Nursing Professional Development

Issues of Concern

Critical updates and changes in the 2022 standards can be found in the StatPearls companion reference, "Nursing Professional Development Standards." The scope of practice for the NPD practitioner reflects the changing landscape in healthcare. The NPD scope of practice defines the who, what, where, when, why, and how that drives nursing professional development practice. It is reflected in the updated NPD practice systems model, which includes inputs, throughputs, and outputs. All NPD activities occur in the context of interprofessional practice and learning environments. NPD practitioners continuously use environmental scanning to ascertain internal and external opportunities and challenges within the organization.

Evolving trends in healthcare and nursing education have influenced NPD practice. There is a continued emphasis on interprofessional education, collaborative practice, and EBP. Due to the various positions that focus on education, there is a need for role clarity for NPD practitioners. The updated standards outline differences between NPD practitioners, clinical nurse specialists, academic clinical nurse educators, and academic nurse educators. Other trends affecting NPD practice include longer life expectancy, burgeoning patient technology, healthy practice, learning environments, and global events.

NPD practice changed focus during the pandemic, transitioning from in-person to virtual educational delivery formats. One strategy described by Reid et al is to prepare NPD practitioners to teach in a virtual environment.[3] They had a transition-into-practice program that had to be taught virtually, and many NPD practitioners identified they had little experience teaching in a virtual format. The organization developed a blended learning program to assist NPD practitioners in facilitating learning in a virtual environment.

Staffing redeployment during COVID-19 was an issue during the pandemic. Several approaches to address this were published. Fox and Richter described how their NPD practitioners were split into 3 teams to meet the demand for the orientation and training of frontline staff. One team was responsible for orienting new hire employees and travel nurses.[4] Another team trained staff for a different role or unit due to the low census in their unit. The third team was responsible for real-time education and support of all staff in the clinical units. They identified this as a hat trick when a player achieves 3 goals in a single game. The NPD team achieved 3 goals to meet the demands for ongoing education and training of all staff.

Another approach to surge staffing was identified by Kelley et al.[5] Their organization changed from primary nursing to a team nursing model and introduced RN extenders and senior or graduate nurses for each level of care environment. RN extenders had to have at least 12 months of clinical experience, no corrective action in the last year, and completion of competencies in their current clinical setting. These employees assisted in monitoring changes in patient status, performing nursing tasks, providing patient education, documenting care, and reporting back to the RN team leader. Senior and graduate nurses with and without a professional RN license were also used. Many state boards of nursing initiated emergency care guidelines that allowed nursing students to assist in staffing without violating the State Nursing Practice Act.

NPD practitioners support the transition of nurses and other healthcare team members across learning and practice environments. With the new practice arenas come new roles for nurses. The Future of Nursing Report from the Institute of Medicine challenged nurses to assume new and expanded roles to help meet the evolving needs of the healthcare system. There are now nurse navigators, health coaches, community health workers, and many new roles in nursing informatics, telehealth, and patient safety. Nursing as a profession and associations such as ANPD are working to increase diversity in the field. We need diverse practitioners to help meet the needs of the diverse population.

Return on investment is another important concept impacting NPD. Ongoing restrictions and healthcare changes continue to reshape how healthcare organizations operate and how they measure success. Return on investment (ROI) is a key factor in the viability of any organization. NPD practitioners must establish and articulate the financial and clinical impact of NPD practice through ROI data.[6][7] NPD practitioners can use this method to evaluate education priorities and allocate resources based on statistically relevant data. Demonstration of ROI allows NPD practitioners to compete for limited resources. An updated known cost of outcomes table was included in the 2018 article. This helps NPD practitioners identify improved outcomes' financial value and calculate economic impact. This table is updated regularly; a copy of the 2020 edition can be found on the ANPD website.

