Australian Practice Nurses Research Articles

Nurturing Australian Nurse Practitioners: A 24-Year Odyssey Toward Independence and Recognition

Nurturing Australian Nurse Practitioners: A 24-Year Odyssey Toward Independence and Recognition

WCN24-1353 A journey of an Argentinian Nephrologist to an Australian Renal Nurse Practitioner

WCN24-1353 A journey of an Argentinian Nephrologist to an Australian Renal Nurse Practitioner

A review of the growth and development of Australian practice nursing: Insights for the dietetic workforce.

AimThe aim of this scoping review was to provide an overview of the development of practice nurses, and the learnings that could be applied to improve the profile of dietetics practice in primary care.MethodsA scoping review synthesising peer‐reviewed and other literature relevant to the development of Australian practice nurses was conducted. Structured searches using keywords ‘general practice’, ‘nurse’ and ‘Australia’ were conducted in PubMed and Google Scholar in June 2021. Key government websites, Department of Health and Services Australia, were searched to identify grey literature. One reviewer screened the titles and abstracts against inclusion criteria; two reviewers conducted full‐text screening independently. Data on the evolution of practice nursing were extracted based on its interest and transferability to the dietetics workforce.ResultsA total of 102 results (82 peer‐reviewed and 20 other literature) were included in the review. Key drivers for practice nurse role development in Australia were government funding, practice nurse practice standards, cost–benefit analyses of practice nurses, career and education opportunities, general practitioner and patient perspectives of practice nurses and, individual, community and local needs.ConclusionsThe practice nurse role has grown and strengthened and there are three key learnings that could be translated to strengthen the dietetics workforce in primary care. (1) Use and expansion of government funding, (2) furthering post‐tertiary education and career opportunities, including dietetic primary care practice standards and (3) targeting underserviced areas such as those that are rural and remote and building positive relationships with other stakeholders including practice nurses, general practitioners, patients and the broader primary care team.

Paediatric post-discharge pain and parent perceptions of support from an Australian nurse practitioner led acute pain service.

Poorly managed post-operative pain remains an issue for paediatric patients. Post-discharge telephone follow-up is used by an Australian Nurse Practitioner Acute Pain Service (NpAPS) to provide access to effective pain management post-discharge from hospital. This cross-sectional survey design study aimed to determine the pain levels of children following discharge and parent views on participation in their child's pain management and perceptions of support from the NpAPS. Parents completed the Parents' Postoperative Pain Measure-Short Form (PPPM-SF) and factors affecting parents' participation in children's pain management questionnaire (FPMQ). Results indicated that pain score was high, especially on the day of discharge and 24hours post-discharge. Parents, despite feeling supported by the NpAPS, experienced uncertainty, emotional responses and expressed concerns about communication and coordination of care. The clinically significant pain levels of the majority of children on the day of discharge and day post-discharge from hospital are a concern. Worry and uncertainty among parents, particularly on the day and first night of discharge, suggest this transition period where responsibility of clinical management of pain is handed over to parents may require greater focus for parental support.

The legitimacy of the nurse practitioner as a non-medical surgical assistant: Historical evidence from Australia

ABSTRACT Problem The Non-Medical Surgical Assistant role has been practised in Australia for over 30 years. Despite this, the role remains unregulated, and government policy does not offer a rebate for the private surgical patient when the surgical assistant is not a Medical Practitioner. Aim To investigate the legitimacy; as outlined by Donabedian; of the Nurse Practitioner performing the role of the surgical assistant in Australia. Methods Examination of peak professional bodies’ guidelines, opinions of other service providers, Australian Government policy and the Australian law. Findings While not reflected in Government policy, the Nurse Practitioner is a legitimate and lawful provider of intraoperative surgical assisting care in Australia. Discussion The Medical Benefits Schedule does not reflect contemporary, evidence-based practise or the law concerning the Nurse Practitioner undertaking the role of a surgical assistant, this causes the patient an out of pocket expense or reduced access to care. Conclusion The Australian Nurse Practitioner is a legitimate and lawful provider of these services.

What is the scope of practice of the Nurse Practitioner as a surgical assistant in Australia?

