Implementing Advanced Nurse Practitioner Roles in Acute Care

Faculty of Nursing, University of Alberta, Edmonton, Canada.
JONA The Journal of Nursing Administration (Impact Factor: 1.27). 04/2003; 33(3):139-45. DOI: 10.1097/00005110-200303000-00004
Source: PubMed


Medical shortages are seen as the driving force behind the recent implementation of the advanced nurse practitioner (ANP) role in some Canadian hospitals. The authors analyzed the implementation of the ANP role in one tertiary care teaching hospital from the organizational change perspective. Despite successful implementation, issues of role definition, scope of practice boundaries, and staff reactions remain unresolved. Recommendations are discussed for implementing ANP roles in other acute care facilities.

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    • "The essential components of the NP role, necessary to fully encompass the patient needs in a holistic manner were seen as moving too far from the traditionally accepted nursing perspective (Dunn 1997, Walsh 1999, Phillips 2007, Por 2008). The elevation of status was also perceived as unacceptable by other nursing colleagues and created a sense of isolation for the NPs (Cummings et al. 2003, Dunphy et al. 2009). "
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    ABSTRACT: This article presents a discussion of the importance of providing meaningful advanced practice nursing role definition and clarity to improve international standards of nursing titles and scopes of practice. A plethora of international literature exists discussing advanced practice nursing roles and their contribution to healthcare delivery in various countries. However, lack of consistency around title, role definition and scope of practice remains. CINAHL and Medline databases were searched using 'nurse practitioner', 'nurse practitioner role', 'nurse practitioner practice', 'nurse practitioner in public health', 'advanced practice nursing roles' and 'development of new nursing roles' with articles limited to years 1995-2010. Citations used in those articles were also explored. All cited articles were in the English language. This article supports the need to strengthen the Nurse Practitioner role in health care and professional clarity is identified as a strategy to enhance this. Themes around role clarity, professional identity, ability to enhance healthcare provision and inter-professional issues are examined. The need to more clearly articulate advanced nursing roles in light of the evolution of the Nurse Practitioner role is highlighted. Much work has already occurred in this domain and a means of adapting and broadening these developments for a wider, more global audience whilst maintaining local context is discussed. Although evidence exists that advanced practice nursing roles are increasing internationally, uncertainty around role clarity remains. This is problematic because the valuable contribution of nursing roles is lost, if the ability to clearly express their function does not exist.
    Full-text · Article · Jul 2011 · Journal of Advanced Nursing
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    • "Lack of role clarity contributes to confusion and resistance to the role by others. Variable support, understanding and acceptance of the NP role by stakeholders such as managers, physicians and other professional staff influence implementation (Goss Gilroy Inc 2001, van Soeren & Micevski 2001, Cummings et al. 2003, Martin-Misener et al. 2009, van Soeren et al. 2009). JAN: REVIEW PAPER Factors affecting nurse practitioner role implementation "
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    ABSTRACT: To review the literature about the Canadian experience with nurse practitioner role implementation and identify influencing factors. Although nurse practitioners have been in existence for more than 40 years, their integration into healthcare systems has been challenging. While frameworks exist to guide implementation of these roles, clear identification of factors influencing role implementation may inform best practices. Given that Canada has witnessed considerable growth in nurse practitioner positions in the past decade, an exploration of its experience with role implementation is timely. A review of Canadian literature from 1997 to 2010 was conducted. Electronic databases including CINAHL, Cochrane Database of Systematic Reviews, Health Source: Nursing Academic Edition, Medline, Social Science Index, PubMed, Web of Science and PsychINFO and government and professional organization websites were searched. An integrative review was performed guided by Whittemore and Knafl's method. Ten published studies and two provincial reports were included. Numerous facilitators and barriers to implementation were identified and analysed for themes. Three concepts influencing implementation emerged: involvement, acceptance and intention. Involvement is defined as stakeholders actively participating in the early stages of implementation. Acceptance is recognition and willingness to work with nurse practitioner. Intention relates to how the role is defined. This integrative review revealed three factors that influence nurse practitioner role implementation in Canada: involvement, acceptance and intention. Strategies to enhance these factors may inform best practice role implementation processes.
    Full-text · Article · Jun 2011 · Journal of Advanced Nursing
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    • "Instrumental research utilization directly relates to "doing" things, that is, providing direct, observable action associated with the application of research findings. In today's healthcare environments, doing is valued and nurses are expected to complete tasks at work [26,49]. As a result, it makes sense that acute care pediatric nurses would see more direct relevance, in terms of their work, for instrumental research utilization. "
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    ABSTRACT: Research utilization investigators have called for more focused examination of the influence of context on research utilization behaviors. Yet, up until recently, lack of instrumentation to identify and quantify aspects of organizational context that are integral to research use has significantly hampered these efforts. The Alberta Context Tool (ACT) was developed to assess the relationships between organizational factors and research utilization by a variety of healthcare professional groups. The purpose of this paper is to present findings from a pilot study using the ACT to elicit pediatric and neonatal healthcare professionals' perceptions of the organizational context in which they work and their use of research to inform practice. Specifically, we report on the relationship between dimensions of context, founded on the Promoting Action on Research Implementation in Health Services (PARIHS) framework, and self-reported research use behavior. A cross-sectional survey approach was employed using a version of the ACT, modified specifically for pediatric settings. The survey was administered to nurses working in three pediatric units in Alberta, Canada. Scores for three dimensions of context (culture, leadership and evaluation) were used to categorize respondent data into one of four context groups (high, moderately high, moderately low and low). We then examined the relationships between nurses' self-reported research use and their perceived context. A 69% response rate was achieved. Statistically significant differences in nurses' perceptions of culture, leadership and evaluation, and self-reported conceptual research use were found across the three units. Differences in instrumental research use across the three groups of nurses by unit were not significant. Higher self-reported instrumental and conceptual research use by all nurses in the sample was associated with more positive perceptions of their context. Overall, the results of this study lend support to the view that more positive contexts are associated with higher reports of research use in practice. These findings have implications for organizational endeavors to promote evidence-informed practice and maximize the quality of care. Importantly, these findings can be used to guide the development of interventions to target modifiable characteristics of organizational context that are influential in shaping research use behavior.
    Full-text · Article · Jun 2010 · BMC Health Services Research
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