Expanding Leadership and Professional Development Opportunities for Oncology Nurse Practitioners

Nurse practitioners (NPs) are key contributors to quality patient care. There are more than 270,000 licensed NPs in the United States, of which approximately 3,600 to 4,800 provide cancer care (Coombs et al., 2020). Access to professional development (PD) opportunities for NPs is integral to enhancing NP clinical practice, leadership, and professionalism. Benefits of NP PD include supporting the full scope of practice, improving practice quality and efficiency, and enhancing patient care (Austin et al., 2021). Other benefits of PD include increased satisfaction, improved retention of competent NPs, and career advancement (Austin et al., 2021). This necessary PD can be provided by several entities, including employers, individual mentors, and professional organizations.

Professional organizations can provide often unrealized PD benefits for NPs. Professional development opportunities through nursing organizations may include networking, participating in mentoring programs, guidance on quality improvement projects, research experience, scientific writing support, and resources to increase presentation, communication, and leadership skills (Austin et al., 2021). Further, NP involvement in professional organizations contributes to improved clinical practice, patient outcomes, and policy and practice changes (Goolsby & Dubois, 2017). The number of NPs who are members of professional nursing organizations is difficult to estimate due to a lack of reliable data. (Goolsby & Dubois, 2017). The purpose of this paper is to describe a quality improvement project designed to improve engagement and PD benefits for NPs in a local chapter of X.

Methods

The first author partnered with X Board members to discuss how to improve NP engagement and PD benefits in X. X serves nurses and NPs from a widespread area in central that includes two large academic medical centers, multiple urban and rural community hospitals, many independent practices, several community colleges, and three large universities. The Plan Do Study Act (PDSA) Model for Improvement was used to guide this project. This model is a succinct, systematic method of making changes on a small scale and evaluating each step to ensure ongoing improvement (IHI, 2022). Application of each PDSA step is depicted in Figure 1 and detailed below. The project was deemed exempt by the Institutional Review Board (IRB) and thus did not require approval or oversight.

Figure 1.

PDSA Cycle 1: Needs Assessment

Plan: Literature review

The first author met with the X Leadership and Mentorship Co-Chair, Programs Chair, and a Director-at-Large to review findings from her Capstone project which identified that only 60% (14/24) of NPs practicing at were members of X, [Blinded 2020]. The team also evaluated prior research that identified a need for professional organizations to provide structure and support for PD (Mlambo, Silén, & McGrath, 2021). The team concluded that NP engagement and PD were key areas of focus for X. Thus, they planned to survey current X NP members to identify and guide how they could increase NP engagement and further support NP PD.

Do: Needs Assessment Survey

Survey items focused on NPs were added to an existing X membership survey. The original survey assessed member interests and learning needs to inform program planning. The new NP-focused items assessed (1) areas of content expertise among NP members, (2) NP member desire to present a continuing education session, and (3) NP PD needs. The survey was sent via e-mail to all members on the X members list-serv. Only NPs were asked to respond to the NP-specific questions. Numeric responses to closed-ended questions were imported into Excel to calculate frequencies and percentages. The Matrix method was used to organize and evaluate short-answer responses to open-ended questions (Garrard J., 2013). Specifically, responses were imported into Excel, categorized, and counted by two team members.

Study: Evaluation of Results of Needs Assessment Survey

Thirty-nine X members responded to the survey. Thirteen out of the 39 respondents were NPs. Responses to NP-specific questions revealed that 62% of X NPs felt X could offer more NP PD. Respondents’ specific areas of PD interest were mentoring, leadership training, networking opportunities, and NP-level continuing education. Additionally, approximately half (n = 7) of the NP respondents were interested in enhancing their PD by providing a X continuing education presentation to all of X members. Across all respondents (NPs and non-NPs), a wide range of potential topics for X continuing education presentations were identified (Table 1).

Table 1.

