• Nurse practitioners;
  • scope of practice;
  • clinical skills;
  • clinical procedures;
  • education;
  • rural practice;
  • research


  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgment
  8. References


To report findings from a survey, analysis, and evaluation of the frequency and criticality of clinical skills and procedures (CSPs) used by nurse practitioners (NPs). In addition, data regarding NP demographic, geographic, and educational preparation were also obtained.

Data sources

Participants were a convenience sample of 452 NPs in Oregon (31% response rate).


Findings point to the importance of assessing both frequency and criticality of practice skills. Demographic and geographic data reflected significant dichotomies between urban and rural practice. Rural NPs face challenges of providing care with more distant physician specialists and reported the use of a greater number of CSPs. A majority of participants reported learning most of the CSPs used in practice outside of their NP educational programs. The frequency and criticality of CSPs utilized in practice are both important considerations for NP clinicians and educators.

Implications for practice

NPs planning to practice in rural areas may need broader exposure and training in CSPs. An understanding of CSPs used by NPs may better inform administrative, reimbursement, licensure, and certification issues for advanced practice nursing. NP clinicians and faculty involved in NP education should seek to promote improved congruence between the CSPs taught in programs and those used in clinical practice.


  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgment
  8. References

Nurse practitioners (NPs) in Oregon provide a variety of primary, acute, and specialty care services across the human life span. In Oregon, NPs have a high level of autonomy with no state-mandated requirements for collaborative or supervisory association with physicians or other healthcare providers. Within the context of their advanced practice nursing positions, NPs are expected to perform a number of psychomotor clinical skills and procedures (CSPs) during patient care encounters for diagnostic and/or therapeutic purposes. For a variety of reasons, including the shortage of primary care physicians, the role and expectations for NP practice is expanding, especially in rural areas where the availability of physicians in primary and specialty care is reduced. The purpose of this research project was to survey and analyze the CSPs used by Oregon NPs.

CSPs used in patient care are acquired either through educational venues (e.g., NP programs and continuing education offerings) or through “on-the-job” training. University NP programs often offer courses that address specifically the need for CSPs. Guidelines developed by national organizations such as Criteria for Evaluation of Nurse Practitioner Programs (NTF, 2008), The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006), and the Nurse Practitioner Primary Care Competencies in Specialty Areas (NONPF, 2002) do not delineate specific CSPs required for NP curricula or practice. The NTF Criteria do recognize that “faculty must have the preparation, knowledge-base, and clinical skills appropriate to their area of teaching responsibility” (NTF, 2008, p. 15). The lack of established guidelines for specific CSP training thus require university faculty to determine the essential content for student learning. As Cole and Ramirez (2003) stated, “The ideal set of procedures to be taught to FNP students remains elusive” (p. 40). Gathering information from current, practicing NPs regarding their need and use of CSPs can help guide educators in developing evidence-based NP program content and competencies. Obtaining relevant data and evaluating differences in CSPs used by rural versus urban NPs may also inform educators and future NPs of expected practice needs. The findings from this research study delineated differences in rural and urban NP practice. However, aspects related to urban–rural differences will not be addressed in detail in this article.

Literature review

A review of the literature provided minimal documents addressing the current evaluation of NP CSPs. A literature review in CINAHL and Medline (OVID) was conducted using the keywords: clinical or practice skills, procedures, skills criticality, task analysis, job analysis, NP, and advanced practice nursing. Results of the literature review confirmed a general lack of articles specifically addressing the status of CSPs used in NP practice or education. The literature related to job and/or task analysis and criticality of tasks included a number of studies that helped inform the development of this research project (Fabrey & Walla, 2004; Patterson, Ferguson & Thomas, 2008; Perry, Rauk, McCarthy, & Milidonis, 2008). However, these studies lacked a specific examination of clinical skills or did not focus on NP practice.

Relating to this project, Hastings-Tolsma, Rosen, Bawden, and Mancuso (2008) completed a detailed task analysis of national nurse midwifery practice. Cole and Ramirez (2000) completed a survey in which NPs in emergency care settings self-assessed the procedures they performed. Kleinpell (1997) broadly examined through a survey questionnaire the role and practice profiles of acute-care NPs. In this article, Kleinpell identified procedures frequently and infrequently performed by ACNP but did not quantify the frequency or criticality of use. Articles that specifically addressed differences in rural and urban CSPs were not found in the literature review.

