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Aim
The aim was to determine how nurse practitioner (NP) roles are translated into clinical practice across Victoria, Australia. This paper reports details about NP work patterns and scopes of practice across multiple clinical settings and geographic locations.
Design
A quantitative survey design was used. A data abstraction tool, based on previou...
Citations
... NPs practice autonomously and independently within agreed caseloads in the Irish context and scopes of practice in the Australian context [4]. Tey undertake care across broad contexts and settings-wide-ranging both geographically and clinically-and are capable of reducing health service gaps and increase services where wait times for treatment are excessive [5,6]. Further, evidence supports a reduction in hospital transfers when NPs are involved in care [7], that hospital readmissions reduced and safe prescribing increased with the inclusion of NPs in service delivery [6,8]. ...
Aim. To determine Senior Nurse Managers’ perceptions of integration of Nurse Practitioner roles in Healthcare Organisations across Ireland and Australia. Background. Introduction of the Nurse Practitioner role in both countries is well established with national policies aimed at developing a critical mass in the health workforce. Current policy requires Senior Nurse Managers to be actively involved in the introduction of and oversight of the integration of Nurse Practitioners across healthcare settings. This is integral in the context of the success and sustainability of the services provided by the Nurse Practitioner. Methods. A quantitative, cross-sectional cloud-based survey of senior nurse managers across Ireland and Australia from April to September 2022. Results. Of 300 responses received, 122 were eligible for analysis. Of these, 77% expressed that there should be a specific role to support the integration of Nurse Practitioner roles at local level, and 61% recommended that this should occur at a national level, whilst 48% reported the absence of a standardised governance structure. Three reporting structures were identified: professional, clinical, and operational. Autonomous clinical decision making and prescribing were two Nurse Practitioner functions most identified. Fifty-five percent reported having performance indicators for Nurse Practitioner roles, with 24% agreeing that performance indicators captured the quality of care provided. Thirty-five percent of senior nurse managers indicated that there were agreed reporting timelines for performance indicators and a requirement for the provision of an annual report. Conclusion. Whilst some participants reported structure to guide and evaluate the work and value of Nurse Practitioners, the approach was inconsistent across organisations and countries. This paper demonstrates that integration is not broadly established across both countries. Implications for the Profession. The main findings were that Nurse Practitioners were misunderstood and the development of a structured framework to support the integration of Nurse Practitioners would provide long-term benefits.
... Globally the Nurse Practitioner (NP) role is evolving and is now integral to most universal health systems (Ljungbeck et al, 2021;Scanlon, Murphy, & Tori, 2018). Nurse practitioners have consistently demonstrated improved patient outcomes, high levels of patient satisfaction, and delivery of safe, high-quality care (Barnett, Balkissoon, & Sandhu, 2022;Lowe, Tori, Jennings, Schiftan, & Driscoll, 2021;Whitehead et al, 2022). Whilst these benefits have been reported internationally since the 1960s, within the Australian healthcare context evaluations of the NP role remain consistently positive in areas of patient safety, improved continuity of care, and greater accessibility to fiscally viable healthcare since the introduction of the role in 2000 (Currie, Cater, Lutze, & Edwards, 2021;Jennings et al., 2015;Ljungbeck et al., 2021). ...
Background: The flexibility and value of the Nurse Practitioner (NP) role has been recognized as providing significant benefits for patient groups internationally since the 1960s, and nationally since 2000. At the time of this study, approximately 400 NPs were endorsed to deliver care across diverse clinical and geographic Victorian locations. However, little was known about the supportive requirements to meet their networking and mentoring needs. The aim of this study was to determine the NPs' degree of membership and engagement and perceived provision of mentorship with NP Communities of Practice (CoP). Methods: An exploratory prospective cross-sectional multi-site study using an online survey was used to collect data. A total of 182 participants responded to the survey. Findings: NPs depend on each other to learn what they need to learn to transition to the NP role in clinical and non-clinical aspects of the role. While the benefits of NP CoP membership proved instrumental in facilitating transformational leadership knowledge, the Victorian NP CoP reinforced that there was room for improvement in the manner in which the groups were not only set up but also how they continued to meet the cohort's contemporary needs. Most participants reported associated membership benefits such as support, networking, as well as being able to undertake educational opportunities. Further, a small number found NP CoP membership contributed to their sense of belonging, effectively decreasing their sense of professional isolation. To a lesser degree, mentorship and information sharing were reported. Conclusion: Participants identified the NP CoP as collegial, supportive environments which nurtured and facilitated transition to the NP role. By including educational, leadership, networking, and mentoring opportunities, the Victorian NP CoP decreased professional isolation for both neophyte and experienced NPs. However, the NP CoP did not meet all member's needs.
... Four of those were surveys sent to students, and the incentive was an option to be included in a drawing for a gift card with values ranging from $25 to $55. One study of NP students required participants to submit information from 10 patient encounters before they were awarded the $50 incentive (Lowe et al., 2021). The studies offering incentives to complete their online survey had response rates ranging from 10.6% to 40%, averaging 28.49%. ...