Discussion around the scope of practice of all nurse practitioners (NPs) in Australia was a component of the recent review of NPs’ eligibility to have broader access to the Medical Benefits Schedule (MBS). This review process has been prolonged and, while the MBS review officially concluded on the 30 June 2020, no information regarding decisions about expanded NP access to the MBS for patient rebates had been disclosed at the time of publication. It is anticipated that the MBS review will contribute little change to NP access to the MBS. The MBS is the primary funding process for private-sector medical services in Australia and is a barrier to the scope of practice of Australian NPs. Specifically, in the perioperative setting the lack of access to the ‘assistance at operations’ MBS item numbers limits the NP’s scope of practice as it leaves the private sector surgical patient out-of-pocket when an NP provides surgical assisting services. This discussion paper considers the international non-medical surgical assistant experience and relates this to the Australian context exploring the complexities associated with the term advanced practice nursing, regulation of the NP compared to other clinicians, and the matters of funding and protectionism in the perioperative space.

Preparing Australian Nurse Practitioners to Meet Health Care Demand

The Australian health care system remains slow in realizing the potential benefit of nurse practitioner (NP) roles. National and international evidence suggests NPs provide an accessible and acceptable way in which health systems can meet the demand for health care delivery, particularly in primary and community settings. One significant barrier to the integration and growth of NP roles in Australia is the highly individualized approach to education that encourages NPs to develop a narrow and specialized skill set. In this report, we discuss whether the current approach to the educational preparation of NPs in Australia adequately addresses existing and emerging health care demand.

Models of prescribing, scope of practice, and medicines prescribed, a survey of nurse practitioners.

The aim of this study was to explore current Australian Nurse Practitioners (NPs) models of prescribing used and medicines prescribed within their scopes of practice. Descriptive online electronic national survey. An online survey of Australian NPs was conducted in 2017. A total of 252 NP participants reported on their current prescribing practices. Participants reported prescribing via three prescribing models with autonomous prescribing the most frequently used, followed by prescribing under supervision and prescribing under a structured arrangement. Participants reported prescribing 298 separate medications, representative of all major drug classifications from the Australian Medicines Handbook. NPs appear to engage in several modes of prescribing as relevant to their context of practice with most NPs prescribing using all models of prescribing at different times. Findings also highlight the diversity of and breath of the medicines that NP prescribes and highlight the need for NPs to have broad capability in relation to the quality use of medicines, irrespective of specialty or location of practice. Findings of this research add to the international literature on NP prescribing and through identification of models of prescribing and medicines prescribed inform future NP education and policy.

The CKD-DETECT study: An RCT aimed at improving intention to initiate a kidney health check in Australian practice nurses.

The burden of Chronic Kidney Disease (CKD) on the Australian health system is growing. Efforts to reverse this trend have not been successful. This paper evaluates the effectiveness of a targeted asynchronous web based e-learning module on general practice nurses' behavioural intentions in relation to opportunistic screening practices for people at risk of CKD. Double blinded pre-post interventional randomised control design. Participants were nurses working in general practice settings in Australia. Participants were randomised to a knowledge based active control or targeted behavioural based intervention which were delivered using asynchronous e-learning modules. The intervention was designed to influence the behavioural constructs of the theory of planned behaviour (TPB): attitude, subjective norm and perceived behavioural control (PBC). Of the 420 participants, we analysed the primary and secondary outcomes for 212 (50.47%) who had complete follow up data. There were no significant differences (p 0.424, [d] 0.04) in behavioural intention between the intervention and control groups at follow-up, when controlling for baseline values. However, regression models assessing the relationship between the change in the TPB constructs and behavioural intention at follow-up for all participants, regardless of study arm, demonstrated a significant change in intention to initiate a kidney health check. Although these changes could not be attributed to the effect of the intervention. Attitude (r2 = 0.3525, p 0.0004) and PBC (r2 = 0.3510, p 0.0005) models accounted for approximately 35% of the explained variance in behavioural intentions and social norm (r2 = 0.3297, p 0.0171) accounted for approximately 33% of the variance. When all TPB constructs were included in the model, 37% of the variance in intention was explained. A targeted behavioural online intervention was no more effective than a knowledge based online program to improve primary health care nurses' intention to initiate a kidney health check in people at risk of chronic kidney disease. Collaborative efforts are required by all staff working in general practice to develop models of care to improve screening practices for chronic kidney disease. Future research should focus on interventions that improve collaboration between health care professionals in the primary care setting and public health campaigns to increase awareness of risks of CKD and the importance of screening in the primary care setting.

