Developing an advanced nurse practitioner service in emergency care: attitudes of nurses and doctors

Emergency department nurses' role transition towards emergency nurse practitioner: A realist-informed review

BACKGROUND

The integration of emergency nurse practitioner (ENP) services in emergency departments (EDs) has been well established, especially in high-income countries such as the United Kingdom, the United States and Australia. Different types of reviews, including integrative, literature and systematic, have been carried out to examine evidence regarding the impact of ENPs on the quality of ED services. Unfortunately, there is still limited explanation of the influencing factors that may result in a successful transition process from Registered Nurse to Emergency Nurse Practitioner. This review aims to understand these factors.

METHODS

A realist approach (RAMESES) guided this review. CINAHL Plus, MEDLINE, PsycINFO, EMBASE and Web of Science databases were searched to capture studies from 1990 to 2020, combined with policy documents from professional bodies and government websites and relevant references from identified sources. Realist data analysis was carried out on the included articles to understand how context, mechanism and outcomes related to the ED nurses' role transition.

RESULTS

Forty-eight articles were included. There were differences in preparatory education and scope of practice of the role. The review configured various contexts, mechanisms and outcomes of the role transition along with their interactions.

CONCLUSION

The findings provide a comprehensive understanding regarding the emergency nurses' role transition, with a view to providing better insights and explanations to interested parties who would like to integrate the ENP service in their ED.

Investigating opinions of, and perceptions to, advanced practice radiation therapist roles

INTRODUCTION

The demand for cancer services is growing due to increased incidence and the number of people who survive their initial diagnosis but require ongoing therapy. One method of increasing capacity in radiation oncology is to delegate tasks from one professional group to another. In the last ten years there has been increasing interest in advanced practice radiation therapist (APRT) roles. The majority of the Australian literature relates to metropolitan radiation oncology centres with a paucity of information from regional or rural settings. This study sought to explore the knowledge of, and attitudes to APRT roles of members of three professional groups in public radiation oncology centres in Tasmania.

METHOD

Data was collected through a self-reported online survey from radiation oncologists (RO), radiation oncology medical physicists (ROMP) and radiation therapists (RT) working in Tasmanian public radiation oncology services regarding their knowledge and understanding of APRT roles, acceptance and support for the roles and where APRTs could contribute to improving patient care. The survey incorporated a combination of five point Likert scale, Yes/No/Don't know and Yes/No/Not Applicable choices. The survey was reviewed by a professional panel of RT, RO and ROMP from mainland Australian radiation oncology centres.

RESULTS

At the time of survey invitation, there were 52 RTs, 7 ROs, and 7 ROMPs working in the identified departments. The survey had an overall response rate of 48.5%with profession specific response rates of 48.1% (RT), 42.9% (RO) and 57.1% (ROMP). General agreement was found amongst survey respondents with regards to understanding of APRT roles having themes of clinical expertise, leadership, communication, collaboration and teaching. Where participants were offered a list of tasks to choose those appropriate to APRT roles, the highest agreement was with "Contour organs at risk per protocol", "Image review - soft tissue online decision making/adaptive RT" and "Principal investigator in clinical research. The notion of establishing ARPT roles was well supported, as strong agreement was found with the statements related to improvement in job satisfaction, opportunities, recruitment and retention for RTs, and that APRTs could be used to relieve workload of other professionals.

CONCLUSION

This exploratory study found that the respondents were generally in favour of APRT roles, but that they were not clear about the tasks to be performed by APRTs. It was identified that patients, ROs, ROMPs, RTs and the department would benefit from the implementation of APRT roles. Sseveral areas of practice were identified by respondents which they perceived would improve the quality of patient care.

Specific Competencies of Prehospital Emergency Nursing: The Views of Spanish University Professors

BACKGROUND

The guarantee of nursing competence in prehospital urgent care requires the identification and delimitation of the specific competencies. This work describes the importance attributed by professors of Spanish universities to the competencies of prehospital nursing positions and indicates the most appropriate training level required to achieve them.

METHOD

The current work consisted of a survey with an online questionnaire. Sixty competencies over 10 domains were studied.

RESULTS

The most valued domains were those of general and personal competencies. The competencies considered most important were "Recognizes the vital risk and knows how to perform basic and advanced life support maneuvers" and "Provides quality health care." The nursing degree is considered appropriate to train students to the required level in only eight competencies.

