research article about nurse practitioners

Understanding nurse practitioner scope of practice: Regulatory, practice, and employment perspectives now and for the future

Affiliations.

• 1 RSHudspeth Consulting, LLC, Boise, Idaho.
• 2 Washington State University, Pullman, Washington.
• PMID: 31348141
• DOI: 10.1097/JXX.0000000000000268

The nurse practitioner (NP) role has existed for 50 years. During the past 10 years, a national effort to use NPs to the full extent of their education based on the 2008 Consensus Model for Advanced Practice Registered Nurse Regulation and the 2010 Institute of Medicine Report on the Future of Nursing continues to result in variable scopes of practice (SOP) between states. Subsequently, NPs have a lack of clarity on SOP because it relates to population foci and practice setting. Review and analysis of state-based statutes and rules with the current literature focused on NP SOP, including documents by the National Council of State Boards of Nursing, was conducted. Clarification and understanding of SOP is essential for safe practice and optimum access to care. Inconsistent SOP regulation continues to exist between states, and NPs can be in employment situations that place them in a position to possibly breech their SOP. Although practice is not setting specific, NP licensure is based on NP education and certification that is competency based within population foci, and credentialing by employers should align with these parameters. Continuing to work toward a more common NP SOP between states and achievement of full practice authority means periodic reassessment of NP education and practice models. Practice mobility is essential for continued advancement of the NP profession and increased access to care by the public.

Publication types

• Historical Article
• Employment / trends
• History, 20th Century
• History, 21st Century
• Nurse Practitioners / history*
• Practice Patterns, Nurses' / trends
• Scope of Practice / history*
• United States

Advocacy and the Advanced Nurse Practitioner

• First Online: 07 November 2022

Cite this chapter

• Mick McKeown 4  

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This chapter presents a critical appraisal of mental health nursing’s interest in and relationship to advocacy with a view to highlighting the role of advanced practice mental health nurses (APMHNs), amongst other team members, in both performing advocacy and respecting and acting upon the voice of advocates. In this regard, a distinction will be made between nurses taking up an advocacy role and the important role and function of independent advocates, the latter requiring understanding and support from nurses and health-care teams to be maximally effective. Nurses, thus, are charged with a responsibility to be advocates and support other advocates, especially in the case of recognition of the limitations of nurse advocacy. Within the nursing advocacy role, a further distinction will be made between advocating at the level of patient care for meeting the rights and needs of individuals and advocating on a broader stage for social justice ends salient to nursing and health care.

No voice is too soft when that voice speaks for others. — Janna Cachola (Janna Cachola is an actor, singer and author. This quote of hers has been taken up by numerous advocacy organisations, e.g. https://borgenproject.org/tag/quotes-about-advocacy/ .)

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McKeown, M. (2022). Advocacy and the Advanced Nurse Practitioner. In: Higgins, A., Kilkku, N., Kort Kristofersson, G. (eds) Advanced Practice in Mental Health Nursing. Springer, Cham. https://doi.org/10.1007/978-3-031-05536-2_18

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No. 1 Rankings for the School of Nursing and a Pipeline to the “Best Jobs”

According to  U.S. News and World Report  2024 rankings, the Johns Hopkins School of Nursing is the No.1 Doctor of Nursing Practice (DNP) program No. 1 nursing master’s program (tied). This is the third year in a row that our DNP program received the top ranking, and the master’s program continues to be among the top programs in the country.

In specialty areas, we ranked:

• No. 1 in NP Adult Gerontology Primary Care—DNP    
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The National Organization of Nurse Practitioner Faculties (NONPF) is advocating to standardize the DNP as the entry into practice degree for nurse practitioners by 2025, making our designation as the top program all the more impactful. And, U.S. News and World Report ranked nurse practitioners the No. 1 “Best Job” for 2024 as well.

Nurses make up the largest health care workforce, and one of the best things about the profession is that there are endless possibilities. At all levels, nursing is central to health care in the future.

Check out even more nursing roles ranked among the “Best Jobs ” and “ Best Health Care Jobs ”  

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What is a nurse practitioner? 

By Michael Feder

This article has been vetted by University of Phoenix's editorial advisory committee.  Read more about our editorial process.

Reviewed by  Raelene Brooks , Dean, College of Nursing

In this article

• Nurse practitioner vs. other practitioner roles
• Day-to-day responsibilities of an NP
• Types of nurse practitioners
• How to become an NP: Educational pathways
• Nurse practitioner salary information
• Learn nursing skills at University of Phoenix

The United States is experiencing a physician shortage . American Medical Association President Jesse M. Ehrenfeld, MD, MPH, cites “critical strains” on physicians and considers “an urgent crisis … hitting every corner of this country.” The physician shortage can limit access to vital healthcare for millions of Americans.

