioner role on acute hospital length of stay and cost-savings for patients with hip fracture: A retrospective cohort study. J Adv Nurs. 2017;73(11):2652–63. https://doi.org/10.1111/jan.13330 .

Currie J, Edwards L, Colligan M, Crouch R. A time for international standards? Comparing the emergency nurse practitioner role in the UK, Australia and New Zealand. Accid Emerg Nurs. 2007;15(4):210–6. https://doi.org/10.1016/j.aaen.2007.07.007 .

Currie J, Chiarella M, Buckley T. An investigation of the international literature on nurse practitioner private practice models. Int Nurs Rev. 2013;60(4):435–47. https://doi.org/10.1111/inr.12060 .

Coleman S, Havas K, Ersham S, Stone C, Taylor B, Graham A, et al. Patient satisfaction with nurse-led chronic kidney disease clinics: A multicentre evaluation. J Ren Care. 2017;43(1):11–20. https://doi.org/10.1111/jorc.12189 .

Adams S, Mustafa M, Bareham C, Carryer J, Tenbensel T, Poghosyan L. The organizational climate for nurse practitioners working in primary health care in New Zealand: A national survey. J Nurse Pract. 2022;18(7):736–40. https://doi.org/10.1016/j.nurpra.2022.04.024 .

Dierick-van Daele AT, Metsemakers JF, Derckx EW, Spreeuwenberg C, Vrijhoef HJ. Nurse practitioners substituting for general practitioners: Randomized controlled trial. J Adv Nurs. 2009;65(2):391–401. https://doi.org/10.1111/j.1365-2648.2008.04888.x .

Gysin S, Sottas B, Odermatt M, Essig S. Advanced practice nurses’ and general practitioners’ first experiences with introducing the advanced practice nurse role to Swiss primary care: A qualitative study. BMC Fam Pract. 2019;20(1):1–11. https://doi.org/10.1186/s12875-019-1055-z .

Limoges-Gonzalez M, Mann NS, Al-Juburi A, Tseng D, Inadomi J, Rossaro L. Comparisons of screening colonoscopy performed by a nurse practitioner and gastroenterologists: A single-center randomized controlled trial. Gastroenterol Nurs. 2011;34(3):210–6. https://doi.org/10.1097/SGA.0b013e31821ab5e6 .

Sharp DB, Santos LA, Cruz ML. Fatty liver in adolescents on the U.S.-Mexico border. J Am Acad Nurse Pract. 2009;21(4):225–30. https://doi.org/10.1111/j.1745-7599.2009.00397.x .

Steinke MK, Rogers M, Lehwaldt D, Lamarche K. Conducting research through cross national collaboration. Int J Nurs Pract. 2018;24(1):1–6. https://doi.org/10.1111/ijn.12607 .

Steinke MK, Rogers M. Evaluation of an international program for nurse practitioner students. J Am Assoc Nurse Pract. 2021;33:1216–22. https://doi.org/10.1097/JXX.0000000000000525 .

Bobbette N, Ouellette-Kuntz H, Tranmer J, Lysaght R, Ufholz L-A, Donnelly C. Adults with intellectual and developmental disabilities and interprofessional, team-based primary health care: A scoping review. JBI Libr Syst Rev. 2020;18(7):1470–514. https://doi.org/10.11124/JBISRIR-D-19-00200 .

Christian R, Baker K. Effectiveness of nurse practitioners in nursing homes: A systematic review. JBI Libr Syst Rev. 2009;7(30):1333–52. https://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=jbi&AN=JBI4838 .

Taylor A, Staruchowicz L. The Experience and effectiveness of nurse practitioners in orthopaedic settings: A comprehensive systematic review. JBI Libr Syst Rev. 2012;10(42 Suppl):1–22. https://doi.org/10.11124/jbisrir-2012-249 .

Donald F, Kilpatrick K, Reid K, Carter N, Martin-Misener R, Bryant-Lukosius D, et al. A systematic review of the costeffectiveness of nurse practitioners and clinical nurse specialists: What is the quality of the evidence? Nurs Res Pract. 2014;2014:896587. https://doi.org/10.1155/2014/896587 .

Chavez KS, Dwyer AA, Ramelet A-S. International practice settings, interventions and outcomes of nurse practitioners in geriatric care: A scoping review. Int J Nurs Stud. 2018;78:61–75. https://doi.org/10.1016/j.ijnurstu.2017.09.010 .

Fong J, Buckley T, Cashin A, Pont L. Nurse practitioner prescribing in Australia: A comprehensive literature review. Aust Crit Care. 2017;30(5):252–9. https://doi.org/10.1002/2327-6924.12271 .

Fong J, Cashin A, Buckley T. Models of prescribing, scope of practice, and medicines prescribed, a survey of nurse practitioners. J Adv Nurs. 2020;76(9):2311–22. https://doi.org/10.1111/jan.14444 .

Hurlock-Chorostecki C, Forchuk C, Orchard C, van Soeren M, Reeves S. Hospital-based nurse practitioner roles and interprofessional practice: A scoping review. Nurs Health Sci. 2014;16(3):403–10. https://doi.org/10.1111/nhs.12107 .

Pearce PF, Hicks RW, Pierson CA. Keywords matter: A critical factor in getting published work discovered. J Am Assoc Nurse Pract. 2018;30(4):179–81.

Langford CA, Pearce PF. Increasing visibility for your work: The importance of a well-written title. J Am Assoc Nurse Pract. 2019;31(4):217–8. https://doi.org/10.1097/JXX.0000000000000212 .

Klein TA, Pearce PF. Dissemination: writing for publication. In: Staffileno BA, Murphy MP, Buchholz SW, editors. Research for advanced practice nurses: from evidence to practice. 4th ed. New York, NY: Springer Publishing Company; 2022. p.399–422.

Almukhaini S, Martin-Misener R, Weeks LE, Macdonald M, Hussain H, Macdonald D, et al. Advanced practice nursing roles in Arab countries in the Eastern Mediterranean region: a scoping review protocol. JBI Evid Synth. 2021;19(4):891–8.

Madkhali NA, Santin O, Noble H, Reid J. Understanding breast health awareness in an Arabic culture: qualitative study protocol. J Adv Nurs. 2016;72(9):2226–37.

Byrne C, Radley A, Inglis SK, Beer LJZ, Palmer N, Pham MD, et al. Reaching mEthadone users Attending Community pHarmacies with HCV: an international cluster randomised controlled trial protocol (REACH HCV). BMJ Open. 2020;10(8):e036501.

Main P, Anderson S. Evidence for continuing professional development and recency of practice standards for regulated health professionals in Australia: protocol for a systematic Review. JMIR Res Protoc. 2022;11(4):e28625.

Download references

Author information

Authors and affiliations.

Loyola University New Orleans (ret.), New Orleans, LA, USA

Patricia F. Flannery Pearce

San Francisco, USA

Louisiana State Board of Nursing, Baton Rouge, LA, USA

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Patricia F. Flannery Pearce .

Editor information

Editors and affiliations.

DePaul Community Health Center, New Orleans, LA, USA

Sophia L. Thomas

School of Nurse Anesthesia, Texas Christian University, Fort Worth, TX, USA

Jackie S. Rowles

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Cite this chapter.

