The evolution of the role of the Emergency Nurse Practitioner in Scotland: a longitudinal study.

AIMS AND OBJECTIVES: To examine how the role of the Emergency Nurse Practitioner has evolved in Scotland. BACKGROUND: In 2001, Cooper and colleagues published a report on their survey (carried out in 1998) which described the extent and nature of Emergency Nurse Practitioner services in Scotland. They described a nascent nursing role and service that existed in almost half of Emergency Departments and that concentrated its activity on the management of minor distal limb trauma and wound management. Since that date, several relevant and important political, professional and local issues have combined to accelerate the development of this role. DESIGN: Longitudinal survey of Scottish Emergency Departments (n = 97 in 1998, n = 93 in 2009). METHOD: Census survey of all Scottish Emergency Departments identified by NHS National Services Scotland's Information and Statistics Division Accident and Emergency Waiting Times dataset 2006-07. RESULTS: Emergency Nurse Practitioners are now practising in the majority (89%) of Emergency Departments and Minor Injury Units compared with 47% in 1998. Most departments (78%) use Emergency Nurse Practitioners in dual roles, and most departments (67%) differentiate their Emergency Nurse Practitioners from other nursing staff by use of a title. Wide variations in pay, role and scope of practice still exist. CONCLUSIONS: The role of the Emergency Nurse Practitioner has increasingly become part of mainstream health care delivery in Emergency Departments across Scotland and can now be considered to be common place. This study demonstrates that 'Advanced Nursing Practitioners' and 'Nurse Practitioners' cannot necessarily be considered to be synonymous, and nursing roles that are allowed to evolve naturally adopt a non-uniform level of practice. RELEVANCE TO CLINICAL PRACTICE: This paper is of interest to Nurse Practitioners and workforce planners.

Linking theory to practice in introductory practice learning experiences.

Nurse educators internationally are challenged with finding a sufficient number of suitable practice learning experiences for student nurses. This paper reports on a study which aimed to evaluate the utilisation of specialised and highly technical environments ("new" environments) as first practice learning experiences for adult nursing students in the UK. A survey was conducted on 158 first year student nurses who were allocated to either "new" or "old" (those that have been traditionally used) environments. Data analysis was conducted using Mann-Whitney U test and exploratory factor analysis was performed. Results have demonstrated that all environments afford novice nurses the opportunity to observe or practice the essential skills of nursing. In addition, the "new" environments have revealed greater opportunity to observe and practice aspects of practice related to governance of care. This paper concludes that a nursing curriculum which makes clear association between the essential nature of nursing and practice based learning outcomes will help the student to appreciate contemporary nursing practice and to link nursing theory with practice. Further research is required to explain the observation that aspects of practice related to governance are more visible within highly technical areas of practice.

Re-valuing nursing's currency: shifting away from hierarchical binary opposition.

This paper starts a discussion amongst nurse educators internationally regarding the nature of curricula for initial nursing licensure. Nursing is compelled by traditional views of nursing into taking a long-established and expected place in the health care hierarchy, which is reflected in current curricula. In order to establish a re-valued nursing currency within healthcare, nursing educators are required to re-examine these established norms and re-design these curricula, based on the premise that nursing is now set in a complex and unpredictable system.

Confident to seek help: the development of skill and judgement in nurse practitioners. A mixed methods study.

BACKGROUND: Healthcare is undergoing a transformation in terms of traditional role and skill assignations of staff, with an attendant blurring of boundaries. Expert judgement is used in order to develop and assess learners as they prepare for these new roles. OBJECTIVES: To determine factors related to the perceived usefulness of feedback, to find out how participants use expert judgement, to develop skill and to examine how the context of learning affects the development of judgement. SETTING: Four NHS Health Board areas within Scotland. PARTICIPANTS: 95 nurse practitioners who had successfully completed a specified course of skills based education between September 2008 and August 2010. 10 participants agreed to follow up interview. DESIGN: Survey and follow-up semi-structured interviews. METHODS: Mixed methods. 20 item, internet based questionnaire (n = 85) and semi-structured interviews (n = 10), collected between September 2010 and February 2011. RESULTS: Response rate was 55%-confidence level of 99%, this sample yields a confidence interval of 12.9%. The results demonstrate that the demonstration of skill and the perception of expertise of the supervisor are related to the perceived usefulness of feedback (p < 0.004). The participants use feedback as one strategy to develop skill and judgement, although the mining of the tacit knowledge of medical colleagues, reference to associated theory and peer support and learning strategies are also seen to be important. The development of judgement is restricted by the tightly controlled learning environment. CONCLUSIONS: Identification of participants with the expertise of the supervisory group reveals a group who are highly aspirational and for whom the governance of learning leads the participants to be confident to seek help and not the confidence to identify learning needs. Learning is seen to be dominated by the context in which it is set and as the participants learn motor skills, they learn to fit in and manage a brittle working environment.

The role of expert judgement and feedback in sustainable assessment: a discussion paper.

Skill assessment is an enduring issue for nurses both in the nursing education and practice. Emphasis is placed upon assessment for the attainment of learning outcomes within courses of education, at the expense of skill maintenance and skill development within practice. The concept of "sustainable assessment" combines and encourages both ideas and the role of judgement in assessment is crucial to this. Within courses of nursing education, skill is invariably guided and eventually assessed by the aid of an expert in the field, a connoisseur who applies the judgement of the specialist and delivers the criticism of connoisseur in the form of feedback. This paper concludes that the utilisation of this feedback to develop the students' ability to help judge their own practice is central to the notion of sustainable assessment and calls for discussion and research into this emerging field of enquiry.

Triangulation for the assessment of clinical nursing skills: a review of theory, use and methodology.

AIM: To review the use and usefulness of the methodological strategy of triangulation in the assessment of skill in nursing curricula. DESIGN: Systematic search of the literature relevant to the definition and assessment of skill, reliability and validity of assessment methods and triangulation of assessment strategies. DATA SOURCES: One hundred and twenty papers from nursing, medical, educational and social scientific databases, relevant websites and relevant books were reviewed. Forty papers were included based on their relevance to the theory and methodology of clinical skills assessment of health care professionals, particularly nurses. Papers concerning vocational skills assessment and the assessment of skill in school children were excluded. RESULTS: There is a current imperative within the field of health care professional education to assess clinical skills and to quantify this assessment. However, clinical skill, as it relates to cognition, is poorly defined concept and may be viewed as a quality of the practitioner and, as such, is difficult to quantify. Very many methods of assessing clinical skill have been documented and there are inherent issues in ensuring both reliability and validity of these assessment strategies for clinical skill. This has led commentators to suggest that the process of triangulation should be employed. CONCLUSIONS: The paper fundamentally questions whether the concept of triangulation can be applied to skills assessment without dependable measures of reliability and validity of the tools of assessment and concludes that the process of applying multiple modes of assessment should not be confused with the process of triangulation.