Transcript Slide 1
Ms. Joan Dembo, ANP Candidate, MRH, Portlaoise Dr. Dympna Casey, School of Nursing & Midwifery NUI, Galway The aim of this study was to explore the attitudes of emergency nurses, emergency doctors and GPs to the ANP role in the ED prior to its introduction Three themes identified from the literature which may negatively influence the attitudes of health care professionals Role definition Blurring of inter-professional boundaries Education of ANPs Confusion surrounding the definition of the role (Griffin and Melby, 2006) Lack of clarity regarding role boundaries and role function (Bryant-Lukosius et al. 2004; Martin and Considine, 2005) Lack of understanding of scope of practice (Clarins, 2007) ANP practice crosses traditional nurse/doctor boundaries and can result in tension between health professionals (Clarins, 2007) Collaboration with other health professions crucial for successful role implementation (NCNM, 2005) Fear of the ANP being seen as “mini-doctor” and losing nursing identity (Castledine, 2002) Opposition to role also from nursing staff fearing that ANPs will be used as doctor substitutes (Edwards et al. 1999, Llyod Jones, 2005) Lack of consensus internationally regarding the educational requirements for ANP practice Some countries such as the US, Australia and Ireland have a master’s degree as a minimum requirement for ANP practice (Wickham, 2003; Griffin and Melby, 2006; MacDonald, Herbert and Thibeault, 2006; Searle, 2007) The UK in particular has experienced inconsistencies and a lack of national agreement regarding educational standards and clinical practice (Davidson and Rogers, 2005) A quantitative approach non-experimental descriptive survey design Attitudes to the ANP questionnaire (Griffin & Melby, 2006) ◦ 26 items and 2 open questions All emergency nurses (n = 72) doctors (n = 23) working in 3 acute hospitals in midlands GPs (n = 122) in 4 midland counties who referred to these acute EDs A response rate of 58.9% (n = 128) was achieved. ◦ Nurses (n=40) ◦ Hospital doctors (n=17) ◦ GPs (n=71) Ethical approval was obtained from the regional ethics committee and data was collected in March 2009. 23 GPs Hosp. Dr 17 71 17 CNM Staff Nurses 57 71 Male Female Age distribution of study respondents and years of experience Range Average Age 25-67 43 Years of 1-40 14 experience Overall Emergency nurses, doctors and GPs hold a positive attitude to the introduction of an emergency ANP service. The findings from this study show a statistically significant difference (95% CI [6.25, 12.57] (p = 0.0001) between the attitudes of nurses and doctors. Indicating that nurses had a more positive attitude than doctors to the introduction of an ANP service in the ED. Furthermore hospital based staff had a more positive attitude to the introduction of an ANP service than GPs (95% CI [3.8-10], (p = 0.0001). 120.00 110.00 Total Score 100.00 90.00 80.00 66 70.00 81 60.00 Nurse Doctor Occupation 81.3% (n = 104) A/SA that the scope of ANP practice involved assessment, investigation, diagnosis, treatment and discharge /referral of patients with minor injuries. 70 Agree 60 50 Strongly agree 40 Undecided 30 Disagree 20 10 Strongly disagree 0 Scope of ANP practice However only 47 (36.7%) of all respondents perceived The majority of doctors and nurses 79.7% (n = 107) did not perceive 60 50 Agree 40 Strongly agree 30 Undecided 20 Disagree 10 0 ANP is a threat to the traditional role of the doctor Strongly disagree Most 112 (87.5%) A/SA that there should be standardised education for ANPs Most 98 (76.6%) felt that the ANP should have at least 5 years clinical experience The majority of nurses and doctors perceived that introducing an ANP service would reduce waiting times Only 20 (15.6%) of all respondents thought that an ANP service would divide the nursing team in the ED 95 (74.2%) D/SD that an ANP service would deskill emergency nurses and doctors. 