BACKGROUND: In 2011, the Institute of Medicine published a report on the future of nursing, which recommended nurse practitioner postgraduate training in the form of fellowships or residencies. Since then, the number of postgraduate programs has grown, but data is still scarce regarding their efficacy and benefits.
OBJECTIVE: The goal of this integrative review is to synthesize available literature regarding the outcomes of nurse practitioner postgraduate fellowships and/or residencies on clinical competence and perceived readiness to practice.
METHODS: CINAHL, PubMed, and citation searching were used to search relevant subject headings, MeSH headings, and keywords related to fellowships and residencies for nurse practitioners, resulting in 11 articles being included based on inclusion and exclusion criteria. Synthesis was completed using the Garrard Matrix method to identify common themes among the studies.
RESULTS: Eight quasi-experimental and three cross-sectional studies were included in this review. Programs included multiple areas of focus, including primary care, critical care, and pediatric acute care. Common themes among the studies were an increased level of preparedness, reduced turnover, and greater job satisfaction.
CONCLUSIONS: The major theme found among the studies was an increased confidence and preparedness to practice. Minor themes include increased job satisfaction and decreased intent to quit.

BACKGROUND: Simulation is a technique being used increasingly in healthcare education which offers opportunities to evaluate nursing proficiencies. The use of valid and reliable instruments is recognised as the foundation for a robust assessment, however competency-based health assessment courses for graduate nurses can consequently become reductionist in measuring proficiencies.
OBJECTIVE: The specific review question was: In simulation-based education, what are the criteria that evaluate graduate nursing student\'s competence in obtaining a health history and performance of patient assessment?
METHODS: Eleven studies were included in the review. Papers were critically appraised with The Joanna Briggs Institute quasi-experimental studies checklist. Bloom\'s taxonomy was used to structure this narrative review.
RESULTS: Seven papers evaluated cognition through questionnaires and two papers used a Likert-scale to determine self-perceived knowledge. Six papers evaluated psychomotor skills with a behavioural checklist. Diversity of application was factored into the studies when testing affective skills. Three papers used Likert-scales to evaluate preparedness, six papers used Likert-scales to evaluate self-confidence and one used a Likert-scale to evaluate autonomy. Three papers used a checklist to evaluate professionalism. Four papers used faculty member/ standardised patient feedback.
CONCLUSIONS: Reductionist evaluation instruments create a barrier when evaluating competency. The limited validity and reliability of assessment instruments in simulation, as well as the lack of standardisation of affective skills assessment, presents a challenge in simulation research. Affective skills encompass attitudes, behaviours and communication abilities, which pose a significant challenge for standardised assessments due to their subjective nature. This review of the simulation literature highlights a lack of robustness in the evaluation of the affective domain. This paper proposes that simulation assessment instruments should include the standardisation of affective domain proficiencies such as: adaptation to patients\' cognitive function, ability to interpret and synthesise relevant information, ability to demonstrate clinical judgement, readiness to act, recognition of professional limitations and faculty/standardised-simulated patient feedback. The incorporation of the affective domain in standardised assessment instruments is important to ensure comprehensive assessment of simulation particularly in the development of health history and physical assessment proficiencies. Attention to all of the domains in Blooms taxonomy during simulation assessment has the potential to better prepare professionals for the patient care setting.

Electronic health records are integral to the advanced practice registered nurse role, yet access and training during academic preparation are profoundly limited. Lack of exposure to electronic health records prevents students from becoming fully prepared for the responsibilities of clinical practice and potentially impacts quality of care, patient safety, and communication among patients and providers. This scoping review of 20 articles on electronic health record use in advanced practice registered nursing student education shows significant gaps in current research. Nine articles were classified as research. The remaining 11 were non-research reports of teaching innovations describing the use of simulated electronic health records in graduate nursing education or the use of an electronic health record in interprofessional education activities. Most of the limited research did not use valid and reliable instruments or robust designs, employed disparate approaches and tools to study the phenomenon, and measured low-level outcomes such as student navigation and confidence in using electronic health records. The non-research literature draws attention to the deficits in educational resources, including unaffordable electronic health records for academic use. Although rigorous evidence is lacking, a common theme throughout the reviewed literature was the benefit of simulation to develop electronic health record skills.

