Examining the Educational Pathways and Other Antecedents of Nurse Practitioners Who Work in the Emergency Care Setting as Predictors of Future Perceptions of Competence and Capability

Background: Research on educational needs of nurse practitioners (NPs) who work in emergency settings suggest that the emergency department (ED) is a very complex and unique setting. NPs who choose to work in this setting are required to have a particular education and skills to meet the demands of working in the ED. Currently, there are three major educational pathways for NPs to work in an ED: On-the-job experience, university-based postmaster’s emergency programs, and postmaster’s emergency fellowships. However, there are no national or state regulatory mandates on the educational background that is needed to function as an NP in this setting. Purpose: The following research questions guided this study: (1) Do educational pathways of family nurse practitioners who work in an emergency setting affect perceptions of competence and capability? (2) Are these perceptions of competence and capability of nurse practitioners who work in an emergency setting affected by prior professional experiences working in an emergency setting as a registered nurse (RN) and prior experience working in the NP role in any setting or specialty? (3) How do NPs in emergency settings perceive the complexity of their role during their first month and twelfth month on the job? Methods: This study recruited 215 NPs from several NP organizations, social media, and snowball sampling. Of these participants, 153 had on-the-job training, 44 had a university-based emergency program, and 18 had emergency fellowship program qualifications. An online survey with MANOVA was used to answer research questions 1 and 2, while the Wilcoxon signed-rank test was used to answer research question 3. Results: On educational pathways, MANOVA revealed there were statistically significant differences among the three educational pathways on three competence subscales: cardiovascular (p=.28), musculoskeletal (p=.24), and nervous system (p=.47). However, no statistical difference was found on the combined capability subscales. On years as an RN in an ED, NPs with less than one year of experience reported lower resuscitation competence compared to those with 6-10 years of experience, p = .041. 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 all health care settings reported statistically significant higher scores compared to those with fewer years on the combined competence subscales, F (45, 423) = 2.397, p <.001, partial eta squared = .203; as well as on the combined capability subscales, F (15,510) = 4.149, p < .001, partial eta squared = .109. The participants reported a statistically significant decrease in terms of the perceived complexity of their tasks (z = -11.471, p <.001) and environment (z = -11.043, p <.001) from the first month to the twelfth month. Conclusions: Educational pathways affect competence but not in a clear pattern. RN experience does not affect perceptions of capability. Years of experience as an NP affects perceptions of competence and capability the most. Perceptions of the complexity of tasks and environments of NPs tend to decrease over 12 months.