CONCLUSION

The proposed competencies can be considered as specific competencies necessary in prehospital emergency nursing. Effective performance requires training to a higher level than a nursing degree. [J Contin Educ Nurs. 2020;51(12):556-567.].

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.

What are the clinical practice experiences of specialist and advanced paramedics working in emergency department roles? A qualitative study

Aim:

Little is known about paramedics who have left the ambulance service to work in emergency departments (EDs). This study sought to explore the lived experiences of paramedics working in specialist/advanced ED roles, focusing on role transition, influences on effective clinical practice and perceptions of role optimisation. A secondary aim of the study was to make recommendations on the future development of specialist/advanced ED roles for paramedics.

Methods:

This was a qualitative study utilising descriptive phenomenology to collect and describe the lived experiences of participants via semi-structured interviews. The final sample comprised three emergency care practitioners (ECPs), three student ECPs and two advanced clinical practitioners (ACPs), all Health and Care Professions Council registered paramedics. Interview data were transcribed verbatim and analysed using inductive thematic analysis.

Results:

Conclusions:

While role transition to the ED represents a turbulent period for paramedics, elements of pre-hospital paramedic practice transfer directly into ED roles and contribute to effective practice. Participants found that they were accepted and supported to work in the ED setting and spoke positively of future role expansion. A lack of access to medicines presents a significant barrier to current clinical practice and a disparity in practice between paramedics and their nursing counterparts. The change in legislation to allow independent prescribing for advanced paramedics will address some of these issues, but interim improvements are required to extend existing arrangements to paramedics, improving the quality and safety of care they provide and ultimately the patient experience.

A Narrative Review of the Description of Training Profiles Used for Emergency Nursing Care Worldwide

BACKGROUND

This study describes the training profiles of emergency care nurses worldwide, which can serve as a guide for training these professionals.

METHOD

A narrative review was developed.

RESULTS

Five training profiles were identified, according to the requirements of undergraduate, postgraduate, complementary training, and previous work experience within the training itineraries of emergency nursing worldwide.

CONCLUSION

The most appropriate level of training for emergency nursing is the 1-year postgraduate level (academic or specialty). The description of these profiles can guide the regulatory organizations and professionals regarding the most appropriate training requirements for effective, safe, and adjusted care assistance. [J Contin Educ Nurs. 2019;50(12):543-550.].

Nurse Practitioners in Orthopaedic Surgical Settings: A Review of the Literature

PURPOSE:

The purpose of this article was to conduct an extensive literature review of nurse practitioners (NPs) in orthopaedic surgical settings to delineate whether a need exists for NPs in these settings.

BACKGROUND:

Due to physician shortages and changes in healthcare, patients are experiencing difficulty accessing orthopaedic surgeons. To meet this need, NPs are becoming an essential part of the multidisciplinary orthopaedic team in Level 1 trauma hospitals.

RESULTS:

Nurse practitioners are qualified and competent to work in a variety of orthopaedic settings including preoperative clinics, primary care orthopaedic clinics, and pre-/postoperative care within the hospital. The benefits of NPs in orthopaedic surgical settings includes increased access to care, improved team communication, decreased length of stay, improved quality of care, and improved patient satisfaction. Moreover, NPs meet patient needs while surgeons are operating, and have a positive impact on resident surgeon education.

CONCLUSION:

A need exists for NPs in orthopaedic surgical settings to both improve access to healthcare for patients and reduce the burden on orthopaedic surgeons.

Determination of nursing procedures and competencies in emergency departments: A cross-sectional study

The aim of this study was to determine the nursing procedures carried out by emergency department nurses. This descriptive study was carried out between April and September 2015 in the emergency departments of two state hospitals and one university hospital in Turkey. The study population comprised 139 emergency nurses working for at least 1 year in the emergency department of one of the three hospitals. Data were gathered by using the Emergency Nursing Procedures Questionnaire, which is composed of three sections to reveal nursing procedures performed in emergency departments. The procedures most frequently performed by the participants were administration of pain medication and assessment of patient responses (3.97 ± .18). Assessment of the patient's nutritional status (1.79 ± 1.16) was among the least frequently performed nursing procedures. Emergency nurses carried out nursing care procedures less frequently and took part most frequently in procedures related to medical diagnosis and treatment. According to results of this study, these procedures and competencies will highlight what knowledge and skills emergency nurses need. They will also guide in the creation of in-service training programs and illuminate competencies that need improvement.

