The mental health nurse practitioner in the emergency department: an Australian experience

This paper describes the establishment of a mental health nurse practitioner (MHNP) position in New South Wales, Australia. The authors report on a MHNP role that functions collaboratively within a large inner city emergency department. Attention is centred on what constitutes advanced mental health nursing practice in the emergency department setting. Three areas associated with the work of MHNPs--therapeutic techniques, prescribing and care coordination and referral--are highlighted to explore the scope of the MHNP role. The authors propose that the success of this position is based on a process of consultation and evaluation, partnership between disciplines and clinical services and the role maintaining a truly nursing focus rather than attempting to replace or replicate psychiatric medicine.     

A trial of nurse practitioner scope of practice

AIMS: The aim of this paper is to report a trial to investigate the feasibility of the nurse practitioner role in local health service delivery and to provide information about the educational and legislative requirements for nurse practitioner practice. BACKGROUND: Nurse practitioners have been shown to offer a beneficial service and fill a gap in health care provision. However, the lack of publications describing, critiquing, or defending the way that existing nurse practitioner roles have been developed may lead to a lack of clarity in comparing the nurse practitioner scope of practice internationally. In Australia, credible exploratory research is needed to realize the potential of nurse practitioners to bridge the divide of inequitable distribution of health services. A trial of nurse practitioner services in the Australian Capital Territory provided an excellent opportunity to investigate these scope and continuity issues. METHODS: This was an observational analytic study using multiple data sources. Four models of nurse practitioner service were chosen from a competitive field of applications that were evaluated according to efficacy, feasibility, and sustainability across specified selection criteria. Each model in the trial included a clinical support team, with the nurse practitioner candidate 'working-into-the-role' and collecting demographic, clinical practice, patient outcome, and health service and consumer survey data over a 10 month period. FINDINGS: The trial identified the broad potential of the nurse practitioner role, its breadth and limitations, and its impact on selected health services in the Australian Capital Territory. Data from individual models were compared highlighting generic elements, and formed the basis for the development of the scope of practice for the Australian Capital Territory nurse practitioner models. CONCLUSIONS: This study has validated a research-based, iterative process for initial development of nurse practitioner scope of practice for any Australian specialization. Importantly, the study concluded with the scope of practice as a finding, rather than commencing with it a priori. Although general areas of health care need and under-servicing were identified at the outset, the process tested both the expansion and parameters of the roles.     

The emergency nurse practitioner role in major accident and emergency departments: professional issues and the research agenda

The emergency nurse practitioner (ENP) is a rapidly developing role within emergency health care provision in the United Kingdom (UK). This paper explores some of the available literature concerning the development of the role in the context of major accident and emergency departments. The professional and legal implications of this shift in role boundaries are discussed. The current inconsistencies in educational provision and the potential consequences for practice in this area, are highlighted. The relative plethora of rigorous evaluation studies of ENP role effectiveness in North America, is contrasted with the current paucity of empirical data available in the UK. A number of methodological issues concerning the evaluation of ENP services are identified. The need for research in this area, alongside a programme of continuing local audit to guide and inform evidence-based practice, is emphasized.     

A confirmatory factor analysis of the novice nurse practitioner role transition scale

As interest in supporting new nurse practitioners' (NPs) transition to practice increases, those interested in measuring the concept will need an instrument with evidence of reliability and validity. The Novice NP Role Transition (NNPRT) Scale is the first instrument to measure the concept. The preliminary exploratory factor analysis revealed a five-factor structure: organizational alignment, mentorship, sense of purpose, perceived competence and self-confidence, and compensation. Using a cross-sectional design and data from 210 novice NPs, the purpose of this study was to confirm the NNPRT Scale's internal factor structure via confirmatory factor analysis (CFA). The sample was primarily female (97.5%), White (75.9%), and certified in primary care (53.5%). The CFA confirmed the five-factor structure, and model fit was improved by moving and omitting items (χ²[619] = 1277.799, p < 0.001; Root Mean Square Error of Approximation = 0.071 [0.066−0.077]). The final NNPRT Scale includes 37-items, and internal consistency reliability was calculated at 0.95. Convergent validity evidence was supported by a positive, significant correlation with receiving a formal orientation in the first NP position; a negative, significant correlation with turnover intention; and a lack of a relationship with years of prior registered nurse experience. The NNPRT Scale is an instrument with sound evidence of reliability and validity. The NNPRT Scale will be useful for researchers, administrators, and clinicians looking to explore factors that affect NNPRT, as well as by clinicians and administrators implementing programs to support novice NPs' transition to practice.     

