The triumph and continuing struggle of nurse practitioners in New South Wales,Australia

Finally nurse practitioners in New South Wales, Australia, are legally recognized after more than a decade of struggle. In this article the authors provide an update on the nurse practitioner movement, including the continuing conflict with the medical profession as nursing strives to achieve full implementation and acceptance of the nurse practitioner role in New South Wales. Discussion includes nurse practitioner role legislation and authorization process. The issues and concerns expressed by the medical and nursing professions are outlined, and the authors make recommendations to strengthen and support the advanced professional role and status of nurse practitioners.     

Faculty mentorship: support for nurse practitioner students and staff within the rural community health setting

As pointed out in the introduction, there are certain practical concepts within our base of nursing knowledge that can only be taught through experience. Many things are easier to teach by example. As we turn back the clock in nursing, we can see how Florence Nightingale, Clara Barton, and Lillian Wald were role models to their nursing peers in their era. They taught nursing by example, by role modeling their clinical expertise. Today, this model is still effective and faculty mentoring of nurse practitioner students and CHNs in a compassionate and collegial leadership results in higher quality of health care for our nation's needy clients and their families. But greater yet are the opportunities for flexible nurse practitioner faculty practice and personal interactions on many levels for nursing faculty who wish to share their expertise. Mentorship by nurse practitioner faculty for nurse practitioner students and CHNs in a rural clinical setting has revealed many positive aspects in providing quality care for rural clients and growth for nurses. Exposure to the rural community health system helps us, as nurses, to identify the many strengths it possesses for innovative rural nursing practice.     

Standardized patient experiences: evaluation of clinical performance and nurse practitioner student satisfaction

Standardized Patients (people trained to accurately portray a specific patient) have been widely used by medical schools and, to a lesser degree, by schools of nursing as a method for evaluating clinical performance. These trained patients provide a viable method for teaching and evaluating nurse practitioner students as they progress through their educational programs toward clinical competency. Evaluation using Standardized Patient Experiences provides objective and valid information regarding students' synthesis of didactic information and abilities to apply knowledge in the clinical setting. The purpose of this article is to describe the implementation of Standardized Patient Experiences across a curriculum for family nurse practitioner and adult geriatric nurse practitioner students. Students evaluated the experiences throughout the curriculum and overwhelmingly found them to be realistic, challenging, and of value to their programs of study.     

Development of nurse specialists/advanced practitioners in Ireland

An Bord Altranais (Irish Nursing Board) published "Report of the Commission on Nursing: A Blueprint for the Future" in 1998. This report was the result of collaborative work among those involved in nursing in Ireland. It recommended the establishment of clinical career pathways, which would allow a nurse with extensive experience and advanced expertise, as well as an appropriate course, to be recognized as a clinical nurse specialist. Further advancement along this pathway could possibly enable the nurse to progress to an advanced practitioner grade. The report acknowledged that there are "various and differing interpretations" of the title "practitioner". This article explores the growth and development of the roles of the clinical nurse specialist and advanced nurse practitioners in Ireland over the past number of years. The literature reflects elements of confusion that exist in some areas about the role of a clinical nurse specialist and an advanced nurse practitioner. The "Review of the Scope of Nursing and Midwifery Practice" (An Board Altranais, 2000) recognized a lack of clear differentiation between the role of the clinical nurse specialist and the advanced nurse practitioner. Overall, some clear roles are identified for the nurse who advances or wishes to advance along clinical career pathways in nursing. However, there still appears to be a certain degree of confusion about the use of titles such as "nurse specialist" and/or "nurse practitioner". The guidelines about the level of practice and education/training required for the nurse moving along the pathways of clinical nurse specialism and/or advanced nursing practice is somewhat obscure and is interpreted in different ways in the literature.     

Development and implementation of the specialized nurse practitioner role: Use of the PEPPA framework to achieve success

In 2003, amendments to the Nurses' Act in Quebec, Canada, allowed for an expanded nursing role. Specialized nurse practitioners were introduced to the health-care system in 2005. By merging medical knowledge with advanced practice nursing, the specialized nurse practitioner is gaining in popularity and acceptance with staff members and patients. To guide our team through the process, we used the PEPPA (participatory, evidence-based, patient-focused process for guiding the development, implementation, and evaluation of advanced practice nursing) framework. By using a framework specifically designed for the development, implementation, and evaluation of an advanced practice nursing role, we were better prepared for the path that lay ahead. Ultimately, the goal of the implementation of the specialized nurse practitioner role is to improve the quality of care to a specific population of patients, whether it is through individualized clinical follow-up, evidence-based practice, patient teaching, or promoting continuous education for the nurses.     

