Evidence-Based Practice

Background
Evidence-based practice (EBP) is essential to providing safe, effective care and
improving outcomes for clients and populations. EBP helps healthcare organizations
meet the Institute for Healthcare Improvement's (IHI) quadruple aim of improving
population health, enhancing the care experience, decreasing costs, and empowering
clinicians (Nundy et al., 2022). To support this aim, the Institute of Medicine (IOM)
established a goal of 90% or greater of clinical decision-making to be evidence-based
by 2020. This goal still needs to be met; however, providers and organizations continue
to make strides in using evidence to improve care decisions. Advanced practice nurses
must answer the call to advance the IOM’s imperative to implement evidence-based
care, fulfill the quadruple aim, and improve health and outcomes for all Americans.

Evidence-Based Practice
Evidence-based practice (EBP) involves applying evidence obtained through research,
clinical expertise, and the client's values and preferences to nursing practice (Melnyk &
Fineout-Overholt, 2023). Evidence provides direction for practice that supports holistic,
person-centered care. It also supports the need for nurses and other providers to
integrate self-care, personal responsibility, spirituality, and reflection into their practice.
As the healthcare delivery system evolves and transforms, holistic, evidence-based
approaches to person-centered care are crucial to improving client outcomes, raising
standards of care, ensuring client safety, engaging in interprofessional collaboration,
and developing healthy work environments while increasing job satisfaction (Melnyk &
Fineout-Overholt, 2023).
Evidence-Practice
• Based Individual clinical expertise
• Patient's values and expectations
• Research evidence

The Journey to EBP

Although knowledge about effective nursing interventions is increasing, using the best
available evidence in practice needs to catch up to these developments. Melnyk and
Fineout-Overholt (2023) identified steps to ensure the best evidence is implemented
safely and effectively across nursing roles.
Title: Seven Steps of the EBP Process
Step 0: Cultivate a spirit of inquiry
• Cultivate a spirit of inquiry or a sense of curiosity that helps to challenge
existing practices and seek creative solutions to problems (Johns Hopkins
Center for Nursing Inquiry, n.d.). A spirit of inquiry motivates nurses to pursue
 research to support evidence-based, holistic, person-centered care and
promotes professional excellence.
Step 1: Ask a clinical question
• Identify a client-focused clinical problem and develop a question using the
PICOT format. PICOT is a framework for developing clinical research
questions that are focused, answerable, and relevant to healthcare. PICOT
questions identify the population, intervention, comparison, outcome, and
time (PICOT) related to a clinical concern.
Step 2: Search for the best evidence
• Find the best available evidence to answer the question. A systematic,
strategic, and thorough search of current literature ensures that relevant
information is applied.
Step 3: Critically appraise the evidence
• Critically appraise, evaluate, and synthesize the available research to weigh
the evidence and suggest a recommendation for change.
Step 4: Integrate best evidence with one's clinical expertise and patient preferences and
values to make a practice change or decision
• Implement the recommendation. Use clinical expertise and the population's
preferences to integrate the evidence-based solution into current practice.
Step 5: Evaluate the outcomes of practice decision or change
• Evaluate the implementation. Determine if the EBP change provided the
expected outcome and, if not, determine if an additional change is required.
Step 6: Disseminate the results
• Disseminate the results to advance EBP. Share the outcomes of the change
and lessons learned during the process via publication or presentation.

Barriers and Facilitators of EBP

Although healthcare providers, clients, and administrators are expected to engage in

EBP, barriers to implementation may prevent the timely translation of evidence into
practice. Barriers to the use of EBP include lack of time, resistance from colleagues or
leadership, inadequate skill sets, and lack of autonomy to support change (McArthur et
al., 2021; Melnyk & Fineout-Overholt, 2023). To overcome the challenges, advanced
practice nurses must collaborate with other disciplines to champion the use of EBP
across settings and support shifts in organizational culture to embrace the advancement
of EBP.

Scenario Correct Match

Sheri, a nurse practitioner, desires to implement EBP with Provide time to appraise available
her clients; she is currently scheduled for four 12-hour studies and implement findings
shifts per week plus one-day on-call. critically.
Nnena is a new nurse educator. She has been actively Provide a mentor with proficiency in
reading journals but needs to feel prepared to implement EBP implementation and change
new strategies in the classroom. strategies.
 Scenario Correct Match
Bo, a nurse executive, has noted that many practices Sponsor journal clubs and EBP
within the organization do not follow EBP. His colleagues rounds to integrate EBP into
share that "things have always been done this way." organizational culture.

EBP and Nursing Scholarship

Throughout history, nurses have used evidence to advance nursing practice. For
example, early in professional nursing, Florence Nightingale used statistical analysis to
evaluate the spread of infectious diseases and implement innovative approaches to
handwashing and sanitation (Carpenter et al., 2022). Nurses continue to promote
innovation and lead through nursing scholarship. Scholarship involves pursuing
knowledge and applying EBP to inform nursing science and practice, influence policy,
and address health inequities for clients and populations (American Association of
Colleges of Nursing [AACN], 2021).
Scholarship engagement promotes professional development and is a characteristic of
a lifelong learner. Nursing scholarship is often conceptualized as a framework with four
domains: discovery, application, integration, and teaching (Boyer, 1990; Keating et al.,
2021).

