BackgroundThe prevalence of chronic illness and multimorbidity rises with population aging, thereby increasing the acuity of care. Consequently, the demand for emergency and critical care services has increased. However, the forecasted requirements for physicians have shown a continued shortage. Among efforts underway to search for innovations to strengthen the workforce, there is a heightened interest to have nurses in advanced practice participate in patient care at a great extent. Therefore, it is of interest to evaluate the impact of increasing the autonomy of nurses assuming advanced practice roles in emergency and critical care settings on patient outcomes.ObjectivesThe objectives of this study are to present, critically appraise, and synthesize the best available evidence on the impact of advanced practice nursing on quality of care, clinical outcomes, patient satisfaction, and cost in emergency and critical care settings.Review methodsA comprehensive and systematic search of nine electronic databases and a hand-search of two key journals from 2006 to 2016 were conducted to identify studies evaluating the impact of advanced practice nursing in the emergency and critical care settings. Two authors were involved selecting the studies based on the inclusion criteria. Out of the original search yield of 12,061 studies, 15 studies were chosen for appraisal of methodological quality by two independent authors and subsequently included for analysis. Data was extracted using standardized tools.ResultsNarrative synthesis was undertaken to summarize and report the findings. This review demonstrates that the involvement of nurses in advanced practice in emergency and critical care improves the length of stay, time to consultation/treatment, mortality, patient satisfaction, and cost savings.ConclusionsCapitalizing on nurses in advanced practice to increase patients’ access to emergency and critical care is appealing. This review suggests that the implementation of advanced practice nursing roles in the emergency and critical care settings improves patient outcomes. The transformation of healthcare delivery through effective utilization of the workforce may alleviate the impending rise in demand for health services. Nevertheless, it is necessary to first prepare a receptive context to effect sustainable change.Electronic supplementary materialThe online version of this article (10.1186/s12960-017-0237-9) contains supplementary material, which is available to authorized users.

Sleep quality is an important aspect of sleep, but no meta-analysis has elucidated its relationship with blood pressure (BP) and hypertension. A meta-analysis was conducted in October 2016 using multiple databases, including Embase and Medline.Studies that assessed subjective sleep quality and BP or hypertension were included.Upon full-text evaluation, 29 articles from 45 041 patients were selected, of which 22 articles were included in the meta-analysis and seven were presented narratively. Poor sleep quality was significantly associated with a greater likelihood of hypertension (odds ratio, 1.48; P value = .01). Poor sleepers had higher average systolic BP (mean difference = 4.37, P value = .09) and diastolic BP (mean difference = 1.25, P value = .32) than normal sleepers without statistical significance. Patients with hypertension had significantly worse sleep quality scores (mean difference = 1.51, P value < .01), while BP dippers had significantly better scores (mean difference = −1.67, P value < .01).The findings highlight the relationship between sleep quality and hypertension. global PSQI scores (indicative of poorer sleep quality) than patients with normotension. 14,20 Apart from its association with BP, poor sleep quality may be associated with the dipping pattern of BP. For a healthy patient, there is at least a 10% reduction in nocturnal BP as compared with daytime BP; such a patient is characterized as a "dipper."21 "Nondippers" demonstrate an increased activity in the sympathetic nervous system and a decreased activity in the parasympathetic nervous system, which probably explains the higher nocturnal BP. 22 Nondipping BP is associated with higher risk for cardiorenal organ damage such as left ventricular hypertrophy and cerebrovascular diseases. 23 Poor sleep quality may be associated with nondipping patterns through their disruption of the circadian rhythm. 24This association is supported by previous research reporting higher PSQI global scores for nondippers than dippers. 25,26 However, no metaanalysis has been conducted to summarize these findings.Current evidence suggests a potential association between poor subjective sleep quality and hypertension, but it has not been verified through a systematic approach. The primary aims of the present systematic review and meta-analysis are to summarize current evidence and to determine whether poor subjective sleep quality is associated with elevated BP. The secondary aim is to examine whether the associations differ by geographic regions. | METHODS | Search strategyMultiple databases were used for the present review, namely Medline Search terms included a combination of synonyms of "sleep quality," 9 "hypertension," 3 and "blood pressure" 3 as adapted from relevant review articles. 3,9 All articles with English abstracts were assessed. | Study inclusion criteria• Primary studies with a cross-sectional, prospective, or retrospective design• Studies that examined sleep quality with a self-reported questionnaire• Studies that defined hypertension with cri...

