The discursive practices of nurse practitioner legislation in Australia

Harvey, Clare; Driscoll, Andrea; Keyzer, Dirk M.

doi:10.1111/j.1365-2648.2011.05650.x

Cited by 15 publications

(14 citation statements)

References 13 publications

(19 reference statements)

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“…To date there are approximately 700 practicing NPs in Australia (Harvey, Driscoll, & Keyzer, 2011), a small number compared to the 150,000 NPs in the United States (Rosenberg, 2012). Resistance to the NP role by medical practitioners is suggested as one of the key reasons for this small number.…”

Section: Introductionmentioning

confidence: 99%

Medical acceptance of the nurse practitioner role in Australia: A decade on

MacLellan

Higgins

Levett‐Jones

2015

Journal of the American Association of Nurse Practitioners

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Purpose In Australia, nurse practitioners (NPs) were first endorsed in 2000. After more than a decade, the number of NPs remains relatively small with previous research suggesting medical resistance as a key reason for this. This article presents a selection of narratives from a study that explored the transition experiences of newly endorsed NPs with particular attention to relationships with their medical colleagues. Data sources A critical ethnographic approach was undertaken to explore the experiences of 10 Australian NPs who were interviewed three to four times for up to an hour throughout their first year of practice. Conclusions Participants’ narratives provide insight into their transition to practice and the barriers and facilitators to their new role. In contrast to previous research, medical colleagues were generally supportive and collegial while resistance was demonstrated most often by senior nurses yielding positions of power. Implications for practice This study provides insight into the influences that key health professionals have over the transition of NPs. Despite the fact there are still negative attitudes being expressed by some medical associations, in this study medical colleagues were largely supportive of the NP role and that integral to the development of these interprofessional relationships was mutual respect and effective communication.

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Section: Introductionmentioning

confidence: 99%

Medical acceptance of the nurse practitioner role in Australia: A decade on

MacLellan

Higgins

Levett‐Jones

2015

Journal of the American Association of Nurse Practitioners

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“…Ultimately, they were saddened by the loss of potential for nursing and society because of this regulatory culture. Although there is very little empirical research on this topic, a few studies, as mentioned earlier, corroborate these findings about how nurses who are working in innovative and advanced roles struggle with regulatory barriers (Donald et al., ; Harvey et al., ; Sangster‐Gormley et al., ; Wall, ). As Sandelowski () asserts, the summaries that are derived through qualitative description research are valuable as end products on their own but also serve as entry points for further study.…”

Section: Discussionmentioning

confidence: 83%

“…To date, there has been little investigation of the impacts and consequences of existing professional regulatory practices on nurses and nursing (Benton, Gonzalez‐Jurado, & Beneit‐Montesinos, ). Research by Harvey, Driscoll, and Keyzer () and literature reviews conducted by Sangster‐Gormley, Martin‐Misener, Downe‐Wamboldt, and DiCenso () and Donald et al. () revealed that regulatory processes have been a constraining factor in the implementation of the nurse practitioner (NP) role, an innovative, advanced nursing role.…”

Section: Background: Nursing Roles and Regulationmentioning

confidence: 99%

The impact of regulatory perspectives and practices on professional innovation in nursing

