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The Leadership Experience of Advanced Practice Nurses in a Tertiary Hospital Setting: Focus Group Interview

상급종합병원 전문간호사의 리더십 경험: 포커스 그룹 면담

  • Received : 2023.09.10
  • Accepted : 2023.09.26
  • Published : 2023.10.31

Abstract

Purpose : This study aimed to identify and describe the leadership experience of advanced practice nurses (APN). Methods : Data were collected through five focus group interviews in 2022 with a total of 24 APNs in groups of 4-6 participants. All interviews were recorded, transcribed, and data were analyzed using qualitative content analysis. Results : Nine categories emerged from three main themes. First, "Roles of APN leadership" comprised a trusted clinical expert, a moderator for the entire team, a resource person for nurturing the next generation, and a change agent for improving clinical practice. Second, "Facilitators and barriers to APN leadership" included ambiguity of APN role, support system, and institutional backing. Third, "Strategies for strengthening APN leadership competencies" comprised systematic leadership education and speaking up for APNs. Conclusion : APNs are passionate about their expertise and practice, but lack the legal and organizational authority and support to provide successive leadership. Systematic education including leadership and organizational advocacy will enable APN to provide leadership that benefits patients, institutions, and the wider healthcare system.

Keywords

Acknowledgement

본 연구는 2022년도 삼성서울병원 간호본부지원(과제번호: SMC-NSD-2022-07)과 2021년 한국전문간호사협회지원(과제번호: 2021-02)에 의해 수행됨