Development and regulation of advanced nurse practitioners in the UK and internationally

The NHS in the UK is under increasing pressure as a result of financial and recruitment issues, as well as an ageing population. Nursing has continued to adapt to this challenging time. Over the past few years, the advanced nurse practitioner (ANP) role has been implemented widely in primary and secondary care. However, the ANP role has lacked consistency in scope of practice, training and regulation. This article summarises the development of the ANP role in the UK and internationally, and issues relating to regulation. Globally, ANPs are regulated by one of three different bodies: nationally by central government or a professional body, or locally by employers. In the UK, the role is regulated by local procedures, relying on employers to make decisions about the scope and preparation for practice. Some of the challenges in the UK in relation to ANP regulation are discussed, including variations in scope, organisational constraints and lack of support. These challenges are exacerbated by a lack of role clarity, thereby indicating there is a need to improve regulation of ANPs. The Royal College of Nursing has responded to these challenges by introducing 'credentialing', a system for recording qualifications, skills and experience, but the uptake of this process is yet to be evaluated. Therefore, employers and ANPs should be aware of their collective responsibility for ensuring appropriate role regulation.

Advanced nurse practitioners in municipal healthcare as a way to meet the growing healthcare needs of the frail elderly: a qualitative interview study with managers, doctors and specialist nurses

Background

The number of frail elderly people with complex nursing and medical care needs is increasing, and consequently, the healthcare burden. The implementation of Advanced Nurse Practitioners globally has been shown to make healthcare more effective and increase patient safety, continuity of care and access to care. In Sweden, research about Advanced Nurse Practitioners is limited. Thus, this study aimed to investigate the opinions of managers, doctors and nurses in primary care and municipal healthcare about the role of ANPs in municipal healthcare as a way to meet the increasing healthcare needs of the frail elderly.

Methods

Managers, doctors and specialist nurses in primary care and municipal healthcare adopted a qualitative, descriptive design through 12 semi-structured interviews. The data were analysed using content analysis.

Results

The participants expressed both opportunities as well as challenges with Advanced Nurse Practitioners in municipal healthcare. This role considered to satisfy frail elderly people’s healthcare needs and making the healthcare more effective as the doctors would have more time for other patients. The challenges mainly consist of doubts from the managers whether the nurses would be motivated to pursue further education to become an Advanced Nurse Practitioner if the role becomes a reality. The doctors were unsure if the nurses would consider taking the responsibility the role would imply.

Conclusions

Advanced Nurse Practitioner is considered to be a valuable resource not only for the frail elderly but also for the nurses in the municipal healthcare and for the doctors in primary care as they probably would make healthcare more effective. They might be a way to meet the increasing healthcare needs of frail elderly, however there are also challenges to overcome before they can become a reality in a Swedish healthcare context. Consequently, this role deserves further investigation.

Electronic supplementary material

The online version of this article (10.1186/s12912-017-0258-7) contains supplementary material, which is available to authorized users.

How does role transition affect the experience of trainee Advanced Clinical Practitioners: Qualitative evidence synthesis

BACKGROUND

Advanced Clinical Practitioners have been developed to address current and future gaps in the medical workforce. Insight into problems associated with Advanced Clinical Practitioner transition may help present and future trainees adapt to their changing and demanding health environment.

AIMS

To identify potential problems experienced by trainee Advanced Clinical Practitioners during transition and what the implications might be for workforce planning.

DESIGN

A qualitative evidence synthesis to examine the issue of role transition for Advanced Clinical Practitioners.

DATA SOURCES

The electronic databases accessed (1997-2016) were MEDLINE, EMBASE, CINAHL, BNI, AMED and PubMed and also included Researchgate, thesis publications, hand searching and NHS staffing reports.

REVIEW METHODS

Eleven studies were identified between 1997 - 2016. Thematic synthesis was undertaken, creating codes, descriptive and analytical themes. Quality appraisal of individual studies was conducted using the tool of Walsh and Downe.

FINDINGS

Six analytical themes were identified that addressed the key issues of transition discussed in the 11 articles and which were directly related to the proposed research project: experience of change, orientation to role, mentorship, clinical skills, clinical supervision and Masters' level education.

CONCLUSIONS

Findings from all 11 articles were similar. Where these six themes were ignored, there was often either a failure to reach expected goals or resignation from the role. Future employers must ensure that they establish a comprehensive orientation and education programme to be certain that qualified Advanced Clinical Practitioners are suitably prepared for their role in health care.

