Delineating advanced practice nursing in New Zealand: a national survey

Background

A variety of advanced practice nursing roles and titles have proliferated in response to the changing demands of a population characterized by increasing age and chronic illness. Whilst similarly identified as advanced practice roles, they do not share a common practice profile, educational requirements or legislative direction. The lack of clarity limits comparative research that can inform policy and health service planning.

Aims

To identify advanced practice roles within nursing titles employed in New Zealand and practice differences between advanced practice and other roles.

Method

Replicating recent Australian research, 3255 registered nurses/nurse practitioners in New Zealand completed the amended Advanced Practice Delineation survey tool. The mean domain scores of the predominant advanced practice position were compared with those of other positions. Differences between groups were explored using one‐way ANOVA and post hoc between group comparisons.

Results

Four nursing position bands were identified: nurse practitioner, clinical nurse specialist, domain‐specific and registered nurse. Significant differences between the bands were found on many domain scores. The nurse practitioner and clinical nurse specialist bands had the most similar practice profiles, nurse practitioners being more involved in direct care and professional leadership.

Conclusions

Similar to the position of clinical nurse consultant in Australia, those practicing as clinical nurse specialists were deemed to reflect the threshold for advanced practice nursing. The results identified different practice patterns for the identified bands and distinguish the advanced practice nursing roles.

Implications for nursing policy

By replicating the Australian study of Gardener et al. (2016), this NZ paper extends the international data available to support more evidence‐based nursing workforce planning and policy development.     

The first evaluation of the advanced practice nurse role in Finland - the perspective of nurse leaders

fagerström l. & glasberg a.-l. (2011) Journal of Nursing Management 19, 925–932 The first evaluation of the advanced practice nurse role in Finland – the perspective of nurse leaders Aims The aim of this study is to explore and describe nurse leaders’ (NLs) experiences of the role of advanced practice nurses (APNs). Background The first group of advanced practice nurses (17) in Finland graduated in 2006 and were thereafter employed by seven different organizations in more or less clearly defined advanced practice nurses roles. Methods Seven nurse leaders at the relevant organizations were interviewed a year after the introduction of the advanced practice nurses role. Content analysis was used to analyze the data. Results All of the nurse leaders emphasized the importance of the advanced practice nurses role in their organization. The advanced practice nurses’ scope of practice comprised a more autonomous and independent role than registered nurses. Advanced practice nurses are an important resource in the care of patients with chronic diseases and acute health problems. An important aspect regarding support for the advanced practice nurses role is the provision of information to all health-care personnel and patients about the role and clearly defined areas of responsibility. Conclusions Advanced practice nurses are an important resource in the development of evidence-based nursing and improve the availability of health-care services for patients. Implications for nursing management Nurse leaders are responsible for creating sustainable structures and the prerequisites needed for advanced practice nursing through the formation of supportive organizational systems.     

Bridging Cultures for Latino Children: School Nurse and Advanced Practice Nurse Partnerships

TOPIC:  Barriers to use of mental health services by Latino families include stigma, service costs, and disparity of services with cultural values and traditions. School nurses are in key positions to recognize mental health needs of Latino children and form relationships that facilitate family connections with mental health services. Advanced practice psychiatric nurses may be contracted by school districts to provide consultation to school nurses or may be available to school nurses through connections with school-based health centers. Case examples are provided to illustrate the value of school nurse consultation with an advanced practice psychiatric nurse in promoting awareness of cultural influences on children's symptoms and behaviors and developing culturally sensitive approaches to engage Latino children and families in school and health services.
PURPOSE:  This paper aims to review literature on Latino mental health and present rationale for school nurse and advanced practice nurse partnerships to promote culturally sensitive approaches that facilitate Latino family access and utilization of health services.
SOURCES:  Published literature and case scenarios.
CONCLUSIONS:  With advanced practice nurse consultation, school nurses identify mental health needs of Latino children and develop culturally sensitive approaches that bridge Latino families' access to and utilization of health services.     

The role and scope of the clinical nurse consultant in Wentworth area health service, New South Wales, Australia

Aims  This paper reports phase one of a two-part study in a New South Wales area health service, which aimed to evaluate the grading system for clinical nurse consultants.
Background  Since its inception in 1986, the role and scope of practice of clinical nurse consultants in New South Wales has been viewed with differing expectations leading to role conflict from the nurse consultants themselves and others in health care including managers and other clinicians.
Method  A quantitative approach was used for this study. A survey comprising of open and closed questions was mailed to all clinical nurse consultants ( n  = 42) employed in the area.
Results  The data presented suggest that ambiguity continues about the role, the scope and the differences within the grading system of clinical nurse consultants.
Conclusions  Clinical nurse consultants need leadership training and support from their managers to fulfil their role. More work is required to clarify the role of clinical nurse consultants.     

