Tertiary Nurse Practitioners

Tertiary nurse practitioners are proposed to meet the specialized health care needs of complex patients. Societal changes, increasing numbers of medically vulnerable people and increased costs of health care demand innovative responses to health care delivery. Nurse practitioners' effectiveness in primary care settings supports their introduction into acute care settings. Nurse practitioners are involved in tertiary care in response to a need for the delivery of care to patients with specialized needs. The evolution of the tertiary nurse practitioner role pre-dated the response of educational institutions to provide appropriate preparation for practitioners in tertiary care. Curricular imperatives and policy issues that will influence professional practice of the tertiary nurse practitioner are discussed .     

Nurse practitioner's capability

Nurse practitioner development affirms the social value of nursing staff and promotes the professional image of nursing. As the medical environment and doctor-patient relations change, how should a nurse practitioner carry out clinical care? Apart from having foundations in medical knowledge and high-quality nursing techniques, nurse practitioners must have other clinical skills, in order to break out of their former difficult position, promote nursing competitiveness, provide a multi -dimensional service, win the people's acclamation and develop international links.     

Mental health nurse practitioners in Australia: improving access to quality mental health care

Under The Nurses Amendment (Nurse Practitioners) Act 1998, New South Wales became the first state in Australia to legislate for nurse practitioners. Mental health was identified as a priority 'area of practice' for nurse practitioners. Issues surrounding the implementation of the nurse practitioner role in Australia and the potential for the role to address the current crisis in mental health nursing and the mental health sector will be discussed. The potential for partnerships with other health-care providers, in particular medical practitioners, will demonstrate how successful implementation of the role can fulfil consumer demand for primary prevention counselling, improve access to mental health services and early intervention, and provide mental health services that better reflect national priorities. This examination of the Australian context will be contrasted with a review of the overseas literature on mental health nurse practitioners.     

Nurse practitioners substituting for general practitioners: randomized controlled trial

Title.  Nurse practitioners substituting for general practitioners: randomized controlled trial.
Aim.  This paper is a report of a study conducted to evaluate process and outcomes of care provided to patients with common complaints by general practitioners or specially trained nurse practitioners as first point of contact.
Background.  Studies in the United States of America and Great Britain show that substituting nurse practitioners for general practitioners results in higher patient satisfaction and higher quality of care. As the American and British healthcare system and settings differ from that in the Netherlands, a Dutch trial was conducted.
Methods.  A total of 1501 patients in 15 general practices were randomized to consultation by a general practitioner or a nurse practitioner. Data were collected over a 6-month period in 2006 by means of questionnaires, extracting medical records from practice computer systems and recording the length of consultations.
Findings.  In both groups, the patients highly appreciated the quality of care. No statistically significant differences were found in health status, medical resource consumption and compliance of practical guidelines in primary care in the Netherlands. Patients in the NP intervention group were more often invited to re-attend, had more follow-up consultations and their consultations took statistically significantly longer.
Conclusion.  Nurse practitioners and general practitioners provide comparable care. Our findings support an increased involvement of specially trained nurse practitioners in the Dutch primary care and contribute to knowledge of the effectiveness of care provision by nurse practitioners from a national and international perspective.     

Effective collaboration: the key to better healthcare

Timely access to primary healthcare is becoming increasingly difficult for many Canadians. In a healthcare system created for managing acute illness and communicable disease, the complex care that millions of Canadians with chronic illnesses require is not being appropriately managed. The answer is not more healthcare dollars; it's better use of the funding already allocated. The key to delivering accessible, comprehensive and cost-effective care is effective collaboration among health professionals. The nurse practitioner role offers a unique skill set, incorporating health promotion and disease prevention into primary healthcare, complementing the roles of a variety of other health professionals. In spite of increasing interest and commitment to collaboration, numerous barriers remain. Perceived competition, leadership struggles and confusion about the role have hindered collaboration between nurse practitioners and physicians. Increased interest in interprofessional education has given rise to improved awareness and respect for the knowledge of other disciplines, raising hopes that fostering interdisciplinary working relationships will result in better client care. Nurse practitioners must take the lead in increasing the visibility of their role, improving public understanding and fostering collaborative relationships with other health professionals in order to provide the most effective care for Canadians.     

Private practice part 1, setting up and starting a new business

Nurse Practitioners are experts in clinical care, but most are novices when it comes to business, marketing, financial management and working outside mainstream healthcare settings. However, these skills are essential for nurse practitioners who want to grow, innovate and work in independent practice.Within current nurse practitioner degrees there is little focus on business studies. As a result, individual nurse practitioners have to try and work things out for themselves or seek out peers     

Ambulatory care centers: a unique opportunity for nurse practitioners

Nurse practitioners continue to struggle to find avenues for professional fulfillment. Urgent care or ambulatory care centers (ACCs) may, because of their need to respond to consumer demands for more comprehensive services, offer nurse practitioners a unique opportunity to establish productive primary care practices based on the concepts of total patient care. A model for such a practice has operated successfully since 1983, establishing that both professional and business success can result from the collaborative efforts of nurse practitioners and physicians in an ACC setting.     

Nurse practitioners and physicians: patients' perceived health and satisfaction with care

The advent of managed care has created changes in the health care environment and nurse practitioners have found a need to evaluate their care. Perceived health and patient satisfaction were measured in a multiethnic sample of 160 clinic patients, ages 18 to 89, in a managed care setting. Results of the Medical Outcomes Study SF-20 and the Nurse Practitioner Satisfaction Instrument indicated no statistically significant difference in perceived health and satisfaction with care, whether the care was given by a nurse practitioner or a primary care physician. The findings warrant further study and may mean that nurse practitioners placed in managed care environments can be expected to perform as effectively as they have in non-managed care environments.     