How can healthcare professionals — including nurses — reduce the impact of the shortage?

Part of the answer may lie with nurses who want to grow their skills and continue their education and career by becoming nurse practitioners (NPs).

Nurse practitioners fulfill a vital role in the healthcare system. An NP is an advanced practice registered nurse (APRN) who has completed additional training beyond that required of registered nurses (RNs). Nurse practitioners can provide either primary or specialty care, depending on their focus, education and experience.

Explore degrees that expand your skills and prepare you to lead in nursing. 

NPs work with patients of all ages and in various settings, including hospitals, clinics and private practices. NPs have extensive training that enables them to provide many of the same services as physicians, often at a lower cost . Depending on the state, they may also be able to practice independently without physician oversight, further increasing their ability to meet patients’ needs. In fact, an NP might be a patient’s primary healthcare provider.

Nurse practitioners undergo training to perform various duties , including:

• Conducting physical exams
• Ordering and interpreting diagnostic tests
• Diagnosing acute and chronic conditions
• Prescribing medications
• Providing health education
• Making necessary specialist referrals

Becoming a nurse practitioner involves substantial training and certification, including active licensure as an RN, a graduate degree in nursing and advanced clinical training. Read on to learn more about nurse practitioners, including their daily responsibilities, practices and differences from other healthcare professionals.

Nurse practitioner vs. other practitioner roles 

While nurse practitioners can share many of the same responsibilities as physicians or physician assistants, critical differences between professions go beyond experience and salary.

Nurse practitioners vs. doctors 

Even though nurse practitioners and physicians have overlapping responsibilities, key differences between the roles include education, training and scope of practice.

Medical doctors must complete a four-year undergraduate degree, four years of medical school and three to seven years of residency. NPs typically need a bachelor’s degree in nursing , a master’s or doctoral degree in nursing practice and to pass an NP board exam.

University of Phoenix requires all nurse practitioner students to attend a five-day, in-person residency. This is to ensure the efficacy of their training, says Raelene Brooks, PhD, RN.

Brooks is the dean of the College of Nursing, and she points to the importance of this program differentiator. During their residency training, students perform exams on live models as a way to put theory into practice and gain skills that will benefit them in healthcare settings.  

While NPs and medical doctors can diagnose conditions, prescribe treatments and act as primary care providers, the scope varies for NPs based on state laws. In some states, NPs can practice independently; in others, they must have a collaborative agreement with a physician.

Because of their shorter training period, NPs can often cost less to employ than medical doctors . This can help make healthcare more affordable and accessible in underserved areas.

Nurse practitioners vs. physician assistants 

Nurse practitioners and physician assistants (PAs) provide patient care services, but there are big differences in their education, training, practice model and areas of specialization.

Compared with the nursing background of NPs, which emphasizes a holistic approach to patient care, PAs usually focus on a disease-centered medical model.

To illustrate this difference, Brooks refers to a diabetes diagnosis. A physician or PA might focus on managing the illness through medication, she says, whereas a nurse practitioner will try to understand the patient’s community, diet and lifestyle as well. Does diabetes run in the family? Are there other ways, such as diet and exercise, to mitigate the effects of the disease? Understanding this will help them diagnose, educate and treat patients for their diseases.

Most PAs hold a master’s degree in physician assistant studies . Their education typically mirrors that of doctors, focusing on diagnosis and treatment, and the scope of care is greater. For example, nurse practitioners cannot provide surgical care, but physician assistants who work with surgeons may, for example, be able to close incisions and perform duties before, during and after surgery.

Areas of specialization and practice can overlap between NPs and PAs. NPs often serve specific populations like pediatrics, women’s health, mental health and older adults, while PAs also work in areas such as family medicine, emergency medicine and psychiatry. 

Nurse practitioners vs. registered nurses 

While NPs and RNs are types of nurses who play crucial roles in patient care, nurse practitioners have more education and responsibilities than RNs.

RNs usually hold a diploma, associate degree or bachelor’s degree in nursing. After completing the degree or program, they must pass the National Council Licensure Examination (NCLEX-RN) to become licensed RNs .

Although NPs all begin as RNs they must go on to complete a master’s or doctoral degree and additional clinical training. They must also pass a national certification exam in their specialty .

