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Access to care is a critical topic of discussion at the national and state levels as efforts continue to address health inequities across the country. One proposed solution has been the enactment of full practice authority (FPA) of nurse practitioners (NPs). Since the inception of the NP role, there has been on-going debate about the impact of NPs on health outcomes, economics of our health care infrastructure, and the appropriate level of practice authority that should be associated with the role. The purpose of this integrative review is to evaluate what is known about the impact of NP state practice regulation on health and health outcomes. This integrative review, following the methods of Whittenmore and Knafl, was conducted from January 1992 through April 2025. Comprehensive searches were conducted in PsychInfo, CINAHL, and PubMed databases using the concepts: NP, access to care, health outcomes, and state practice regulations. After inclusion and exclusion criteria were applied, 13 studies were included. Results were categorized under three themes: provider density, health, and health outcomes. Evidence from the literature suggests that at a minimum, FPA does not worsen health outcomes but rather positively influences that state's workforce migration, retention, and provider-to-patient ratios. These findings support the need for states with reduced or restricted practice authority to adopt FPA. This evidence is a resource for nurses, who engage with policymakers on the topic of granting FPA in their states.

The sustained well-being of the nurse practitioner (NP) workforce is threatened by pervasive role ambiguity. This ambiguity is frequently cited as a barrier to successful professional integration and practice. Although existing literature acknowledges this issue, it lacks a formal definition within the context of NP practice. This omission prevents targeted evaluation of its true impacts and the development of effective interventions. The purpose of this article is to present a concept analysis of role ambiguity within the NP context. Rodgers' evolutionary concept analysis was used. A targeted integrative literature review was conducted across PubMed, CINAHL, and Scopus. This process resulted in 29 articles selected for thematic analysis. The analysis revealed NP role ambiguity manifests as both an internal professional identity conflict and an externally imposed issue driven by systemic barriers. The derived working definition is a state of confusion or lack of clarity regarding the practice authority, scope of practice, abilities, and educational preparation of NPs experienced not only by NPs themselves but also by health care consumers, other health care staff, administrators, and the public ultimately leading to decreased job satisfaction, difficulties in professional identity formation, and the marginalization of NPs. Key attributes include conflict over scope of practice and the discrepancy between the anticipated and actual NP role. Antecedents span legal, organizational, and financial barriers, with consequences such as underutilization and burnout. These findings require recognizing NP role ambiguity as an externally imposed systemic challenge that generates internal conflict. Nurse practitioners should leverage this clarified definition to advocate for broader professional recognition and guide the implementation of external strategies, such as targeted education campaigns and policy advocacy, to support professional sustainability.

Nurse practitioners (NPs) play a major role in delivering primary and chronic care to Medicare beneficiaries, making their prescribing patterns an important area of study. This study examined national trends in NP prescribing under Medicare Part D from 2013 to 2022, focusing on overall prescribing volume, prescriptions per Medicare beneficiary, and condition-specific prescribing patterns compared with physicians and physician assistants. We conducted a retrospective analysis of the Centers for Medicare and Medicaid Services Medicare Part D Prescribers dataset from 2013 to 2022. Trends in total prescriptions, prescriptions per Medicare beneficiary, and prescribing by provider type were analyzed. Condition-specific analyses focused on cardiovascular, neuropsychiatric, and endocrine conditions, comparing prescribing patterns across provider groups. Total Medicare Part D prescriptions increased modestly between 2013 and 2022, while prescriptions per Medicare beneficiary declined. During this period, NP prescribing increased substantially, accounting for 15.6% of all Part D prescriptions by 2022, while the proportion attributed to physicians decreased. Cardiovascular, neuropsychiatric, and endocrine medications represented nearly 60% of NP prescriptions. Across these clinical areas, NP prescribing increased alongside stable or modest changes in specialist prescribing, indicating redistribution of prescribing responsibility rather than an increase in prescribing intensity. Nurse practitioner prescribing for Medicare beneficiaries expanded markedly over the past decade, particularly within key chronic disease categories. These findings point to the expanding role of NPs in medication management for older adults and emphasize the need for adequate training and support as they take on a larger share of care for Medicare beneficiaries.

