Indeendent Nurse Prctitiners in ustrli frm Sci-Pliticl Persective - Essay Example

Indeendent nurse rctitiners in ustrli frm sci-liticl ersective The cntributin f nurse prctitiner services t ppultin nd public helth is being highly recgnized in grwing number f cuntries rund the wrld. With gret del f effrt they wrk independently s bth emplyees nd prt f tem whether it is in remte nd rurl res, in emergency deprtments in hspitls r in generl prctice. The prctice f independent nurses are hwever n issue t cnstnt discussin nd chnge. Recent chnges in nursing prctice nd its visin frm sci-pliticl perspective is the subject f current pper. Nurses prctitiners in sci-pliticl re required hve high level f eductin, usully Msters level, expert clinicl skills nd significnt yers f experience. They wrk in cllbrtin with ther helth cre prviders, whereas cpertin is essentil fr ptiml helth utcmes. Nurse prctitiners re nw endrsed in mst sttes nd territries nd wrking successfully nd cllbrtively with dctrs nd ther helth cre wrkers. The ustrlin Gvernment is currently funding prject t tril the use f nurse prctitiners in the ged cre envirnment. Stephens highlights tht s student nurse prctitiner she is lwys hving t educte ther helth prfessinls n wht nurse prctitiner is. She believes tht nurse prctitiners must educte ther helth prfessinls t every pprtunity pssible, s t wht nurse prctitiner is. T try nd ssist nurse prctitiners with their eductin f helth cre prctitiners Stephens ddresses questins which re ften sked when being questined but the nurse prctitiner rle. The secnd questin rised by Stephens is relting t the cst effectiveness f the nurse prctitiner. She sttes tht there is nt enugh literture t mke cnclusin upn this issue. This is n issue tht shuld ls be cnsidered in the ustrlin develpment f the nurse prctitiner nd shuld lwys be cnsidered in ech individul cse. The issue f cst effectiveness runs int mny ther issues, few being, scpe f prctice, time mngement nd enterprise brgining greements. ll f the fctrs impinging n the issue f cst effectiveness shuld be cnsidered t mke independent nlysis f the nurse prctitiners finncil plusibility. Crinsn (1995) perfrmed literture review explring the benefits nd difficulties when implementing emergency nurse prctitiner service. The definitin f the emergency nurse prctitiner Crinsn presented, sttes tht the prctitiner cres fr the ptient, ssessing them, requests the pprprite dignstics nd then trets the perceived prblem withut the invlvement f dctr. Crinsn ls sttes in this definitin tht the prctitiner is respnsible fr cring fr minr helth prblems. It is interesting tht the definitin f the emergency nurse prctitiner specificlly mentins tht the ptient des nt need t see dctr, insted f fcusing cmpletely n wht the emergency nurse prctitiner des. The definitin implies tht the emergency nurse prctitiner is tking the plce f the dctr when deling with minr helth prblems. Crinsn suggests tw resns fr why there hs been push twrds creting emergency nurse prctitiners, ne resn being the incresing presenttins t emergency deprtments nd the ther resn is becuse f the develpment f the "The Scpe f Prfessinl Prctice" (Crinsn.I.,1995, pg 1321). This hs stted tht individul prctitiners re respnsible fr their prctice nd it us up t them t mintin their knwledge nd skills t perfrm their rle. ccrding t this scpe f prfessinl prctice it is therefre up t the nurse prctitiner t ensure their knwledge nd clinicl skills re dequte in perfrming their rle nd nt the rgnistins. This utnmy is nt seen s smething which the individul cnsiders egtisticlly, hwever ls the individul cncerned shuld understnd the rle they hve within the helthcre tem where ther prctitiners prctice nd hw this effects them. Crinsn sttes tht the entire multidisciplinry helthcre tem needs t hve input when creting emergency nurse prctitiner service, s tht ll stke hlders re cntent with the service being