University Health Network Framework for Advanced Nursing Practice: Development of a Comprehensive Conceptual Framework Describing the Multidimensional Contributions of Advanced Practice Nurses

Factors affecting nurse practitioner role implementation in Canadian practice settings: an integrative review

“…Systems level factors include a lack of legislative and regulatory authority for the role, conflicting role definitions, multiple titles, inadequate organization of care, no established funding mechanisms, opposition from the medical profession and inconsistent educational requirements (Dunn & Nicklin 1995, Schreiber et al. 2003, Bryant‐Lukosius & DiCenso 2004, Micevski et al. 2004, Delamaire & Lafortune 2010).…”

Advanced practice nursing: A principle‐based concept analysis

“…The literature has a general consensus that advanced practice nursing is beyond basic clinical nursing practice. Advanced practice nursing includes higher clinical skill, specialization of care, depth, breadth, and expansion of knowledge, degree of data synthesis, advancement with complexity of skills and interventions acquired through graduate education, expanded theoretical and research‐based interventions, and autonomous roles with expanded boundaries and scope of practice (AANP, 2002; Bryant‐Lukosius et al, 2004; Davies & Hughes, 2002; DeBourgh, 2001; Donnelly, 2007; Fawcett, Newman, & McAllister, 2004; Gardner, Chang, & Duffield, 2007; Hamric et al, 2000; Hanson & Hamric, 2003; Hickey, Ouimette, Venegoni, 2000; Ingersoll, McIntosh, & Williams, 2000; Jamieson & Williams, 2002; Ketefian, Redman, Hanucharurnkul, Masterson, & Neves, 2001; MacDonald, Herbert, & Thibeault, 2006; Micevski, Mulcahy, Belford, & Kells, 2004; Murphy‐Ende, 2002; Mirr Jansen, & Zwygart‐Stauffacher, 2006; Spross & Heaney, 2000). Donnelly comments, “APNs provide services quite different and independent from mainstream nursing practice” (p. 4).…”

“…There is consensus within the literature that advanced practice nursing, in its most general form, refers to the whole field and encompasses the environment, the roles, the resources, and the structures that permit ANP to occur (Bryant‐Lukosius & DiCenso, 2004; Bryant‐Lukosius et al, 2004; DeBourgh, 2001; Fawcett et al, 2004; Gardner et al, 2007; Hamric et al, 2000; Hanson & Hamric, 2003; Hickey et el., 2000; Ingersoll et al, 2002; Ketefian et al, 2001; Mirr Jansen, & Zwygart‐Stauffacher, 2006; Murphy‐Ende, 2002; Spross & Heaney, 2000; Wells, 2002). ANP, then, is an umbrella term that refers to the practice or what APNs do , and their different roles, practice domains, supportive and derivative factors (Bryant‐Lukosius & DiCenso; Bryant‐Lukosius et al; DeBourgh,; Gardner et al; Hamric et al; Hanson & Hamric; Micevski et al, 2004; Spross & Heaney). There is confusion when these terms are used interchangeably since there is a difference in nomenclature and definition, but the literature was moderately consistent at providing definitions congruent with those stated above.…”

“…Although there is a slight identity crisis within the nursing profession owing to the plethora of roles and titles, advanced practice nursing is pragmatically mature according to how well the literature discusses its contribution to the profession (Ormond‐Walshe & Newham, 2001). There is consensus in the literature that APNs are legal, economic, and professional agents of change, who contribute to the profession in numerous ways that can be summed into five main categories or sub‐roles: expert clinical practice, education, research, professional, and organizational (AANP, 2002; Bryant‐Lukosius & DiCenso, 2004; Bryant‐Lukosius et al, 2004; Davies & Hughes, 2002; Donley, 2000; Gardner et al, 2007; Hamric et al, 2000; Hanson & Hamric, 2003; Jamieson & Williams, 2002; Mantzoukas & Watkinson, 2006; Micevski et al, 2004; Mirr Jansen, & Zwygart‐Stauffacher, 2006; Perron & Holmes, 2006; Rose et al, 2002; Spross & Heaney, 2000). The overall pragmatism of advanced practice nursing is attaining practice autonomy, professional integrity, and being the leaders in developing practice while adding to and shaping the discipline to advance the science from which APNs practice, and improving the provision of care (Arslanian‐Engoren et al, 2005; Donley; Mantzoukas & Watkinson).…”

“…The professional domain incorporates the APN attributes of leader, change agent, accountability, political activism, advocacy, power and authority, scholarship, commitment, and expanded scope of practice, knowledge, skills, and competencies. Lastly, the organizational domain includes management, policy development and implementation, administration, and decision making (Bryant‐Lukosius et al, 2004; Cole, 2003; Cumbie et al, 2004; Davies & Hughes, 2002; DeBourgh, 2001; Donnelly, 2007; Furlong & Smith, 2005; Gardner et al, 2007; Hamric et al, 2000; Hanson & Hamric, 2003; Jamieson & Williams, 2002; Micevski et al, 2004; Mick & Ackerman, 2000; Oberle & Allen, 2001; Ormond‐Walshe & Newham, 2001; Pearson & Peels, 2002; Perron & Holmes, 2006; Rose et al, 2002; Spross & Heaney, 2000; Wells, 2002).…”