Abstract:This discursive paper synthesises empirical evidence and expert professional opinion on the factors that enable or hinder the development and sustainability of specialist and advanced practice roles. Providing a critical appraisal of current knowledge, it provides a reference source for disciplinary debate and policy development regarding the nursing and midwifery resource and informs clinicians of the myriad issues that can impact on their capacity to expand their scope of practice.
“…This resulted in increased pressure on staff in new roles, overall service disruption and service delays. This finding supports and adds to the literature emphasising the importance of organisational, managerial and team support for the successful development and implementation of new or expanded roles [30,35,37].…”
Background
Pelvic Floor Muscle Training (PFMT) has been shown to be effective for pelvic organ prolapse in women, but its implementation in routine practice is challenging due to lack of adequate specialist staff. It is important to know if PFMT can be delivered by different staff skill mixes, what barriers and facilitators operate in different contexts, what strategies enable successful implementation and what are the underlying mechanisms of their action. PROPEL intervention was designed to maximise the delivery of effective PFMT in the UK NHS using different staff skill mixes. We conducted a realist evaluation (RE) of this implementation to understand what works, for whom, in what circumstances and why.
Methods
Informed by the Realist and RE-AIM frameworks, the study used a longitudinal, qualitative, multiple case study design. The study took place in five, purposively selected, diverse NHS sites across the UK and proceeded in three phases to identify, test and refine a theory of change. Data collection took place at 4 time points over an 18 month implementation period using focus groups and semi-structured interviews with a range of stakeholders including service leads/managers, senior practitioners, newly trained staff and women receiving care in the new service models. Data were analysed using thematic framework approach adapted to identify Context, Mechanism and Outcome (CMO) configurations of the RE.
Results
A heightened awareness of the service need among staff and management was a mechanism for change, particularly in areas where there was a shortage of skilled staff. In contrast, the most established specialist physiotherapist-delivered PFMT service activated feelings of role protection and compromised quality, which restricted the reach of PFMT through alternative models. Staff with some level of prior knowledge in women’s health and adequate organisational support were more comfortable and confident in new role. Implementation was seamless when PFMT delivery was incorporated in newly trained staff’s role and core work.
Conclusion
Roll-out of PFMT delivery through different staff skill mixes is possible when it is undertaken by clinicians with an interest in women’s health, and carefully implemented ensuring adequate levels of training and ongoing support from specialists, multi-disciplinary teams and management.
“…This resulted in increased pressure on staff in new roles, overall service disruption and service delays. This finding supports and adds to the literature emphasising the importance of organisational, managerial and team support for the successful development and implementation of new or expanded roles [30,35,37].…”
Background
Pelvic Floor Muscle Training (PFMT) has been shown to be effective for pelvic organ prolapse in women, but its implementation in routine practice is challenging due to lack of adequate specialist staff. It is important to know if PFMT can be delivered by different staff skill mixes, what barriers and facilitators operate in different contexts, what strategies enable successful implementation and what are the underlying mechanisms of their action. PROPEL intervention was designed to maximise the delivery of effective PFMT in the UK NHS using different staff skill mixes. We conducted a realist evaluation (RE) of this implementation to understand what works, for whom, in what circumstances and why.
Methods
Informed by the Realist and RE-AIM frameworks, the study used a longitudinal, qualitative, multiple case study design. The study took place in five, purposively selected, diverse NHS sites across the UK and proceeded in three phases to identify, test and refine a theory of change. Data collection took place at 4 time points over an 18 month implementation period using focus groups and semi-structured interviews with a range of stakeholders including service leads/managers, senior practitioners, newly trained staff and women receiving care in the new service models. Data were analysed using thematic framework approach adapted to identify Context, Mechanism and Outcome (CMO) configurations of the RE.
Results
A heightened awareness of the service need among staff and management was a mechanism for change, particularly in areas where there was a shortage of skilled staff. In contrast, the most established specialist physiotherapist-delivered PFMT service activated feelings of role protection and compromised quality, which restricted the reach of PFMT through alternative models. Staff with some level of prior knowledge in women’s health and adequate organisational support were more comfortable and confident in new role. Implementation was seamless when PFMT delivery was incorporated in newly trained staff’s role and core work.