Pearce, P.F.F. (2023). The NP and Research: A Global Perspective. In: Thomas, S.L., Rowles, J.S. (eds) Nurse Practitioners and Nurse Anesthetists: The Evolution of the Global Roles. Advanced Practice in Nursing. Springer, Cham. https://doi.org/10.1007/978-3-031-20762-4_7

Download citation

DOI : https://doi.org/10.1007/978-3-031-20762-4_7

Published : 06 June 2023

Publisher Name : Springer, Cham

Print ISBN : 978-3-031-20761-7

Online ISBN : 978-3-031-20762-4

eBook Packages : Medicine Medicine (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here .

Loading metrics

Open Access

Study Protocol

A global perspective of advanced practice nursing research: A review of systematic reviews protocol

Roles Conceptualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliations Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada, Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Montréal, Québec, Canada

Contributed equally to this work with: Isabelle Savard, Li-Anne Audet, Abby Kra-Friedman

Affiliation Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada

Affiliations Henrietta Szold School of Nursing, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Ein Kerem, Jerusalem, Israel, School of Nursing, Duquesne University, Pittsburgh, Pennsylvania, United States of America

Affiliation Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Montréal, Québec, Canada

Affiliation Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore

Affiliation College of Nursing, University of Kentucky, Lexington, Kentucky, United States of America

Affiliation School of Nursing, MGH Institute of Health Professions, Boston, Massachusetts, United States of America

Affiliation School of Nursing, Old Dominion University, Virginia Beach, Virginia, United States of America

Affiliation School of Health Sciences, University of Dundee, Dundee, Scotland, United Kingdom

Affiliation Louise Herrington School of Nursing, Baylor University, Dallas, Texas, United States of America

Affiliation St James Public Health Services, Montego Bay, St James, Jamaica

Affiliation Department of Nursing and Midwifery, University of Huddersfield, Queensgate, Huddersfield, United Kingdom

• Kelley Kilpatrick, 
• Isabelle Savard, 
• Li-Anne Audet, 
• Abby Kra-Friedman, 
• Renée Atallah, 
• Mira Jabbour, 
• Wentao Zhou, 
• Kathy Wheeler, 
• Elissa Ladd, 

• Published: January 24, 2023
• https://doi.org/10.1371/journal.pone.0280726
• Reader Comments

Introduction

In 2020, the World Health Organization called for the expansion and greater recognition of all nursing roles, including advanced practice nurses (APNs), to better meet patient care needs. As defined by the International Council of Nurses (ICN), the two most common APN roles include nurse practitioners (NPs) and clinical nurse specialists (CNSs). They help ensure care to communities as well as patients and families with acute, chronic or complex conditions. Moreover, APNs support providers to deliver high quality care and improve access to services. Currently, there is much variability in the use of advanced practice nursing roles globally. A clearer understanding of the roles that are in place across the globe, and how they are being used will support greater role harmonization, and inform global priorities for advanced practice nursing education, research, and policy reform.

To identify current gaps in advanced practice nursing research globally.

Materials and methods

This review of systematic reviews will provide a description of the current state of the research, including gaps, on advanced practice nursing globally. We will include reviews that examine APNs, NPs or CNSs using recognized role definitions. We will search the CINAHL, EMBASE, Global Health, HealthStar, PubMed, Medline, Cochrane Library Database of Systematic Reviews and Controlled Trials Register, Database of Abstracts of Reviews of Effects, Joanna Briggs Institute, and Web of Science electronic databases for reviews published from January 2011 onwards, with no restrictions on jurisdiction or language. We will search the grey literature and hand search the reference lists of all relevant reviews to identify additional studies. We will extract country, patient, provider, health system, educational, and policy/scope of practice data. We will assess the quality of each included review using the CASP criteria, and summarize their findings. This review of systematic reviews protocol was developed following the PRISMA-P recommendations.

PROSPERO registration number

CRD42021278532.

Citation: Kilpatrick K, Savard I, Audet L-A, Kra-Friedman A, Atallah R, Jabbour M, et al. (2023) A global perspective of advanced practice nursing research: A review of systematic reviews protocol. PLoS ONE 18(1): e0280726. https://doi.org/10.1371/journal.pone.0280726

Editor: Xian-liang Liu, Charles Darwin University, AUSTRALIA

Received: October 1, 2021; Accepted: January 8, 2023; Published: January 24, 2023

Copyright: © 2023 Kilpatrick et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All data is included in the paper and/or Supporting information .

Funding: This work is supported by the McGill University Faculty of Medicine and Health Sciences and the Newton Foundation via the Susan E. French Chair in Nursing Research and Innovative Practice held by KK. KK is also supported by a Fonds de recherche du Québec-Santé ( https://frq.gouv.qc.ca/en/health/ ) Research Scholar Senior (Award Number 298573) salary award. There was no additional external funding received for this study, and the authors received no specific funding for this work. All the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

In 2020, the World Health Organization [ 1 ] called for the expansion and greater recognition of all nursing roles, including nurses in advanced practice, to better meet patient care needs. Nurses in advanced practice roles, as defined by the International Council of Nurses (ICN), are most often identified as advanced practice nurses (APNs), with the two most common APN roles being nurse practitioners (NPs) and clinical nurse specialists (CNSs) [ 2 ]. They help ensure care to communities as well as patients and families with acute, chronic or complex conditions [ 2 ]. In addition to providing direct care, NPs and CNSs support care providers to deliver high quality care and improve access to services [ 3 – 5 ]. Nurses in these roles have educational preparation at the Master’s level or above in addition to in-depth clinical expertise and complex decision-making skills [ 6 ]. A global analysis of advanced practice nursing policy, regulation and practice by Ladd et al. [ 7 ] highlighted that advanced practice nursing roles are growing at an accelerated rate. However, these authors argue that advanced practice nursing roles have emerged unequally across the globe in response to local care needs without clear supports to develop consistent expanded roles for nurses. A recent review of systematic reviews of primary healthcare NP roles identified 396 primary studies included in the 40 systematic reviews representing on average 3 countries (range not reported to 9) [ 8 ]. Although there are several systematic reviews of APN and CNS roles in other clinical settings [ 4 , 5 , 9 ], no synthesis of this body of evidence is available for other recognized advanced practice roles, making it challenging to compare advanced practice nursing roles across jurisdictions.

Currently, there is much variability in the use of advanced practice nursing roles globally [ 1 , 7 , 10 , 11 ]. A clearer understanding of the roles that are in place across the globe, how they are being used and the outcomes that are being assessed would support greater role harmonization, and inform global priorities for advanced practice nursing education, research, and policy reform.

To identify current gaps in advanced practice nursing research globally, we propose to conduct of review of systematic reviews of studies examining APNs, NPs or CNSs using recognized advanced practice nursing role definitions [ 2 ]. We will seek to answer the question: Do current systematic reviews that include APNs, NPs or CNSs represent countries where these roles are found globally? To do so, we will address the following three aims:

• Identify the countries included in systematic reviews of APNs, NPs or CNSs;
• Describe the types of included studies, study population, role definitions, and context of care identified in the systematic reviews; and
• Examine the types of outcomes of APN, NP or CNS roles included in systematic reviews globally.

This review of systematic reviews will provide a description of the current state of the research, including gaps, on advanced practice nursing globally. We adapted methods used in an umbrella review that sought to identify indicators sensitive to the practice of primary healthcare NP practice [ 12 ]. The protocol for the review of reviews was developed following the PRISMA-P recommendations by Shamseer et al. [ 13 ]. The review of reviews is registered with the PROSPERO International Prospective Register of Systematic Reviews (Prospero ID CRD42021278532).

