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Harnett N, Bak K, Zychla L, Gutierrez E, Warde P. Defining advanced practice in radiation therapy: A feasibility assessment of a new healthcare provider role in Ontario, Canada. Radiography (Lond) 2019; 25:241-249. [DOI: 10.1016/j.radi.2019.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 11/26/2022]
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Harnett N, Bak K, Lockhart E, Ang M, Zychla L, Gutierrez E, Warde P. The Clinical Specialist Radiation Therapist (CSRT): A case study exploring the effectiveness of a new advanced practice role in Canada. J Med Radiat Sci 2018; 65:86-96. [PMID: 29864246 PMCID: PMC5986013 DOI: 10.1002/jmrs.281] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/29/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The Clinical Specialist Radiation Therapist (CSRT), is a new advanced practice (AP) role for radiation therapists (RTTs). Following training, education and evaluation, the CSRT performs specific duties in autonomous ways, making advanced clinical decisions in their area of specialization. This case study examines the CSRT's impact on quantity (i.e., increasing capacity), improving quality and stimulating research and innovation. METHODS Between 2007 and 2016, 23 CSRTs worked in 10 cancer centres in various AP position. A standardised metrics package, focusing on wait-times, patient volumes, patient throughput, time-savings, quality initiatives, satisfaction, research and innovation was developed and used to collect qualitative and quantitative data. Data were self-reported by the CSRTs but electronic databases, pre/post-studies, surveys and interviews were also used. RESULTS Quantity projects (n = 76) related to patient volumes, wait-times, patient throughput and time-savings increased capacity and allowed more patients to enter the system. The presence of a CSRT allowed, on average, 13 additional patients (either new or re-treated) to be seen, at their respective cancer centre, per month. An average of 1.4 yearly quality improvement initiatives were led by each CSRT, which contributed to improvements in quality of care and satisfaction. CSRTs demonstrated a high level of involvement in research, innovation and knowledge translation activities, either as leaders or part of interprofessional teams. CONCLUSION CSRTs positively impact quantity (capacity of the system), quality, research and innovation. Future efforts include permanent and sustainable team integration, practice standards, formal and comprehensive educational preparation, and approaches to consistent, valid assessment of AP in radiation therapy.
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Affiliation(s)
- Nicole Harnett
- Radiation Medicine ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Kate Bak
- Radiation Treatment ProgramCancer Care OntarioTorontoOntarioCanada
| | | | - Michelle Ang
- Radiation Treatment ProgramCancer Care OntarioTorontoOntarioCanada
| | - Laura Zychla
- Radiation Treatment ProgramCancer Care OntarioTorontoOntarioCanada
| | - Eric Gutierrez
- Radiation Treatment ProgramCancer Care OntarioTorontoOntarioCanada
| | - Padraig Warde
- Radiation Medicine ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
- Radiation Treatment ProgramCancer Care OntarioTorontoOntarioCanada
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Stasa H, Cashin A, Buckley T, Donoghue J. Advancing advanced practice - clarifying the conceptual confusion. NURSE EDUCATION TODAY 2014; 34:356-361. [PMID: 23953150 DOI: 10.1016/j.nedt.2013.07.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 06/19/2013] [Accepted: 07/16/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND In recent years, there has been a substantial increase in the number of nurses holding advanced practice nursing positions. However, the lack of clarity regarding key terms such as 'advanced practice nursing', 'advanced nursing practice', 'scope of practice' and 'extended practice', and international variability in how these terms are used has created significant confusion. This lack of clarity is problematic for nurses, other health professionals, health service consumers, educators and policy makers, particularly given the global mobility of the nursing workforce. OBJECTIVES 1) To highlight the significant international variability in how advanced practice nursing, and associated terms such as extended and expanded practice, are defined and regulated across a variety of different English speaking countries, including the US, UK, New Zealand, Canada and Australia. 2) To propose innovative formulations for how the nursing profession may attempt to ensure greater precision and agreement around advanced practice terminology. DESIGN Discursive paper. RESULTS It was found that there is a considerable lack of clarity regarding the precise definitions of key terms surrounding the discussion of advanced practice. Additionally, there are large disparities in how the five chosen countries regulate advanced practice nursing, and roles such as that of the nurse practitioner. CONCLUSIONS It is suggested that the confusion regarding advanced practice terminology can be reduced definitionally by minimising the use of the term 'expanded practice'; defining advanced practice nursing to refer to the type of practice in defined and regulated advanced practice nursing scopes; and defining advanced nursing practice as expert practice within a regulated nursing scope.
