title: Learning to attain an advanced level of professional responsibility.
abstract: BACKGROUND
  After graduation, nurse practitioner students are expected to be capable of providing complex, evidence-based nursing care independently, combined with standardized medical care. The students who follow work-study programs have to develop their competencies in a healthcare environment dominated by efficiency policies.
  
  
  OBJECTIVE
  This study aims to explore nurse practitioner students' perceptions of their professional responsibility for patient care.
  
  
  METHODS
  This qualitative interpretative study entails a content analysis of 46 reflective case studies written by nurse practitioner students.
  
  
  RESULTS
  The students felt responsible for the monitoring of patients' health status, attending to psychosocial problems, emphasizing compliance, and optimizing the family's role as informal caregivers. At the same time, students struggled to understand the complexities of their patients' needs, and they had difficulty applying their knowledge and skills to complex medical, psychological, and social problems.
  
  
  CONCLUSIONS
  The students' perceptions of their new responsibility were characterized by a strong focus on curative care, while psychosocial components of health and illness concerns were often overlooked. The students experienced difficulties in meeting the criteria of advanced practice nursing described in the Dutch competency framework.
authors.affiliation: Rotterdam University of Applied Sciences, The Netherlands; Erasmus University Rotterdam, The Netherlands. Electronic address: speaj@hr.nl.
authors.forename: Ada
authors.initials: A
authors.lastname: Ter Maten-Speksnijder
authors.affiliation: Ghent University, Belgium.
authors.forename: Mieke
authors.initials: M
authors.lastname: Grypdonck
authors.affiliation: Buurtzorg Nederland, The Netherlands.
authors.forename: Aart
authors.initials: A
authors.lastname: Pool
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy and Management, The Netherlands.
authors.forename: Pauline
authors.initials: P
authors.lastname: Meurs
authors.affiliation: Rotterdam University of Applied Sciences, The Netherlands; Erasmus University Rotterdam, Institute of Health Policy and Management, The Netherlands.
authors.forename: AnneLoes
authors.initials: A
authors.lastname: Van Staa
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004511:Education, Nursing, Graduate; D055318:Evidence-Based Nursing; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009722:Nurse Practitioners / Q000193:education*; D015402:Nursing Education Research; D011231:Preceptorship; D011361:Professional Competence; D036301:Qualitative Research; D013338:Students, Nursing / Q000523:psychology
keywords: Advanced practice nursing; Nurse practitioner; Professional responsibility; Qualitative research; Reflective practice; Scope of practice