Inclusion criteria

Types of studies..

We will include all relevant published and unpublished systematic reviews reported from January 2011 onwards, with no restrictions on jurisdiction or language. For a review to be identified as systematic, a specific research question must be present or sufficient information must be provided so reviewers can identify the components of a research question (i.e., PICOS) related to advanced practice nursing. Additionally, the review must use prespecified inclusion and exclusion criteria, as well as systematic methods to identify relevant published and unpublished evidence to minimize the risk of bias in the retained studies [ 14 ]. Systematic reviews will be included provided the advanced practice nursing role is clearly defined and the APN, NP or CNS has decision-making autonomy [ 2 ].

Types of participants.

Participants will include patients and providers. Patients of any age, health condition, groups or communities receiving care from an APN, NP or CNS in all types (e.g., public/private; teaching/non-teaching,), sizes (e.g., small/medium/large) and locations (e.g., urban/rural) of community or care agencies (e.g., acute, long-term care, primary care, home care) will be retained. Providers will include all members of the healthcare team in all types, sizes, and locations of organizations. We will extract data to describe the country, number of participants, patient health conditions (e.g., diabetes, mental health), type of care (e.g., post-operative care), organizational characteristics, provider roles in the team, reason of APN, NP or CNS intervention (e.g., educational offering), and type of outcome.

Types of interventions.

We will include studies of APNs, NPs or CNSs in all sectors. To capture the countries where the roles that are implemented, we will identify studies in acute care and primary healthcare settings. Acute care will be defined as in-hospital or specialized ambulatory care to address specific health conditions [ 15 ]. Primary care will refer to the entry point of the healthcare system where patients receive comprehensive healthcare services for common health concerns [ 16 ].

Advanced practice nursing includes clinical and non-clinical activities related to education, research, and administration [ 17 , 18 ]. According to the International Council of Nurses, APNs are nurses prepared at the graduate level who have acquired in-depth expertise, complex decision-making skills and advanced clinical competencies [ 2 ]. Master’s or doctoral educational preparation is recommended and in many countries is required with national board certification for licensure and entry-level practice [ 2 ]. Given the diversity of terms used globally to identify APNs, NPs, and CNSs, members of the research team will help identify role titles specific to their region. For example, CNSs may be identified as nurse consultants in some regions in the United Kingdom. We will be attentive to the countries and geographical distribution of the systematic reviews that are identified and adjust our search strategy as needed.

NPs are autonomous clinicians who practice in ambulatory, acute and long-term care as primary and/or specialty care providers, both independently and in coordination with healthcare professionals and others. NPs assess, diagnose, treat, and manage acute episodic and chronic illnesses. NPs are experts in health promotion and disease prevention. They order, conduct, supervise, and interpret diagnostic and laboratory tests, prescribe pharmacological agents and non-pharmacologic therapies, as well as teach and counsel patients, among other services. In addition to clinical practice, they may serve as healthcare researchers, interdisciplinary consultants, and patient advocates. NPs provide a wide range of services to individuals, families, groups, and communities [ 3 ]. For nurses to be considered as NPs in our review of reviews, the review must specify that they completed a formal post-baccalaureate or graduate NP education program.

CNSs have expertise in a nursing specialty and perform a role that includes practice, consultation, collaboration, education, research and leadership. CNSs assist in providing solutions for complex healthcare issues and are leaders in the development of clinical practice guidelines, promoting the use of evidence, and facilitating system change [ 2 ]. CNSs specialize in a specific area of practice that may be defined in terms of a population, setting, disease or medical subspecialty, type of care or type of problem. For nurses to be considered as CNSs, the review has to specify that they completed a graduate degree and the role described must be reflective of the CNS role definition.

Types of comparators.

We will extract data related to the comparator (i.e., control) group to provide a brief description of the group to which care is being compared. Comparator groups can include the following, among others: usual care, best care, care provided by other healthcare professionals (e.g., physicians), or adherence to clinical practice guidelines.

Types of outcomes.

The outcomes of interest for this review of reviews will include any outcome of an advanced practice nursing role. We will document measures at the levels of the patient (e.g., health status, patient satisfaction, quality of life), the provider (e.g., job satisfaction, quality of care), the health system (e.g., costs, length of hospital stay, rehospitalisation, resource utilisation), education, or policy/scope of practice. Outcomes will be categorized as clinical, provider, health system, educational, policy/scope of practice.

Exclusion criteria

We will exclude reviews developed to address broad research questions (e.g., integrative reviews, literature reviews, scoping reviews).

We will exclude from the review of reviews studies related to physician assistants. Certified registered nurse anesthetists are excluded because, as of yet, they do not have global APN presence in the majority of countries with APN roles. We will also exclude nurse midwives since, across the different countries, not all regulatory requirements require these roles to be filled by nurses and nor are these roles consistently identified as advanced practice nursing roles. In reviews that include a mix of APN, NP and CNS roles and other provider roles, we will extract only data related to APNs, NPs and CNSs.

Moreover, we will exclude reviews where the impact of the APNs, NPs or CNSs cannot be teased out and is not reported separately from that of other types of nurses or healthcare team members. We will develop a list of all excluded reviews, along with the reasons justifying their exclusion.

Database search

We will limit our search to January 2011 onwards to capture the most up-to-date trends, as evidence is outdated after five years in about half of published reviews [ 19 ]. We will search the following electronic databases: CINAHL, EMBASE, Global Health, HealthStar, PubMed, Medline, Cochrane Library Database of Systematic Reviews and Controlled Trials Register, Database of Abstracts of Reviews of Effects (DARE), Joanna Briggs Institute, and Web of Science. We will combine subject headings and keywords related to advanced practice nursing (e.g.: advanced practice nursing, nurse-led), APN (e.g., advanced practice nurse, advanced practice clinician, advanced practitioner, nurse prescriber), NP (e.g., nurse practitioner, advanced practice registered nurse, family nurse practitioner, primary healthcare nurse practitioner, adult gerontology nurse practitioner, pediatric nurse practitioner, oncology nurse practitioner, emergency nurse practitioner, mental health nurse practitioner, neonatal nurse practitioner), and CNS (e.g., nurse specialists, clinical nurse specialist, infection control practitioner, nurse consultant, specialist nurse) roles/titles, along with a search filter based on the CADTH systematic reviews and meta-analyses search filter and that developed by Lunny et al. for reviews of systematic reviews to capture a broad range of roles across settings [ 20 , 21 ]. Subject headings and keywords will also include more general roles/titles, as well as those specific to primary and acute care settings, and corresponding acronyms where applicable. The full preliminary search strategy developed for the PubMed database, which will subsequently be adapted to each electronic database, is presented in S1 Appendix . We will adapt strategies reviewed by an academic librarian that have been used successfully in previous reviews [ 21 ]. In addition, we will hand search the reference lists of all relevant reviews to identify additional studies.

Moreover, we will search the grey literature will for the period of January 2011 onwards using the following websites and tools: World Health Organization, Organization for Economic Co-operation and Development (OECD), International Council of Nurses, CADTH Information Services, CADTH Grey Matters Tool, and ProQuest Dissertation and Theses. We will search the PROSPERO International Prospective Register of Systematic Reviews to identify registered review protocols, and will contact authors of registered PROSPERO reviews to ascertain study status. For each website, the content will be searched using the same search terms as those used for the published literature, e.g.: (Advanced practice nurs* OR Nurse practitioner* OR Clinical nurse specialist*) AND (Primary care OR Acute care) AND Systematic review*. If there is not an inherent search function on the website, a search will be conducted of all webpages and weblinks. The preliminary search strategy for the grey literature is presented in S2 Appendix .