The role of the triage nurse practitioner in general medical practice: an analysis of the role

A 2-year pilot study was undertaken in a group general practice to evaluate the nurse practitioner triage role. The study was undertaken in several stages which included a patient satisfaction questionnaire survey, follow-up interviews with 30 patients from the questionnaire survey, and analysis of the nurse practitioner's work at different points over the 2-year study period. This paper describes the work of the nurse practitioner in comparison with that of seven general practitioners in a group general medical practice over a 5-day period in February 1996 and included patients' perceptions of their consultation. In this particular group medical practice, as in others throughout the country, many patients request same day appointments, often for self-limiting conditions, social advice and health education. This study demonstrates that the nurse practitioner can deal with such patients effectively and is undertaking an expanded and extended role in order to provide an holistic service to patients with which they are highly satisfied. It can be concluded that given the right kind of education and training and a supportive framework within the practice, the nurse practitioner undertaking a triage role can provide a highly effective service to patients and is a valuable member of the primary health care team.     

The evolution of the neonatal nurse practitioner role in Australia: A discussion paper

AimThe neonatal nurse practitioner role originated in the 1960's in the Unites States from a short fall in physicians. This occurred because of changes in medical training which reduced time in specialist areas and in conjunction, the demand for neonatal care increased due to the survival of premature babies and advances in specialised care. The aim of this review is to identify the discrepancies between roles and responsibilities, highlight the challenges NNP face and explore possible role development opportunities to make the position sustainable.MethodCurrent review of the literature (MESH TERMS – neonatal and/or nurse practitioner, Australia) revealed fourteen published articles and government documents identifying requirements for endorsement and standards for nurse practitioner practice.ResultNeonatal nurse practitioners spend most of their time delivering direct patient care regardless of the clinical setting, however elements of research, education and leadership are still incorporated within clinical practice. Alongside the clinical role, antenatal counselling, facilitation of communication amongst the multidisciplinary team and parents, prescribing, ordering diagnostic tests have all became core components to define the scope of the NNP. However, as the role has expanded NNP must adapt to changes to continue to be recognised as a valuable member of the multidisciplinary team especially as registered nurses start to take on extended roles.ConclusionThe senior clinical role of the neonatal nurse practitioner continues to evolve. There are challenges to be overcome, however there are now more than thirty neonatal nurse practitioners in Australia and together the possibilities for expansion of their role are limitless. This can only be of benefit to our babies, their families and the nursing profession.     

The role of computer-assisted simulation in nurse practitioner education

PURPOSE: To develop a better understanding of the role of computer-assisted simulations (CAS) in nurse practitioner (NP) education by observing 4 pairs of students complete a CAS case. DATA SOURCES: Qualitative observational study of 8 students performing in a computer laboratory and a series of post-observation interviews. Observations were recorded, refined, coded, and quantified based on the theoretical framework of ecological psychology. CONCLUSIONS: Each pair of students established their own "personalities" for the completion of the task. Misinterpretation of information was common and the absence of a live patient interaction affected the reasoning process of the students. The students demonstrated the ability to develop a perspective on the case based on previous nursing experience. Students generally obtained adequate data on which to base differential/final diagnoses. Observations provided information regarding strengths and weaknesses of students and methods used to solve scenarios. IMPLICATIONS FOR PRACTICE: All students agreed that the CAS scenarios were realistic, useful learning experiences, and that the knowledge gained would be transferable to real clinical situations. Such experiences provide useful experience with terminology, sequencing of the examination, and decision-making.     