Domains of Nursing Scholarship

Discovery: Generation of new knowledge through research: conducting studies,
collecting data, analyzing results, and disseminating findings.
Application: Using knowledge in practice: developing and implementing practical and
innovative interventions to improve outcomes for clients and populations.
Integration: Interpreting knowledge across disciplines: adding value and meaning to
evidence by integrating knowledge from different sources and engaging in
interprofessional collaboration.
Teaching: Disseminating knowledge to others: formal or informal information sharing by
teaching and mentoring nurses, nursing students, and other healthcare professionals.

Correct
Scenario Domain
Kevin, a psychiatric mental health nurse practitioner, collaborates with social Integration
workers, psychologists, and psychiatrists to implement a counseling program
in their healthcare system.
Liam, a population health nurse, is leading a study to analyze data from Discovery
electronic health records and an online survey to determine the efficacy of
telehealth visits in rural areas.
Malika, a nurse educator, leads a student group in an intensive care unit. Teaching
 Correct
Scenario Domain
Urielle, a nurse practitioner, is implementing a new model to promote healthy Application
weight in adolescent clients.

Scholarship is essential for nurses in all roles across the care continuum; however, engagement
with scholarship and EBP varies with nurses' educational preparation.
EBP Across Levels of Nursing Education
Baccalaureate
• Understand the basics of evidence-based practice
• Follow evidence-based policy and procedure in practice

Master's
• Use evidence to create evidence-based practice (EBP) guidelines
• Create and lead teams to implement EBP

Practice-Focused Doctorate (DNP)

• Apply advanced leadership skills to change practice
• Translate research into practice
• Measure outcomes and analyze data for populations

Research-Focused Doctorate (Ph.D.)

• Conduct research independently and lead research teams
• Seek support/grants to support research
• Disseminate findings through scholarly publications and teaching

Postdoctoral Programs
• Pursue additional research training
• Teach the research process to others

Interprofessional Collaboration

Nurses are not alone in the imperative to provide evidence-based care. Healthcare
professionals from different disciplines can work together to evaluate and apply
evidence critically, address gaps in knowledge and practice, and disseminate findings to
improve outcomes. Interprofessional collaboration in research and EBP enables
healthcare teams to benefit from diverse perspectives to develop more holistic,
comprehensive, and practical approaches to care for clients and populations.
AACN Competencies

AACN (2021) identified scholarship as one of the ten essential domains for competent
nursing practice. Scholarship includes generating, synthesizing, translating, applying,
and disseminating nursing knowledge.
Specific scholarship competencies for advanced nursing roles include:
Advances the scholarship of nursing
• Apply and critically evaluate advanced knowledge in a defined area of nursing
practice.
• Engage in scholarship to advance health.
• Discern appropriate applications of quality improvement, research, and
evaluation methodologies.
• Collaborate to advance one's scholarship.
• Disseminate one's scholarship to diverse audiences using a variety of
approaches or modalities.
• Advocate within the interprofessional team and with other stakeholders for the
contributions of nursing scholarship.

Integrate the best evidence into nursing practice

• Use diverse sources of evidence to inform practice.
• Lead the translation of evidence into practice.
• Address opportunities for innovation and changes in practice.
• Collaborate in developing new/revised policies or regulations in the light of new
evidence.
• Articulate inconsistencies between practice policies and best evidence.
• Evaluate outcomes and impact of new practices based on the evidence.

Promote the ethical conduct of scholarly activities

• Identify and mitigate potential risks and areas of ethical concern in the conduct of
scholarly activities.
• Apply IRB guidelines throughout the scholarship process.
• Ensure the protection of participants in the conduct of scholarship.
• Implement processes that support ethical conduct in practice and scholarship.
• Apply ethical principles to the dissemination of nursing scholarship.

Learn More
The categories include extensive experience, some experience, and limited experience.
The scholarship competencies are:
• Critically evaluate advanced knowledge in nursing practice.
• Collaborate to advance one's scholarship.
• Disseminate one's scholarship to diverse audiences.
• Use diverse sources of evidence to inform practice.
• Lead the translation of evidence into practice.
• Address opportunities for innovation and changes in practice.
• Articulate inconsistencies between practice policies and best evidence.
• Evaluate outcomes and impact of new practices based on the evidence.
 • Implement processes that support ethical conduct in practice and scholarship.

National Organization of Nurse Practitioner Faculties

(NONPF)

NONPF (2022) practice scholarship competencies are aligned to domain four of the
2021 AACN Essentials and include:

• Advance the scholarship of NP nursing practice

• Integrate the best evidence into NP practice
• Promote the ethical conduct of scholarly activities

Evidence-Based Models
Evidence-based models are often used to guide the process of translating evidence into
practice. Several evidence-based models have been developed to assist nurses in this
process. Click each tab below to explore commonly used models.

