The core role of the nurse practitioner: practice, professionalism and clinical leadership.

AIM: To draw on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand. BACKGROUND: Enacted legislation provides for mutual recognition of qualifications, including nursing, between New Zealand and Australia. As the nurse practitioner role is relatively new in both countries, there is no consistency in role expectation and hence mutual recognition has not yet been applied to nurse practitioners. A study jointly commissioned by both countries' Regulatory Boards developed information on the core role of the nurse practitioner, to develop shared competency and educational standards. Reporting on this study's process and outcomes provides insights that are relevant both locally and internationally. METHOD: This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner program curricula and interviews with 15 nurse practitioners from the two countries. Data were analysed according to the appropriate standard for each data type and included both deductive and inductive methods. The data were aggregated thematically according to patterns within and across the interview and material data. FINDINGS: The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care. CONCLUSION: A clearly articulated and research informed description of the core role of the nurse practitioner provides the basis for development of educational and practice competency standards. These research findings provide new perspectives to inform the international debate about this extended level of nursing practice. RELEVANCE TO CLINICAL PRACTICE: The findings from this research have the potential to achieve a standardised approach and internationally consistent nomenclature for the nurse practitioner role.

Development and validation of a novel approach to work sampling : a study of nurse practitioner work patterns

Objectives: This methodological paper reports on the development and validation of a work sampling instrument and data collection processes to conduct a national study of nurse practitioners’ work patterns. ---------- Design: Published work sampling instruments provided the basis for development and validation of a tool for use in a national study of nurse practitioner work activities across diverse contextual and clinical service models. Steps taken in the approach included design of a nurse practitioner-specific data collection tool and development of an innovative web-based program to train and establish inter rater reliability of a team of data collectors who were geographically dispersed across metropolitan, rural and remote health care settings. ---------- Setting: The study is part of a large funded study into nurse practitioner service. The Australian Nurse Practitioner Study is a national study phased over three years and was designed to provide essential information for Australian health service planners, regulators and consumer groups on the profile, process and outcome of nurse practitioner service. ---------- Results: The outcome if this phase of the study is empirically tested instruments, process and training materials for use in an international context by investigators interested in conducting a national study of nurse practitioner work practices. ---------- Conclusion: Development and preparation of a new approach to describing nurse practitioner practices using work sampling methods provides the groundwork for international collaboration in evaluation of nurse practitioner service.

The first Australian nurse practitioner census : a protocol to guide standardized collection of information about an emergent professional group

Internationally, collection of reliable data on new and evolving health-care roles is crucial. We describe a protocol for design and administration of a national census of an emergent health-care role, namely nurse practitioners in Australia using databases held by regulatory authorities. A questionnaire was developed to obtain data on the role and scope of practice of Australian nurse practitioners. Our tool comprised five sections and included a total of 56 questions, using 28 existing items from the National Nursing and Midwifery Labour Force Census and nine items recommended in the Nurse Practitioner Workforce Planning Minimum Data Set. Australian Nurse Registering Authorities (n = 6) distributed the survey on our behalf. This paper outlines our instrument and methods. The survey was administered to 238 authorized Australian nurse practitioners (85% response rate). Rigorous collection of standardized items will ensure health policy is informed by reliable and valid data. We will re-administer the survey 2 years following the first survey to measure change over time.

Telling tales, shaping stories : the creative practitioner and the artful life story