References

  1. Shin DH. The vision of hospitalist system in Korea. The Korean Journal of Medicine. 2021;96(1):1-6. https://doi.org/10.3904/kjm.2021.96.1.1
  2. Landsperger JS, Semler MW, Wang L, Byrne DW, Wheeler AP. Outcomes of nurse practitioner-delivered critical care: A prospective cohort study. Chest. 2016; 149(5):1146-1154. https://doi.org/10.1016/j.chest.2015.12.015
  3. Seol M, Shin YA, Lim KC, Leem C, Choi JH, Jeong JS. Current status and vitalizing strategies of advanced practice nurses in korea. Perspectives in Nursing Science. 2017;14(1):37-44. https://doi.org/10.16952/pns.2017.14.1.37
  4. Hospital Nurses Association. 2022 Survey on the status of hospital nursing staff placement [Internet]. Seoul: Hospital Nurses Association; 2023 [cited 2023 Jul 02]. Available from: https://khna.or.kr/home/pds/utilities.php
  5. Audet LA, Paquette L, Bordeleau S, Lavoie-Tremblay M, Kilpatrick K. The association between advanced practice nursing roles and outcomes in adults following cardiac surgery: A systematic review of randomized controlled trials. International Journal of Nursing Studies. 2021;122:104028. https://doi.org/10.1016/j.ijnurstu.2021.104028
  6. Newhouse RP, Stanik-Hutt J, White KM, Johantgen M, Bass EB, Zangaro G, et al. Advanced practice nurse outcomes 1990-2008: A systematic review. Nursing Economics. 2011;29(5):230-250.
  7. Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M, et al. Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. British Medical Journal. 2012;344:e1717. https://doi.org/10.1136/bmj.e1717
  8. Kim MY, Choi SJ, Seol M, Kim JH, Kim HY, Byun SJ. The frequency of job performance of the korean professional medical support staff at medical institutions over 500 beds. Jornal of Korean Critical Care Nursing. 2018;11(1):15-27.
  9. Duignan M, Drennan J, McCarthy VJC. Impact of clinical leadership in advanced practice roles on outcomes in health care: A scoping review. Journal of Nursing Management. 2021;29(4):613-622. https://doi.org/10.1111/jonm.13189
  10. Egerod I, Kaldan G, Nordentoft S, Larsen A, Herling SF, Thomsen T, et al. Skills, competencies, and policies for advanced practice critical care nursing in Europe: A scoping review. Nurse Education in Practice. 2021;54:103142. https://doi.org/10.1016/j.nepr.2021.103142
  11. Sfantou DF, Laliotis A, Patelarou AE, Sifaki-Pistolla D, Matalliotakis M, Patelarou E. Importance of leadership style towards quality of care measures in healthcare settings: A systematic review. Healthcare (Basel). 2017;5(4):73. https://doi.org/10.3390/healthcare5040073
  12. Kim JS, Kim YM, Jang KS, Kim BN, Jeong SH. Concept analysis of nursing leadership. Journal of Korean Academy of Nursing Administration. 2015;21(5):575-586. https://doi.org/10.11111/jkana.2015.21.5.575
  13. Duff E. A structural equation model of empowerment factors affecting nurse practitioners competence. Nurse Education in Practice. 2019;38:145-152. https://doi.org/10.1016/j.nepr.2019.06.002
  14. van Kraaij J, van Oostveen C, Vermeulen H, Heinen M, Huis A, Adriaansen M, et al. Nurse practitioners' perceptions of their ability to enact leadership in hospital care. Journal of Clinical Nursing. 2020;29(3-4):447-458. https://doi.org/10.1111/jocn.15105
  15. Woo BFY, Zhou W, Lim TW, Tam WWS. Practice patterns and role perception of advanced practice nurses: A nationwide cross-sectional study. Journal of Nursing Management. 2019;27(5):992-1004. https://doi.org/10.1111/jonm.12759
  16. Korean Accreditation Board of Nursing Education. Operation guideline of the advanced practice nurses' training course [Internet]. Seoul: Korean Accreditation Board of Nursing Education; 2016 [cited 2023 Mar 01]. Available from: http://www.kabone.or.kr/kabon03/index03_02.php
  17. Kim MY, Choi SJ, Seol M, Kim JH, Kim HY, Byun SJ. The current status of professional medical support staffs in medical institutions with over 500 beds. Jorunal of Korean Clinical Nursing Research. 2017;23(2):131-141. https://doi.org/10.22650/JKCNR.2017.23.2.131
  18. Lee GA, Shin SH, Ko SJ. Influences of critical thinking disposition, nurse managers' transformation and transactional leadership style on nurses' competency with evidence based practice. Journal of Korean Academy of Nursing Administration. 2020;26(4):305-315. https://doi.org/10.11111/jkana.2020.26.4.305
  19. Kim S, Seo MH, Jeong SH, Kim HS, Kim YL. A Literature review of research on leadership of Korean hospital nurse. Journal of Korean Academy of Nursing Administration. 2019;25(5):404-423. https://doi.org/10.11111/jkana.2019.25.5.404
  20. Won HJ, Cho SH. A Review of research on self-leadership in nurses'. Journal of Korean Academy of Nursing Administration. 2013;19(3):382-393. https://doi.org/10.11111/jkana.2013.19.3.382