BACKGROUND: This integrative review examined how simulation is being used to teach graduate nursing students about the social determinants of health (SDH).
METHODS: The literature search focused on studies that included a sample of graduate nursing students who participated in an SDH simulation-based education (SBE). The timeframe used was 2013 to 2023 as this is when SBE emerged in graduate nursing education. Databases searched included Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Web of Science.
RESULTS: Nine studies included a sample of graduate nursing students and were included in this review. Published studies ranged from 2013 to 2023.
CONCLUSIONS: The findings of this review highlight the need for graduate nursing faculty to design, implement, and evaluate transformative SDH-specific SBE that prepares students to understand their role as social justice advocates for health equity.

Nursing science is at serious risk of extinction. The lack of funding for research, absence of healthcare policies underpinned by nursing science, and general lack of understanding of nursing metaparadigms all contribute to the stunted growth in nursing science. Doctoral research is a platform for the development and refinement of nursing science. The purpose of this qualitative retrospective document review was to describe the doctoral contribution to nursing in sub-Saharan Africa (SSA). Electronic dissertations for doctoral degrees in nursing within a 5-year period from universities in SSA were included. The extracted data comprising the purpose of the studies, the models used in the studies, and the studies\' contributions to nursing science were analyzed against a knowledge contribution framework. In total, 166 documents were included, mostly from South African universities, with a predominant focus on developing models, frameworks, and strategies within nursing practice. Only 17% of the studies applied grand nursing theories or models, with the rest of the studies applying theories from other disciplines. The contribution to nursing science from the doctoral studies was poor. The low uptake of nursing models in doctoral research in SSA may significantly contribute to the lack of refinement of nursing science within SSA. Structured approaches focused on integrating the nursing metaparadigms, theories, and models and fundamental underpins for doctoral education in Africa are essential to influencing the refinement of nursing science.

OBJECTIVE: Explore potential education and clinical pathways for nurses entering the profession through a Graduate Entry Nursing programme to transition to advanced practice roles.
METHODS: Realist review.
METHODS: A two stage process included 1) a systematic search of the following electronic databases EMCARE, MEDLINE, CINAHL, ERIC, and Scopus for published peer reviewed literature reporting academic pathways for graduates of graduate entry nursing programmes to progress to advanced nursing roles, and 2) consultation with key education programme stakeholders of graduate entry nursing programmes across Australasia, who undertook an inductive interpretive approach using realist logic to determine what works, for whom, and in what circumstances.
RESULTS: Twelve published articles that explored advanced practice academic pathways for graduate entry nursing graduates were synthesised in terms of context, mechanisms, and outcomes. Data were then interpreted as to what works, for whom, in what context, and why, to develop new understandings of opportunities for advanced practice pathways for these students. No specific tailored academic pathway for graduate entry nursing graduates to progress to advanced practice was identified. Important relationships were identified between financial imperatives, political drivers, and registration requirements.
CONCLUSIONS: Transformative strategies for new education pathways were identified as necessary to inspire innovation in nurturing graduate entry nurse graduates to progress to advanced practice roles. Effective collaboration and consultation within and across agencies and organisations are needed to both develop and implement accessible, expedient, and equitable programmes to enable this capable cohort to contribute to the health workforce.

The QSEN Institute developed the quality and safety education for nurses (QSEN) competencies for both undergraduate and graduate-prepared nurses to support their development of the knowledge, skills, and attitudes needed to deliver safe, quality care. The purpose of this scoping review was to (1) determine the extent of evidence about the current use of QSEN competencies in graduate nursing curricula and (2) determine the application of the QSEN competencies among graduate-prepared nurses in clinical practice.
Arksey and O\'Malley\'s methodological framework for scoping reviews was used to explore the literature about the use of the QSEN competencies in graduate nursing education and practice available in PubMed, Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, and Web of Science. Quality was assessed using Melnyk, Gallagher-Ford, and Fineout-Overholt\'s critical appraisal tools.
In total, 423 articles were reviewed, 10 of which met inclusion criteria; five described quality improvement projects, two addressed curricular design, and three were program evaluations. Only one article described the use of QSEN competencies in practice. Overall, the amount of literature was scant and of low quality. All the articles described the use of QSEN competencies in graduate education except one, which also described them in practice in a graduate nurse residency program.
Although the QSEN competencies were adopted for use in graduate curricula and practice settings, there is a wide variation in the actual use and application with limited reporting of outcomes. The graduate QSEN competencies can be leveraged to equip nurses with the knowledge, skills, and attitudes to address quality and safety challenges in any nursing environment including the operational environment in deployed and austere settings. This review provides recommendations to address gaps in research, graduate nursing education, and clinical practice.

