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Lewis R. The evolution of advanced nursing practice: Gender, identity, power and patriarchy. Nurs Inq 2022; 29:e12489. [PMID: 35279899 PMCID: PMC9787357 DOI: 10.1111/nin.12489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 12/30/2022]
Abstract
To address longstanding workforce shortages, increase efficiency and control the costs associated with the modern health-care provision, there has been a worldwide policy to promote increased flexibility within the health-care workforce. This is being done primarily by extending the 'scope of practice' of existing occupational roles into what is referred to as 'advanced' practice. The development of the advanced practice nurse (APN) has occurred within the context of a shortage of medical staff, and the need to control cost. However, the means by which substantially repurposed occupational groups such as these, are incorporated into complex, hierarchical organisations such as the UK national health service (NHS) remains poorly understood. Using modern sociological theory, the development of the APN role has been examined in terms of power, control, professional identity and gender relations. Each of the theoretical approaches used adds to the quality of the discussion, although none provide a comprehensive picture. However, when synthesised, they do provide an enhanced insight into the evolution of the role. It is argued here that by critically examining the development of the APN role, this will enable both a better understanding of, and the means to influence, its future direction of travel.
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Affiliation(s)
- Robin Lewis
- Applied Health and Social Care Research Centre, College of Health, Wellbeing and LifesciencesSheffield Hallam UniversitySheffieldUK
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Campbell J. Regulation of Advanced Critical Care Practitioners: Past, present and future. J Intensive Care Soc 2020; 21:7-11. [PMID: 32284711 PMCID: PMC7137167 DOI: 10.1177/1751143718809682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The role of Advanced Critical Care Practitioners was included in the Department of Health's recent consultation document on the regulation of Medical Associate Professions. This prompted the author, an Advanced Critical Care Practitioner, to examine the regulation of Advanced Critical Care Practitioners in the past, present and future. National competence frameworks have been developed. However, there continued to be criticism on the lack of regulation and title protection of Advanced Critical Care Practitioners. This article discusses the response of governing bodies to the consultation and its potential future implications for Advanced Critical Care Practitioners.
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Affiliation(s)
- Johan Campbell
- Adult Critical Care Unit, Wishaw General Hospital, Wishaw, UK
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Abstract
Background: Collaborative working between professionals is a key component of integrated care. The academic literature on it largely focuses either on integration between health and social care or on the dynamics of power and identity between doctors and nurses. With the proliferation and extension of nursing roles, there is a need to examine collaborative working amongst different types of nurses. Method: This study explored experiences of collaborative working amongst generalist and specialist nurses, in community and acute settings. We carried out semi-structured interviews, incorporating the Pictor technique, with 45 nurses, plus 33 other key stakeholders. Transcripts were analysed using Template Analysis. This article focuses on one major thematic area that emerged from the analysis: the significance of interpersonal relationships amongst nurses, and between them and other professionals, patients and carers. Results: Relationship issues were ubiquitous in participants’ accounts of collaborative working. Good personal relationships facilitated collaboration; face-to-face interaction was especially valued. Relationships were recognized as requiring effort, especially in new roles. Organisational changes could disrupt productive personal networks. Conclusion: Relationship issues are integral to successful collaborative working. Policy and practice leaders must take this into account in future service developments. Further research into collaborative relationships in different settings is needed.
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Wise S, Duffield C, Fry M, Roche M. Workforce flexibility - in defence of professional healthcare work. J Health Organ Manag 2017; 31:503-516. [PMID: 28877617 DOI: 10.1108/jhom-01-2017-0009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The desirability of having a more flexible workforce is emphasised across many health systems yet this goal is as ambiguous as it is ubiquitous. In the absence of empirical studies in healthcare that have defined flexibility as an outcome, the purpose of this paper is to draw on classic management and sociological theory to reduce this ambiguity. Design/methodology/approach The paper uses the Weberian tool of "ideal types". Key workforce reforms are held against Atkinson's model of functional flexibility which aims to increase responsiveness and adaptability through multiskilling, autonomy and teams; and Taylorism which seeks stability and reduced costs through specialisation, fragmentation and management control. Findings Appeals to an amorphous goal of increasing workforce flexibility make an assumption that any reform will increase flexibility. However, this paper finds that the work of healthcare professionals already displays most of the essential features of functional flexibility but many widespread reforms are shifting healthcare work in a Taylorist direction. This contradiction is symptomatic of a failure to confront inevitable trade-offs in reform: between the benefits of specialisation and the costs of fragmentation; and between management control and professional autonomy. Originality/value The paper questions the conventional conception of "the problem" of workforce reform as primarily one of professional control over tasks. Holding reforms against the ideal types of Taylorism and functional flexibility is a simple, effective way the costs and benefits of workforce reform can be revealed.