prvided. Until recently there hd been ucity f reserch r literture relting t the rle in ustrli. Hwever, there ws strng necdtl evidence tht nurses, thrugh necessity nd chice, hd been rviding cmrehensive nd exert rimry cre, midwifery services, mentl helth services, wmen's helth services nd ublic helth services (t nme nly few) t the ustrlin cmmunity fr mny yers. The Nurse rctitiner rject ws significnt mrker in the reserch nd develment f the nurse rctitiner rle in ustrli. Sttes nd territries in ustrli hve been wtching the NSW Nurse rctitiner rject crefully nd mst hve nw begun lcl imlementtin rject. Given the federl system nd the stte-bsed rgnistin f mny helth services nd regultin f helth rfessinls, if the lessns frm ustrli re t be heeded, the mst difficult sect f imlementing the different mdels f nurse rctitiner services will be in negtiting with the lcl key stkehlders. Within the chnging cntext f helth cre rvisin, the execttins f the registered nurse include hving utnmy within the wrk setting nd mking decisins cnsistent with their sce f rctice, nd hving the freedm t ct un thse decisins, s tht they cn ce with the mny cmlex nd differing demnds tht re lced un them in rctice, either in helth tem r lne. This is n emerging trend in the creer thwy f the dvnced rctising Registered Nurse, rticulrly in the rle f rimry Helth Cre, rivte rctice nd rurl/remte nursing. This unit will rvide them with the strtegies required fr successful rctice s n indeendent nurse rctitiner. There re t lest fur sets f stkehlders when cnsidering the mnged cre envirnment in its brdest sense: () the client r fmily in their chice f mdlity r clinicin, (b) the clinicl stff in surting their selectin f thereutic strtegy, (c) the mngement stff in the llctin f resurces tht meet the needs nd cn tentilly chieve the behvirl utcme criteri, nd (d) thse wh set funding r ccredittin licy but the linkge between level f need nd level f resurce vilbility in mnged cre envirnment. Whether it is the fmily, the clinicin, the emlyer, the insurnce crrier, r gvernment entity, the centrl issue is hw t best mnge the vilble resurces t meet the need nd chieve desired utcme. Study designs must ssess resurces used with the trditinl mesures f initil sttus, nd rgress nd utcme shuld surt client-fmily, clinicl, suervisin, mngement, nd licy decisins in mnged cre envirnment. The nging debte n the future fr nurse rctitiners hs minly fcused n the discurse between the nursing nd medicl bdies. Hwever the cnsumer resnse nd discussin is extremely imrtnt. The ublic surt f nurses is cnfirmed nnully s inin lls in ustrli shw tht the ublic hve the highest degree f cnfidence nd trust in nurses s rfessinl gru. Nurses reetedly scre higher thn lwyers nd dctrs, s it ws n surrise tht the nurse rctitiner rle ws well received by the ublic. tient stisfctin surveys cnducted in cnjunctin with mny f the ilt rjects surt this ssertin. dditinlly, these surveys revel tht ele recited the reductin in witing time fr cre t mny f the ilt sites. Mny ele fllwed u their sitive remrks by recmmending tht mre nurse rctitiners shuld be used t exnd the service. The high degree f cnsumer stisfctin with the services rvided by nurse rctitiners ws indictive f the verll utcmes f the study. Desite this, nther mbiguus issue rse in the reserch tht is imrtnt. It is the lck f cmmunity understnding f wht nursing is. Mst wuld believe they hve gd understnding f nursing, but like mny nurses, they re unble t rticulte their understnding f the sce f the rle f nursing. The reserch int this very questin is in its infncy nd the discurse nd nrrtive trditins t describe the rle re nly just being identified. Virgini Hendersn sent mst f her rfessinl creer ttemting t describe nursing in n envirnment f cnstnt scil chnge. She recgnised the difficulties inherent in describing rle erfrmed glblly, but shed s strngly by the mny dd-n lyers f the culturl, ecnmic nd liticl influences f ech