Advanced Nursing Roles Research Articles

Consensus on competencies for advanced nursing practice in Spain

There is a lack of international consensus on the exact definition and core competencies of advanced practice nursing (APN) roles, a problem particularly acute in our national context due to the lack of APN role development, which has a significantly short history in our country. The main objective of this paper was the delineation of the competence framework for Advanced Practice Nurses in our national context based on expert consensus through the Delphi method Based on a preliminary literature review process, a conglomerate of 17 domains of competence (clusters of related competencies) were identified. This initial set was revised, refined and validated by a group of expert panellists on the subject (clinicians, researchers, managers, and teachers) through successive rounds in search of a suitable consensus on each of the various proposed items The results helped to establish a solid foundation in the form of a skills map that could identify those sets of more specific competencies for advanced practice roles, regardless of regulatory and professional practice context, identifying domains such as Research and Evidence Based Practice, Clinical and Professional Leadership, or Care Management This set of skills related to advanced practice roles in our environment can delineate competency standards common to this level of nursing practice, and serve as a reference for policy development, a review of roles, or the establishment of academic profiles.

Patients' perspectives of fast-track surgery and the role of the fast-track clinical nurse consultant in gynecological oncology.

This study examines the role of the fast-track nurse in gynecology from a patient perspective. The fast-track nurse is a specialist nursing role, which coordinates patient care, in addition to providing specialized clinical care. Semistructured interviews were conducted with women who had fast-track surgery for gynecological cancer.

The Development of Evidence Briefs to Transfer Knowledge About Advanced Practice Nursing Roles to Providers, Policymakers and Administrators.

The transfer of health-related research knowledge between producers and users is a complex, dynamic and iterative process. There has been little research describing the preferred knowledge transfer strategies used by different stakeholder groups, including healthcare providers, policymakers and administrators. The purpose of the survey was to gain an understanding of the content and preferred dissemination strategies of knowledge users of briefing notes about the effectiveness of advanced practice nursing (APN) roles in Canada. An on-line cross-sectional survey was conducted from December 2011 to January 2012. Purposeful sampling was used to identify the target audience. The questionnaire included six items. The response rate was 44% (n=75/170). Participants identified that the briefing note should concisely summarize definitions for APN roles and information about the safety, effectiveness, cost savings and effective role implementation strategies. Multiple approaches were favoured to disseminate the information. Preferred dissemination strategies included personalized emails, meeting with briefing note recipients, engaging nurse practitioners and clinical nurse specialists in organizations where APN roles have been successfully implemented, engaging the media and using social media. The use of briefing notes has shown promise. More research is needed to evaluate the effectiveness of tailored briefing notes.

An investigation of barriers and enablers to advanced nursing roles in Australian general practice

Over the past decade, there has been substantial increase in nurses' roles in primary health care, particularly in general practice settings. Simultaneously, there has been an expansion of advanced roles for nurses across a range of clinical environments. This paper draws upon findings from a study that sought to develop a framework to support development of advanced nursing roles in general practice. It presents findings from one part of that study that explored barriers and facilitators to the development of these roles. Twenty-three key leaders from nursing, general practice and professional organisations participated in semi-structured interviews. Data were analysed using thematic analysis. A range of factors was identified as key to developing advanced roles in general practice. These included increasing awareness and attractiveness of practice nursing, health reform activities, practice limitations, education and professional development. Understanding complex systems and workforce issues is required to promote active intervention that can facilitate development of advanced nursing roles in Australian general practice.

Experiences of working as an advanced practice nurse in Finland--the substance of advanced nursing practice and promoting and inhibiting factors.

