A game of snakes and ladders: negotiating the 'ups and downs' of endorsement as a nurse practitioner in Australia.

BACKGROUND: Australian legislation supporting the nurse practitioner (NP) role was enacted in 1998. Since then, NPs have played an important advanced practice role within the interdisciplinary healthcare team. However, the literature suggests that transition to the NP role can be challenging. AIM: This paper highlights the complex transition experiences of ten recently endorsed Australian NPs. The convoluted legislative and regulatory requirements that were negotiated by the NPs are presented as narratives. METHODS: Informed by an ethnographic approach, participants were interviewed several times during their first year. Interview transcripts were thematically analysed and aggregated into three narratives representative of key findings. KEY FINDINGS: The findings exemplify the complexity of navigating through a labyrinth of bureaucracy and the extensive negotiations required to appease those who yielded power over their future practice. CONCLUSION: This study raises awareness of the transition experiences of Australian NPs and their challenges and barriers during this time.

Pressure ulcer prevention in Australia: the role of the nurse practitioner in changing practice and saving lives.

This paper reports on a successful nurse practitioner-led Pressure Ulcer Prevention Program (PUPP), established with members from nursing, allied health and senior management, within a regional area health service in Australia. The aims of PUPP were to quantify the prevalence of pressure ulcers within the health organisation, evaluate the policy compliances, identify cost effectiveness by implementing appropriate pressure redistributing surfaces and raise awareness of pressure ulcer prevention amongst all levels of clinical staff. The strategies include annual point prevalence study across 41 facilities, mattress replacement and online education program. The prevalence survey data were collected by skin inspection and chart audits by the trained surveyors. Since this quality improvement program commenced in 2008, it has demonstrated a reduction in pressure ulcer prevalence by 16.4%, increased pressure ulcer risk assessment by 7.9% and use of appropriate pressure-relieving devices by 46.5%, which led to cost saving of AUD 500 000. This paper highlights the patient and organisation benefits that management and clinicians can accomplish through a systemic collaborative approach, in particular with strong support from the Area Executive Team of the health organisation.

An exploration of the factors that influence nurse practitioner transition in Australia: A story of turmoil, tenacity, and triumph.

BACKGROUND AND PURPOSE: Nurse practitioner (NP) legislation was introduced in Australia in 1998 with the first NPs endorsed 2 years later. Although the number of NPs has slowly increased, they still face significant challenges adjusting to their new role. The aim of this study was to explore the factors that influence the experience of new NPs. METHODS: Ten newly appointed NPs were interviewed three to four times over a 12-month period. Using a summative content analysis, data were reduced to four key factors that influence the experience of role transition: personal, intraprofessional, interprofessional, and organizational. CONCLUSIONS: The findings illustrate that for many participants, transition was a time of turmoil and a great deal of tenacity was required to navigate the journey. However, despite the challenges, some participants were triumphant and able to forge a successful role for themselves. IMPLICATIONS FOR PRACTICE: This study highlights the need for the nursing profession to support new NPs. It also demonstrates that the provision of structured orientation programs is needed to facilitate effective transition to these complex and challenging roles. Clarity of expectations and a gradual increase in responsibilities are likely to optimize adjustment to the NP role.

Measuring the impact of a 'point of view' disability simulation on nursing students' empathy using the Comprehensive State Empathy Scale.

BACKGROUND: Although empathy is an integral component of professional practice and person-centred care, a body of research has identified that vulnerable patients groups frequently experience healthcare that is less than optimal and often lacking in empathy. AIM: The aim of this study was to examine the impact of an immersive point-of-view simulation on nursing students' empathy towards people with an Acquired Brain Injury. SETTING AND PARTICIPANTS: A convenience sample of 390 nursing students from a cohort of 488 participated in the study, giving a response rate of 80%. Students undertook the simulation in pairs and were randomly allocated to the role of either a person with Acquired Brain Injury or a rehabilitation nurse. The simulated 'patients' wore a hemiparesis suit that replicated the experience of dysphasia, hemianopia and hemiparesis. DESIGN: Characteristics of the sample were summarised using descriptive statistics. A two-group pre-test post-test design was used to investigate the impact of the simulation using the Comprehensive State Empathy Scale. t-Tests were performed to analyse changes in empathy pre post and between simulated 'patients' and 'rehabilitation nurses'. RESULTS: On average, participants reported significantly higher mean empathy scores post simulation (3.75, SD=0.66) compared to pre simulation (3.38 SD=0.61); t (398)=10.33, p<0.001. However, this increase was higher for participants who assumed the role of a 'rehabilitation nurse' (mean=3.86, SD=0.62) than for those who took on the 'patient' role (mean=3.64, SD=0.68), p<0.001. CONCLUSION: The results from this study attest to the potential of point-of-view simulations to positively impact nursing students' empathy towards people with a disability. Research with other vulnerable patient groups, student cohorts and in other contexts would be beneficial in taking this work forward.

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

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.

Nurse practitioner role transition: a concept analysis.

BACKGROUND: Transitioning from registered nurse to nurse practitioner (NP) can be challenging personally and professionally. Insight into transition experiences may help validate the experiences of new NPs and provide greater understanding of the challenges faced during their professional journey. PURPOSE: The purpose of this article is to report a concept analysis of transition from registered nurse to NP. The article provides new knowledge, understanding, and clarity about the concept of transition. DATA SOURCES: Walker and Avants' framework for concept analysis was used to identify the attributes, antecedents, and consequences of the concept. A literature review of refereed journals was undertaken. Model cases from an ethnographic study conducted in Australia provide real life examples of the attributes of transition. CONCLUSIONS: Transitioning to the role of NP is complex and dependent on the individual and the attitudes of healthcare colleagues. Change and adaptation are required of both the NP and members of the healthcare team. Failure to adapt by either party undermines the potential for NPs to deliver improved health care. IMPLICATIONS FOR PRACTICE: Mentorship along with a nurturing environment may be effective strategies for increasing the NP's self-confidence and ensuring a smooth and successful transition period.

Reconceptualising the objectives of a pilot study for clinical research.

This is a methodological study in which a case report is used to retrospectively analyse the link between a successful pilot study and stalled main study to identify potential methodological weaknesses in the planning process. The analysis identified unanticipated influences related to hospital processes and discipline boundaries that adversely influenced participant recruitment and retention for a clinical trial. The findings of the study demonstrate that, whilst the pilot is an important step in research planning to confirm the design and operational processes for a study, a thorough analysis of the relevant health service environment is an important additional objective for the pilot study.