Cole and Ramirez (2003) conducted a national survey of family NP (FNP) program directors to assess the procedures taught in FNP programs. In this article and in support of the current study, the authors suggested FNP programs should survey their graduates to learn “what procedures graduates are performing … in their educational programs” (Cole & Ramirez, 2003, p. 43). Blunt (2001) in a brief article, discussed pedagogical aspects related to teaching NP clinical skills. Additional studies or articles addressing CSPs that are taught in NP educational programs were not located in the literature search. Hvranak, Tuite, and Baldesseri (2005) indicated the use of standardized patients and high-fidelity simulation in the development and evaluation of CSPs in NP students but did not delineate specific CSPs.

Project aims

The specific aims of this research project were:

  • Develop an instrument for surveying Oregon NP CSPs, demographic, geographic, and practice-related information.
  • Using primary data sources (Oregon NPs in clinical practice), acquire self-reported responses to the survey instrument.
  • Analyze and summarize responses of Oregon NP to the CSP survey questionnaire.
  • Analyze and summarize responses to survey questionnaire regarding NP demographics and other aspects of NP clinical practice.


  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgment
  8. References

The Oregon Health & Science (OHSU) Institutional Review Board reviewed and approved this minimal risk study. The study employed a descriptive survey methodology. The survey instrument was designed and distributed to a convenience sample of Oregon NPs. Completed surveys were returned through the U.S. mail. Data from returned surveys were entered into the IBM SPSS™ Version 19 (2010) statistical software program to facilitate descriptive statistical analyses of the survey data.

Sample and sources of data

The potential sample of 1450 participants was derived from the Oregon State Board of Nursing's (OSBN's) list of advanced practice registered nurses licensed as an NP. A convenience sample was derived from the OSBN list of licensed FNP, adult (ANP), geriatric (GNP), and pediatric NPs (PNP). Exclusion criteria included any advanced practice nurse with Oregon licensing as an acute care NP, school or college NP, and/or psychiatric-mental health NP. Other categories of Oregon advanced practice nurses, such as Clinical Nurse Specialist (CNS), Certified Nurse Midwife (CNM), and Certified Registered Nurse Anesthetist (CRNA), were also excluded from the survey. Participants were required to read English to complete the survey. No personal identifying data were collected during the survey.

Instrument development and distribution

The final survey instrument was developed in the early stages of the project utilizing input from the literature (Cole & Ramirez, 2000; Cole & Ramirez, 2003) and university statistician support. The survey was vetted through a review process by a panel of expert NPs. This panel consisted of three FNPs, each with more than 20 years of teaching and primary care clinical experience. The panel members also had a breadth of exposures working in urban, suburban, and rural settings. Input from this panel on the completeness of the listed CSP, as well as the formatting of the survey, were incorporated prior to survey distribution.

The survey instrument consisted of two parts. The first part (see Figure 1) consisted of demographic, geographic, and practice-related questions. The second part of the survey (see Figures 2 and 3) listed 90 CSPss selected from Ambulatory Care Procedures for the Nurse Practitioner (Colyar & Ehrhardt, 2004). In this part of the survey, NPs were asked to identify if during their current practice activities they perform each CSP and the relative frequency of use. In addition, to assess the criticality of each CSP, the respondent was asked to indicate the importance of the CSP within the scope of their practice. For each CSP, the survey also asked the respondent to indicate how the CSP was initially learned: through on-the-job training, continuing education (CE), or during the NP's initial educational program.


Figure 1. Demographic, geographic, and practice-related survey questions.

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Figure 2. Example of survey questions of clinical skills and procedures.

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Figure 3. Complete list of clinical skills and procedures included in survey (Colyar & Ehrhardt, 2004).

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The survey was distributed via U.S. mail to the NP's address found on the acquired OSBN list of advanced practice nurses. A stamped and addressed return envelope was enclosed for returning the completed survey via U.S. mail. A one-page introduction and explanation of the study was included with each mailed survey. Return of the survey implied consent to participate in the study.

Data collection, entry, and analysis

Surveys were collected via U.S. mail in a preaddressed postage-paid envelope. No individual identifying data were requested on the survey or return envelopes. As surveys were returned, each one was coded with a unique number for data entry. The participant's responses were entered into the SPSS™ statistical software program with appropriate coding of fields and values from the survey instrument. Data obtained from the demographic and practice-related questions were assigned ordinal values for entry into the statistical software. All responses were entered in a duplicate SPSS file and compared to the original files to minimize the potential for missed or inaccurate data entry. Descriptive statistical analyses were used to evaluate and summarize the data.