BACKGROUND: Advanced practice nurses and future nursing researchers must be adequately educated with the best available evidence. However, we know little about educational strategies and their characteristics used explicitly to educate advanced practice nurses and future researchers.
METHODS: A scoping review was used to map the latest educational strategies used in master\'s and doctoral nursing education between 2011 and 2021. Components of educational strategies were extracted based on the Guideline for Reporting Evidence-Based Practice Educational Interventions and Teaching and the Saskatchewan Education Department Framework of Professional Practice. The New World Kirkpatrick Model was used to categorize the associated learning outcomes. A narrative description approach was used to synthesize the findings.
RESULTS: A total of 56 studies were included. Several information was missing regarding the theoretical foundations of the educational strategies. A total of 158 educational strategies were identified. Individual work (e.g., homework) was the most popular educational strategy. Most studies assessed learning outcomes related to reactions (e.g., satisfaction) or learning (e.g., knowledge).
CONCLUSIONS: More studies should be done using interactive instruction or multimodal approaches, while the authors should better describe intervention components. A systematic review of effectiveness needs to be conducted to evaluate the best educational strategies in the master\'s and doctoral nursing education.

OBJECTIVE: To map knowledge regarding Quality Improvement in the implementation science paradigm in graduate nursing education in professional programs.
METHODS: This is a scoping review, conducted from October to December 2021, following the assumptions established by the Joanna Briggs Institute and the PRISMA-ScR protocol.
RESULTS: 18 studies were selected. Being, 7 articles (38.8%) about the implementation strategies and development of Quality Improvement projects for graduate nursing students. The included studies emphasize Quality Improvement as a methodological strategy capable of capturing a problem in practice, to be solved without losing scientific rigor, and emphasize the importance of obtaining Quality Improvement skills in professional programs.
CONCLUSIONS: Implementation science and Quality Improvement projects advance professional programs to improve and develop quality health care.

OBJECTIVE: The aim of this scoping review was to explore the evidence relating to master\'s education for leadership development in adult/general nurses who are not in advanced practice or leadership roles and its impact on practice.
BACKGROUND: The importance of effective, clinical leadership in nursing and health care, has been highlighted following failings reported by Public Inquiries both nationally and internationally. While initiatives have been implemented to address these, the provision of safe, quality care remains problematic. Complex care requires highly skilled professionals to challenge and lead improvements in practice. Master\'s education results in graduates with the skills and confidence to make these changes and to become the clinical leaders of the future.
METHODS: An a priori scoping review protocol was developed by the review team. This was used to undertake searches across CINAHL Ultimate; Medline (Ovid), Scopus and ProQuest Complete databases, chosen due to their relevance to the subject area. Articles were limited to those in the English Language, peer reviewed and published since 2009. Citation chaining via the reference lists of frequently identified articles were also searched. A further search for relevant grey material using the same relevant keywords and phrases was performed using the limited, Trip Database and Google Scholar.
RESULTS: Eight articles were selected for data extraction, and these were published between 2011 and 2019. The articles were predominantly from the UK and Europe, with a focus either on master\'s education or on aspects of leadership in nursing and healthcare. Themes identified: a) The need for clinical leadership; b) master\'s education for clinical leadership skills; and c) master\'s education for professional and organisational outcomes.
CONCLUSIONS: The scoping review identified that there is a need for strong clinical leadership in the practice setting. Evidence shows that effective nursing leadership can improve patient outcomes as well as enhancing workplace culture and staff retention. The review has shown that the skills required for clinical leadership are those produced by master\'s education. Studies of the impact of master\'s education are often self reported and tend to focus on nurses in advanced practice roles. More research is required into master\'s education for adult/general nurses not in advanced roles and in examining the link between master\'s education and improved patient, professional and organisational outcomes.