Expanded Practice Roles Research Articles

The Secret of Serotinous Leadership:: The Pandemic Crisis Changed Care Models, But Only After Leaders Changed Their Minds About Them

The COVID-19 pandemic punctured the status quo, triggering a reassessment of mindsets, biases and assumptions that had impeded widespread adoption of virtual care models and advanced nursing practice roles within them. Now, as we move to a post-pandemic environment, we enter a new phase, one in which continued progress on these fronts is not assured. Formalizing these breakthroughs as new standards of care - and securing nurses’ expanded practice roles - rests on the ability of nurse leaders to address a phenomenon called “cultural lag” and imaginatively shape the transformation on which continued progress depends.

The role of the registered nurse first assistant within the perioperative setting.

Perioperative setting registered nurse first assistants (RNFAs) are described as non-medical practitioners who perform surgical interventions during surgery. They provide medical care to perioperative patients under the supervision of a consultant surgeon. First assistants in surgery can be an expanded perioperative nursing role. A review of the literature illuminates the need for continuous learning in developing skills in becoming competent RNFA practitioners and how they utilise acquired skills to assist, mentor and teach their colleagues within the perioperative setting. The RNFA is an advanced and expanded practice role. RNFAs contribute significantly to the provision of care within all phases of perioperative care (preoperative, intraoperative, postoperative). There is little literature on the role of the RNFA due to its relatively recent emergence in the healthcare sector and the small number of countries where it is implemented.

Australian Mental Health Nurses’ Attitudes to Role Expansion

This study examined the attitudes of Australian community mental health nurses toward role expansion. This study used an exploratory descriptive design. An anonymous questionnaire was completed by 154 community mental health nurses in metropolitan and rural areas to explore their attitudes to expanded practice. Nurses demonstrated an overwhelmingly positive attitude toward expanded practice and considered all stakeholders, particularly consumers, would be the beneficiaries if nurses were legally able to undertake tasks such as prescribing medication. As a large proportion of the specialist mental health workforce, mental health nurses comprise a largely underutilized resource. With consumers identified as the primary beneficiaries of expanded practice, it is likely that nurses' motivation to pursue expanded practice roles will assist in the provision of improved mental health care.

Expanded Practice Roles for Community Mental Health Nurses in Australia: Confidence, Critical Factors for Preparedness, and Perceived Barriers

As the momentum for nurse practitioner roles rapidly increases in Australia, little scholarly attention has been directed towards barriers to role expansion, the confidence necessary to undertake expanded practice roles (other than prescription of medication), or the educational preparation required for expanded roles. This paper reports on community mental health nurses' views regarding confidence to undertake expanded roles, their opinions regarding the necessary preparation for such roles, and barriers to role expansion. An questionnaire was administered to 296 community mental health nurses employed in metropolitan and rural settings in Victoria, Australia. In regards to various domains of expanded practice, nurses were least confident about prescribing but more than half (54%) reported that they would either “definitely” or “probably” feel confident. Over 90% reported “probably” or “definitely” feeling confident to make recommendations for involuntary treatment. Eighty-four percent and 79% reported similar levels of confidence in relation to ordering diagnostic tests and referring patients to medical specialists, respectively. Most (95%) agreed that extra educational preparation was necessary in relation to undertaking expanded practice roles successfully. Factors considered most strongly as barriers to expanded nursing practice included the medical profession, followed by fear of litigation, and government departments and policies.

Expanded Practice Roles for Community Mental Health Nurses: A Qualitative Exploration of Psychiatrists’ Views

The aim of this paper was to explore the perspectives of psychiatrists regarding the potential impact of expanded nursing practice roles on mental health care delivery. In-depth interviews and a focus group were conducted with psychiatrists from metropolitan and rural Victoria, Australia, using a qualitative exploratory design. Four main themes emerged: nurses' preparation to undertake expanded practice; power and autonomy of nurses; final responsibility rests with psychiatrists; and, the future of expanded nursing practice. Participant responses to these themes were varied and diverse. Participant responses elucidate the complexity of the issues and suggest that a number of factors influence psychiatrists' opinions of the expanded practice role.

EXPANDED PRACTICE ROLES FOR COMMUNITY MENTAL HEALTH NURSES: WHAT DO CONSUMERS AND CARERS HAVE TO SAY?

Community-based mental health as the primary focus of treatment has influenced more autonomous roles for mental health nurses. A limited literature suggests that this has resulted in the expansion of community mental health nursing into territory usually the exclusive domain of the medical profession. Consumers and carers are the two groups most affected by changes to service delivery; however, their views regarding the changing role of community mental health nurses have not been sought. This paper presents the findings of a qualitative study involving indepth interviews with Australian consumers (n = 4) and carers (n = 6) designed to explore their views and opinions about the expanded practice roles of community mental health nurses. Four main themes were identified: accessibility and convenience; relationship with clinicians; beneficiaries of expanded nursing practice; and, are nurses up to it? The findings suggest expanded practice roles are perceived positively by consumers and carers and therefore worthy of further investigation.