Advanced nursing practice: policy, education and role development

Aims and objectives. This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. Background. The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. Conclusion. The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. Relevance to clinical practice. In a rapidly changing people‐centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.     

Advanced practice nursing: A principle-based concept analysis

Purpose: To analyze and clarify the conceptual basis of advanced practice nursing to determine the state of the knowledge from the perspective of four overarching principles derived from the philosophy of science: epistemological, pragmatic, linguistic, and logical.
Data sources: Written discourse regarding advanced practice nursing from refereed journals published between 2000 and 2007.
Conclusions: Conceptualization of a core definition of advanced practice nursing will enhance external legitimacy and recognition; understanding advanced practice nurse (APN) roles, sub-roles, and competencies will enhance internal cohesion. The outcome of this concept analysis is a greater understanding of the conceptual basis of advanced practice nursing and a current best estimate of the probable truth surrounding advanced practice nursing.
Implications for practice: A greater understanding of the conceptual basis of advanced practice nursing will help to gain clarity, internal cohesion, external legitimacy, and acceptance of APN roles by society and other healthcare professions.     

Advanced practice nurses' scope of practice: a qualitative study of advanced clinical competencies

Scand J Caring Sci; 2011; 25; 661–670 Advanced practice nurses’ scope of practice: a qualitative study of advanced clinical competencies Aim To describe and explore Advanced Practice Nurses’ clinical competencies and how these are expressed in clinical practice. Background Discussion concerning advanced clinical practice has been ongoing in the USA since the 1960s and in the UK since the late 1980s. Approximately 24 countries, excluding the USA, have implemented the role of Advance Practice Nurse (APN). In the Nordic countries, especially Sweden and Finland, APNs have been introduced in some organizations but their competency domains have not yet been clearly defined. Theoretical framework The study’s theoretical framework emanates from Aristotle’s three‐dimensional view of knowledge that is epistêmê, technê, and phronesis. Methods Between October 2005 and January 2006, focus group interviews of Clinical Nurse Specialists who provide expert functions in pediatric, internal medicine, and surgical units (n = 26) and APN students (n = 8) were conducted. The data material was analyzed using inductive content analysis. Findings Grouped into five main themes, the study results indicate that APNs possess advanced level clinical competencies in: (A) assessment of patients’ caring needs and nursing care activities, (B) the caring relationship, (C) multi‐professional teamwork, (D) development of competence and nursing care, and (E) leadership in a learning and caring culture. Conclusion Clinical competencies consist of advanced skills, which typify an expanding role that offers new possibilities for holistic patient care practice. APNs’ scope of practice is characterized by responsibility and competence in making autonomous judgments based on expanded clinical competence. On an advanced level, clinical competence consists not merely of advanced skills for assessing and meeting the needs of patients but also the creation of safe and trustful relationships with patients and collaboration with colleagues. APNs can realize advanced skills in their actions through their manner of knowing, doing, and being.     

An evaluation of nursing development in a community NHS Trust

Aim   This study sets out to evaluate the contribution of the Nursing Development Officer (NDO) on nursing developments within a local UK NHS Trust.
Background   Qualified nursing staff are an essential, although expensive resource and it is suggested that the contribution of professional employees should be continually assessed and developed in order to ensure that they are meeting the aims of the organization. Consequently a significant amount of resources has been focussed on the development of this staff group.
Method   Following a review of the literature the researcher collected two sets of data. Firstly quantitative data via a questionnaire from fieldstaff, and secondly qualitative data from semi-structured interviews with the nurse managers. Data were analysed manually by the researcher.
Findings   The main theme to emerge was the potential scope of the NDO role within the organization. The NDO was frequently consulted by nursing staff for advice and help, particularly for information on courses. Managers identified a range of themes which were the personal qualities of the NDO, the scope of service provided by the NDO, the qualities of the training and development department, the needs of nurses within the Trust and, finally, a range of corporate and external issues which impact on nursing development.
Conclusions   This study has evaluated the contribution of the NDO on nursing development and further highlighted the complementary systems that are necessary to enhance nursing within a healthcare organization.     