Study selection

To enhance inter-rater agreement, all reviewers will be trained to use the screening instrument and inclusion/exclusion criteria. We will upload the retained studies into the EndNote and RAYYAN software [ 22 ], after which duplicates will be removed. Two reviewers will independently screen titles and abstracts using the predefined inclusion/exclusion criteria, and recommend exclusion or further full-text review. Any discrepancies will be discussed among the reviewers. Inter-rater agreement will be estimated using the kappa statistic. Additional training sessions will be planned if inter-rater agreement is low and Cohen’s kappa is below 60% [ 23 ].

To be included in our review of reviews, each paper must be identified as a systematic review, and focus on an advanced practice nursing role or intervention. If the abstract contains insufficient information or there is no abstract available, we will complete a full-text review. We will complete a full-text review for all the reviews retained after the initial screening, again using the predefined inclusion/exclusion criteria. Any coding discrepancies will be discussed among the reviewers until agreement is reached on the inclusion or exclusion of the review. In the event they are unable to reach a consensus, a third reviewer will act as tie-breaker.

Data extraction

Data from included full-text papers will be extracted by one coder and subsequently reviewed by a second coder. Any discrepancies will be resolved by consensus. A structured tool developed for a previous review of reviews will be adapted and pilot-tested by the investigators [ 12 ]. We will extract data from the methods and results section of each full-text paper. The data we will extract will include: review aim or focus; review characteristics (e.g., publication year); name and number of electronic databases searched; participant and intervention characteristics; number and types of studies included in the review; countries where studies were conducted; specification of patient, provider, health system, educational, policy, and scope of practice outcomes; and funding source [ 24 ]. Additionally, we will document APN, NP or CNS and non-APN involvement in the research team who conducted the review by extracting data related to the professional designation of the research team members.

Design of included studies

Because the addition of APNs, NPs and CNSs is a complex healthcare system intervention, different types of information are needed to inform research about advanced practice nurses [ 25 ]. Systematic reviews included in our review of systematic reviews may include the results of randomized controlled trials, prospective controlled observational studies and cohort studies, retrospective controlled observational and cohort studies, and surveys. We will develop a summary table to present key findings.

Assessment of review quality

Two reviewers will independently rate each systematic review using the 10-item Critical Appraisal Skills Programme (CASP) criteria [ 26 ] to assess the systematic review’s methodologic quality. As described above, inter-rater agreement will be assessed using Cohen’s kappa, and any disagreements will be discussed among the reviewers until they come to a consensus. We will generate a summary table with the CASP ratings.

The primary outcome of the review of reviews is to document APNs, NPs or CNSs research globally to identify gaps in current research. We will examine each advanced practice nursing role separately.

Data synthesis

A narrative synthesis of the findings will be compiled. We will use an iterative process to identify patterns and relationships emerging across the different reviews and years when they were conducted [ 27 ]. We will develop summary tables outlining the key review characteristics (e.g., publication year, countries where primary studies were conducted), outcomes (i.e., patient, provider, health system, educational, policy/scope of practice), type of advanced practice nursing role, and quality assessment. We will keep a record of all review-related decisions. No additional quantitative analyses are planned as this is not recommended for overviews because of the potential risk of overlap in studies that appear in more than one review [ 28 ].

The identification of advanced practice nursing roles that are currently in place, the countries where these nurses practice and the outcomes being used to examine practice will shed light on current gaps in the literature, and identify stronger and weaker areas of evidence related to advanced practice nursing globally. The review of systematic reviews builds on a recently completed umbrella review of NPs in primary healthcare. The current review of reviews will synthesize the characteristics of advanced practice nursing roles, study populations, contexts and outcomes to determine how closely these roles align with ICN definitions. In contexts where the roles are not optimally implemented or utilized, the findings will support the development of recommendations at the clinical, educational, and regulatory levels to improve role clarity, role implementation and access to high quality care. In addition, the development of an international strategic plan for APN role development will aid countries hoping to further expand APN practice.

Supporting information

S1 checklist. prisma-p 2015 checklist..

https://doi.org/10.1371/journal.pone.0280726.s001

S1 Appendix. Preliminary search strategies (PubMed) for the published literature.

https://doi.org/10.1371/journal.pone.0280726.s002

S2 Appendix. Preliminary search strategies for the grey literature.

https://doi.org/10.1371/journal.pone.0280726.s003

• 1. World Health Organization. State of the World’s Nursing Report 2020- Investing in education, jobs and leadership. Health Workforce. 6 April 2020. Available from: https://www.who.int/publications/i/item/9789240003279 .
• 2. International Council of Nurses, Schober M, Lehwaldt D, Rogers M, Steinke M, Turale S, et al. Guidelines on Advanced Practice Nursing. 2020. Available from: https://www.icn.ch/system/files/documents/2020-04/ICN_APN%20Report_EN_WEB.pdf .
• 3. American Association of Nurse Practitioners (ANNP). Discussion paper: Quality of nurse practitioner practice. 2020. Available from: https://storage.aanp.org/www/documents/advocacy/position-papers/Quality-of-NP-Practice-Bib_11.2020.pdf .
• View Article
• PubMed/NCBI
• Google Scholar
• 6. Canadian Nurses Association, Almost J. Regulated Nursing in Canada: The Landscape in 2021. February 2021. Available from: https://www.cna-aiic.ca/en/nursing-practice/the-practice-of-nursing/regulated-nursing-in-canada .
• 11. Schumann L, Bird B, Pilane C, Duff E, Geese F, Jelic M, et al. Mapping of advanced nursing competencies from nineteen respondent countries against the strong model of advanced practice nursing (2000) and the International Council of Nurses (2008) Advanced Practice Nursing Competencies (2013–2017). International Council of Nurses NP/APN Network Research Subgroup Publication. March 2019. Available from: https://internationalaanporg/Research/SG .
• 21. CADTH. CADTH search filters database. Ottawa. 2022. Available from: https://searchfilters.cadth.ca/list?q=&p=1&ps=20&topic_facet=systematic%20reviews%20000000%7CSystematic%20reviews .
• 26. Critical Appraisal Skills Programme (CASP). CASP Checklist: 10 questions to help you make sense of a systematic review. 2018. Available from: https://casp-uk.net/casp-tools-checklists/ .

The Productivity of Professions: Evidence from the Emergency Department

This paper studies the productivity of nurse practitioners (NPs) and physicians, two professions performing overlapping tasks but with stark differences in background, training, and pay. Using quasi-experimental variation in patient assignment to NPs versus physicians in 44 Veterans Health Administration emergency departments, we find that, on average, NPs use more resources but achieve worse patient outcomes relative to physicians. The costs of lower productivity surpass the pay differences between the professions. Yet even larger productivity variation exists within each profession, implying substantial productivity overlap between the two professions. Within professions, wages and assigned patient complexity vary only weakly with productivity.

