A qualitative study on the roles and responsibilities of nurse consultants in Hong Kong

This study aims to explore the roles and responsibilities of seven newly appointed nurse consultants (NCs) in various clinical specialties in Hong Kong as a pioneer project. Qualitative approaches using direct observation and semi‐structured interviews were adopted with two full‐day observations on the seven NCs plus 56 semi‐structured interviews of NCs, nurses, doctors and patients. Five major NCs’ roles and responsibilities had been identified, namely providing expert practice, initiating service development, leading education, guiding continuous quality improvement (CQI) and conducting research and providing evidence‐based practice. The seven NCs within this study have by and large achieved building professional excellence, respect and trust within their own spheres. It is strongly recommended that the NC post be formally established in the new Nurses Career Structure to enable expert clinical nurses to develop a clinical career to contribute to service and patient care to its maximum.     

An emergency department-based mental health nurse practitioner outpatient service: part 2, staff evaluation

The nurse practitioner role incorporates enhancing access to health-care services, particularly for populations that are underserved. This entails working collaboratively with colleagues across multidisciplinary teams and emphasizing a nursing model of practice within the nurse practitioner role. In Australia, the added value associated with establishing mental health nurse practitioner (MHNP) positions based in the emergency department (ED) is emerging. This paper presents qualitative findings from a study using a mixed-method design to evaluate an ED-based MHNP outpatient service in Sydney, Australia. One component of the evaluation involved semistructured interviews conducted with a random selection of study participants and a stratified sample of ED staff. This is the second of a two-part paper that presents an analysis of the qualitative data derived from the staff interviews (n = 20). Emergency staff were very supportive of the outpatient service, and perceived that it enhanced overall service provision and improved outcomes for patients. Moreover, staff expressed interest in receiving more formal feedback on the outcomes of the service. Staff also felt that service provision would be enhanced through additional mental health liaison nurses working in the department, especially after hours. An ED-based MHNP outpatient service expedites access to follow up to individuals with a broad range of problems, and supports ED staff in the provision of safe, effective, and more holistic care.     

The nurse navigator: Broker,boundary spanner and problem solver

BackgroundThe Queensland Health nurse navigator service is an innovative model that has recently emerged as a way of bridging gaps in care and supporting care coordination for patients with highly complex care needs. The translation of key principles into practice, and how nurse navigators operationalise their role in the care of individual patients in a highly complex health system while engaging a diverse team of health care providers, requires further understanding.AimTo explore how nurse navigators in Queensland operationalise their novel roles.MethodsThis was a qualitative study involving in-depth interviews with three nurse navigators. To explore interprofessional relationships and modes of operation, an exploratory multiple-case study design was used to produce illustrative case examples of practice.FindingsThree main modes of operation were identified and illustrated: the boundary spanner, the problem solver, and the broker. These modes of operation offer important insight into the practices and experiences of nurse navigators.DiscussionThe ‘problem solver’ demonstrates capacity to instigate system improvements, using patient advocacy as a mechanism for broader systems initiatives. The ‘boundary spanner’ exemplifies how nurse navigators can transcend traditional health system boundaries and build networks across nonhealth settings. The ‘broker’ illustrates the nurse navigator's relational role in forging partnerships with patients, across stakeholders in patient care, and across settings (and beyond the health sector).ConclusionThese case examples are demonstrative of how nurse navigators operate across a continuum, delivering holistic and individualised care.     

