Two hundred days of nurse practitioner prescribing and role development: a case study report from a hospital-based acute pain management team
Anthony V. SchoenwaldIpswich Hospital, Department of Anaesthesia and Intensive Care, PO Box 73, Ipswich, QLD 4305, Australia. Email: anthony_schoenwald@health.qld.gov.au
Australian Health Review 35(4) 444-447 https://doi.org/10.1071/AH10946
Submitted: 6 July 2010 Accepted: 13 January 2011 Published: 6 September 2011
Abstract
Purpose. This report evaluates a beginning Nurse Practitioner (NP) role in Acute Pain Management.
Healthcare setting. The role was implemented within an anaesthesiology-based pain service. The NP author developed this pain service in 2002 and was endorsed as an NP 6 years later. The NP reviews all clients undergoing major surgery or trauma and provides pain management to women for caesarean section. Prior to this role, there were significant delays for some patients requiring prompt analgesia. This was because of the decreased availability of anaesthetists to fully participate in the pain service due to the demand for complex anaesthesiology practice.
Method of data collection. Data were conveniently collected by the NP on prescription and service provision over 200 working days.
Main findings. Therapeutic activity reflected contemporary pain management practice and espouse the NP as a safe and effective clinician. The role has improved patient access to pain management through the prompt use of non-pharmacological interventions, drugs used to treat analgesic side effects, opioids and non-opioid analgesics.
Principal conclusions. These initial positive outcomes are consistent with NP role development described elsewhere in Australia and overseas across a variety of healthcare settings. To sustain this role, robust continuing education and clinical support is required.
What is known about the topic? There is little published information on the development of the Nurse Practitioner (NP) role in acute pain services in Australia or overseas. The acute pain role is a new development in Australia and so previous descriptions of NP practice have focussed on other specialty areas such as Emergency or Mental Health.
What does this paper add? This report demonstrates positive and safe client outcomes as a result of a NP role in acute pain management. More importantly, it may contribute to accumulating evidence that NPs are safe prescribers of opioids and other analgesics in acute settings.
What are the implications for practitioners? Novice NPs and Candidates practising in this specialty need to use this information as support for their own role development and implementation in other acute pain services in Australia.
References
[1] Carryer J, Gardner G, Dunn S, Gardner A. The core role of the nurse practitioner: practice, professionalism and clinical leadership. J Clin Nurs 2007; 16 1818–25.| The core role of the nurse practitioner: practice, professionalism and clinical leadership.Crossref | GoogleScholarGoogle Scholar |
[2] Courtenay M, Carey N. Nurse independent prescribing and nurse supplementary prescribing practice: national survey. J Adv Nurs 2008; 61 291–9.
| Nurse independent prescribing and nurse supplementary prescribing practice: national survey.Crossref | GoogleScholarGoogle Scholar |
[3] Barber N. Extended prescribing rights – the UK Experience. Aust Pres 2009; 32 118–9.
[4] Running A, Kipp C. Prescriptive patterns of nurse practitioners and physicians. J Am Acad Nurse Pract 2006; 18 228–33.
| Prescriptive patterns of nurse practitioners and physicians.Crossref | GoogleScholarGoogle Scholar |
[5] Gardner A, Gardner G, Middleton S, Della P. The status of Australian nurse practitioners. Aust Health Rev 2009; 33 679–89.
| The status of Australian nurse practitioners.Crossref | GoogleScholarGoogle Scholar |
[6] Acute Postoperative Pain Management. Sydney: National Prescribing Service; 2007.
[7] Macintyre PE, Scott DA, Schug SA, Visser EJ, Walker SM, editors. Acute pain management – scientific evidence. Melbourne: Australian and New Zealand College of Anaesthetists; 2010.
[8] Cipher DJ, Hooker RS, Guerna P. Prescribing trends by nurse practitioners and physician assistants in the United States. J Am Acad Nurse Pract 2006; 18 291–6.
| Prescribing trends by nurse practitioners and physician assistants in the United States.Crossref | GoogleScholarGoogle Scholar |
[9] Van Ruth L, Mistiaen P, Francke A.. Effects of nurse prescribing of medication: a systematic review. J Healthcare Admin 2008; 5 1–31.
[10] National Regional Profile: Ipswich (C) (Local Government Area). Classifications Code LGA33960. Australian Bureau of Statistics; 2010. Available at http://www.abs.gov.au/ausstats/abs@nrp.nsf/lookup/LGA33960Main+Features12005-2009 [verified 24 August 2011].