We are grateful to Ricardo Alonso, Sandy Black, Marika Cabral, David Card, Stuart Craig, Janet Currie, Shooshan Danagoulian, Qing Gong, Joshua Gottlieb, Mitch Hoffman, Tom Hubbard, Bapu Jena, Amanda Kowalski, Brad Larsen, Darren Lubotsky, Bentley MacLeod, Neale Mahoney, David Molitor, Jessica Monnet, Ciaran Phibbs, Maria Polyakova, Julian Reif, Michael Richards, Steve Rivkin, Evan Rose, Susan Schmitt, Molly Schnell, Brad Shapiro, Isaac Sorkin, Chris Walters, and many seminar and conference participants for helpful comments and suggestions. Sam Bock, Noah Boden-Gologorsky, Damien Dong, Akriti Dureja, Jesse Kozler, Matthew Merrigan, Jonatas Prates, Aadit Shah, KeminWang, JustineWeng, SamWylde, and Saam Zahedian provided excellent research assistance. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

MARC RIS BibTeΧ

Download Citation Data

• October 26, 2022

Working Groups

Conferences, mentioned in the news, more from nber.

In addition to working papers , the NBER disseminates affiliates’ latest findings through a range of free periodicals — the NBER Reporter , the NBER Digest , the Bulletin on Retirement and Disability , the Bulletin on Health , and the Bulletin on Entrepreneurship  — as well as online conference reports , video lectures , and interviews .

Art as Self-reflection in Nurse Practitioner Role Transition

Affiliation.

• 1 By Lisa K. Diamond, DNP, FNP-C, University of Colorado, Anschutz Medical Campus, Aurora, [email protected] .
• PMID: 37011594
• DOI: 10.1097/NNE.0000000000001412
• Nurse Practitioners*
• Nurse's Role*
• Nursing Education Research

• Career Opportunities

opens in a new window

Challenges and Opportunities for NPs in Primary Care

With the ever-changing healthcare landscape, the role of primary care nurse practitioners is increasingly vital. As frontline clinicians, they are crucial in delivering comprehensive and patient-centered care. However, similar to many facets of healthcare, nurse practitioners face various challenges and opportunities for growth.

Typical Nurse Practitioner Roles in Primary Care Settings

Nurse practitioners are the largest group of primary care providers in the United States. Their patient-centered care bridges covered care and access to affordable healthcare. However, that bridge will look different depending on your state. 

Each state has its own health code that dictates the scope of practice for nurse practitioners. Some states allow nurse practitioners to have more freedom in their scope of practice, but as clinicians, nurse practitioners have a combination of the following responsibilities:

• Completing thorough patient assessments
• Ordering and interpreting diagnostic testing, like labs and imaging
• Prescribing medication
• Initiating and managing treatment plans
• Coordinating care between primary care clinics, specialty clinics, and other treatment modalities
• Counseling and educating patients and their families

Additionally, nurse practitioners in primary care can work in a variety of environments:

• Healthcare systems
• Health maintenance organizations
• Nurse-managed clinics
• Nurse practitioner-owned practices
• Nursing homes
• Health departments

Most Common Challenges Nurse Practitioners Face in Primary Care

The common challenges nurse practitioners face in primary care are similar to the field’s general challenges. These obstacles can significantly hinder advanced practice registered nurses’ ability to provide optimal healthcare to their patients. The most common challenges include the following:

• Staffing shortages
• Increased patient load
• Job inflexibility
• Patient demands

Ways Nurse Practitioners Overcome These Challenges to Provide Optimal Patient Care

Nurse practitioners have the power to advocate for themselves and their patients in order to overcome challenges and succeed in their practice. Here are a few ways to do just that.

• Staffing shortages : Nurse practitioners are essentially the solution to staffing shortages for primary care clinicians. They are available to fill the gaps where primary care physicians may be missing, especially in rural and underserved communities. Another way to overcome staffing shortages is for NPs to educate future advanced practice registered nurses. That way, NP roles will also be filled down the road.
• Increased patient load : While reducing the number of patients nurse practitioners see daily is most likely not an option, streamlining schedules and workflows can significantly help overcome increased patient load. You should delegate tasks to your supporting nurses and medical assistants, but it’s essential, u to delegate within their scope of practice. 

Additionally, using technology to its full potential to reduce paperwork and other tedious tasks can help reduce the strain of increased patient loads.

• Burnout : The rates of burnout among healthcare professionals have grown significantly over the past few years. The focus has started to shift to the prevention of burnout versus treating the symptoms. To overcome this challenge, nurse practitioners can do more than just focus on self-care. First, use your paid time off. You earned it! Also, even though it feels like you shouldn’t stop working, take your lunch hour and avoid eating lunch at your desk.
• Job inflexibility : Overcoming job inflexibility will require negotiation between you and your employer. Negotiating flexibility into your work week, like administrative time, compressed work weeks, or even telehealth or remote days, can help reduce the strain of scheduling inflexibility. 
• Patient demands : Besides your patient load becoming more demanding, patients themselves have become more challenging. With increased resources and insurance coverage from the Affordable Care Act, patients have more access to covered diagnostics and treatment modalities, increasing the demand for your care coordination role. You must use your clinic’s support staff to complete tasks within their scope of practice to help decrease the burden of administrative work.

Opportunities Emerging for Nurse Practitioners in Primary Care

Although they face many challenges in their practice, nurse practitioners have opportunities to grow and thrive in their careers. Here are a few things to pay attention to as you think about the future of your career.

• Physician shortage : With the continuing primary care physician shortage, the healthcare field is turning toward nurse practitioners and other advanced practice clinicians to bridge the gap in care. With a nurse’s training plus advanced training to interpret diagnostics and have prescriptive authority, nurse practitioners provide a smooth, cost-effective approach to healthcare.
• Aging patient population : Because the population continues to age, there is an increased need for gerontology and primary care as a whole. Older patients tend to have more healthcare needs but struggle with access to healthcare. Nurse practitioners have the training necessary to manage patient polypharmacy and coordinate specialists and appropriate therapies. 
• Emerging specialties : With newer specialties like infusion and aesthetic nurse practitioners, opportunities to diversify skills and knowledge are becoming more prevalent. Continuing your education can allow you to find a specialty or subspecialty that piques your interest. 
• Telemedicine : Telehealth and virtual care are innovative solutions that allow the expertise of nurse practitioners to reach patients in remote and underserved areas. This technology allows nurse practitioners to provide consultations, monitor patients, and offer follow-up care without transportation worries.

How Does the Integration of Nurse Practitioners Benefit the Healthcare System and Patient Outcomes in Primary Care?

Since integrating nurse practitioners into the healthcare system in 1965, data has consistently shown the many benefits to patients and healthcare. According to the American Association of Nurse Practitioners , patients who seek care from advanced-practice registered nurses have fewer unnecessary emergency room visits and hospital readmissions. Additionally, patients have higher satisfaction ratings and increased access to care. 

Nurse practitioners often have a dual focus when working with their patients. Not only do they focus on the current problem or illness, but they also provide education and resources to prevent future issues. This approach helps reduce unnecessary emergency room visits and hospital readmissions. 

The role of nurse practitioners encompasses both the care and the cure of the patient. Patients often feel heard and spend more time with their nurse practitioner during appointments. This practice can foster a solid patient-provider relationship and increase patient satisfaction. 

Working as a nurse practitioner can present challenges, but guiding patients and their families can be one of the most rewarding experiences. Are you looking for your next opportunity to positively impact your patients and the healthcare system? Search thousands of nurse practitioner jobs on Health eCareers. 