  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgment
  8. References

Demographic, geographic, and practice-related findings

A total of 1450 surveys were mailed to Oregon NPs and 452 (31%) completed surveys were returned. The results from the demographic, geographic, and practice-related questions (see Figure 1) are reported as follows. For the NP's area of certification, the first listed percentage is from the survey responses and is compared to the state's total percentage (in brackets) for each specialty. The majority of the sample were FNPs (70%[73%], n = 316) and responses for the other certification areas were: ANP (18%[22%], n = 82), PNP (11%[9%], n = 49), and GNP (4%[3%], n = 17). The results for each NP specialty area corresponds closely to the specialty distribution from all of the state's licensed NPs. Some of the NPs (3%, n = 12) indicated certification in more than one area. Of the 438 that identified a practice location, urban NPs were the majority of respondents (45.7%, n = 200), with suburban (23.3%, n = 102), rural (30.3%, n = 133), and frontier (0.7%, n = 3) completing the sample. In regards to the type of educational program attended, 81.4% (n = 364) NPs had a Master's degree, 9.8% (n = 44) went through a certificate program, 8.3% (n = 37) had post-master's certificates, and 0.4% (n = 2) were doctorally prepared.

The results for the estimated annual patient visits were 40% (n = 181) for >10,000, 25% (n = 113) for 5000—10,000, 20% (n = 90) for 2500—5000, and 15% (n = 68) for <2500. The majority reported having a physician for collaboration on-site (74%, n = 334), while for 16% (n = 72) physician availability was local (< 5 miles). For 7% (n = 32) of the NPs, a collaborating physician was 5–50 miles away and for 3% (n = 14), the availability was greater than 50 miles.

Table 1 presents data related to the geographic availability of specific physician specialists. The majority indicated the identified physician specialists were available locally. For 3–11% of the sample (depending on specialists) available physicians were located at a distance (>50 miles). For example, 11% (n = 46) of Oregon NPs indicated the nearest available cardiologist was more than 50 miles away. Using the same distance criteria, the availability of a 24-h, physician-staffed emergency department was 86% (n = 377), 13% (n = 56), and 2% (n = 8) for local, regional, and distant respectively.

Table 1. Percentage (number of respondents) reporting distances to availability of physician specialists
MD specialistLocal (<5 mi)Regional (5–50 mi)Distant (>50 mi)
  1. *Number of total respondents. **Numbers rounded off to nearest whole percentage.

Orthopedist (N = 438)*80 (352)**17 (74)3 (12)
Cardiologist (N = 436)68 (295)22 (95)11 (46)
General surgeon (N = 437)80 (352)17 (73)3 (12)
Ob/GYN (N = 434)81(350)16 (70)3 (14)
Dermatologist (N = 433)73 (314)21 (92)6 (27)
Ophthamologist (N = 432)81 (349)16 (70)3 (13)

Findings from CSP questionnaire

The specific responses to the questions for all 90 items on the skills and procedure questionnaire are beyond the scope of this article. However, some of the data are summarized as follows. Table 2 identifies the CSPs used by more than 50% of the respondents and the percentage of these respondents that indicated the CSP was learned in their NP program. The CSP used by the largest number of respondents (76.1%, n = 436) was cerumen impaction removal, which was reportedly learned in the NP program by 30.7% (n = 134). Table 3 lists the CSPs used by less than 10% of the NPs, with vasectomy being the CSP used by the fewest (3%, n = 13) NPs.

