Nurse Practitioner Issue and PICOT Question
Select an issue in nurse practitioner (NP) practice that is of interest to you and in which you would like to see a practice change occur. Conduct a review of literature to see what is currently known about the topic. Describe the scope and relevance of the issue and your recommended change. Provide reference support from at least four outside scholarly sources to support your ideas. Then create a PICOT question for the issue using the template below:
In ________(Population) what is the effect of ___________(Intervention) in comparison to ___________ (Comparison) on _____________ (Outcome) to be completed over __________ (Time).
Describe each element of your PICOT question in one or two sentences, being sure to address all of the following:
P-Population and problem– What is the nursing practice concern or problem and whom does it affect?
I–Intervention– What evidence-based solution for the problem would you like to apply?
C–Comparison– What is another solution for the problem? Note that this is typically the current practice, no intervention at all, or alternative solutions.
O–Outcome– Very specifically, how will you know that the intervention worked? Think about how you will measure the outcome.
T–Time frame– What is the Timeframe involved for the EBP initiative or the target date of completion?
Adapted from Melnyk, B., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare (4th ed.). Wolters Kluwer.
You can create the issue just choose something that has enough research for the review of literature. Any questions let me know please.
The Selected Issue that Affects Nurse Practitioner Practice
Nurse practitioners play a critical role in improving health and patient outcomes. Job retention is a significant factor that influences NPs’ practice and the ability of the NP to improve health and patient outcomes. Job retention for a nurse practitioner is a reflection of job satisfaction which is determined by various factors, mainly burnout. Turnover rates among nurse practitioners are significant as they influence staffing ratio and health care costs. Nurse retention is not only important for nurse practitioner’s practice but also for hospitals as they strive to hold on to experienced and novice nurses (Lockhart, 2020). Working hours have been strongly linked to job satisfaction, which affects retention. The role of a nurse practitioner is demanding; hence NPs may strive in practice to meet expectations and fulfill their duty.
Turnover rates are common among new nurses, with 18% of nurses having a likelihood of changing jobs within the first year of graduation (Lockhart, 2020). The national turnover rates for the nursing profession range between 8.8% to 37.0% depending on the location and the nursing specialty (Haddad, Annamaraju, & Toney-Butler, 2020). According to the Bureau of Statistics, the national turnover rate for nurse practitioners is 12 %, which is twice that of the physicians (Hoff, Carabetta, & Collinson, 2019). There have been various aspects affecting the role of nurse practitioners. The most significant aspect is the expanded roles of nurse practitioners through full practice authority granted by the state laws. Expanded roles of NP have had implications on how practitioners experience their jobs, particularly due to burnout, work-related stress, and satisfaction. NPs are more likely to experience a reduced internal motivation, experience frustration due to limited ability to feel empowered, increased burnout hence exhibit lower job satisfaction increasing the desire to quit their jobs due to the demands of the job (Hoff, Carabetta, & Collinson, 2019).
Turnover rates among the nurse practitioner impact not only the practice but also the health care facilities. On average, health facilities lose between $4.4 to 6.9 % million annually due to nurse turnover (Lockhart, 2020). Shift length has been the most cited cause of nurse turnover, with healthcare facilities that utilize a 12-hour shift reporting more challenges with employee retention (Lockhart, 2020). Increased demand for health care has increased demand for primary care services offered by NPs. This has resulted in NPs working overtime and longer shifts to meet the current demand given the current shortage of primary care providers. Working overtime has been associated with fatigue, stress, burnout, while mandatory overtime is linked to lower commitment to the health organization (Son, Lee, & Ko, 2019).
The Scope and Relevance of the Issue and the Recommended Change
The turnover rates for nurse practitioners indicate a level of instability in the profession and pose challenges for maximum productivity in practice. With the projected supply gaps, especially in primary care, nurses, including nurse practitioners leaving their jobs has gained international attention to mitigate further shortages in healthcare professionals in the future. Turnover rates for nurse practitioners may worsen the current situation of shortages of primary care providers. Factors associated with turnover, including fatigue, high-stress levels, and burnout, affect the overall practice of NPs. It has an adverse impact on their performance, including their ability to collaborate effectively with other healthcare professionals. Current projections indicate that demand for health care, especially primary health care, will increase due to changes in a population characterized by an older population that will require health services to manage chronic diseases. This may strain NPs more as they meet the demand resulting in long working hours, which increases the likelihood of the NPs leaving their jobs due to increase workload, fatigue, stress, and burnout.
The recommended evidence-based change to promote retention of NPs in practice is the reduction of the working hours from a 12-hour working shift to an 8-hours shift. EBP comprises a problem-solving approach that integrates the best evidence from appropriate and well-designed studies to address health-related issues (Melnyk & Fineout-Overholt, 2018). There are different findings that support the recommended change. A 12-hour shift has been associated with increased job dissatisfaction and adverse effects such as fatigue, musculoskeletal disorders, and sleepiness compared to an 8-hour shift (Banakhar, 2017). Reduction of hours per shift is recommended to new NPs who are at an increased risk of leaving their jobs to lower job satisfaction. Based on the findings of a study indicate that nurses working a 12-hour shift reported less or no participation in education programs and fewer opportunities to discuss with other nurses about patient care (Emmanuel et al., 2020). New NPs require more time to facilitate collaboration and consultation with other health care providers and continuing education.
The PICOT question is: In new NPs (Population), what is the effect of an 8-hour shift (Intervention) in comparison to a 12-hour shift (Comparison) on reducing turnover rates (Outcome) to be completed over a year (Time). The issue of concern is turnover rates, and the target population is new nurses as they are at higher risk of leaving their jobs. The recommended change or the evidence-based intervention is implementing an 8-hour shift. Comparison is the current practice common in the majority of health care facilities, which is a 12-hour shift. The expected outcome is reducing turnover rates. The outcome will be measured through the number of NPs quitting their jobs, the number of those with the intent of quitting, and relating the incidences to low job satisfaction, fatigue, increased workload, and burnout. The timeframe is one year, a period in which chances of turnover are higher.