The role of inter-professional relationships and support for nurse prescribing in acute and chronic pain

Title.  The role of inter-professional relationships and support for nurse prescribing in acute and chronic pain.
Aim.  This paper is a report of a study to explore nurse prescribers' views on the role of inter-professional relationships and other means of support for nurse prescribing for patients in acute and chronic pain.
Background.  Research indicates that good team relationships are important for supporting nurse prescribing but that poor understanding of the role by other healthcare professionals can act as a barrier. While collaborative working is central to the role of pain nurses, there is a lack of research on the impact of nurse prescribing on inter-professional working or the support needs of these nurses.
Method.  A qualitative approach was adopted using thematic analysis of semi-structured interview data collected during 2006 and 2007. Participants were 26 nurses who prescribed medicines for patients with acute and/or chronic pain.
Findings.  Nurses' believed that prescribing encouraged collaborative working and sharing of knowledge across professional boundaries and that this helped to broaden understanding of the wider remit of pain management. Collaboration with doctors served a number of functions, including support and continuous learning. Barriers to effective nurse prescribing were a lack of understanding of its role amongst healthcare professionals and inadequate support. Formal support structures, such as regular clinical supervision, were seen as crucial to meeting nurses' ongoing learning.
Conclusion.  Factors that promote understanding of nurse prescribing and support inter-professional relationships are likely to have a positive impact on the effectiveness of nurse prescribing. A more consistent approach is required within organisations to support nurse prescribing.     

Nurse prescribing in dermatology: doctors' and non-prescribing nurses' views

Title.  Nurse prescribing in dermatology: doctors' and non-prescribing nurses' views.
Aim.  This paper is a report of a study conducted to explore doctor and non-prescribing nurse views about nurse prescribing in the light of their experience in dermatology.
Background.  The cooperation of healthcare professionals and peers is of key importance in enabling and supporting nurse prescribing. Lack of understanding of and opposition to nurse prescribing are known barriers to its implementation. Given the important role they play, it is necessary to consider how the recent expansion of nurse prescribing rights in England impacts on the views of healthcare professionals.
Method.  Interviews with 12 doctors and six non-prescribing nurses were conducted in 10 case study sites across England between 2006 and 2007. Participants all worked with nurses who prescribed for patients with dermatological conditions in secondary or primary care. Thematic analysis was conducted on the interview data.
Results.  Participants were positive about their experiences of nurse prescribing having witnessed benefits from it, but had reservations about nurse prescribing in general. Acceptance was conditional upon the nurses' level of experience, awareness of their own limitations and the context in which they prescribed. Fears that nurses would prescribe beyond their level of competence were expected to reduce as understanding and experience of nurse prescribing increased.
Conclusion.  Indications are that nurse prescribing can be acceptable to doctors and nurses so long as it operates within recommended parameters. Greater promotion and assessment of standards and criteria are recommended to improve understanding and acceptance of nurse prescribing.     

Primary care nurse practitioners and the interface with secondary care: a qualitative study of referral practice

In the United Kingdom nurse practitioners are assuming responsibilities traditionally considered to be within the domain of general practitioners. Important amongst these is the referral of patients to medical consultants in secondary care, a responsibility commonly associated with the general practitioner's role as 'gatekeeper' to health care. This paper describes a study designed to identify issues raised by the challenge that a developing nursing role presents to interprofessional working at the interface between primary and secondary care. When invited to comment, study participants (nurse practitioners, nurse educators, medical consultants and general practice registrars) related nursing referrals to issues associated with professional boundary changes, namely: teamwork, regulation of practice, communication, professional conflict and professional relationships. This paper discusses the views of primary and secondary care practitioners about who should take responsibility for the referral of patients in the light of concerns raised about professional competence and accountability. Individual nurse practitioners and their colleagues have found pragmatic ways to manage their work however, although UK government policy supports development of advanced clinical nursing, there remains much work to be done to provide the professional and legal infrastructure to support the role.     

专科护士的使用与管理

目的:总结该院专科护士的临床使用情况,探讨专科护士的科学使用方法,为临床更科学、有效地使用专科护士提供依据。方法:对该院38名专科护士的临床工作进行研究分析,并对专科护士的核心能力进行调查。结果:2010年该院专科护士开设护理门诊2个,组织与落实护理教学42例,撰写护理论文64篇,举办继续教育学习班15期,担任科室护理组长31人,制定专项技术指南6本,举办门诊义务健康教育12次。与普通护士相比,专科护士的核心能力提高显著。结论:专科护士制度是学科建设发展的方向,专科护士的临床使用要明确定位,专科护士的发展要循序渐进,逐步完善。     