Evaluation of new advanced practice nursing roles, from different angles, is strongly recommended in the literature. New nurses' experiences of working in an advanced role may highlight problems and/or factors that promote or inhibit a successful implementation of new advanced nursing roles. To explore advanced practice nurses' experiences of the content of their nursing care and to describe promoting or inhibiting factors for working with a full scope of advanced nursing practice. The study design was explorative and descriptive. A total of 24 advanced practice nurses participated in focus group interviews (two were interviewed individually) about the processes, structure and outcome of working as advanced practice nurses. Qualitative manifest content analysis was used for data analysis. The substance of advanced practice nursing can be described with three main themes: a broader and deeper holistic view of patients' state of health, an independent and responsible manner of working and knowing own limits. Promoting factors were an identity as a nurse with advanced competency, feedback from satisfied patients and fruitful teamwork is a necessity. Inhibiting factors were a lack of organisational understanding for advanced nursing practice, poor planning leads to unsatisfactory advanced practice nursing models and advanced practice nurses' lack of courage in adopting new advanced roles. The participants experienced both a personal inner transition and a role transition that were either supported or opposed. Vague or nonexistent definitions and concepts, insufficient knowledge, insufficient support and undefined roles hindered participants' role transition. Two main strategies should be employed. The first is the realisation of more strategic leadership and support from organisations on all management levels, including nursing organisations/unions, while the second is to more realistically prepare future advanced practice nurses for the challenges they will face, through mentorship programmes and continuous further training.

Exploring the potential for advanced nursing practice role development in Kenya: a qualitative study.

BackgroundDefinitions of advanced nursing practice abound, yet little has been published concerning the context for advanced nursing in sub-Saharan Africa. This study set out to explore the existence of, and potential for, advanced nursing practice in Kenya.MethodsTen nurses were invited to participate in semi-structured qualitative interviews. Participants were purposively selected to provide insight into the practice of experienced nurses in urban, rural, community, hospital, public and private health care settings. Interview narratives were recorded, transcribed and subsequently analysed using a thematic approach.ResultsAll participants reported that they were engaged in the delivery of expert, evidence-based care. The majority also undertook administrative activities, teaching in the practice area and policy and practice advocacy. However, only the two private practice nurses interviewed during the study were working with the level of autonomy that might be expected of advanced nurse practitioners.ConclusionsWhile participants were undertaking many of the activities associated with advanced nursing roles, advanced nursing practice as widely understood in the (largely western derived) international literature was not identified. The nurses practicing with the greatest autonomy were generally those with the lowest educational qualifications rather than the highest. Highly qualified nurses and midwives tend to move into management and education, and see little opportunity for advancement while remaining in clinical practice. It is notable that, although a growing number of universities offer master’s level education, no African countries have yet regulated an advanced level of practice. The existence of the physician substitute ‘clinical officer’ cadre in Kenya, as in other Sub-Saharan African countries, suggests that the development of the advanced nurse practitioner role is unlikely at present. However, there is a pressing need for advanced nurses and midwives who can implement evidence-based practice and exercise clinical leadership in the drive to attain the Millennium Development Goals and their post-2015 successors.

Advanced practice nursing, health care teams, and perceptions of team effectiveness.

This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families.

Recognising the differences in the nurse consultant role across context: a study protocol.

BackgroundThe advanced practice role of the Nurse Consultant is unique in its capacity to provide clinical leadership across a range of contexts. However, the Nurse Consultant role has been plagued with confusion due to lack of clarity over function and appropriateness for purpose within health organisations across contexts. Changing health service delivery models are driving the emergence of new nursing roles, further clouding the waters related to role positioning and purpose. There is an urgent need for evidence of impact and demonstration of how Nurse Consultants contribute to health care outcomes. This study aims to gain a clearer understanding of the Nurse Consultant role and its impact in metropolitan and rural New South Wales (NSW) Australia.DesignThe proposed study employs a sequential mixed method design, underpinned by Realistic Evaluation, to explore how Nurse Consultants contribute to organisational outcomes. The ‘context – mechanism – outcome’ approach of realistic evaluation provides a sound framework to examine the complex, diverse and multifaceted nature of the Nurse Consultant’s role.MethodParticipants will be stakeholders, recruited across a large Local Health District in NSW, comprising rural and metropolitan services. A modified and previously validated survey will be used providing information related to role characteristics, patterns and differences across health context. Focus groups with Nurse Consultant’s explore issues highlighted in the survey data. Focus groups with other clinicians, policy makers and managers will help to achieve understanding of how the role is viewed and enacted across a range of groups and contexts.DiscussionLack of role clarity is highlighted extensively in international and Australian studies examining the role of the Nurse Consultant. Previous studies failed to adequately examine the role in the context of integrated and complex health services or to examine the role in detail. Such examination is critical in order to understand the significance of the role and to ascertain how Nurse Consultants can be most effective as members of the health care team. This is the first Australian study to include extensive stakeholder perspectives in order to understand the relational and integrated nature and impact of the role across metropolitan and rural context.