Table 2. CSPs used by >50% of respondents and percentage learned in NP program
Skill/ProcedureTotal N% Total% NP indicated skilled learned in NP program
1. Cerumen impaction removal43676.1%30.7%
2. Bites (cats, dogs, insects, etc.)43672.7%35.5%
3. Papanicolaou (Pap) Smear43972.7%89.3%
4. Abscess incision and drainage43771.6%19.2%
5. Electrocardiogram (ECG) interpretation43764.8%43.7%
6. Skin tag removal43663.3%24.2%
7. Nebulizer administration43762.2%27.8%
8. Peak flow meter43061.9%32.8%
9. Microscopy (e.g., wet mount)43859.6%67.2%
10. Tick removal43459.4%13.4%
11. Skin closure—sutures43557.5%46.9%
12. Venipuncture43457.4%22.8%
13. Epistaxis control43556.8%29.9%
14. Capillary blood collection (finger stick)43555.9%34.1%
15. Foreign body removal: ear or nose43155.7%26.7%
16. Wood's light examination42955.0%37.8%
17. X-ray interpretation—chest43853.7%45.5%
18. Punch biopsy43752.9%28.4%
19. Eye irrigation43552.6%34.3%
20. Corneal abrasion43452.3%34.6%
21. X-ray interpretation—bones43852.1%39.3%
22. Burns—debridement43651.6%19.6%
23. Skin biopsy/lesion removal43351.3%31.1%
Table 3. CSPs used by <10% of respondents
Skill/ProcedureTotal N% total
1. Auricular hematoma evacuation4349.9%
2. Holter monitor application4359.7%
3. Paracervical nerve block4299.3%
4. Ultrasonagraphy4339.0%
5. Tongue laceration repair4358.3%
6. Colposcopy/cervical biopsy4348.1%
7. Tooth avulsion and fracture4348.1%
8. Implantable venous catheter access4348.1%
9. Lumbar puncture4347.1%
10. Bone marrow aspiration/biopsy4346.5%
11. Gastric lavage4336.5%
12. Chest tubes for emergency transport4345.5%
13. Occipital nerve block4345.3%
14. Breast biopsy: fine needle aspiration4314.6%
15. Frenotomy for ankyloglossia4324.4%
16. Flexible sigmoidoscopy4344.1%
17. Abdominal paracentesis4353.9%
18. Circumcision and dorsal penile nerve block4343.7%
19. PICC line insertion4323.2%
20. Vasectomy4313.0%

The survey asked each NP the frequency of use for each CSP. Table 4 summarizes the results from the frequency of use for the CSP using the previous list (Table 2) of CSPs used by more than 50% of respondents. In the survey, the response options for “frequency of use” were: routinely (≥once/week), frequently (≥once/month), and rarely (few times/year). More than 50% of the respondents indicated they routinely did Papanicolaou (Pap) smears (69.6%, n = 208), microscopy (55.2%, n = 139), and x-ray interpretation of bones (53.9%, n = 111). Many of the listed CSPs were rarely used by the respondents, and tick removal (83.5%, n = 202), ear and nose foreign body removal (70.7%, n = 157), and burn debridement (70%, n = 152) were the three chosen as most rarely used.

Table 4. CSPs used by >50% of respondents and percentage of frequency of use
Skill/ProcedureTotal N% routinely% frequently% rarely
1. Cerumen impaction removal31337.7%39.9%22.4%
2. Bites (cats, dogs, insects, etc.)30515.4%32.5%52.1%
3. Papanicolaou (Pap) smear29969.6%12.4%18.1%
4. Abscess incision and drainage30620.9%35.6%43.5%
5. Electrocardiogram (ECG) interpretation26541.9%38.9%19.2%
6. Skin tag removal26319.8%40.3%39.9%
7. Nebulizer administration25236.1%36.5%27.4%
8. Peak flow meter25236.1%36.5%27.4%
9. Microscopy (e.g., wet mount)25255.2%22.6%22.2%
10. Tick removal2423.3%13.2%83.5%
11. Skin closure—sutures23825.2%37.0%37.8%
12. Venipuncture23132.9%23.3%43.7%
13. Epistaxis control2298.3%25.8%65.9%
14. Capillary blood collection (finger stick)23132.5%25.1%42.4%
15. Foreign body removal: ear or nose2229.9%19.4%70.7%
16. Wood's light examination22012.3%25.9%61.8%
17. X-ray interpretation—chest22148.9%33.0%18.1%
18. Punch biopsy22116.3%33.5%50.2%
19. Eye irrigation20910.0%23.4%66.5%
20. Corneal abrasion21415.4%34.6%50.0%
21. X-ray interpretation—bones20653.9%25.7%20.4%
22. Burns—debridement2178.8%21.2%70.0%
23. Skin biopsy/lesion removal21117.1%47.9%35.1%

The survey also addressed the criticality of the CSP by asking respondents to evaluate the importance of each skill to their clinical practice. Table 5 also uses the list from Table 2 to display whether a CSP was very important, important, moderately important, minimally important, or not important. Of these 23 CSPs, Pap smears was identified by the highest percentage of NPs (70.3%, n = 223) as very important and tick removal had the highest percentage (14.9%, n = 39) of being not important to the respondent's practice. All 23 of the CSPs on this list were rated by 50% or more of the respondents to be either very important or important to their practice. The relationship between a CSP's importance to practice, and whether it was learned in the NP program, was not specifically evaluated. This is an appropriate data correlation that would be important to investigate in future analyses.