Norman K. Denzin (1989) claims that the central assumption of the biographical method—that a life can be captured and represented in a text—is open to question. This paper explores Denzin’s statement by documenting the role of creative writers in re-presenting oral histories in two case studies from Queensland, Australia. The first, The Queensland Business Leaders Hall of Fame, was a commercial research project commissioned by the State Library of Queensland (SLQ) in 2009, and involved semi-formal qualitative interviews and digital stories. The second is an on-going practice-led PhD project, The Artful Life: Oral History and Fiction, which investigates the fictionalisation of oral histories. Both projects enter into a dialogue around the re-presentation of oral and life histories, with attention given to the critical scholarship and creative practice in the process. Creative writers represent a life having particular preoccupations with techniques that more closely align with fiction than non-fiction (Hirsch and Dixon 2008). In this context, oral history resources are viewed not so much as repositories of historical facts, but as ambiguous and fluid narrative sources. The comparison of the two case studies also demonstrates that the aims of a particular project dictate the nature of the re-presentation, revealing that writing about another’s life is a complex act of artful ‘shaping’. Alistair Thomson (2007) notes the growing interdisciplinary nature of oral history scholarship since the 1980s; oral histories are used increasingly in art-based contexts to produce diverse cultural artefacts, such as digital stories and works of fiction, which are very different from traditional histories. What are the methodological implications of such projects? This paper will draw on self-reflexive practice to explore this question.

Governmentality and the reflection of legal educators : assessment practices as a case study

This paper presents a conceptual framework, informed by Foucault’s work on governmentality, which allows for new kinds of reflection on the practice of legal education. Put simply, this framework suggests that legal education can be understood as a form of government that relies on a specific rationalisation and programming of the activities of legal educators, students, and administrators, and is implemented by harnessing specific techniques and bodies of ‘know-how’. Applying this framework to assessment at three Australian law schools, this paper highlights how assessment practices are rationalised, programmed, and implemented, and points out how this government shapes students’ legal personae. In particular, this analysis focuses on the governmental effects of pedagogical discourses that are dominant within the design and scholarship of legal education. It demonstrates that the development of pedagogically-sound regimes of assessment has contributed to a reformulation of the terrain of government, by providing the conditions under which forms of legal personae may be more effectively shaped, and extending the power relations that achieve this. This analysis provides legal educators with an original way of reflecting on the power effects of teaching the law, and new opportunities for thinking about what is possible in legal education.

Executive coaching : perspectives of effectiveness from executives and coaches

Over the past two decades there has been a remarkable expansion in the use of executive coaching as an executive development technique. The increasing prominence of executive coaching has been attributed to the emergence of new organisational cultures and the subtler competencies needed by executives in these faster moving organisations. The widespread popularity of executive coaching has been based largely on anecdotal feedback regarding its effectiveness. The small body of empirical research has been growing but conclusive outcomes are rare. The prominent question for those with the business imperative to implement executive coaching has been what are the ingredients of the process that engender an effective outcome? This investigation has focused on the factors of executive coaching that contribute to effectiveness. A qualitative methodology facilitated an in-depth study of the experiences of the participants of executive coaching with the perceptions of both executives and coaches being sought. Semi-structured interviews and a focus group provided rich, thick descriptions and together with a process of inductive analysis produced findings that confidently identify the key factors that contribute to coaching effectiveness. Six major themes were identified, each comprising a collection of meanings. These themes have been labelled Executive Engagement, Preliminary Assessment and Feedback, Coaching Process, Coach.s Contribution, Trusting Relationship and Support from the Organisation. One theme, Coaching Process, comprises three significant sub-themes, namely, Encouragement and Emotional Support, Challenge and Reflection and Enhancing Executive Performance. The findings of this study add value to the field by identifying factors contributing to coaching effectiveness, and providing for the coaching practitioner a basis for enhancing their practice of executive coaching to better meet the needs of executives and their organisations.

Valuation methods for resident funded retirement villages in Australia : a practitioner's perspective

