Nurse practitioner candidates: Shifting professional boundaries

Multidisciplinary team attitudes to an advanced nurse practitioner service in an emergency department

AIM

The aim of this study was to examine an emergency department's (ED) multidisciplinary teams' (MDTs) attitudes towards an advanced nurse practitioner (ANP) service. The ED in question is not the author's place of work.

METHOD

A Likert-type questionnaire was used to gain a total attitude score (TAS), which was analysed in relation to participants' gender, age, professional background, level of education and years of experience in the ED, as well as previous and current contact with emergency nurse practitioners and/or ANPs. A total of 115 questionnaires were distributed, and respondents included doctors, nurses, managers, pharmacists, radiographers and a physiotherapist. Participants provided qualitative data to explain their choices, and were asked to describe positive and negative aspects of an ANP service. The data were analysed using a mixed-methods approach.

FINDINGS

The TASs were generally positive and there were no statistical differences between the professional groups, although there was some resistance from participants.

CONCLUSION

Overall, the MDT believes the ANP service will improve patient care, waiting times, team divisions and patients' experiences in the ED if the roles and responsibilities are clearly defined and communicated. In addition, the service should receive enough funding to ensure its sustainability and appropriate supervision by a senior doctor should be made available.

Exploring emergency nurse practitioners' perceptions of their role

Since the 1980s, the emergency nurse practitioner (ENP) role has evolved as increasing socioeconomic pressures and changing government policy have led to new working practices in emergency departments. Similarly, a lack of consensus regarding educational support for ENPs and the regulation of ENP training, mean that variations remain in the scope of practice, role description and academic requirements for ENPs.

AIM

To explore ENPs' perceptions of their changing role, including their educational requirements and whether their training needs are being met.

METHOD

This qualitative phenomenological study examined the views of six ENPs using semi-structured interviews.

FINDINGS

The study identified four themes: inadequate protected time for continuing professional development (CPD); importance of senior medical support in role expansion and CPD; inconsistent educational preparation for expanded roles; and the ENPs' perceived reasons for role expansion. Although all the participants stated that it was challenging to find time for CPD when working in busy clinical environments, this was regarded as less important than the positive effect of senior medical support for advanced roles.

CONCLUSION

Over the past three decades, the ENP role has become well established, which has led to increased confidence, and the development of collaborative ways of working, among ENPs and their colleagues. However, while ENPs have embraced the challenges of their changing role, educational support has not been consistent. There are still disparities in ENPs' scope of practice, expectations of the role between services, and the educational preparation required to undertake the role.

The effectiveness of interprofessional education in healthcare: A systematic review and meta-analysis

Interprofessional education (IPE) emphasizes collaborative practice that aims at promoting the working relationships between two or more healthcare professions. However, there is paucity of literature about the effectiveness of IPE program in the healthcare. This systematic review and meta-analysis aims to objectively determine the effectiveness of IPE in that field in terms of the improvement of students' knowledge, skills and attitudes. The databases of OVID, ISI Knowledge of Science, and Medline (PubMed) were searched for the full-text English language articles published during 2000-2016 using the MeSH terms "interprofessional education" AND "healthcare professionals" AND "multi-professional" AND "impact" AND "effectiveness" OR "collaborative practice" OR "medical students" in Endnote X7. A systematic search finally selected 12 articles for detailed review and meta-analysis. The effect summary value of 1.37 with confidence interval of 0.92-1.82 identifies statistically significant effectiveness of intervention by IPE program in healthcare. The Z test value of 5.99, significant at 5% level of significance, also shows a significant impact of IPE intervention as calculated by the random-effects model. This meta-analysis shows a positive impact and effectiveness of educational intervention by IPE program in various disciplines of healthcare. However, analysis of further clinical trials may be helpful in identifying the effect of IPE program on the students' clinical competence.