PDSA Cycle 1: Survey of X members’ topics of interest in continuing education (n=39)

	n (%)
Disease Specific Interest
Childhood	3 (7.7%)
Breast	4 (10.0%)
Sarcoma	7 (19.7%)
Head/Neck	9 (23.1%)
Brain	10 (25.6%)
Lung	14 (35.9%)
Hematologic	16 (41.0%)
GI	17 (43.6%)
Topics of Interest
Toxicity Management	14 (35.9%)
Survivorship	14 (35.9%)
Oncologic Emergencies	12 (30.7%)
New Treatment Options	12 (30.7%)
Genomics	10 (25.6%)
Opioid Prescribing	10 (25.6%)
Psychosocial Issues	10 (25.6%)
Scope of Practice	10 (25.6%)
Legislative Updates	9 (23.1%)
Quality Improvement	8 (20.5%)
Leadership	8 (20.5%)
Professional Development	7 (17.9%)
Prevention & Detection	6 (15.4%)

Act: Program Development

The first author joined the X Board as Co-Chair of Leadership and Mentorship to help apply survey results. Survey results were applied to create the X PROPEL (Professional Resources and Opportunities for NP Education and Leadership), consisting of quarterly continuing education sessions delivered by X NP members to all of X members. The program was planned with the intent to meet NP member PD needs identified in the survey (i.e., mentoring, leadership training, and networking opportunities). Mentorship was addressed by planning to provide 1:1 mentoring to NP program speakers. Leadership experience was addressed by planning to provide opportunities for NP presenters to share their professional expertise and gain visibility as local content experts to all of X membership. Networking opportunities were addressed by planning to target program advertising to NP members and having the sessions provide a venue for NP members to connect.

Survey results from all of X membership (NPs and non-NPs) were applied to help select topics for the first three NP-delivered continuing education sessions. Selected topics were (1) areas of interest and educational need for all X members identified through the survey, and (2) specialty areas in which an NP member had the expertise and a desire to present. The X board determined that the final session should focus on health disparities to align with priorities set forth by the Oncology Nursing Society (Jones et al., 2021a, Jones et al., 2021b) and because a X NP member had an interest in providing a session on this topic.

PDSA Cycle 2: Program Implementation: X: PROPEL

Plan: X: PROPEL Program

Continuing education sessions were coordinated with NP presenters and scheduled virtually due to uncertainty around the COVID-19 pandemic and X’s historical success with virtual programs. Sessions were held on weekday evenings online when other X programs are generally well attended. Dates were selected to complement regular X chapter programs and avoid scheduling conflicts for members. Presenters were provided an honorarium to compensate them for their time and recognize their professional expertise. Continuing education credit was applied for and secured for each session so that all attendees who completed the evaluation of the session’s learning objectives would receive one continuing education unit. The first author attended each session and moderated a question-and-answer session at the conclusion of each presentation.

Do: X: PROPEL Program Sessions

Each session was planned and delivered by an NP member who was interested in presenting and who had clinical expertise in the topic area of the respective presentation (Figure 2). Throughout this process, the NP presenter was provided mentorship from the program coordinators [blinded, blinded] who serve as X Leadership and Mentorship Co-Chairs, are doctoral-prepared nurses, and have vast experience preparing and delivering professional presentations. Mentorship was delivered through a series of 1:1 Zoom meetings and was customized based on individual needs. Mentorship content included (1) outlining presentation content, (2) ensuring the inclusion of health equity-related content, (3) identifying and evaluating current relevant research, (4) reviewing the use of impactful visual resources on slides, and (4) presentation practice and feedback, with emphasis on how to give presentations with cultural humility and awareness of structural inequalities. Program coordinators utilized evidence-based resources provided by for how to prepare a presentation (Garner, 2021). Mentorship was guided by an equity lens from the authorship team that includes underrepresented members in nursing and a nurse scientist whose research focus includes health equity in oncology care. The program coordinators attended each session in which they provided an introduction of the speaker, provided an overview of how to use the chat function in Zoom to ask questions, moderated the chat, and facilitated the question-and-answer section of the presentation.

