NCGNP Pioneer in Acute Care and Standards of Practice

A Necessity Not a Luxury: Preparing Advanced Practice Nurses to Care for Older Adults

Building APRN Gerontology Workforce Capacity Through New APRN Gerontological Specialist Certification

Nursing Programs Could Sharpen LTC Focus

Review question/objective This review asks “What is the experience and effectiveness of nurse practitioners in orthopaedic settings”? The objective of the quantitative component of this review is to synthesise the best available evidence on effectiveness of orthopaedic nurse practitioner specific care on patient outcomes and process indicators. The objective of the qualitative component of this review is to synthesise the best available evidence on the experience of becoming or being an orthopaedic nurse practitioner in relation to role development, role implementation and (ongoing) role evaluation. The objective of the text and opinion component of this review is to synthesise the best available evidence of the contemporary discourse on the effectiveness and experience of nurse practitioners in orthopaedic settings. Types of participants Nurse practitioner is an expanded form of advanced practice.11 For the purpose of this systematic review the International Council of Nurses (ICN) definition20 of nurse practitioner will apply whereby a Nurse Practitioner/Advanced Practice Nurse is defined as a Registered Nurse with expert knowledge, complex decision making skills and possessing competency for expanded practice. Importantly the practice of nurse practitioner/advanced practice nurse is characterised further by the “context and/or country” that they practice within.20 Therefore an ‘orthopaedic’ nurse practitioner is defined in accordance with the above definition and with a specific scope of practice (as authorised) within a relevant and specific ‘orthopaedic’ setting. The quantitative and qualitative components of this review will consider studies that include orthopaedic nurse practitioners in acute care or sub-acute orthopaedic settings. The textual component of this review will consider publications that pertain to orthopaedic nurse practitioners in acute care or sub-acute orthopaedic settings, where there exists a particular focus on the ‘orthopaedic’ aspect of nurse practitioner practice. Types of intervention(s)/phenomena of interest The quantitative component of this review will examine interventions of orthopaedic nurse practitioner specific care. For this systematic review, orthopaedic nurse practitioner specific care refers to those aspects of care the orthopaedic nurse practitioner is responsible for and/or records as performance outcomes such as: occasions of service/numbers seen; time to and length of nurse practitioner consultation; time to nurse practitioner intervention; referral patterns and other measures of intervention effectiveness. The qualitative component of the review will examine as phenomena of interest the experience of becoming or being an orthopaedic nurse practitioner in relation to role development, role implementation and (ongoing) role evaluation. The text and opinion component of the review will examine opinions on the effectiveness and experience of nurse practitioners in orthopaedic settings including role development, implementation and evaluation of nurse practitioners in orthopaedic settings. Types of outcomes The quantitative component of this review will consider as primary outcomes the following patient outcomes: • patients’ level of pain • pressure injury • urinary tract infection • patient satisfaction • in-hospital patient mortality • hospital readmission • patients’ health-related quality of life • functional status • malnutrition score • constipation • wound care/complications • other clinical complications • morbidity • other patient encounter data that characterise orthopaedic nurse practitioner practice • other relevant nurse-sensitive outcome data The quantitative component of this review will consider as secondary outcomes the following nurse related outcomes or process indicators/outcomes: • orthopaedic nurse practitioner satisfaction • key stakeholder (health professional) satisfaction • specialised knowledge/skill translation • hospital length of stay • cost benefit

In many parts of the world, vulnerable patient populations may be cared for by a clinical nurse specialist (CNS). Nurses desiring to develop themselves professionally in the clinical arena, within the specialty of their choice, have the opportunity to obtain the knowledge, skills, experience and qualifications necessary to attain advanced practice positions such as CNS or nurse consultant (NC). Although studies have demonstrated the benefits of such roles and while the World Health Organization (WHO) recommends it, advanced nursing practice is not yet integrated into the health care culture in Saudi Arabia. The reasons for this are multiple, but the most important is the poor image of clinical nursing throughout the country. This article aims to share a perspective on CNS practice, while casting light on some of the obstacles encountered within Saudi Arabia. A model is proposed representing specialist nurse–physician collaborative practice for implementation nationally. The model has been implemented in the care of the colorectal and stoma patient populations while taking into consideration patient population needs and local health care culture. This model is based on the concepts of holistic “patient-centered care”, specialist nurse–physician collaborative practice, and the four practice domains for NCs (expert practice, leadership, research and education) as indicated by the Department of Health in the United Kingdom. We suggest this model will enable the introduction of advanced specialist nursing and collaborative partnerships in Saudi Arabia with benefits for patients, physicians, health care organizations and the nursing profession as a whole.