  21. Jeon JM, Lee KS, Park CJ, Woo HY. Effects of nurses' transformational leadership on job attitude : The mediating effects psychological capital. Journal of the Korea Academia-Industrial cooperation Society. 2016;17(7):228-236. https://doi.org/10.5762/kais.2016.17.7.228
  22. Choi HG, Ahn SH. Influence of nurse managers' authentic leadership on nurses' organizational commitment and job satisfaction: Focused on the mediating effects of Empowerment. Journal of Korean Academy of Nursing. 2016;46(1):100-108. https://doi.org/10.4040/jkan.2016.46.1.100
  23. Lee SY, Lee MH, Kim HK, Park OL, Sung BJ. Effects of head nurses' servant leadership on organizational commitment among clinical nurses: Focused on the mediating effect of empowerment. Journal of Korean Academy of Nursing Administration. 2015;21(5). https://doi.org/10.11111/jkana.2015.21.5.552
  24. Patton MQ, editor. Qualitative evaluation and research methods. CA: Saga Publications,; 2002.
  25. Lee BS, Eo YS, Lee MA. Leadership experience of clinical nurses: Applying focus group interviews. Journal of Korean Academy of Nursing. 2015;45(5):671-683. https://doi.org/10.4040/jkan.2015.45.5.6716
  26. Kallio H, Pietila AM, Johnson M, Kangasniemi M. Systematic methodological review: developing a framework for a qualitative semi-structured interview guide. Journal of Advanced Nursing. 2016;72(12):2954-2965. https://doi.org/10.1111/jan.13031
  27. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Research. 2005;15(9):1277-1288. https://doi.org/10.1177/1049732305276687
  28. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24(2):105-112. https://doi.org/10.1016/j.nedt.2003.10.001
  29. Elo S, Kyngas H. The qualitative content analysis process. Journal of Advanced Nursing. 2008;62(1):107-115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
  30. Lincoln YS, Guba EG, editors. Naturalistic inquiry. Newbury Park, CA: Sage; 1985.
  31. Cashin A, Buckley T, Donoghue J, Heartfield M, Bryce J, Cox D, et al. Development of the nurse practitioner standards for practice Australia. Policy, Politics, & Nursing Practice. 2015;16(1-2):27-37. https://doi.org/10.1177/1527154415584233
  32. Lamb A, Martin-Misener R, Bryant-Lukosius D, Latimer M. Describing the leadership capabilities of advanced practice nurses using a qualitative descriptive study. Nursing Open. 2018;5(3):400-413. https://doi.org/10.1002/nop2.150
  33. Lee J, Kang H, Song JH. The effect of role ambiguity on adaptive performance: The serial multiple mediation effect of visionary leadership and learning agility. The Korean Journal of Human Resource Development Quarterly. 2023;25(1):187-223. https://doi.org/10.18211/kjhrdq.2022.25.1.007
  34. Kim S, Lee TW, Kim GS, Cho E, Jang Y, Choi M, et al. Nurses in advanced roles as a strategy for equitable access to healthcare in the WHO Western Pacific region: A mixed methods study. Human Resources for Health. 2021;19(1):19. https://doi.org/10.1186/s12960-021-00555-6
  35. Korean Law Information Center. Rule of the advanced practice nurses' qualification Ministry of Health and Welfare [Internet]. Sejong: Korean Law Information Center; 2022 [cited 2023 Apr 20]. Available from: https://www.law.go.kr/lumLsLinkPop.do?lspttninfSeq=61761&chrClsCd=010202
  36. Kim MY, Choi SJ, Kim JH, Leem CS, Kang Y-a. Intention to delegate clinical practice of medical specialists in accordance with the enactment of the scope of practice for advanced practice nurses. Journal of Korean Academy of Nursing. 2023;53(1):39-54. https://doi.org/10.4040/jkan.22098
  37. National Council of State Boards of Nursing. National guidelines for nursing delegation. Journal of Nursing Regulation. 2016;7(1):5-14. https://doi.org/10.1016/s2155-8256(16)31035-3
  38. Barnes H. Nurse practitioner role transition: A concept analysis. Nursing Forum. 2015;50(3):137-146. https://doi.org/10.1111/nuf.12078
  39. Barnes H, Faraz Covelli A, Rubright JD. Development of the novice nurse practitioner role transition scale: An exploratory factor analysis. Journal of the American Association of Nurse Practitioners. 2021;34(1):79-88. https://doi.org/10.1097/JXX.0000000000000566
  40. Kim MY, Choi SJ, Jeon MK, Kim JH, Kim HY, Leem CS. Study on systematization of advanced practice nursing in Korea. Journal of Korean Clinical Nursing Research. 2020;26(2):240-253. https://doi.org/10.22650/JKCNR.2020.26.2.240
  41. Korean Academy of Medical Sciences. The regulations in the management of accreditation committee for subspeciality board certification in Korea [Internet]. Seoul: Korean Academy of Medical Sciences; 2021 [cited 2022 Jan 25]. Available from: https://www.kams.or.kr/business/judge/sub1/.