Andrea Mosher, CPNP, PMHS, is a suburban emergency room RN turned primary care pediatric NP. With this drastic evolution in practice, there was a steep learning curve. Now, her daily role is based significantly on educating patients and families, so writing freelance health content is the perfect fit to share her knowledge with patients and other healthcare workers.

Related Articles

Top Challenges and Opportunities for Nurse Practitioners

A Nurse Practitioner’s Guide to Locum Tenens

5 Common NP Interview Questions

Pennington County Sheriff’s Office psychiatric practitioner makes all the difference for co-workers

RAPID CITY, S.D. (KOTA) - There’s no doubt that the stress of being a police officer or a firefighter can push you to your limit.

Psychiatric Nurse Practitioner Heather Courage is the heartbeat of first responder’s mental health services in Pennington County ... helping them break through mental obstacles, one person at a time.

Courage is vital in providing the Rapid City Police Department, Pennington County Sheriff’s Office, Rapid City Fire Department and South Dakota Division of Criminal Investigation with psychiatric support they may need. helping to deal with traumatic events and other things they may experience on the job.

Courage also conducts psychiatric evaluations for officers and deputies going through the pre-employment process, ensuring that they are in a good mental state to execute the duties of their jobs.

Courage says that her experience as a nurse during the COVID-19 pandemic served as a catalyst for her interest in psychiatric therapy.

“It was really working as a frontline nurse during COVID and just seeing how people in this industry really sacrifice themselves for others and how that really, when you’re doing that for years and years and years and how that really takes a toll on you,” Courage explained.

Courage added that it can be really tough at times to get her clients to open up about their on-duty experiences. Still, she finds it rewarding knowing that she was able to make a difference in their lives.

“There’s so many times that I sit across from them in this room and see, and just see them go, ‘Wow it’s okay.’ Like, and I know that I’m like, this is where I’m meant to be. This is what I’m supposed to be doing. I can see it in them and their reactions like, ‘It’s okay to talk about how I feel,” she said.

In some situations, when 911 calls are tougher than others, Courage and a peer support group will hold diffusing and debriefing sessions, seeking to evaluate an officer’s mental state after their call to duty and determine if intervention is needed.

Sheriff’s Office Wellness Coordinator Corey Brubakken explained what makes Courage so effective at her job.

“She is very approachable. I would say that she displays a level of trust and confidence with our employees, that I’ve seen anyway,” Brubakken said.

Courage loves when she reaches breakthroughs with the people she’s working with, making them understand, if they can provide self-care to themselves then they can show their best versions to the people in their lives.

Copyright 2024 KOTA. All rights reserved.

Many mobile home residents in Pennington County find themselves in tax trouble

Names released of suspects from search in Rapid City neighborhood

The Latest on the Snow Potential for This Weekend

Three arrested after high-risk drug search in Rapid City

Gypsy Rose Blanchard announces separation from husband 3 months after her prison release

Latest news.

Black Hills research symposium hosted by BHSU

Deadwood organizes burger battle

South Dakota Mine bladesmithing competition

Vandal spray paints derogatory words on elementary school in Rapid City

Native American tribes to work with U.S. Forest Service in co-stewardship efforts

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Nursing professional development evidence-based practice.

Barbara A. Brunt ; Melanie M. Morris .

Affiliations

Last Update: March 4, 2023 .

• Introduction

Evidence-based practice is “integrating the best available evidence with the healthcare educator’s expertise and the client’s needs while considering the practice environment. [1] One of the roles of the NPD practitioner in the 2022 edition of the Nursing Scope and Standards of Practice is a champion for scientific inquiry. In this role, the NPD practitioner promotes a spirit of inquiry, the generation and dissemination of new knowledge, and the use of evidence to advance NPD practice, guide clinical practice, and improve the quality of care for the healthcare consumer/partner. Scholarly inquiry is a standard of practice within that role. It is defined as “The nursing professional development (NPD) practitioner integrates scholarship, evidence, and research findings into practice” (p. 104).

There is often confusion between quality improvement, evidence-based practice, and research. A seminal article by Shirey and colleagues. [2]  differentiated these three topics. Evidence-based practice is a systematic problem-solving approach that is evidence-driven and translates new knowledge into clinical, administrative, and educational practice. Institutional Review Board (IRB) approval is usually not required unless outcomes are intended for publication, or the project could potentially expose individuals to harm.

The EBP process, as defined by Melnyk and Fineout-Overholt, includes seven steps:         

• Encouraging and supporting a spirit of inquiry
• Asking questions
• Searching for evidence
• Appraising the evidence
• Integrating evidence into practice
• Evaluating outcomes
• Sharing results

Implementing EBP in practice has been shown to lead to a higher quality of care and better patient outcomes, but nurses encounter many barriers when implementing EBP. NPD practitioners can facilitate the implementation of EBP by ensuring a supportive environment for EBP, providing educational sessions to nurses about the EBP process, being role models, and mentoring nurses.

• Issues of Concern

PICOT Question

The foundation of EBP is developing a PICOT question, which identifies the terms to be used to search for the best evidence to answer a burning clinical question. [3] This framework breaks down the question into keywords. P stands for patient/population; I refers to Intervention; C stands for comparison/control; O stands for the outcome; and T refers to the time frame. When looking at the population, it is important to consider the relevant patients, including age, sex, geographic location, or specific characteristics that would be important to the question.

The intervention examines the management strategy, diagnostic test, or exposure of interest. There may not always be a comparison in the PICOT analysis. If there is, this would be a control or alternative management strategy compared to the intervention. Outcomes should be measurable, as the best evidence comes from rigorous studies with statistically significant findings. The time factor looks at what period should be considered. There are a variety of clinical domains that PICOT questions can evaluate, such as intervention, diagnosis, etiology, prevention, prognosis/prediction, quality of life, or therapy. Writing a good PICOT question for an effective search and making robust, evidence-based recommendations to improve care and outcomes is critical.

The Evidence

While there are multiple ways to evaluate and rank evidence in the literature, one of the most widely used in nursing in the United States uses seven levels. These seven accepted levels of evidence are assigned to studies based on the methodological quality of the design, validity, and application to patient care. In addition, these levels provide the “grade” or strength of the recommendation.

• Level I –  Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs) or evidence-based clinical practice guidelines based on a systematic review of RCTs or three or more RCTs of decent quality with comparable results.
• Level II -  Evidence obtained from at least one well-designed RCT
• Level III – Evidence obtained from well-designed controlled trials without randomization
• Level IV -  Evidence from well-designed case-control or cohort studies        
• Level V - Evidence from a systematic review of descriptive and qualitative studies (meta-syntheses)
• Level VI – Evidence from a single or descriptive or qualitative study              
• Level VII - Evidence from the opinion of authorities and/or reports of expert committees.

Roe-Prior discussed the strength of evidence by comparing it to a murder trial. A suspect’s conviction should require more than the testimony of one witness. If a crowd of people all agree that the suspect was the perpetrator or there was DNA evidence, that evidence is much stronger. Studies without a comparative group, methodologically weak studies, or poorly controlled studies could be likened to one witness. Roe Prior encouraged individuals to also look at non-nursing research findings since research centered on other disciplines, like psychology or education, could be appropriate.