The Leadership Role of Nurse Educators in Mental Health Nursing

Leadership behaviors and actions influence others to act, and leadership in clinical practice is an important mediator influencing patient outcomes and staff satisfaction. Indeed, positive clinical leadership has been positioned as a crucial element for transformation of health care services and has led to the development of the Practice Doctorate Movement in the United States. Nurse educators in health care have a vital leadership role as clinical experts, role models, mentors, change agents, and supporters of quality projects. By enacting these leadership attributes, nurse educators ensure a skilled and confident workforce that is focused on optimizing opportunities for students and graduates to integrate theory and practice in the workplace as well as developing more holistic models of care for the consumer. Nurse educators need to be active in supporting staff and students in health care environments and be visible leaders who can drive policy and practice changes and engage in professional forums, research, and scholarship. Although nurse educators have always been a feature of the nursing workplace, there is a paucity of literature on the role of nurse educators as clinical leaders. This discursive article describes the role and attributes of nurse educators with a focus on their role as leaders in mental health nursing. We argue that embracing the leadership role is fundamental to nurse educators and to influencing consumer-focused care in mental health. We also make recommendations for developing the leadership role of nurse educators and provide considerations for further research such as examining the impact of clinical leaders on client, staff, and organizational outcomes.     

Role development and effective practice in specialist and advanced practice roles in acute hospital settings: systematic review and meta-synthesis

AIMS: This paper reports a study whose aim was to identify and synthesize qualitative research studies reporting barriers or facilitators to role development and/or effective practice in specialist and advanced nursing roles in acute hospital settings. BACKGROUND: The number of clinical nurse specialist, nurse practitioner, advanced nurse practitioner and consultant nurse roles has grown substantially in recent years. Research has shown that nurses working in innovative roles encounter a range of barriers and facilitators to effective practice. METHODS: Systematic literature searches were undertaken, and relevant studies identified using specific inclusion and exclusion criteria. The selected studies were appraised, and their findings synthesized using Ritchie and Spencer's 'Framework' approach. RESULTS: Fourteen relevant studies were identified, mostly from the UK. They described a range of barriers and facilitators affecting specialist and advanced nursing practice. These related to the practitioner's personal characteristics and previous experience, professional and educational issues, managerial and organizational issues, relationships with other health care professionals, and resources. The factors most widely identified as important were relationships with other key personnel, and role definitions and expectations. CONCLUSIONS: Relationships with other staff groups and role ambiguity are the most important factors which hinder or facilitate the implementation of specialist and advanced nursing roles. These factors seem interlinked, and the associated problems do not appear to resolve spontaneously when staff become familiar with the new roles. In order to reduce role ambiguity and the consequent likelihood of negative responses we recommend that, when specialist and advanced nursing roles are introduced, clear role definitions and objectives are developed and communicated to relevant staff groups; these definitions and objectives should be updated as necessary.     

Psychiatric-mental health head nurse management concerns

Psychiatric-mental health head nurses supervise and direct patient care, and therefore, possess a critical, front-line perspective of nursing practice problems. This article explores this perspective by interviewing four head nurses about patient care, staffing, and organizational management concerns. Interestingly, some of the findings of the study, such as head nurse concerns regarding retaining, recruiting, and motivating staff, and increasing patient acuity, already have been supported in the general nursing literature. Other concerns, including the need to clarify the role of the nurse and to define areas of responsibility with other mental health professionals, seem unique to mental health nursing.     

Reporting a research project on the potential of aged care nurse practitioners in the Australian Capital Territory

Aim. This paper reports a project investigating the potential role of the nurse practitioner in aged care across residential, community and acute care venues in the Australian Capital Territory. Background. Australia, like many other countries, faces unprecedented challenges in the provision of health care. Escalating health care costs, an ageing population, increasing prevalence of comorbidities and chronic illnesses, inefficient health care delivery, changing models of health care and shifting professional role boundaries are factors that have contributed to the development of advanced practice roles for nursing. Design. This was a mixed methods study using multiple data sources. Methods. Student aged care nurse practitioners were examined across the continuum of care in the acute, community and residential aged care settings. The potential role of the nurse practitioner in these areas was evaluated qualitatively and quantitatively to identify a model of care to enhance the delivery of efficient and effective health care. Results. The project findings have demonstrated that there is potential for significant improvement in client outcomes arising from a transboundary aged care nurse practitioner model. The improved outcomes are associated with a decrease in acute hospital admissions for residential care clients, timely intervention for a range of common conditions and strengthened multidisciplinary approaches to care provision for older people. Conclusions. Overall the project findings strongly support the potential of a transboundary aged care nurse practitioner role. This role would focus on skilled assessment, timely assessment and intervention, brokering around access to care and clinical leadership and education for nurses. Relevance to clinical practice. This paper offers further evidence of support for the role of nurse practitioners in complementing existing health services and improving delivery of care.     

