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
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.
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- "The volume of research papers, scholarly discussion and polemic debate in the peer-reviewed international literature relating to advanced practice nursing is vast, attesting to the quest to progress and refine knowledge about this evolving level of nursing service and its impact on patient outcomes (for example: Currie et al., 2007; Jones, 2005; Lowe et al., 2012; Newhouse et al., 2011; Pulcini et al., 2010; Thoun, 2011). Paradoxically, this international body of literature also contributes to perpetuating the confusion by continuing to assert its nature with scant attention to systematically debating the core issues. "
ABSTRACT: The size and flexibility of the nursing workforce has positioned nursing as central to the goals of health service improvement. Nursing's response to meeting these goals has resulted in proliferation of advanced practice nursing with a confusing array of practice profiles, titles and roles. Whilst numerous models and definitions of advanced practice nursing have been developed there is scant published research of significant scope that supports these models. Consequently there is an ongoing call in the literature for clarity and stability in nomenclature, and confusion in the health industry on how to optimise the utility of advanced practice nursing.
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- "As nurse practitioner services have developed , sub speciality areas such as emergency, cardiovascular, endocrinology and oncology have adopted the nurse practitioner role for the delivery of high quality patient care (American Academy of Nurse Practitioners, 2010). The nurse practitioner role in Australia was first developed in 1994 with a pilot project to address feasibility within the health context (Currie et al., 2007). Since this inception, there are now over 1000 endorsed nurse practitioners, protected by title legislation and working to generic competency standards that govern practice across a variety of clinical settings (Nursing and Midwifery Board Australia, 2014). "
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.
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- "Variations in the roles that NPs adopt, both nationally and internationally, have been found [10-13]. The implementation of NPs in Australia has been mitigated by role ambiguity, confusion and uncertainty amongst both health care professionals and consumers in relation to their function and role [10-13]. "
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.