A time for international standards?: comparing the Emergency Nurse Practitioner role in the UK, Australia and New Zealand.

Emergency Department, Cabrini Hospital, Melbourne, Australia.
Accident and Emergency Nursing 11/2007; 15(4):210-6. DOI: 10.1016/j.aaen.2007.07.007
Source: PubMed

ABSTRACT The aim of this paper is to compare the Emergency Nurse Practitioner (ENP) role in the UK, Australia and New Zealand. Whilst geographically distant, the role of the ENP within these three countries shares fundamental similarities, causing us to question, is this a time to implement international standards for the role? The ENP role in all three countries is gradually establishing itself, yet there are shared concerns over how the role is regulated and deficits in standardisation of scope of practice and educational level. Together these issues generate confusion over what the ENP role embodies. One method of demystifying the ENP role would be to progress towards international standards for regulation, education and core components of practice.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Aims To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. Background The delivery of quality care in the emergency department is emerging as one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. Data sources: A comprehensive search of four electronic databases from 2006-2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. Review methods: A three step approach was used. Following a comprehensive search, two reviewers assessed all identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data were extracted using standardised tools. Results Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis. Conclusion Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reform of emergency service provision. The findings suggest that further high quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in evidence based health service planning.
    International Journal of Nursing Studies 07/2014; DOI:10.1016/j.ijnurstu.2014.07.006 · 2.25 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the opinions of Israeli ED nurses as to (1) an expansion of their powers and autonomy in treating commonly presenting ED conditions, (2) whether nurses or physicians should be responsible for giving ED patients necessary information and (3) whether ED nurses should perform triage. The development of the new emergency nurse practitioner role has relieved the pressure on emergency departments, reduced patient waiting times and raised patient satisfaction. Israel has yet to introduce either this role or the triage approach into its emergency departments. This investigation was designed as a cross-sectional study by self-administered questionnaire. The researchers distributed a questionnaire they had developed and validated to 270 registered nurses working in 18 general hospital emergency departments. The responses were analysed by chi-square and t-tests and anova. Of respondents 60-90% agreed that they should be granted ten out of a list of twelve new powers, and a large majority thought nurses should be responsible for performing triage. They wanted to increase the information they gave to patients, both on general ED functioning and on specific medically related matters. The contribution of this study is the positive response of a large representative sample of ED nurses to extending their powers. It will be necessary to establish postregistration training courses and draw up new regulations reshaping the delivery of emergency medicine. The study demonstrates that ED nurses are convinced that they need the authority to diagnose and treat commonly presenting ED conditions and perform triage and discharge in order for their department to optimally exploit the resources available to it. The study should promote the development of the emergency nurse practitioner role in Israel and so reduce patient waiting times.
    Journal of Clinical Nursing 11/2013; 23(1-2). DOI:10.1111/jocn.12405 · 1.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite well-articulated benefits, the introduction of Nurse Practitioners (NPs) in Australia has been slow. Poorly defined nomenclature relating to advanced practice roles in nursing and variations in such roles both across Australia and worldwide have resulted in confusion and uncertainty regarding the functions and roles of NPs. Qualitative studies focussing on the perceived impact on the care settings into which NPs are introduced are scarce, but are valuable in providing a complete contextual account of NPs in care delivery settings. This study aimed to investigate the perceived impact of the NP on the delivery of care in the ED by senior doctors, nurses, and NPs. Results will facilitate adoption and best use of this human resource innovation. A cross-sectional qualitative study was undertaken in the Emergency Departments (EDs) of two large Australian metropolitan public teaching hospitals. Semi-structured, in-depth interviews were conducted with five nurse practitioners, four senior doctors (staff specialists and ED directors) and five senior nurses. Transcribed interviews were analysed using a grounded theory approach to develop themes in relation to the conceptualisation of the impact of the NP role on the ED. Member checking of results was conducted by revisiting the sites to clarify findings with participants and further explore emergent themes. The impact of the NP role was perceived differently by different groups of participants. Whilst NPs were observed to deliver few quantitative improvements to ED functioning from the perspective of ED directors, NPs believed that they assisted doctors in managing the increasing subacute presentations to the contemporary ED. NPs also believed they embraced a preventative paradigm of care which addressed the long term priorities of chronic disease prevention and cost containment in the broader healthcare environment. The ambiguous position of the NP role, which crosses the gap between nursing and medicine, emerged and resulted in a duality of NP governance. Interpretation of the NPs' role occurred through different frames of reference. This has implications for the development of the NP role in the ED. Collaboration and dialogue between various stakeholders, such as ED doctors and senior nursing management is required.
    BMC Health Services Research 09/2013; 13(1):356. DOI:10.1186/1472-6963-13-356 · 1.66 Impact Factor
    This article is viewable in ResearchGate's enriched format