ARCC Model
The Advancing Research and Clinical Practice Through Close Collaboration (ARCC)
model is an organized conceptual framework to guide the system-wide implementation
and sustainability of EBP to promote quality, safety, and improved population health
(Dearholt et al., 2023). The model requires an organizational assessment of readiness
for change, including strengths and barriers to EBP implementation. Mentors assist with
the implementation and evaluation of EBP strategies throughout the organization. The
model helps establish an organizational culture of EBP, which helps promote job
satisfaction and employee retention for nurses (Melnyk et al., 2021).
Title: Advancing Research and Clinical Practice Through Close Collaboration (ARCC)
Model
• Step 01: Assessment of organizational culture and readiness for EBP
• Step 02: Identification of strengths and major barriers to EBP
• Step 03: Development and use of EBP mentors
• Step 04: EBP implementation

Johns Hopskins EBP Model

The Johns Hopkins evidence-based practice (JHEBP) model is a powerful problem-
solving approach to clinical decision-making designed to guide individuals or groups
through identifying and implementing EBP. The model follows a three-phase process to
examine the practice question, evidence, and translation (PET). The model aims to
ensure that the latest research findings and best practices are quickly and appropriately
incorporated into client care (Johns Hopkins Medicine Center for Evidence-Based
Practice, n.d.).
PET Process
Title: Work in Interprofessional Teams
The model begins with inquiry and moves into a practice, learning, and reflection loop.
Inside this loop, the process includes practice question, evidence, and translation. The
process can return to inquiry during the learning part of the loop if more questions arise.
After the loop, the process moves on to best practices and practice improvements. It
then returns to inquiry, and the process begins again.

i-PARIHS
The integrated-promoting action on research implementation in health sciences (i-
PARIHS) model presents the interplay of factors involved in successfully implementing
evidence-based practice in clinical settings (Harvey & Kitson, 2016). The underlying
assumption of this model is that successful implementation results when relevant
stakeholders facilitate innovation in their contextual environment (Hunter et al., 2020).
This model is often used to promote behavioral change in individuals, teams, and
organizations.
This model is a spiral that begins in the center and spirals outward. The middle of the
spiral is facilitation, which includes facilitator roles and processes (what the facilitator
focuses on and what skills the facilitator needs).
Throughout the process, the facilitator must focus on the following:
• Innovation
• Recipients
• Inner context: Local
• Inner context: Organization
• External context
Throughout the process, the facilitator must utilize the following skills:
• Project management & improvement skills
• Team & process skills
• Influencing & negotiating skills

Iowa Model EBP

A collaborative team developed the Iowa model to guide clinical and administrative
decisions that foster client care outcomes, frequently used by interprofessional teams
(Iowa Model Collaborative, 2017). The model is based on a straightforward multistep
process, including feedback loops.
Title: The Iowa Model of Evidence-Based Practice to Promote Quality of Care
Problem-focused triggers
• Risk management data
• Process improvement data
• Internal/external benchmarking data
• Financial data
• Identification of clinical problem
Knowledge-focused triggers
• New research or other literature
 • National agencies or organizational standards & guidelines
• Philosophies of care
• Questions from institutional standards committee
Is this topic a priority for the organization?
• If no, consider other triggers.
• If yes, form a team, assemble relevant research & related literature, and
critique & synthesize research for use in practice.
Is there a sufficient research base?
• If no, conduct research.
• If no, base practice on other types of evidence (case reports, expert opinion,
scientific principles, and theory) and move to pilot.
• If yes, pilot the change in practice by doing the following:
o Select the outcomes to be achieved
o Collect baseline data
o Design EBP guideline(s)
o Implement EBP on pilot units
o Evaluate process & outcomes
o Modify the practice guideline
Is change appropriate for adoption in practice?
• If no, continue to evaluate quality care and new knowledge and return to start.
• If yes, institute the change in practice and perform the following:
o Monitor and analyze structure, process, and outcome data from the
environment, staff, cost, patient, and family.
o Finally, disseminate results.

Stetler Model
The Stetler model was developed to provide a pathway for advanced practice nurses to
assess the best available evidence and determine if it can be applied within a practice
setting. The model emphasizes the relationship between critical thinking and research
findings and is intended for use in direct care settings by nurse practitioners and other
providers (Stetler, 2001).
Title: The Stetler Model
• Phase One: Preparation
• Phase Two: Validation
• Phase Three: Comparative Evaluation Decision Making
• Phase Four: Translation/Application
• Phase Five: Evaluation

ACE Star Model

The ACE star model of knowledge transformation is a formula designed to translate
research literature evidence into professional nursing practice. The model assists with
overcoming challenges associated with interpreting a large volume of research
evidence and moving recommendations into practice. The model also emphasizes the
importance of evaluating the impact of evidence-based changes on healthcare
outcomes (STAR Model, n.d.).
Title: ACE Star Model of Knowledge Transformation
Step One: Knowledge Discovery
• Comprehensive search of the research literature to generate evidence.
Step Two: Evidence Summary
• Condense the evidence into a one evidence-based practice
action/intervention.
Step Three: Translation into Practice
• Developing a plan to implement the one evidence-based practice
action/intervention into practice.
Step Four: Integration into Practice
• Taking the one evidence-based practice action/intervention and using it in
practice
Step Five: Evaluation
• Once the evidence-based practice action/intervention has been used in
practice, evaluate its impact on critical areas such as healthcare outcomes,
nurse satisfaction, patient satisfaction, and economic impact.