Other frameworks for identifying levels of evidence include The Oxford Centre for Evidence-Based Medicine Levels of Evidence and Burns framework. [4] The Oxford Centre describes five levels with various subparts as listed here:

• 1a           Systematic review of RCTs
• 1b           Individual RCT
• 2a           Systematic review of cohort studies
• 2b           Individual cohort study
• 2c           Outcomes research
• 3a           Systematic review of case-control studies
• 3b           Individual case-control study
• 4             Case series
• 5             Expert opinion

Burns uses three levels to differentiate the strength of the evidence presented:

• I             At least 1 RCT with proper randomization
• II.1         Well-designed cohort or case-control study
• II.2         Time series comparisons or dramatic results from uncontrolled studies
• III           Expert opinions

Roe Prior outlined guidelines for the literature review. [5] Use keywords from the PICOT question to perform simple, then more complex searches in reliable databases, preferably limited to the past five years, although landmark studies can be included. Limit the review to peer-reviewed and research articles and use caution when including only full-text articles, as some key papers may be missed. Check the validity of any online sources and use original research where possible. Remember that textbooks are often obsolete by their publication date, and books are considered secondary sources.

The Cochran Library is comprised of multiple databases where systematic reviews on healthcare topics can be found. Using the Preferred Reporting Items for Systemic Review and Meta-Analysis (PRISMA) Guidelines to evaluate a systemic review or meta-analysis can help the individual ensure the findings are valid and reliable. Findings from the literature review are put into an evidence-based table. There are various formats for these tables, but they all include information about the source, design, sample, summary of findings, and level of evidence for each of the articles included.

The most frequently used EBP models are the Iowa Model, the Advancing Research and Clinical Practice through Close Collaboration (ARCC) Model, the Star Model of Knowledge Transformation, and the John Hopkins Nursing Evidence-based Practice (JHNEBP) Model. The IOWA Model focuses on implementing evidence-based practice changes, and the ARCC model on advancing EBP in systems by using EBP mentors and control and cognitive behavioral therapies. The Star Model provides a framework for approaching EBP, and the John Hopkins Model is a problem-based approach to clinical decision-making accompanied by tools to guide its use.

The Iowa model was revised and updated in 2017 by the Iowa Model Collaborative. [6]  Changes in the healthcare environment, such as a focus on implementation science and emphasis on patient engagement, prompted a reevaluation, revision, and validation of the model. This model differs from other frameworks by linking practice changes within the system. Model changes included an expansion of piloting, implementation, patient engagement, and sustaining change.

Support for the ARCC Model was outlined in an article by Melnyk and colleagues in a study exploring how an evidence-based culture and mentorship predicted EBP implementation, nurse job satisfaction, and intent to stay. [7] This model involves assessing organizational culture and readiness for EBP using EBP mentors who work with clinicians to facilitate the implementation of evidence-based practice.

A concept analysis of feelings of entrapment during the COVID-19 pandemic, using the ACE Star Model, was completed by Lee and Park. The ACE Star model is used to understand the cycle, nature, and characteristics of knowledge used in various aspects of EBP. The model consists of five steps: discovery research, evidence summary, translation to guidelines, practice integration, and process and outcome evaluation.

The JHNEBP Model is a problem-solving approach to clinical decision-making with user-friendly tools to guide individual or group use. It is explicitly designed to meet the needs of the practicing nurse and uses a three-step process called PET: practice question, evidence, and translation. In a study conducted by Speroni and colleagues on using EBP models across the United States, this was the second most frequently used model by the 127 nurse leaders who responded to the questionnaire. [8]

EBP Competence and Implementation

NPD practitioners are instrumental in implementing EBP. Harper and colleagues conducted a national study to examine NPD practitioners’ beliefs and competencies, frequency of implementing EBP, and perceptions of organizational culture and readiness for EBP. [9] The Association for Nursing Professional Development (ANPD) collaborated with the Center for Transdisciplinary Evidence-Based Practice at The Ohio State University to explore the NPD practitioners’ beliefs and experiences with EBP, as well as to explore relationships among NPD practitioner characteristics and healthcare organizational outcomes such as nursing sensitive quality indicator scores and core measures. A total of 253 NPD practitioners from 43 states and the District of Columbia participated in this study. Findings indicated that NPD practitioners need to develop personal competence in EBP, become involved in shared governance, collaborate with others to facilitate the implementation of EBP, and become comfortable with using quality metrics to demonstrate the effectiveness of NPD activities.

The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare of the Ohio State University developed an Evidence-Based Practice Certificate, which was approved by the Accreditation Board for Specialty Nursing Certification in 2018. There are 24 EBP competencies; 13 for practicing registered nurses and an additional 11 competencies for practicing advanced practice nurses and EBP experts. These competencies are outlined in an article by Melnyk et al. [10]

Although these competencies were initially written for nurses, they apply to other interprofessional team members who have received advanced EBP education. In addition to demonstrating completion of the EBP coursework, applicants must demonstrate current EBP knowledge through content review and successful testing and submit a portfolio to review that shows an EBP practice change project before receiving a certificate.

In 2020, ANPD worked with the Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare to develop a curriculum for the Nursing Professional Development EBP Academy. [11] The program consists of live webinars, 26 asynchronous modules, and the completion of an EBP change initiative/project. This Academy curriculum aligns with the EBP Certificate educational requirements.

There are numerous resources available for NPD practitioners on evidence-based practice. There is a peer-reviewed journal published by Sigma Theta Tau International, Worldviews on Evidence-based Nursing, which includes original research with recommendations applicable to use as best practices to improve patient care. ANPD has a year-long evidence-based fellowship consisting of theory and completion of an evidence-based project. The Nursing Professional Development Evidence-Based Practice (EBP) Academy is a 12-month mentored program designed to guide the NPD practitioner through creating PICOT questions, gathering and critically appraising literature, and EBP implementation, evaluation, dissemination, and sustainment. Participation in the EBP Academy enhances the evidence-based competencies of nursing professional development practitioners to enable them to fulfill their role as champions of scientific inquiry and mentor other healthcare professionals in implementing EBP practices.

EBP in Action

One organization evaluated the use of evidence-based practice in clinical practice after nurses attended a formal evidence-based practice course. [12]  Nurses who attended the organization’s EBP course were invited to participate in focus groups to provide additional qualitative data. Data from two focus groups highlighted the impact of the EBP course, areas for further development, and potential barriers to the use of EBP. The nurses indicated that the course changed their way of thinking and enhanced their patient care. They stated there was a need for mentoring and that time was a significant barrier to EBP. That information was used by organizational leadership to help identify areas needing consideration for educational offerings and support mechanisms.

Another large academic medical center evaluated the implementation of an EBP program. [13]  They noted that although their approach to educating professional staff on EBP provided initial benefits, holding the gains over a one-year period was difficult. The “train-the-trainer” model envisioned by the team was not realistic, as the participants did not feel well-versed enough to teach others. They concluded future efforts require attention to participant feedback and the implementation of measures to decrease the barriers to implementing EBP.

There are numerous examples in the literature of individuals/organizations using evidence-based principles to develop programs in a variety of settings. McGarity and colleagues examined frontline nurse leaders oriented with only on-the-job training questioning whether their level of competence is improved with a professional development program. [14] This project used a pre-and post-survey design to evaluate a leadership development curriculum. The intervention was an evidence-based leadership curriculum that consisted of twelve four-hour classes. The fact that all 38 frontline nurse leaders who participated in this project improved their competencies reinforced the need for formal professional development. The outcome of this training program showed that all 38 frontline nurse leaders who attended it were more confident in their skills and improved their competence in leading effective teams, reinforcing the need for education.