Figure 2.

X PROPEL Program Sessions

Study: X: PROPEL Program Evaluation

The extent to which the program impacted NP engagement with X and PD skills was assessed subjectively through presenter surveys and objectively through presentation attendee surveys.

Presenter surveys.

Nurse practitioner presenters (n=4) completed surveys of behavioral intentions to engage in PD activities. The survey items were constructed by, who is a PhD-prepared behavioral scientist with expertise in survey development, following standard well-established guidelines to measure behavioral intentions (Ajzen, I., 2010). Validity of these methods to measure behavioral intentions has been demonstrated among nurses (α = 0.884) (Cui et al., 2022). Content validity of the items was evaluated by the rest of the authorship team. Survey items used a seven-point Likert scale (1 = extremely unlikely to 7 = extremely likely), which assessed respondents’ intentions to engage in PD activities, as a result of participating in this program (Table 2). Respondents rated a high likelihood of attending another NP-focused session (M = 6.75, SD = 0.43). They also rated a high likelihood of attending an X Chapter meeting (M = 6.25, SD = 0.83) with slightly less likelihood of seeking an X Board position (M = 5.50, SD = 1.50). Although networking opportunities may have been limited given the use of a virtual platform, NPs rated a high likelihood of contacting another X NP to seek professional guidance (M = 6.50, SD = 0.87). In addition, NPs felt they would give additional local or national presentations (M = 5.75, SD = 0.83). Open-ended responses of suggestions on how X can better serve and engage NPs included, “continue to offer discussions that are relevant for the speakers and mentor them in their development” and “thank you for providing NP-specific presentations as our needs can be different from RN practice.” All presenters agreed that participating in the program improved their leadership skills (M = 6.00, SD = 0.71) and caused others to perceive them as experts and leaders in their field of specialty (M = 6.00, SD = 0.71), and prepared them to speak professionally again (M = 6.00, SD = 0.71). All four presenters indicated that the provided mentoring improved their presentation skills and prepared them for their session.

Table 2.

PDSA Cycle 2: X PROPEL: NP Presenter Survey (n = 4)

	Mean (SD)
Leadership:
By participating in the NP Speaker Series do you feel:
(1 = strongly disagree to 7 = strongly agree)
your leadership skills were improved?	6.00 (0.71)
it impacted how other members perceived your expertise and leadership in your specialty field?	6.00 (0.71)
it prepared you to speak again for X or in another setting?	6.00 (0.71)
As a result of attending this presentation, how likely are you to engage in the following activities: (1 = extremely unlikely to 7 = extremely likely)
Attend another X NP focused session	6.75 (0.43)
Attend a X Chapter Meeting	6.25 (0.83)
Consider a X Board position	5.50 (1.50)
Contact another X NP to seek professional guidance	6.50 (0.87)
Participate in the X sponsored conference abstract preparation program	5.75 (1.30)
Participate in the X sponsored conference presentation preparation program	5.75 (1.30)
Give a local presentation	5.75 (0.83)
Give a national presentation	5.75 (0.83)

Attendee surveys.

The extent to which the NP presenters’ participation in the program affected their PD skills was also measured objectively through the attendee presentation evaluation surveys (Table 3). Attendees’ intentions to engage in PD and X activities were assessed using the same previously described behavioral intention survey that presenters completed. This facilitated the evaluation of the extent to which the NP presenters were conveying an example of leadership within X by highlighting expertise in their field. Overall responses indicated that attendees were most likely to seek additional NP-delivered continuing education and attend more X meetings, demonstrating the professional leadership of the presenters.

Table 3.