Nurse practitioners (NPs) in the United States have an expanding role in medication prescribing and management as professional autonomy increases. To synthesize up-to-date, US-based evidence on NP and physician prescribing with respect to quality, patterns, and longitudinal trends. We searched Medline, Cumulative Index to Nursing and Allied Health Literature, PubMed, and PsycINFO (June 2024-December 2025) for US quantitative studies published since 2000 comparing NP and physician prescribing quality, patterns, or trends. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews framework, three reviewers screened 3,031 records with consensus resolution. A total of 17 studies were included. Prescribing quality was generally comparable between NPs and physicians, although findings related to opioid and antibiotic prescribing were mixed. Prescribing patterns varied by medication type and practice setting, with NPs accounting for a higher proportion of psychotropic and chronic disease medications and greater use of noncontrolled or over-the-counter medications in rural areas. Over time, NP prescribing increased, opioid prescribing declined, and adoption of newly approved medications was slower than physician prescribing. NP prescribing is generally comparable to physician prescribing across several quality indicators, with variation observed by medication type, outcome measure, and clinical context. The findings support the integration and expansion of NP-provided medication management as a means of meeting patient care needs without compromising quality. Variation in NP prescribing across medication types and practice settings highlights the importance of supporting NP prescribing roles with resources and clinical supports that are tailored to therapeutic area and practice setting.

The demand for advanced practice registered nurses is surging in response to evolving health care needs and workforce shortages, particularly in pediatrics. These shortages underscore the importance of retaining pediatric nurse practitioners (PNPs). Lack of mentorship can pose challenges in transition to practice for PNPs, and there is limited research on the implications of mentorship. To evaluate the relationship between having a mentor and the duration PNPs remain in their first professional role, describe the prevalence of mentorship among PNPs, and explore key characteristics of those mentoring relationships. This study used convergent mixed-method design. A 28-question survey created by the authors sent to certified PNPs. Primary quantitative analysis used univariable/multivariable logistic regression models with mentorship status as the primary exposure and descriptive analysis of other variables. Analysis of open-ended questions analyzed with qualitative descriptive method with coding by two independent coders. Results indicate that having a mentor in their first position was significantly associated with greater odds of remaining in that role (odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.06-1.96). Among 599 PNPs no longer in their first position, mentorship in the first role was associated with increased odds of remaining in the position for over 2 years (OR = 2.59, 95% CI: 1.84-3.63). Qualitative analysis identified three main themes relating to PNPs and mentoring including "time to transition," "guidance and support," and "shaping the future." This study highlights the importance of mentorship when transitioning to practice for PNPs and its potential long-term effect on retention.

Collaborative testing (CT) and its implementation into nurse practitioner (NP) programs is not well understood. Given the adoption of competency-based learning in nursing curricula, a pilot of CT in an NP program was implemented at a large, urban university. Over two years, CT was applied in three NP courses using integrated testing software. Students from two family NP cohorts (N2023 = 36 and N2024 = 34) who participated in the CT modality were evaluated for their feedback. The aim was to evaluate examination score outcomes and the student experience with the CT modality. Reported findings include examination scores from two NP courses and cross-sectional survey results with quantitative and qualitative findings. The mean examination score change from individual to weighted total was 6.3% in the 2023 cohort and 2.69% in the 2024 cohort. Students were surveyed with a questionnaire on their experience with CT at the completion of three courses. A means analysis shows high scores of student experience with CT and a paired t -test indicates a difference between the cohorts ( p < .0001). An analysis of one qualitative question through thematic analysis is presented, and findings show students have a positive experience in relation to knowledge retention, decreased test anxiety, and peer collaboration. Minimal barriers were identified in the execution or delivery of CT. Our findings indicate that CT may be efficiently implemented into NP courses, improve student outcomes and experience, and support competency based education.