2001 Fellows off the American Academy off Nurse Practitioners

The Fellows of the American Academy of Nurse Practitioners (FAANP) Program has been established by the Academy to recognize nurse practitioners who have made outstanding contributions to health care practice, research, education or policy and to facilitate leadership in the nurse practitioner profession. Priority initiatives of FAANP are the development of leadership and mentorship programs for nurse practitioners. In addition, a yearly Think Tank is held to discuss the future of nurse practitioners and health care outside the confines of traditional thinking.
The American Academy of Nurse Practitioners is pleased to present the 2001 Fellows. The 16 new Fellows were inducted at the Academy National Conference in Orlando on June 28, 2001.     

Nurse practitioner: reflecting on the future

The role of the nurse practitioner was first conceptualized in the late 1960s. Today, there are approximately 70,000 nurse practitioners in practice, they receive third-party insurance reimbursements, and they are in many specialty practices, as well as working in primary care practices promoting health and disease prevention. In the future, economics will shape our health care industry, placing a greater demand for nurse practitioners in this trillion-dollar marketplace. This article explores the evolving role of the nurse practitioner in education, practice, and research to meet the challenges of the health care needs into the 21st century.     

A nurse practitioner model of practice in the neonatal intensive care unit

PURPOSE: The purpose of this study was to describe the practice of the nurse practitioner (NP) in the neonatal intensive care unit (NICU) in an attempt to define an advanced practice nursing model that is unique to NP practice in the NICU. DESIGN: This qualitative research used an ethnographic case study design to answer the research question: 'What is the practice model of nurse practitioners working in the NICU?' METHODS: Seven nurse practitioners working in five level II/III NICUs in Massachusetts and Rhode Island were interviewed and observed in practice. Audiotaped interviews using open-ended questions and field notes from participant observations were analyzed for patterns of behavior. RESULTS: These nurse practitioners practiced within a model of advanced practice nursing that emphasized health, holism, and caring within the highly technological and medical NICU environment. CLINICAL IMPLICATIONS: A model of NP practice in the NICU is emerging and needs further development and testing. Nurse educators and administrators must find ways to support the nursing model in the advanced practice nursing role in the NICU. Nurse practitioners need to be more active in promoting a clearer understanding of their practice and contributions to the NICU care delivery team.     

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 costs of training a nurse practitioner in primary care: the importance of allowing for the cost of education and training when making decisions about changing the professional-mix

What is already known on this topic * Cost containment through the most effective mix of staff achievable within available resources and organisational priorities is of increasing importance in most health systems. However, there is a dearth of information about the full economic implications of changing skill mix. * In the UK a major shift in the primary care workforce is likely in response to the rapidly developing role of nurse practitioners and policies aimed to encourage GP practices to transfer some of their responsibilities to other, less costly, professionals. * Previous research has developed an approach to incorporating the costs of qualifications, and thus the investment required to develop a skilled workforce, for a variety of health service professionals including GPs. What this study adds * This paper describes a methodology of costing nurse practitioners that incorporates the human capital cost implications of developing a skilled nurse practitioner workforce. With appropriate sources of data the method could be adapted for use internationally. * Including the full cost of qualifications results in nearly a 24 per cent increase in the unit cost of a Nurse Practitioner. * Allowing for all investment costs and adjusting for length of consultation, the cost of a GP consultation was nearly 60 per cent higher than that of a Nurse Practitioner.     

Who wants to work in geriatrics: Findings from a national survey of physicians and nurse practitioners

BackgroundAs the United States population is aging, there is a chronic shortage of geriatrics- and gerontology- trained clinicians despite a variety of incentives. With primary care clinicians also in short supply, health systems are trying to cope with the increasing demand for care for older adultsPurposeThe purpose of this study was to examine respondents' willingness to recommend their career to others and beliefs about changes necessary to enhance the supply of appropriately prepared cliniciansMethodsThis study used a national survey of a stratified sample of 276 physicians and 134 nurse practitioners working in primary care and geriatric practices.FindingsAmong nurse practitioner respondents, 29% would "definitely" recommend a career as a geriatrician vs. seventeen percent of physicians; thirteen percent of physicians would "definitely" recommend a career as a nurse practitioner specializing in adult/gerontology vs. 42% for nurse practitioners. Those trained in geriatrics were more likely to recommend a career in the field.DiscussionNurse practitioners and physicians differ in their willingness to recommend careers in in gerontology and geriatrics, but less than a majority would strongly recommend careers in either specialty. Based on clinical reports, substantial reforms in payment and reimbursement for services may be necessary to bolster the geriatric field's attractiveness, and better prepare the workforce to care for older adults.     

Population Aging: Implications for Nurse Practitioners

Population aging has occurred as a result of increased longevity throughout the lifespan coupled with declining birth rates. In the practice arena this demographic shift will increase the need for health services focused on chronic disease, comorbid status, and the unique health promotion for older adults. Nurse practitioner programs and continuing education providers must strengthen content on geriatrics and chronic disease management. Research on health care needs and care outcomes of older adults must increase. Nurse practitioners can best position themselves for this demographic shift by increasing their knowledge about health care needs of older adults.