... Six articles did not report the number of items on their surveys, but those that did report had a range from 7 to 149 items (<10 items, n = 2; 10-30 items, n = 21; 30-50 items, n = 16; more than 50 questions, n = 6). The study with only seven questions had a 40% response rate (Lowe et al., 2021), and the study with 149 questions had a 30.1% response rate (Nodine et al., 2021). Only 14 studies reported an estimated time to complete their survey, which ranged from 7 to 30 minutes, with the average length of time estimated at 14.75 minutes. ...
Background
Online surveys in nursing research have both advantages and disadvantages. Reaching a sample and attaining an appropriate response rate is an ongoing challenge and necessitates careful consideration when designing a nursing research study using an online survey approach.
Objective
In this study, we aimed to explore response rates and survey characteristics of studies by nurse researchers that used online methodologies to survey nurses, nursing students, and nursing faculty.
Methods
We conducted an integrative review of research studies that used online surveys for data collection published from 2011–2021. We examined response rates and survey characteristics such as recruitment method, use of incentives, question type, length of survey, time to complete the survey, and use of reminders.
Results
Our review included 51 studies published by nurses with target samples of nurses, nursing students, or nursing faculty. Study sample sizes ranged from 48–29,283, the number of respondents ranged from 29–3,607, and the response rates ranged from 3.4%–98%, with an average of 42.46%. Few patterns emerged regarding recruitment or other factors to enhance response rates; only five studies used incentives.
Conclusion
Response rates to online surveys are unlikely to reach the rates seen in older mailed surveys. Researchers need to design online survey studies to be easily accessible, concise, and appealing to participants.
... Most sources described NPs in terms of the educational and practice requirements necessary for endorsement by the Nursing and Midwifery Board of Australia. 16,18,[29][30][31][32][33][34] They conceptualised NPs' role in terms of their scope of practice. 8,16,29,30,[33][34][35][36] Other sources noted the potential of NPs to improve health care access, health outcomes and consumer satisfaction within rural health services 30 address service gaps 14,32 ; and adapt to changing community needs. ...
... 16,18,[29][30][31][32][33][34] They conceptualised NPs' role in terms of their scope of practice. 8,16,29,30,[33][34][35][36] Other sources noted the potential of NPs to improve health care access, health outcomes and consumer satisfaction within rural health services 30 address service gaps 14,32 ; and adapt to changing community needs. 14 Several sources reported NPs' descriptions of their role in primary health care that included providing care from a social and holistic perspective; with a focus on wellness, health promotion, prevention of ill health, management of chronic disease and encouraging community participation in health services. ...
... Whilst there is an absence of research outlining how the role of the NP functions in rural primary health care, articles described the NP role as incorporated into, or forming part of multidisciplinary teams 8,39 ; nongovernment organisations 8,29 ; local health districts (LHD) or health services. 30,36 The review revealed that NPs were working in community mental health and drug and alcohol services 8,31,34 ; at remote Aboriginal Medical Services 37 and Aboriginal Community Controlled Health Services 39 ; primary care in rural and remote locations 32,37,38 ; providing nurse-led assessment and treatment centres and community-based clinics 20,21,30,36,41,42 ; providing specialist aged care 35 and psychogeriatric services 8 ; NP locum services 14 ; and palliative care. 33 Some NPs worked across multiple health care settings, for example across hospital, residential aged care, general practice and community health. ...
Introduction:
Australians in rural areas experience limited access to services and poorer health outcomes than residents of metropolitan areas. Nurse practitioners (NPs) were introduced in 2000 to reduce pressure on the health system, address workforce shortages and improve rural populations' access to health care services.
Objective:
This scoping review sought to identify, examine and synthesise research evidence of NP practice in Australian rural primary health care services to better understand how NPs are addressing service gaps in rural areas and to identify existing gaps in our knowledge.
Design:
Peer-reviewed and grey literature from July 2012 to June 2022 was accessed from seven electronic databases, grey literature and hand searching of reference lists and citations.
Findings:
From 154 articles, 19 articles of relevance were identified. Several projects describe the processes required for success, whilst others reported the challenges and barriers encountered. Limited research evidence of rural NP practice exists with a significant gap about how roles operate and their value in primary health care.
Discussion:
Uptake and envisaged benefits of rural primary health care NP roles have yet to be realised, with barriers to implementing and sustaining NP roles persisting. Low-level awareness with ambiguity at health service and community level adversely impact on systematic implementation of NP roles.
Conclusions:
Robust evaluations demonstrating the value of NP skills and practice are needed in combination with bipartisan support from all levels of health care and government providing adequate funding to enable effective implementation of NP roles in poorly resourced rural areas.
... Mentoring and coaching at the point of care will be key to successful implementation of RN prescribing (Fox et al., 2022b). Clinical leadership and education are intrinsic to the Australian Nurse Practitioner Standards for Practice (Nursing and Midwifery Board of Australia, 2021) and a recent study of nurse practitioner work patterns suggests that development of a sustainable nurse practitioner workforce is linked to true integration of nurse practitioners into the workforce (Lowe, Tori, Jennings, Schiftan, & Driscoll, 2021). Formally engaging nurse practitioners in the facilitation and education of RNs to prescribe would provide an opportunity for nurse practitioners to support professional development pathways and succession planning. ...
