Challenging the blueprints of the NHS

Nursing and midwifery education has evolved over the past few decades, making many in the profession — as well as education — slightly confused as to what is going on. In this third column, Lyn Karstadt continues to shed light on these issues and discusses whether the ongoing changes occurring in the shape of health services and nurse education are really to the benefit of all nurses.

The role of the nurse practitioner in congenital heart surgery

Pediatric nurse practitioners are often members of the interdisciplinary team caring for children with congenital heart disease. The collaborative practice model, in which a physician-led team of physicians, nurse practitioners, and other clinicians work together to provide comprehensive, quality patient care, has had positive benefits for patients and their families, physicians, and nurses. The acute care pediatric nurse practitioner combines advanced training in assessment, diagnosis, and management of common pediatric health problems with advanced nursing expertise in patient education, counseling, and health promotion to meet the specialized needs of children with complex acute and chronic illnesses. This article focuses on the development and current practice of pediatric nurse practitioners in acute care settings and concludes with a discussion of the role of nurse practitioners on the postoperative cardiac surgery service at Children's Hospital, Boston.

The evolving role of the acute care nurse practitioner in critical care

PURPOSE OF REVIEW

The newest nurse practitioner role is the acute care nurse practitioner. This paper presents the latest data on the role from both a US and international perspective.

RECENT FINDINGS

Now present in the USA for at least 15 years, the acute care nurse practitioner role has become well established in critical care settings and is moving into international healthcare. The few outcome studies conducted to date demonstrate the acute care nurse practitioner provides quality patient and family care, improves patient satisfaction, is cost effective, and is an answer to the hospital's shortage of medical residents with new restrictions on working hours.

SUMMARY

The role of acute care nurse practitioners in critical care is increasing worldwide. Most countries are experimenting with this latest nurse practitioner as an extended-role healthcare provider with many potential benefits to patients and their families, as well as the healthcare system.

The capability of nurse practitioners may be diminished by controlling protocols

Nurse practitioners will become a vital component of the health workforce because of the growing need to manage chronic illness, to deliver effective primary health services, and to manage workforce challenges effectively. In addition, the role of nurse practitioner is an excellent example of increased workforce flexibility and changes to occupational boundaries. This paper draws on an Australasian research project which defined the core role of nurse practitioners, and identified capability as the component of their level of practice that makes their service most useful. We argue that any tendency to write specific protocols to define the limits of nurse practitioner practice will reduce the efficacy of their contribution. The distinction we wish to make in this paper is between guidelines aiming to support practice, and protocols which aim to control practice.

The Practice Doctorate: Innovation or Disruption?

Advanced practice nurses, particularly nurse practitioners, have been described as a disruptive innovation. The American Association of Colleges of Nursing (AACN) has proposed that by 2015 all advanced practice nurses be prepared with a Doctor of Nursing Practice (DNP). This article uses critical reflection on published literature to examine the potential difficulties that mandating such a change may present to potential students, practicing advanced practice nurses, colleges of nursing, and doctoral education in general. After considering the pressures in the nursing profession to prepare nurse faculty and reviewing the success of current models of education for advanced practice, we explore in depth the unintended consequences of the AACN recommendation. Implications for academic nursing, curriculum, advanced practice nurses, doctoral education, titling and licensure, economic issues, and the lack of evaluation research are addressed. We recommend abandoning the 2015 deadline for implementation of advanced practice nurse preparation with the DNP.

Residency programs for primary care nurse practitioners in federally qualified health centers: a service perspective

A number of social forces are converging to shape the coming health care and professional practice environment for nurse practitioners (NPs) and the public they serve. Two major innovations of the 1960s, NPs and community health centers, have reached their fourth decade since their inception. These forces have traveled parallel and overlapping paths in their mission to provide high quality health care. Today the current federally qualified community health centers (FQHCs) are a major component of the nation's safety net for the medically underserved, special populations, and the uninsured throughout the United States. Nurse practitioners in the FQHC settings are responsible for highly complex care across lifecycles, with a focus on the treatment and management of disease along with prevention and health promotion. The author suggests that FQHC-based formal residency programs in primary care at either the post-master's or post-doctoral level are the next step in the evolution of both FQHCs and NP preparation. Possible funding mechanisms through changes in federal graduate medical education legislation are explored.

Advanced practice nursing outcomes: a review of selected empirical literature

PURPOSE/OBJECTIVES

To review selected empirical literature examining outcomes of advanced practice nursing with a specific focus on the work of oncology advanced practice nurses (APNs).

DATA SOURCES

Published articles (descriptive and data-based) and books.

DATA SYNTHESIS

Well-designed, methodologically sound investigations offer clear and compelling evidence that APNs are effective in improving outcomes in diverse populations and settings. Data on outcomes of oncology APNs are more limited but do demonstrate statistically significant improvements in clinical outcomes in the homecare and ambulatory settings. The increase in oncology APNs and the evolution of viable roles for oncology APNs across cancer practice settings offer opportunities to further assess the outcomes of advanced practice nursing.

CONCLUSIONS

Understanding the effects of oncology advanced practice nursing on clinical, cost, and satisfaction outcomes is critical. These data will help to explain how APNs can be used most effectively in the healthcare system to ensure the delivery of quality cancer care.

IMPLICATIONS FOR NURSING

Assessing the outcomes of advanced practice nursing care has been identified as a priority by the Oncology Nursing Society. Expansion of APN roles in oncology creates myriad opportunities to investigate this issue. APNs should be cognizant of the work that has been done in this area and use this knowledge as a foundation from which to launch further investigations.