It's not the task, it's the shifting exploring physicians' and leaders' perspectives on task shifting in emergency departments in Norway

BACKGROUND

Task shifting is an approach where specific tasks are transferred, when convenient, from health workers with high qualifications to health workers with less training and lower qualifications. This approach is mainly used to utilize the available human resources for health. Tasks that are traditionally linked to the physician role have increasingly been transferred to registered nurses during the last decade. Knowledge regarding the experiences and reflections of physicians and their leaders related to giving up tasks or how such policies can best be implemented is limited. This study aimed to explore physicians' and their leaders' perspectives on task shifting, especially to registered nurses, in different Norwegian emergency departments.

METHODS

The study was carried out from June to October 2022. It had an explorative and descriptive qualitative design and an inductive approach, semi-structured interviews was used. The study involved ten physicians and leaders from three different regional hospitals in south-eastern Norway. Manifest and latent content analysis were used to analyse the data. The COREQ guidelines were applied in the study.

RESULTS

From the three categories 1) The rationale for task shifting, 2) Teambuilding and 3) Implementation of task shifting, with nine subcategories. One overall main theme emerged: It is not the task, it is the shifting - moving towards a person-centred culture.

CONCLUSIONS

The study indicates that developing a person-centred culture and fostering a team approach in emergency departments is more important than simply shifting tasks, as task shifting may lead to fragmented care and resistance from physicians. Hospital leaders must invest time and effort into organising teams and providing clear leadership to support the redesign of professional roles, recognising the cultural and traditional challenges involved. Policymakers should promote guideline development, team training programs, and cooperation methods to support a person-centred culture and effective task shifting in emergency departments.

"I don't Want to Die Alone" Nurses' Perception of Ageism: A Qualitative Study

The aim of the study was to learn the perceptions and thoughts of nurses with whom older patients interact constantly. In this research, semi-structured interview was used. In a research hospital in Istanbul between March-June 2019, 16 volunteers were included in the study. Researchers led individual semi-structured interviews regarding nurses' perceptions, how they overcame those challenges, and need and expectations aging care (dying patients). All interviews were analysed using thematic analysis methods and synthesized into major themes. The research was planned based on the 32-item checklist (COREQ) guideline. Nurses (N = 16) reported three themes: (i) ageing perceptions (ii) care for dying patients, (iii) expectations and five subthemes emerged in this study. It is understood that nurses have a positive perception of ageing. In addition, nurses have expectations from the state (financial support, gerontology service etc.) and society (respectful, understanding etc.) to reduce the difficulties they experience while caring for dying patient.

Models of care with advanced practice nurses in the emergency department: A scoping review

INTRODUCTION

Emergency departments play a critical role in healthcare systems internationally. Visits for emergency care continue to increase, related to poor access to primary care, the COVID-19 pandemic, and health human resource issues. International literature shows similar stressors in the emergency department. Extended wait times to see health providers lead to poor outcomes, and innovative models of care are needed to address emergency department overcrowding and to meet the needs of patients. Advanced practice nurses have the expertise and scope of practice to optimize and address primary and acute care needs and could be further integrated into the emergency healthcare systems. It is unclear what and how advanced practice nurses are functioning in emergency departments to improve patient and organization outcomes.

METHODS

This scoping review was a comprehensive search of MEDLINE, EMCARE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and gray literature. Authors developed inclusion and exclusion criteria, performed title and abstract screening, and full text screening using review software. Data about models of care with advanced practice nurses were extracted and organized to understand patient, provider, and organizational outcomes. We also extracted information about the development and implementation of roles.

RESULTS

Of the 6780 records identified, 76 met inclusion criteria. Emergency department models of care, mainly using nurse practitioners, include fast-track, generalized emergency, minor injury, orthopedics, pediatrics, geriatrics, specific populations, and triage. Reported patient outcomes include improvement in key metrics specific to emergency departments, such as total length of stay, wait times to be seen by a provider, left without being seen rates, treatment for pain, costs, and resource use. When comparing nurse practitioners to other providers, outcomes were similar or better for patient and organizational outcomes.

DISCUSSION

Various models of care utilizing advanced practice nurses in emergency departments are present internationally and information about how they are developed, integrated, and utilized provides practical information to support and sustain new roles. There is an opportunity to expand the use of these roles into emergency departments as the nurse practitioner scope of practice grows. Given the current crisis across healthcare systems, there is need for innovation, and improving delivery of emergency services with these advanced practice nursing models of care can help to address important health policy priorities in Canada and other countries.

TWEETABLE ABSTRACT

Advanced Practice Nurse models of care in emergency - Improved outcomes for patients and organizations - A review of the literature. @SamanthaH_RN.