Evidence-Based Practice Project

Background
Advanced practice nurses play a crucial role in evidence-based practice (EBP) by
integrating the best available research evidence with clinical expertise and client
preferences to inform decision-making and improve outcomes. They must critically
appraise evidence and determine its relevance and applicability to clients and
populations. Advanced practice nurses also play an essential role in promoting the use
of EBP across practice settings by educating and mentoring other nurses and
healthcare professionals about the use of evidence in decision-making, advocating for
resources to support EBP, and participating in research and quality improvement
initiatives.
Over the next eight weeks, you will learn more about integrating evidence into practice
by designing an evidence-based practice project. This project comprises related
assignments that include identifying a practice problem, developing a PICOT question,
appraising and synthesizing literature, presenting recommendations based on findings,
and disseminating the findings to peers. The PICOT format includes client population of
interest (P), intervention or area of interest (I), comparison intervention or group (C),
outcome (O), and time (T).
It is recommended that you choose a practice change that is specific, measurable, and
related to your future role in advanced nursing practice. Nurse Practitioner students
must choose a practice change that impacts client care directly and avoid topics
related to changes in public policy or law, such as full-practice authority.
Recommendation for Practice Change
Week 1: Spirit of inquiry: Identify a client-centered practice problem
Week 2: Ask a clinical question: Develop a PICOT question
Weeks 3 and 4: Search for evidence: Find and appraise quantitative and qualitative
research articles to support the PICOT question
Week 5: Critically appraise the evidence: Gather and appraise additional research and
synthesize evidence
Week 6: Ethics appraisal: Evaluate ethical considerations in research related to practice
problem
Week 7: Present recommendations: Create a PowerPoint to identify findings and
recommendations
Week 8: Disseminate to peers: Share findings with classmates via Kaltura presentation

Practicum and Professional Considerations

Practicum Readiness
Important information about the practicum experience, clinical documentation, and
professional preparedness is provided below. Your Experiential Learning Coordinator
(ELC) and course faculty are valuable resources to support your practicum rotations.

PMH Clinical Requirements

In this specialty track, there are 5 practicum courses:

• NR547: Differential Diagnosis in Psychiatric-Mental Health Across the Lifespan

Practicum (Outpatient Medication Management – Required)
• NR605: Diagnosis and Management in Psychiatric-Mental Health Across the
Lifespan I Practicum
• NR606: Diagnosis and Management in Psychiatric-Mental Health II Practicum
• NR607: Diagnosis and Management in Psychiatric-Mental Health III Practicum
• NR668: Psychiatric-Mental Health Capstone Practicum and Intensive

125 hours are required in each clinical course for a total of 625 clinical hours:

• 500 Medication Management hours.

• 125 hours (one session) Psychotherapy hours with an approved Psychotherapist as
listed in the PMHNP handbook with exposure to two modalities and can complete
group, individual, or family therapy or a combination.
• Telepsychiatry/telehealth experiences are permitted, depending on state, preceptor,
and student registered nurse licensing guidelines – further details provided in the
practicum handbook and courses.
• PMHNP students can only participate in treating and caring for mental illnesses and
cannot care for the medical management of other non-psychiatric conditions. The
evaluation and treatment of physical diseases are outside the student's scope for the
program.
Practicum sites need not correspond with the topic of the current course, but it is
expected that the student will seek clinical placement to ensure a well-rounded clinical
experience, which includes psychiatric and mental health care across the lifespan. The
student should be able to display a variety of decision-making complexity by means of
documenting the evaluation and management (E&M) code for the encounter.
Students must be approved for practicum (approval, contracts, and compliance) before
beginning clinical rotation. Students will be notified via course faculty on the first day of
the session.
Reminder there are several steps in the process to register for your practicum course.
You must identify a site and preceptor willing to work with you for each of your
practicum courses. The practicum application, including all preceptor documentation,
must be submitted at least two sessions (120 days) prior to the start of the first
practicum course and two sessions (120 days) prior to the start of any subsequent
practicum course. Students are required to have their Chamberlain standard healthcare
compliance items at least 30 days prior to the start of their session. Your site may
require additional compliance items per the contract, we ask that those items are
completed 30 days prior to the start of the session. These deadlines ensure that
contracting and compliance items are complete for students to successfully start their
practicum on time.
Refer to the PMHNP Practicum HandbookLinks to an external site.Open this document
with ReadSpeaker docReader for a complete list of requirements, acceptable sites, and
preceptors.

