Advanced Practice Nurse Task Questionnaire (APN-TQ)

Abstract

The Advanced Practice Nurse Task Questionnaire (APN-TQ), developed by Beckmann et al. in 2023, is a specialized psychometric instrument designed to accurately assess the professional tasks performed by Advanced Practice Nurses (APNs). A core objective during its development was ensuring the measure remained independent of the specific APN role (e.g., Nurse Practitioner or Clinical Nurse Specialist) or the particular healthcare setting in which the nurse operates.

The rigorous development process began with an extensive literature review, specifically aligning identified APN tasks with the core competencies outlined in Hamric’s model of advanced nursing practice. Utilizing an adapted version of Guide No. 87 from the Association for Medical Education in Europe, the researchers initially identified 62 distinct tasks. Following detailed face and content validity analyses involving expert refinement, the instrument was finalized into 32 items organized across seven distinct factors. Validation research was successfully conducted using a sample of nurses in Switzerland who possessed extended nursing expertise comparable to that of an APN, providing robust findings related to Exploratory Factor Analysis (EFA), construct validity, and internal consistency.

Keywords

Advanced Practice Nursing, APN-TQ, Competency Assessment, Direct Clinical Practice, Leadership, Collaboration, Ethical Decision-Making, Evidence-Based Practice, Psychometric Validation, Switzerland, Hamric’s Model

Authors

Beckmann, Sonja, Schmid-Mohler, Gabriela, Müller, Marianne, Spichiger, Elisabeth, Nicca, Dunja, Eicher, Manuela, Ullmann-Bremi, Andrea, Petry, Heidi

Purpose

The primary purpose of the APN-TQ is to establish a standardized and comprehensive method for evaluating the tasks executed by Advanced Practice Nurses. This standardization is crucial for ensuring that the assessment of APN functions is objective, regardless of potential variations in specific professional titles or diverse healthcare environments.

By providing a clear framework of APN task performance, the instrument serves to support professional development, guide curriculum planning in advanced nursing education, and facilitate policy discussions regarding the scope of practice for APNs within national healthcare systems, particularly in contexts like Switzerland where the role is continually evolving.

Construct

The APN-TQ measures the frequency of performance across seven distinct domains of advanced nursing practice, reflecting a comprehensive model of APN competencies. The underlying construct focuses on the practical application of advanced knowledge and clinical expertise in daily tasks.

The seven core factors that constitute the construct are: Evidence-based practice, Ethical decision-making, Consultation, Leadership, Direct clinical practice, Guidance and coaching, and Collaboration. These factors map directly onto established frameworks, such as Hamric’s model of advanced nursing practice, ensuring the instrument captures the breadth of high-level responsibilities expected of APNs.

Validity

The validation process for the APN-TQ involved multiple methods to ensure the instrument accurately measures the intended construct.

Construct Validity: The study utilized the Kruskal–Wallis test to examine differences in task performance among various APN groups (e.g., Nurse Practitioners (NPs) versus Clinical Nurse Specialists (CNSs)). Results supported the researchers’ hypotheses, showing significant differences across competencies. Specifically, direct clinical practice tasks were performed more often by NPs compared to CNSs and those in blended roles. Conversely, CNSs reported performing leadership tasks more frequently than NPs and those in blended roles, confirming the instrument’s ability to differentiate between established APN subtypes.

Face Validity: Expert analysis was employed to refine the initial pool of items. This crucial step ensured that all tasks were relevant, clearly phrased, and readily understood by the target population. Items were modified, adapted, or removed based on expert feedback regarding relevance and clarity.

Content Validity: Content validity was assessed through written content validation and cognitive debriefing interviews. The research team critically reviewed nine items that achieved a Content Validity Index (CVI) score of 0.8. While two items were eliminated, seven were deliberately retained due to their critical conceptual importance for monitoring the ongoing professional development of APNs in Switzerland.

Reliability

Internal Consistency: The internal consistency of the APN-TQ was assessed using Cronbach’s alpha, a standard measure of reliability in psychometric testing. The resulting alpha coefficients for the various subscales exhibited a range from .795 to .879. These values indicate that the APN-TQ possesses good to excellent internal consistency, suggesting that the items within each factor reliably measure the same underlying construct.

Factor Analysis

Exploratory Factor Analysis: An Exploratory Factor Analysis (EFA) was conducted to determine the underlying structure of the 32 items. The researchers employed a principal axis factoring technique combined with Varimax rotation.

This analysis yielded a robust seven-factor solution, which accounted for 54.93% of the cumulative variance observed in the data. The identified factors align with core APN competencies, reinforcing the theoretical foundation of the instrument. The seven factors are:

• Evidence-based practice
• Ethical decision-making
• Consultation
• Leadership
• Direct clinical practice
• Guidance and coaching
• Collaboration

Instrument

Test Type: Original

Format: Items are assessed using a four-point frequency scale. The response categories are: “never,” “occasionally” (1–10 times, approximately every third working day), “frequently” (11–20 times, approximately every second working day), or “constantly” (>20 times, almost every working day).

Language Available: English

Population Group: Human (Male and Female)

Age Group: Adulthood (18 years and older), including Young Adulthood (18-29 years), Thirties (30-39 years), and Middle Age (40-64 years).

Population Details: The initial validation study participants were nurses located in Switzerland who possessed extended nursing expertise comparable to that of an APN.

Test Methodology: The validation methodology included Test Validity, Construct Validity, Content Validity, Test Reliability, Internal Consistency, Factor Analysis, and Exploratory Factor Analysis.

Keywords

APN-TQ, Psychometrics, Nursing Competencies, Kruskal–Wallis test, Cronbach’s alpha, Clinical Nurse Specialist (CNS), Nurse Practitioner (NP), Content Validity Index (CVI), Varimax Rotation

Authors

Author ORCID Identifier: 0000-0002-6574-5893 (Sonja Beckmann), 0000-0002-2610-636X (Gabriela Schmid-Mohler), 0000-0002-7691-0719 (Manuela Eicher), 0000-0001-5220-4273 (Heidi Petry)

Affiliation Email addresses: [email protected] (Sonja Beckmann)

Correspondence Address: Beckmann, Sonja: Universitätsspital Zürich, Zentrum Klinische Pflegewissenschaft, Raemistrasse 100, Zurich, Switzerland, CH-8091, [email protected]

Permissions & Fee and Test Year

Permissions: Contact the Corresponding Author for permissions regarding use of the instrument.

Fee: No

Commercial: No

Test Year: 2023

Reference’s

Beckmann, S., Schmid‐Mohler, G., Müller, M., Spichiger, E., Nicca, D., Eicher, M., Ullmann‐Bremi, A., & Petry, H. (2023). Validation of the newly developed Advanced Practice Nurse Task Questionnaire: A national survey. Journal of Advanced Nursing, 79(12), 4791–4803. doi:10.1111/jan.15752

Items of the Advanced Practice Nurse Task Questionnaire (APN-TQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The Advanced Practice Nurse Task Questionnaire (APN-TQ) is a 32-item measure. The items are grouped across seven factors:

• Evidence-based practice

• Ethical decision-making

• Consultation

• Leadership

• Direct clinical practice

• Guidance and coaching

• Collaboration

No data is Available regarding the specific content of each item. The test location is 2024-26730-030, Table 3, Pages 4798-4799.