ntin, regin nd lcl re (Cle, Rmirez, 2000 ). Fr nurses wrking in the rle f nurse rctitiners in the ilt reserch sites in ustrli, the exerience ws sitive nd rewrding. The rle identity ws strng, due t firm understnding by tht gru f exert nurses nd becuse the ilt frmewrk ws clerly defined. There were mny interesting bservtins mde by the nurse rctitiners, including 'tient wnershi', rfessinl bundries nd rfessinl ccuntbility nd resnsibility. rfessinl bundries hve lwys verled in helth cre nd hve tended t hve intuitive edges with the helth rfessinls develing wrkble understnding f them. The legitimistin f the nurse rctitiner rle hs seen these bundries further blur, resulting in nxiety nd cnfusin fr mny helth rfessinls (Cper et l., 2002). The cntinuum f chnge, exressed in the develment f the nurse rctitiner rle, is nt new. The rertin nd functin f registered nurse brdened nd evlved drmticlly in ech decde f the twentieth century. There is n resn t ssume tht this evlutin will nt cntinue s the helth needs f the cmmunity chnge during the twenty-first century. Nurse rctitiners re mnifesttin f this rgress. ne f the cncerns f resident medicl fficers (RMs) t ne ilt site during the Nurse rctitiner rject ws tht their wrkld wuld increse becuse they hd t 'suervise' the nurse rctitiner. In fct, even in this reserch hse where review f the clinicl decisins f nurse rctitiners ws required s rt f the reserch methdlgy, there ws evidence tht the wrkld f the RM ws reduced. Surveys cnducted t tht time shwed tht 25% f medicl resndees erceived decrese in wrkld s n utcme f the nurse rctitiner ilt rject t tht site (Hwie., 1992). The scpe f prctice f nurse prctitiners is effected by stte legisltin nd the helthcre rgnistins plicy, sme f the results which indicte the use f ctivities nd prtcls crried ut by nurse prctitiners mybe flse s t wht nurse prctitiners mybe ctully ble t perfrm. The results f the prctitiners beliefs f relevnce f prcedures is mre ccurte mesure f wht prcedures re required t prctice s emergency nurse prctitiner. Fifty percent f prctitiners hd perfrmed thirty five f the seventy ne prcedures nd fifty percent r greter viewed fifty six f the prcedures s being f imprtnce t the prctitiner rle. This illustrtes big gp in wht nurse prctitiners see s wht is imprtnt t llw them t prctice nd wht they cn ctully d. This rises issues relting t wht is limiting nurse prctitiners scpes f prctice nd if they re being utilised t the full extent they culd be. It is cknwledged tht ech emergency nurse prctitiners experience nd eductin is unique nd tht their expertise my lie in differing spects f emergency cre, hwever t prctice utnmusly t level suggested by the emergency nurses sscitin wh hve develped set f stndrds fr emergency nurse prctitiners, the prctitiner must hve minimum level f experience nd eductin. This mens there must be minimum set f prcedures r skills fr the prctitiner t utnmusly cmpetently prctice. Cle nd Rmirez believe by shwing the clinicl relevnce f prcedures perfrmed by emergency nurse prctitiners, they hve highlighted wht eductin is required t be incrprted int future emergency nurse prctitiner curses. They ls believe the results re f use fr nvice r lerning prctitiners t nticipte wht skills they my require t tech themselves s they cn prctice s nurse prctitiners. s stted by the uthrs ech nurse prctitiner needs t mke determintin f wht skills they my require r be llwed t use in their setting. The list f ctivities nd the results relting t their relevnce re f definite use t ssist the prctitiner t determine the skills they require t prctice utnmusly. While much erly reserch n nurse rctitiner services ers t cncentrte n rimry cre, it hs becme incresingly cmmn, rticulrly in ustrli, fr nurse rctitiners t rctice in tertiry cre fcilities in cute cre settings: the nurse rctitiner mdel f rctice ws riginlly designed t meet the needs f mbultry ultins t mintin helth, yet there remin