The nature and implications of support in graduate nurse transition programs : an Australian study

It is widely recognized that support is critical to graduate nurse transition from novice to advanced beginner-level practitioner and to the integration of neophyte practitioners into safe and effective organizational processes. Just what constitutes support, however, and why (if at all) support is important, when, ideally, support should be given, by whom, how, and for how long, have not been systematically investigated. Building on the findings (previously reported) of a yearlong study that had, as its focus, an exploration and description of processes influencing the successful integration of new graduate nurses into safe and effective organizational processes and systems, the findings presented in this article strongly suggest that support is critical to the process of graduate nurse transition, and that integration into “the system” is best provided during the first 4 weeks of a graduate nurse transition program and thereafter at the beginning of each ward rotation; that “informal teachers” and the graduate nurses themselves are often the best sources of support; and that the most potent barriers to support being provided are the untoward attitudes of staff toward new graduates. Drawing on the overall findings of the study, a new operational definition of support is proposed and recommendations are made for future comparative research on the issue.

Complementary therapies or 'luxury' therapies? A nurse's experience in the use of complementary therapies in nursing practice

Complementary therapies have an increasing popularity. This case study explores the experience of a nurse who practises complementary therapies within the health care system where there is a still a widespread of skepticism within the medical profession. It is considered by the nurse that it is a 'luxury' to include these therapies in nursing practice.

Nurse academics meeting the challenges of scholarship and research

This research study explored nurse academics' perceptions and experiences of scholarship and research. Interviews were carried out with 20 nurse academics in four Australian states. A grounded theory approach was used to explore issues they faced. The paper discusses how academics engaged in research and scholarship integrate it into their work practices. The participants spoke of problems encountered, such as the difficulty of gaining higher degrees whilst undertaking additional research. They indicated they felt under significant pressure to publish. The organisational structures that a small number of institutions put in place to facilitate the development of a scholarly research culture are illustrated.

A trial of nurse practitioner scope of practice

Aims. The aim of this paper is to report a trial to investigate the feasibility of the nurse practitioner role in local health service delivery and to provide information about the educational and legislative requirements for nurse practitioner practice.

Background. Nurse practitioners have been shown to offer a beneficial service and fill a gap in health care provision. However, the lack of publications describing, critiquing, or defending the way that existing nurse practitioner roles have been developed may lead to a lack of clarity in comparing the nurse practitioner scope of practice internationally. In Australia, credible exploratory research is needed to realize the potential of nurse practitioners to bridge the divide of inequitable distribution of health services. A trial of nurse practitioner services in the Australian Capital Territory provided an excellent opportunity to investigate these scope and continuity issues.

Methods. This was an observational analytic study using multiple data sources. Four models of nurse practitioner service were chosen from a competitive field of applications that were evaluated according to efficacy, feasibility, and sustainability across specified selection criteria. Each model in the trial included a clinical support team, with the nurse practitioner candidate 'working-into-the-role' and collecting demographic, clinical practice, patient outcome, and health service and consumer survey data over a 10 month period.

Findings. The trial identified the broad potential of the nurse practitioner role, its breadth and limitations, and its impact on selected health services in the Australian Capital Territory. Data from individual models were compared highlighting generic elements, and formed the basis for the development of the scope of practice for the Australian Capital Territory nurse practitioner models.

Conclusions. This study has validated a research-based, iterative process for initial development of nurse practitioner scope of practice for any Australian specialization. Importantly, the study concluded with the scope of practice as a finding, rather than commencing with it a priori. Although general areas of health care need and under-servicing were identified at the outset, the process tested both the expansion and parameters of the roles.

A historical review of the nurse practitioner role in Australia

Internationally, the nurse practitioner role has been shown to be cost-effective, safe, and instrumental in improving patient outcomes. The nurse practitioner role in Australia is in its infancy. Major stakeholders such as the nurses' boards and state departments of health throughout Australia were contacted to identify major policies and discussion papers. Database searches were conducted in CINAHL and EBSCOhost. Disparity between states exists in all facets of the nurse practitioner role, especially in definition of the role, scope of practice, educational qualifications, and specialized functions. Access to Medicare funding is unobtainable, resulting in inequity of access to health services for disadvantaged communities. The State Nurse Practitioner Taskforce Reports highlight the disparity between the role of nurse practitioner in each State of Australia and has led to fragmentation of the role at a national level. There is a need for consistency, which could be achieved if it were coordinated by a national nursing body with a voice in national health policy development and implementation

Emergency nurse practitioner care and emergency department patient flow: case-control study