Advanced practice nursing, health care teams, and perceptions of team effectiveness

This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families.

The Role Descriptions of Triage Nurse in Emergency Department: A Delphi Study

Background. Triage nurses play a pivotal role in the emergency department. However some researchers have attempted to expand triage nurse's role; remarkable discrepancies exist among scholarly communities. The aim was to develop a role description of triage nurse relying on the experts. Methods. A modified Delphi study consisting of 3 rounds was performed from March to October 2014. In the first round, an extensive review of the literature was conducted. Expert selection was conducted through a purposeful sample of 38 emergency medicine experts. Results. Response rates for the second and third rounds were 37% and 58%. Average age of panelists was (38.42 ± 5.94) years. Thirty-nine out of 54 items reached to the final round. Prioritizing had the higher agreement rate and least agreement on triage related interventions. Conclusion. Triage nursing as a relatively new role for nurses needs significant development to be practiced. Comprehensive educational programs and developmental research are required to support diagnostic and therapeutic interventions in triage practice by nurses.

An exploration of clinical practice in sites with and without clinical nurse or midwife specialists or advanced nurse practitioners, in Ireland

BACKGROUND

Clinical specialist (CS) and advanced practitioner (AP) roles have increased in nursing and midwifery internationally. This study explored clinical practice in sites with and without clinical nurse or midwife specialists or advanced nurse practitioners in Ireland.

METHODS

Using a case study design, interview, observational and documentary data from postholding sites (CSs or APs employed) were compared with data from non-postholding sites (no CSs or APs employed). Interviews and observations were conducted with postholders (n = 23), and compared with data from healthcare professionals (nurses or midwives, doctors) (n = 23) in matched services. Interviews were held with Directors of Nursing and Midwifery (n = 23), healthcare professionals (n = 41), service users (n = 41) with experience of receiving care or working with postholders, and non-postholders in matched services. The data were analysed using Nvivo (Version 8).

RESULTS

The findings suggest that postholders' practice appeared to differ from non-postholders' in relation to case management and service provision. Postholders were seen as having an impact on readmission rates, waiting lists/times, collaborative decision-making, continuity of care and workload management. Postholders' autonomy to manage caseloads was perceived to lead to smoother transition of patients/clients through the healthcare system. Service-users' self-reports appeared to appreciate the individualised holistic care provided by postholders. Postholders' role in facilitating person-centred care and promoting interprofessional team working, are essential elements in quality care provision and in global healthcare workforce planning.

CONCLUSIONS

To meet changing healthcare demands, promote person-centred care, and improve service delivery, more specialist and advanced practice posts in nursing and midwifery should be developed and supported within healthcare.

Attitudes toward expanding nurses' authority

BACKGROUND

In recent years, an increasing number of care procedures previously under the physician's authority have been placed in the hands of registered nurses. The purpose of this study was to examine the attitudes of nurses towards expanding nurses' authority and the relationships between these attitudes and job satisfaction facets, professional characteristics, and demographics.

METHOD

A cross-sectional study was conducted between 2010 and 2011 in three major medical centers in Israel. Participants included 833 nurses working in 89 departments. Attitudes toward the expansion of nurses' authority were assessed by self-report questionnaire, as well as job satisfaction facets including perception of professional autonomy, nurse-physician working relations, workload and burnout, perceptions of quality of care, and nursing staff satisfaction at work.

RESULTS

Nurses reported positive attitudes toward the expansion of nurses' authority and moderate attitudes for interpretation of diagnostic tests in selected situations. The results of multivariate regression analyses demonstrate that the nurses' satisfaction from professional autonomy and work relations were the most influential factors in explaining their attitudes toward the expansion of nurses' authority. In addition, professionally young nurses tend to be more positive regarding changes in nurses' authority.

CONCLUSIONS

In the Israeli reality of a nurse's shortage, we are witnessing professional transitions toward expansion of the scope of nurses' accountability and decision-making authority. The current research contributes to our understanding of attitudes toward the expansion of nurses' authority among the nursing staffs. The findings indicate the necessity of redefining the scope of nursing practice within the current professional context.