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Affiliation(s)
- Helen Stasa
- Sydney Nursing School, University of Sydney, 88 Mallett St, Camperdown, NSW 2050, Australia; Nurse Practitioner Standards Review Project, Sydney Nursing School, University of Sydney, 88 Mallett St, Camperdown, NSW 2050, Australia.
| | - Andrew Cashin
- School of Health & Human Sciences, Lismore, Southern Cross University, Military Road, East Lismore, NSW 2480, Australia; Nurse Practitioner Standards Review Project, Sydney Nursing School, University of Sydney, 88 Mallett St, Camperdown, NSW 2050, Australia.
| | - Thomas Buckley
- Sydney Nursing School, University of Sydney, 88 Mallett St, Camperdown, NSW 2050, Australia; Nurse Practitioner Standards Review Project, Sydney Nursing School, University of Sydney, 88 Mallett St, Camperdown, NSW 2050, Australia.
| | - Judith Donoghue
- University of Technology, Sydney, Australia; Nurse Practitioner Standards Review Project, Sydney Nursing School, University of Sydney, 88 Mallett St, Camperdown, NSW 2050, Australia.
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Ramis MA, Wu CJ, Pearson A. Experience of being an advanced practice nurse within Australian acute care settings: a systematic review of qualitative evidence. INT J EVID-BASED HEA 2013. [DOI: 10.1111/1744-1609.12029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roche M, Duffield C, Wise S, Baldwin R, Fry M, Solman A. Domains of practice and Advanced Practice Nursing in Australia. Nurs Health Sci 2013; 15:497-503. [DOI: 10.1111/nhs.12062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/20/2013] [Accepted: 03/13/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Roche
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - Christine Duffield
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - Sarah Wise
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - Richard Baldwin
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - Margaret Fry
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - Annette Solman
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
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Ramis MA, Pearson A, Jo Wu CJ. The experience of being an advanced practice nurse in Australian acute care settings: A systematic review of qualitative evidence. ACTA ACUST UNITED AC 2012; 10:3960-4018. [PMID: 27820520 DOI: 10.11124/jbisrir-2012-404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND There is a vast amount of international literature which, although agreeing on the need for advanced practice nurse roles, simultaneously debates and discusses the difficulties with nomenclature, definition and subsequent implementation of such roles. Due to this ambiguity it is difficult to equally compare evidence in this field across different countries. A context-specific systematic review on the qualitative evidence of the experience of being an advanced practice nurse in Australia has not been undertaken previously, however it is imperative for nursing managers and leaders to understand the complexities of advanced nursing roles in order to effectively utilise and retain these experienced and valuable nurses. With the creation of a national nursing regulating authority in 2010, it is timely to explore in-depth the experience of being an advanced practice nurse from a national perspective. OBJECTIVE To identify the experience of being an advanced practice nurse working in Australian acute care settings. INCLUSION CRITERIA Registered nurses working in advanced practice roles in acute care settings throughout Australia.The experience of being an advanced practice registered nurse working in an Australian acute care setting, as reported by the nurses themselves.Interpretive qualitative studies including designs such as phenomenology, grounded theory and ethnography. SEARCH STRATEGY A three step search strategy was used to identify published and unpublished studies. The search process was conducted from August to October 2011 and considered published and unpublished studies from 1990 to October 2011. METHODOLOGICAL QUALITY Studies were appraised for methodological quality by two independent reviewers using the Joanna Briggs Qualitative Assessment and Review Instrument. DATA EXTRACTION Data was extracted from the papers included in the review using the standardised Joanna Briggs Institute Qualitative Assessment and Review Instrument data extraction tool. DATA SYNTHESIS Research findings were pooled using the Joanna Briggs Institute Qualitative Data and Review Instrument. RESULTS Three published studies and one unpublished dissertation were included in the review. From these four studies, 216 findings were extracted, forming 18 categories which were then analysed to create six synthesised findings. Six meta-syntheses under the headings of expert knowledge, confidence, education, relationships, negative experiences and patient centred experience were formed from the findings. CONCLUSIONS The synthesised findings confirm that the experience of advanced practice nurses in Australian acute care settings is complex and greatly influenced personally and professionally by the organisation as well as the unpredictable nature of working with people. IMPLICATIONS FOR PRACTICE A deeper understanding of the essence of being an advanced practice nurse may be of benefit for recruitment and retention planning. Health care organisations must also be aware of the impact they have on the nurse's experience if they are to commit to retention of nurses and to patient safety. IMPLICATIONS FOR RESEARCH If the topic of advanced practice is to remain current in the Australian nursing profession then ongoing research must be conducted to identify if the title is being used more frequently within the nursing research. Nurses must be supported in publishing quality research if they are to improve articulation of their experiences.