Aims To explore registered nurses' perceptions towards the role of advanced practice nurses and to examine registered nurses' interests in becoming advanced practice nurses. Background Globally, the development and implementation of advanced practice nurses have been deemed propitious. Advanced practice nurses are recruited and developed from the current pool of registered nurses. Empirical research is needed to inform practice on ensuring the sustainability of the advanced practice nurse workforce through the recruitment and development of the current population of registered nurses. Methods A nationwide cross‐sectional online survey was conducted in Singapore. Registered nurses from all public health care institutions were surveyed. Results Respondents (n = 1,025) displayed optimism and acceptance towards advanced practice nurses. However, only 30.7% hoped to become advanced practice nurses. Nursing leaders were reported to have a low success rate in identifying registered nurses who were both suitable and interested in the advanced practice nurse role. Conclusions Registered nurses' positive perspectives towards the role of advanced practice nurses do not translate into interests in the role. The study offers pragmatic applicability in ensuring the sustainability of the advanced practice nurse workforce. Implications for Nursing Management Advanced practice nurse‐specific residency programmes for pre‐master registered nurses may be facilitative to retaining and recruiting registered nurses for the advanced practice nurse workforce.

Aim: To explore Master of Nursing students' perspectives toward the impact of coronavirus disease 2019 (COVID-19) on the advanced practice nurse preparatory education and practice. Background: Like many nursing education programmes, the advanced practice nurse preparatory training was greatly affected and had to radically change to adapt to the disruptions caused by the pandemic. The COVID-19 pandemic has created a strain on the healthcare system and advanced practice nurses have been expected to modify their normal practice to provide care in unprecedented ways. Methods:The study used a descriptive qualitative design. Semi-structured videoconference interviews were conducted in an autonomous university (June-July 2020). The recruitment of participants (n = 14) concluded upon data saturation. A thematic analysis was conducted. The COnsolidated criteria for REporting Qualitative research (COREQ) guidelines were used. Findings: Three main themes were identified: (1) overcome adversity through innovation, (2) acceptance of remote learning and (3) versatility of advanced practice nurses in an ongoing pandemic. Each theme was further explained by two subthemes to further elucidate the impact of COVID-19 on the advanced practice nurse preparatory training and practice. Discussion: The evolution of the advanced practice nurse preparatory education catalysed by the COVID-19 pandemic brought on innovation. The ability of advanced practice nurses to adapt to evolving healthcare needs was also highlighted. Conclusion:Although face-to-face teaching and services are gradually returning, some innovations that arose during the pandemic may be worth keeping. Implications for nursing: Nursing educators in higher education institutions can benefit from adopting technology to mitigate the challenges posed by the ongoing pandemic Implications for nursing policy: Nurse leaders should review the role of advanced practice nurses to determine how best to capitalise on their practice to meet rising healthcare needs.

Aims:To explore registered nurses' perceptions towards the role of advanced practice nurses and to examine registered nurses' interests in becoming advanced practice nurses.Background: Globally, the development and implementation of advanced practice nurses have been deemed propitious. Advanced practice nurses are recruited and developed from the current pool of registered nurses. Empirical research is needed to inform practice on ensuring the sustainability of the advanced practice nurse workforce through the recruitment and development of the current population of registered nurses. Methods:A nationwide cross-sectional online survey was conducted in Singapore.Registered nurses from all public health care institutions were surveyed.Results: Respondents (n = 1,025) displayed optimism and acceptance towards advanced practice nurses. However, only 30.7% hoped to become advanced practice nurses.Nursing leaders were reported to have a low success rate in identifying registered nurses who were both suitable and interested in the advanced practice nurse role.Conclusions: Registered nurses' positive perspectives towards the role of advanced practice nurses do not translate into interests in the role. The study offers pragmatic applicability in ensuring the sustainability of the advanced practice nurse workforce. Implications for Nursing Management:Advanced practice nurse-specific residency programmes for pre-master registered nurses may be facilitative to retaining and recruiting registered nurses for the advanced practice nurse workforce. K E Y W O R D Sadvanced practice nurses, nurse practitioners, personnel recruitment, professional image, registered nurses, staff nurses