Objective: The present study aimed to compare ED waiting times (for medical assessment and treatment), treatment times and length of stay (LOS) for patients managed by an emergency nurse practitioner candidate (ENPC) with patients managed via traditional ED care. Methods: A case–control design was used. Patients were selected using the three most common ED discharge diagnoses for ENPC managed patients: hand/wrist wounds, hand/wrist fractures and removal of plaster of Paris. The ENPC group (n = 102) consisted of patients managed by the ENPC who had ED discharge diagnoses as mentioned above. The control group (n = 623) consisted of patients with the same ED discharge diagnoses who were managed via traditional ED care. Results: There were no significant differences in median waiting times, treatment times and ED LOS between ENPC managed patients and patients managed via traditional ED processes. There appeared to be some variability between diagnostic subgroups in terms of treatment times and ED LOS. Conclusion: Patient flow outcomes for ENPC managed patients are comparable with those of patients managed via usual ED processes.

Development, reliability and validity of an instrument measuring the attitudes and knowledge of emergency department staff regarding the emergency nurse practitioner role

Introduction: The Emergency Department (ED) at The Northern Hospital is currently participating in the Victorian Department of Human Services funded Emergency Nurse Practitioner Project. This project aims to develop, implement and evaluate the Emergency Nurse Practitioner role in Victorian EDs. This led to a need to develop a specific data collection tool called The Northern Emergency Nurse Practitioner Staff Survey to examine the knowledge and attitudes of ED medical and nursing staff. This paper describes the development of The Northern Emergency Nurse Practitioner Staff Survey and presents the results of reliability and validity studies. Method: Twenty-five items were developed and piloted on a sample of 58 ED medical and nursing staff. Content and face validity were established by expert panel review. Reliability was established by tests of unidimensionality, exploratory factor analysis and internal consistency. Results: Four items were discarded because of low item to total correlation. Exploratory factor analysis of the remaining items revealed five factors with eigenvalues >1 and acceptable correlation coefficients that explained 76.7% of the variance. Cronbach’s coefficent α for these items was 0.926 indicating a high degree of internal consistency. The factors were titled to reflect the content domain of the items in each factor and the factors arranged in a logical sequence to form the final version of The Northern Emergency Nurse Practitioner Survey.

Defining the scope of practice of the emergency nurse practitioner role in a metropolitan emergency department

This study examined the emergency nurse practitioner candidate (ENPC) scope of practice in a Victorian emergency department (ED). The emergency nurse practitioner (ENP) role is relatively new in Victoria and the scope of the ENP(C) practice is yet to be defined. International research literature regarding the ENP role has focused on outcomes such as patient satisfaction, waiting times and/or ED length of stay, accuracy and adequacy of documentation, use of radiography, and patient education, health promotion and communication issues. A prospective exploratory design was used to conduct this cohort study. There were 476 ENPC-managed patients between 14 July 2004 and 31 March 2005 with an average age of 29 years. The majority (77.2%) of ENPC-managed patients were discharged from the ED. The majority of the ENPC time was devoted to clinical practice (55%) and development of clinical practice guidelines (25%). Of patients managed by the ENPC, 49.6% required medications, 51% required diagnostic imaging and 8.6% required pathology testing during their ED stay. The most common discharge referrals were made to local medical officers (73.5%) and the most common referrals made for patients requiring admission were made to the plastic surgery (37.3%) and orthopaedic (35.5%) units. Extensions to the current scope of emergency nursing practice are pivotal to effective management of specific patient groups by ENP. The ENP model of care is an important strategy for the management of increased service demands in Victoria; however, little is known about the scope of the ENPC practice and many outcomes of the ENP care are yet to be defined. Further research to better understand the relationships between ENP outcomes is required if the contribution that ENPs make to emergency care is to be accurately quantified.

Nurse practitioner competency standards: findings from collaborative Australian and New Zealand research

Background: The title, Nurse Practitioner, is protected in most jurisdictions in Australia and New Zealand and the number of nurse practitioners is increasing in health services in both countries. Despite this expansion of the role, there is scant national or international research to inform development of nurse practitioner competency standards.

Objectives: The aim of this study was to research nurse practitioner practice to inform development of generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries.

Design: The research used a multi-methods approach to capture a range of data sources including research of policies and curricula, and interviews with clinicians. Data were collected from relevant sources in Australia and New Zealand.

Settings: The research was conducted in New Zealand and the five states and territories in Australia where, at the time of the research, the title of nurse practitioner was legally protected.