An inductive qualitative approach to explore Nurse Practitioners views on leadership and research: An international perspective.

To explore the ways in which Irish and Australian Nurse Practitioners (NPs) implement leadership and research in their roles and whether there is a difference in how leadership and research are demonstrated between NPs in Ireland and Australia. The original concept of the NP role was to expand nursing practice in order to provide high-quality, accessible health care to patients. This placed NPs at the crux of changes to healthcare delivery. Implementing these changes requires leadership. Research demonstrates the effects of these changes to healthcare delivery and contributes to healthcare knowledge from the nursing profession. In the qualitative phase of a mixed methods study, an interpretative descriptive approach was used to draw on participant experiences. Thirty-eight respondents agreed to be interviewed following an online survey. Ten interviews were recorded and transcribed verbatim. Data were analysed using Braun and Clarke thematic analysis method. The research complied with the consolidated criteria for reporting qualitative research, COREQ. Ten participants, five NPs from Ireland and five from Australia were interviewed. Four themes emerged from the analysis: (a) Innovative leadership, which included the categories of leadership activities, the work of NPs and trailblazers; (b) Optimism, incorporating pride in achievements, the future outlook for the role and continued innovation of NPs over time; (c) Research, which included the NP research role, research challenges, support and research leadership; and (d) Resilience, which included overcoming resistance, isolation and seeking positive support systems. Nurse Practitioners are clinical leaders focused on improving healthcare delivery for patient populations. There is a lack of understanding of the NP role. Nurse Practitioners lack confidence to be independently research active. Research by NPs requires support from nurses in academia. There is no difference in the role in Ireland and Australia. Nurse Practitioners are engaged in healthcare transformation. Nurse Practitioners require support from research experts in academia to make a significant contribution to nursing knowledge in healthcare delivery.

"It's about fitting in with the organisation": A qualitative study of employers of nurse practitioners.

To explore the views of employers about the value nurse practitioners (NPs) add to health services, enablers and barriers to employing NPs, and intentions to employ NPs or expand NP services in the future. Research on Australian NPs has focused on NPs' experiences or patient-related factors like waiting times. Few studies have explored NP roles from the perspective of employers. Australian NPs employed by the private sector are eligible for reimbursement by the national health insurance scheme (Medicare Australia), potentially generating revenue for employers and broadening their career opportunities. We aimed to explore private sector employers' views on the barriers and facilitators to employing NPs and to identify factors affecting NP employability. A qualitative descriptive exploratory study. Employers of NPs from 23 private and nonprofit health services in Western Australia were interviewed. Inductive content analysis was used to explore the data. Enablers to employing an NP included enhanced customer service and improved health outcomes. Barriers to employing an NP included lack of financial benefit and inadequate experience or qualifications. Employers also identified future directions for NP employability, such as filling a gap that added value to the health service. Employers wanted NPs to work towards a shared vision of patient care that aligned with organisational needs. Findings can inform NP education and workforce planning to optimally meet employer and patient health needs.

A National Study of Australian Nurse Practitioners’ Organizational Practice Environment

The nurse practitioner (NP) workforce in Australia plays a vital role in helping the country meet the current demand for health care. Data from Australian NPs using the Nurse Practitioner Primary Care Organizational Climate Questionnaire demonstrated that one-seventh of the overall Australian NP population completed the study. The response was overwhelmingly positive in the area of practice; 71.6% of NPs had no restriction on their practice and felt valued by their organization. The results of this study enable a benchmark for ongoing national evaluations in addition to international comparative data.

