Perceptions of NP Roles in Australia: Nurse Practitioners, Managers, and Policy Advisors

Reflections on establishing a nurse practitioner role across acute hospital and home-based palliative care settings in Australia

BACKGROUND

Nurse practitioners have been well-established in many parts of the world and valued as a senior role in healthcare systems. This paper offers an appraisal of a palliative care nurse practitioner model of care project and augments an understanding of being a nurse practitioner (NP) in the Australian context.

AIMS

To enhance outcomes for people regardless of care setting; and to enhance professional relationships between hospital and community services. A secondary objective was to facilitate a seamless transition from one service to another.

METHODS

The setting was a home-based palliative care service and a tertiary acute hospital, between which the role was employed. This paper describes the role from the NP's perspective, using the NP's log of work and personal reflections.

RESULTS

Despite describing many challenges, an NP shared model of care has benefits not just for smoothing the client's journey through settings of care, but also for increased opportunities for clinicians to work together.

CONCLUSIONS

There are opportunities for further research, including models of role implementation, the skills required by the clinician, and acceptance and respect of the NP role.

"It's about fitting in with the organisation": A qualitative study of employers of nurse practitioners

AIMS AND OBJECTIVES

To explore the views of employers about the value nurse practitioners (NPs) add to health services, enablers and barriers to employing NPs, and intentions to employ NPs or expand NP services in the future.

BACKGROUND

Research on Australian NPs has focused on NPs' experiences or patient-related factors like waiting times. Few studies have explored NP roles from the perspective of employers. Australian NPs employed by the private sector are eligible for reimbursement by the national health insurance scheme (Medicare Australia), potentially generating revenue for employers and broadening their career opportunities. We aimed to explore private sector employers' views on the barriers and facilitators to employing NPs and to identify factors affecting NP employability.

DESIGN

A qualitative descriptive exploratory study.

METHOD

Employers of NPs from 23 private and nonprofit health services in Western Australia were interviewed. Inductive content analysis was used to explore the data.

RESULTS

Enablers to employing an NP included enhanced customer service and improved health outcomes. Barriers to employing an NP included lack of financial benefit and inadequate experience or qualifications. Employers also identified future directions for NP employability, such as filling a gap that added value to the health service.

CONCLUSIONS

Employers wanted NPs to work towards a shared vision of patient care that aligned with organisational needs.

RELEVANCE TO CLINICAL PRACTICE

Findings can inform NP education and workforce planning to optimally meet employer and patient health needs.

Integration of nurse practitioners using a change management framework: the way forward

Objective The aim of the present study was to investigate and describe the application of a change management theoretical framework in relation to nurse practitioner (NP) role integration. Methods A survey formed Phase 1 of a broader mixed-methods study to explore perceptions of the change process involved with integrating NPs into Australian health care settings. The stakeholder participants were NPs, nurse managers and nurse policy advisers. Results Key themes were identified adding information about how NPs, nurse managers and nurse policy advisers perceive the integration of NPs into Australian healthcare. The themes correlate to the components of organisational change management necessary to embed NPs into the healthcare workforce. Conclusions Healthcare reform is a complex organisational change. Alignment of several key elements is required for the process to be successful. A change management proposal for reframing organisations provides an apt framework for use in the Australian context of reforming workforce to integrate NPs into healthcare teams. The theoretical framework proposes that multiple lenses be applied to change processes, to integrate NPs into the workforce and highlights the need for exceptional leadership throughout such endeavours. What is known about the topic? NPs provide safe and efficient care to patients, often in settings where access to health care is limited. NPs have been identified as a key strategic workforce reform initiative to address some of the known healthcare gaps. What does this paper add? This paper adds information about how NPs, nurse managers and nurse policy advisers perceive progress of the integration of NPs into healthcare settings. The findings are contextualised within an organisational change framework and highlight the complexity of healthcare reform. What are the implications for practitioners? The findings provide a novel approach for managing workforce reform and identify the components of change management necessary to embed NPs into the healthcare workforce.