Infusing gerontological nursing content into advanced practice nursing education

The concept of advanced nursing practice is still evolving even as the nursing profession evolves. Davies and Hughes’s article was one of the first to transcend the role understandings of clinical nurse specialists (CNSs) and nurse practitioners (NPs) to describe advanced nursing practice in terms of competencies. Their work was seminal to my own thinking about advanced nursing practice, resulting in the definition proposed in Advanced Nursing Practice: An Integrative Approach (Hamric AB, Spross JA, Hanson CM, eds. Advanced Nursing Practice: An Integrative Approach. Philadelphia: WB Saunders; 1996:42-56). This way of understanding advanced nursing practice as a constellation of competencies embedded in a variety of roles, rather than in terms of particular roles, has become the dominant way we define advanced nursing practice today. Davies and Hughes’s insight that “the term advanced nursing practice extends beyond roles” has helped to diffuse the intraprofessional rivalry between CNSs and NPs and the divisiveness it created within the profession, even as it has helped extend the understanding of advanced nursing practice in evolving roles. I think of published scholarship as an ongoing conversation, a series of one-way dialogues, if you will, that builds on previous conversations and lends new insights to our continued efforts to strengthen the nursing profession. It is one of the key reasons why we need to stay abreast of the literature, so we can be responsible contributors to the conversation. We all build our ideas from the insights of others even as we contribute our own insights to the dialogue. Davies and Hughes built upon my earlier conversations about the CNS role, and I in turn built upon their important insights about advanced nursing practice. Since that time, others have contributed to the development of our understanding, and my definition continues to evolve based on these contributions. And so it goes. Let the conversation continue! Ann B. Hamric, PhD, RN, FAAN Although the term advanced nursing practice has been used extensively to describe the practice of the CNS, it is difficult to find a clear definition of the term. The role has been articulated as a constellation of subroles: clinician, educator, researcher, and consultant. However, describing various subroles does not capture the broader picture of the CNS’s contribution to health care delivery. This has lead to discussions among faculty of one university regarding the need to clarify advanced nursing practice as the first step in redesigning the educational preparation for the CNS as an advanced nurse practitioner. In this article, an overview of advanced practice is provided, differences in practice levels are discussed, and characteristics and competencies inherent to advanced nursing practice are delineated. How these characteristics and competencies interact to present a picture of advanced nursing practice is illustrated in a case study.

Integrating Gerontology Competencies Into Graduate Nursing Programs

Moving Towards Harmony: Exemplars of Advanced Nursing Practice for British Columbia

The following manuscript explores the historical development, as well as current and future roles of advanced practice nursing with specific emphasis on the clinical nurse specialist and the nurse practitioner. The term advanced practice nursing is based on the definition provided by the American Nurses Association (ANA). A statement originating from the National Association of Clinical Nurse Specialist provides the spheres of influence framework used in the critical analysis of the competencies, as well as implications for practice, role development, and scopes of practice for the clinical nurse specialist. Nurse practitioner education and development is based on the curriculum guidelines and program standards as developed by the National Organization of Nurse Practitioners. ADVANCED NURSING PRACTICE AND ISSUES OF A NEW MILLIEUM Historically advanced practice roles have lacked clarity. 1,2 Confusion regarding the educational preparation, titles, roles, and functions hampered understanding for quite some time.3 Harrell and McCullock 4 identified that words such as “specialist” or “advanced” were used to describe nursing roles without respect to educational or experiential backgrounds created confusion in the discussion of advanced practice nursing. Some institutions were using individuals with less than graduate level education in advanced practice roles, while others with graduate degrees lacked certification (American Association of Colleges of Nursing. 5 The educational background of the advanced practice nurse (APN) varied from state to state. These issues proved to be confusing for institutional management, nursing personnel, health care team members, as well as clients. Great strides have been made by the nursing profession to alleviate confusion, provide continuity and insure quality educational preparation for the advanced practice nurse. The American Academy of Nurse Practitioners has developed a number of statements that addressed standards of practice, curriculum and roles. 6,7,8 The American Nurses Association (ANA) 9 developed the Scope and Standards of Advanced Practice Registered Nursing in 1995, and the American Association of Colleges of Nursing (AACN) 10 produced The Essentials of Master's Education for Advanced Practice Nursing in 1996. That same year the ANA 11 published the Model Practice Act, a document that provided states with a recommendation for the incorporation of APNs into the mix of healthcare providers. The National Association of Clinical Nurse Specialists (NACNS) 12 produced their Statement on Clinical Nurse Specialist Practice and Education in late 1998. This document provided a solid base from which to clearly identify the clinical nurse specialist from other advanced practice nurses. The AACN 5 published its position statement on Certification and Regulation of Advanced Practice Nurses in 1998. Collectively these efforts provided the backbone for consistency among the advanced practice nurse population.

When a dose of advanced practice nursing is the treatment.