Humanbecoming theory in practice: a case for theory-guided nurse practitioner education

The age-old battle of what to include in nursing education continues. Now this battle extends itself into nurse practitioner education with a slightly different twist. Abandoning nursing theory-guided education for the medical model leaves nurse practitioner education flat. In this author's academic experience, nursing theory was included in the curriculum. The exemplar presented is testament to the distinction and significance of including nursing theory-guided education. The unique difference between nurse practitioners and physicians is the use of theory in practice.     

The clinical nurse specialist and nurse practitioner roles: room for both or take your pick?

OBJECTIVE: The aim of this paper is to contribute to pertinent discussions regarding advanced practice nursing roles. In particular discussion will focus on the potential implications for the developing nurse ractitioner (NP) role on the existing clinical nurse specialist (CNS) roles. SETTING: The literature presented originates primarily from the United States of America (USA), United Kingdom and Australia. Specific emphasis is placed on the psychiatric/mental health nursing context. PRIMARY ARGUMENT: Amidst the confusion in terminology to describe and explain advanced, expanded or extended nursing roles, and to distinguish between the clinical nurse specialist and the nurse practitioner, there is a need to establish clarity. The need for both clinical nurse specialist and nurse practitioner roles has been hotly debated in the USA. CONCLUSIONS: The roles of clinical nurse specialist and nurse practitioner may be complementary but fulfil different functions. It is therefore important that both roles be maintained and implemented in response to consumer and health service needs.     

Nurse Practitioners' Use of Nursing Diagnosis

The role of the nurse practitioner (NP) represents a unique blend of nursing and medical functions. Few studies exist that address the nursing component of the NP role and no literature is available to document the extent to which nurse practitioners utilize nursing diagnoses in their clinical practice. Thus, the author reports findings of a study that sought to describe the use of nursing diagnosis in current NP practice and to identify advantages and barriers to the use of nursing diagnoses by NPs. Fifteen percent of nurses surveyed used nursing diagnoses in their practice. The diagnoses most commonly used reflected attention to clients' lifestyles and daily living problems.     

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.     

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.     

Evaluating the clinical effectiveness of neonatal nurse practitioners: an exploratory study

Aim and objectives. The aim of the investigation was to establish if there was any preliminary evidence to indicate if the quality of care and clinical outcomes for premature birth babies are affected by the type of practitioner (i.e. nurse practitioner vs. medical practitioner) responsible for the initial assessment, treatment and management of neonates during the first 6–12 hours following admission to a neonatal intensive care unit. Background. The United Kingdom (UK) has seen a proliferation in the number of nurse practitioners in the past decade. While there is a growing body of evidence to suggest that nurse practitioners in primary care settings are able to provide a high quality and effective level of clinical service comparable with many of their medical counterparts, there has been relatively little evaluation of the nurse practitioner role in acute or high dependency hospital settings. Design and methods. The study design used a mixed method approach combining a retrospective examination and quality assessment of nursing and medical records. A random sample of 61 sets of medical records, relating specifically to the initial management and treatment of neonates were criterion assessed by an experienced consultant neonatologist and a variety of patient outcome data collated and analysed. Results. The analysis of the patient outcome data and quality assessment of nursing and medical records revealed that there was no statistical difference in the standard and quality of care provided between nurse practitioners and medical staff in the vast majority of areas evaluated. However, trends in the data suggest that Advanced Neonatal Nurse Practitioners (ANNPs) did not perform as well as their medical counterparts in terms of the overall completeness or comprehensiveness of the standard care provided in a number of areas. Conclusion. Neonatal nurse practitioners provide an alternative model of service delivery in the initial admission and management of premature birth babies. While the results of the study suggest that ANNPs do not perform as well as medical staff, in the majority of cases, they still performed to an acceptable standard. Nonetheless, some deficits in the standard of care provided by both groups of practitioners were identified which in turn have implications for ongoing training and skills development. Relevance to clinical practice. The findings suggest that ANNPs are capable of taking on an advanced role in the assessment and management of neonates.     

