How nurse practitioners implement their roles
Jane L. DesboroughACT Health, Level 2, 11 Moore Street, Canberra City, ACT 2601, Australia. Email: janedes@tpg.com.au; jane.desborough@anu.edu.au
Australian Health Review 36(1) 22-26 https://doi.org/10.1071/AH11030
Submitted: 3 April 2011 Accepted: 16 August 2011 Published: 24 February 2012
Abstract
Objective. This is a report of a qualitative health research study examining how nurse practitioners construct and implement their roles.
Methods. In-depth interviews and a focus group discussion were conducted to obtain narrative data from nurse practitioners from a variety of clinical backgrounds. Data were analysed utilising the principles of grounded theory.
Subjects. Seven nurse practitioners participated in face-to-face interviews and six participated in a focus group discussion.
Results. The central process of ‘developing legitimacy and credibility’ is achieved through the processes of: ‘developing Clinical Practice Guidelines’, ‘collaborating with the multidisciplinary team’, ‘communicating’, and ‘transitioning to practice’.
Conclusion. Policy makers and those responsible for operationalising nurse practitioner roles need to support the central process of developing legitimacy and credibility vital for successful implementation. First, this involves enabling a supportive and informed process of Clinical Practice Guideline development. Second, key inter-disciplinary relationships need to be identified to facilitate collaboration and sources of mentorship for nurse practitioners. Finally, an identified period of transition will facilitate identification, development and implementation of the above processes.
What is known about the topic? The contemporary role of the nurse practitioner was introduced to provide a flexible, innovative, integrated care strategy, providing increased continuity of nursing care at an advanced practice level. Implementation of the role of the nurse practitioner can be challenging and is influenced by several identified barriers and facilitators.
What does this paper add? This paper adds an understanding of workplace relationships and processes, which are integral to the construction and implementation of nurse practitioner roles. The interplay of these processes and relationships support the central process of ‘developing legitimacy and credibility’.
What are the implications for practitioners? This paper provides a clear guide for policy makers and those responsible for operationalising nurse practitioner roles in regard to the requirements underpinning successful role development and implementation.
Additional keywords: advanced practice, clinical guidelines, grounded theory, qualitative methods, research in practice, workforce issues.
References
[1] Implementing the Nurse Practitioner Role in Aged Care (INPRAC). Canberra: Health ACT; 2007.[2] Gardner A, Gardner G, Middleton S, Della P. The status of Australian nurse practitioners: findings from the first national census. Aust Health Rev 2009; 33 679–89.
| The status of Australian nurse practitioners: findings from the first national census.Crossref | GoogleScholarGoogle Scholar | 20166918PubMed |
[3] Koelbel P, Fuller S, Misener R. Job satisfaction of nurse practitioners: an analysis using Herzberg’s theory. Nurse Pract 1991; 16 45–56.
[4] Hayes E. Helping preceptors mentor the next generation of nurse practitioners. Nurse Pract 1994; 19 62–6.
| Helping preceptors mentor the next generation of nurse practitioners.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2czksVCqsg%3D%3D&md5=0051ecda616ea783d5a1a807e2c98ed9CAS | 8065662PubMed |
[5] El Jardali F. Barriers to effective collaboration between nurse practitioners and family physicians. A discussion paper submitted to Health Canada. Ottawa, ON: Canadian Nurses Association; 2003.
[6] van Soeren MH, Micevski V. Success; indicators and barriers to acute nurse practitioner role implementation in four Ontario hospitals. AACN Clin Issues 2001; 12 424–37.
| Success; indicators and barriers to acute nurse practitioner role implementation in four Ontario hospitals.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2FjtlWqtQ%3D%3D&md5=8ad97874fb92529ec9afd254ef3b982aCAS | 11759360PubMed |
[7] Gardner G, Gardner A, Middleton S, Della P, Kain V, Doubrovsky A. The work of nurse practitioners: findings from a national work sampling study. J Adv Nurs 2010; 66 2160–9.
| The work of nurse practitioners: findings from a national work sampling study.Crossref | GoogleScholarGoogle Scholar | 20636472PubMed |
[8] Blustein DL, Palladino Schultheiss DE, Flum H. Toward a relational perspective of the psychology of careers and working: a social constructionist analysis. J Vocat Behav 2004; 64 423–40.
| Toward a relational perspective of the psychology of careers and working: a social constructionist analysis.Crossref | GoogleScholarGoogle Scholar |
[9] Charmaz K. Constructing grounded theory. A practical guide through qualitative analysis. London: Sage; 2006.
[10] Grounded Theory. A theoretical and practical application in the Australian Film Industry Database. University of Wollongong. 2005. Available at http://ro.uow.edu.au/commpapers/46 [verified 1 April 2011].
[11] Nurse practitioners in the ACT: the framework. 2nd edn. Canberra: Health ACT; 2008.
[12] Wilson K, Coulson L, Hillege S, Swann W. Nurse practitioners’ experience of working collaboratively with general practitioners and allied health professionals in New South Wales, Australia. Aust J Adv Nurs 2005; 23 22–7.
| 16502965PubMed |
[13] Josselson R. The space between us: exploring the dimensions of human relationships. San Francisco, CA: Jossey-Bass; 1992.