Participants: The research was conducted with a purposeful sample of nurse practitioners from diverse clinical settings in both countries. Interviews and material data were collected from a range of sources and data were analysed within and across these data modalities.

Results: Findings included identification of three generic standards for nurse practitioner practice: namely, Dynamic Practice, Professional Efficacy and Clinical Leadership. Each of these standards has a number of practice competencies, each of these competencies with its own performance indicators.

Conclusions: Generic standards for nurse practitioner practice will support a standardised approach and mutual recognition of nurse practitioner authorisation across the two countries. Additionally, these research outcomes can more generally inform education providers, authorising bodies and clinicians on the standards of practice for the nurse practitioner whilst also contributing to the current international debate on nurse practitioner standards and scope of practice.

Burnout in the caring nurse: learning resilient behaviours

This paper reviews current literature to offer a discussion related to burnout, an issue that affects the entire healthcare sector, including nurses and patients. Literature suggests a correlation between moral distress and burnout in nurses. These issues are considered to be current and affect recruitment and retention of nurses. The authors propose supporting nurses by using knowledge of resilient behaviours as a means of transcending burnout and workplace stress. The authors believe that this process can be achieved through existing hospital professional development processes, for example supervision, reflective practice, in-service education and other forms of professional development.

Transference in the nurse-patient relationship

The therapeutic relationship has been considered foundational to psychiatric nursing practice since at least the mid-20th century. However, this does not, in itself, guarantee either its continuity or relevance to current practice. Concepts such as the therapeutic relationship require sustained attention, both in theory and in practice, to illustrate ongoing relevance to the discipline. This paper addresses the therapeutic relationship in psychiatric nursing via aspects of psychoanalytic theory, particularly the notion of transference, as theorized by both Freud and Lacan. Two case fragments provide practice material, through which transference in the nurse–patient relationship is explored. The nurse, in the context of his/her relationship with the patient, a sick stranger, offers both a listening and the potential development of transference. This transference can be experienced, in part, as a form of attachment to the nurse, one that is not regarded pejoratively as dependency. There is the potential, within the nurse–patient relationship, for a psychical holding to develop, one from within which both the patient can speak and transference might arise. It is argued that listening to the patient has the potential to assist the patient and, with the development of transference, can provide the context for important work.

Mapping postgraduate nurse education in Australia 2001-2002

Workforce planning at a national level within nursing and midwifery has been largely fragmented and uncoordinated with health-care organisations, state health authorities, peak nursing organisations and the tertiary sector often engaging in independent decision making and planning. In order to gain an increased understanding of the complexity of contemporary nurse education and to quantify the number of graduates of nursing education courses into categories that are meaningful for workforce planning, the federal Department of Education, Science and Training commissioned a national study in 2002. The aim of this study was to map and quantify current and projected numbers of Australian domestic nursing postgraduate students within their respective specialisation according to each State/Territory. All Australian universities offering postgraduate courses in nursing were electronically surveyed (n=30). Two non-university providers of postgraduate nursing education were also asked to participate, but only one responded. Data were gathered on the number of domestic postgraduate nursing students enrolled in 2002, the number of course completions in 2001 and projected completions for 2002. Of the 13 broad band specialty categories developed for the study, the specialties of Midwifery and High Dependency were dominant in both student enrolments and course completions, including projected completions. The range of specialties that were offered varied by State/Territory, as did the number and percentage of students enrolled, completing and projected to complete each specialty program. Generic courses (without listed specialisations) continue to complicate the process of attempting to tease out and quantify accurately the number of enrolled and completing postgraduate students according to area of specialty practice.

Competency and capability: imperative for nurse practitioner education

Objective:
The objective of this study was to conduct research to inform the development of standards for nurse practitioner education in Australia and New Zealand and to contribute to the international debate on nurse practitioner practice.
Setting:
The research was conducted in all states of Australia where the nurse practitioner is authorised and in New Zealand.
Subjects:
The research was informed by multiple data sources including nurse practitioner program curricula documents from all relevant universities in Australia and New Zealand, interviews with academic convenors of these programs and interviews with nurse practitioners.
Primary argument:
Findings from this research include support for master's level of education as preparation for the nurse practitioner. These programs need to have a strong clinical learning component and in-depth education for the sciences of specialty practice. Additionally an important aspect of education for the nurse practitioner is the centrality of student directed and flexible learning models. This approach is well supported by the literature on capability.
Conclusions:
There is agreement in the literature about the lack of consistent standards in nurse practitioner practice, education and nomenclature. The findings from this research contribute to the international debate in this area and bring research informed standards to nurse practitioner education in Australia and New Zealand.