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Zhao Y, Quadros W, Nagraj S, Wong G, English M, Leckcivilize A. Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review. BMC Med 2024; 22:286. [PMID: 38978070 PMCID: PMC11232288 DOI: 10.1186/s12916-024-03509-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Advanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams. METHODS We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level). RESULTS We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs' backgrounds and characteristics, clinical team members' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained. CONCLUSIONS We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.
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Affiliation(s)
- Yingxi Zhao
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK.
| | | | - Shobhana Nagraj
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mike English
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Attakrit Leckcivilize
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
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Wise S, Duffield C, Fry M, Roche M. Nurses' role in accomplishing interprofessional coordination: Lessons in 'almost managing' an emergency department team. J Nurs Manag 2021; 30:198-204. [PMID: 34436800 DOI: 10.1111/jonm.13464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022]
Abstract
AIM To describe how nurse coordinators accomplished day-to-day interprofessional coordination in an Australian emergency department team, drawing some lessons for the design of nurse coordinator roles in other settings. BACKGROUND Previous studies have examined leadership within nursing teams, and there are a growing number of registered nurses employed as care coordinators. There is limited literature on how the day-to-day coordination of interprofessional teams is accomplished, and by whom. METHOD Nineteen semi-structured interviews with emergency department registered nurses, doctors and nurse practitioners analysed thematically. RESULTS Three themes describe how coordinators accomplished interprofessional coordination: task coordination and oversight, taking action to maintain patient flow and negotiating an ambiguous role. CONCLUSION Better-defined nurse coordinator roles with clearer authority and associated training are essential for consistent practice. However, accomplishing interprofessional coordination will always require the situated knowledge of the complex nursing-medical division of labour in the workplace and the interpersonal relationships that are only gained through experience. IMPLICATIONS FOR NURSING MANAGEMENT The design of nurse coordinator roles must include the thorny question of 'who leads' interprofessional teams in the day-to-day coordination of tasks. New and inexperienced nurses may not have the necessary situated knowledge or interpersonal relationships to succeed. However, such roles offer an important development opportunity for future nurse managers.
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Affiliation(s)
- Sarah Wise
- Centre for Health Economics Research and Evaluation, Faculty of Business, University of Technology Sydney, Sydney, NSW, Australia
| | - Christine Duffield
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Nursing and Health Services Management, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Michael Roche
- School of Nursing, Midwifery, and Public Health, University of Canberra, Canberra, ACT, Australia
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Wynne R, Jackson D, Prince J, O'Regan A, Kirk A, Ferguson C. Clinical quality registries: An approach to support research capacity building in clinical academic partnerships. J Clin Nurs 2021; 30:e29-e31. [PMID: 33350523 DOI: 10.1111/jocn.15619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Rochelle Wynne
- Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, Western Sydney University & Western Sydney Local Health District, Blacktown Hospital, Blacktown, NSW, Australia.,School of Nursing & Midwifery, Deakin University, Geelong, Vic., Australia
| | - Debra Jackson
- Faculty of Health, University of Technology (UTS, Ultimo, Sydney, NSW, Australia
| | - Joanne Prince
- Integrated & Community Health, Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Amanda O'Regan
- Integrated & Community Health, Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Andrea Kirk
- Directorate of Nursing & Midwifery, Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, Western Sydney University & Western Sydney Local Health District, Blacktown Hospital, Blacktown, NSW, Australia
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Sevilla Guerra S, Miranda Salmerón J, Zabalegui A. Profile of advanced nursing practice in Spain: A cross-sectional study. Nurs Health Sci 2017; 20:99-106. [DOI: 10.1111/nhs.12391] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 11/29/2022]
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Jakimowicz M, Williams D, Stankiewicz G. A systematic review of experiences of advanced practice nursing in general practice. BMC Nurs 2017; 16:6. [PMID: 28115913 PMCID: PMC5241982 DOI: 10.1186/s12912-016-0198-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/27/2016] [Indexed: 11/17/2022] Open
Abstract
Background Despite efforts to achieve conceptual clarity, advanced practice nursing continues to reside in a liminal space, unable to secure ongoing recognition as a viable means of healthcare delivery. This is particularly evident in general practice where advanced practice role development is more fluid and generally less supported by the hierarchical structures evident in the hospital system. This review synthesises published qualitative studies reporting experiences of advanced practice nursing in general practice. The panoramic view provided by patients, nurses and doctors within this novel context, offers a fresh perspective on why advanced practice nurses have struggled to gain acceptance within the healthcare milieu. Methods We conducted a systematic review of qualitative studies that explored the experiences of patients, nurses and doctors who had contact with advanced practice nurses working in general practice. Published work from 1990 to June 2016 was located using CINAHL and PubMed. The full text of relevant studies was retrieved after reading the title and abstract. Critical appraisal was undertaken and the findings of included studies were analysed using the constant comparative method. Emergent codes were collapsed into sub-themes and themes. Results Twenty articles reporting the experiences of 486 participants were included. We identified one major theme: legitimacy; and three sub-themes: (1) establishing and maintaining confidence in the advanced practice nurse, (2) strengthening and weakening boundaries between general practitioners and advanced practice nurses and (3) establishing and maintaining the value of advanced practice nursing. Conclusions We set out to describe experiences of advanced practice nursing in general practice. We discovered that general practitioners and patients continue to have concerns around responsibility, trust and accountability. Additionally, advanced practice nurses struggle to negotiate and clarify scopes of practice while general practitioners have trouble justifying the costs associated with advanced practice nursing roles. Therefore, much work remains to establish and maintain the legitimacy of advanced practice nursing in general practice. Electronic supplementary material The online version of this article (doi:10.1186/s12912-016-0198-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Jakimowicz
