Nurse Practitioner Candidates Research Articles

Death Anxiety and Its Related Factors among Advanced Nurse Practitioner Candidates: A Cross-Sectional Study

Death Anxiety and Its Related Factors among Advanced Nurse Practitioner Candidates: A Cross-Sectional Study

Mentoring the Wellbeing of Specialist Pediatric Palliative Care Medical and Nursing Trainees: The Quality of Care Collaborative Australia.

The Quality of Care Collaborative Australia (QuoCCA), working across 6 tertiary centers throughout Australia, builds capability in the generalist and specialist pediatric palliative care (PPC) workforce, by providing education in metropolitan and regional areas. As part of the education and mentoring framework, Medical Fellows and Nurse Practitioner Candidates (trainees) were funded by QuoCCA at four tertiary hospitals throughout Australia. This study explores the perspectives and experiences of clinicians who had occupied the QuoCCA Medical Fellow and Nurse Practitioner trainee positions in the specialised area of PPC at Queensland Children's Hospital, Brisbane, to identify the ways in which they were supported and mentored to maintain their wellbeing and facilitate sustainable practice. Discovery Interview methodology was used to collect detailed experiences of 11 Medical Fellows and Nurse Practitioner candidates/trainees employed by QuoCCA from 2016 to 2022. The trainees were mentored by their colleagues and team leaders to overcome challenges of learning a new service, getting to know the families and building their competence and confidence in providing care and being on call. Trainees experienced mentorship and role modelling of self-care and team care that promoted wellbeing and sustainable practice. Group supervision provided dedicated time for reflection as a team and development of individual and team wellbeing strategies. The trainees also found it rewarding to support clinicians in other hospitals and regional teams that cared for palliative patients. The trainee roles provided the opportunity to learn a new service and broaden career horizons as well as establish wellbeing practices that could be transferred to other areas. Collegial interdisciplinary mentoring, with the team learning together and caring for each other along common goals, contributed immensely to the wellbeing of the trainees as they developed effective strategies to ensure their sustainability in caring for PPC patients and families.

Education and Mentoring of Specialist Pediatric Palliative Care Medical and Nursing Trainees: The Quality of Care Collaborative Australia.

The Quality of Care Collaborative Australia (QuoCCA) builds capability in the generalist and specialist paediatric palliative care (PPC) workforce throughout Australia. It supports regional and community services to provide care close to families' homes, as well as building expertise in tertiary centers. Medical Fellows and Nurse Practitioner candidates (specialist trainees) were funded by QuoCCA at four tertiary hospitals throughout Australia supported by an education and mentoring framework. This study explored the activity and experiences of clinicians who had occupied these roles to evaluate their effectiveness to build PPC capability. Online surveys recorded the monthly activity of Medical Fellows, with a point in time check of knowledge, skills and confidence in 2019. Discovery Interview methodology was used to collect detailed experiences of 11 trainees employed between 2018 to 2022 in Queensland. A combination of mentoring and formal and informal education, peer support and practical experience was valuable for trainees. They found the support of the whole interdisciplinary team advantageous to learning. Shadowing experienced team members gave them the opportunity to learn practical skills, especially regarding communication with families. Practicing clinical skills was beneficial, through being on call, attending home visits, supporting families, prescribing medications and developing treatment plans in collaboration with the team.The trainee experience was optimised through learning from families, personal reflection, involvement in research projects and delivering QuoCCA education. The QuoCCA trainee roles for Medical Fellows and Nurse Practitioner candidates exhibit a valuable and effective education and mentorship framework that could be applied to other specialties. The service leadership and collaborative interdisciplinary team support various modes of education and mentoring. The roles not only develop the trainees' specialised PPC clinical skills, they also improve their general clinical practice, including communication, empathy and holistic care. A structured curriculum of education is recommended to protect these positive outcomes.

How the Institutional and Policy Context Shapes the Establishment of Nurse Practitioner Roles and Practice in New Zealand's Primary Health Care Sector.