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Affiliation(s)
- Mary-Anne Ramis
- 1. The Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, South Australia, 5005. 2. Queensland University of Technology, School of Nursing, Kelvin Grove Campus, Brisbane 4059
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Chang AM, Gardner GE, Duffield C, Ramis MA. Advanced practice nursing role development: factor analysis of a modified role delineation tool. J Adv Nurs 2011; 68:1369-79. [DOI: 10.1111/j.1365-2648.2011.05850.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chang AM, Gardner GE, Duffield C, Ramis MA. A Delphi study to validate an Advanced Practice Nursing tool. J Adv Nurs 2010; 66:2320-30. [DOI: 10.1111/j.1365-2648.2010.05367.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McKENNA HUGH, KEENEY SINEAD, HASSON FELICITY. Health care managers’ perspectives on new nursing and midwifery roles: perceived impact on patient care and cost effectiveness. J Nurs Manag 2009; 17:627-35. [DOI: 10.1111/j.1365-2834.2008.00948.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Elsom S, Happell B, Manias E. Nurse practitioners and medical practice: opposing forces or complementary contributions? Perspect Psychiatr Care 2009; 45:9-16. [PMID: 19154248 DOI: 10.1111/j.1744-6163.2009.00195.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The medical profession in Australia has expressed concern about the expansion of nursing practice into areas that are traditionally the domain of medicine. Particular apprehension is raised in relation to the prescription of medications. This paper will consider and critique the argument that the standard of care provided by a nurse practitioner would be of lesser quality than that provided by a medical practitioner. CONCLUSIONS Despite the medical profession's opposition for nurse practitioner roles, there is little evidence suggesting that the quality of services offered by a nurse practitioner would be inferior. PRACTICE IMPLICATIONS Available evidence suggests that care and treatment from nurse practitioners in primary health care is equal to that provided by medical practitioners.
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Affiliation(s)
- Stephen Elsom
- Centre for Psychiatric Nursing, University of Melbourne, Carlton, Victoria, Australia
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Abstract
PURPOSE This study aims to determine the extent to which community mental health nurses are currently practicing beyond the traditional scope of nursing practice. DESIGN AND METHODS A self-administered questionnaire was distributed to community mental health nurses in Victoria, Australia. FINDINGS The majority of participants reported routine involvement in practices that would normally be considered beyond the scope of nursing practice, such as prescribing, ordering diagnostic tests, and referral to specialists. PRACTICE IMPLICATIONS The extent to which the current mental health service system is dependent upon nurses transgressing professional and legal boundaries warrants further study. Psychiatrists and community mental health nurses need to work collaboratively to understand their respective knowledge and skills and to be clear about how they take responsibility for client care.
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Affiliation(s)
- Stephen Elsom
- Centre for Psychiatric Nursing, University of Melbourne, Carlton, Victoria, Australia.
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Abstract
Significant changes to the delivery of mental health services have resulted in the expansion of the community mental health nursing role. This qualitative study was undertaken to explore the extent to which community mental health nurses are currently engaged in expanded forms of practice. Focus groups were undertaken with community mental health nurses (n = 27) from metropolitan and rural Victoria, Australia. Thematic analysis identified the following major themes: reported practice, consumers as beneficiaries of expanded practice, risk of harm and litigation, and barriers to expanded practice. The findings emphasize the need for significant changes in current legislation if expanded practice for nurses is to become a reality.