Client Population

The PMH patient population must include experience with children (up to 12 years old),
adolescence (13-21 years old), adults (22-64 years old), and geriatrics (65 years and
older).

AGAC Clinical Requirements

In this specialty track, there are 6 practicum courses:

• NR569: Differential Diagnosis in Acute Care Practicum- 125 hours

• NR570: Common Diagnosis and Management in Acute Care Practicum- 125 hours
• NR571: Complex Diagnosis and Management in Acute Care Practicum- 125 hours
• NR572/573: Advanced Acute Care Management- 100 hours; Advanced Acute Care
Management Lab - 25 hours in Rockford, IL
• NR574: Acute Care Practicum I- 125 hours
• NR575: Acute Care Practicum II- 100 hours; 25 hours in Rockford, IL

An Urgent Care or Department Fast Track rotation is required for NR569.

An Emergency Department rotation is required for one (1) practicum course prior to
reaching NR575.
A Hospitalist rotation is required for two (2) practicum courses prior to reaching NR575.
An Intensivist (ICU) rotation is required for one (1) practicum course prior to reaching
NR575.
A Specialty Focus can only be used for NR575. Students may choose between Urgent
Care, Emergency Department, Hospitalist, Intensivist, or an acute/critical care sub-
specialty.
Students must be approved for practicum (approval, contracts, and compliance) before
beginning clinical rotation. Students will be notified via course faculty on the first day of
the session.
Reminder there are several steps in the process of registering for your practicum
course. You must identify a site and preceptor willing to work with you for each of your
practicum courses. The practicum application, including all preceptor documentation,
must be submitted at least two sessions (120 days) prior to the start of the first
practicum course and two sessions (120 days) prior to the start of any subsequent
practicum course. Students are required to have their Chamberlain standard healthcare
compliance items at least 30 days prior to the start of their session. Your site may
require additional compliance items per the contract; we ask that those items are
completed 30 days prior to the start of the session. These deadlines ensure that
contracting and compliance items are complete for students to successfully start their
practicum on time.
Refer to the AGACNP Practicum HandbookLinks to an external site.Open this
document with ReadSpeaker docReader for a complete list of requirements, acceptable
sites, and preceptors.

Client Population

• The AGACNP patient population is limited to adult patients (12+ years).

• Discuss patient population stipulation with preceptors.
• Children under the age of 12 may not be seen in the clinical setting, even under the
supervision of a preceptor.
• Hours logged for any patient under the age of 12 will not be counted towards the
required hours.

AGPC Clinical Requirements

In this specialty track, there are 5 practicum courses:

• NR576: Differential Diagnosis in Adult-Gerontology Primary Care

• NR577: Primary Care Management of Adolescents and Adults
• NR578: Primary Care Management of Older Adults
• NR579: Palliative Care in Adult-Gerontology Across the Spectrum
• NR580: Adult-Gerontology Primary Care Capstone Practicum and Intensive

125 hours are required in each clinical course for a total of 625 clinical hours.
Practicum sites need not correspond with the topic of the current course, but it is
expected that the student will seek clinical placement to ensure a well-rounded clinical
experience. During the program, the experience should include a good mixture of well-
child (ages 13-17), acute, chronic, and wellness visits for adolescents and adults of all
ages. The student should be able to display a variety of decision-making complexity by
means of documenting the office evaluation and management (E&M) code for the visit.
The majority of clinical time should be spent in an outpatient primary care setting.
Rounding on clients in the hospital is permitted under the following circumstances:

• the course instructor is aware of the rounding

• the site has been approved for student rounding
• the preceptor has facility privileges where the rounding will occur
• clients seen in a facility are clients of the provider’s outpatient practice
• the student actively participates in the client’s care (time spent observing does not
count towards clinical hours)
• time spent is no more than 25% of total practicum hours for that course

Students must be approved for practicum (approval, contracts, and compliance) before
beginning clinical rotation. Students will be notified via course faculty on the first day of
the session.
Reminder: there are several steps in the process to register for your practicum course.
You must identify a site and preceptor willing to work with you for each of your
practicum courses. The practicum application, including all preceptor documentation,
must be submitted at least two sessions (120 days) prior to the start of the first
practicum course and two sessions (120 days) prior to the start of any subsequent
practicum course. Students are required to have their Chamberlain standard healthcare
compliance items at least 30 days prior to the start of their session. Your site may
require additional compliance items per the contract, we ask that those items are
completed 30 days prior to the start of the session. These deadlines ensure that
contracting and compliance items are complete for students to successfully start their
practicum on time.
Refer to the AGPCNP Practicum HandbookLinks to an external site.Open this
document with ReadSpeaker docReader for a complete list of requirements, acceptable
sites, and preceptors.

Client Population

• The AGPCNP patient population is limited to adult patients (13+ years).

• Discuss patient population stipulation with preceptors.
• Children under the age of 13 may not be seen in the clinical setting, even under the
supervision of a preceptor.
• Hours logged for any patient under the age of 13 will not be counted towards the
required hours.

