Page 122 - JSOM Winter 2024

An Ongoing Series

Improving Self-efficacy in Flight Nurse Practitioners in Preparation
for the Role of the Law Enforcement Tactical Nurse Practitioner

Gregory S. Wamack, DNP, MSN, APRN, AEMT, FNP-C, CFRN, CTRN

ABSTRACT
Background: Research indicates that number of nurse prac- tactical physicians are becoming more prevalent. However,
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titioners (NPs) is growing. Additional training is necessary to many law enforcement agencies nationwide still do not have
increase self-efficacy in tactical settings. Evidence shows the advanced-level providers working with their SWAT teams to
Tactical Combat Casualty Care (TC3) course is the national provide operational medical care and training.
standard for tactical medical training. Purpose: This pilot study
aimed to demonstrate that the TC3 course increases the tactical With the rise of the advanced practice nurse (APN) provider
self-efficacy of flight nurse practitioners (FNPs) in preparation since the latter half of the 20th century, traditional physician-
for the role of the law enforcement tactical nurse practitioner. only roles can now be filled with APNs. However, as these
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Methodology: Selected FNPs completed a TC3 course to in- APNs move into new areas of clinical practice, their self- efficacy
crease tactical self-efficacy through a combination of formal is low because they are in a new, unknown environment.
(didactic), informal (vicarious), and physiological condition- Therefore, they experience a high level of arousal and engage
ing (scenario-based) positive verbal or written reinforcement, their defense mechanisms to limit any negative consequences.
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as theorized by Bandura. A general self-efficacy scale (GSES) As the APNs understand their new work environment through
was administered, and data were compared and analyzed us- physiological conditioning, positive performance accomplish-
ing two-tailed paired t tests. Results: Clinical relevance was ments, written/verbal reinforcement, vicarious experiences,
identified in the fact that tactical self-efficacy increased in all and formal education, defense mechanisms and heightened
participants, and a statistically significant increase in tactical arousal decrease, and newfound self-efficacy increase. As
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self-efficacy was seen in 50% of the FNPs. Conclusions: In- this self-efficacy increases, the APNs increase their effort to
creasing the tactical self-efficacy of FNPs helped prepare them overcome additional barriers, perceived threats, and adverse
for the role of the law enforcement tactical nurse practitioner experiences to understand their new role thoroughly. Negative
in support of a metropolitan Special Weapons and Tactics stimuli are no longer feared but expected and welcomed. 2
team. This project is not generalizable but brings the current
body of knowledge together regarding NPs working in tactical This project took place at a multihospital healthcare system
environments. Future studies are still needed. in the southeast region of the United States. At the center of
this system are two university-based Level 1 trauma centers,
Keywords: nurse practitioner; TC3 course; self-efficacy; tactical one adult and one pediatric. Attached to the healthcare system
combat casualty care; flight nurse is a multi-aircraft flight program. The medical crew members
of the flight program form a multidisciplinary team built on
safety, trust, knowledge, skill, and collaboration. One of
5–8
the disciplines represented on the flight team was the flight
Introduction
nurse practitioner (FNP). All the FNPs on the flight team were
Physicians have been involved in tactical medicine for many credentialed, highly skilled, and trained APNs who had low
years, providing medical oversight of the local police depart- self-efficacy in the tactical environment because of a lack of
ment’s Special Weapons and Tactics (SWAT) team medics and exposure to and training on tactical conditions. 2,5–8
operational support when the team is called out. Most tacti-
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cal physicians are board-certified emergency medicine physi- Although APNs are situated within the nursing domain, they
cians who have increased their tactical self-efficacy through perform broadened and expanding activities in the medical
formal and informal educational opportunities, performance/ domain for patients whose needs fall within the parameters
training, and physiological conditioning related to tactical of their respective board certifications. 4,9,10 The family prac-
operations. In 2005, only 18% of responding emergency tice and emergency board-certified APN with a background
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medicine residencies offered a tactical medicine or law en- in emergency department nursing, critical care, and/or prehos-
forcement subspecialty. These subspecialties have grown, and pital care is the ideal advanced-level provider in the absence
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Correspondence to gswamack@liberty.edu
Dr. Gregory S. Wamack is a Flight Nurse Practitioner for Vanderbilt LifeFlight in Nashville, TN.

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