Evaluating an australian emergency nurse practitioner candidate training program

Nurse Practitioners (NPs) receive core clinical training at master’s level, with their employer providing the opportunity to upskill in clinical and procedural competencies. It is increasingly recognised that this generic education requires supplementary training for operating effectively within a specific clinical environment. In this paper we describe a pilot program designed to train Australian NP Candidates to work effectively within the Emergency Department Fast Track model of care. The training program consisted of a 12-month period: four hours in-house training per week over two semesters, running concurrently with the NP candidate’s University semesters, and 3 months’ clinical practice to consolidate. The training team defined milestones for Semesters one and two, and developed a case review form to assess application of the candidate’s knowledge in new clinical situations, as well as check for gaps in understanding. A clinical skills guide was developed for the candidate to work toward, and a comprehensive assessment was carried out at two time points in the training program. Feedback was obtained from the mentors and the candidate at the end point of the training program, and has been used to refine the program for 2017. This in-house training program provided specialised, evidence-based training for the emergency department environment, resulting in development of the nurse practitioner candidate as a high functioning team member.

A scoping review of the progress of the evolution of the Doctor of Nursing Practice in the USA to inform consideration of future transformation of Nurse Practitioner education in Australia

BackgroundIn 2004 a consensus was reached through a vote of membership of the American Association of Colleges of Nursing to move Nurse Practitioner education from the masters to the doctoral level by 2015. AimTo determine progress to meet the goal of moving towards doctoral level education for American Nurse Practitioners and identify the associated discourse. MethodA scoping review was undertaken to dertermine the progress towards the goal of the of moving from the Master of Science Nursing to the Doctor of Nursing Practice degree as the point from which Nurse Practitioner certification and licensure can be applied for in the USA, the reported outcomes resulting from the introduction of the Doctor of Nursing Practice and the evolution of the discourse re the design and intent and of the Doctor of Nursing Practice. FindingsThere has been ongoing evolution in the vision of the Doctor of Nursing Practice degree since 2004. Whilst there have been challenges, support for continued development and implementation of the Doctor of Nursing Practice is strong. DiscussionThese findings are considered with regard to informing potential future directions for Nurse Practitioner education in Australia. ConclusionIt is timely in Australia to consider development of a post endorsement bespoke Professional Doctorate for Nurse Practitioners. To address the issue of course load in Nurse Practitioner Masters Programmes the discipline should work towards being recognized as able to offer an extended masters degree for Nurse Practitioners. Australian Nurse Practitioner faculty should come together as a group to consult on development of Nurse Practitioner education in Australia.

Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service

BackgroundReducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia.MethodsDonabedian’s structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings.ResultsStructural dimensions identified included the ‘in-reach’ nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction.ConclusionsThis study provides valuable insights into the contribution of the NP model of care within an aged care, HA service and how staff manipulated the process dimensions to improve referral to the NPs. NP service in this study was dynamic, flexible and responsive to both patient and organisational demands.

Attitudes to Changes in Cervical Screening Guidelines: Preliminary Views of Australian General Practitioners and Nurse Practitioners

Attitudes to Changes in Cervical Screening Guidelines: Preliminary Views of Australian General Practitioners and Nurse Practitioners

Consensus on an Australian Nurse practitioner specialty framework using Delphi methodology: results from the CLLEVER 2 study.

The aim of this study was to achieve profession-wide consensus on an Australian nurse practitioner specialty framework. Since its introduction in 1998, the Australian nurse practitioner profession has grown to over 1300 endorsed practitioners, representing over 50 different specialties. To complement better a generalist learning and teaching framework with specialist clinical education, prior research proposed a broad framework of Australian nurse practitioner specialty areas termed metaspecialties. This study employed an online three-round modified Delphi method. Recruitment using purposive sampling and snowballing techniques identified an eligible sample from a population of nurse practitioners with at least 12months' postendorsement experience (n=966). Data were collected using online survey software from September 2014-January 2015 and analysed using descriptive statistics and content analysis. The Content Validity Index and McNemar's Test for Change were used to determine consensus on the nurse practitioner metaspecialties. One-fifth of the total eligible population completed the study. Participants achieved high consensus on four metaspecialties, including: Emergency and acute care, primary health care, child and family health care and mental health care. Two metaspecialties did not achieve consensus and require further investigation. A large sample of nurse practitioners achieved consensus on an Australian metaspecialty framework, increasing the likelihood of widespread acceptance across the profession. This technique may be appropriate for use in jurisdictions with smaller populations of nurse practitioners. Ongoing research is needed to re-evaluate the metaspecialties as the profession grows.