Nurse migration: the effects on nursing education

This paper is an opinion piece based on experience and supported where possible with literature, which addresses an issue of both national and international interest. It focuses on one aspect of the multifaceted social phenomenon of nurse migration, i.e. nurse education.
Background:  Much has been written about the direct effects of nurse migration on the nurse migrant, the delivery of health care in the countries that supply the nurses, and the countries that receive them. However, there is little information regarding the direct effects of migration on nurse education within the literature.
Aim:  The aim of this paper is to raise awareness of the positive and negative effects of nurse migration on nurse education both in the countries that supply nurses and those which receive them.
Methods:  Both scholarly and 'grey' literature is used to support the discussion on the 'real' challenges faced by nurse educators and clinical nurses in those countries that supply or receive nurses. In addition, practical recommendations for nurse educators are presented. Furthermore, the nursing profession is challenged to become politically active, to become involved and to take responsibility for the decisions made about nurse education in order to protect the integrity of nurse education and patient safety.
Conclusion:  The quality of nurse education in many countries has been undermined as a result of rapid, mass migration. There is an urgent need to take practical steps to maintain the integrity of nurse education and the nurse's preparation for practice in order to protect patients' safety.     

The development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand

ABSTRACT:  This paper reports the three-stage development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. In Study 1, clinical indicator statements ( n  = 99) generated from focus group data, which were considered to be unobservable in the nursing documentation in consumer case notes, were included in a three-round Delphi process. Consensus of ratings occurred for the mental health nurse and academic participants ( n  = 7) on 83 clinical indicator statements. In Study 2, the clinical indicator statements ( n  = 67) that met importance and consensus criteria were incorporated into a questionnaire, which was piloted at a New Zealand mental health service. The questionnaire was then modified for use in a national field study. In Study 3, the national field study, registered mental health nurses ( n  = 422) from 11 New Zealand District Health Board mental health services completed the questionnaire. Five categories of nursing practice were identified: professional and evidence-based practice; consumer focus and reflective practice; professional development and integration; ethically and legally safe practice; and culturally safe practice. Analyses revealed little difference in the perceptions of nurses from different backgrounds regarding the regularity of the nursing practices. Further research is needed to calibrate the scores on each clinical indicator statement with behaviour in clinical practice.     

Care of patients with chronic obstructive pulmonary disease in primary health care

Aim.  This paper is a report of a study of nurses' perceptions of caring for patients with chronic obstructive pulmonary disease.
Background.  Chronic obstructive pulmonary disease is a global health problem and the number of patients being treated with this disease in primary healthcare settings is increasing. This places new demands on the nurses involved.
Method.  A phenomenographic approach was adopted, using a purposive sample. Data were generated between February and May 2003 from 20 interviews with district nurses and general nurses who cared for patients in primary healthcare settings with chronic obstructive pulmonary disease.
Findings.  In most cases, nurses cared for older people with moderate to severe chronic obstructive pulmonary disease. They described this care from two overall orientations: task and individual. The nurses' perceptions of the care of these patients were described as creating commitment and participation by establishing a good relationship with patients and supporting them in their personal care, educating patients by supplying information and knowledge in various ways, co-operation by co-operating with or referring to other caregivers, and arranging and implementing clinical examinations and treatments.
Conclusion.  The type of care depended on who the patient met: either a task-oriented nurse or an individual-oriented nurse. Therefore, nursing programmes should pay special attention to the support and guidance of new and inexperienced and task-oriented nurses. Healthcare planners should take into consideration the need for individualized care when organizing care and allocating resources for chronically ill people.     

Nurse practitioners' perceptions and participation in pharmaceutical marketing

Title.  Nurse practitioners' perceptions and participation in pharmaceutical marketing.
Aim.  This paper reports on a study conducted to describe family nurse practitioners' perceptions towards and participation in pharmaceutical marketing and to explore the relationships among related variables.
Background.  The pharmaceutical industry's intense global marketing strategies have resulted in widespread concern in healthcare professionals and professional groups, sectors of the public in many countries, and in the World Health Organization. Research on healthcare providers' participation in pharmaceutical marketing indicates that these relationships are conflicts of interests and compromise healthcare providers' prescribing practices and trust. Nursing, as a discipline, appears to be slow to address the impact of pharmaceutical marketing on nursing practice.
Method.  Questionnaires about perceptions and participation in pharmaceutical marketing were completed by a random sample of 84 licensed family nurse practitioners in the United States of America in 2007.
Findings.  Family nurse practitioners viewed pharmaceutical company marketing uncritically as educational and beneficial. They also perceived other providers but not themselves as influenced by pharmaceutical marketing. The findings supported those found in previous research with nurses and physicians.
Conclusion.  Lack of education, participation in marketing and psychological and social responses may impede family nurse practitioners' ability to respond critically and appropriately to marketing strategies and the conflict of interest it creates.