The responsibilities of NPs and RNs differ significantly. Consider the following job duties of RNs:

• Provide direct patient care
• Administer medications
• Monitor patient progress
• Educate patients and families

NPs have a broader scope of practice. They can diagnose and treat acute or chronic conditions, prescribe medication and perform certain procedures.

RNs and NPs can both work in different medical settings and gain experience in various fields. RNs might specialize in critical care or trauma, for example, and NPs can specialize in areas like family practice, pediatrics, adult gerontology, mental health and women’s health, among others.

Day-to-day responsibilities 

What does a nurse practitioner do each day? Like any nursing-focused profession, the answer depends on where they practice and what they specialize in. Generally speaking, however, NPs often perform the following tasks :

• Take medical histories and conduct exams
• Diagnose acute and chronic illnesses
• Develop treatment plans and prescribe medication
• Educate their patients on health promotion

Remember, the scope of an NP’s practice can vary based on their location, autonomy and specialty.

Types of nurse practitioners 

While not exactly among the many related but alternative careers to nursing , working as an NP does offer a discrete professional experience. That’s especially true if you want to specialize in a particular branch of care. Some nurse practitioners focus on family medicine, while others might devote their practice to pediatrics. Other specialties include psychiatric and mental health care, acute care and neonatal care.

NPs specialize in particular areas of focus and their education is tailored to their chosen focus. Let’s walk through a couple of specialties for NPs below.

Family nurse practitioner 

Family nurse practitioners (FNPs) focus on providing care for patients of all ages throughout their lives. That includes holistic care, disease prevention, counseling and more. FNPs often act as advocates who help their patients navigate the healthcare system, and they can coordinate care among specialists or other health providers. The role of an FNP can vary widely, depending on the state in which they practice and the healthcare setting they choose. Some FNPs may choose to work in a busy physician’s office, for example, while other FNPs dedicate their careers to caring for patients in rural areas.

Psychiatric mental health nurse practitioner 

Nurse practitioners focusing on psychiatric mental health help patients manage their mental health conditions with therapy and medication. Known as psychiatric-mental health nurse practitioners (PMHNPs), these professionals conduct comprehensive psychiatric evaluations to identify mental health issues, including substance use disorders, depression and anxiety. They’re also able to provide various forms of crisis intervention, including psychotherapy and medications.

The MSN/PMH program at University of Phoenix was launched in 2022 in response to national health trends outlined by the Office of Disease Prevention and Health Promotion , Brooks says. The UOPX program not only teaches disorder assessment and prevention, self-care management and psychotherapeutic intervention, she explains, but it also emphasizes the importance of identifying possible physical causes behind mental health disorders.

For example, Brooks mentions that hyperthyroidism can appear as substance abuse or even a mental health disorder. Having a solid understanding of physical health factors and assessing for those first can help PMHNPs provide more effective and accurate care. 

Educational pathways 

The educational pathways to becoming a nurse practitioner are relatively straightforward. It all starts with earning your RN license.

• If you’re an RN with an associate degree or nursing diploma, you’ll need to earn a Bachelor of Science in Nursing (BSN). BSNs strengthen relevant skills and help continue your progress toward graduate-level coursework.

The University of Phoenix RN to Bachelor of Science in Nursing helps you build on what your experience has taught you while empowering you to focus on advanced skills.

• If you already have a bachelor’s degree in an unrelated field and wish to earn your Master of Science in Nursing, the UOPX nurse bridge program could be right for you. This program begins with required nursing bridge courses that prepare students to choose one of five available master’s degree tracks. Two of these prepare students for nurse practitioner roles.
• If you already hold a bachelor’s degree in nursing and have three years of  full-time work experience within the past 10 years (two years of which are clinical-based RN experience), you can apply to either the Master of Science in Nursing/Family Nurse Practitioner or Master of Science in Nursing/Psychiatric Mental Health Nurse Practitioner programs.

In addition to the standard degree pathways, every prospective NP must successfully complete supervised clinical hours. University of Phoenix requires students to complete 600 hours of clinical experience through designated program courses.

After that, you’ll need to pass your state’s licensing exam and earn the appropriate certification(s) from the American Academy of Nurse Practitioners Certification Board or the American Nurses Credentialing Center (each requires periodic renewal). UOPX’s nurse practitioner programs academically prepare students for this step, Brooks notes.

Nurse practitioner salary 

Nurse practitioner salaries can vary based on many factors, including location, experience and specialty. As of May 2022, those who worked in hospitals and outpatient care centers earned more than NPs who worked in doctor offices or with other health practitioners. As of May 2022, nurse practitioners salaries ranged between $91,250 and $208,080 , according to the U.S. Bureau of Labor Statistics.