Non-medical practitioners in the staffing of emergency departments and urgent treatment centres in England: a mixed qualitative methods study of policy implementation

BACKGROUND

Patient demand, internationally, on emergency departments and urgent care treatment centres has grown. Shortages of staff, particularly of emergency medicine doctors, have compounded problems. Some countries are pursuing solutions of including non-medical practitioners e.g., nurse practitioners and physician associates/assistants in their emergency department workforces. This study investigated at the macro and meso level of the health system in England: what the rationale was and the factors influencing the current and future employment, or otherwise, of non-medical practitioners in emergency departments and urgent treatment centres.

METHODS

Mixed qualitative methods in the interpretative tradition were employed. We undertook, in 2021-2022, a documentary analysis of national, regional and subregional policy (2017-2021), followed by semi-structured interviews of a purposive sample (n = 18) of stakeholders from national, regional and subregional levels. The data were thematically analysed and then synthesised.

RESULTS

There was general national policy support for increasing the presence of non-medical practitioners as part of the solution to shortages of emergency medicine doctors. However, evidence of policy support dissipated at regional and subregional levels. There were no published numbers for non-medical practitioners in emergency departments, but stakeholders suggested they were relatively small in number, unevenly distributed and faced uncertain growth. While the experience of the COVID-19 pandemic and its aftermath were said to have made senior decision makers more receptive to workforce innovation, many factors contributed to the uncertain growth. These factors included: limited evidence on the relative advantage of including non-medical practitioners; variation in the models of service being pursued to address patient demand on emergency departments and the place of non-medical practitioners within them; the lack of a national workforce plan with clear directives; and the variation in training for non-medical practitioner roles, combined with the lack of regulation of that level of practice.

CONCLUSIONS

We identified many features of a system ready to introduce non-medical practitioners in emergency departments and urgent treatment centres but there were uncertainties and the potential for conflict with other professional groups. One area of uncertainty was evidence of relative advantage in including non-medical practitioners in staffing. This requires urgent attention to inform decision making for short- and long-term workforce planning. Further investigation is required to consider whether these findings are generalisable to other specialties, and to similar health systems in other countries.

A survey of nurse practitioner perceptions of integration into acute care organisations across one region in Ireland

Aim

The purpose of the study was to explore nurse practitioner perceptions of integration practices in acute hospitals across one health care region in Ireland.

Background

A recent Department of Health National policy towards developing a critical mass of nurse practitioners was implemented across Ireland. Successful integration of nurse practitioner roles is integral to the success of the service and sustainability of the roles for the long term.

Method

An electronic survey was circulated to a convenience sample of 85 nurse practitioners across a single, acute health care region in Ireland.

Results

Sixty‐six (78%) of nurse practitioners participated. A standardized governance structure was reported by 24 (36%) participants. Thirty‐two (48%) participants expressed their job description clearly defined their role. Consultant physicians were identified as the most supportive stakeholder by participants.

Conclusions

This research identifies that nurse practitioner integration is not currently structured. A framework to support nurse practitioner integration is required to ensure ongoing support for the role. This research identifies that integration is not currently optimized.

Implications for Nursing Management

Failure to successfully integrate the nurse practitioner role risks the long‐term sustainability of the role and is a missed opportunity to demonstrate the success of advanced clinical leadership to health care.

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.

Core competencies of clinical nurse specialists: A comparison across three Nordic countries

AIM

To describe and compare the clinical nurse specialist core competency use in Finland, Denmark and Iceland.

BACKGROUND

Clinical nurse specialist roles were first developed more than 60 years ago in the United States. Within the Nordic countries, the clinical nurse specialist role emerged around 2000. There is scarcity of clinical nurse specialist competency descriptions outside of North America, and research has been limited to examine or validate established competencies across different countries.

DESIGN

A descriptive correlational study.

METHODS

An online survey was conducted from May to September 2019. A population sample of clinical nurse specialists in Finland, Denmark and Iceland was recruited. A validated self-report questionnaire of clinical nurse specialist competencies was used. The data were analysed using descriptive and inferential statistics, and the STROBE checklist was used as the reporting guideline.

RESULTS

A total sample of 184 clinical nurse specialists, 52 from Finland, 95 from Denmark and 37 from Iceland, participated in the study (response rate = 72%, 35% and 48%, respectively). Overall, clinical nurse specialists utilised the organisational competency most frequently followed by the patient, clinical nursing leadership and scholarship competency. Univariate analysis of variance test between-country effects showed statistically significant difference in patient competency (p = .000) and in organisational competency (p < .05). There were no statistically significant differences between counties in the utilisation of clinical nursing leadership and scholarship competency.