Table 5. Criticality of CSPs to NP practice
Skill/ProcedureTotal N% very important% important% moderately important% minimally important% not important
1. Cerumen impaction removal32439.8%22.8%20.1%7.1%10.2%
2. Bites (cats, dogs, insects, etc.)31734.4%27.8%17.7%10.1%10.1%
3. Papanicolaou (Pap) smear31770.3%10.7%5.0%2.5%11.4%
4. Abscess incision and drainage32442.6%24.7%13.9%10.2%8.6%
5. Electrocardiogram (ECG) interpretation28256.0%20.6%12.1%5.7%5.7%
6. Skin tag removal27423.4%23.7%26.6%13.9%12.4%
7. Nebulizer administration26747.9%20.6%17.2%6.0%8.2%
8. Peak flow meter25543.5%23.5%16.5%6.3%10.2%
9. Microscopy (e.g., wet mount)27455.1%17.2%10.2%5.1%12.4%
10. Tick removal26217.2%22.5%26.0%19.5%14.9%
11. Skin closure—sutures25446.9%21.7%15.0%6.3%10.2%
12. Venipuncture25140.6%19.1%13.1%13.1%13.9%
13. Epistaxis control24820.6%28.6%23.0%16.1%11.7%
14. Capillary blood collection (finger stick)24534.3%24.1%17.1%11.0%13.5%
15. Foreign body removal: ear or nose24423.0%32.0%20.1%13.5%11.5%
16. Wood's light examination23721.1%23.2%23.6%17.7%14.3%
17. X-ray interpretation—chest24156.8%20.3%10.8%3.3%8.7%
18. Punch biopsy24431.1%32.0%16.8%6.6%13.5%
19. Eye irrigation23326.2%27.5%21.9%12.4%12.0%
20. Corneal abrasion22934.1%30.1%14.4%10.0%11.4%
21. X-ray interpretation—bones22757.3%15.9%11.5%3.1%12.3%
22. Burns—debridement23929.3%26.4%18.4%12.6%13.4%
23. Skin biopsy/lesion removal23537.9%25.5%17.0%7.2%12.3%

NPs recognize that some CSPs although done rarely are still considered important for their practice. Table 6 is a comparative list from all of the 90 CSPs in which at least half of the respondents identified a CSP as being done rarely but also considered by half or more to be very important or important.

Table 6. CSP used rarely but rated as either very important or important by ≥50%
Skill/ProcedureTotal N% CSP rarely used% very important or important
1. Foreign body removal: ear or nose22271%55%
2. Burns—debridement21770%56%
3. Foreign body removal: eye14967%53%
4. Eyebrow laceration repair12767%51%
5. Eye irrigation20967%54%
6. Splinting (fiberglass)14958%55%
7. Skin closure—dermabond19657%53%
8. Topical hemostasis or electrocautery19856%52%
9. Trigger point injection11254%50%
10. Bites (cats, dogs, insects, etc.)30552%62%
11. Digital nerve block18351%59%
12. Punch biopsy22150%63%
13. Corneal abrasion21450%64%
14. Nail removal18250%57%


  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgment
  8. References

Results of this study demonstrate the range, frequency, and criticality of CSPs Oregon NPs use in practice. The study demonstrates the importance of assessing not only the frequency of skills use in practice but also the criticality or importance of a CSP to practice, even if that CSP is used infrequently. NP educators share some of the responsibility to adequately, and appropriately, train NP students in the CSP used in practice. A review of the literature found few studies that examined the range, frequency, or criticality of the CSP currently utilized by practicing NPs. This study is a preliminary step through survey methodology to query aspects of demographics, geography, and the CSP used by Oregon NPs (FNP, ANP, GNP, and PNP). Psychometric evaluation of the survey instrument was not included in this original project but is an important consideration for further use or replication of this work.