PDSA Cycle 2:X PROPEL Program Evaluation: Attendee Survey (combined 4 sessions)

Evaluation Questions	n	Mean (SD)
To assist us in evaluating the effectiveness of the educational activity, please complete the evaluation form by circling the appropriate rating: (1 = not at all, 2 = low, 3 = medium, 4 = high)
To what extent did the content help you meet the educational program objective?	54	3.88 (0.41)
How would you rate the speaker’s ability to communicate the topic?	54	3.88 (0.46)
How would you rate the appropriateness of the speaker’s presentation?	54	3.97 (0.08)
How would you rate the inclusion of information related to cancer health disparities and health equity?	31*	3.87 (0.82)
As a result of attending this presentation, how likely are you to engage in the following activities: (1 = extremely unlikely to 7 = extremely likely)
Attend another X NP-focused session	34	6.91 (0.28)
Attend a X Chapter Meeting	34	6.71 (0.61)
Consider a X Board position	24	2.82 (1.72)
Contact another X NP to seek professional guidance	25	4.22 (1.16)
Participate in the X sponsored conference abstract preparation program	30	4.56 (2.28)
Participate in the X sponsored conference presentation preparation program	27	5.13 (1.86)
Learn more about how to mitigate cancer health disparities and improve health equity	19	5.61 (1.35)
	Example of Response
Did the program provide information that will be helpful in clinical practice?	• “This was education I’m not getting in my MSN program.” • “Improved knowledge base.”
Did the program provide information that is helpful to better care for patients impacted by health disparities?	• “Understanding challenges to treatment for some groups is helpful.” • “Great reminders of disparities that impact this patient population.” • “Inclusion is so important and this talk has important information that can be used in daily practice.”

Note.

^*Item was inadvertently omitted from the first session evaluation.

Additionally, attendees were asked to complete a program evaluation survey utilizing a four-point Likert scale (1 = not at all to 4 = high) to evaluate each session on (1) learning objectives, (2) the speaker’s ability to communicate the topic, (3) the appropriateness of the topic, and (4) the inclusion of information related to cancer health disparities and health equity (Table 3). These items are routinely used by X to assess the extent to which presenters and presentation content meet stated learning objectives and award continuing education units through the standards of the approving body, the California Board of Nursing. Mean scores for all items ranged from 3.87 (SD 0.82) to 3.97 (SD 0.08), indicating an overall high level of agreement that all presenters demonstrated strong presentation and leadership skills. The survey also included two open-ended questions; all responses to these questions were positive.

Act: Future Considerations

Ongoing program planners will consider the results of program evaluations and NP presenter evaluations. Given the high scores on the presenter evaluations and attendees’ interest in attending other NP-focused sessions, X will focus on increasing engagement with NPs to share their expertise as presenters in the regular X program planning for the upcoming year. X is in the process of program planning specifically for peer mentoring and networking for Black and African American nurses, creating an additional opportunity to collaborate with NPs further as we continue to promote equity as an organization. Utilizing the “pay it forward” approach, one goal was to coach the NP speakers as mentors to share their expertise and experience with other X members and peers to create future mentor relationships. There was interest in participating in other PD program sessions on abstract and presentation preparation, lending the opportunity to consider ways to increase engagement through advertising or personal communications. Educational approaches utilized verbal and visual approaches to aid in learning and comprehending content from each session. Ending with a question-and-answer section we aimed for attendees to develop their knowledge and cognitive learning and attempt to foster networking among members. Networking opportunities were likely limited due to the virtual program and limited personal connections, free discussion, or collaboration and therefore unable to be adequately assessed. Future efforts will focus on networking opportunities for NPs within the program, including offering in-person or hybrid sessions. In-person sessions include dinner, with an opportunity for free discussion and personal connection. Additionally, we plan to incorporate NP-focused initiatives within our Chapter’s Regional Conference, a full-day in-person education and networking program. Virtual options for continuing education allow for easy access and flexibility to attend, but creative approaches would need to be integrated should this platform continue to be utilized in future program planning.