The implementation of the nurse practitioner (NP) workforce in primary health care (PHC) in New Zealand has been slow, despite ongoing concerns over persisting health inequalities and a crisis in the primary care physician workforce. This article, as part of a wider institutional ethnography, draws on the experiences of one NP and two NP candidates, as they struggle to establish and deliver PHC services in areas of high need, rural, and Indigenous Māori communities in New Zealand. Using information gathered initially by interview, we develop an analysis of how the institutional and policy context is shaping their experiences and limiting opportunities for the informants to provide meaningful comprehensive PHC. Their work (time and effort), with various health organizations, was halted with little rationale, and seemingly contrary to New Zealand's strategic direction for PHC stipulated in the Primary Health Care Strategy 2001. The tension between the extant biomedical model, known as primary care, and the broader principles of PHC was evident. Our analysis explored how the perpetuation of the neoliberal health policy environment through a "hands-off" approach from central government and district health boards resulted in a highly fragmented and complex health sector. Ongoing policy and sector perseverance to support privately owned physician-led general practice; a competitive contractual environment; and significant structural health sector changes, all restricted the establishment of NP services. Instead, commitment across the health sector is needed to ensure implementation of the NP workforce as autonomous mainstream providers of comprehensive PHC services.

A quality improvement pilot to initiate treatment summaries and survivorship care plans in oncology services in South Australia

Aim:To review, test and refine standardised tools for nurses to initiate treatment summaries and care plans, and identify barriers and enablers to providing them. Background:This paper reports on a pilot study informed by the development of a Survivorship Framework in South Australia. Methods:Expression of interest was sought for adult medical oncology services to pilot standardised tools within existing services and resources. A quality improvement approach was used over three months with nurse practitioners and nurse practitioner candidates to obtain feedback, refine tools and resources, and identify barriers and enablers. Quantitative and qualitative data was recorded at each site using spreadsheets, at fortnightly meetings, and at a final debriefing. Content analysis was used to identify key themes in the context of barriers and enablers. Findings:Four medical oncology clinics in South Australia participated (three metropolitan, one regional). Forty-three consultations were delivered at three sites. Barriers included time to complete documentation, perceived knowledge and skills, re-orientation of clinics and referral pathways, competing service priorities and lack of administrative support. Enablers included interrelationships within and between pilot teams, supporting resources, and increased familiarity with tools. Discussion and conclusion:There is potential for nurses to initiate treatment summaries and care plans in the treatment setting with the use of standardised tools. Further refinements are needed to make the process less time burdensome, additional specialised training is needed to improve confidence of nurses to work in a wellness model, and numerous system challenges need to be overcome to improve overall feasibility of using standardised tools to provide survivorship support to patients. Lack of systems to populate information, and lack of referral processes to support survivorship discussions with patients are likely to limit the initiation of survivorship care in treatment settings in South Australia. Further nurse-led development of tools for treatment summaries and care plans should occur in parallel with translational research designed to address system challenges. What is already known about this topic?– Structured survivorship care is recommended to facilitate the individual follow-up needs, health and wellness of people treated for cancer. Many health services are grappling with the challenge of delivering survivorship care in a sustainable way. It is clear that embedding survivorship care routinely and at scale presents a significant implementation challenge for oncology services. What this paper adds.– Nurses are well placed to lead the initiation of treatment summaries and care plans, however, this pilot provides real-world insight into the system and practical challenges that need to be addressed to provide essential components of survivorship care in South Australia https://doi.org/10.37464/2020.371.3

158 Malnutrition Screening by an Interdisciplinary Integrated Care Team is an Essential Component of Comprehensive Geriatric Assessment