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Affiliation(s)
- Sarah Wise
- Faculty of Health, University of Technology Sydney , Sydney, Australia
| | | | - Margaret Fry
- Faculty of Health, University of Technology Sydney , Sydney, Australia
| | - Michael Roche
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University , Sydney, Australia
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Tesseyman S, Hallett C, Brooks J. Crisis at Guy's Hospital (1880) and the nature of nursing work. Nurs Inq 2017; 24. [DOI: 10.1111/nin.12203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Sheri Tesseyman
- School of Nursing and Health Sciences; Westminster College; Salt Lake City UT USA
| | - Christine Hallett
- The School of Nursing, Midwifery and Social Work; The University of Manchester; Manchester UK
| | - Jane Brooks
- The School of Nursing, Midwifery and Social Work; The University of Manchester; Manchester UK
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Benton DC, Cusack L, Jabbour R, Penney C. A bibliographic exploration of nursing's scope of practice. Int Nurs Rev 2016; 64:224-232. [DOI: 10.1111/inr.12337] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D C Benton
- National Council of State Boards of Nursing, Chicago, IL, USA
| | - L Cusack
- Adelaide Nursing School, The University of Adelaide, Adelaide, SA, Australia
| | - R Jabbour
- College of Nurses of Ontario, Toronto, ON, Canada
| | - C Penney
- Policy, Practice and Quality Assurance, College of Registered Nurses of British Columbia, Vancouver, BC, Canada
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Chen SL, Hsu HY, Chang CF, Lin ECL. An exploration of the correlates of nurse practitioners' clinical decision-making abilities. J Clin Nurs 2016; 25:1016-24. [PMID: 26879045 DOI: 10.1111/jocn.13136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This study investigated nurse practitioners' clinical decision-making abilities and the factors that affect these abilities. BACKGROUND Nurse practitioners play an important role in clinical care decision-making; however, studies exploring the factors that affect their decision-making abilities are lacking. DESIGN A cross-sectional descriptive survey was employed. METHODS A purposive sample of 197 nurse practitioners was recruited from a medical centre in central Taiwan. Structured questionnaires consisting of the Knowledge Readiness Scale, the Critical Thinking Disposition Inventory and the Clinical Decision-Making Model Inventory were used to collect data. RESULTS The intuitive-analytical type was the most commonly used decision-making model, and the intuitive type was the least frequently used model. The decision-making model used was significantly related to the nurse practitioners' work unit. Significant differences were noted between the nurse practitioners' clinical decision-making models and their critical thinking dispositions (openness and empathy). The nurse practitioners' years of work experience, work unit, professional knowledge and critical thinking disposition (openness and empathy as well as holistic and reflective dispositions) predicted the nurse practitioners' analytical decision-making scores. Age, years of nurse practitioner work experience, work unit and critical thinking disposition (holistic and reflective) predicted the nurse practitioners' intuitive decision-making scores. CONCLUSIONS This study contributes to the topic of clinical decision-making by describing various types of nurse practitioner decision-making. The factors associated with analytic and intuitive decision-making scores were identified. These findings might be beneficial when planning continuing education programmes to enhance the clinical decision-making abilities of nurse practitioners. RELEVANCE TO CLINICAL PRACTICE The study results showed that nurse practitioners demonstrated various clinical decision-making types across different work units. Consideration of nurse practitioners' knowledge readiness and their specific needs while planning on-duty education programmes is necessary.
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Affiliation(s)
- Shiah-Lian Chen
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Hsiu-Ying Hsu
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Chin-Fu Chang
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Esther Ching-Lan Lin
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Wilson-Miller R, Stanley H. Nurse-led intravitreal injection clinics: defining the ophthalmic nurse's scope of practice and educational needs. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/ijop.2014.5.4.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Helen Stanley
- Assistant Head of School and Postgraduate Academic Programme Lead, School of Health Sciences, University of Brighton, UK
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Bacon D, Borthwick AM. Charismatic authority in modern healthcare: the case of the 'diabetes specialist podiatrist'. SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:1080-1094. [PMID: 23278366 DOI: 10.1111/1467-9566.12024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Professional specialisation is broadly considered to result from increased complexity in professional knowledge and to be linked to specialist education, formalised credentials and registration. However, the degree of formal organisation may vary across professions. In healthcare, although medical specialisation is linked to rigorous selection criteria, formal training programmes and specialist registration, some forms of specialisation in the allied health professions are much less formal. Drawing on Weber's concept of charismatic authority, the establishment of a specialist role in podiatry, the 'diabetes specialist podiatrist', in the absence of codified or credentialed authority, is explored. 'Charismatic' leaders in podiatry, having attracted a following of practitioners, were able to constitute a speciality area of practice in the absence of established career pathways and acquire a degree of legitimacy in the medical field of diabetology.
