Defining the scope of practice of the emergency nurse practitioner role in a metropolitan emergency department

This study examined the emergency nurse practitioner candidate (ENPC) scope of practice in a Victorian emergency department (ED). The emergency nurse practitioner (ENP) role is relatively new in Victoria and the scope of the ENP(C) practice is yet to be defined. International research literature regarding the ENP role has focused on outcomes such as patient satisfaction, waiting times and/or ED length of stay, accuracy and adequacy of documentation, use of radiography, and patient education, health promotion and communication issues. A prospective exploratory design was used to conduct this cohort study. There were 476 ENPC-managed patients between 14 July 2004 and 31 March 2005 with an average age of 29 years. The majority (77.2%) of ENPC-managed patients were discharged from the ED. The majority of the ENPC time was devoted to clinical practice (55%) and development of clinical practice guidelines (25%). Of patients managed by the ENPC, 49.6% required medications, 51% required diagnostic imaging and 8.6% required pathology testing during their ED stay. The most common discharge referrals were made to local medical officers (73.5%) and the most common referrals made for patients requiring admission were made to the plastic surgery (37.3%) and orthopaedic (35.5%) units. Extensions to the current scope of emergency nursing practice are pivotal to effective management of specific patient groups by ENP. The ENP model of care is an important strategy for the management of increased service demands in Victoria; however, little is known about the scope of the ENPC practice and many outcomes of the ENP care are yet to be defined. Further research to better understand the relationships between ENP outcomes is required if the contribution that ENPs make to emergency care is to be accurately quantified.     

EverCare nurse practitioner practice activities: similarities and differences across five sites

PURPOSE: To examine the similarities and differences in the performance and frequency of performance of EverCare nurse practitioner (NP) practice activities at demonstration sites in five states. This study builds upon a previous study in which the development and testing of the EverCare Nurse Practitioner Role and Activity Scale (ENPRAS) was conducted. DATA SOURCES: A Background Data Sheet and the ENPRAS, a 99-item tool that encompasses six role subscales-Collaborator, Clinician, Care Manager/Coordinator, Counselor, Communicator/Cheerleader, and Coach/Educator, were completed by 127 EverCare NPs at demonstration sites in five states (Georgia, Maryland, Massachusetts, Colorado, and Florida). CONCLUSIONS: Performance of NP activities across the demonstration sites in five states was generally consistent, with significant differences only in the amount of time spent on activities associated with the Collaborator and Coach/Educator roles. Overall, EverCare NPs spent more time on Clinician and Communicator/Cheerleader role activities than on activities associated with the other roles. EverCare NP patient caseload was positively related to frequency of performance of the Clinician and Care Manager/Coordinator roles. IMPLICATIONS FOR PRACTICE: EverCare NPs provide proactive primary care to long-stay nursing home residents. The observed consistency reflects a strong centrally directed practice model. The identified roles and activities of the EverCare NP are consistent with previous studies and reports focused on the roles and activities of NPs who provide care to nursing home residents in other models of care delivery. Policy makers, healthcare providers, and the public should take these findings into account when considering a national model of care for this population. Future studies should examine the effect of variations in performance of activities on resident-specific and setting-specific outcomes.     

Reconceptualizing the core of nurse practitioner education and practice

Purpose: The movement to the doctor of nursing practice (DNP) is progressing rapidly with new programs emerging and curricular documents being developed. We argue that the implementation of the DNP is a good move for nursing, provided that we use the opportunity to reconceptualize the core of advanced practice nursing, especially nurse practitioner (NP) practice.
Data sources: Theory and research articles from nursing focused on advanced practice nursing, NPs, and doctoral education.
Conclusions: The foundation of NP education is currently based essentially on borrowed or shared content in assessment, pharmacology, and pathophysiology. We argue that the heart and soul of nursing is in health promotion, both in healthy persons and in those dealing with chronic illness. Current master's programs do not prepare NPs to assume high-level practice focused on health promotion and disease management using the latest theoretical developments in health behavior change, behavioral sciences, exercise physiology, nutrition, and medical anthropology. Although these are touched upon in most NP programs, they do not represent the core science of NP education and need to be a critical part of any DNP program.
Implications for practice: Ultimately, our vision is for NP care to be consistently "different," yet just as essential as physician care, leading to positive outcomes in health promotion and disease management.     