Discussion

This quality improvement project sought to identify and respond to the PD needs of NPs through a local chapter of X. Identified PD needs of NP X members included mentoring, leadership training, networking opportunities, and NP-level continuing education. Coordination and implementation of this program provided mentoring for NP speakers, a leadership opportunity for NP members, an opportunity for networking with further identification of needs, and NP-level education for all members.

Our NP-led continuing education program, X PROPEL, increased engagement and PD opportunities for NPs by setting up a mentorship process leveraging the expertise of established members of a professional organization. Mentoring will be a key element of the program for ongoing success. Recognizing the lower memberships among NPs in X, this program provides a unique opportunity to connect with local content-expert NPs to engage in X and increase membership while providing valuable learning opportunities for all members. This program met identified needs of current NP members by offering NP-level continuing education sessions and highlighted leadership skills and qualities of content-expert NPs while mentoring those NPs through their public speaking sessions. Nurse practitioners rated a high likelihood of contacting another X NP to seek professional guidance, therefore we will focus efforts in this area to promote networking opportunities among members. Given the success of this program and the strong interest in attending other NP-focused sessions by both NP members and non-NP members, this program will be integrated into the organization’s ongoing model for X program planning. This highlighted the ongoing need to draw on current member expertise to increase the engagement of current members.

The development of this program supports the responsibility of X as a professional organization by promoting excellence through providing a benefit for members, and advocating for the profession while providing evidence-based education. Our program also supports the results of a survey conducted by the Advanced Practice Provider (APP) Workgroup which was developed by The National Comprehensive Cancer Network (NCCN) Best Practices Committee (2021). The survey focused on PD opportunities for APPs, which include NPs, at NCCN Member Institutions and identified PD opportunities should include development in skills related to communication, leadership, and writing, conference participation, mentorship programs, and networking with other APPs (Austin et al., 2021). Austin et al. (2021) report that APPs should have opportunities to participate in activities that highlight expertise and being leaders in their field. In addition, our program aligns with offerings being developed by other professional organizations, including one whose mission supports all providers considered to be APPs in their educational, clinical, and PD. Specifically, this organization has created a mentorship program pairing mentors and mentees to help providers grow professionally (http://www.apsho.org).

Strengths of this program include the use of PDSA methodology, which allows for the evaluation of small-scale solutions and incites innovation and continuous improvement for ongoing program evaluation and implementation. Another strength includes employing the infrastructure of an existing professional organization to collaborate on resource utilization (e.g., program planning, monetary support for speaker honorariums, and member audience). This program not only addresses NP PD and leadership needs but also draws on the expertise of NPs to support the continuing education needs of chapter membership. Additionally, this program leveraged the strength of a diverse planning committee that included multiple perspectives and skill sets from professional nursing, including NPs, registered nurses, and nurse scientists.

A limitation of this project may be the questionable generalizability of findings due to the program containing only four sessions and evaluations from approximately 50 attendees. However, the intention of this initiative was to assess and meet the local needs of NPs and X members. Thus, the processes used in this project may be useful for others to create customized programs based on local needs. Additionally, evaluation surveys were updated after the first session to include feedback related to cancer health disparities and health equity—a decision that was made after realizing that this platform offered nurses the opportunity to collaborate with colleagues on promoting health equity in cancer care and research. Future program evaluation surveys will continue to include this feedback.

As indicated by PDSA methodology, future PDSA cycles of this PD quality improvement program will be responsive to ongoing program sessions and evaluations. It is anticipated that the program will continue to evolve and expand to increase mentoring, leadership training, networking, and educational opportunities for NPs. Nurse practitioners have a variety of ways to obtain PD. By engaging with professional organizations in their specialty areas, as done in this project, NPs may increase their clinical expertise and PD skills. This program exemplifies an innovative collaboration between a professional organization’s membership and leaders to enhance NP PD while disseminating cutting-edge information on disease processes and treatments to members who deliver transformative cancer care.