The pleasure of your company: attitudes and opinions of preceptors toward nurse practitioner preceptees

PURPOSE: To survey the attitudes and opinions of preceptors about their experiences with nurse practitioner students. DATA SOURCES: Original research using a mailed questionnaire designed by the researchers to 196 physician and nurse practitioner preceptors (23% response rate). CONCLUSIONS: Preceptors desired faculty support and feedback, wanted involvement in shaping the curriculum, and had strong opinions about the precepting experience. IMPLICATIONS FOR PRACTICE: The attitudes and opinions of preceptors are extremely important to the availability of a qualified and motivated pool of preceptors, the clinical growth of the students, the quality of the student's learning experience, and the survival of nurse practitioner programs.     

An action research project to develop and evaluate the role of an advanced nurse practitioner in dementia

Summary

• ? This paper outlines the first phase of a project to generate and evaluate the role of an advanced nurse practitioner inductively from first principles.
• ? The role was developed by interviewing a wide range of health-care professionals, carers and patients.
• ? The resulting role is responsive to perceived need at grassroots level rather than to the needs of managers with no clinical experience.
• ? Although the role might not be generalizable to other settings, the method can be applied to any role in any clinical area.

     

Patients' assessments of consulting a nurse practitioner: the time factor

AIM: This paper reports a study exploring patients' views about consulting with a primary care nurse practitioner. BACKGROUND: United Kingdom based randomized controlled trials comparing the work of doctors and nurse practitioners add considerable weight to the view that patients tend to be more satisfied with primary care nurse practitioner consultations. However, there is a need for qualitative research to explore issues raised by the trials. METHODS: A judgement sample of 10 patients consulting with a primary care nurse practitioner was drawn. In-depth interviews were conducted and analysed thematically. The data were collected in 2000-2001. FINDINGS: The following themes were identified in the data: time spent in the consultation; and time as a commodity in patients' lives. Time matters to patients when they consult on their health, whether it is time to discuss problems or time saved as a result of having issues resolved, thus minimizing further visits. Factors associated with the style and emphasis of consultations are also important. CONCLUSIONS: Understanding the relationship between time, and style and emphasis of consultation may help to explain patients' satisfaction with primary care nurse practitioners.     

Hospital‐based nurse practitioner roles and interprofessional practice: A scoping review

This scoping review provides current global understanding of the rapidly evolving nurse practitioner role within hospital settings, and considers the level of understanding of its enactment within interprofessional teamwork. Arksey and O'Malley's framework was used to explore recent primary research, reviews, and gray literature in two ways. First, hospital‐based nurse practitioner literature was mapped to country of origin, and thematically summarized. Second, clearly developed and consistently defined key interprofessional concepts were identified in the interprofessional literature then conceptually mapped to the nurse practitioner studies by their operationalization. The nurse practitioner review located 103 abstracts. Twenty‐nine, originating from four countries, met the inclusion criteria. The interprofessional concept review identified a total of 137 relevant abstracts, however, only ten met the inclusion criteria. Understanding the nurse practitioner role within hospital teams remains limited due to a small number of countries producing evidence, the lack of nurse practitioner role title standardization hindering consistent knowledgebase development, and limited application and inconsistent operationalization of concepts within nurse practitioner research. Research focused on role enactment is needed to understand the uniqueness of the hospital‐based nurse practitioner role.     

Strategies to promote the professional transition of new graduate nurse practitioners: A systematic review

New graduate nurse practitioner (NP) postgraduate support programs and interventions have proliferated, sparking controversy. The Institute of Medicine/National Academy of Medicine recommends residency programs for new graduate NPs; however, the NP community debates whether new graduate NPs need additional training and whether such training compromises patient access to care. This systematic review aimed to synthesize evidence regarding the effectiveness of interventions and strategies to promote the professional transition of new graduate NPs. Interventions identified in the current literature included fellowship programs and a webinar. Strategies included mentorship, experiential learning, interprofessional training, and professional socialization. The studies reviewed primarily evaluated NPs’ perceptions of the interventions’ effects on their professional transitions. The findings from this systematic review highlight challenges in evidencing postgraduate support programs. The small number of available studies underscores a critical problem for the NP community: additional evidence is needed to inform whether and how to support new graduate NPs as they transition to practice.