Wall

2017

Nursing Inquiry

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Since at least the 1970s in Canada, there have been calls for health system reforms based on innovative roles and expanded scopes of practice for nurses. Professional regulatory organizations, through legislation, define the standards and parameters of professional nursing practice. Nursing regulators emphasize public protection over the advancement of nursing; regulatory processes and decisions tend to be conservative and risk-averse. This study explored the impact that regulatory processes have on innovation in nursing roles. Nurses in a range of unique practice situations were interviewed, including nurses in non-traditional roles and/or settings, those with cross-jurisdictional career histories, and those working in interdisciplinary practices and educational settings. For these nurses, nursing practice was viewed through a traditional clinical lens, which did not fit for them. They experienced hassle, delay, and inconsistencies in regulatory practices. They felt mistreated and fearful of the regulator and lamented the ways in which ambitious, creative, capable nurses were stymied in attempting new applications for nursing knowledge. Nursing is constraining its own mandate to contribute to health care through stringent licensing processes. Healthcare reform provides an opportunity for nursing regulators to rethink their processes and provide the latitude for nurse-driven change. K E Y W O R D Shealthcare reform, innovation, nursing, professional regulation, regulatory conservatism | INTRODUCTIONFor decades, there have been calls for health system reform based on innovative roles for health professionals and maximized professional scopes of practice. Nursing has been regarded as central to a more sustainable system that focuses on primary, community-based care rather than acute care, and on health rather than illness. Although policy documents from health professionals and policy-makers continue to call for a redeployment of professional skill, the system continues to be physician-and hospital-focused and there has been little fundamental movement toward envisioned reforms. Professional regulatory organizations, through legislation, define the standards and parameters of professional practice. Nursing regulators tend to emphasize public protection over the advancement of nursing. Thus, professional regulatory processes tend to be quite conservative, with an emphasis on risk reduction. This conservative regulatory perspective may constrain innovation and the use of professional knowledge that has been envisioned over the years.There is almost no empirical evidence about the impact that professional regulatory practices have on innovation in health professional roles such as nursing. This article reports the findings of a qualitative study that aimed to explore the impact of nursing professional regulation (licensing) on nurses' abilities to expand their scopes of practice and develop innovative and advanced roles for nurses that respond to emerging health and system needs and ensure that nursing is able to att...

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“…As such, nurse practitioner roles have typically been implemented as either substitutes for medical professionals or as complementing and enhancing the overall care provided by medical professionals (Bonsall and Cheater 2008). In contrast to a biomedical focus of diagnosis and disease treatment held by many medical professionals, nurse practitioners practice within a holistic philosophy of care that emphasises therapeutic relationships and awareness of the whole person (Gould, Johnstone et al 2007, Harvey, Driscoll et al 2011). …”

Section: Introductionmentioning

confidence: 99%

How do nurse practitioners work in primary health care settings? A scoping review

Grant

Lines

Darbyshire

et al. 2017

International Journal of Nursing Studies

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Abstract:Objectives: This scoping review explores the work of nurse practitioners in primary health care settings in developed countries and critiques their contribution to improved health outcomes.Design: A scoping review design was employed and included development of a research question, identification of potentially relevant studies, selection of relevant studies, charting data, collating, summarising and reporting findings. An additional step was added to evaluate the methodological rigor of each study. Results: 74 articles from eight countries were identified, with the majority emanating from the United States of America. Nurse practitioners working in communities provided care mostly in primary care centres (n=42), but also in community centres (n=6), outpatient departments (n=6), homes (n=5), schools (n=3), child abuse clinics (n=1), via communication technologies (n=6), and through combined face-to-face and communication technologies (n=5). The scope of nurse practitioner work varied on a continuum from being targeted towards a specific disease process or managing individual health and wellbeing needs in a holistic manner. Enhanced skills included co-ordination, collaboration, education, counselling, connecting clients with services and advocacy. Measures used to evaluate outcomes varied widely from physiological data (n=25), hospital admissions (n=10), use of health services (n=15), self-reported health (n=13), behavioural change (n=14), patient satisfaction (n=17), cost savings (n=3) and mortality/morbidity (n=5). ConclusionsThe majority of nurse practitioners working in community settings did so within a selective model of primary health care with some examples of nurse practitioners contributing to comprehensive models of primary health care. Nurse practitioners predominantly worked with populations defined by an illness with structured protocols for curative and rehabilitative care. Nurse practitioner work that also incorporated promotive activities targeted improving social determinants of health for people rendered vulnerable due to ethnicity, Aboriginal identity, socioeconomic disadvantage, remote location, gender and aging. Interventions were at individual and community levels with outcomes including increased access to care, cost savings and salutogenic characteristics of empowerment for social change.

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The discursive practices of nurse practitioner legislation in Australia

Abstract: This paper exposes the influence that powerful discourses can have on a major change to professional practice.

Cited by 15 publications

References 13 publications

Medical acceptance of the nurse practitioner role in Australia: A decade on

Medical acceptance of the nurse practitioner role in Australia: A decade on

The impact of regulatory perspectives and practices on professional innovation in nursing

How do nurse practitioners work in primary health care settings? A scoping review

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