Abstract Background Malnutrition plays a key role in the pathogenesis of frailty and nutritional interventions may reduce the incidence. Comprehensive Geriatric Assessment (CGA) is the gold standard in assessment once frailty has been identified. Recent Nutritional Screening Data indicated that only 20% of Irish hospitals screened 76-100% of patients. Twenty-three percent of those aged 60-79 years and 30% of those >80 years were at risk of malnutrition (Russell & Elia, 2011). This emphasises the importance of a validated malnutrition screening tool as an integral component of CGA. This study evaluates the use of the Malnutrition Screening Tool (MST) by an integrated interdisciplinary team aimed at early identification of frail patients at risk of malnutrition. Methods A prospective study of consecutive frail patients, admitted through the emergency department (ED) to an acute hospital over five months was performed. Each patient had an interdisciplinary assessment (IA) performed. The IA included a MST tool. Patients were identified as frail using the Variable Indicative of Placement (VIP). Team members, consisting of a physiotherapist, speech and language therapist and advanced nurse practitioner candidates were trained by the team dietitian to use MST. Age, gender, Clinical Frailty Score (CFS) and MST were recorded in an excel datasheet. A patient scoring ≥2 on the MST indicated risk of malnutrition and the need for Dietetic Assessment (Wu et al. 2012). Results Three-hundred and sixty CGA’s were completed by an integrated interdisciplinary team over five months. The mean age (+/-SD) was 82.4 (+/-7). The male to female ratio was 1:1. The mean CFS (+/-SD) was 5.5 (+/-1.2) (mildly to moderately frail). Ninety-two percent (n=331) were screened using the MST. Thirty-five percent (n=115) were at risk of malnutrition. Conclusion Integrated interdisciplinary team training on the MST, resulted in successful identification of 35% (n=115) of frail patients “At Risk of Malnutrition”. Identification, combined with appropriate dietetic intervention, may reverse frailty in some of these patients.

Australian research investigating the role of nurse practitioners: A view from implementation science

Summary The catalyst for the paper was a rapid review of the literature which identified Australian research on nurse practitioners. This paper reports on those studies investigating individual nurse practitioner roles, framed in terms of the implementation science literature and three stages of implementation: exploration and adoption of the role, initial implementation of the role, and full operation of the role. Database searching of the peer-reviewed literature was supplemented with searching relevant web sites. Most studies focused on certain aspects of the nurse practitioner role rather than undertaking a comprehensive evaluation. There was no consistency in the way the roles were described, making it difficult to compare what may be similar roles in different studies. The research generally treats the nurse practitioner role as the independent variable, rather than the care provided by the nurse practitioner. The concept of implementation fidelity was absent from all studies, except for one which addressed the issue indirectly. Many studies included little contextual information, making it difficult to judge the role of context in influencing both implementation and patient outcomes and establish plausible links between the activities of the nurse practitioners and patient outcomes. Based on the findings, a checklist is recommended for use in future studies which would enhance the ability to make judgements about implementing nurse practitioner models of care; facilitate comparison of similar roles and increase the capacity to make informed decisions about the prospects for wider implementation of nurse practitioner roles or models of care.

A regional approach to the education of nurse practitioner candidates to meet the health needs of rural Australians.

Local health services expressed interest in supporting a nurse practitioner (NP) program specifically designed for rural practice environments. To develop and deliver a generalist NP program that prepares candidates for practice in rural contexts. The Master of Clinical Nursing (Nurse Practitioner) program was designed with an understanding of the burden of disease impacting on rural Australians, application of the national health priorities, the Australian Government's refocus on preventative health care and rural health workforce shortages. This program offers nurses who work in rural and remote settings an opportunity to advance their careers. Increasing the numbers of rural NPs will improve rural populations access to healthcare and potentially improve health outcomes. This program will equip those seeking endorsement as a NP to effectively work in rural contexts.