Conclusion
Roll-out of PFMT delivery through different staff skill mixes is possible when it is undertaken by clinicians with an interest in women’s health, and carefully implemented ensuring adequate levels of training and ongoing support from specialists, multi-disciplinary teams and management.
“…Advanced practice nurses found it difficult to delineate themselves from other health care professionals and attributed it to poorly defined job scopes (Woo et al, ). Such role confusion can detrimental to APN development if overlooked (Fealy et al, ).…”
Aims:To explore registered nurses' perceptions towards the role of advanced practice nurses and to examine registered nurses' interests in becoming advanced practice nurses.Background: Globally, the development and implementation of advanced practice nurses have been deemed propitious. Advanced practice nurses are recruited and developed from the current pool of registered nurses. Empirical research is needed to inform practice on ensuring the sustainability of the advanced practice nurse workforce through the recruitment and development of the current population of registered nurses.
Methods:A nationwide cross-sectional online survey was conducted in Singapore.Registered nurses from all public health care institutions were surveyed.Results: Respondents (n = 1,025) displayed optimism and acceptance towards advanced practice nurses. However, only 30.7% hoped to become advanced practice nurses.Nursing leaders were reported to have a low success rate in identifying registered nurses who were both suitable and interested in the advanced practice nurse role.Conclusions: Registered nurses' positive perspectives towards the role of advanced practice nurses do not translate into interests in the role. The study offers pragmatic applicability in ensuring the sustainability of the advanced practice nurse workforce.
Implications for Nursing Management:Advanced practice nurse-specific residency programmes for pre-master registered nurses may be facilitative to retaining and recruiting registered nurses for the advanced practice nurse workforce.
K E Y W O R D Sadvanced practice nurses, nurse practitioners, personnel recruitment, professional image, registered nurses, staff nurses
“…ANPs' scope of practice has evolved on a continuum since its inception in 2002 (Casey et al, ; Fealy et al, ; NCNM, ; NMBI, ). Participants acknowledged this evolution positively as aiding their personal and professional development, maintaining their motivations and challenging their practices:Erin “I would always have perceived it as a role that was going to be essentially clinically‐based and patient focused; very much a nursing role.”…”
Section: Resultsmentioning
confidence: 99%
“…ANPs' scope of practice has evolved on a continuum since its inception in 2002 (Casey et al, 2017;Fealy et al, 2018;NCNM, 2008;NMBI, 2017). Participants acknowledged this evolution positively as aiding their personal and professional development, maintaining their motivations and challenging their practices:…”
Section: Role Dimensions and Core Conceptsmentioning
Aims
To explore Advanced Nurse Practitioners' (ANP) (Emergency) perceptions of their role, positionality and professional identity.
Background
Advanced nursing practice was formally established in the Republic of Ireland in 2001 with 336 ANPs currently registered, projection increasing to a critical mass of 750 by 2021. Advanced practitioners (Emergency) give full emergency care for a specific cohort of clients with unscheduled, undifferentiated and undiagnosed conditions.
Design
Qualitative narrative inquiry using Bourdieu's concepts of habitus, field and capital as the theoretical framework was undertaken.
Methods
Data were collected in 10 in‐depth interviews and thematic analysis applied.
Results
Five key themes emerged: participants' career pathways, personal and professional transitions, role dimensions and core concepts, and position in the organization and emergent professional identity. Role transitioning and a change in habitus, field and capital revealed the uniqueness of their nursing role. Minimizing waiting times, timely patient care and patient satisfaction were key performance indicators. A heightened awareness regarding higher‐level decision‐making, autonomy and accountability is integral to advanced practice.
Conclusion
This study presents unique insights into the ANP role covering recruitment, organizational culture changes required and support to ease transition emerged.
Impact
Better understanding the motivation to undertake the role, the transition experience and use of advanced practice skills sets will inform the targets for the future recruitment and retention of ANPs are met nationally and internationally. Dissatisfaction with previous management roles and wanting to be clinically close to patients were motivations to follow an advanced practice clinical career trajectory. Positionality and emergent professional identity are key enablers ensuring that advanced practitioners' roles demonstrate the attributes of advanced practice. Educators could use the findings to develop recruitment, retention and progression strategies. Disseminating the role and scopes of practice could positively influence collaborative models of service delivery and policy development.
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