Nurse practitioner (NP) programs must strike a balance between competency-based education and time-based requirements. Direct patient care clinical hours (DPCC) are widely used, yet the relationship between DPCC hours and certification outcomes remains unknown. To examine whether DPCC hours are associated with NP certification pass rates and domain scores. The survey was sent to 462 nursing schools with either family nurse practitioner or adult gerontological primary care nurse practitioner programs in the United States to compile NP certification pass rates and domain scores from American Nurses Credentialing Center (ANCC) and American Academy of Nurse Practitioners Certification Board (AANPCB) reports (2019-2023), as well as other school characteristics. Pearson correlations assessed association between DPCC hours and pass rates. Generalized estimating equations (GEE) regression estimated the odds of achieving a perfect pass rate (100%) and a pass rate of at least 80% as a function of DPCC hours modeled as a threshold (&#x2264;750 vs. >750), adjusting for year, faculty-to-student ratio, and total simulation hours. Direct patient care clinical hours positively correlated with pass rates. In AANPCB models, schools with >750 DPCC hours had an eightfold greater odds of a perfect pass rate (AOR = 8.306, p < .001) and fourfold greater odds of at least 80% (AOR = 4.739, p = .008) compared with those with &#x2264;750 hours. In ANCC models, schools with >750 hours showed 3.5 times higher likelihood of having perfect pass rates (AOR = 3.500, p = .075) compared with schools with &#x2264;750 hours. Higher DPCC hours are associated with improved certification examination performance. These findings provide support for a minimum of 750 DPCC hours.

In 2020, approximately 17% of the US population was older than 65 years and is projected to double by the year 2050. In Hawai'i, the k&#x16b;puna (older adult) population percentage is higher than the national average, with 19% of the state's population being 65 years or older. Additionally, life expectancy in Hawai'i is the highest in the United States, with an average lifespan of 81 years, compared with the national average of 77 years, and 71 years in the state with the lowest life expectancy. The rapidly growing proportion of the population older than 65 years makes it vitally important that the United States and Hawai'i prepare a workforce of highly skilled, competent, and confident health care professionals who can provide geriatric care. The purpose of this article is to describe an innovative, evidence-based geriatrics curriculum called "Aging With Grace." The learning activity fostered intraprofessional collaboration, defined as collaboration among individuals from varied backgrounds within the same discipline, including nurse practitioner and prelicensure registered nurse (RN) students. This curriculum was designed to 1) improve knowledge and competency in caring for k&#x16b;puna (older adults), 2) apply skills to a simulated scenario caring for a k&#x16b;puna with complex needs in a safe and positive environment, 3) build competency in intraprofessional collaboration and promote career ladder growth for RN students, and 4) develop competency in telehealth.

Previous research has empirically demonstrated that personal resilience and organizational level interventions are important considerations when studying workplace adversity such as burnout and excessive workloads in the context of a pandemic. To explore interest in participating in a wellness initiative program designed specifically for advanced practice registered nurses (APRNs) and physician associates (PAs), with a voluntary option for participation in research. An anonymous, brief, online survey with Likert-response type items and one free-text question was delivered with passive informed consent via email to all APRNs and PAs (N = 312 participants) within one health care system. A positive correlation between likelihood of seeking well-being care and having sufficient time (0.36, p < .01) was found, which indicates that APRNs or PAs who felt they had sufficient time to get counseling were actually more likely to seek counseling services. Results from the path model show that the comfort-level of seeking counseling completely mediates the relationship between fear of negative perceptions of receiving counseling and the likelihood of participating in a wellness program. Well-being strategies are important for organizations to engage in to support their employees; however, confidentiality concerns and competing priorities for time may influence engagement. Interest among APRNs and PAs for participation in research exists if enough information is provided and anonymity can be assured. Organizations should focus on finding innovative ways to integrate wellness into APRN and PA practice that mitigates the belief around the burden of time commitment and seeks ways to provide psychological safety for its employees.