Aim
To explore the nature and extent of peer‐reviewed literature related to the use of diagnostic imaging by nurse practitioners (NPs) to inform future practice and research.
Background
Nurse practitioners undertake advanced assessment, diagnosis, and management of patients, including requesting and interpretation of diagnostic imaging. It is unclear what evidence exists related to the quality use of radiological investigations by NPs in recent years.
Design
A scoping review based on the steps suggested by the Joanna Briggs Institute.
Methods
A structured review of the databases Medline, CINAHL and Embase was undertaken using the keywords and MESH terms ‘nurse practitioner’, ‘medical imaging’, ‘diagnostic imaging’, ‘scan’ and ‘radiography’. Only English language articles were included, and no date limit was applied. Database review was completed on 30 May 2021.
Results
Eight themes were identified—country and clinical context, requesting diagnostic imaging, performing diagnostic imaging, image‐guided interventions, interpreting diagnostic imaging, training education and knowledge, impact on resource usage and comparison with medical practitioners. There were more studies across a greater breadth of clinical specialties and imaging modalities in the United States than in other countries. Nurse practitioner practice is frequently benchmarked against that of medical colleagues. There is a paucity of studies focusing on educational preparation and the lack of relevant university curricula for NPs around diagnostic imaging.
Conclusion
There are significant gaps in the evidence outside of the United States across several of the identified themes. Further studies are needed to explore NP access to and use of diagnostic imaging and to understand the barriers and facilitators to this.
Relevance to Clinical Practice
Studies from four countries were included in this review. The evidence suggests that, where studied, nurse practitioners (NPs) can safely and appropriately request and interpret plain x‐rays in the emergency and minor injuries setting. Further research is needed to evaluate the educational needs of NPs in relation to diagnostic imaging and their use of advanced imaging techniques, particularly outside of the United States.
Patient or Public Contribution
No patient or public contribution.
Introduction
Nurse prescribing is well consolidated in many countries. In Spain, recent legislation has allowed nurse to prescribe under specific conditions, but the implementation process is complex.
Objectives
First, to describe nurses' knowledge and expectations of nurse prescribing in a health institution in Spain. Second, to report the nurses' prescriptions in a pilot group at 6 months.
Methods
A descriptive, online survey design was used to identify nurses' knowledge and expectations of prescribing. The results were compared according to the nurses' professional position and training. We analyzed the number and type of prescriptions issued in the first 6 months.
Results
Training needs (overall score = 4.2/5) and lack of knowledge of the law (4.25/5) were scored lower by nurses with postgraduate training. Subjective assessment of preparedness among nurses was high (>4/5), and the highest-scoring expected impact was improvement in patients' experience (4.25/5). Years of nursing experience were negatively correlated with preparedness and the expectation of an increase in patient management errors. A total of 212 prescriptions were issued (2 drugs and 200 health devices).
Conclusions
Nurses perceived good preparedness but also the need for more training in medicines and prescribing law. Expectations of prescribing were favourable. Most prescriptions were for health devices.
Background
The enactment of laws that permit voluntary assisted dying reflects community views about end-of-life choices for those who are suffering and dying and includes a commitment to equitable access. Australian and New Zealand voluntary assisted dying frameworks are embedded in healthcare and authorise medical practitioners to assess whether a person meets prescribed eligibility criteria for access to voluntary assisted dying.
Aim
In this article, we argue that including nurse practitioners as assessing practitioners in Australian and New Zealand voluntary assisted dying frameworks can promote equitable access.
Method
We demonstrate that nurse practitioners have the required education and skillset to assess eligibility, eligibility assessment is within their scope of practice, and recent evidence demonstrates that they may be more likely to participate in voluntary assisted dying than medical practitioners. Reviewing information relied on by lawmakers, we highlight the cursory consideration given to roles for nurse practitioners, and that their exclusion from assessing eligibility has not been justified.
Conclusion
As new voluntary assisted dying laws are implemented in health services across Australia and New Zealand, research on the actual and potential contribution of nurse practitioners must be undertaken and reported. This will make it more likely that there is evidence to inform decisions about whether including nurse practitioners as assessing practitioners is feasible and necessary as laws are reviewed.
While the health grants to local governments recommended by Fifteenth Union Finance Commission in the wake of Covid 19 pandemic lays emphasis on the trust-based approach to local governments and decentralization of health, the danger of Mission Creep can undo the potential and effectiveness of the grants to strengthen the primary health care sector. Lack of sensitization towards local governments; the misconception that local governments and its stakeholders are illiterate, weak and corrupt entities; absence of an institutional monitoring mechanism to conduct a follow-up of the recommendations made by the respective Finance Commissions; lack of co-ordination between various Ministries of union and state governments; and the erosion of cooperative federalism can all contribute to health grants falling prey to the vicious cycle of Mission Creep Syndrome.