Advocacy in Pain Management: The Role of the Anaesthetic Nurse Specialist

Peri-operative nursing practice is constantly changing and demanding specialist knowledge, skills and expertise to embrace these changes. All patients in need of anaesthesia are entitled to the same high quality peri-operative care and therefore those assisting the anaesthetist must be competent and effective practitioners. With this in mind the authors shall give a reflective account highlighting the role of Anaesthetic Nurse Specialist (ANS) in promoting leadership within the peri-operative environment and how it can be nurtured and facilitated to achieve professional autonomy and promote patient advocacy.

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.

Exploring attitudes and opinions of radiation therapists in British Columbia towards advanced practice

Introduction

Although the notion of advanced practice (AP) has been widely accepted and implemented in some countries, for example, the United Kingdom, in Canada it is has yet to be widely tested as a model of working. Currently it has been implemented and evaluated in Ontario, but this approach is not widespread across the country. To date in British Columbia (BC), there are no advanced practitioners and no research has been conducted regarding the opinions and attitudes of radiation therapists (RTs) in BC towards the implementation of AP. Understanding RTs attitudes and perceptions towards AP may be important when considering the acceptance and implementation of new roles. The research objectives were to explore the attitudes and opinions of RTs and establish what the term AP means to BC RTs, and also to discover what they consider to be benefits, and barriers to implementing AP.

Materials and methods

A quantitative approach was utilised and an on-line questionnaire was sent to 266 RTs that currently practice in BC. Likert and demographic questions were used to explore the definition of AP and ascertain opinions about the barriers and benefits of implementing AP in BC.

Results

A total of 183 questionnaires were completed for a response rate of 69%. The majority of respondents agreed with the Canadian Association of Medical Radiation Technologies (CAMRT) and the literature's definition of AP. Cost, time, lack of support and training and issues of medical dominance were cited as barriers. Job satisfaction, autonomy, and increased recruitment and retention of staff were considered benefits.

Conclusions

Although RTs believe there are obstacles to be overcome regarding the adoption and implementation of AP, these are outweighed by the potential benefits such as enhanced patient care due to increased levels of professional knowledge and development that can lead to increased levels of job satisfaction. These are seen as important drivers for creating the AP role in BC.

A comparison of ambulance responses to incidents of Medical Emergency Teams led by nurses and paramedics--A retrospective single-center study

BACKGROUND

In Poland there are currently two main types of Medical Emergency Team: basic, run by nurses or paramedics, and specialist, led by physicians. They differ not only in professional qualifications but also in their terms of reference.

OBJECTIVES

We compared the responses to incidents of Medical Emergency Teams led by nurses and paramedics, in terms of the frequency of pharmacotherapy use and medical rescue activities.

STUDY DESIGN

Ambulance call reports.

SETTINGS

Medical Emergency Teams in Eastern Poland.

PARTICIPANTS

Medical Emergency Teams led by nurses or paramedics. Exclusion criteria were cancelation of calls by the dispatcher, calls with no patient on the scene, and neonatal and interhospital transportation.

METHODS

A retrospective analysis of ambulance call reports. A comparison of actions of nurses and paramedics taken in the field, and decisions concerning transportation of the patient to a hospital or leaving the home were collected.

RESULTS

Of 1115 Medical Emergency Teams calls, those led by paramedics (60.5%) were more common. Paramedics, more often than nurses, provided aid solely in the field-27.5% and 16.0%, respectively-and less frequently transported patients to the hospital-38.5% and 50.7%, respectively. Significant differences in administration of oxygen therapy and analgesics were identified; paramedics used them more often than nurses. Paramedics used cervical collars, 3.6% and 1.1% (p=0.01), respectively, and performed 12-lead electrocardiograms, 4.7% and 1.4% (p=0.002), respectively, significantly more frequently than did nurses.

CONCLUSIONS

Despite the comparable competency of paramedics and emergency nurses in Poland, Medical Emergency Teams' activities varied depending on whether a nurse or a paramedic was the team leader. It is recommended that further in-depth research is conducted in this area.

Using the Donabedian framework to examine the quality and safety of nursing service innovation

AIMS AND OBJECTIVES

To evaluate the safety and quality of nurse practitioner service using the audit framework of Structure, Process and Outcome.

BACKGROUND

Health service and workforce reform are on the agenda of governments and other service providers seeking to contain healthcare costs whilst providing safe and effective health care to communities. The nurse practitioner service is one health workforce innovation that has been adopted globally to improve timely access to clinical care, but there is scant literature reporting evaluation of the quality of this service innovation.

DESIGN

A mixed-methods design within the Donabedian evaluation framework was used.