Steering a course towards advanced nurse practitioner: a critical care perspective

Aim: This article is a report of a study of the experiences of expert critical care nurses in their transition to the role of advanced nurse practitioner within an intensive care unit (ICU) setting. Background: The advanced nurse practitioner role was developed to support the ICU team and to undertake many of the roles traditionally associated with junior medical staff in this specialized area. The impetus for this study therefore was generated from the need to explore the role development experiences of trainee advanced nurse practitioners to inform future developments and practice. Methods: This study used grounded theory methodology to conduct and analyse data from 25 participants. The data were collected between March 2010 and August 2010, using interview format. Data collection and analysis was conducted simultaneously using methods associated with grounded theory, theoretical sampling and the constant comparative method. Results: ‘Staying the course to advanced nursing practice’ emerged as the core category, with four related major categories and substantive codes. In conjunction, the substantive theory explaining the essential processes involved comprised of three inextricably linked processes: situational, development and conceptual meaning. The developed conceptual model captures the unique experiences of expert critical care nurses during their transition to confident and competent advanced nurse practitioners. Conclusion: This study provides an account of the role transition from expert critical care nurse to advanced nurse practitioner, specifically the synthesis of expert nursing practice with traditional medical values. The conceptual model has the potential to be utilized as a framework for others embarking upon similar projects, informing advanced nurse practitioner roles within and out with critical care settings.     

Nurse practitioners - or advanced clinical nurses?

This article reviews a specific finding from a research project that examined the experiences of students, teachers and clinicians involved in a nurse practitioner degree programme. The development of advanced clinical nursing roles has presented challenges to the professional structure of nursing, particularly in the area of the unregulated and confusing array of titles adopted by nurses that infer advanced clinical practice. Over a 2-year period, practitioner ethnography was used to examine a sample of 10 student nurse practitioners who were undertaking a clinical degree programme (BSc (Hons) Nurse Practitioner). Data were also collected from 11 other individuals involved in the degree programme: teachers, medical mentors and senior academics. The data were systematically analysed and structured, leading to the inductive identification of themes and frameworks. The sample's experience of the development of advanced clinical nursing roles led to consideration of the evolution of new career structures and identities associated with advanced nursing practice. This evidence enabled a view of advanced clinical nursing roles within a framework of advanced nursing practice. The development of advanced clinical nursing is dependent on the cooperation of clinical nurses, educators, managers, doctors and politicians. Nevertheless, that development can only succeed if strategic policy is backed by the development of a professional clinical nursing career framework that enables the process.     

A day in the life of a school health nurse

Registered nurses Daria Del Prete, Cheryl Schroeder, Clare Sullivan, and Patti Scott all work with the Vanderbilt University School of Nursing School Health Program. They work in two Nashville elementary schools that serve primarily inner-city children who face many barriers to health care. Many of these school-children have special needs, including complex medical, social, emotional, and learning problems that require a variety of nursing and case management services during the school day. Current staffing at the health centers allows for full-time nursing coverage at each site. Some days, a school nurse and nurse practitioner work together. Other days, there is just a nurse or nurse practitioner working alone. This article is a composite of a typical day at the Fall-Hamilton Elementary School with a school nurse (Cheryl Schroeder) and pediatric nurse practitioner (Patti Scott) working together. (All students names have been changed.)     

Emerging role of the pediatric nurse practitioner in acute care

The pediatric nurse practitioner role in the tertiary setting is one of several emerging roles gaining recognition in the various groups of advanced practice nursing programs today. The advanced practice nurse (APN) who is a pediatric nurse practitioner (PNP) in an acute care setting helps to provide cost-effective, quality patient care for critically and chronically ill children who are in these settings. The foundation of advanced practice nursing in this role incorporates the general role expectations of advanced nursing preparation, including case management, clinical pathway development, consultation and education, research, and collaboration, with the specific knowledge and skills of the pediatric nurse practitioner to function effectively with sick children in the acute care areas.     

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.