Nonprescription Drug Therapy: Issues and Opportunities

Nonprescription drug therapy is tightly woven into the fabric of American health care. Market forces are expected to contribute to significant expansion of nonprescription drug use. Consumers place high value on nonprescription drug therapy; however, self-medicating patients frequently need assistance from a learned intermediary to assure optimal integration of nonprescription drug therapy into the total care regimen. Pharmacist-assisted self-care holds vast potential to serve the public interest, but this expanded practice role will require higher levels of professional practice commitment by American pharmacy. That commitment must be supported by practice-relevant, competency-based, patient-centered college and school of pharmacy curricula and continuing education that assures perpetual intellectual proficiency in nonprescription drug pharmacotherapy. That knowledge and competency must be integrated holistically into the total mix of patient comorbidity and polypharmacy. The pharmacist-assisted self-care business and professional practice model must be further facilitated by state and national pharmacy organizations, chain and independent community pharmacy, pharmacy wholesalers, and others. Consumers await expanded and differentiated pharmacy-based, pharmacist-provided medication therapy management services focused on the safe, appropriate, and effective selection, use, and monitoring of nonprescription drugs therapy.

Consumers' Level of Comfort with an Advanced Practice Role for Registered Nurses in General Practice: A Queensland, Australia, Study

A study was carried out in Queensland, Australia, which aimed to ascertain how comfortable consumers were with both the current and an expanded practice role for nurses employed in general practice. Consumers from metropolitan, rural and remote areas were represented. The self-report questionnaire was completed by 87 females and 19 males. Consumers rated their level of comfort from very comfortable to very uncomfortable on a five-point scale in nurses performing 24 different routine and advanced procedures. They were most comfortable with nurses giving vaccinations and managing treatment of wounds and less comfortable with nurses diagnosing and treating minor illnesses. Overall, consumers were very comfortable with nurses performing what may be considered traditional roles of the practice nurse. They were less comfortable with the more extended roles that are seen more as the traditional role of the general practitioner. However, for no procedure were consumers uncomfortable with nurses performing that task. There were no differences in responses due to consumers' age, sex or previous contact with practice nurses. These results may be used to expand the role of practice nurses to complement the services provided by general practitioners.

Decisions by nurses in acute care to undertake expanded practice roles.

Since 1992, expanded practice has been an important issue in the career progression of the qualified nurse. Its contemporary relevance in the early years of the 21st century is underpinned by recent and ongoing national initiatives to blur the boundaries between healthcare providers, and to regulate practice at a higher level. This article reports the findings of a survey and in-depth, semi-structured interviews conducted with nurses from across the UK, which explores their views and experiences in terms of decisions regarding whether or not to undertake expanded practice roles. Insights are gained in a variety of domains of expanded practice including preparation for the role, competency verification, perceptions of accountability and liability, effects on patient care, role refusal and utilization of evidence to underpin expanded practice. These reported views and experiences have important implications for current practice and future research.

International collaboration: initial steps and strategies.

The nurse practitioner (NP) movement, which began in the United States in 1965, has caused sweeping changes both in nursing and in health care delivery. The concept of NPs then spread to the United Kingdom (U.K.) and continues to move globally. The international development of NPs has been streamlined through collaborative efforts of the U.S. and the U.K. There have been striking similarities in the evolution of expanded practice roles in both countries. In 1993, NPs from the U.S. and the U.K. came together to support the first international NP conference and, in the process, developed a framework for global international collaboration. This article summarizes the collective knowledge and the strategies for success developed through this collaborative effort.

The role of the perinatal home care clinical nurse specialist.

The perinatal home care clinical nurse specialist (CNS) is a cost-effective expert with the education and clinical skills to function in an expanded practice role in home care. The benefits of employing a perinatal home care CNS, a sample job description, the roles involved, and a model for evaluation are presented.

Emergency interhospital critical care transport for children

The importance of pediatric interhospital transport has increased dramatically in the past 5 to 10 years. Reasons include improved capabilities of tertiary care centers receiving transported patients, advances in availability of portable equipment that functions well in moving vehicles, and widespread recognition that pediatric transport differs from that of adult transport. Practitioners of pediatric transport must deal with adaptation to previously developed models for adult and neonatal transport. National medical, regulatory, and educational organizations have recently focused attention on medical transport in general and pediatric issues in particular. Research in the field remains preliminary but is increasing rapidly, both in quantity and quality, with major progress being made in the areas of triage, training nonphysician personnel in expanded practice roles, and establishing baseline national standards.

Court upholds expanded practice roles for nurses.

In the first reported judicial interpretation of modern nursing practice acts, Sermchief v. Gonzales, the Missouri Supreme Court has decided that “new functions for nurses delivering health services” may evolve without statutory constraints.’ The notion that nurses in expanded roles are practicing medicine without a license was cast aside, as the court specifically held that nurses may render diagnosis and treatment in accordance with standing orders and protocols. While directly affecting only nurses in Missouri, the court's recognition of nursing as a profession with its own prerogatives and responsibilities has important implications for the future of nursing.At issue was Missouri's nursing practice act which had been drafted with the assistance of members of the Missouri Nurses Association and passed by the legislature in 1975.

Compliance Clinic: An Opportunity for an Expanded Practice Role for Pharmacists

The development and operation of a pharmacy-based clinic providing specialized services to noncompliant patients is described. Physicians refer patients who are not complying with their medication regimens to the pharmacy. The pharmacist interviews the patient to determine the reasons for noncompliant behavior and to reinforce the need for taking medications as directed. Special packaging, such as unit-of-use, may be used to encourage compliance. Medication calendars also are employed. The program has yet to be evaluated fully, but it is concluded that the compliance clinic has permitted the growth of comprehensive pharmacy practice.