METHODS

The Donabedian framework was used to evaluate the Structure, Process and Outcome of nurse practitioner service. A range of data collection approaches was used, including stakeholder survey (n = 36), in-depth interviews (11 patients and 13 nurse practitioners) and health records data on service processes.

RESULTS

The study identified that adequate and detailed preparation of Structure and Process is essential for the successful implementation of a service innovation. The multidisciplinary team was accepting of the addition of nurse practitioner service, and nurse practitioner clinical care was shown to be effective, satisfactory and safe from the perspective of the clinician stakeholders and patients.

CONCLUSIONS

This study demonstrated that the Donabedian framework of Structure, Process and Outcome evaluation is a valuable and validated approach to examine the safety and quality of a service innovation. Furthermore, in this study, specific Structure elements were shown to influence the quality of service processes further validating the framework and the interdependence of the Structure, Process and Outcome components.

RELEVANCE TO CLINICAL PRACTICE

Understanding the Structure and Process requirements for establishing nursing service innovation lays the foundation for safe, effective and patient-centred clinical care.

An exploration of the perceptions of Emergency Physicians and Trainees, towards Emergency Nurse Practitioners in Australia

OBJECTIVE

To explore Emergency Physicians perceptions towards the Emergency Nurse Practitioner role, specifically, examining their support, its perceived benefits, difficulties, impact in the clinical environment and proposed scope of practice.

METHODS

A survey was distributed to all members of the Australasian College of Emergency Medicine via Survey Monkey between August and November 2009. Statistical analysis of the data was performed using the SPSS package.

RESULTS

A total of 50.8% (n = 315) responded positively to supporting the Emergency Nurse Practitioner role whilst 20% (n = 124) responded negatively. When comparing those who have worked with Emergency Nurse Practitioners vs those who have not, 59.8% (n = 307) of those who have worked with Emergency Nurse Practitioners were positively identified as supporting the role, compared to 7.5% (n = 8) of those who had not. In those who had not worked with Emergency Nurse Practitioners 53.3% (n = 57) neither agreed nor disagreed in supporting the role. With respect to the benefits and the proposed scope of practice, a response trend of greater significance was found in those who had previously worked with Emergency Nurse Practitioners.

CONCLUSION

Emergency healthcare is evolving in line with increasing demands. Worldwide, the Emergency Nurse Practitioner role has been researched and critiqued at length. This paper provides evidence of Emergency Physicians positive perceptions and recognition of benefits of the Emergency Nurse Practitioner role within Australia. This was especially apparent amongst clinicians that have previously worked alongside them. Despite this, concerns were expressed with regard on-going medical training, medico-legal implications and training of Emergency Nurse Practitioners.

Perceptions of the advanced nurse practitioner role in a hospital setting

AIM

To explore perceptions of junior doctors, nurses and advanced nurse practitioners (ANP) in relation to the role of the ANP.

METHOD

A qualitative cross-sectional design was used, embedded in an interpretative philosophy. A non-probability sample of six junior doctors, six ward nurses and six ANPs took part in focus groups and individual semi-structured interviews. A mixture of phenomenological and grounded theory approaches were used to collect the data.

FINDINGS

Four major themes were identified - diverse definitions of the ANP role between medical and surgical wards in the hospital at day compared to hospital at night work; role vagueness and ambiguity; communication and education needs; and constraints and barriers. The study found varied perceptions and understanding of the role of the ANP within the hospital at day. Conversely, the hospital at night concept seemed correctly perceived - the role appeared well-established, organised and orchestrated the appropriate responses as required in both medicine and surgery. During the hospital at day, nurses on medical wards were more inclined to use the medical staff as their first responders. The absence of the bleep filtering system in medicine during the day was identified as one of the main barriers. A definitive understanding of the role during the hospital at day has been recognised as the second main barrier. A constraint well known to the ANP team was the inability to provide a bleep filter system in medicine during the day.

CONCLUSION

The study finds the need for improved education, clinical support and system management during the hospital at day, with more of an emphasis within medical wards.

Views of the Israeli public on expanding the authority of nurses

AIM

To explore the views of the Israeli public on expanding the authority of nurses and identify factors affecting these views.

BACKGROUND

New advanced nursing roles are currently being introduced and nursing is undergoing dynamic change. Public views on expanding the authority of nurses and factors affecting public views await investigation.