Salary ranges are not specific to students or graduates of University of Phoenix. Actual outcomes vary based on multiple factors, including prior work experience, geographic location and other factors specific to the individual. University of Phoenix does not guarantee employment, salary level or career advancement. BLS data is geographically based. Information for a specific state/city can be researched on the BLS website.

Consider a nurse practitioner role 

Because of their versatility and skill set, NPs fulfill a vital role in the communities they serve. Becoming a nurse practitioner is an excellent way for RNs to grow their knowledge and enhance their careers, especially in rural or other underserved areas.

Prospective NPs can leverage their existing skills and competencies to grow their education in one of UOPX’s two nurse practitioner programs:

• Master of Science in Nursing/Family Nurse Practitioner : In this program, you’ll gain such skills as research analysis, policy analysis, diagnosis formulation, treatment planning, patient education, holistic care, advanced assessment and much more.
• Master of Science in Nursing/Psychiatric Mental Health Nurse Practitioner : Learn how to treat psychiatric disorders within diverse populations. Areas of focus include assessment, intervention and pharmacological management.

To learn more about online nursing degrees at UOPX — including those that lead to a fulfilling career as a nurse practitioner — contact University of Phoenix.

ABOUT THE AUTHOR

A graduate of Johns Hopkins University and its Writing Seminars program and winner of the Stephen A. Dixon Literary Prize, Michael Feder brings an eye for detail and a passion for research to every article he writes. His academic and professional background includes experience in marketing, content development, script writing and SEO. Today, he works as a multimedia specialist at University of Phoenix where he covers a variety of topics ranging from healthcare to IT.

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The Johns Hopkins School of Nursing Has Been Ranked the No. 1 Doctor of Nursing Practice (Dnp) Program and No. 1 Master’s (Tied) by U.S. News & World Report for 2024.

Newswise — The Johns Hopkins School of Nursing has been ranked the No. 1 Doctor of Nursing Practice (DNP) program and No. 1 master’s (tied) by U.S. News & World Report for 2024.

“Our community of leaders keep us top-ranked in the nation,” says Dean Sarah Szanton, PhD, RN, FAAN. “This recognition brings us ever closer to improving health and eliminating health inequities for individuals, families, and communities.”

U.S. News and World Report’s named Johns Hopkins SON the best DNP program and named nurse practitioners as the “Best Job” for 2024.

In specialty areas, the school ranked:

• 1 in NP Adult Gerontology Primary Care—DNP
• 1 in DNP Nurse Practitioner: Psychiatric/ Mental Health, Across the Lifespan Programs
• 2 in NP Adult Gerontology Acute Care—DNP
• 3 in Nurse Practitioner (NP) Family—DNP (tied)
• 4 in Leadership—DNP (tied)

The Johns Hopkins School of Nursing was named the No. 3 nursing school in the world for 2023, according to QS World University . The school also leads in inclusive excellence. In 2023, JHSON earned its sixth consecutive HEED award from INSIGHT into Diversity and fifth consecutive “Best Schools for Men in Nursing” designation from the American Association for Men in Nursing.

With new technology at our fingertips and new, real-world demands emerging, there is a tremendous opportunity to redesign nursing education, and ultimately health care.

The school is preparing its curriculum for the future of health care with Dr. Robert Atkins, JHSON Executive Vice Dean is leading the shift: “We’re working with communities to diversify clinical placements, better leverage simulation and immersive learning, and prioritize core competencies over content.”

 In fall 2023, the school also launched the Institute for Policy Solutions, which champions nurse-led solutions that drive American health care policy and practice toward preventive, whole-person care.

Now and in the future, nurses will be a driving force in efforts to create a healthier world.

“It is our mission to improve health and reduce health inequities everywhere,” says Dean Sarah Szanton, PhD, RN, FAAN. “We achieve that by preparing future nursing and research leaders.”

*Previous U.S. News and World Report rankings were numbered by the year ahead, but the organization now refers to the current year in rankings.

Located in Baltimore, the Johns Hopkins School of Nursing is a globally-recognized leader in nursing education, research, and practice. In U.S. News & World Report rankings, the school is No. 1 nationally for its DNP program and No. 1 (tied) for its master’s. In addition, JHSON is ranked as the No. 3 nursing school in the world by QS World University. The school is a five-time recipient of the INSIGHT Into Diversity Health Professions Higher Education Excellence in Diversity (HEED) Award and a four-time Best School for Men in Nursing award recipient. For more information, visit www.nursing.jhu.edu .

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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.

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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-.

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• 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.
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