[11] Quarterly public hospitals performance report – December quarter 2010. Queensland Health; 2010. Available at www.health.qld.gov.au/performance/docs/QHQPHPR.pdf [verified 25 July 2011].
[12] Sherwin J. Audit of pain at day one following caesarean section under spinal anaesthesia: comparing a combination of intrathecal fentanyl and morphine with intrathecal fentanyl only. 2010. MSc thesis, University of Leicester, UK.
[13] Macintyre P, Schug S. Acute Pain Management – A Practical Guide. Oxford, MA: Oxford University Press; 2007.
[14] Wheatley R, Madej T. Organization of an acute pain service. In: Rowbotham D, Macintyre P, editors. Clinical Pain Management – Acute Pain. London: Arnold; 2003. pp. 183–202.
[15] Waldron R. Australia’s looming anaesthetist shortage: ANZCA and ASA combined workforce study. ANZCA Bull 2009;
[16] Kleinpell RM, Ely EW, Orabenkort R. Nurse practitioners and physician assistants in the ICU: an evidence-based review. Crit Care Med 2008; 36 2888–97.
| Nurse practitioners and physician assistants in the ICU: an evidence-based review.Crossref | GoogleScholarGoogle Scholar |
[17] Schuster M, Standl T. Cost drivers in anesthesia: manpower, technique and other factors. Curr Opin Anaesthesiol 2006; 19 177–84.
| Cost drivers in anesthesia: manpower, technique and other factors.Crossref | GoogleScholarGoogle Scholar |
[18] Rawal N. Organization, function, and implementation of acute pain service. Anesthesiol Clin North America 2005; 23 211–25.
| Organization, function, and implementation of acute pain service.Crossref | GoogleScholarGoogle Scholar |
[19] Seaton S, Reeves M. Oxycodone as a component of multimodal analgesia post-caesarean section in Australia and New Zealand. J Pharm Pract Res 2009; 39 104–8.
[20] Seaton S, Reeves M, McLean S. Oxycodone as a component of multimodal analgesia for lactating mothers after caesarean section: relationships between maternal plasma, breast milk and neonatal plasma levels. Aust N Z J Obstet Gynaecol 2007; 47 181–5.
| Oxycodone as a component of multimodal analgesia for lactating mothers after caesarean section: relationships between maternal plasma, breast milk and neonatal plasma levels.Crossref | GoogleScholarGoogle Scholar |
[21] Lemberg KK, Kontiner VK, Siiskonen AO, Viljakka KM, Ylinkauhaluoma JT, Korpi ER, Kalso EA. Antinociception by spinal and systemic oxycodone: why does the route make a difference? Anesthesiology 2006; 105 801–12.
| Antinociception by spinal and systemic oxycodone: why does the route make a difference?Crossref | GoogleScholarGoogle Scholar |
[22] D’Arcy Y. Be in the know about pain management. Nurse Pract 2009; 34 43–7.
| Be in the know about pain management.Crossref | GoogleScholarGoogle Scholar |
[23] Charlton CR, Dearing KS, Berry JA, Johnson MJ. Nurse practitioners’ communication styles and their impact on patient outcomes: an integrated literature review. J Am Acad Nurse Pract 2008; 20 382–8.
| Nurse practitioners’ communication styles and their impact on patient outcomes: an integrated literature review.Crossref | GoogleScholarGoogle Scholar |
[24] Rehan HS, Chopra D, Kakkar AK. Physician’s guide to pharmacovigilance: Terminology and causality assessment. Eur J Intern Med 2009; 20 3–8.
| Physician’s guide to pharmacovigilance: Terminology and causality assessment.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1M7mtFCgtA%3D%3D&md5=0f9199bb3e7fe58cc1ad137ea5a53e2bCAS |
[25] Bradley E, Hynam B, Nolan P. Nurse Prescribing: reflections on safety in practice. Soc Sci Med 2007; 65 599–609.
| Nurse Prescribing: reflections on safety in practice.Crossref | GoogleScholarGoogle Scholar |
[26] Page M, Bajorek B, Brien J. Prescribing in teaching hospitals: a qualitative study of social and cultural dynamics. J Pharm Pract Res 2008; 38 286–91.
[27] Van Der Weyden MB. Doctor displacement: a political agenda or a healthcare imperative. Med J Aust 2008; 189 608–9.