Designed for independent living, retirement villages provide either detached or semi-detached residential dwellings with car parking and small private yards. Retirement village developments usually include a mix of independent living units (ILUs) and serviced apartments (SAs) with community facilities providing a shared congregational area for village activities and socialising. Retirement Village assets differ from traditional residential assets due to their operation in accordance with statutory legislation. In Australia, each State and Territory has its own Retirement Village Act and Regulations. In essence, the village operator provides the land and buildings to the residents who pay an amount on entry for the right of occupation. On departure from the units an agreed proportion of either the original purchase price or the sale price is paid to the outgoing resident. The market value of the operator’s interest in the Retirement Village is therefore based upon the estimated future income from Deferred Management Fees and Capital Gain upon roll-over receivable by the operator in accordance with the respective residency agreements. Given the lumpiness of these payments, there is general acceptance that the most appropriate approach to valuation is through Discounted Cash Flow (DCF) analysis. There is however inconsistency between valuers across Australia in how they undertake their DCF analysis, leading to differences in reported values and subsequent confusion among users of valuation services. To give guidance to valuers and enhance confidence from users of valuation services this paper investigates the five major elements of discounted cash flow methodology, namely cash flows, escalation factors, holding period, terminal value and discount rate. Whilst there is dissatisfaction with the financial structuring of the DMF in residency agreements, as long as there are future financial returns receivable by the Village owner/operator, then DCF will continue to be the most appropriate valuation methodology for resident funded retirement villages.

The voices of the exegesis

In a recent journal article, Luke Jaaniste and I identified an emergent model of exegesis. From a content analysis of submitted exegeses within a local archive, we identified an approach that is quite different from the traditional thesis, but is also distinct from previously identified forms of exegesis, which Milech and Schilo have described as a ‘context model’ (which assumes the voice of academic objectivity and provides an historical or theoretical context for the creative practice) and a ‘commentary’ model’ (which takes the form of a first person reflection on the challenges, insights and achievements of the practice). The model we identified combines these dichotomous forms and assumes a dual orientation–looking outwards to the established field of research, exemplars and theories, and inwards to the methodologies, processes and outcomes of the practice. We went on to argue that this ‘connective’ exegesis offers clear benefits to the researcher in connecting the practice to an established field while allowing the researcher to demonstrate how the methods have led to outcomes that advance the field in some way. And, while it helps the candidate to articulate objective claims for research innovation, it enables them to retain a voiced, personal relationship with their practice. However, it also poses considerable complexities and challenges in the writing. It requires a reconciliation of multi-perspectival subject positions: the disinterested perspective and academic objectivity of an observer/ethnographer/analyst/theorist at times and the invested perspective of the practitioner/ producer at others. The author must also contend with a range of writing styles, speech genres and voices: from the formal, polemical voice of the theorist to the personal, questioning and sometimes emotive voice of reflexivity. Moreover, the connective exegesis requires the researcher to synthesize various perspectives, subject positions, writing styles, and voices into a unified and coherent text. In this paper I consider strategies for writing a hybrid, connective exegesis. I first ground the discussion on polyvocality and alternate textual structures through reference to recent discussions in philosophy and critical theory, and point to examples of emergent approaches to texts and practices in related fields. I then return to the collection of archived exegeses to investigate the strategies that postgraduate candidates have adopted to resolve the problems that arise from a polyvocal, connective exegesis.

Clinical education for nephrology nurse practitioner candidates in Australia : a consensus statement

Objectives: To develop recommendations for the clinical education required to prepare Australian Nurse Practitioner candidates for advanced and extended practice in nephrology settings. Methods: Using the Delphi research technique a consensus statement was developed over a nine month period. All endorsed and candidate Nephrology Nurse Practitioners (NNP) were invited to participate as the expert panel. The Delphi research technique uses a systematic and iterative process. The expert panel were asked to generate a list of items which were then circulated to all NNPs. They were asked to determine their degree of agreement or disagreement with each statement using a 5-point Likert scale There was opportunity for free-text comments to be provided if desired. Results from each round were collated; the document was refined and circulated to the experts for a subsequent round. Consensus was demonstrated after three Delphi rounds. Results: The consensus statement comprises four components explaining the role and membership of the mentorship team, the setting and location of NNP clinical education, learning strategies to support the NNP, and outcomes of NNP clinical education. Demographic questions in the final survey revealed information about the qualifications, years of experience, and practice location of Australian NNPs. Conclusions: The consensus statement is not prescriptive but it will inform NNP candidates, university course providers and mentors about the expected extended nephrology specific clinical education that will enable the NNP to provide advanced nursing care for patients regardless of the stage of chronic kidney disease (CKD) and the practice setting.