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Affiliation(s)
- Dawn Bacon
- Southern Health National Health Service Foundation Trust, Orthopaedic Choice, Southampton Centre for Innovation and Leadership in Health Sciences, University of Southampton
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Dowling M, Beauchesne M, Farrelly F, Murphy K. Advanced practice nursing: A concept analysis. Int J Nurs Pract 2013; 19:131-40. [DOI: 10.1111/ijn.12050] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Maura Dowling
- School of Nursing and MidwiferyNational University of Ireland Galway Ireland
| | - Michelle Beauchesne
- School of NursingBouve College of Health ScienceNortheastern University Boston Massachusetts USA
| | - Frances Farrelly
- School of Nursing and MidwiferyNational University of Ireland Galway Ireland
| | - Kathy Murphy
- School of Nursing and MidwiferyNational University of Ireland Galway Ireland
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Sangster-Gormley E, Martin-Misener R, Burge F. A case study of nurse practitioner role implementation in primary care: what happens when new roles are introduced? BMC Nurs 2013; 12:1. [PMID: 23343534 PMCID: PMC3562226 DOI: 10.1186/1472-6955-12-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 01/18/2013] [Indexed: 11/20/2022] Open
Abstract
Background At the time of this study (2009) the role of the nurse practitioner was new to the province of British Columbia. The provincial government gave the responsibility for implementing the role to health authorities. Managers of health authorities, many of whom were unfamiliar with the role, were responsible for identifying the need for the NP role, determining how the NP would function, and gaining team members’ acceptance for the new role. Method The purpose of the study was to explain the process of nurse practitioner role implementation as it was occurring and to identify factors that could enhance the implementation process. An explanatory, single case study with embedded units of analysis was used. The technique of explanation building was used in data analysis. Three primary health care settings in one health authority in British Columbia were purposively selected. Data sources included semi-structured interviews with participants (n=16) and key documents. Results The results demonstrate the complexity of implementing a new role in settings unfamiliar with it. The findings suggest that early in the implementation process and after the nurse practitioner was hired, team members needed to clarify intentions for the role and they looked to senior health authority managers for assistance. Acceptance of the nurse practitioner was facilitated by team members’ prior knowledge of either the role or the individual nurse practitioner. Community health care providers needed to be involved in the implementation process and their acceptance developed as they gained knowledge and understanding of the role. Conclusion The findings suggest that the interconnectedness of the concepts of intention, involvement and acceptance influences the implementation process and how the nurse practitioner is able to function in the setting. Without any one of the three concepts not only is implementation difficult, but it is also challenging for the nurse practitioner to fulfill role expectations. Implications for research, policy, practice and education are discussed.
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Affiliation(s)
- Esther Sangster-Gormley
- School of Nursing, University of Victoria, PO Box 1700, STN CSC, Victoria, British Columbia, V8W 2Y2, Canada.
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Kilpatrick K, Lavoie-Tremblay M, Ritchie JA, Lamothe L, Doran D, Rochefort C. How are acute care nurse practitioners enacting their roles in healthcare teams? A descriptive multiple-case study. Int J Nurs Stud 2012; 49:850-62. [DOI: 10.1016/j.ijnurstu.2012.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 01/10/2012] [Accepted: 01/17/2012] [Indexed: 10/28/2022]
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Fleming E, Carberry M. Steering a course towards advanced nurse practitioner: a critical care perspective. Nurs Crit Care 2011; 16:67-76. [DOI: 10.1111/j.1478-5153.2011.00448.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sangster-Gormley E, Martin-Misener R, Downe-Wamboldt B, DiCenso A. Factors affecting nurse practitioner role implementation in Canadian practice settings: an integrative review. J Adv Nurs 2011; 67:1178-90. [DOI: 10.1111/j.1365-2648.2010.05571.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Lee CY, Komatsu H, Zhang W, Chao YF, Kim KK, Kim GS, Cho YH, Ko JS. Comparison of the Hospice Systems in the United States, Japan and Taiwan. Asian Nurs Res (Korean Soc Nurs Sci) 2010; 4:163-73. [DOI: 10.1016/s1976-1317(11)60001-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 09/30/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022] Open
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