Clarifying Clinical Nurse Consultant work in Australia: A phenomenological study

The Clinical Nurse Consultant role in Australia is an Advanced Practice Registered Nurse Role (APRN). This role has been conceptualized from the discrete pillars of research, education, practice, system support and leadership, articulated in the Strong Model of Advanced Practice. This conceptualization has been manifested in job descriptions, workforce. planning and course design. This paper explored whether there was a more refined way of conceptualizing the unique 'value add' of the role. A hermeneutic phenomenological approach was employed to explore the lived experience of the role. It was identified that the pillars of education, practice, leadership and research are interconnected and expressed in the system work of the Clinical Nurse Consultant. The findings have implications for education and workforce planning.

The role and development of consultancy in nursing practice

The term consultancy is used in many contexts. It has been applied to advanced nursing practice roles such as clinical nurse specialist, advanced nurse practitioner, nurse practitioner and other occupations. This causes confusion in the healthcare setting as the word is often used interchangeably between roles and has traditionally been used in a medical context. In addition, the development of nurse consultant posts has further compounded the uncertainty around consultancy. However, regardless of the role holder, consultancy in nursing is normally used in the context of a person in possession of expertise. This article describes consultancy in nursing; identifying its development, approaches, application and possibilities for the future.

Retos y oportunidades: aportaciones de la Enfermera de Práctica Avanzada en la cronicidad. Aprendiendo de las experiencias

Undoubtedly, our society is facing new economic, political, demographic, social and cultural challenges that require healthcare services able to meet the growing health needs of the population, especially in dealing with chronic conditions. In this new context, some countries such as the United Kingdom have made a firm commitment to develop new models for chronic patients care based on the introduction of new figures of Advanced Practice Nurses, which includes 4 cornerstones of professional practice: advanced clinical skills, clinical management, teaching and research. The implementation of this new figures implies a redefinition of professional competencies and has its own accreditation system and a specific catalogue of services adapted to the population requirements, in order to provide chronic care support from Primary Care settings. This trajectory allows us analysing the process of design and implementation of these new models and the organizational structure where it is integrated. In Spain, there are already experiences in some regions such as Andalucia and the Basque Country, focused on the creation of new advanced nursing roles. At present, it is necessary to consider suitable strategic proposals for the complete development of these models and to achieve the best results in terms of overall health and quality of life of patients with chronic conditions, improving the quality of services and cost-effectiveness through a greater cohesion and performance of healthcare teams towards the sustainability of healthcare services and patient satisfaction.

Exploring the potential for advanced nursing practice role development in Kenya: a qualitative study

Exploring the potential for advanced nursing practice role development in Kenya: a qualitative study

Knowledge Gaps Regarding APN Roles: What Hospital Decision-Makers Tell Us

The implementation of advanced practice nursing (APN) roles can yield improvements in patient and health system outcomes, and supportive leadership is integral in facilitating the implementation of such roles. The purpose of this study was to explore the awareness and understanding of APN roles among hospital decision-makers, and to learn about the information they require and the ways in which they prefer to receive that information. Fifteen administrators and leaders from two multi-site acute care organizations were interviewed. Their practical knowledge of APN roles was based on experience developing the roles or working with APNs in hospital programs. The most common sources of APN information were internal contacts (i.e., APNs) and documents from nursing organizations. Participants reported difficulty distinguishing between the roles of nurse practitioners (NPs) and clinical nurse specialists (CNSs), and identified knowledge regarding CNS roles as their greatest need. They required specific information regarding the "value-added" benefits offered by an APN role. Strategies to address the knowledge gaps of healthcare leaders are urgently needed in order to support the implementation of new APN roles and to sustain existing ones.

