A trial of nurse practitioner scope of practice

Aims. The aim of this paper is to report a trial to investigate the feasibility of the nurse practitioner role in local health service delivery and to provide information about the educational and legislative requirements for nurse practitioner practice. Background. Nurse practitioners have been shown to offer a beneficial service and fill a gap in health care provision. However, the lack of publications describing, critiquing, or defending the way that existing nurse practitioner roles have been developed may lead to a lack of clarity in comparing the nurse practitioner scope of practice internationally. In Australia, credible exploratory research is needed to realize the potential of nurse practitioners to bridge the divide of inequitable distribution of health services. A trial of nurse practitioner services in the Australian Capital Territory provided an excellent opportunity to investigate these scope and continuity issues. Methods. This was an observational analytic study using multiple data sources. Four models of nurse practitioner service were chosen from a competitive field of applications that were evaluated according to efficacy, feasibility, and sustainability across specified selection criteria. Each model in the trial included a clinical support team, with the nurse practitioner candidate 'working-into-the-role' and collecting demographic, clinical practice, patient outcome, and health service and consumer survey data over a 10 month period. Findings. The trial identified the broad potential of the nurse practitioner role, its breadth and limitations, and its impact on selected health services in the Australian Capital Territory. Data from individual models were compared highlighting generic elements, and formed the basis for the development of the scope of practice for the Australian Capital Territory nurse practitioner models. Conclusions. This study has validated a research-based, iterative process for initial development of nurse practitioner scope of practice for any Australian specialization. Importantly, the study concluded with the scope of practice as a finding, rather than commencing with it a priori. Although general areas of health care need and under-servicing were identified at the outset, the process tested both the expansion and parameters of the roles. What is already known about this topic: • Nurse practitioners offer a beneficial service and fill a gap in health care provision. • The nurse practitioner scope of practice varies from country to country. • Australian nurse practitioners are well positioned to bridge the divide of inequitable distribution of health services not only between metropolitan and rural/remote areas, but also within metropolitan areas. What this paper adds: • Research-based, iterative processes for development of clinical protocols that define the scope of practice for diverse nurse practitioner models. • A test of both the expansion and parameters of the roles applicable for any Australian specialization. • Systems and processes to inform health policy deliberations

ESTUDO SOBRE AVALIAÇÃO DE DESEMPENHO DE ENFERMEIRAS. METODOLOGIA UTILIZADA E RESULTADOS ENCONTRADOS - PARTE II

Nesta segunda parte do estudo sobre avaliação do desempenho de enfermeiras é apresentada a metodologia adotada, os instrumentos utilizados para a coleta de dados e os critérios adotados na discussão dos resultados. É apresentada, também, parte da discussão dos resultados, o que obedecem, para melhor compreensão, a uma seqüência prè-determinada. Dessa forma são discutidos resultados referentes aos itens "objetivos dos programas de avaliação de desempenho" e "elementos responsáveis pela avaliação de desempenho". Este último item subdivide-se em "caracterização profissional", que é totalmente discutida nesta parte do estudo, e "preparo profissional específico", que será apresentado na terceira parte do trabalho. O referencial teórico pertinente a resultados faz parte da discussão aqui apresentada.In this second part of this study the methodology, the instruments utilized for the data gathering and the criteria used in the discussion of the date are presented. Part of the discussion of the results, which, for better comprehension, follow a pre-established path, is also presented. The results concerning the itens "objectives of the performance evaluation programs" and "elements responsible for the performance evaluation" are discussed. This last item is subdivided into "profissional characterization", which is totally discussed in this part of the study, and "specific professional skill" which will be presented in the third part of this paper, The theoretical background related to the results is contained in the discussion presented