A regional approach to the education of nurse practitioner candidates to meet the health needs of rural Australians

Background: Local health services expressed interest in supporting a nurse practitioner (NP) program specifically designed for rural practice environments. Aim: To develop and deliver a generalist NP program that prepares candidates for practice in rural contexts. Methods: The Master of Clinical Nursing (Nurse Practitioner) program was designed with an understanding of the burden of disease impacting on rural Australians, application of the national health priorities, the Australian Government’s refocus on preventative health care and rural health workforce shortages. Results: This program offers nurses who work in rural and remote settings an opportunity to advance their careers. Increasing the numbers of rural NPs will improve rural populations access to healthcare and potentially improve health outcomes. Conclusion: This program will equip those seeking endorsement as a NP to effectively work in rural contexts.

Establishing a nurse practitioner collaborative: evolution, development, and outcomes.

The first Australian palliative care nurse practitioner (NP) was endorsed in 2003. In 2009 the Victoria Department of Health funded the development of the Victorian Palliative Care Nurse Practitioner Collaborative (VPCNPC). Its aim was to promote the NP role, develop resources, and provide education and mentorship to NPs, nurse practitioner candidates (NPCs), and health service managers. Four key objectives were developed: identify the demographic profile of palliative care NPCs in Victoria; develop an education curriculum and practical resources to support the training and education of palliative care NPCs and NPs; provide mentorship to NPs, NPCs, and service managers; and ensure effective communication with all key stakeholders. An NPC survey was also conducted to explore NPC demographics, models of care, the hours of study required for the role, the mentoring process, and education needs. This paper reports on the establishment of the VPCNPC, the steps taken to achieve its objectives, and the results of the survey. The NP role in palliative care in Australia continues to evolve, and the VPCNPC provides a structure and resources to clearly articulate the benefits of the role to nursing and clinical services.

Advanced nursing practice hours as part of endorsement requirements for nurse practitioners in Australia: A definitional conundrum

To define what can be considered to be nursing practice, time that can be calculated as the practice of nursing as well as what is considered to be advanced nursing practice and how all this can be related to the current endorsement process for nurse practitioner (NP) in Australia. Current codes and guidelines cited by the Nurse and Midwifery Board of Australia related to nursing practice and NPs, cited competency standards from the Australian Midwifery Accreditation Council, as well as published material of peak nursing bodies from within Australia as well as internationally were used. Information was also obtained through government health and professional organization websites. All information in the literature regarding current and past status and nomenclature of advanced practice nursing was considered relevant. The definitional entanglement of what is considered to be nursing practice, the calculation of specific hours and what is advanced nursing practice interferes with endorsement of NPs in Australia, and a clear understanding of what is meant by advanced practice is required to move forward. Dependent on how practice is interpreted by the Nurse and Midwifery Board of Australia directly affects the outcome of the endorsement proceedings for individual NP candidates.

Rural nurse to nurse practitioner: an ad hoc process

Despite a 10-year history of nurse practitioner (NP) development in New Zealand (NZ) there is no formalised or universal process for ensuring the transition of willing nurses to NP status. This unmet need is of particular interest in the rural context where workforce issues are paramount. The aim of this study was to explore the transition from rural nurse to NP in NZ. A qualitative descriptive survey was sent to all NZ nurses with a rural address. Ninety-two questionnaires were returned, of which 21 respondents were working in a rural location and aiming to become an NP. Data analysis included description of demographic data and thematic analysis of open-ended question responses. Four themes encompassed the experiences of the 21 potential NP candidates: uncertainty about opportunities for employment as an NP and legislative and funding barriers for NP practice; support or resistance from GPs and nurse colleagues, self-doubt, and the importance of mentoring; difficulties with the NP authorisation process; and meeting the NP competencies within the challenges imposed by rural location. At the systems level of workforce design, stronger linkages between policy development, investment, employment creation, funding streams, professional regulation and overall communication require attention.