FNP Clinical Requirements

In this specialty track, there are 5 practicum courses

• NR511 Differential Diagnosis and Primary Care

 • NR601 Primary Care and the Maturing and Aged Family
• NR602 Primary Care of the Childbearing and Childrearing Family
• NR603 Advanced Clinical Diagnosis and Practice Across the Lifespan
• NR661/667 APN Capstone Course

125 hours are required in each clinical course for a total of 625 clinical hours.
Practicum sites need not correspond with the topic of the current course, but it is
expected that the student will seek clinical placement to ensure a well-rounded clinical
experience. During the entire program, experience should include well-child and acute
visits for children from birth through young adulthood as well as adult visits focusing on
management of acute and chronic illness and wellness. The student should be able to
display a variety of decision-making complexity by means of documenting the office
evaluation and management (E&M) code for the visit.
The majority of clinical time should be spent in an outpatient primary care setting.
Rounding on clients in the hospital is permitted under the following circumstances:

• the course instructor is aware of the rounding

• the site has been approved for student rounding
• the preceptor has facility privileges where the rounding will occur
• clients seen in a facility are clients of the provider’s outpatient practice
• the student actively participates in the client’s care (time spent observing does not
count towards clinical hours)
• time spent is no more than 25% of total practicum hours for that course

Students must be approved for practicum (approval, contracts, and compliance) before
beginning clinical rotation. Students will be notified via course faculty on the first day of
the session.
Reminder there are several steps in the process of registering for your practicum
course. You must identify a site and preceptor willing to work with you for each of your
practicum courses. The practicum application, including all preceptor documentation,
must be submitted at least two sessions (120 days) prior to the start of the first
practicum course and two sessions (120 days) prior to the start of any subsequent
practicum course. Students are required to have their Chamberlain standard healthcare
compliance items at least 30 days prior to the start of their session. Your site may
require additional compliance items per the contract; we ask that those items are
completed 30 days prior to the start of the session. These deadlines ensure that
contracting and compliance items are complete for students to successfully start their
practicum on time.

• Refer to the FNP Practicum HandbookLinks to an external site.Open this document

with ReadSpeaker docReader for a complete list of requirements, acceptable sites,
and preceptors.
o Guide to Reviewing FNP Lifespan Experience Hour Requirements for
information on how to review and track your hour requirement in the
clinical logging tool.

Pediatric and Lifespan Experience Requirements

 Requirements Beginning with the March 2023
Current Requirements Session
Pediatrics- Specialty dealing with the health and An exclusive Primary care pediatric practicum
medical care of infants, children, and adolescents experience will be approved for NR602, NR603, or
from birth up to the age of 18. May be used for one NR667 for one session (125 hours). Students may
session for any of the practicum courses. gain pediatric experience with a Family Medicine
site starting with NR511.
Students should ensure they are seeing all ages
and patients across the lifespan. This includes Lifespan experience is a practicum
ages zero and up. requirement for the program and to sit for
national board certification. Lifespan
experience requires evidence of care for all
age groups, through approved clinical logs,
including care for patients in each of the four
pediatric age groups: <1, 1-4, 5-11, and 12-17
years old, for a total of 125 hours. Failure to
meet the experience and hour requirements
for the program could delay graduation and
result in a course failure in NR667. The FNP
program will not be successfully completed
unless this requirement is met. Requests
for exclusive primary care pediatric practicum
experiences can be for NR602, NR603, or
NR667 for one session (125 hours). Students
may gain pediatric exposure at Family
Medicine or Internal Medicine sites starting in
NR511.

Preceptor Requirements
Students may use up to three (3) preceptors per course. Preceptors must be approved
and credentialed through the practicum application process.
Students may not work with a provider at any time who has not already been approved
and credentialed. It is recommended that students have at least one (1) alternative
provider who is approved in the event of the primary preceptor’s absence. Time spent
with preceptors who are not approved will NOT count towards the required hours.
In the event that you may not satisfy clinical hour requirements due to the preceptor’s
absence, contact course faculty and ELC immediately.
Providers may precept more than one (1) student per session; however, preceptors may
only work with one (1) student at a time on a given day. If more than one (1) student
(from any school) is assigned to the same preceptor, each student must be scheduled
on different days (i.e., student A is with Dr. X on Mon. & Tues. and student B is with Dr.
X on Wed. & Thurs.).