An increasing number of countries are exploring the option of introducing Advanced Practice Nurses (APN), such as Nurse Practitioners (NP), as part of the health care workforce. This is particular relevant in light of the increase of the elderly and chronically ill. It is crucial that this introduction is preceded by an in depth understanding of the concept of advanced practice nursing as well as an analysis of the context. Firstly, a conceptual clarification of Advanced Practice Nurses and Nurse Practitioners is provided. Secondly, a framework is introduced that assists in the analysis of the introduction and development of Advanced Practice Nurse roles in a particular health care system. Thirdly, outcomes research on Advanced Practice Nursing is presented. Argumentation developed using data based papers and policy reports on Advanced Practice Nursing. The proposed framework consists of five drivers: (1) the health care needs of the population, (2) education, (3) workforce, (4) practice patterns and (5) legal and health policy framework. These drivers act synergistically and are dynamic in time and space. Outcomes research shows that nurse practitioners show clinical outcomes similar to or better than those of physicians. Further examples demonstrate favourable outcomes in view of the six Ds of outcome research; death, disease, disability, discomfort, dissatisfaction and dollars, for models of care in which Advanced Practice Nurses play a prominent role. Advanced Practice Nurses such as Nurse Practitioners show potential to contribute favourably to guaranteeing optimal health care. Advanced Practice Nurses will wield the greatest influence on health care by focusing on the most pressing health problems in society, especially the care of the chronically ill.

within the walls of the hospital setting. Today’s healthcare environment mandates that patients with serious diseases live in their homes, causing the need for acute and critical care settings to reach out to their patients not only to assist them in maintaining a quality of life but also to decrease costs of hospital readmissions. This situation is especially true for patients with chronic heart failure (CHF). In the United States, many patients with CHF regularly visit CHF clinics that are run by advanced practice nurses; these clinics assist patients with maintaining and often improving their state of heart failure, while also proving cost-effective. The Synergy Model provides the framework for nurses to manage complex clients experiencing acute exasperation of their illness and to work toward reducing the trajectory of the illness. The purpose of this article is to discuss the application of The Synergy Model to an ambulatory CHF clinic. We will discuss the characteristics of a patient who visited a local clinic, with the advanced practice nurse holding a Authors

An increasing number of countries are exploring the option of introducing Advanced Practice Nurses (APN), such as Nurse Practitioners (NP), as part of the health care workforce. This is particular relevant in light of the increase of the elderly and chronically ill. It is crucial that this introduction is preceded by an in depth understanding of the concept of advanced practice nursing as well as an analysis of the context. Firstly, a conceptual clarification of Advanced Practice Nurses and Nurse Practitioners is provided. Secondly, a framework is introduced that assists in the analysis of the introduction and development of Advanced Practice Nurse roles in a particular health care system. Thirdly, outcomes research on Advanced Practice Nursing is presented. Argumentation developed using data based papers and policy reports on Advanced Practice Nursing. The proposed framework consists of five drivers: (1) the health care needs of the population, (2) education, (3) workforce, (4) practice patterns and (5) legal and health policy framework. These drivers act synergistically and are dynamic in time and space. Outcomes research shows that nurse practitioners show clinical outcomes similar to or better than those of physicians. Further examples demonstrate favourable outcomes in view of the six Ds of outcome research; death, disease, disability, discomfort, dissatisfaction and dollars, for models of care in which Advanced Practice Nurses play a prominent role. Advanced Practice Nurses such as Nurse Practitioners show potential to contribute favourably to guaranteeing optimal health care. Advanced Practice Nurses will wield the greatest influence on health care by focusing on the most pressing health problems in society, especially the care of the chronically ill.

Review Questions/Objectives: The review objective is to examine the experience of nurses delivering nurse initiated interventions in the acute care setting. The review question is: What is the acute care nurse’s experience of delivering nurse initiated interventions to patients? Inclusion Criteria Types of Participants Nurses working or who have worked in the acute care hospital setting including but not limited to: - Enrolled and Registered Nurses - Clinical Initiative Nurses - Clinical Nurse Specialists - Extended Practice Nurses - Advanced Practice Nurses - Nurse Practitioners Phenomena of Interest The nurses' experience of delivering nurse initiated interventions, including but not limited to: - Nurse Initiated Analgesia - Nurse Initiated Intravenous Cannulation - Nurse Initiated X-rays - Nurse Initiated Blood Tests - Nurse Initiated Intravenous Fluids - Nurse Initiated Discharge Context Acute care hospital settings and ambulatory care settings, or the equivalent will be considered. These will include but not be limited to: - Metropolitan - Regional/ Rural - Settings that see and treat emergency presentations in the absence of an emergency department. - Nurse initiated interventions delivered to patients in acute care settings. Studies undertaken internationally in similar setting will also be considered. This review will exclude NII delivered in the aged care and primary care setting. The delivery of health care in these settings occurs under a different model of care to the acute care setting. The research findings generated from aged care and the primary care setting are considered to be outside the scope of this review. This review seeks only to explore the experience of the nurse delivering NII in the acute care setting.