CONCLUSION

A small variability was found in the comparison of the clinical nurse specialist use of core competency in the spheres of patient, nursing, organisation and scholarship within three Nordic countries.

RELEVANCE TO CLINICAL PRACTICE

The CNS competency scale may be utilised in benchmarking clinical nurse specialist roles and practice within and across countries. The long-term goal for the competency descriptions is to enhance the clinical nurse specialist role clarity, integration and evaluation as well as inform post-graduate education.

'The Lynchpin of the Acute Stroke Service'-An envisioning of the scope and role of the advanced nurse practitioner in stroke care in a qualitative study

BACKGROUND

Stroke prevalence is rising internationally. Advanced practice nursing is established across many jurisdictions; however, its contribution to stroke services is under research.

AIM

To gain insights into the future scope and role of future advanced nurse practitioners in stroke care from the perspectives of key stakeholders.

DESIGN

A qualitative descriptive approach.

METHODS

Interviews were conducted in 2019 with a purposive sample of 18 participants, comprising stroke nurses, stroke unit managers, stroke survivors and their family carers, recruited in one UK healthcare trust. The research is reported in line with COREQ. Data were analysed in accordance with an inductive content analysis approach.

RESULTS

The abstraction process generated four main themes. These were 'The lynchpin of the acute stroke service', 'An expert in stroke care', 'Person and family focussed' and 'Preparation for the role'.

CONCLUSION

These findings offer new perspectives on the potential scope and role of advanced nurse practitioners in stroke service delivery. Further research should focus on how to address the challenges confronted by advanced nurse practitioners when endeavouring to engage in autonomous clinical decision-making.

IMPACT

Study findings may advance postregistration education curricula, clinical supervision models and research directions.

RELEVANCE TO CLINICAL PRACTICE

There is support for the implementation of advanced practice nursing in the hyperacute and acute stroke phases of the care pathway. An interprofessional model of clinical supervision has potential to support the developing advanced nurse practitioner in autonomous clinical decision-making.

Evidence-informed policymaking: Modelling nurses' career pathway from registered nurse to advanced practice nurse

AIM

To formulate, validate, and disseminate policy, modelling nurses' career pathway from registered to advanced practice nurse.

METHOD

The evidence-informed policy and practice pathway framework was utilized. Multiple methods were used, including scoping review of literature, consultation of key informants, survey study, and expert group round-table discussions during 5-year project between 2013 and 2018.

RESULTS

Through (a) sourcing, (b) using, and (c) implementing the evidence, the expert group worked systematically to formulate a policy on a career pathway from registered to advanced practice nurse. The formulated career pathway includes three competence levels: registered nurse, specialized nurse, and advanced practice nurse, which includes the roles of nurse practitioner and clinical nurse specialist. In addition, validation and dissemination of the policy, as well as its effective implementation and the process of integrating it into practice, were examined.

CONCLUSION

Evidence-informed policymaking is an effective, interactive way to work collaboratively in achieving consensus and translating knowledge into practice. The formulated policy will contribute to the increased awareness, acknowledgement, and implementation of the registered nurses' traditional and new roles within health care environments. Implementing and integrating the policy in national health care policy, legislation, education, and organizations across the country is a work in progress.

'Thinking outside the box': advanced geriatric nursing in primary health care in Scandinavia

Background

Older people are frequent users of primary health care (PHC) services. PHC services have been critiqued, mainly regarding limited accessibility and continuity of care. In many countries, investment in nurse practitioners (NPs) has been one strategy to improve PHC services. In the North of Europe, the NP role is still in its infancy. The aim of this study was to explore the feasibility of introducing geriatric nurse practitioners (GNPs) in PHC in Scandinavia, from multiprofessional and older persons’ perspectives.

Methods

The study had a qualitative design, including 25 semi-structured interviews with nurses, nurse leaders, physicians, politicians and older persons from several communities in Scandinavia. The material was analysed by means of qualitative content analysis.

Results

The results highlight current challenges in health services for the older population, i.e. comorbid older patients with complex care needs aging in place, lack of competent staff, and organisational challenges. The results present an envisioned GNP scope of practice in health services for the older population, including bringing advanced competence closer to the patient, an autonomous role including task-shifting, and a linking role. The results also present factors influencing implementation of the GNP role, i.e. GNP competence level, unclear role and scope of practice, and openness to reorganisation.

Conclusions

The results indicate that it is feasible to implement the GNP role in primary health care in Scandinavia. Notwithstanding, there are factors influencing implementation of the GNP role that should be considered.

Electronic supplementary material

The online version of this article (10.1186/s12912-019-0350-2) contains supplementary material, which is available to authorized users.