Clinical Time: Hours Requirement

Each NP track requires successful completion and documentation of DIRECT client
care of the practicum hour requirement per course.
All hours are required to be completed and logs and evaluations submitted by 11:59 PM
MT on Saturday of Week 8.
Students who are unable to complete the required number of clinical hours by the end
of the course may request an incomplete grade if specific requirements are met.
Contact course faculty early if you anticipate that you may not be able to successfully
obtain the required number of DIRECT client care hours.
What is considered "clinical time"?
Clinical time is only related to direct client care
Direct client care includes:
• care preparation
• assessment
• discussion and plan development with preceptor
• client and family teaching
• documentation of the client encounter within the medical record (if applicable)
• group therapy (PMH track)- total time is divided by the number of participants.
Each group member is documented individually.
• procedures (FNP, AGAC, and AGPC tracks)
• time spent in rounds (your clients only) provided the rounding site is an
approved practicum site under contract with Chamberlain. (FNP, AGAC, and
AGPC tracks)
What Doesn't Count Toward Time?
Non-direct client care includes:
• Total “scheduled time” at a site (i.e., “8 hours” for 9-5 pm)
• Downtime in between clients
• In-services, hospital training, and “shadowing”
• Breaks
• Time spent while your preceptor sees other clients where you are not directly
involved in their care
• Clinical log documentation of client encounters

Maintaining Balance
Many students find it difficult to work full-time when entering the practicum courses. If you have
difficulty keeping up with coursework and/or the required number of clinical hours, you may
need to adjust your work schedule or ask for help from family and/or friends.

Strategies for Maintaining Balance

Stress management is essential to success in a busy clinical practicum course.

• Maintaining your usual family obligations, work schedule, coursework, and clinical
hours can have a significant toll on your mental and physical well-being. If a change
is needed, make it early. Don’t jeopardize your health or chances for success to “do
it all”.
• Practice selfcare and develop a plan for success.
 • Review the Quick Coherence TechniqueLinks to an external site. and the One-
Moment MeditationLinks to an external site. for practical suggestions to quickly reset
stress levels.

Patient Population and Documentation

Requirements
Patient Population and Documentation Requirements are track specific and will be
discussed further in your practicum courses. Please review track-specific practicum
resources in the student resource center, prior to your first practicum course, for more
information on these requirements.

Professional Practice Considerations

The advanced practice registered nurse (APRN) role is significantly different than that of
the registered nurse (RN). APRN practice is largely defined by state statutes, including
the Nurse Practice Act, and governed by the state Board of Nursing, though other laws,
regulations, and boards may impact practice. APRNs, including nurse practitioners
(NPs), are responsible for following all relevant statutes in their state of practice.

Scope of Practice
Scope of practice is categorized as practice authority and prescriptive authority. Practice
authority refers to the NP’s ability to practice without physician oversight, whereas prescriptive
authority refers to the nurse practitioner's authority to prescribe medications. Practice authority
and prescriptive authority together are described as practice "environments" according to state
laws and regulations.

Ethical, Safe Prescribing

Prescriptive authority encompasses more than writing a prescription correctly. Ethical
prescribing starts with being well-informed about medications. Adherence to state laws is
paramount to ethical prescribing. Prescriptive authority for nurse practitioners regulates
prescribing rights beyond medications, including durable medical equipment and medical
services such as physical or occupational therapy.

Controlled Substances
Many states have specific requirements related to prescribing controlled substances. In
addition, The U.S. Department of Justice Drug Enforcement Agency (DEA) coordinates with
local, state, and federal agents to reduce illicit drug use. The DEA issues eligible providers with
a registration number to write prescriptions for controlled substances. Examine the image below
to learn more about the characteristics of a valid DEA number.

Opioid Prescribing
The alarming increase in opioid prescriptions has led to an epidemic of drug overdose
deaths. In 2022, the Centers for Disease Control and Prevention (CDC) released
updated guidelines for the responsible prescribing of opioids for clients of all ages. Four
main principles are highlighted to improve opioid prescribing, including:
• determining whether to initiate opioids for pain
• opioid selection and dosage
• opioid duration and follow-up
• assessing risk and addressing the harms of opioid use

12 Essential Consideration for Safe Pain Management

1. Opioids are not first-line therapy
2. Establish goals for pain and function
3. Discuss risk and benefits
4. Use immediate-release opioids when starting
5. Use the lowest effective dose
6. Prescribe short durations for acute pain
7. Evaluate benefits and harms frequently
8. Use strategies to mitigate risk
9. Review PDMP data
10. Use urine drug testing
11. Avoid concurrent opioid and benzodiazepine prescribing
12. Offer treatment for opioid disorder

Prescription Drug Monitoring Programs (PDMPs)

Safeguards addressing the opioid public health crisis include PDMPs. These electronic
databases enable providers to access information regarding a client’s prescription
history of controlled substances. Nearly all states have implemented PDMPs, and some
states require providers to check the PDMP before prescribing controlled substances.
According to the CDC (2020), PDMPs demonstrate promising results in changing
prescribing behaviors, decreasing the use of multiple providers by clients, and
decreasing substance abuse treatment admissions.

Summary

Evidence-based practice (EBP) helps healthcare organizations and providers

to meet the Institute for Healthcare Improvement's (IHI) quadruple aim of
improving population health, enhancing the care experience, decreasing
costs, and empowering clinicians (Nundy et al., 2022). Advanced practice
nurses must demonstrate competency in evaluating and appraising research
evidence to translate evidence into practice. Interprofessional collaboration
helps promote the implementation of evidence-based care to enhance
healthcare outcomes. Evidence-based models are often used to translate the
best available evidence into practice.