80 (62.4%) thought that the ANP should combine their role with working in the main department 76 (59.4%) of all respondents indicated that they had a clear understanding of the role. There was a statistically significant difference between the scores for doctors and nurses A higher proportion of nurses agreed that they had a clear understanding of the ANP role than doctors (87.2% v 48.2%, x² = 17.03, p = 0.0002) 2 open-ended questions Analysed using Burnard’s (1991)thematic analysis 2 main themes identified Perceived benefit of the role ◦ “reduce patient waiting times” Perceived difficulties introducing role ◦ “If roles not clearly outlined confusion and increased stress occur for full workplace.” Positive attitudes of nurses and doctors supports findings from other studies (Griffin and Melby, 2006; Norris and Melby, 2006; Martin and Considine, 2007; Searle, 2007) Nurses more positive than doctors (Griffin and Melby, 2006) Greatest perceived benefits reduced patient waiting times and reduction in time doctors spend with non-urgent patients (Barr, Johnston and McDonnell, 2000; Byrne et al. 2000; Griffin and Melby, 2006) Clear understanding of role (Griffin and Melby,2006) Poor support for autonomous practice (Davidson and Rogers, 2005) Educational standardisation well supported (Griffin and Melby, 2006) Conducted in one HSE area limits generalisability of findings Purposive sampling strategy, may not be representative Ensure clear understanding of role Staff education sessions -have been found to enhance staff knowledge of the ANP role (Martin and Considine, 2005). Clearly articulate boundaries of practice ANP’s working in main dept. counted in nursing numbers needs to be addressed Onus on ANPs to be more articulate regarding the nursing components of role Poor support for autonomous practice needs to be explored Further research needed to explore the attitudes of health professionals to autonomous ANP practice Reduced patient waiting times greatest perceived benefit of role audit needed to ascertain this after role introduction Patient satisfaction needs to be established after introduction of role Barr, M, Johnston, D. and McConnell, D. (2000) Patient satisfaction with a new nurse practitioner service. Accident and Emergency Nursing 8 (3), 144-147. Bryant-Lukosius D, DiCenso A, Browne, G. and Pinelli, J. (2004) Advanced practice nursing roles: development, implementation and evaluation. Journal of Advanced Nursing 48(5), 519529. Byrne, G., Richardson, M., Brunsdon, J. and Patel, A. (2000) Patient satisfaction with emergency nurse practitioners in A & E. Journal of Clinical Nursing 9, 83-93. Castledine, G. (2002) The development of the role of the clinical nurse specialist in the UK. British Journal of Nursing 11 (7), 505-508. Clarins, O.A. (2007) Strategies to overcome barriers to effective nurse practitioner and physician collaboration. The Journal for Nurse Practitioners 3 (8), 538-548. Davidson, J. and Rogers, T. (2005) A lesson from the UK? Australasian Emergency Nursing Journal 8, 5-8. Edwards, B, Andrews, C, Holloway, I. and Potter, P. (1999) Nurse practitioners: are we being true to the spirit of nursing? Emergency Nurse 7 (3), 26-31. Griffin, M. and Melby, V. (2006) Developing an advanced nurse practitioner service in emergency care: attitudes of nurses and doctors. Journal of Advanced Nursing 56 (3): 292301. Llyod Jones, M. (2005) Role development and effective practice in specialist and advanced practice roles in acute hospital settings: systematic review and meta-synthesis. Journal of Advanced Nursing 49 (2), 191-209. MacDonald, J, Herbert, R. and Thibeault, C. (2006) Advanced practice nursing: unification through a common identity. Journal of Professional Nursing 22 (3), 172179. Martin, R. and Considine, J. (2005) Knowledge and attitudes of ED staff before and after implementation of the emergency nurse practitioner role. Australasian Emergency Nursing Journal 8, 73-78. National Council for the Professional Development of Nursing and Midwifery (2005) A Preliminary Evaluation of the Role of the Advanced Nurse Practitioner. NCNM: Dublin. Norris, T. and Melby, V. (2006) The Acute Care Nurse Practitioner: challenging existing boundaries of emergency nurses in the United Kingdom. Journal of Clinical Nursing 15, 253-263. Searle, J. (2007) Nurse practitioner candidates: shifting professional boundaries. Australasian Emergency Nursing Journal 11 (1), 20-27. Wickham, S. (2003) Development of nurse specialists/advanced practitioners in Ireland. British Journal of Nursing 12 (1), 28-33.