Creating Entrustable Professional Activities (EPAs) for Acute Care Pediatric Nurse Practitioner Students

 From the 3/5/2021 newsletter

Perspective/Opinion

Creating Entrustable Professional Activities (EPAs) for Acute Care Pediatric Nurse Practitioner Students

Jill C. Kuester, MSN, RN, CPNP-AC, Katie McDermott, MSN, RN, CPNP-AC, Jennifer K. Pfister, MSN, RN, CPNP-AC, C-NPT, Christine Schindler, PhD, CPNP, and Leslie Talbert, DNP, RN, CPNP-AC/PC

 

EPAs are widely used in measuring the progress of residents in graduate medical education. The members of the Marquette team describe their KINETIC3 capstone in which they adopted an EPA approach to graduate nursing education…

Nursing and medicine go together like peanut butter and jelly. Although distinct, we complement one another. As interdisciplinary teams improve at working together, we have found the ability to gain insights from the more traditional pathways of each other’s endeavors.

The Kern Institute holds a yearlong program known as the KINETIC³ Teaching Academy where the goal is to improve medical education. Character, caring, and competence in medical education are at the center of the program with each participant or group focused on completing a project incorporating these traits.

The five core faculty members from Marquette University’s Acute Care Pediatric Nurse Practitioner (MU ACPNP) program completed a capstone project focused on creating Entrustable Professional Activities (EPAs). Guided by the Code of Ethics published by the American Nurses Association which explicitly states that nurses have compassion and respect for their patients and families, nurses already have a strong reputation for caring. We knew that the KINETIC³ program might offer a different perspective to build upon this foundation.

As nursing has been named the most trusted profession for nineteen years in a row (Gallup), we wondered how this could be operationalized into our graduate level curriculum. EPAs have been widely used in medical education but remain a novel concept in nursing education. The MU ACPNP faculty believed the act of entrustment was well suited to our nurse practitioner students. 

Utilizing this concept from medical education and knowledge gained through the KINETIC3 courses, our group conducted a systematic literature search, synthesized that literature, and created a template to guide development of the individual EPAs. Each member then focused on one of five EPA topics: 

• Reflective practice 
• Leadership identity 
• Holism 
• Social justice 
• Magis - the concept of using talents to strive for excellence 

Each project team member was the designated lead on an individual EPA and drafted the EPA using the template. Iterative cycles of reflection, collaborative review, feedback, and revision were conducted to ensure consensus regarding content, outcomes, and assessment sources. These collaborative sessions were held synchronously, both in-person and virtually, to promote clarity in communication. The final stage of revisions included alignment of language and descriptors used across all five EPAs to promote continuity of content and universality of tone. 

Each EPA includes a succinct action-oriented title followed by a more robust description linked to key literature, as well as a justification statement calling out its significance and impact beyond the walls of Marquette. Each EPA encompassed several nurse practitioner competency domains and described the required knowledge, skills, and attitudes the students must possess for success. Some of the methods of assessment we will use include, but are not limited to, direct observation, critical review and evaluation of projects, reflective journaling, and exit interviews.

As graduate students move into professional practice, our goal is for them to embody the values we espouse as a faculty in alignment with MU’s mission, vision, and core values. EPAs hold the promise of operationalizing the transformation to a competency-based education framework for PNPs by defining a pathway with a common language and clearly articulated ideal outcomes. The KINETIC3 program afforded us the opportunity to learn and work as a team to intentionally develop key strategies to enhance the development of the competent and compassionate nurse practitioner.

Jennifer K. Pfister MSN, CPNP-AC, C-NPT, is a Pediatric Critical Care Nurse Practitioner at MCW/Children’s Wisconsin and a Transport Team Clinical Educator at Children's Wisconsin. She also has a joint appointment at Marquette University where she is part-time faculty within the Acute Care Pediatric Nurse Practitioner program. 

Christine Schindler, PhD, CPNP, is a Pediatric Nurse Practitioner and Advanced Practice Provider Director for Critical Care/Palliative Care At MCW/Children’s WI. She has a joint appointment at Marquette University where she serves as a Clinical Associate Professor and director of the Acute Care Pediatric Nurse Practitioner program. 

Leslie Talbert, DNP, is a Pediatric Nurse Practitioner at MCW/Children’s Wisconsin. 

Katie McDermott, MSN, RN, CPNP-AC, is a Pediatric Nurse Practitioner for Critical Care at MCW/Children’s Wisconsin and has a joint appointment at Marquette University where she is part-time faculty within the Acute Care Pediatric Nurse Practitioner program. She also serves as the Program Director at the Dairy Cares Simulation Lab at Children's Wisconsin. 

Jill C. Kuester, MSN, RN, CPNP-AC, is a Pediatric Critical Care Nurse Practitioner at MCW/Children’s Wisconsin. She has a joint appointment at Marquette University where she serves as Part-time Faculty in the Acute Care Pediatric Nurse Practitioner program.