Key Points

• EBP is applying evidence obtained through research, clinical expertise, and

the client's values and preferences for nursing practice (Melnyk & Fineout-
Overholt, 2023).
• Barriers to the use of EBP include lack of time, resistance from colleagues or
leadership, inadequate skill sets, and lack of autonomy to support change
(McArthur et al., 2021; Melnyk & Fineout-Overholt, 2023).
• Advanced practice nurses must demonstrate competency in nursing
scholarship to expand nursing research and promote the application of EBP.
• The American Association of Colleges of Nursing (AACN, 2021) identified
scholarship as one of the ten essential domains for competent nursing
practice.
• Scholarship is the pursuit of knowledge and application of EBP to inform
science and clinical practice, influence policy, and address health inequities
for clients and populations (AACN, 2021).
• Nursing scholarship is often conceptualized as a framework with four
domains: discovery, application, integration, and teaching (Boyer, 1990;
Keating et al., 2021).
• Evidence-based models help guide the process of translating the best
available evidence into practice.
 Nurse Practitioner Program Expectations for Scholarly Sources

Throughout your program and coursework, you will be asked to identify scholarly sources to support your
assignments. Scholarly sources, which are often referred to as academic, peer-reviewed, or referred sources,
are written by professionals or experts in the field to share new knowledge or research regarding a specific
topic. These sources are published through systems in which the quality of the information is ensured.
A scholarly source is a primary publication that presents original research from a professional field. A primary
source is always the preferred reference, however, secondary sources are accepted if the primary source is
unable to be located.
Scholarly Source Parameters for this program:

• Peer-reviewed – How do I find peer-reviewed articles?

• Journal article requirements:
o Applicable to the population under discussion.
o Published within the last 5 years.
• Current Clinical Practice Guidelines (CPG)- Finding Clinical Practice Guidelines - may be older than 5
years, depending on the last review.
• Intended for clinicians (Nurse Practitioners, Physicians, Physician’s Assistants)
• Directly related to the situation that you are researching (Ex: Sources for treatment of strep pharyngitis
in cancer patients should not be used as rationale for treatment decisions if your patient does not have
cancer)
• Studies should be based on human research.
Sources to AVOID using:

• Nursing and Allied Health Journals: For the purposes of this program, the information in peer-
reviewed nursing journals is correct but not sufficiently detailed; Clinician-level journals are
appropriate for graduate-level education.
• Summary Websites: Do not use disease-specific websites and clinician sources such as Medscape,
MayoClinic, Up-to-Date, CDC, Drugs.com, WebMD, hospital websites, etc. The information from these
sources may not be current or is provided as a quick reference summary. As a graduate NP student,
you need to understand the science behind the practice. EXCEPTION: ICD-10 and CPT codes may be
researched and cited from Internet sources.
• General Healthcare Websites: Websites that provide the layperson with information but are not
meant for professionals. These could include .org or .edu websites, blogs, or commercial sites.
• Evidence Summaries within Databases: Health sciences databases often provide access to evidence
summaries to support evidence-based practice. While the evidence summaries you find are a useful
starting point for your research, you will want to use and cite the original publications that the
summaries are based on. To assist you with finding original publications see the Chamberlain Library
FAQ What is an original research or single study article, and how do I find it in the library databases?
• Textbooks: Textbooks provide an overview of key information, but, again, are not sufficient to
facilitate scholarly discussion. This includes e-books.

06/2022, rev 3/2023, rev 12/2023

 Nurse Practitioner Program Expectations for Scholarly Sources

• Quick Reference Apps and Handbooks: These include smartphone apps and handbooks that can be
used to quickly formulate a differential or provide arguments for your treatment or testing decisions.
Searching for Peer-Reviewed Sources:

• The Chamberlain Library is always your best resource. Begin by reviewing the NP Program Library
Guide. There are tutorials to learn how to research and librarians are available to assist you.
• Google Scholar can be linked to the Chamberlain Library, click HERE for directions.
• RefWorks is a program designed to help you format and save your APA references. RefWorks can be
linked to the Chamberlain Library, click HERE for directions.
• Please do not use Internet search engines to conduct your research as this may result in obtaining
sources that are not scholarly.

06/2022, rev 3/2023, rev 12/2023

General Instructions

Over the next eight weeks, you will learn more about integrating evidence into practice
by designing an evidence-based practice project. This project is comprised of related
assignments. This week, you will identify a client-focused clinical problem for which a
nurse practitioner (NP) could advocate for an evidence-based practice (EBP) change. You
will conduct a literature review to determine what is currently known about the problem
so that you will be able to develop a concise question for next week’s assignment.

Include the following sections:

1. Application of Course Knowledge: Answer all questions/criteria with

explanations and detail.

a. Identify a clinical problem for which an NP could advocate for an evidence-based

change that is client-focused. Avoid topics that are related to full practice authority,
staffing, or burnout. The problem should be centered around clients and the care
nurse practitioners provide for the population.
b. Describe the scope and impact of the problem.
c. Discuss the role of the NP in addressing the problem.
d. Explain why the problem is of interest to you.