The results of the demographic and geographic data are reflective of Oregon's dichotomy between urban and rural areas. Although the majority of the NPs indicated local availability of physician collaborators and specialists, the frontier and rural Oregon NPs face the challenges of providing patient care with physician colleagues located at greater distances. The autonomy of Oregon NPs (no state-mandated physician collaboration is required) is also evident in the high percentage of CSP utilized by the survey respondents.

In regards to the responses from the CSP questionnaire, it is evident that the majority of the reporting NPs did not learn their CSPs in their NP educational program. Only two (Pap smears and microscopy) of the 90 CSPs listed were reported as being learned in their NP program by more than 50% of the NPs. These data have clear implications for the NP educator and indicate the need for reviewing the scope of skills training in NP programs. The frequency of use is one measure of the importance of CSPs, but the criticality or importance of clinical skills is also an important consideration for the practicing NP and the NP educator. The removal of a foreign body from the ear or nose may be done rarely, but the NPs indicated this was still an important skill for their clinical practice. As NPs in clinical practice and NP educators consider the learning of clinical skills needed for competency, the criticality of a skill should be considered as well as the frequency of use.


Survey methods have inherent limitations. It is recognized that this study's survey tool may not have adequately represented a suitable list of NP CSPs. The results, obtained only from the responding Oregon family, adult, geriatric, and PNPs, have limited generalizability to other geographic regions, other primary care or advanced nursing practice providers. Survey data in the study rely on the subjective interpretation and response of the participants, and this may have influenced the validity and reliability of the instrument. No formal psychometric evaluation of the validity or reliability of the survey instrument was performed. In addition, the results obtained from the returned surveys may not be an accurate representation of the majority of NPs in Oregon.


The primary purpose of this research project was to survey and analyze the CSPs used by Oregon NPs. Findings delineating the CSPss used by NPs may better inform administrative, reimbursement, licensure, and certification issues related to advanced practice nurses. The implications of the findings may also inform NP clinician and faculty educators of the current CSPs used in practice in order to facilitate the development of appropriate skills training in NP programs. The apparent lack of evidence for guiding educational activities in NP CSP development demonstrates the need for a more informed process. The content knowledge and psychomotor CSPs used and needed in clinical practice should provide the evidence for informing NP program educational curricula. The evolving role of the NP in clinical settings is in flux because of healthcare system forces such as primary care physician shortages, expanded NP autonomy, changing NP reimbursement, and patient acceptance of NP-delivered care. Educational organizations with NP programs should seek to offer didactic and psychomotor skills training that is current and based on expected clinical needs. Having a better understanding of the CSPs used by NPs may also better inform administrative, reimbursement, licensure, and certification issues related to advanced practice nursing.

NPs may offer a partial solution to the increasing shortage of physicians in rural areas. Acquiring data regarding the unique aspects of rural practice may help to better prepare NPs seeking positions in these underserved areas. This study identified some of the differences between rural and urban NPs. Rural NPs face challenges of providing care with more distant physician specialists and reported the use of a greater number of CSPs in their clinical practice. Those professionals involved in NP training (e.g., conferences, university programs, clinical supervisors) may benefit from research that identifies the needs of current or future rural NP providers.

The generalizability of this study is restricted in part because of some of the limitations previously mentioned. However, it may serve as a preliminary step to encourage further research into gathering national data regarding CSPs in NP practice. It may also serve to promote further explorations into the role NP programs and educators have in training students in CSPs. As was initially mentioned, NP practice in Oregon is very autonomous as compared to some other states in which NP practice is more restricted. The influence and relationship of practice autonomy on the breadth and criticality of CSPs for NP practice is an unknown, but likely important, variable in NP practice.

The findings also point to a need for further research that evaluates and correlates the actual, and not reported, skills presented in educational venues. Developing congruence between the training opportunities in NP educational programs and the needed skills for NP clinical practice should be a future goal for the NP profession.

With minimal literature addressing the CSPs utilized by NPs, this study was initiated to help inform advanced nursing practice and NP educational programs. Initial survey steps included survey development and distribution followed by data analysis. NP clinicians and faculty involved in NP education may use the results of this study to consider options to promote improved congruence between the CSPs taught and the CSPs used in clinical practice.


  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgment
  8. References

This study was supported in part by a grant provided by the Oregon Health and Science University Foundation's Betty Gray Rural Health Development Fund.


  1. Top of page
  2. Abstract
  3. Background
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgment
  8. References
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