P08.26 The impact of education on australian practice nurses’ knowledge and attitudes in relation to chlamydia testing: findings from the australian chlamydia control effectiveness pilot (accept)

Introduction ACCEPt is a randomised controlled trial of annual chlamydia testing for 16–29 year olds in general practice. Part of the trial examines whether practice nurses (PNs) can play a role in chlamydia testing. PNs previously identified education as an important facilitator to their involvement in testing. We evaluated the impact of education on PNs’ knowledge and attitudes in relation to chlamydia testing. Methods The 2-hour education program was delivered at clinics to PNs by ACCEPt staff. A survey was conducted at baseline and repeated 6–12 months post education; analysis focused on PNs who completed both surveys. The survey used Likert scales, which were analysed as continuous variables (scores). We used t-tests to assess if changes in mean scores between survey rounds were greater in the education group. Results In total 72 PNs completed both surveys (42 of which received education). Changes in mean scores between survey rounds in the education group were significantly different to the non-education group for the statements: most chlamydia infections in men are asymptomatic (p = 0.01); I would offer a chlamydia test to a 23-year old married female having a pap test (p = 0.04); I would like to be more involved in testing (p = 0.04); I would like to be more involved with managing a recall/reminder system (p = 0.05); and time/workload constraints are barriers to testing (p = 0.001). The increases in mean knowledge score (p Conclusion Our evaluation suggests PN participation in the ACCEPt education program improved chlamydia testing knowledge and attitudes among PNs and could be utilised more widely across primary care. The findings also suggest time/workload constraints became a stronger barrier after education, presumably due to greater involvement in testing. Future analyses will determine if the education program combined with other initiatives have increased testing rates. Disclosure of interest statement ACCEPt was commissioned and funded by the Australian Government Department of Health and Ageing. Additional funding has been received from the National Health and Medical Research Council, the Victorian Department of Health and NSW Health.

Cycles of reflection and challenge: Using sequential blended learning strategies to enhance student understanding of, and transition to, the Nurse Practitioner role in Australia

Summary Aim This paper describes and discusses the development and implementation of sequential blended learning strategies in one Australian post-graduate nursing program designed to support student transition to the Nurse Practitioner (NP) role. Background Despite the availability of NP practice standards and role descriptions, the diversity and complexity of NP practice can make it difficult for students commencing post-graduate NP programs to comprehend what ways they need to develop to meet professional expectations. Scholarly critique This paper examines this contemporary post-graduate education issue. Blended learning strategies provided an opportunity to address the requirements, diversity and complexity of NP practice early in the NP program. Students were confronted with the gap between their current level of competence and NP competence, and supported to plan and travel the transitional and developmental pathway to achieve competence. Conclusion Working with students from early on in their degree enables them to progressively and more clearly envision the gap between their current level of competence and that required of the Australian NP role. Adopting a sequential blended learning approach is one way to engage students in preparing for their future role. Consideration of design elements integral to blended learning approaches is important, including a need for authenticity and support. Preparing NPs who fully comprehend the nature and scope of their practice is both vital for safety and of strategic importance to the nursing profession. Examples of how to facilitate student understanding of the NP role are needed to inform educational practice.

A game of snakes and ladders: negotiating the ‘ups and downs’ of endorsement as a nurse practitioner in Australia

Background: Australian legislation supporting the nurse practitioner (NP) role was enacted in 1998. Since then, NPs have played an important advanced practice role within the interdisciplinary healthcare team. However, the literature suggests that transition to the NP role can be challenging.Aim: This paper highlights the complex transition experiences of ten recently endorsed Australian NPs. The convoluted legislative and regulatory requirements that were negotiated by the NPs are presented as narratives.Methods: Informed by an ethnographic approach, participants were interviewed several times during their first year. Interview transcripts were thematically analysed and aggregated into three narratives representative of key findings.Key Findings: The findings exemplify the complexity of navigating through a labyrinth of bureaucracy and the extensive negotiations required to appease those who yielded power over their future practice.Conclusion: This study raises awareness of the transition experiences of Australian NPs and their challenges and barriers during this time.