Equipping Stroke Nurses to Take on Extended Roles Within Acute Stroke Care Through an Advanced Practice Fellowship: An Evaluation Study

Abstract

Background Stroke nurses are adopting extended roles to improve patient care due to limited numbers of vascular neurologists, however, little is known of this experience. We evaluated the impact of an internationally implemented fellowship education program to equip experienced stroke nurses, nationally and internationally, to undertake extended acute stroke roles.Methods We conducted semi-structured interviews with the following groups of individuals associated with the NET SMART Advanced Practice fellowship program: 1) Stroke nurse program graduates; 2) currently enrolled stroke nurse fellows; 3) local physician mentors; 4) service managers of program graduates. Interviews took place between February-August 2018 and were analysed using the Theoretical Domains Framework. Results Interviews were held with stroke nurses (n=11), mentors (n=4) and a service manager (n=1). Four themes were identified: 1) ‘The learning journey’- describing motivations for undertaking the training and course content; 2) ‘Organizational and professional change’-experiencing professional resistance to the new role, or lack of a suitable role to move into after program completion, 3) ‘What hindered the learning journey?’- small hospitals with low patient volume makes completion challenging; 4) ‘What helped the learning journey?’- a supportive team facilitated completion. Conclusion We found overwhelming skill development and professional growth by nurses, and this was echoed by mentors and managers. However, despite expanding their stroke-specific knowledge and skills, non-U.S.A. nurses faced systemic challenges in implementing theirskills including lack of acceptance of extended nurse roles from wider professions.