Legislative issues impacting on the practice of the South African nurse practitioner

PURPOSE: To present an overview of the impact of the nurse practitioner (NP) on the South African health care arena and describe the legislative framework for NP practice. DATA SOURCES: Statutes and laws of the government of South Africa; published professional guidelines; authors' experiences. CONCLUSIONS: The key challenges for NPs in South Africa lie in lobbying for enabling legislation, obtaining access to education and training opportunities, and managing risks within the rapidly changing environment. IMPLICATIONS FOR PRACTICE: Some aspects of the NP's accountability and responsibilities have as yet not been adequately addressed in the current legislative framework and will certainly increase the risk for malpractice. South African NPs will have to establish partnerships with important role players, not only in South Africa, but also internationally, to ensure that an enabling environment for quality health services is created.     

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.     

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.     

Advancing the clinical perspective: a practice development project to develop the nurse practitioner role in an acute hospital trust

Aims. The aims of this project were to investigate awareness and foster understanding of the concept of the nurse practitioner and to facilitate and support the development of nurse practitioner roles within an acute hospital trust. Background. A limited understanding of and minimal support for the development of the Nurse Practitioner (NP) role were identified within an acute hospital trust in the south of England. This was the impetus for pursuing the project outlined in this paper. Theoretical perspective. The project used practice development theory synonymously with action research methodology comprising of four action research cycles. Method. Data were collected in a variety of ways within the four overlapping cycles using formal and informal methods, which were analysed concurrently during the project. Techniques included questionnaires, semi‐structured interviews, meetings, discussions and the project leader's field notes’ diary. Outcomes. A better understanding of the concept and support for NP posts were enhanced across the trust. A Nurse Practitioner Development Group (NPDG) was established, which helped to facilitate the development of NP posts. An example of such a post was established within a NP‐led gynaecology pre‐operative assessment clinic, which was a pilot project and constituted Action Research cycle 3. Conclusion. It is concluded that the development of NP roles, with the support of a NPDG, within an agreed strategy offers a robust process for NP development within an acute hospital setting. Relevance to clinical practice. This project demonstrated how practice development and action research might be used together as a systematic process for developing and supporting professional roles that aim to improve the quality of patient care and the effectiveness of health care services.     

试论护理实践范围的界定

讨论了界定护理实践范围的重要性，介绍和比较了一些国家和地区从事护理工作各层次人员的实践范围，对护理实践范围的界定与描述、护士工作内容。提出明确界定护理实践范围有利于保护人民健康的利益，规范和保护护士依法执业，规范对护士工作内容和责任的界定，促进护理专业和学科的发展，使护理专业适应社会发展的要求，为人民健康事业提供高质量的护理服务。     

Praxis and the role development of the acute care nurse practitioner

Acute care nurse practitioner roles have been introduced in many countries. The acute care nurse practitioner provides nursing and medical care to meet the complex needs of patients and their families using a holistic, health-centred approach. There are many pressures to adopt a performance framework and execute activities and tasks. Little time may be left to explore domains of advanced practice nursing and develop other forms of knowledge. The primary objective of praxis is to integrate theory, practice and art, and facilitate the recognition and valuing of different types of knowledge through reflection. With this framework, the acute care nurse practitioner assumes the role of clinician and researcher. Praxis can be used to develop the acute care nurse practitioner role as an advanced practice nursing role. A praxis framework permeates all aspects of the acute care nurse practitioner's practice. Praxis influences how relationships are structured with patients, families and colleagues in the work setting. Decision-makers at different levels need to recognize the contribution of praxis in the full development of the acute care nurse practitioner role. Different strategies can be used by educators to assist students and practitioners to develop a praxis framework.     