Nurse practitioners are well placed to lead in the effective management of delirium

Objective: To acknowledge the detrimental impact that delirium continues to have on an individual and at the system level in an Australian acute inpatient setting and highlight the potential role that nurse practitioners can play in evidenced based prevention and management. Setting: Australian acute inpatient public hospital. Primary argument: Despite extensive literature and national policy driven initiatives delirium continues to be a neglected iatrogenic condition for elderly people. A local investigation by nurse practitioner candidates in an acute care hospital setting highlights the poor recognition of the problem. Delirium management must be a key part of the scope of practice for the gerontological nurse practitioner. Conclusions: Recognition and management of delirium is problematic. Leadership and continuity of care using evidence based prevention strategies; accurate diagnosis and treatment are important aspects of the gerontology nurse practitioners’ (GNP) scope of practice.

Scope of emergency nurse practitioner practice: where to beyond clinical practice guidelines?

Aim: The aim of this paper is to discuss some of the issues around continuing development of the Emergency Nurse Practitioner (ENP) role in a Victorian metropolitan Emergency Department (ED) setting. More specifically the discussion will consider the evolving clinical practice of the ENP in relation to clinical practice guidelines (CPG) and optimal utilisation of ENP skills and expertise. Background: Internationally the mainstay of ENP practice is predominantly minor injury/minor illness models of care. This trend reflects traditional areas of need, or service gap. It is recognised however, that for a service to be sustainable and effective, it must be flexible, dynamic and prepared for future challenges.The development of CPGs to inform ‘scope of practice’, has become contentious. The restrictive nature of ENP specific guidelines has become evident over time, and together with the labour intensive nature of their development, continuing use is questionable. The trend towards the use of multidisciplinary clinical practice guidelines that utilise existing clinical protocols has gained support for future nurse practitioner (NP) role development. These guidelines are generally of a robust, evidence based nature, with regular review and update and don’t apply to any specific clinician group. Method: An exploration of the progression of the ENP role and service model at a large metropolitan hospital ED was undertaken. An examination of the ongoing changes in demand for ENP service within this organisation was carried out together with the strategies in place, or required, for ENP role expansion and flexibility. Setting: The setting for this discussion is a large metropolitan Emergency and Trauma centre in Melbourne, Victoria, Australia. The ENP team consists of endorsed ENP and those in training, generally referred to as Emergency Nurse Practitioner Candidates (ENPC). This ENP/C team is employed and cover sixteen hours per day, seven days per week, primarily in the ‘fast-track’ area of the department. ‘Fast-track’ is an area within the ED specifically treating patients presenting with minor injury and minor illness deemed likely to be seen, treated and discharged within a four hour time frame. Conclusion: The ENP model of care at this organisation confirms ongoing evolvement and expansion of the role in terms of increasing numbers of ENP/C. Questions continue as to the most efficient utilisation of the role to best benefit the ED as a whole and more specifically, patient outcomes. The need for a continued, cooperative and collaborative approach by stakeholders to inform role progression and continuing clinical practice expansion is paramount for continuing department improvements and better patient outcomes.

Nurse practitioner prescribing practice in Australia

In Australia, nurse practitioner (NP) services are a relatively new development with little being known about the prescribing practices of Australian NPs. The aim of this study was to conduct the first national study of Australian NP prescribing practices. Focus groups were conducted to inform construction of an electronic survey that was available for all NPs and NP candidates across Australia to complete. Seventy-two percent of authorized NPs and 39% of NP candidates reported that their practice involved prescribing pharmaceutical agents. Of those respondents who did prescribe during the course of their practice, 59% (n = 29) of the authorized NPs and 64% (n = 16) of the NP candidates reported that they usually prescribe at least once a day. The results from this study suggest that fewer Australian NPs prescribe than do NPs in the United States, and those who do prescribe do so less frequently. The current health policy framework in Australia while creating space for the role of the NP is restricting the role's utility and potential contribution to the health care of Australians.

