Advanced Practice Nurses’ Experiences in Sustaining Practice During a Prolonged Global Crisis

Aim:
To understand advanced practice nurses' experiences during the COVID-19 pandemic and identify strategies to support their coping and well-being while sustaining clinical practice.

Background:
Advanced Practice Nurses are registered nurses with graduate-level education who provide essential care to individuals, families, and communities across the globe. Nurse practitioners, clinical nurse specialists, and other designations are part of the broader Advanced Practice Nurse population. The COVID-19 pandemic provided a unique opportunity to study their coping, and well-being and practice sustainability.
Methods:

Qualitative description was used to analyze narrative responses to questions administered within a survey circulated at two points during the COVID-19 pandemic. Snowball sampling and distribution via advanced practice nursing organizations were used. There were 928 participants in the first phase of the data collection in 2020 and 659 respondents in 2021 during phase two. Overall, there were 1587 participants from 53 countries.

Findings:
Supports and opportunities provided by practice settings and employers were found to be helpful in the early months of the pandemic. However, beyond six months of global crisis response advanced practice nurses began to identify more closely with supports external to the work team and practice setting. These included time with others, meditation, mindfulness, hiking, yoga, and time off. Some maladaptive behaviours, including increased alcohol use, were also identified during phase two (late pandemic) data collection. Experiences of support from employers and colleagues were variable and may have been linked to pre-existing conditions in the employee/workplace relationship. Advanced Practice Nurse coping, well-being, and clinical practice benefitted from in-workplace supports such as information sharing, team activities, relationships with colleagues, and feeling supported by employers in the early phases of a system crisis. In later phases, external supports and time away from the practice setting were described as more helpful.

Conclusion:
Advanced Practice Nurse coping, well-being, and clinical practice benefitted from in-workplace supports such as information sharing, team activities, relationships with colleagues, and feeling supported by employers in the early phases of a system crisis. In later phases, external supports and time away from the practice setting were described as more helpful. This work suggests there is a tipping point where approaches to supporting advanced practice nursing professionals in a prolonged crisis should move from workplace initiatives to activities external to the practice setting.