METHOD

In a correlational study, a questionnaire was administered to 200 male and female Israelis aged 18 and older treated at a hospital or healthcare clinic at least once over the past year.

RESULTS

Most respondents are in favour of expanding the authority of nurses, considered vital for patients. In addition, the public is in favour of certifying clinical nursing specialists in all fields. Influential factors were ethnicity, personal acquaintance with nurses, income and religiosity.

CONCLUSIONS

The public has a positive perception of expanding the authority of nurses, and major determinants are familiarity with nursing, ethnicity, income and religiosity.

IMPLICATIONS FOR NURSING MANAGEMENT

Understanding public views on expanding the authority of nurses in Israel will help policymakers adjust their actions according to social perceptions and needs. This will help nursing managers further the process of expanding nurse authority, to the satisfaction of both nurses and the public they serve.

Exploring the relationship between social identity and workplace jurisdiction for new nursing roles: a case study approach

BACKGROUND

The introduction of new healthcare roles internationally has had mixed results with some evidence that variations can be accounted for by the manner of their introduction rather than role content. Explanation may be found partly in the ways in which new roles establish a workplace jurisdiction; that is, recognition in the workplace of a role's legitimate rights to undertake a particular scope of practice.

OBJECTIVE

To explore the factors that influence the development of workplace jurisdiction of new nursing roles.

DESIGN AND SETTING

Critical realist multiple case study design within two NHS Acute Hospital Trusts in England and two new nursing roles as embedded units of analysis in each case (n=4 roles). In Phase 1, data were collected through semi-structured interviews (n=21), non-participant observation of committees (n=11), partial participant observation and shadowing of the role holders' working day (n=9), together with analysis of organisational documents (n=33). In Phase 2, follow up interviews with role-holders (n=4) were conducted. Participants Staff in new nursing roles (n=4) were selected purposively as embedded units according to the theoretical framework and other informants (n=17) were selected according to the study propositions.

RESULTS

Qualitative analysis demonstrated that different role drivers produced two different role types, each of whom faced different challenges in negotiating the implementation of the role in the workplace. Negotiation of workplace jurisdiction was shown to be dependent on sharing social identities with co-workers. Four major workplace identities were found: professional, speciality, organisational and relational.

CONCLUSION

The current focus on setting legal and public jurisdictions for new nursing roles through national standards and statutory registration needs to be complemented by a better understanding of how workplace jurisdiction is achieved. This study suggests that social identity is a significant determinant.

Healthcare providers attitudes and perceptions of 'inappropriate attendance' in the Emergency Department

Emergency Departments (EDs) worldwide are facing a crisis from overcrowding and a common perception exists that inappropriate use of the ED is a major contributing factor. Patients, who attend the ED with non-urgent problems, could be dealt with by a General Practitioner; such patients use time and resources that would otherwise be used for patients with more appropriate needs.

STUDY AIM

To explore attitudes and perceptions of healthcare providers regarding 'inappropriate attendance' in the ED.

STUDY DESIGN

Using a survey questionnaire, this descriptive quantitative study included ED nurses, doctors and paramedics from three regional hospitals in the Republic of Ireland.

RESULTS

A total of 163 surveys were returned (59% response rate). There was an overwhelming agreement among respondents that inappropriate attendance in Irish ED exists and poses a considerable challenge for healthcare providers. Results suggest differences of opinion on what represents inappropriate ED use. Potential solutions to address the issue of inappropriate ED attendance include General Practitioners and Advanced Nurse Practitioners practicing within the ED setting; education and greater public awareness and faster access to a specialist opinion in the Out Patient Department.

Perceptions of the benefits and challenges of the role of advanced practice nurses in nurse-led out-of-hours care in Hong Kong: a questionnaire study

AIMS AND OBJECTIVES

The aim of the study was to identify the factors that nurses perceive may facilitate or hinder the development of advanced practice nurse roles in Hong Kong.

BACKGROUND

Advanced practice nurses are increasingly prominent in nurse-led out-of-hours care in Hong Kong in response to changes to junior doctors' hours of work.

SETTING

Three five-day workshops for Hong Kong-based advanced practice nurses were offered in partnership with UK clinicians. The aim of the workshops was to share UK experiences of implementation of the 'Hospital at Night' model of care delivery. The questionnaire study undertaken was not part of the workshop programme. However, the workshops gave the authors a unique opportunity to access relatively large numbers of Hong Kong-based advanced practice nurses.