Research in the field of NPD has increased. Harper et al. detailed the task force's work on redesigning ANPD’s small research grant process.[8] One of the purposes of this group was to develop a cost-effective framework to advance the scientific research base of the specialty. They identified a spirit of inquiry approach, a consistent, intentional, and applied professional curiosity, as a key element of modern NPD practice (p. 119). They collected data from randomly selected ANPD convention attendees using a round table discussion from Journal for Nurse in Professional Development editorial board members. They included an open-ended question about the ANPD annual convention evaluation beginning in 2016. Ten spirit-of-inquiry areas identified were:

1. Determination of strategies that significantly increase the engagement of learners
2. Types of technology that enhance learning
3. Development of learning outcome metrics
4. Strategies to sustain behavior change pursuant to NPD intervention
5. Strategies that result in successful career and care continuum transitions
6. NPD practices or programs that significantly impact outcomes (residencies, onboarding, competency management, life support, etc)
7. Examine models (Lean, Six Sigma, etc) that create more efficient and effective NPD practices       a. Time studies       b. Interruptions
8. Examine stakeholders’ views that impact the perceived value of NPD practice, role, and influence       a. Chief nursing officers       b. Managers       c. Chief financial officers       d. Academic educators
9. Factors that increase the "buy-in" of stakeholders and target audiences
10. Strategies that influence the adoption of interprofessional development (pp. 121-122)

Numerous studies have been conducted in these focus areas. Phillips et al described a longitudinal, quasi-experimental sepsis simulation pilot study on the impact of boost methodology on nurse knowledge retention.[9] Boost methodology was used to stimulate the recall of information. Boosts can be done in various ways, including question-and-answer, scenarios, video clips, or statements that connect learners to previously learned content. Their findings suggested that boost methodology may impact nurse knowledge retention. This could affect healthcare organizations by decreasing the need to reeducate staff and decreasing the burden of traditional education formats.

Harper et al conducted a study on preceptor practice in 2020. ANPD used a nonexperimental, cross-sectional, descriptive design using the practice analysis method to identify the roles and competencies essential to preceptor practice.[10] Using the Ulrich Precepting Model to identify the roles, knowledge, and activities necessary for preceptor practice, they surveyed 3,623 preceptors. Within the spheres of quality, safety, and evidence, the Ulrich model identified seven roles of preceptors within the context of nursing and the broader healthcare system. The 7 roles identified were teacher or coach, role model, leader or influencer, facilitator, socialization agent, evaluator, and protector. The study validated the 7 roles and compared those roles with the NPD practitioner roles identified in the standards.

The capacity of the NPD leader has expanded. The value of NPD relies heavily on the ability to show value across the board in ways that benefit the entire organization. There is a StatPearls article specific to the NPD leadership role in advancing the specialty practice of NPD. An important responsibility of the NPD leader is to help develop a department plan that supports the organization’s mission, vision, and strategic goals. Leadership is not an organizational position but a personal, professional behavior. The Association for Nursing Professional Development has a Leadership Academy and an Evidence-Based Practice Academy to help NPD practitioners develop leadership skills.

As with any specialty, certification is available for NPD practitioners. In addition to the basic certification in nursing professional development offered through the American Nurse Credentialing Center, there is also advanced certification in nursing professional development offered through the Competency and Credentialing Institute. The advanced certification is portfolio-based.[11] A description of the development of this certification can be found in the article by Harper et al.[12]

Clinical Significance

NPD practitioners are critical in preparing healthcare personnel for current and future roles and helping individuals cope with an ever-changing healthcare environment. They facilitate the professional role development of nurses and other healthcare personnel, encouraging interprofessional education and collaboration. They become champions of scientific inquiry by promoting the generation and dissemination of new knowledge and the use of evidence to influence NPD practice, guide clinical practice, and improve patient care. They actively support, promote, and demonstrate NPD as a practice specialty.

Nursing, Allied Health, and Interprofessional Team Interventions

The focus of NPD practice is the healthcare consumer or partner. All NPD activities occur in the context of interprofessional practice and learning environments. NPD practitioners work with members of the interprofessional team to achieve desired outcomes. The outputs of NPD practice include learning, change, and professional role competence and growth, which help achieve optimal care outcomes and population growth.