Progression of the mental health nurse practitioner role in Australia

The guiding principle of health care is to serve the needs of the public. Healthcare services are therefore required to be increasingly flexible and open to new approaches to meet changing demands. They must also adjust and expand as new challenges are presented. Public awareness of mental health issues and the current demands placed on health services for access to affordable and appropriate mental health care have never been so great. The introduction of nurse practitioners (NPs) in Australia is a proud and long-anticipated moment for the discipline of nursing. However, a major challenge for the introduction of NPs in Australia will be to reassure medical colleagues, allied health professionals and the public that NPs are able to deliver high-quality primary care. This paper elaborates on the progress of the mental health NP role in Australia. Attention is centred on the characteristics the mental health NP role, the maintenance of professional competency to practise at an advanced clinical level, and the prospects and potential significance of NPs for mental health nursing practice. The nurse-led clinic, implemented through the process of consultation and systematic evaluation, is identified as an avenue for the extension of mental health NP practice in the delivery of autonomous primary care.     

The impact of nurse practitioner regulations on population access to care

Background

By 2025, experts estimate a significant shortage of primary care providers in the United States, and expansion of the nurse practitioner (NP) workforce may reduce this burden. However, barriers imposed by state NP regulations could reduce access to primary care.

An evaluation of a community aged care nurse practitioner service

Evaluation aims. An evaluation is presented that aimed to augment current understandings of the nurse practitioner role by investigating potential outcomes of a community aged care nurse practitioner (ACNP) service on clients and the health care team. Background. In Australia, the nurse practitioner role is being implemented in a variety of health care settings and is characterized by extended practice: prescribing of medications, requests for diagnostic investigations, referral to medical specialists and admitting clients to inpatient facilities. Design. An exploratory qualitative evaluation method through data collection by interview and thematic analysis was undertaken. Method. All clients referred to the ACNP service between June and August 2003, and a convenience sample of health professionals, were invited to participate in individual semi‐structured interviews. Results. Findings suggested that an ACNP could provide a high quality of holistic nursing care and positively affect clients’ physical and psychological symptom management, enhance clients’ quality of life, assist with supplies, provide health education and assist with advocacy. Health professionals commented on effective collaboration with the ACNP service during their partnerships in client care provision. Conclusions. Overall, the positive effects of the ACNP service on clients and the health care team support the full implementation of the role within the community setting. Relevance to clinical practice. Funding support for the nurse practitioner role is a vital addition to consideration in the development of international policy on advanced practice nursing. Without adequate funding, the full benefits of the nurse practitioner role in clinical practice, as suggested by the findings presented in this evaluation, will be compromised.     

The scope of private practice nursing in an Australian sample

The changing Australian health care system is creating new opportunities for nurses who work directly with clients in private practice settings. This study examines the scope of practice of a cohort of nurses in private practice. In a questionnaire sent to 106 self-employed nurse entrepreneurs, questions were asked pertaining to the participants' scope of practice, their clients, the types of services offered, and their fee structures. Questions about scope of practice were divided into domains of clinical practice, business consultancy, education, and research. Quantitative and qualitative data were collected for a final sample 54 eligible responses. Participants had been in private practice for an average of 7.6 years (range: 1-20) and reported a mean of 21 years of nursing experience (range: 4-42) before entering private practice. Over half held diplomas in specialty areas. Most participants reported clinical practice, consultancy, or education as the primary work domain; research was much less important as a work activity. Nurses reported difficulties with building client base and receiving adequate fees for service, particularly in clinical practice. Increasing awareness within the nursing profession and health sector about various aspects of private practice nursing could improve service quality for their clients.     

Setting or Patient Care Needs: Which Defines Advanced Practice Registered Nurse Scope of Practice?

The purpose of this article is to provide insight into the roles and population focus of both the family nurse practitioner and the adult gerontology/acute care nurse practitioner. The article looks at problems that seem to be increasing in prevalence in terms of who should be taking care of primary care patients and who should be taking care of acute care patients. Solutions are offered that could keep both types of practitioners out of the sphere of litigation.