Competency and Capability: Imperative for Nurse Practitioner Education

Objective The objective of this study was to conduct research to inform the development of standards for nurse practitioner education in Australia and New Zealand and to contribute to the international debate on nurse practitioner practice. Setting The research was conducted in all states of Australia where the nurse practitioner is authorised and in New Zealand Subjects The research was informed by multiple data sources including nurse practitioner program curriculae documents from all relevant universities in Australia and New Zealand, interviews with academic convenors of these programs and interviews with nurse practitioners. Primary argument Findings from this research include support for masters level of education as preparation for the nurse practitioner. These programs need to have a strong clinical learning component and in-depth education for the sciences of specialty practice. Additionally an important aspect of education for the nurse practitioner is the centrality of student directed and flexible learning models. This approach is well supported by the literature on capability. Conclusions There is agreement in the literature about the lack of consistent standards in nurse practitioner practice, education and nomenclature. The findings from this research contribute to the international debate in this area and bring research informed standards to nurse practitioner education in Australia and New Zealand

Nurse Practitioner Competency Standards: Findings from Collaborative Australian and New Zealand Research

Background: The title, Nurse Practitioner, is protected in most jurisdictions in Australia and in New Zealand and the number of nurse practitioners is increasing in health services in both countries. Despite this expansion of the role there is scant national or international research to inform development of nurse practitioner competency standards. Objectives: The aim of the study was to research nurse practitioner practice to inform development of generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries. Design: The research used a multi-methods approach to capture a range of data sources including research of policies and curricula, and interviews with clinicians. Data were collected from relevant sources in Australia and New Zealand Settings: The research was conducted in New Zealand and the five states and territories in Australia where, at the time of the research, the title of nurse practitioner was legally protected. Participants: The research was conducted with a purposeful sample of nurse practitioners from diverse clinical settings in both countries. Interview and material data were collected from a range of sources and data were analysed within and across these data modalities. Results: Findings included identification of three generic standards for nurse practitioner practice namely, Dynamic Practice, Professional Efficacy and Clinical Leadership. Each of these standards has a number of practice competencies, each of these competencies with their own performance indicators. Conclusions: Generic Standards for nurse practitioner practice will support a standardised approach and mutual recognition of nurse practitioner authorisation across the two countries. Additionally these research outcomes can more generally inform education providers, authorising bodies and clinicians on the standards of practice for the nurse practitioner whilst also contributing to the current international debate on nurse practitioner standards and scope of practice

Advanced practice nursing role development: factor analysis of a modified role delineation tool

Aim his study reports the use of exploratory factor analysis to determine construct validity of a modified advanced practice role delineation tool. Background Little research exists on specific activities and domains of practice within advanced practice nursing roles, making it difficult to define service parameters of this level of nursing practice. A valid and reliable tool would assist those responsible for employing or deploying advanced practice nurses by identifying and defining their service profile. This is the third paper from a multi-phase Australian study aimed at assigning advanced practice roles. Methods A postal survey was conducted of a random sample of state government employed Registered nurses and midwives, across various levels and grades of practice in the state of Queensland, Australia, using the modified Advanced Practice Role Delineation tool. Exploratory factor analysis, using principal axis factoring was undertaken to examine factors in the modified tool. Cronbach’s alpha coefficient determined reliability of the overall scale and identified factors. Results There were 658 responses (42% response rate). The five factors found with loadings of ≥.400 for 40 of the 41 APN activities were similar to the five domains in the Strong model. Cronbach’s alpha coefficient was .94 overall and for the factors ranged from 0.83 to 0.95. Conclusion Exploratory factor analysis of the modified tool supports validity of the five domains of the original tool. Further investigation will identify use of the tool in a broader healthcare environment