An interpretive study of the nurse teacher's role in practice placement areas

The role of the nurse teacher in the clinical area is widely debated in the literature, however there are few research studies that focus exclusively on this issue. Of note is the particular dearth of research from a Scottish perspective. This article reports on a research study which was designed to illuminate nurse teachers' experiences regarding their role in the practice placement area. An interpretive research approach was used in order to gain an understanding of the role of the nurse teacher in the clinical area.The study involved 18 nurse teachers, from three nursing departments across Scotland, taking part in focus group interviews. Five main themes are reported in this article: being an advisor, being a supporter, being a regulator, being an interpreter and being a networker. Findings from the study revealed that the nurse teachers have a multifaceted role which includes providing advice and support to trained staff and students, regulating professional standards, interpreting assessment documentation and networking with clinical staff.     

Acute coronary syndrome nurses: perceptions of other members of the health care team

Acute coronary syndromes (ACS) are a major health care problem and result in a large number of hospital admissions each year. Nurses across the NHS are being empowered to undertake a growing range of responsibilities but little research evidence exists related to the impact on patient care nor working practice with other health professionals. This paper reports part of the evaluation of a British Heart Foundation pilot project to place an 'ACS nurse' in participating hospitals. In each of 5 hospitals, 100 staff across accident and emergency, general medicine and cardiac specialities were sent a questionnaire. The response rate was 33%. Respondents felt that the ACS nurse role was beneficial to patient care and had little overlap with existing roles within the hospital. Support for nurse initiated thrombolysis was high, but comments reflected the on-going debate around accountability and training. Communication and problem solving were identified as key elements of the ACS nurse role. Findings in this study show support for the integration of an ACS nurse role as a way to provide improved care to ACS patients.     

Relationship of RN role responsibilities to job satisfaction.

This study tested a delivery of care model that maximizes the role of the registered nurse in rehabilitation by providing care based on the scope of practice exclusive to the registered nurse and supplementing that practice with licensed and non-licensed support personnel. The model of care was developed as a response to the nursing shortage. The model attempts to best utilize the limited resource of registered nurse staffing. The nursing shortage is a national and global public health problem that is expected to intensify as the nursing population ages. The hypothesis was that when the rehabilitation registered nurse is allowed to function in areas for which they are exclusively trained, job satisfaction will significantly improve as long as there is sufficient support staff to provide for non-essential functions. The conceptual model for the study is based on Donabedian's model which demonstrates the relationship between satisfaction and patient outcomes. Results indicated that after an initial stage of discomfort resulting from a change in role expectations nurse satisfaction improved when registered nurses functioned within their exclusive scope of practice.     

Practice nursing in rural Australia

Rural Australia faces unique issues in workforce management and health care delivery. This paper provides an integrated review of the existing literature describing the work of practice nurses in rural Australia and the perceptions of consumers. Distinct differences are evident in the role of the practice nurse between rural and metropolitan practices. A key difference is that the rural practice nurse is known within the community and plays an important role in care coordination. Findings from two studies of consumer perceptions of the role of PN in rural areas suggest that the more remotely located the consumer, the greater is their perception that the nurse works under the direct supervision of the doctor. Currently, remotely located residents do not support an expanded autonomous role for the nurse. Greater research is required to develop the role of the practice nurse in rural Australia.     