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Affiliation(s)
- Stephen Elsom
- School of Nursing, The University of Melbourne, Carlton, Victoria, Australia
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Gardner G, Chang A, Duffield C. Making nursing work: breaking through the role confusion of advanced practice nursing. J Adv Nurs 2007; 57:382-91. [PMID: 17291202 DOI: 10.1111/j.1365-2648.2007.04114.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper reports a study to develop a research-informed model of the service parameters and an analysis framework for advanced practice nursing roles. BACKGROUND Changing patterns of health care are forcing service planners to examine new service delivery models. Apparent is the call for nursing service that incorporates expanded levels of autonomy, skill and decision-making. A number of nursing roles conform to this description under the generic title of advanced practice nurse. However, there is confusion in the health service community internationally about nomenclature, role and scope for advanced practice nursing roles. An emerging priority in response to recent developments in the nurse practitioner role is to establish service parameters for advanced practice nursing and to differentiate operationally between advanced practice and practitioner nursing roles. METHODS We conducted an interpretive, qualitative examination of the practice of a random sample of nine advanced practice nurses working in three acute care hospitals in south east Queensland, Australia in 2006. Data collection involved individual in-depth interviews, which were deductively analysed and tested against published advanced practice nursing models. RESULTS The data most comprehensively supported the Strong Model of Advanced Practice as representing the practice experiences of the research participants. This model supports definition of the service parameters and the design of an operational framework for implementation and evaluation of advanced practice nursing roles. CONCLUSION The findings differentiate advanced practice nurse and nurse practitioner roles, and offer an operational framework to identify, establish and evaluate advanced and extended nursing positions. Subject to further validation, this outcome can provide operational information for implementing innovative nursing roles appropriate to consumer needs and specific health service models.
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Affiliation(s)
- Glenn Gardner
- Clinical Nursing Queensland University of Technology and Royal Brisbane and Women's Hospital, Brisbane, Australia.
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Glover DE, Newkirk LE, Cole LM, Walker TJ, Nader KC. Perioperative Clinical Nurse Specialist Role Delineation: A Systematic Review. AORN J 2006; 84:1017-30. [PMID: 17157092 DOI: 10.1016/s0001-2092(06)63999-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A CLEARLY DEFINED ROLE for the perioperative clinical nurse specialist (CNS) has not been identified or established. USING ROLE THEORY as a framework, a systematic review of the literature was conducted to provide recommendations for a delineated CNS role and to compare this role with other nursing roles. SEVERAL FACTORS CONTRIBUTE to CNS role confusion, including the versatility of the position, lack of certification examinations, and variance of state recognition. FUTURE RESEARCH should investigate merging of CNS and nurse practitioner titles, perioperative CNS functions, spheres of influence, and patient outcomes.
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Wortans J, Happell B, Johnstone H. The role of the nurse practitioner in psychiatric/mental health nursing: exploring consumer satisfaction. J Psychiatr Ment Health Nurs 2006; 13:78-84. [PMID: 16441397 DOI: 10.1111/j.1365-2850.2006.00916.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There is a substantial body of literature pertaining to the role of the nurse practitioner. Research directed towards consumer satisfaction suggests that the care provided by nurse practitioners is perceived as at least equal to that provided by a medical practitioner. However, there is a paucity of literature examining the nurse practitioner role in the psychiatric/mental health field. An evaluation of a Nurse Practitioner demonstration model has recently been undertaken in the Crisis, Assessment and Treatment Team in Victoria, Australia. This article presents the findings of a qualitative, exploratory study. Individual interviews were conducted with consumers (n = 7) who had received care and treatment provided by the nurse practitioner candidate. Data analysis revealed two main themes: the quality of the service provided, and the unique role of the nurse. The findings supported the available literature in articulating the specific aspects of the nurse practitioner role that are favourably perceived by consumers of services. This study contributes to the limited body of knowledge in the psychiatric/mental health nursing field and specifically emphasizes the importance of the relationship between nurse practitioner and consumer in facilitating the provision of effective care and treatment.
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Affiliation(s)
- J Wortans
- Nurse Practitioner Demonstration Project, Northern Area Mental Health Service, Epping, UK
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Abstract
The role of the nurse practitioner has been described as the apex of nursing practice. Such a statement has significant implications for the professional status of nursing in its own right. The aim of this paper is to discuss the nature of the nurse practitioner role in Australia and the importance of distinguishing between advanced and expanded practice. Evaluations of the nurse practitioner role suggest that specifically nursing contributions lead to a high level of consumer satisfaction. If nursing in general, and mental health nursing in particular, is to maintain and further develop their professional status, debate about the implications of the nurse practitioner role, and the terminology used to describe its scope, is crucial.
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Affiliation(s)
- Stephen Elsom
- Centre for Psychiatric Nursing Research and Practice, School of Nursing, University of Melbourne, Carlton, Victoria, Australia
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