Describing Clinical Nurse Specialist Practice: A Mixed-Methods Study.

PURPOSE/AIMS: To describe clinical nurse specialist practice in Québec, Canada, and propose a dashboard to track role dimensions and outcomes. DESIGN: Sequential mixed-methods study across 6 sites in Québec (June 2021 to May 2022). METHODS: Phase 1: Focus groups (n = 8) and individual interviews (n = 3) were conducted to adapt a time and motion tool. Phase 2: Time and motion studies (n = 25; 203 hours 5 minutes) described clinical nurse specialist practice. Phase 3: A rapid literature review and study participants' feedback informed the dashboard's development. Analysis: Descriptive statistics, with content analysis for qualitative data. RESULTS: The proportion of time clinical nurse specialists spent in role dimensions included clinical (22.8%), education (11.2%), administrative/leadership (48.6%), research (9.6%), and personal (7.7%). On average, they spent 17% of work time with patients, but this varied across specialties and locations. Key dashboard characteristics and uses were identified. CONCLUSIONS: Important differences were noted in clinical nurse specialist time spent in activities across specialties and regions in Québec. Approximately one-fifth of work time was spent in direct patient care. Additional research is needed to examine the link between clinical nurse specialist practice and outcomes in other jurisdictions and test the implementation of a dashboard to make their practice more visible.

Identifying indicators sensitive to primary healthcare nurse practitioner practice: A review of systematic reviews.

AIM: To identify indicators sensitive to the practice of primary healthcare nurse practitioners (PHCNPs). MATERIALS AND METHODS: A review of systematic reviews was undertaken to identify indicators sensitive to PHCNP practice. Published and grey literature was searched from January 1, 2010 to December 2, 2022. Titles/abstracts (n = 4251) and full texts (n = 365) were screened independently by two reviewers, with a third acting as a tie-breaker. Reference lists of relevant publications were reviewed. Risk of bias was examined independently by two reviewers using AMSTAR-2. Data were extracted by one reviewer and verified by a second reviewer to describe study characteristics, indicators, and results. Indicators were recoded into categories. Findings were summarized using narrative synthesis. RESULTS: Forty-four systematic reviews were retained including 271 indicators that were recoded into 26 indicator categories at the patient, provider and health system levels. Nineteen reviews were assessed to be at low risk of bias. Patient indicator categories included activities of daily living, adaptation to health conditions, clinical conditions, diagnosis, education-patient, mortality, patient adherence, quality of life, satisfaction, and signs and symptoms. Provider indicator categories included adherence to best practice-providers, education-providers, illness prevention, interprofessional team functioning, and prescribing. Health system indicator categories included access to care, consultations, costs, emergency room visits, healthcare service delivery, hospitalizations, length of stay, patient safety, quality of care, scope of practice, and wait times. DISCUSSION: Equal to improved care for almost all indicators was found consistently for the PHCNP group. Very few indicators favoured the control group. No indicator was identified for high/low fidelity simulation, cultural safety and cultural sensitivity with people in vulnerable situations or Indigenous Peoples. CONCLUSION: This review of systematic reviews identified patient, provider and health system indicators sensitive to PHCNP practice. The findings help clarify how PHCNPs contribute to care outcomes. PROSPERO REGISTRATION NUMBER: CRD42020198182.

Identifying indicators sensitive to primary healthcare nurse practitioner practice: a review of systematic reviews protocol.

INTRODUCTION: Primary healthcare nurse practitioners (PHCNPs) practice in a wide range of clinical settings and with diverse patient populations. Several systematic reviews have examined outcomes of PHCNP roles. However, there is a lack of consistency in the definitions used for the PHCNP role across the reviews. The identification of indicators sensitive to PHCNP practice from the perspective of patients, providers and the healthcare system will allow researchers, clinicians and decision-makers to understand how these providers contribute to outcomes of care. METHODS AND ANALYSIS: A review of systematic reviews is proposed to describe the current state of knowledge about indicators sensitive to PHCNP practice using recognised role definitions. Outcomes of interest include any outcome indicator measuring the effectiveness of PHCNPs. We will limit our search to 2010 onwards to capture the most up-to-date trends. The following electronic databases will be searched: Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library Database of Systematic Reviews and Controlled Trials Register, Database of Abstracts of Reviews of Effects, EMBASE, Global Health, Health Economics Evaluation Database, Health Evidence, HealthStar, Health Systems Evidence, Joanna Briggs Institute, Medline, PDQ-Evidence, PubMed and Web of Science. The search strategies will be reviewed by an academic librarian. Reference lists of all relevant publications will be reviewed. Grey literature will be searched from 2010 onwards, and will include: CADTH Information Services, CADTH's Grey Matters tool, OpenGrey, Organisation for Economic Co-operation and Development, ProQuest Dissertation and Theses and WHO. The PROSPERO International Prospective Register of Systematic Reviews will be searched to identify registered review protocols. The review protocol was developed using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols recommendations. A narrative synthesis will be used to summarise study findings. ETHICS AND DISSEMINATION: No ethical approval is required for the study. The data used in the study will be abstracted from published systematic reviews. Dissemination strategies will include peer-reviewed publication, conference presentations and presentations to key stakeholders. PROSPERO REGISTRATION NUMBER: CRD42020198182.

[Visible minority nurses and vertical mobility in hospitals] / Infirmières issues de minorités visibles et mobilité verticale en milieu hospitalier.

Canada has experienced a significant change in its ethnic and cultural composition in recent decades. The sustained immigration from non-European countries has given rise to new generation of visible minorities. This new trend is clearly reflected in healthcare institutions. However, the number of visible minority nurses (VMN) is particularly low in management positions. This research adopting critical ethnography and postcolonial approach focuses on the career paths of VMN in Canadian healthcare institutions. Nurses (n = eight, MVN) and managers (n = four caucasian) participated in a series of semi-structured interviews to gather relevant information about the representativeness of the VMN in management positions. Theoretical framework « Othering ¼ was used to guide this research as it makes the link with "la lutte de classement" of Bourdieu. Four main themes closely associated with barriers emerged from the analysis namely ; Hiring and Promotion ; instrumentalization of IMV ; interpersonal and suffering and defensive strategies. Results showed that the VMN faced obstacles, often invisible, that contribute to keeping them at a lower level of the institutional hierarchy, including the hiring and promotion process that they describe as unfair and discriminatory.