The nurse practitioner (NP) role in India is emerging within a health care system historically structured around physician-centered hierarchies and task-based nursing models. This reflective narrative describes my professional transition from a staff nurse to an NP in Critical Care (NPCC), emphasizing the interconnected dimensions of clinical growth, role identity development, and systemic challenges in the Indian context. Drawing on lived experiences and supported by national and international literature, this account highlights the transformative learning trajectory-from task-oriented bedside nursing to advanced clinical reasoning, diagnostic interpretation, and shared decision making expected of NP practice. The transition was shaped by steep learning curves, limited institutional readiness for NP integration, inconsistent preceptorship, role ambiguity, and restricted autonomy, all of which echo barriers reported across India's NPCC implementation. The narrative also explores personal and professional identity evolution, including the shift from functional nursing duties to an advanced practice mindset grounded in evidence-based care, patient advocacy, and leadership. Persistent challenges, such as unclear scope-of-practice policies, resistance from hierarchical structures, and absence of dedicated NP positions in many hospitals, reflect systemic gaps requiring urgent policy action. Despite these barriers, the NP role demonstrated significant potential for strengthening critical care delivery, enhancing clinical outcomes, and addressing workforce shortages. This reflective account underscores the need for legislative clarity, structured preceptorship models, institutional role integration, and ongoing professional development to ensure successful NP role expansion in India. The insights contribute to global dialogues on advanced practice nursing and emerging NP roles in low- and middle-income countries.

Most cervical cancer is preventable, with approximately 90-95% of cases caused by persistent high-risk human papillomavirus (HPV) infection. International women may encounter barriers to cervical cancer prevention due to limited access to education and screening in their home countries. The local problem is that female international students studying in the United States may lack knowledge about HPV and cervical cancer prevention practices available through university health clinics. This quality-improvement project surveyed 355 female students (298 United States, 57 international) at a northeastern US university between October and December 2024 using validated tools that asked questions about knowledge and practices of cervical cancer prevention. Significant knowledge gaps were identified in both groups. Among students 21+ years meeting Pap smear screening criteria, 60.4% of US versus 35.5% of international students reported having had a Pap smear ( p = .0219). The primary barrier for US students was fear of pain (45.3%), whereas for international students, it was lack of understanding of the examination (60%). International students demonstrated lower knowledge across multiple areas, including HPV testing (32% of international vs 54.7% of US students knew that positive HPV did not mean cancer, p = .00256) and screening guidelines (10.4% of international vs 89.6% of US students knew that screening begins at age 21 years, p = .001). Both US and international students rely heavily on social media for their health care information, raising concerns about misinformation. Targeted educational interventions are needed, particularly for international students who may have unique barriers to cervical cancer prevention services.

Alzheimer disease (AD) continues to be underdiagnosed and undertreated in primary care despite the high and growing prevalence. Lack of diagnosis becomes more pressing with the availability of disease-modifying therapies (DMTs) that can slow disease progression during a narrow window of time in the course of the disease. Nurse practitioners (NPs) are central to closing these practice gaps, but persistent deficiencies in knowledge and confidence highlight the need for focused continuing education (CE). A 1.6-hour CE activity was developed on the importance of early AD diagnosis, interpretation of DMT clinical trial data, and strategies to improve DMT access. Outcomes were assessed using pre- and post-activity surveys and a 60-day follow-up survey. A total of 6,541 learners completed the program, the majority of whom were practicing NPs providing direct patient care. Collectively, these providers reported caring for over 35,000 patients at risk for cognitive impairment each week. The CE program led to a remarkable 38% improvement in knowledge, with significant gains across all assessment items (p < .001). The greatest gains were in recognizing the prolonged asymptomatic phase of AD (418% improvement) and identifying risk factors for the primary adverse effect of DMTs (50% improvement). Confidence in key domains improved significantly, with 75%-79% of follow-up respondents who see patients reporting sustained confidence gains. At 60 days, 59% had implemented at least one practice change. This CE program reached a large NP audience and improved knowledge, confidence, and reported practice behaviors related to AD early diagnosis and DMTs.