tremendus unmet needs in cute nd lng-term cre settings fr which nurses hve the tentil, rtunity nd ccuntbility t resnd (Gerghty, 2002). The dvent f trum nurse rctitiners nd nentl intensive cre nurse rctitiners in the United Sttes shuld indicte tht the develment frm urely rimry cre settings t tertiry settings is nturl evlutin. lredy there is sme ctivity nd interest in the tertiry sectr in ustrli. Fr exmle, Jhn Hunter Hsitl in Newcstle (NSW) undertk fesibility ilt study in the nentl intensive cre unit. Hwever, cutin is needed t ensure tht the nurse rctitiner rle is develed becuse f its intrinsic vlue in rviding qulity, fesible, sfe, effective nd ffrdble helth services, nd nt develed nly s resnse t g filling, che dctr substitutin r rfessinl self interest. Strengthening helth systems thrugh nursing cn led t n incresed cverge f bsic helth services fr thse mst in need. Nurses re lredy estblished in the helth wrkfrce in significnt numbers nd re ften wrking t rvide cre t diverse ultins. The lw in ustrli is reltively strightfrwrd-nurses re resnsible fr their ctins n dily bsis, t extend their sce f rctice will nt diminish their ccuntbility. Just s dctrs nw see the vlue f n expnded rle fr nurses wrking in generl medicl prctice, I m cnfident tht nce they fully understnd the rle f nurse prctitiners in the ustrlin helth cre cntext, they will see the vlue fr themselves nd their ptients f emplying nurse prctitiners in generl medicl prctice.' Bibligrhy: 1. Bche.J. (2001) Estblishing n emergency nurse prctitiner service. Emergency Medicine Jurnl. My 2001. Vl 18, Issue 3, pgs 186-193. 2. Bethel.J. & Pntrini.S. (2002) Wrkld nd cse mngement ptentil f the emergency nurse prctitiner. Peditric Nursing, Februry 2002, Vl 14, N 1, pgs 24-28. 3. Cper.M., Lindsy.G., Kinn.S. & Swnn.I. (2002) Evluting Emergency Nurse Prctitiner services: rndmized cntrlled tril. Jurnl f dvnced Nursing, Vl 40, N 6, pgs 721-730. 4. Cle.F. & Rmirez.E. (1997) The emergency nurse prctitiner: n eductinl mdel. Jurnl f Emergency Nursing. pril 1997, Vl 23, N 2, pgs 112-115. 5. Cle.F. (1999) Evluting n emergency nurse prctitiner eductinl prgrm fr its relevnce t the rle. Jurnl f Emergency Nursing, December 1999, Vl 25, N 6, pgs 547-50. 6. Cle.F. & Rmirez.E. (2000) ctivities nd prcedures perfrmed by nurse prctitiners. Jurnl f Emergency Nursing, ctber 2000. Vl 26, N 5, Pgs 455-63. 7. Cle.F. & Rmirez.E. (2000b) ssessing criticl thinking f pplicnts t the Mster f Science in Nursing Emergency Nurse Prctitiner ptin with clinicl cse scenri-bsed interviewing. Jurnl f Emergency Nursing, December 2000. Vl 26, N 6, pgs 609-611. 8. Cle.F., Kuensting.L., McLen.S., bel.C., Micknin.J., Bruseke.P., Wisln.M. Rehwldt.M. & Plines.D. (2002) dvnced Prctice Nurses in Emergency Cre Settings: demgrphic Prfile. Jurnl f Emergency Nursing, ctber 2002, Vl 28, N 5, pgs 414-419. 9. Cle.F. & Rmirez.E. (2002b) Beef Tngue: Mdel fr Teching Cmplex Wund Clsure t Emergency Nurse Prctitiner Students. 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Jurnl f dvnced Nursing. 1997, N 26, pgs 364-370. 24. Tye.C. & Rss.F. (2000) Blurring bundries: prfessinl perspectives f the emergency nurse prctitiner rle in mjr ccident nd emergency deprtment. Jurnl f dvnced Nursing, 2000, Vl 31, N 5, pgs 1089-1096. 25. Rbinsn.S. & Inyng.V. (1999) The nurse prctitiner in emergency medicine- vluble but undefined. The Lncet. ctber 16, 1999, Vl 354, Issue 9187, pg 1319. 26. Skr.M., Kendll.R., ugus.J., Sunders.., Nichll.J. & Wrdrpe.J. (2003) Emergency nurse prctitiners: three prt study in clinicl nd cst effectiveness. Emergency Medicine Jurnl. 2003; Vl 20, Issue 2, pgs 158-163. 27. She.S. & Selfridge-Thms.J. (1997) The Ed nurse prctitiner: Perls nd pitflls f rle trnsitin nd develpment. Jurnl f Emergency Nursing. June, 1997, Vl23, N 3, pgs 235-237. 28. Wlwich.C. (1992) wider frme f reference. Nursing Times, Nvember, 1992, Vl 88, N 46, pgs 34-36. Read More