An investigation of the international literature on nurse practitioner private practice models.

AIM: To investigate and synthesize the international literature surrounding nurse practitioner (NP) private practice models in order to provide an exposition of commonalities and differences. BACKGROUND: NP models of service delivery have been established internationally and most are based in the public healthcare system. In recent years, opportunities for the establishment of NP private practice models have evolved, facilitated by changes in legislation and driven by identification of potential patient need. To date, NP private practice models have received less attention in the literature and, to the authors' knowledge, this is the first international investigation of NP private practice models. DESIGN: Integrative literature review. METHOD: A literature search was undertaken in October 2012. Database sources utilized included Medical Literature Analyses and Retrieval (MEDLINE), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus and the Cochrane Database of Systematic Reviews (CDSR). The grey literature was also searched. The following Medical Subject Headings (MeSH) and search terms used both individually and in combination included nurse practitioners; private practice; joint practice; collaboration; and insurance, health and reimbursement. Once literature had been identified, a thematic analysis was undertaken to extract themes. RESULTS: Thirty manuscripts and five publications from the grey literature were included in the final review. Private practice NP roles were identified in five countries, with the majority of the literature emanating from the USA. The thematic analysis resulted in the identification of five themes: reimbursement, collaborative arrangements, legislation, models of care and acceptability. CONCLUSION: Proportionally, there are very few NPs engaged in private practice internationally. The most common NP private practice models were community based, with NPs working in clinic settings, either alone or with other health professionals. Challenges in the context of legislation and financial reimbursement were identified in each country where private practice is being undertaken.

New Zealand nurses' perceptions of the continuing competence framework.

BACKGROUND: The demonstration of competence and continuing competence for nurses is becoming increasingly important internationally, and many countries have developed continuing competence frameworks. AIM: To explore nurses' perceptions and understanding of and satisfaction with the Nursing Council of New Zealand (NCNZ) Continuing Competence Framework (CCF) and the effectiveness of associated processes. METHOD: A total of 1157 New Zealand (NZ) nurses responded to a web-based survey designed to determine their satisfaction with the NCNZ CCF. The sample was representative of the NZ nursing population with a margin of error of 2.85 and 95% confidence level. FINDINGS: The majority of participants believe that the CCF provides a mechanism to ensure nurses are competent and fit to practice. While some participants indicated an element of poor understanding with regard to aspects of the CCF, overall it is perceived as a credible and reliable process to ensure public safety. CONCLUSIONS: The international literature describes a variety of frameworks and competence indicators used by regulatory authorities to safeguard the public. In the 5 years since the NCNZ implemented the CCF less than 0.02% of notifications related to 'competence' have been recorded. The majority of NZ nurses believe that the CCF provides a mechanism to ensure nurses are competent and fit to practice. However, it is important to note that CCF processes may infer competence but they are not a guarantee that a nurse is safe to practice on any given day.

Confidence in competence: legislation and nursing in New Zealand.

AIM: This article aims to identify and discuss a variety of interpretations, myths and tensions that surround the requirements for demonstrating continuing competence under a new national regulatory regime, which is designed to promote confidence in professional nursing practice in New Zealand (NZ). BACKGROUND: The enactment of the Health Practitioners' Competence Assurance Act (HPCA) 2003 in NZ requires regulatory authorities to implement, administer and monitor systems to ensure that health practitioners registered in a specific scope of practice are competent. The Nursing Council of New Zealand (NCNZ) is the regulatory authority for nurses in NZ. While the onus for demonstrating and maintaining competence is clearly the responsibility of the individual nurse, since the enactment of the HPCA Act, the assessment and monitoring of that competence is the responsibility of the Nursing Council. Demonstration of competence to practise nursing begins during undergraduate nursing education. However, demonstration of continuing competence is a new legislative requirement for nurses in NZ. As a result of this new legislation the NCNZ implemented a mandatory process for the monitoring of the continuing competence of nurses. CONCLUSION: Definitions of continuing competence within legislation and health professional regulation across developed nations have strong similarities. The need for continuing competence frameworks is generally agreed by regulatory authorities to be necessary to protect the safety of the public. However, regulatory processes that monitor the maintenance, assessment and development of continuing competence in nursing practice need to be overt, structured and well communicated in order to engage nurses, promote confidence in professional practice and protect the health and safety of members of the public.