PARTICIPANTS

The workshops were attended by experienced nurses who had been or were about to be appointed as advanced practice nurses. All nurses who attended one of the three workshops (n=120) agreed to participate in the study.

METHODS

Responses to two open questions posed in the questionnaire were the subject of a content analysis.

RESULTS

A prominent finding of the study was that respondents viewed the benefits of introducing advanced practice nurse roles in Hong Kong as outweighing any challenges. One of the main features of the perceived benefits relates to improving the quality and safety of patient care. The greatest challenges associated with the role related to acceptance of the role by other healthcare professionals, and difficulties associated with the general public's traditional attitudes to healthcare provision in Hong Kong.

CONCLUSIONS

Education of the public concerning the implementation of such roles is of crucial importance.

RELEVANCE TO CLINICAL PRACTICE

Findings from this study enhance understanding of the factors that hinder or facilitate advanced practice roles in out-of-hours care in Hong Kong.

Knowledge and attitudes of primary care physicians toward the nurse practitioner role in the Kingdom of Bahrain

PURPOSE

The Kingdom of Bahrain is facing a number of challenges, including an escalating cost of health services, increasing incidence of chronic diseases, and shortage of primary care physicians (PCPs). Introducing the nurse practitioner (NP) specialty in the primary care setting is one way to meet these challenges. The purpose of this quasi-experimental study was to examine the knowledge and attitudes of PCPs about the NP role prior to and following an educational intervention.

DATA SOURCES

The modified Northern Emergency Nurse Practitioner Staff Survey was used to measure the PCPs' attitudes and knowledge. A total of 90 PCPs completed the pretest and posttest.

CONCLUSIONS

The study findings showed that PCPs had poor understanding of the NP role. Their knowledge and attitudes changed significantly after the educational intervention. Also, posttest data indicated a positive correlation between knowledge and attitudes toward the NP role.

IMPLICATIONS FOR PRACTICE

More educational preparation and orientation to the NP role for PCPs and other healthcare professionals are needed before the implementation of the role in the primary care setting in Bahrain. There is a need for the role to be clearly defined prior to implementation to help gain understanding and acceptance.

Emergency nurse practitioners' perceptions of their role and scope of practice: is it advanced practice?

There are multiple interpretations of the nurse practitioner role which appear to be shaped by discourses within and outside the profession and its regulatory body. This study aimed to explore and clarify the role and scope of practice of emergency nurse practitioners in a region in the United Kingdom and determine if they fulfil the proposed criteria for Advanced Nurse Practitioners. A survey approach using questionnaires (n=42) was adopted. The sample included all emergency nurse practitioners working in Accident and Emergency Departments and Minor Injury Units in the region. Statistical data was analysed using SPSS for Windows and qualitative data was content analysed for themes. Results revealed a variation in education. Investigation of role typology and scope of practice revealed a relatively homogenous group where the clinical aspect of the role dominated. The scope of practice was perceived to be influenced by internal factors such as competence; however protocol use, referral rights and prescribing authority could be considered ways that nursing management and medical staff indirectly control the role. Findings suggested that emergency nurse practitioners were working at a level significantly beyond registration, yet do not fulfil the Nursing and Midwifery Council proposed criteria for Advanced Nurse Practitioner.

Emergency nurses: procedures performed and competence in practice

INTRODUCTION

Emergency nurses play an important role in identifying and managing critical illness. Thus, nurses' competence in performing a range of functions is important. This study aimed to identify the procedures performed and associated competencies of emergency nurses.

METHODS

A quantitative descriptive design was used and 403 questionnaires distributed to nurses working across 11 emergency departments in Ireland. Data were collected using a researcher developed questionnaire, measuring 119 nursing procedures and corresponding competency levels. A response rate of 53% (n=214) was achieved.

RESULTS

Results show that activities relating to diagnostic function were conducted most often, followed by activities relating to organisation and work role competencies. Within the helping role, planning patient care was indicated as a key activity. Identifying patient care priorities was conducted most often in the domain of effective management of rapidly changing situations. Activities performed least often were those associated with administering and monitoring therapeutic interventions. Nurses judged themselves to be most competent in diagnostic function. There was a statistically significant positive relationship between nurses level of perceived competence and frequency of practice (p<0.01).

CONCLUSION

Emergency nurses in Ireland engage in a wide range of activities, many of which are described in other countries as advanced practice. Recognition needs to be given and education prioritised in deficit areas.