In: Hamirc AB, Hanson CM, Tracy MF, OGrady ET (eds) Advanced practice nursing: An integrative approach. Ethical decision making: integral to the role of the advanced practice nurse. For instance, a practicing nurse must attain education up to the graduate level and get certified before initiating the practice as a professional. Hamric's Model of Advanced Nursing Practice identifies several core competencies: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision-making.1 This article chronicles a typical patient's journey while participating in a research study involving an APN intervention. Thomas Hill is a 45 year old man with a diagnosis of Acute Leukemia. An official website of the United States government. https://www.cna-aiic.ca/en/nursing-practice/the-practice-of-nursing/advanced-nursing-practice/clinical-nurse-specialists. A regulatory model explains the authority to practice, including legal requirements and the associated scope of practice. These include evidence-based practice, guidance, leadership and coaching. The way these concepts are structured depicts coherence in the structure of Hamric model. Further review of literature has shown that the seven competences determine the overall state of patient wellness. She is aware of the content of the study, the aims, and her role. Advanced practice nurses core competencies: a Advanced Practice Nurses Core Competencies - LWW This session deals with re-integrating back into life. The title change did not change the direction or relevance of the updated content, and this Author, Reston, VA, National League for Nursing (NLN) (1958) Report of the National Working Conference: education of the clinical specialist in psychiatric nursing. HHS Vulnerability Disclosure, Help Informal caregiving in Hematopoietic Blood and Marrow Transplant patients. Elsevier, St. Louis, MO, pp 2766, Indiana University School of Nursing, Indianapolis, IN, USA, You can also search for this author in Clinical Journal: A Tool to Foster Critical Thinking for Advanced Levels of Competence, Ethical Dilemmas in the Care of Premature Infants, Application of the Case Study Design: Nursing Interventions for Discharge Readiness, Privacy Policy (Updated December 15, 2022). The patient is approached by the accrual nurse who educates him about a current nursing discharge teaching study available for eligible transplant patients. WebThe APN Leadership competency is conceptualized by Hamric et al. Grant M, Bhatia S, Cooke L, Ferrell B, Forman SJ. In: Fulton JS, Lyon BL, Goudreau KA (eds) Foundations of clinical nurse specialist practice. Ethical decision making. Total time in the hospital is 28 days. The method used for program development, and administration parallels that tested by McCorkle and colleagues, who have completed research on Standardized Nursing Intervention Program (SNIP).1822 Their research has demonstrated positive outcomes including decreased symptom distress, improved functional status and mental health, decreased caregiver burden, and longer survival.1822 Their recent studies have focused on post surgical patients, and demonstrated the need to focus on the period of transition from the hospital to the home setting. He remembers Mary's instructions to call the MD for certain symptoms, and how to call off hours and on non-clinic days. Mary flexes her schedule to make the teaching session late enough in the day for Mrs. Hill to be there after work. Thoroughly revised and updated, the 7th edition of this bestselling text covers topics ranging from the evolution of advanced practice nursing to evidence-based practice, leadership, ethical decision-making, and health policy. advanced practice nurse, intervention research, transplant. These include application of knowledge in practice, analytical and critical thinking as well as clinical inquiry and professional leadership (Hamric et al., 2005). A day in the lives of APNs in the U.S. Coviello J, Hricz-Borges L, Masulli P. Accompishing quality of life in end-stage heart failure: a hopsice multidisciplinary Approach. Janet S. Fulton . Following the numerous revisions that have been done on the model, most of the crucial characteristics of APN are clearly depicted. The second thematic question related to the core competencies inherent to working as an expert on an advanced level. Which of the following has complicated clarifying the With titles available across a variety of media, we are able to supply the information you need in the most convenient format. This explains why the model aims to improve the central competencies of APN (Oberle & Allen, 2001). Core competency domain Direct clinical practice Ethical decision-making Coaching and guidance Consultation Cooperation Case management Research and After some clarification of the issues, and she understands that for him not being able to drive the car is a symbol of his dependence. eCollection 2020. They schedule several follow-up sessions with the social worker in the next few weeks. In addition, each of the 6 core competencies of the APN role identified by Hamric are outlined and applied using a Get new journal Tables of Contents sent right to your email inbox, September-October 2008 - Volume 22 - Issue 5, Advanced Practice Nurses Core Competencies: A Framework for Developing and Testing an Advanced Practice Nurse Discharge Intervention, Articles in PubMed by LIZ COOKE, MN, RN, AOCN, ANP, Articles in Google Scholar by LIZ COOKE, MN, RN, AOCN, ANP, Other articles in this journal by LIZ COOKE, MN, RN, AOCN, ANP. Mary's expertise impacts not only the patient, but other nurses as she models and mentors professional behavior. Hamric model was formulated by Ann Hamric in 1996. Clinical Nurse Specialist Role and Practice, https://doi.org/10.1007/978-3-319-97103-2_2, https://www.cna-aiic.ca/en/nursing-practice/the-practice-of-nursing/advanced-nursing-practice/clinical-nurse-specialists, https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf, http://www.esno.org/assets/harmonise-common_training_framework.pdf, https://international.aanp.org/Practice/APNRoles, Tax calculation will be finalised during checkout. Their leadership competencies make it easier for them to promote the best practices. We cannot process tax exempt orders online. Furthermore, it provides a base for knowledge development in future through empirical and qualitative research activities. Hamric et al (2005) conceptualize that advanced practice nursing usually entails the application of a wide range of theories, practice and research-based competencies to provide care to patients. She refers him to some literature and opens the door for him and his wife to discuss new values that might have formed out of this intense family experience. Operationalizes and applies the APRN core competencies to the major APRN roles: the Clinical Nurse Specialist, the Primary Care Nurse Practitioner, the Acute Primary care outcomes in patients treated by nurse practitioners or physicians: two-year follow-up. Tom works in the field of construction for a local construction company. WebMutual respect, trust, and the appreciation and recognition of diverse, complementary knowledge are also considered essential elements of collaboration; however, these characteristics develop over time (Hamric, Hanson, Tracy & OGrady, 2014). J Prof Nurs 9(6):313326, Fulton JS (2014) Chapter 1. NONPF does not intend for the requirement of all of this content, nor is the content list comprehensive for all that a program would cover with population-focused competencies. J Nurs Adm 14(1):2430, European Specialist Nurses Organizations (2015) Competences of the clinical nurse specialist (CNS): common plinth of competences for the common training framework of each specialty. Clinical Nurse Specialist and Nurse Practitioner. It is important to note that Hamrics primary criteria of APN are targeted towards the core goal of nursing and the overall health of patients (Hamric et al., 2005). Janice Hill plans to take 12 weeks of family leave to care for her husband and her mother is coming to help take care of the children. He feels so useless and doesn't want the kids to see him struggle. WOMENS HEALTH CLINICAL NURSE He thinks this might be a good idea for his family and so he does the baseline forms, and signs the consent. Hamric & Hanson's Advanced Practice Nursing - Elsevier This article chronicles a typical patient's journey through a post-hospital discharge nursing research study involving APNs as "intervention nurses" and discusses the various aspects of the APN core competencies throughout the process. Mary talks about sexuality and what can be expected at this time. Elsevier, St. Louis, MO, pp 6179, Hicks FD (2014) Chapter 3. government site. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Thoroughly revised and updated, the 7^th edition of this bestselling text covers topics ranging from the evolution of advanced practice nursing to evidence-based practice, leadership, ethical decision-making, and health policy.

, By Mary Fran Tracy, PhD, RN, APRN, CNS, FAAN, Eileen T. O'Grady, PhD, RN, ANP and Susanne J. Phillips, DNP, APRN, FNP-BC, By Mary Fran Tracy, PhD, RN, APRN, CNS, FAAN, Associate Professor, Assistant Dean for the PhD Program and Director of Graduate Studies, School of Nursing, University of Minnesota; Nurse Scientist, University of Minnesota Medical Center, Minneapolis, Minnesota; Eileen T. O'Grady, PhD, RN, ANP, Certified Nurse Practitioner and Wellness Coach; Founder, The School of Wellness, McLean, Virginia and Susanne J. Phillips, DNP, APRN, FNP-BC, Associate Dean - Clinical Affairs, University of California Irvine, Irvine, California, Netter's Head and Neck Anatomy for Dentistry, Gray's Anatomy for Students 5e and Paulsen: Sobotta Atlas of Anatomy, Package, 17th ed., English/Latin - Value Pack, Netter's Advanced Head and Neck Flash Cards, Anatomy and Physiology for Paramedical Practice, Netter's Dissection Video Modules (Retail Access Card), Permissions Wolters Kluwer Health Advanced practice nursing and conceptual models of nursing. He is relieved to discover that what he is feeling is normal. Somehow he thinks that being in his own bed and eating food at home will restore him quickly. Advanced practice nurses scope of This article was supported in part by National Cancer Institute research study R01 CA107446, Standardized Nursing Intervention Protocol. In: Hamric A, Spross J, Hanson C, editors. The site is secure. Cookie Notice Adams S. Integration of the mental health services withi OB/GYN private practice: a collaborative model. A Standardized Nursing Intervention Protocol for HCT Patients (Grant # 5-R01-CA107446). Even though she has her mother in town to help, he sees her worry and continues to struggle with his feelings of inadequacy that he can not help more. Privacy Policy Thomas and Janice discuss the issues with the kids and the adjustments that that their middle child, Susan has had to Thomas's illness. An integrated review of literature in the paper examines the purpose of the Hamric model in assisting and organizing belief systems and knowledge on Advanced Practice Nursing. Elsevier, St. Louis, MO, pp 2560, Baldwin KM, Lyon BL, Clark AP, Fulton JS, Davidson S, Dayhoff N (2007) Developing clinical nurse specialist practice competencies. StudyCorgi. Careers, Unable to load your collection due to an error. 1. WebHamric's Model of Advanced Nursing Practice identifies several core competencies: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and He and his wife get into an argument about his desire to drive to the pharmacy to pick up his medications. WebEarly Origins of the Hamric family. and transmitted securely. No one model is best; the best model is the one that explains the phenomenon of interest. APN intervention research is a relatively new area of research with cancer patients.1822 The APN core competencies provided the framework for the current study. The call is made by his wife, and both are able to come to the medical center quickly. The site is secure. Advanced practice nursing outcomes: a review of selected empirical literature. After a few minutes the kids go out to play in the backyard leaving Thomas and his wife alone with Mary. Grant M. Assessment of quality of life following hematopoietic cell transplantation. (See Table 1). Minarik P, Zeh M, Johnston L. Collaboration with pscyhiatricts in Connecticut. J Prof Nurs 32(4):271282, Fulton JS, Mayo A, Walker J, Urden LD (2019) Description of work processes used by clinical nurse specialists to improve patient outcomes. He finds the kids exhausting and irritating. Hamric Integrative Model: Purpose and Structure "Hamric Integrative Model: Purpose and Structure." National Library of Medicine DePalma J, McQuire D. Research. Hoffmann T, McKenna K, Worrall L, Read SJ. Georgia and As much as nurses are trained to care for patients, there is a general belief that knowledge, skills and experiences often change progressively. In: Tracy MF, OGrady ET (eds) Advanced practice nursing: an integrative approach. Mary begins to discuss reintegration into the work environment, and legislation that protects him from discrimination. Bethesda, MD 20894, Web Policies She has practiced as a CNS since 1991, currently working as a Senior Research Specialist. It conceptualizes the nature of nursing practice as an independent profession. Nurs Outlook 67(5):511522, Hamric AB, Spross JA (1989) The clinical nurse specialist in theory and practice, 2nd edn. Google Scholar, Baldwin KM, Clark AP, Fulton JS, Mayo A (2009) Validation of the NACNS clinical nurse specialist core competencies through a national survey. Musto PK. Accessibility Thomas and his wife meet with the social worker and find the session very helpful. your express consent. Correspondence to Sch Inq Nurs Pract 3:75104, CAS She also is exercising a leadership role in partnership with the MD by being willing to confront the issue of safety. A comprehensive review of the literature. Updates to reflect applicable changes from all new foundational documents: American Association of Colleges of Nursings, Additional discussion of the impact of the lack of an APRN Compact, particularly for those APRNs who practice in telehealth and/or care for patients across state/provincial lines, Additional content throughout on social determinants of health and diversity, equity, and inclusion as applicable to the APRN role, Updated chapter with in-depth discussion of strategies for APRN competency development that outlines how RNs transition into an APRN role, including stages depicting how APRN students build the competencies to achieve mastery. Romain-Glassey N, Ninane F, de Puy J, Abt M, Mangin P, Morin D. J Forensic Nurs. McCorkle R, Jepson C, Malone D, et al. This paper was written and submitted to our database by a student to assist your with your own studies. Numerous conceptual frameworks offer guidelines for Advanced Practice Nursing (APN). "Magento_Ui/js/core/app": { Hamric targeted to develop a model that would apply to the roles of Advanced Practice Nurses (APNs). He is placed on steroids to treat the graft-versus-host reaction and does not need to be admitted because the rash was caught quickly. A model for CNS practice is a process model demonstrating interrelationships among elements constituting practice including domains of practice, practice competencies, and desired outcomes. In: Hamric A, Spross J, Hanson C, editors. These may include health policies, organizational culture and structure, outcome of evaluation and performance among other critical environmental elements. Part 1. In: Hamric A, Spross J, Hanson C, editors. However in recent years this competency has become more essential with an increased interest in evidence-based literature and practice. This article was supported in part by National Cancer Institute research study: R01 CA107446, Standardized Nursing Intervention Protocol. WebThese core competencies are an essential part of the education and clinical experience required to practice as a nurse practitioner. The evolving role of advanced practice nursing within the new Veteran's Health Administration. You can read the full text of this article if you: Keywords Janice really connects and appreciates the time to focus on her. WebHamrics Model Direct Care,Guidance/ Coaching &Consultation This week, you will focus on six of Hamrics Model (2013) of core competencies that are inherent in the APRN role, She reviews the reportable signs and symptoms, and covers more in depth content on infection and precautions. Janice and the children do not experience complicated grief, and with the help of a great deal social support are able to carve out a healthy life after his death. He continues to struggle with the fatigue and still at times thinks about recurrence. The consensus model for regulation of APRNs: Implications for nurse practitioners. StudyCorgi. He will return the next day again for evaluation with the MD. Hanson & Spross (2005) make it clear that collaboration works to effect patients and other provider outcomes.39 Collaboration creates a positive culture if it is clearly defined, and across disciplines.10 In this case Mary's collaboration with the physician and social worker greatly enhances Thomas' psychological quality of life. }. The Theory and Practice of Mental Health Consultation. Cunningham RS. As a matter of fact, there is a direct relationship between nurses and patients bearing in mind that each one of them depends on one another. Existing models and frameworks are discussed for their usefulness in explaining CNS role and practice. Mary was present and helped him and his family make tough decisions such as developing an Advanced Directives, addressing end-of-life concerns, writing letters to the kids on special occasions, making a video tape for closure for the family, and setting up funeral arrangements. Representatives, Elsevier's Novel Coronavirus Information Center. Mary is implementing the experimental condition in a research study testing the effectiveness of an APN coach for patient outcomes. Evidences from literature indicate that the models have structures that depict the generic characteristics of advanced nursing practice. R01 CA107446/CA/NCI NIH HHS/United States, R01 CA107446-04/CA/NCI NIH HHS/United States. Associate Professor, Assistant Dean for the PhD Program and Director of Graduate Studies, School of Nursing, University of Minnesota; Nurse Scientist, University of Minnesota Medical Center, Minneapolis, Minnesota, Certified Nurse Practitioner and Wellness Coach; Founder, The School of Wellness, McLean, Virginia, Associate Dean - Clinical Affairs, University of California Irvine, Irvine, California, Hamric & Hanson's Advanced Practice Nursing, Authors: Mary Fran Tracy, Eileen T. O'Grady, Susanne J. Phillips, Part I Historical and Developmental Aspects of Advanced Practice Nursing, Chapter 1 History and Evolution of Advanced Practice Nursing, Chapter 2 Conceptualizations of Advanced Practice Nursing, NATURE, PURPOSES, AND COMPONENTS OF CONCEPTUAL MODELS, CONCEPTUALIZATIONS OF ADVANCED PRACTICE NURSING: PROBLEMS AND IMPERATIVES, CONCEPTUALIZATIONS OF ADVANCED PRACTICE NURSING ROLES: ORGANIZATIONAL PERSPECTIVES, CONCEPTUALIZATIONS OF THE NATURE OF ADVANCED PRACTICE NURSING, MODELS USEFUL FOR ADVANCED PRACTICE NURSES IN THEIR PRACTICE, Chapter 3 A Definition of Advanced Practice Nursing, DISTINGUISHING BETWEEN SPECIALIZATION AND ADVANCED PRACTICE NURSING, DISTINGUISHING BETWEEN ADVANCED NURSING PRACTICE AND ADVANCED PRACTICE NURSING, CORE DEFINITION OF ADVANCED PRACTICE NURSING, SIX CORE COMPETENCIES OF ADVANCED PRACTICE NURSING, DIFFERENTIATING ADVANCED PRACTICE ROLES: OPERATIONAL DEFINITIONS OF ADVANCED PRACTICE NURSING, CRITICAL ELEMENTS IN MANAGING ADVANCED PRACTICE NURSING ENVIRONMENTS, IMPLICATIONS OF THE DEFINITION OF ADVANCED PRACTICE NURSING, Chapter 4 Role Development of the Advanced Practice Nurse, PERSPECTIVES ON ADVANCED PRACTICE NURSE ROLE DEVELOPMENT, ROLE CONCEPTS AND ROLE DEVELOPMENT ISSUES, Chapter 5 International Development of Advanced Practice Nursing, ADVANCED PRACTICE NURSING ROLES WITHIN A GLOBAL HEALTHCARE CONTEXT, FACILITATING THE INTRODUCTION AND INTEGRATION OF ADVANCED PRACTICE NURSING ROLES, NEXT STEPS IN THE GLOBAL EVOLUTION OF ADVANCED PRACTICE NURSING ROLES, Part II Competencies of Advanced Practice Nursing, DIRECT CARE VERSUS INDIRECT CARE ACTIVITIES, SIX CHARACTERISTICS OF DIRECT CLINICAL CARE PROVIDED BY ADVANCED PRACTICE NURSES, FORMATION OF THERAPEUTIC PARTNERSHIPS WITH PATIENTS, DIVERSE APPROACHES TO HEALTH AND ILLNESS MANAGEMENT, HELPING PATIENTS MANAGE CHRONIC ILLNESSES, THEORIES AND RESEARCH SUPPORTING APRN GUIDANCE AND COACHING, BUILDING RELATIONSHIPS