A snapshot of Australian nurse practitioners' extended practice activities

Introduction The Australian Nurse Practitioner Project (AUSPRAC) was initiated to examine the introduction of nurse practitioners into the Australian health service environment. The nurse practitioner concept was introduced to Australia over two decades ago and has been evolving since. Today, however, the scope of practice, role and educational preparation of nurse practitioners is well defined (Gardner et al, 2006). Amendments to specific pre-existing legislation at a State level have permitted nurse practitioners to perform additional activities including some once in the domain of the medical profession. In the Australian Capital Territory, for example 13 diverse Acts and Regulations required amendments and three new Acts were established (ACT Health, 2006). Nurse practitioners are now legally authorized to diagnose, treat, refer and prescribe medications in all Australian states and territories. These extended practices differentiate nurse practitioners from other advanced practice roles in nursing (Gardner, Chang & Duffield, 2007). There are, however, obstacles for nurse practitioners wishing to use these extended practices. Restrictive access to Medicare funding via the Medicare Benefit Scheme (MBS) and the Pharmaceutical Benefit Scheme (PBS) limit the scope of nurse practitioner service in the private health sector and community settings. A recent survey of Australian nurse practitioners (n=202) found that two-thirds of respondents (66%) stated that lack of legislative support limited their practice. Specifically, 78% stated that lack of a Medicare provider number was ‘extremely limiting’ to their practice and 71% stated that no access to the PBS was ‘extremely limiting’ to their practice (Gardner et al, in press). Changes to Commonwealth legislation is needed to enable nurse practitioners to prescribe medication so that patients have access to PBS subsidies where they exist; currently patients with scripts which originated from nurse practitioners must pay in full for these prescriptions filled outside public hospitals. This report presents findings from a sub-study of Phase Two of AUSPRAC. Phase Two was designed to enable investigation of the process and activities of nurse practitioner service. Process measurements of nurse practitioner services are valuable to healthcare organisations and service providers (Middleton, 2007). Processes of practice can be evaluated through clinical audit, however as Middleton cautions, no direct relationship between these processes and patient outcomes can be assumed

Preparing Students for Democratic Participation: Why Teacher Curricular Speech Should Sometimes be Protected by the First Amendment

This note will examine the legal basis and educational framework for First Amendment protection of classroom speech. The Supreme Court of the United States has not directly addressed the constitutional issues implicated in teacher classroom speech. As a result, the circuit courts are split in the application of an appropriate analysis.15 In most circuits, teacher curricular speech is not protected speech.\u27 6 Among the circuit courts, teacher curricular speech is governed by three competing doctrines: public employee speech, student speech, and academic freedom. 1 7 While the Fourth, Fifth, Sixth, and Seventh Circuits have applied the Pickering public employee analysis,\u27 8 the First, Second, Eighth, and Tenth Circuits have expanded the Hazelwood student speech analysis to include teacher curricular speech. 19 While the teacher, as speaker, is a public employee, the public employee speech doctrine does not fully account for additional protections that may exist within the classroom, nor does it fully account for the distinction between the government as employer and the government as sovereign provider of education. However, to analogize teacher speech with student speech disregards the different roles of students and teachers within the school environment. It is unclear whether academic freedom protections alluded to by the Supreme Court apply to elementary and secondary classrooms. Although the Supreme Court has applied the public employee speech doctrine to elementary and secondary teachers, the Court has applied the academic freedom doctrine almost exclusively to university professors and their institutions. Some circuit courts have based their decisions on academic freedom, but those decisions have laid dormant for over thirty years, ignored (but not explicitly overruled) as those circuits have applied the public employee or student speech doctrine to curricular speech. This note argues that teacher curricular speech occupies a unique position among protected speech, not fully accounted for by any of the doctrines currently employed. This argument is grounded in the educational and philosophical purpose of education and the methods by which that purpose can be achieved

R.I.P., GRAVES, GRIFFINS, and GRAFFITI

Grade Level(s): 4-12In order to enhance the Indiana students’ awareness of the importance of limestone in their state’s development, a series of activities involving cemeteries, stonecutters and epitaphs will be experienced.Newsletter article referencing Indiana limestone and artistry