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Implementing an entrustable professional activities programmatic assessments for nurse practitioner training in
Yi-Hui Chiang1, Hsiang-Chu Yu2, Hung-Chun Chung2
1Department of Nursing, Cardinal Tien Hospital An Kang District, New Taipei City, Taiwan; Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, New Taipei City, Taiwan.
Nurse Education Today
|May 31, 2022
Summary
A new framework using Entrustable Professional Activities (EPAs) was developed for emergency care nurse practitioners. Competency scores did not correlate with seniority, with 18 months needed for autonomy in patient care.
Area of Science:
- Medical Education
- Nursing Practice
- Competency Assessment
Background:
- Entrustable Professional Activities (EPAs) are emerging as a method to operationalize competency-based education in healthcare professions.
- A gap exists in EPA-based frameworks for evaluating emergency care nurse practitioners' clinical competencies.
Purpose of the Study:
- To develop, implement, and evaluate an EPA-based framework tailored for emergency care nurse practitioners.
- To assess the competency development and entrustment levels of novice nurse practitioners in emergency care settings.
Main Methods:
- A prospective observational study was conducted within an accredited nurse practitioner training program in an emergency department.
- A working group developed EPAs using participatory design, with weekly evaluations and multi-assessor observations collected over 20 months.
- Eight novice nurse practitioners and 18 clinical instructors participated in the study.
Main Results:
- Four nested EPAs were created, utilizing a 1-5 supervision-entrustment scale for performance measurement.
- Average scores for assessing acute medical presentations did not correlate with increasing seniority (P=.011 and P=.006).
- Achieving a stable entrustment score of 5 for all EPAs required a maximum of 18 months, highlighting the time needed for autonomy.
Conclusions:
- Entrustability scores may not directly reflect increasing seniority in nurse practitioners.
- Emergency care nurse practitioners require approximately 18 months of training to achieve autonomy in patient care.
- Program directors should tailor supervision-entrustment levels based on EPA complexity and training stage to effectively oversee competency development.
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