Ydrogo and colleagues discussed a multifaceted approach to strengthening nurses’ EBP capabilities in a comprehensive cancer center. [15] They created a program designed to promote a spirit of inquiry, strengthen EBP facilitators, overcome barriers to EBP, and expand nurses’ knowledge of EBP. The program consisted of a blended interactive seminar with leader-directed discussion on promoting a spirit of inquiry, a seven-week course on retrieving, reading, analyzing, and evaluating research papers, and a monthly challenge emailed to staff, posted to the hospital intranet, and included in a weekly nursing newsletter. Both leadership and staff gained increased confidence and a foundation to initiate two research projects and one EBP project shortly after completing the course.

Integrating EBP into an emergency department nurse residency program was the subject of an article by Asselta. [16] In addition to extensive training in the core competencies of emergency nursing, this 6-month program included exemplars in EBP and its positive impact on patient care and/or ED workflow. One of the requirements for this program was for the nurses to participate in developing an EBP project specific to emergency nursing practice. An example of a project comparing intravenous (IV) push medications versus IV piggyback medications was shared. This project demonstrated the advantages of the IV push route of administration, which yielded significant cost savings for the organization.

Pediatric nurses were the focus of a project described by Cline et al. [17] They evaluated nurses’ perceptions of barriers, facilitators, confidence, and attitudes toward research and evidence-based practice. There were 369 nurses who completed the survey during the baseline data collection period, 288 nurses completed the 6-month survey, and 284 nurses completed the 12-month survey. The results indicated that implementation of a curriculum focused on research and EBP may be most successful when implemented with the availability of mentors, in a research-supported environment, with grant funding support for novice researchers, and with an ample amount of time allotted to complete a research study.

Many nurses work in long-term care. Higuchi and colleagues described a study that examined the impact of EBP practice change in ten long-term care (LTC) settings in Canada. [18] Introducing and sustaining practice changes that enhance the quality of care is a significant challenge in LTC facilities. A full-day workshop that included identifying success stories, describing current practice challenges, building a case for change, seizing the moment, and identifying an action plan was presented at each site. Participants completed a questionnaire at the end of the workshop, and all participants were invited to participate in semi-structured interviews five months after the program. The benefits identified in the follow-up interviews were initiating the change process and enhancing team collaboration. This study demonstrated that an interactive workshop had important positive effects on LTC staff.

Clinical nurse educators were the focus of a study conducted by Dagg and colleagues. [19]  Centralization of a new clinical nurse educator (CNE) role created role confusion and poor role outcomes. An evidence-based quality improvement project was completed to integrate the ANPD practice model and transition to the practice fellowship program. An ANPD competency assessment survey tool was selected because it included information specific to the CNE role expectations. The nurse-sensitive indicators selected were fall rates and indwelling urinary catheter rates. Self-assessed competencies and nurse-sensitive quality outcomes of the CNEs were measured before and after the ANPD practice model was integrated into their daily practice. There were only 5 CNEs who completed both the pre-and post-assessment, but results supported that CNEs influenced patient quality outcomes and improved their self-assessed competency.

Phan and Hampton described an evidence-based project focused on promoting civility in the workplace by addressing bullying in new graduate nurses using simulation and cognitive rehearsal. [20]  Nurse bullying (NB) has been a problem for many years, and this can threaten the safety of patients, nurses, and organizations. This study used a mixed-methods, quasi-experimental design.

The NPD Scope and Standards were used to assess, plan, implement, and evaluate the project. In addition to the demographic data collected at baseline, participants completed the Clark Workplace Civility Index (CWCI) at baseline and three times after the intervention (immediately, 2.5 months, and five months). The sample included 36 new graduate nurses (NGNs). The intervention consisted of 2.75 hours of didactic, polling, reflection, simulation role-play, and debriefing. The training was developed virtually on the Zoom platform, and breakout rooms facilitated small group discussions and role-playing. Although there was no statistically significant increase in civility scores, the qualitative data indicated the participants could apply knowledge and skills from the intervention to improve communication, peer relationships, teamwork, patient safety, and care.

• Clinical Significance

Evidence-based practice falls under the champion for scientific inquiry role of the NPD practitioner. According to the NPD scope and standards of practice, the NPD practitioner promotes a spirit of inquiry and assists with generating and disseminating new knowledge. The NPD practitioner also uses evidence to advance the specialty of NPD and guide practice.

The ultimate goal is to promote the quality of care for the healthcare consumer. Competencies for scholarly inquiry include acting as a champion for inquiry, generating new knowledge, and integrating the best available evidence into practice. In addition, the standards include disseminating inquiry findings, including evidence-based practice and quality improvement activities, through educational and professional development activities.

• Enhancing Healthcare Team Outcomes

The healthcare consumer is the ultimate recipient of NPD practice. Therefore, NPD practitioners collaborate with the interprofessional team to ensure quality care, leading to optimal care outcomes and population health. Interprofessional partnerships are critical factors in achieving safe, effective, high-quality care.

• Review Questions
• Access free multiple choice questions on this topic.
• Comment on this article.

Disclosure: Barbara Brunt declares no relevant financial relationships with ineligible companies.

Disclosure: Melanie Morris declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Brunt BA, Morris MM. Nursing Professional Development Evidence-Based Practice. [Updated 2023 Mar 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

In this Page

Bulk download.

• Bulk download StatPearls data from FTP

Related information

• PMC PubMed Central citations
• PubMed Links to PubMed

Similar articles in PubMed

• Beliefs and implementation of evidence-based practice among nurses in the nursing homes of a Swiss canton: An observational cross-sectional study. [J Clin Nurs. 2021] Beliefs and implementation of evidence-based practice among nurses in the nursing homes of a Swiss canton: An observational cross-sectional study. Perruchoud E, Fernandes S, Verloo H, Pereira F. J Clin Nurs. 2021 Nov; 30(21-22):3218-3229. Epub 2021 May 7.
• The Experience and Effectiveness of Nurse Practitioners in Orthopaedic Settings: A Comprehensive Systematic Review. [JBI Libr Syst Rev. 2012] The Experience and Effectiveness of Nurse Practitioners in Orthopaedic Settings: A Comprehensive Systematic Review. Taylor A, Staruchowicz L. JBI Libr Syst Rev. 2012; 10(42 Suppl):1-22.
• Strategies for advancing evidence-based practice in clinical settings. [J N Y State Nurses Assoc. 2004] Strategies for advancing evidence-based practice in clinical settings. Fineout-Overholt E, Levin RF, Melnyk BM. J N Y State Nurses Assoc. 2004 Fall-2005 Winter; 35(2):28-32.
• Review Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses [ 2014] Review Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses McCleery E, Christensen V, Peterson K, Humphrey L, Helfand M. 2014 Sep
• Review Critical Appraisal Tools and Reporting Guidelines for Evidence-Based Practice. [Worldviews Evid Based Nurs. 2017] Review Critical Appraisal Tools and Reporting Guidelines for Evidence-Based Practice. Buccheri RK, Sharifi C. Worldviews Evid Based Nurs. 2017 Dec; 14(6):463-472. Epub 2017 Sep 12.

Recent Activity

• Nursing Professional Development Evidence-Based Practice - StatPearls Nursing Professional Development Evidence-Based Practice - StatPearls

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers