Perceptions of Competence and Capability of Nurse Practitioners Who Work in an Emergency Department

Purpose: : There are no national mandates which educational pathway a NP who works in an emergency care (EC) must complete to work. Employers can hire any NP. The research questions were: (1) Do educational pathways of FNPs who work in an EC affect perceptions of competence/capability? (2) Are perceptions affected by prior experiences working as RN and an NP in any specialty? (3) How do NPs perceive the complexity of their role during month 1 and 12. Competence is defined as unique aspects of practice and provides a model for entry into practice. Capability is the extent an individual can adapt to change and continue to improve even in stressful turbulent environment. This research studied education pathways including: 1) On the job training only, 2) Academic ENP programs or 3) Fellowship ENP program.

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Design: : This was a non-experimental descriptive comparison study of FNP who work in EC.

Setting:: A convenience online survey sample of FNPs who worked in an EC were recruited from professional NP organizations, social media sites and snowball sampling. Finally, the directors of ENP Academic and Fellowship programs were emailed to share the questionnaire with their graduates.

Sample:: FNPs who currently worked in EC setting were included. Sample was 215 with 153 who were on-the-job training, 44 from Academic ENP programs and 18 ENP Fellows. Most were between 35-44, Caucasian, female and had a Master's degree. Most had worked in the EC as an RN greater than 5 years. Finally, 44% had worked in primary care as an NP prior to working in the EC.

Methods: : Participants were asked demographic questions, educational pathway, experience, complexity of role, and then given three instruments, the Survey of Competency, Capability and Complex Adaptive Systems Model. The first used the ENA ENP competencies and asked perceptions of competence at month 1 and 12 employment. The 2nd used the AAENP ENP Practice Standards and asked about perceptions of capability. The 3rd assessed perception of complexity of tasks and environment at month 1 and 12. An online survey with MANOVA was used to answer research questions 1 and 2. Wilcoxon signed-rank test was used for research question 3.

Results: : A MANOVA revealed statistically significant differences among the educational pathways on three competence subscales. No statistical difference was found on the combined capability subscales. However, no statistical difference was found on the combined capability subscales. On years practicing as an NP, MANOVA showed that NPs with more years practicing as an NP in any settings reported statistically significant higher scores compared to those with fewer years on the combined competence.

Implications:: Educational pathways affect competence but not in a clear pattern. RN experience does not affect perceptions of capability. Years as an NP affects perceptions of competence/capability the most. Perceptions of complexity of tasks/environments tend to decrease over 12 month. The ENP is a unique role working in turbulent environment. Employers need to understand certification and scope of practice. All new FNPs struggle the first year of clinical practice. Educators/employers must develop educationally sound competence to capability “Onboarding Processes."