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The growing demand for mental health services in the United States has intensified pressure to expand the psychiatric workforce, prompting some systems to consider deploying nonpsychiatric nurse practitioners (NPs), such as family, adult-gerontology, and pediatric NPs, to independently staff psychiatry-only practices. This essay argues that such a strategy is unsafe, unethical, and inconsistent with advanced practice nursing standards. Psychiatric-mental health NPs receive specialized training in psychopathology, advanced assessment, psychopharmacology, and psychotherapy that generalist NPs do not. The diagnostic and pharmacologic complexity of specialty psychiatric care, particularly for severe and treatment-resistant conditions, amplifies the risks of misdiagnosis, inappropriate prescribing, and inadequate risk management when care is provided by nonspecialists. Case-based evidence and regulatory guidance highlight patient safety concerns and liability exposure when NPs practice beyond their certified scope. The essay differentiates appropriate mental health management in primary care from specialist psychiatric practice and rebuts arguments grounded in workforce shortages and "experience-based" competence. It concludes by outlining safer evidence-informed solutions, postmaster's psychiatric-mental health NP certification, telepsychiatry, and collaborative care models, that expand access while maintaining high standards of psychiatric care.

Teaching and assessing lung point-of-care ultrasound (POCUS) requires attention to both image acquisition and interpretation. Eye tracking offers an objective approach to examining visual attention during scanning, yet its use in hands-on ultrasound training remains limited. This convergent mixed-methods study used eye tracking to characterize visual attention and performance during lung POCUS training. Thirty-five nurse practitioners completed simulation-based lung POCUS training while wearing eye-tracking glasses; three experts completed the same protocol for comparison. Performance was assessed using image acquisition time, fixation metrics, site-level performance scores, and the Objective Structured Assessment of Ultrasound Skills (OSAUS). Mixed-effects models examined learner and contextual factors, including patient, instructor, and equipment characteristics, and their associations with post-training confidence and interpretation accuracy. Experts demonstrated faster image acquisition and more focused gaze patterns than learners. Performance varied across lung zones, with lateral and basal regions presenting the greatest challenges. Lower patient adiposity facilitated scanning, whereas baseline knowledge and confidence were not associated with performance. Higher gaze-based performance was associated with greater post-training confidence, and OSAUS scores were associated with interpretation accuracy. Instructors reported that video-based review was valuable but emphasized that gaze data alone were insufficient without contextual views of probe handling. When used as an analytical approach, eye tracking provides complementary insight into scanning performance and may help inform targeted, site-specific lung POCUS training strategies.

Insomnia affects over one third of adults and is associated with worse health outcomes and greater health care costs. Traditional pharmacologic treatments for insomnia have side effects and limited long-term efficacy. Patients may self-medicate with alternative therapies including medical cannabis, but there are few resources to guide clinicians in evaluating the potential impact of such self-care. A systematic review and meta-analysis were conducted to evaluate the effectiveness, safety, dosing strategies, administration routes, and monitoring practices associated with medical cannabis use in adults with insomnia. Comprehensive searches were conducted in PubMed, Embase, CINAHL Ultimate, and PsycINFO. Cannabinoid formulations included cannabidiol (CBD), cannabinol (CBN), delta-9-tetrahydrocannabinol (THC), alone or in combination, administered by oral capsules, oils, or sublingual solutions. Monitoring practices varied but frequently included sleep diaries, actigraphy, and validated scales such as the Insomnia Severity Index and PROMIS Sleep Disturbance. Medical cannabis may decrease sleep disturbance and daytime sleepiness while increasing total sleep time, with a favorable safety profile and minor adverse effects when dosed and monitored appropriately. CBD doses of 50-300 mg and CBN doses of 20-100 mg were found to be safe and effective for improving sleep. Doses of CBD <50 mg were only effective with the addition of CBN. Formulations with THC did not show significant improvement in sleep and had higher reports of adverse effects. Clinicians should advise patients self-treating with cannabis to avoid THC and start with a low dose of CBN or a combination of CBN/CBD.