Nursing work in Jordan: an example of nursing work in the Middle East

Aim. The study aimed to investigate Jordanian nurses’ perceptions of their role in clinical practice. Background. The lack of regulation of nursing practice by the profession across the Middle East until now has led to each institution setting its own policies regarding the role of the nurse and the practice of nursing. No study to date has examined the role of the nurse working in the acute hospital environment nor explored the practice of nursing in this region. Design and methods. A cross‐sectional questionnaire survey was conducted using a quota sample. A total of 348 medical‐surgical staff nurses and practical nurses from the three healthcare sectors in Jordan participated in the study with a response rate of 77%. The results were analysed by constructing multiple response tables, chi‐square test, anova and log‐linear analysis. Results. Staff nurses in Jordan were expected to carry out the majority of nursing care activities. The role of the practical nurse was limited to the physical and professional domains of nursing care. Activities requiring higher levels of emotional or intellectual labour and interdisciplinary communication were attributed only to the staff nurse. The majority of the respondents reported nursing had not been their first choice of career. Male nurses had a higher intention to leave the nursing profession. The predominant method of care delivery used by nurses was task‐oriented. Conclusion. There was a general consensus regarding what constituted the nurse's work in the clinical area across the three healthcare sectors in Jordan. Role delineation between the two levels of nurses was also clear. There is a need to move from task‐oriented to patient‐centred care to promote quality patient care. Relevance to clinical practice. This study explores the role of the nurse working in the acute hospital environment in Jordan.     

Public health and nursing practice: seizing the receptive moment

Both nursing and government policy indicate the crucial role that all nurses have in the public health arena and yet it would seem that the role of the nurse in general within public health is open to debate and criticism. The author has a responsibility for the development of public health across the undergraduate curriculum within a university. This paper presents a discussion of some of the issues raised from student nurses, nurse lecturers and nurse managers. These discussions are as a result of both a 5 year PhD study undertaken by the author and a revalidation the undergraduate nursing programme within the author's organisation. The aim of the paper being to consider what is needed to put public health at the core of all and every nurse's practice across the UK. It takes the approach of lessons learned as it discusses some of the changes made to the author's own organisations undergraduate nurse curriculum, and those changes which still need to happen in order for nursing to identify its public health capacity. Such changes it may be suggested are easily transferable across all UK nursing curricula.     

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.     

Clinical integration and nursing leadership across an integrated delivery system

As new health systems struggle to combine in today's challenging health care market, mechanisms that facilitate and enhance integration become increasingly important. This article describes the use of clinical paths in an integrated delivery system (IDS) as a methodology to establish a single standard of high-quality care. Through education and sharing of staff development resources across the IDS, the system nurse executive at one large IDS promotes professional practice. As clinical paths are developed across the system, the best clinical practice is put to paper, providing a framework for outcome-driven care. The nurse manager assesses staff's use of clinical paths as an evaluation of their skills and competency and to identify new educational and growth opportunities.     

Nurses as practice change facilitators for healthy behaviors

This study used nurses as practice change consultants to help primary care medical practices improve their delivery of health behavior services to patients. Nurse consultants worked with 20 practices from 2 healthcare systems. In each practice, the nurses helped clinicians and staff to develop a practice-specific protocol so that they could identify and intervene with the health behavior of their patients. As a result of the nurse consultant intervention, health behavior delivery was improved. This article describes the specific methods and the lessons learned through this study. We encourage practices to use nurse consultants as one way of improving quality of care.     

Oral Health–Related Knowledge,Attitudes, and Practice Patterns of Nurse Practitioners: A Mixed Methods Study

This mixed methods study explored the oral health–related knowledge, attitudes, and practice patterns of nurse practitioners (NPs) in Canada. The survey was sent to all NPs across Canada (N = 4,540); 153 respondents (3.4% response rate) completed the online survey, and 4 respondents were subsequently selected to participate in qualitative, semistructured interviews. NPs believe that they have a role in oral health care and are motivated to include oral health into their practice. However, a lack of knowledge and skills, likely caused by gaps in education and training, is limiting their ability to do so with confidence.