The tortuous journey of introducing the nurse practitioner as a new member of the healthcare team: a meta-synthesis

The aim of this study was to explore the obstacles to and the opportunities for achieving optimal interprofessional team collaboration with the introduction of the nurse practitioner (NP). A team approach can contribute importantly to sustainable and safe patient care, and NPs have been added to the healthcare team in many countries. Following the international trend towards the development of the acute care NP, the role has recently been initiated in surgical care in Sweden. The introduction of an advanced nursing role into existing organisations raises questions about how the role will be developed and what its effects will be on collaboration between the different professions. We conducted a systematic review of qualitative studies using the meta-ethnographic approach developed by Noblit and Hare. Literature in the field of nursing was searched on PubMed and CINAHL, and empirical qualitative studies from outpatient and inpatient care in seven countries were included. The studies were appraised according to national guidelines and templates and were analysed and synthesised according to the meta-ethnographic approach. A total of 26 studies were included in the synthesis. The analysis revealed four themes: (i) a threat to professional boundaries, (ii) a resource for the team, (iii) the quest for autonomy and control, and (iv) necessary properties of a developing interprofessional collaboration. Based on these themes, the synthesis was created and presented as a metaphorical journey. The implementation of a new nursing role in a traditional healthcare team is a complex process influenced by many factors and can be described as "a tortuous journey towards a partially unknown destination". The synthesised obstacles and opportunities drawn from international studies may help healthcare organisations and new NPs prepare for, and optimise, the implementation of a new nursing role.

An examination of barriers to nurse practitioner endorsement in senior rural drug and alcohol nurses in New South Wales

INTRODUCTION AND AIMS

To examine barriers senior rural nurses in New South Wales drug and alcohol clinical settings perceive when considering endorsement to Nurse Practitioner (NP).

DESIGN AND METHODS

A survey was designed to record views of senior alcohol and drug nurses in rural New South Wales about becoming a NP. Participants were identified by Area Health Service Directors of Drug and Alcohol Services for each Area Health Service in NSW excluding metropolitan Sydney. Forty eight surveys were distributed, with 17 (35%) completed surveys included in the results.

RESULTS

Of the 17 participants, 12 (70.6%) expressed interest in becoming a NP. The majority (12, 70.6%) were unaware or unsure of endorsement processes. Lack of clarity about the NP role and processes and benefits to becoming a NP was found to be of most concern to all participants. Only 6 participants (35%) indicated they would consider seeking endorsement to NP.

DISCUSSION AND CONCLUSION

Despite agreeing that NP positions in alcohol and drug settings would improve patient access to treatment and care, senior nurses working in these settings in regional areas are unfamiliar with pathways to becoming endorsed. Barriers, such as a lack of internal support from management and colleagues, as well as the fact that respondents reported no foreseeable financial gain in endorsement, also need to be addressed, before more nurses will consider endorsement. Further evaluation of the views of senior nurses in metropolitan alcohol and other drug settings in the process to NP endorsement is needed before clients will benefit from the expertise and enhanced care that NP's may provide.

Stereotyping as a barrier to collaboration: Does interprofessional education make a difference?

This research was part of a Health Canada funded initiative developed to provide evidence about the effectiveness of interprofessional education (IPE) interventions to promote collaborative patient-centred care. Health professional students' ratings of health professions and the effect of IPE on those ratings were examined. Participants were divided into three groups (N=51); control, education, and practice site immersion. Utilizing the Student Stereotypes Rating Questionnaire (SSRQ) which consists of a five point Likert-type scale each group rated health professionals on nine characteristics: academic ability, interpersonal skills, professional competence, leadership, practical skills, independence, confidence, decision-making, and being a team player (Hean, Macleod-Clark, Adams, and Humphris, 2006). Data were collected at four time points; prior to an IPE classroom intervention, following an IPE classroom intervention, following the IPE immersion experience, and four months post IPE immersion experience. Overall, perceptions of other health professions were more positive following the 2.5day interprofessional education session and immersion experience. Student ratings of the seven professions among the nine characteristics will be presented, highlighting similarities and differences across professional groups. Findings support the incorporation of IPE curricula that address the role and functions of other health care professions to facilitate the development collaborative patient-centred care health care teams.