Family Nurse Practitioner students often navigate graduate education while managing personal, professional, and emotional stressors. Many enter programs with histories of trauma, which may impair learning and performance in rigid, high-stakes academic environments. This pilot study explored the feasibility and perceived impact of implementing trauma-informed educational practices (TIEP) in an asynchronous Family Nurse Practitioner course using the Substance Abuse and Mental Health Services Administration's six principles to trauma-informed care as a framework. A mixed methods design was used with two consecutive student cohorts. Trauma-informed strategies were embedded into the course. Quantitative data were collected by pre-intervention and postintervention surveys. Qualitative feedback was obtained from open-ended responses and course evaluations. All students who completed the pre-intervention survey ( n = 25) reported at least one adverse childhood experience, with over half citing trauma related to their nursing practice. Post-intervention surveys ( n = 12) indicated high satisfaction with the trauma-informed course modifications. Thirty-three students provided qualitative feedback through the postintervention survey and course evaluations. Across data sources, students emphasized emotional safety, faculty connection, and the value of wellness reminders. Three themes emerged: (1) prioritizing wellness and emotional safety, (2) trauma is a daily lived reality for students, and (3) connection and communication. Findings suggest that TIEP can be feasibly integrated into asynchronous graduate Nurse Practitioner (NP) education and are well received by students. Although the study did not measure academic or clinical performance outcomes, TIEP aligns with the American Association of Colleges of Nursing Essentials for competency-based graduate education and supports ethical preparation for advanced practice.

Transitioning from graduate school to independent practice for nurse practitioners (NPs) and physician assistants (PAs) is particularly challenging in high-acuity or specialty areas, where additional training, mentorship, and support are critical. Without such support, NPs and PAs often experience job dissatisfaction, burnout, and increased turnover, leading to substantial organizational costs. Postgraduate fellowship programs have emerged as a solution to these issues by providing structured education and mentorship that enhance clinical competence and professional development. This article explores an Acute Care Advanced Practice Provider Fellowship (ACAPPF), a postgraduate fellowship accredited by the American Nurses Credentialing Center Advanced Practice Provider Fellowship Accreditation. This accreditation recognizes transition-to-practice programs for NP and PA programs designed to support the development and management of novice NPs and PAs transitioning to independent practice. The ACAPPF program focuses on developing and implementing innovative educational strategies, including high-fidelity simulation, ultrasound training, professional development learning modalities, psychosocial support, and a unique partnership with medical education. The program emphasizes clinical competency, patient safety, provider resilience, and role integration, ensuring that new NPs and PAs can perform and deliver quality care in high-acuity situations while fostering personal and professional growth. Through its comprehensive curriculum, the ACAPPF helps to bridge the gap between academic preparation and independent clinical practice, contributing to the long-term success and satisfaction of NPs and PAs in complex health care environments.

This article explores the evolving landscape of pharmacogenomics (PGx) and the shift from reactive to preemptive testing in clinical practice. Although many PGx tests are currently performed after adverse drug reactions or when considering specific drugs, there is a growing movement toward obtaining genetic information before medication decisions are made. Through the case of Sarah Jenkins, the article demonstrates how identifying genetic variants related to drug metabolism can guide personalized treatment plans, leading to reduced adverse side effects and improved patient outcomes. Key benefits include the prevention of toxicity, reduction of health care costs by avoiding trial-and-error prescribing and related complications, and enhanced patient engagement. Challenges to widespread implementation are discussed, such as the need for comprehensive health care provider education, data privacy and security concerns, and significant cost and reimbursement barriers, particularly in the US health care system. The article concludes by emphasizing the necessity of finding solutions to these challenges to unlock the full potential of preemptive PGx testing and ensure equitable access to personalized medicine.