Nurse satisfaction with working in a nurse led primary care walk-in centre: an Australian experience

Objective: The aim of this study was to gain insight into the nursing staff’s experiences and satisfaction with working at the ACT nurse led Walk-in Centre. Design and Setting: Interviews with nursing staff working at the ACT Walk-in Centre were informed by a phenomenological approach. Questions were developed within inter, extra and intra-personal variables of satisfaction, underpinned by theprinciples of role theory. Subjects: Twelve nurses were interviewed; three nurse practitioners and nine advanced practice nurses. Their ages ranged from 31 to 63 years and they had a minimum of 15 years of nursing experience. Interviews ranged from 30 minutes to two hours duration. Results: Walk-in Centre nurses’ satisfaction with a number of inter and extra-personal factors was associated with their previous education and experience (intra-personal factors). Role stressors included adapting to autonomy, role incongruity and lack of access to appropriate education, training and sources of collaboration and mentorship. Sources of satisfaction were the autonomous role, relationships with the team and the capacity to deliver quality nursing care. Conclusion: Whilst autonomy is valued by nurses, this does not translate to isolation or independence. Autonomy is only a source of satisfaction when coupled with supportive and cohesive professional relationships with both nursing and medical colleagues. Organisations implementing advanced nursing roles must have a comprehensive understanding of the requirements of nursing autonomy to ensure effective role implementation and associated job satisfaction. These findings add impetus to the need for the development of nursing education programs tailored specifically to primary health care.

Advanced roles for nurses working in general practice: A study of barriers and enablers for nurses in rural Australia

Rural Australians have poorer access to health services than Australians living in metropolitan areas primarily because of shortages in the health professional workforce. Nurses taking on advanced skills could help this situation by relieving doctors but our understanding of the factors that enhance or inhibit uptake is poorly understood in rural areas of Australia. The aim of this study is to identify the barriers and enablers associated with the implementation of advanced nursing roles in rural general practice specifically although an urban general practice was included to ensure that the diversity of practices were represented. The selection of general practices was based on ( 1 ) . a standardised classification system that uses geographic location and population base as the key criterion and ( 2 ) . ease of access for the research team. The general practices were all located within 3 hours drive of the researchers’ home base. Using case study design four rural and one metropolitan located general practices were included. The researchers compared recorded nursing activities with job descriptions, educational opportunities and advanced competency standards. Interviews with practice principals, practice managers and nurses were undertaken. Findings are categorised as: personal which includes motivation, knowledge and time; workplace which includes status, guidelines and practice conventions and routines; and policy which includes national payment systems, and scope of practice. The potential for nurses to advance their practice and meet the needs of patients, particularly in the specialist areas of chronic care and health promotion, is still under developed in the rural practices. The findings have led to the development of a framework for the introduction of advancing practice roles for nurses that will meet the needs of a currently, under-served community.

To investigate the concerns and benefits of job sharing a community based Clinical Nurse Consultant role

Objective: The purpose of this study was to identify concerns and benefits of job sharing the Clinical Nurse Consultant (CNC) Youth Health team role and how these impact on job sharing a nursing leadership role. Design: qualitative descriptive method was used in this study. Setting: Primary care. Subjects: The sample comprised of key stakeholders of the Youth Health care team including members of the multidisciplinary team and health care referrers to the Clinical Nurse Consultants as well as the Clinical Nurse Consultants whom share the role. Main outcome measures: Identification of needs required to assist in developing recommendations for nursing leadership job share models for a changing workforce in healthcare. Results: The study identified several themes needed to ensure successful job sharing of a leadership role: effective communication, compatibility, support, teamwork, mentoring and flexibility in care provision. Implementing systems that support and encourage these are necessary. Conclusion: Results suggest that concerns do exist for organisations when staff job share a leadership role. However, several key points can aid in successful job sharing for organisations and nurses as well as improved patient outcomes. These results should help nurses to develop and facilitate increased success for job sharing of leadership roles and contribute to the current need to be flexible in workforce models of nursing.