FOR APRN GUIDANCE AND COACHING, APRN PRACTICE PRINCIPLES FOR SUCCESSFUL GUIDANCE AND COACHING, GENERATING EVIDENCE: HISTORICAL PERSPECTIVE, FROM POLICY TO PRACTICE: TIPS FOR ACHIEVING MEANINGFUL CHANGES IN PRACTICE BASED ON CURRENT BEST EVIDENCE, LEADERSHIP: DEFINITIONS, MODELS, AND CONCEPTS, CHARACTERISTICS OF APRN LEADERSHIP COMPETENCY, DEVELOPING LEADERSHIP IN THE HEALTH POLICY ARENA, OBSTACLES TO LEADERSHIP DEVELOPMENT AND EFFECTIVE LEADERSHIP, STRATEGIES FOR IMPLEMENTING THE LEADERSHIP COMPETENCY, CHARACTERISTICS OF EFFECTIVE COLLABORATION, IMPACT OF COLLABORATION ON PATIENTS AND CLINICIANS, CONTEXT OF COLLABORATION IN CONTEMPORARY HEALTH CARE, PROCESSES ASSOCIATED WITH EFFECTIVE COLLABORATION, OVERVIEW OF ETHICAL APPROACHES TO RESOLVING ETHICAL CONFLICTS, GOALS OF CARE: A CLINICAL-ETHICAL FRAMEWORK TO ENHANCE APRN PRACTICE, NAVIGATING BARRIERS TO ETHICAL PRACTICE AND STRATEGIES TO OVERCOME THEM, Part III Advanced Practice Roles: The Operational Definitions of Advanced Practice Nursing, CLINICAL NURSE SPECIALIST PRACTICE: COMPETENCIES WITHIN THE SPHERES OF IMPACT, Chapter 13 The Primary Care Nurse Practitioner, CURRENT AND HISTORICAL PERSPECTIVES ON PRIMARY CARE AND THE NURSE PRACTITIONER ROLE, EMERGENCE OF POSTGRADUATE TRAINING IN PRIMARY CARE, PRIMARY CARE WORKFORCE AND THE CONTEXT OF PCNP PRACTICE TODAY, Chapter 14 The Acute Care Nurse Practitioner, ACNP SCOPE OF PRACTICE: LEVELS OF INFLUENCE, PROFILES OF THE ACNP ROLE AND PRACTICE MODELS, SPECIALIZATION OPPORTUNITIES WITHIN THE ACNP ROLE, THE NURSE-MIDWIFERY PROFESSION IN THE UNITED STATES TODAY, IMPLEMENTING ADVANCED PRACTICE NURSING COMPETENCIES, Chapter 16 The Certified Registered Nurse Anesthetist, BRIEF HISTORY OF CRNA EDUCATION AND PRACTICE, ROLE DEVELOPMENT AND MEASURES OF CLINICAL COMPETENCE, Part IV Critical Elements in Managing Advanced Practice Nursing Environments, Chapter 17 Maximizing APRN Power and Influencing Policy, POLICY: HISTORIC CORE FUNCTION IN NURSING, UNITED STATES FUNDAMENTALLY DIFFERS FROM THE INTERNATIONAL COMMUNITY, CURRENT ADVANCED PRACTICE NURSING POLICY ISSUES, APRN POLITICAL COMPETENCE IN THE POLICY ARENA, EMERGING ADVANCED PRACTICE NURSING POLICY ISSUES, Chapter 18 Marketing Yourself as an APRN: Contracting and Negotiation, CHOOSING BETWEEN ENTREPRENEURSHIP/INTRAPRENEURSHIP, Chapter 19 Reimbursement and Payment for APRN Services, BILLING FOR APRN SERVICES: UNDERSTANDING THE PROCESS, Chapter 20 Understanding Regulatory, Legal, and Credentialing Requirements, THE CONSENSUS MODEL FOR APRN REGULATION: LICENSURE, ACCREDITATION, CERTIFICATION, AND EDUCATION, ADVANCED PRACTICE REGISTERED NURSE MASTERS AND DOCTORAL EDUCATION, BENCHMARKS OF ADVANCED PRACTICE NURSING AND EDUCATION, ADVANCED PRACTICE REGISTERED NURSE COMPETENCIES, ELEMENTS OF APRN REGULATION AND CREDENTIALING, LANGUAGE ASSOCIATED WITH THE CREDENTIALING OF APRNS, STANDARDS OF PRACTICE AND STANDARDS OF CARE FOR APRNS, ISSUES AFFECTING APRN CREDENTIALING AND REGULATION, Chapter 21 APRN Outcomes and Performance Improvement Research, CONCEPTUAL MODELS OF CARE DELIVERY IMPACT, PERFORMANCE (PROCESS) IMPROVEMENT ACTIVITIES, FUTURE DIRECTIONS FOR USING OUTCOMES IN APRN PRACTICE, Chapter 22 Future Technologies Influencing APRN PracticeDebora SimmonsPamela Salyer, MAKING SENSE OF COMPLEXITY IN HEALTH INFORMATION TECHNOLOGY, DIAGNOSTIC, THERAPEUTIC, AND PROCEDURAL DEVICES AND APPS, DATA, CLINICAL DECISION SUPPORT, AND ADVANCED ANALYTICS, FUTURE IMPLICATIONS OF TECHNOLOGY-ENABLED ADVANCED PRACTICE REGULATION AND GROWTH: A CALL TO PARTICIPATE, Chapter 23 Using Healthcare Information Technology to Evaluate and Improve Performance and Patient Outcomes, INFORMATICS AND INFORMATION TECHNOLOGY SUPPORTING IMPROVED PERFORMANCE AND OUTCOMES, REGULATORY REPORTING INITIATIVES THAT DRIVE PERFORMANCE IMPROVEMENT, RELEVANCE OF REGULATORY REPORTING TO ADVANCED PRACTICE NURSING OUTCOMES, FOUNDATIONAL COMPETENCIES IN MANAGING HEALTH INFORMATION TECHNOLOGY, FOUNDATIONAL COMPETENCIES IN QUALITY IMPROVEMENT, STRATEGIES FOR DESIGNING QUALITY IMPROVEMENT AND OUTCOME EVALUATION PLANS FOR ADVANCED PRACTICE NURSING.
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