Developing the credibility of continuing education.

The paper begins by acknowledging both the need for nursing to be a research based profession, and the reasons for the well-documented theory-practice gap. It goes on to suggest that what is not so well-documented is an examination of the reasons for the commitment gap between basic and continuing education. The relevance of continuing education to clinical staff will be discussed in relation to the change in the content of nursing theory--from the unwieldy 'certainty-based' medical model, to a more flexible, thus perhaps 'uncertainty-based' medical model. The paper will explore the author's belief that clinical staff need to feel a sense of security in their knowledge base, which therefore leads them at times to reject nursing theory. The paper proposes that a legal framework for nurses practice gives the clinical staff the security in their practice to view the relevance of new nursing theory.

Imaging nursing--reflecting and projecting.

This paper sets out to consider reflected and projected images of nurses. When looking at the reflected images, those images that we see of ourselves, it attempts to consider the image of the role of the nurse, the image of the nursing workforce, and the image of nursing education. In projected images, it looks at nursing projected as a career, and the image of the nurse in law. The key theme running through the article is the privilege of intimacy which nursing provides.

Pharmacokinetics of CPX-351; a nano-scale liposomal fixed molar ratio formulation of cytarabine:daunorubicin, in patients with advanced leukemia.

Forty-eight patients received CPX-351 (liposome-encapsulated cytarabine:daunorubicin at a 5:1 molar ratio) every other day for 3 doses at 10 dose levels. Pharmacokinetic parameters were dose-independent and exhibited low inter-patient variability. CPX-351 showed a negligible distribution phase and prolonged mono-exponential first-order plasma elimination (t(1/2)∼24 h). The plasma ratio of 5:1 was maintained at all dose levels. Nearly all of the detectable cytarabine and daunorubicin in circulation following CPX-351 administration was in the form of liposome encapsulated drug. Dose-dependent hematopoietic effects had early onset with cytopenias at 12 units/m(2), and a gradual increase in frequency and severity, until single induction complete response was achieved at 43 units/m(2). Non-hematologic effects had onset by 24 units/m(2) with shallow dose-response until maximum frequency and severity were observed at the 101-134 units/m(2) dose levels. Single induction response occurred over a 2.3-fold range of doses indicating that CPX-351 may be useful at high doses for patients suitable for intensive chemotherapy and at reduced doses for patients at increased risk of treatment-related mortality. The unique pharmacologic features of CPX-351 contribute to its promising antileukemic efficacy.

Independent, autonomous, or equal: what do we really want?

This article will explore the development of terms such as autonomous and independent in the national and international nursing literature, with particular reference to the development of the nurse practitioner (NP)/advanced nursing role. It will examine the complexity of power relationships in health care and explore the apparent dissatisfaction of nurses with their status, as demonstrated by such issues as the proliferation of nursing ethics and the problems surrounding recruitment and retention. It will discuss why the development of advanced practice roles has been greeted with such suspicion by some medical organizations, and what barriers and benefits there are to collaborative practice. It will explore the relationship between the bodies of knowledge of medicine and nursing, and the perceived blurring of roles that advanced practice can potentiate. Finally, it will make some suggestions for intelligent and harmonious coexistence, which would refocus medical and nursing practice on patient care, rather than on "bunker dwelling."

Going the distance. Education for rural nurses.

Following a research project commissioned by the NSW Health Department Chief Nursing Officer, to identify specific areas of concern regarding nursing vacancies, particularly in specialty areas, a Nursing Retention and Recruitment Taskforce was established by the Minister for Health. One of the issues identified by the Taskforce was that of professional isolation and access to education for nurses working in rural and remote areas. This issue of The Lamp looks at the support and education opportunities currently provided to rural and remote nurses.

Changes in prostaglandin renal synthesis in cardiovascular disease.

We investigated the factors able to stimulate (hormones, drugs, fluid volume changes and prostaglandin precursors) or inhibit (NSAIDs) renal prostaglandin synthesis. We then assessed the effects of NSAIDs on: A) the efficacy of certain drugs (furosemide, ACE-inhibitors), whose action is mediated by a stimulation of prostaglandin synthesis; B) the physiopathology of cardiovascular diseases such as myocardial infarction and heart failure, in which renal and circulatory output is reduced; C) arterial hypertension.