Advanced practice nursing: A concept analysis

A variety of terms are used to describe advanced practice nursing roles internationally. This has resulted in confusion in terminology around these roles. The aim of this concept analysis was to clarify what is meant by advanced practice nursing internationally, what attributes signify advanced practice nursing and what are its antecedents, consequences, references and related terms. Rodgers's evolutionary method of concept analysis was used. Data sources included Medline, CINAHL, Applied Social Sciences Index and Abstracts (ASSIA), Cochrane Library, Science Direct, SCOPUS, Web of Science, Dissertation Abstracts and DARE as well as relevant nursing texts and professional organization websites. The analysis reveals that there are many different articulations of the advanced practice nursing role outlined in the literature. This variety in terminology hinders developments in advanced practice nursing roles. Consensus on advanced practice nursing definitions, terminology, educational requirements and regulatory approaches is integral to the implementation of the advanced practice nursing role internationally.

Aged care nurse practitioners in Australia: evidence for the development of their role

To consider evidence surrounding the emerging role of nurse practitioners in Australia with a particular focus on the provision of healthcare to older people. Methods used included keyword, electronic database and bibliographic searches of international literature, as well as review of prominent policy reports in relation to aged care and advanced nursing roles. This paper reports on evidence from systematic reviews and international studies that show that nurse practitioners improve healthcare outcomes, particularly for hard to service populations. It also maps out the limited Australian evidence on the impact of nurse practitioners' care in aged care settings. If Australia is to meet the health needs of its ageing population, more evidence on the effectiveness, economic viability and sustainability of models of care, including those utilising nurse practitioners, is required.

Changing the way that I am: Students experience of educational preparation for advanced nursing roles in the community

The redesign of the healthcare workforce in the United Kingdom (UK) has resulted in the rapid introduction of more ‘advanced’ community nursing roles. This presents varying challenges for universities seeking to prepare practitioners for these roles. This paper reports on a qualitative study conducted at one university in England which sought to explore the educational experiences of students preparing for and engaging in advanced nursing roles. Data was collected through focus groups and semi-structured interviews. This study found that educational preparation for advanced nursing roles in the community is varied and complex and involved a number of claims, concerns and issues, captured in three themes: 1. Re-inventing roles; 2. Re-creating selves; and 3. Re-engaging with learning. The findings reveal how those in advanced roles work across occupational boundaries and manage conflicts, using differentiated and complex sources and forms of knowledge and skills. Learning occurs in non-linear ways and is a good example of expansive or sideways learning. There is a need for further research on the type of curriculum and methods to best support students preparing for these roles and further study on the impact on patient experience and outcomes.

The role and functions of Clinical Nurse Consultants, an Australian advanced practice role: A descriptive exploratory cohort study

BackgroundThe NSW Health Policy Directive (NSW Department of Health, 2000) lists clinical service and consultancy; clinical leadership; research; education; clinical services planning and management as the five domains of practice for nurses appointed as Clinical Nurse Consultants (CNCs), an Australian advanced practice nurse (APN) role. However, there is no clear definition of what is meant by advanced practice in the Australian nursing context. Nowhere is this more evident than in differentiating between the roles of Clinical Nurse Consultants (CNCs) and Nurse Practitioners (NP) in NSW. To date, limited empirical research has been done to characterise or delineate CNC role activity and responsibility. ObjectivesTo investigate (i) the nature of CNC roles, activities and responsibilities, (ii) differentiate between CNCs by their work patterns and activities, and (iii) empirically conceptualise and differentiate ways CNCs practice in terms of an APN typology. ParticipantsThe study sample was 56 CNCs at one tertiary level public hospital in Australia. MethodsA descriptive exploratory cohort study was conducted to explore CNC role characteristics and patterns of activity. Data were triangulated using an online survey, a follow-up survey, and semi-structured interviews. The data were analysed using descriptive statistics to examine differences between CNC work patterns and role activities. The survey data and the individual reports were thematically analysed to investigate for difference across the population of CNCs. ResultsInterpretation of survey and interview data led to an analyst-developed CNC typology of four CNC categories based on the work patterns and activities of Sole Practitioner, Clinic Coordinator, Clinical Team Coordinator and Clinical Leader. The typology was based on the themes interprofessional, role focus, clinical focus and setting as these themes distinguished and differentiated CNC roles. ConclusionsThe study provides evidence of great diversity and prioritisation within CNC roles. The CNC typology identified in this study is similar to the categorisation of the roles of APNs reported by other researchers. With further testing, the CNC typology could be useful to service managers and policy makers in making decision on the category of CNC required for a position and may also be able to be applied to other APN roles.