- School of Health Sciences, University of Tasmania, 1 Leichhardt Street, Darlinghurst, NSW 2010 Australia
| | - Danielle Williams
- School of Health Sciences, University of Tasmania, Private Bag 135, Hobart, TAS 7001 Australia
| | - Grazyna Stankiewicz
- School of Health Sciences, University of Tasmania, Locked Bag 5052, Alexandria, NSW 2015 Australia
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Identifying advanced practice: A national survey of a nursing workforce. Int J Nurs Stud 2016; 55:60-70. [DOI: 10.1016/j.ijnurstu.2015.12.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 11/22/2022]
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Giles M, Parker V, Mitchell R. Examining Nurse Consultant connectivity: An Australian mixed method study. Nurs Health Sci 2015; 18:154-62. [PMID: 26305104 DOI: 10.1111/nhs.12235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/03/2015] [Indexed: 11/27/2022]
Abstract
The nurse consultant (NC) role in Australia is a senior classification of advanced practice nurse has been described as enhancing health care outcomes largely through extensive collaboration with consumers, nurses, and other health professionals. However, little is known about the actual nature, amount, and quality of NC interactions. This study examines the connectivity of the NC role across metropolitan and rural contexts, using a mixed method sequential design with an online survey and focus groups with NCs and other stakeholders. Results demonstrated that NCs most commonly have high density connectivity patterns with other nursing colleagues, medical staff, patients/clients, and administrative staff. Position grade (1, 2 or 3) influences density of connectivity, as does location, with those based in metropolitan roles engaging significantly less with other clinicians. Findings demonstrate that many NCs are highly collaborative and predominantly embedded into interprofessional practice models. This study provides valuable insight into the diverse and often complex NC role and the way in which NC expertise and influence is deployed and integrated across a large local health district.
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Affiliation(s)
- Michelle Giles
- Clinical Nurse Consultant Research, Hunter New England Local Health District, James Fletcher Campus, Newcastle, NSW, Australia.,School of Health, University of New England, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Vicki Parker
- Clinical Nurse Consultant Research, Hunter New England Local Health District, James Fletcher Campus, Newcastle, NSW, Australia.,School of Health, University of New England, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Rebecca Mitchell
- School of Business and Law, University of Newcastle, Newcastle, NSW, Australia
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McKenna L, Halcomb E, Lane R, Zwar N, Russell G. An investigation of barriers and enablers to advanced nursing roles in Australian general practice. Collegian 2015; 22:183-9. [DOI: 10.1016/j.colegn.2015.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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The role of a clinical nurse consultant in an Australian Health District: a quantitative survey. BMC Nurs 2015; 14:25. [PMID: 26019687 PMCID: PMC4445999 DOI: 10.1186/s12912-015-0075-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/24/2015] [Indexed: 11/26/2022] Open
Abstract
Background This study replicates previous research undertaken in 2013 that explored the role of the Clinical Nurse Consultant in a metropolitan health district in Sydney, Australia. Methods A descriptive survey, using Likert scales, was used to collect data from Clinical Nurse Consultants. Results Clinical Nurse Consultants are well informed about the domains and functions of their role, as stipulated in the relevant award. They identified clinical service and consultancy as the area in which they predominantly practice. Conclusion Despite the clarity of the domains and functions as outlined in the relevant legislated award, the activities undertaken by these clinical nurses are institutionally, individually and contextually constructed.
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Duffield CM, Roche MA, Dimitrelis S, Homer C, Buchan J. Instability in patient and nurse characteristics, unit complexity and patient and system outcomes. J Adv Nurs 2014; 71:1288-98. [DOI: 10.1111/jan.12597] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Christine M. Duffield
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
- Clinical Nursing and Midwifery Research Centre; School of Nursing and Midwifery; Edith Cowan University; Joondalup Perth Western Australia Australia
| | - Michael A. Roche
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - Sofia Dimitrelis
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - Caroline Homer
- Centre for Midwifery, Child and Family Health; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - James Buchan
- School of Health; Queen Margaret University; Edinburgh UK
- University of Technology; Sydney New South Wales Australia
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Knight K, Kenny A, Endacott R. Assessing clinical urgency via telephone in rural Australia. Nurs Health Sci 2014; 17:201-7. [DOI: 10.1111/nhs.12161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 06/22/2014] [Accepted: 06/27/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Kaye Knight
- La Trobe Rural Health School; Bendigo Victoria Australia
| | - Amanda Kenny
- La Trobe Rural Health School; Bendigo Victoria Australia
| | - Ruth Endacott
- School of Nursing & Midwifery; Monash University; Melbourne Victoria Australia
- School of Nursing & Midwifery; Plymouth University; Plymouth UK
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Jokiniemi K, Haatainen K, Meretoja R, Pietilä AM. The Future of the Clinical Nurse Specialist Role in Finland. J Nurs Scholarsh 2014; 47:78-86. [DOI: 10.1111/jnu.12109] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Krista Jokiniemi
- Doctoral student; University of Eastern Finland; Faculty of Health Sciences; Department of Nursing Science, and Assistant Head Nurse; Kuopio Finland
| | - Kaisa Haatainen
- Docent; University of Eastern Finland; and Patient Safety Manager; Kuopio University Hospital; Kuopio Finland
| | - Riitta Meretoja
- Docent; Universtity of Turku; and Development Manager; Corporate Headquarters; Hospital District of Helsinki; Uusimaa Helsinki Finland
| | - Anna-Maija Pietilä
- Professor; University of Eastern Finland; Faculty of Health Sciences; Department of Nursing Science; Social and Health Care Services; Kuopio Finland
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