Perceived barriers to the sustainability and progression of nurse practitioners

In 1998 in Victoria, Australia, the Nurse Practitioner (NP) model was considered with projects exploring the potential for NP implementation in emergency departments (EDs). The aim of this study is to explore the perceived barriers to progression and sustainability of the NP role in Victoria. A survey of the 17 EDs involved in the initial projects was undertaken targeting NP candidates, nurse managers and project officers. A total of 48 individuals were identified and contacted. The survey comprised of demographic details and statements about NP role sustainability and progression using a Likert scale A total of 37 participants (77%) completed the survey. Participants strongly agreed that there were barriers to sustainability, especially lack of ongoing funding from their own organisation and external sources. Other barriers included a lack of understanding from the organisation and medical staff about the role. The main barriers to role progression were the legislative constraints (n=29, 78%) and the cost of Masters programmes (n=29, 78%) This survey revealed a myriad of barriers to role sustainability and progression. These barriers need to be explored and progressed if the NP role is to continue to develop and expand.

E-portfolios: developing nurse practitioner competence and capability

Objective: This paper aims to integrate nurse practitioner literature on competence and capability with post graduate and nursing literature on e‑portfolios in order to demonstrate the potential merits of e‑portfolios in nurse practitioner education for competence and capability development. Primary Argument: In the Nurse Practitioner Standards Project, competence and capability were proposed as key criteria to assess candidates in nurse practitioner educational courses. Portfolios have traditionally been used to demonstrate competence in nursing and are integral to nursing education as well. An examination of the portfolio and electronic portfolio literature in postgraduate nursing education and professional practice indicates that these portfolios fall under two main structures, each with different purposes: 1) A spinal column structure, with evidence and reflective pieces aligned to competency standards or course objectives, for the purposes of meeting prescribed competencies, professional development planning and showcasing evidence for authorisation or potential employers; and 2) A cake mix structure, which consists of a reflective narrative tying evidence together, which enables a greater focus on personal learning journeys, reflection and the development of personal qualities. Finally, evidence from the general nursing literature suggests the complexity of e‑portfolios in assessment and evaluation can be overcome by using qualitative research methods. Conclusion: To meet the competence and capability needs of nurse practitioners, portfolios could be used, for competence and showcasing and for learning and capability. Further research would be useful to refine and explore the use of e‑portfolios to meet the needs of NP candidates and their educators, clinical mentors, authorisation personal and employers. The current evidence on nurse practitioner education, competence, capability and e‑portfolios points to the integration of the use of an e‑portfolio into current nurse practitioner curriculum models to meet the unique needs of nurse practitioner candidates.

Assessing leadership in nurse practitioner candidates

Objective: The aim of this study was to explore the concept of leadership as it applies to nurse practitioners (NPs) and examine the issues around assessing NP candidates in Australia for leadership qualities. Setting: Currently in Australia, registration as a nurse, midwife, enrolled nurse or nurse practitioner is conducted at the state or territory rather than the national level. Nurse practitioner is a protected title in Australia. To practice as a nurse practitioner in Australia, candidates must be endorsed or authorised by the nurse registering authority in the relevant state or territory of Australia. The NP candidate can be based in both hospital and community settings, caring for both inpatients and outpatients, over a range of specialty areas. The context of this paper is Victoria, Australia. Currently there is no national process for the registration of NPs. Each Australian state or territory determines its ownrequirements. Subjects: Nurse practitioner candidates in Victoria, Australia. Primary argument: Clinical leadership is difficult to define and assessment of NP candidates for leadership qualities can be subjective and inconsistent. Leadership is often confused with management and those who are seen by their colleagues as leaders are not necessarily in senior positions. NP candidates applying for endorsement or authorisation to practice as a nurse practitioner are assessed for competency in leadership by the nurse registering authorities with no clear defining criteria. Many of the leadership indicators may fall under a different Standard of Competency for NPs (ANMC 2006). Conclusions: Those who are seen as leaders do not necessarily fulfill consistent and predictable criteria. Many NP candidates will not have achieved clinical leadership as outlined in the ANMC standards for Nurse Practitioners (2006). Definition of leadership has been notoriously difficult across nursing and other disciplines. The concept of transformational leadership appears to fit the NP model appropriately, although measurement of transformational leadership is as equally problematic as the traditional view of leadership. Until an acceptable definition of clinical leadership for an NP is developed, assessing NP candidates for this quality should be creative and flexible, and recognition should be given that leadership qualities may be in developmental stage.

Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne, Australia

The aim of this study was to evaluate the impact of the introduction of Emergency Nurse Practitioner Candidates (ENPC) on waiting times and length of stay of patients presenting to a major urban Emergency Department (ED) in Melbourne, Australia. As part of a Victorian state funded initiative to improve patient outcomes, the role of the Emergency Nurse Practitioner has been developed. The integration and implementation of this role, is not only new to the Alfred Emergency and Trauma Centre but to EDs in Melbourne, Australia, with aims of providing holistic and comprehensive care for patients. A retrospective case series of all patients with common ED diagnostic subgroups were included. The ENPC group (n = 572) included all patients managed by the ENPC and the Traditional Model (TM) group (n = 2584) included all patients managed by the traditional medical ED model of care. Outcome measures included waiting times and length of stay. Statistically significant differences were evident between the two groups in waiting times and length of stay in the ED. The overall median waiting time for emergency patients to be seen by the ENPC was less than for the TM group [median (IQR): ENPC 12 (5.5-28) minutes; TM 31 (11.5-76) minutes (Wilcoxon p < 0.001)]. Length of stay in the ED was also significantly reduced in the ENPC group [median (IQR): ENPC 94 (53.5-163.5) minutes; TM 170 (100-274) minutes (Wilcoxon p < 0.001)]. The comparison of overall waiting times for ENPC shifts vs. non-ENPC shifts revealed significant differences [median (IQR): ENPC rostered 24 (9-52) minutes; ENPC not rostered 33 (13-80.5) minutes (Wilcoxon p < 0.001)]. This study has demonstrated that ENPCs implementation in Melbourne, Australia were associated with significantly reduced waiting times and length of stay for emergency patients. Emergency Nurse Practitioners should be considered as a potential long term strategy to manage increased service demands on EDs. Relevance to clinical practice. This study is the first in Australia with a significant sample size to vigorously compare ENPC waiting times and length of stay outcomes with the TM model of care in the ED. The study suggests that ENPCs can have a favourable impact on patient outcomes with regard to waiting times and length of stay.

Nurse practitioner candidates: Shifting professional boundaries

Summary Background In many countries the introduction of emergency nurse practitioners has been one initiative implemented by governments to address service gaps due to staff shortages: this has particularly been the case in regional and rural areas where the labour skill shortage is most acute. Even in areas where the nurse practitioner role is well established, studies have repeatedly shown enmity among health care professionals around scope of practice and work role boundaries. Aim The purpose of this study was to determine the impact of a new emergency nurse practitioner model of practice from the perspective of health care professionals most closely involved, and to identify the drivers and challenges to the role implementation. Method A descriptive exploratory survey was used to explore staff perceptions of the emergency nurse practitioner role. Results Participants ( N = 37) reported that the model improved collaboration and team dynamics, aided in professionalism in nursing, improved efficiencies/quality of care, enhanced job satisfaction and affected the workload of medical staff and managers. Participants perceived that the demand for the service was high and the Emergency Nurse Practitioner Candidates’ existing qualities helped to develop the role. In addition, implementation of the role was perceived to be supported by extensive marketing, evidence-based protocols, the use of a project officer and Department of Human Services funding. Regular reviews and engagement of relevant key stakeholders was also viewed as central to the success of the role. Challenges to the role were perceived to relate to a number of factors including: professional territorialism, limited marketing to some groups of staff, lack of access to education for the Nurse Practitioner Candidates and to some areas of supervised practice, a protracted endorsement process and lack of funding for a sustainable model. Conclusion Contrary to previous studies, this study showed that the majority of medical, nursing and affiliated staff strongly supported this model of practice, with little enmity evident amongst the health care professionals. Recommendations are made to help further refine the model for future practice.