The perceptions of registered nurses on role expansion

Implementation of nurse-delivered vestibular rehabilitation in primary care: a qualitative study of nurses? views on involvement in an innovative service

AIM

To explore practice nurses' perceptions of vestibular rehabilitation and its place in relation to their general role development.

BACKGROUND

Vestibular rehabilitation has been known for a long time to be effective for chronically dizzy patients in secondary care, but its use in primary care has been limited. A recent pragmatic trial of vestibular rehabilitation delivered by practice nurses in primary care has confirmed its utility in a community setting. This type of role is increasingly common for practice nurses, but few studies explore the nurses' perspective.

METHODS

A qualitative study was undertaken; 19 nurses took part in focus group sessions. Participants discussed their views on vestibular rehabilitation and its potential for integration with their existing role. A thematic analysis of the data was undertaken.

FINDINGS

Four main themes were identified: creating a unique nursing role; the therapeutic role; responsibility and role boundaries; and time. Nurses were positive about developing extended roles, but sought ways to achieve this without eroding fundamental nursing skills. Vestibular rehabilitation was seen as fulfilling both the need for a distinct nursing identity and professional development. Concerns over responsibility for patient assessment and time management constraints are potential obstacles to overcome in the wider development of this therapy in primary care.

CONCLUSIONS

Understanding the perspective of nurses will be vital in future development of chronic disease management within primary care. Whilst nurses may be positive about such role expansion, the implementation of services of this type will require clarity about nurses' responsibilities and flexibility in managing workload.

RELEVANCE TO CLINICAL PRACTICE

Vestibular rehabilitation is simple, low-tech and appropriate for widespread development in primary care. Nurses wishing to provide vestibular rehabilitation or similar chronic disease management activities will need to work with medical colleagues to define role boundaries.

Decisions by nurses in acute care to undertake expanded practice roles

Since 1992, expanded practice has been an important issue in the career progression of the qualified nurse. Its contemporary relevance in the early years of the 21st century is underpinned by recent and ongoing national initiatives to blur the boundaries between healthcare providers, and to regulate practice at a higher level. This article reports the findings of a survey and in-depth, semi-structured interviews conducted with nurses from across the UK, which explores their views and experiences in terms of decisions regarding whether or not to undertake expanded practice roles. Insights are gained in a variety of domains of expanded practice including preparation for the role, competency verification, perceptions of accountability and liability, effects on patient care, role refusal and utilization of evidence to underpin expanded practice. These reported views and experiences have important implications for current practice and future research.

Accountability and Recent Developments in Nursing

Contemporary intensive care nurses are confronted daily with accelerated changes and unprecedented challenges. While advancements in critical care and medical technologies may reflect good intentions for patient care, misguided nursing development may pose a sea of fallibility for intensive care nursing. Conceivably, complex technological developments provoke exponential alienation of intensive care nurses from essential nursing duties. Accountability of the nurse is crucial. A winter of discontent is evident as intensive care nurses assume new roles amidst the new technology. Several themes will be presented in this article.

The expanded role of the critical care nurse: a review of the current position

The advanced practice role of the registered nurse is a topic that is currently being debated both nationally and internationally. This paper examines the literature as it relates to role expansion within nursing in general and more specifically to critical care nurses. The role of the critical care nurse is changing and this has occurred as a result of historical evolution, the use of increasing technology, the blurring of medical and nursing roles and current workforce shortages. The literature reviewed identifies some of the factors that have propelled this process and examines the use of terminology as it relates to advanced practice roles and their titles. Finally, the attributes and educational preparation required to perform at an increased level are examined.

Role expansion in intensive care: survey of nurses' views

The study described here is an investigation of intensive care unit (ICU) nurses' perceptions of how their role is expanding. Six specific skills were selected for consideration. A questionnaire was distributed to nurses working in ICUs in three different hospitals. Questions were based around issues such as education and assessment policies, the transfer of work between nurses and other groups of workers and the effects of ICU nurses accumulating additional skills. Completed questionnaires were received from 33 participants (68.75% response rate). The results showed that most of the nurses were carrying out the skills suggested. The training provided to underpin skill development was a balance of teaching and supervision. However, assessment practices varied. The majority of nurses felt that the existing training programmes were adequate. Data revealed that a range of duties could be released from their role and taken over by other workers, such as technicians and health care assistants. Participants suggested that the crucial element of the nursing role was the incorporation of many activities into the provision of continuous one-to-one total patient care. This was the aspect of work that was reported as being the most satisfying. It was perceived that patients benefited from nurses extending their role in the areas discussed.