Introduction
For many decades, nursing practice has changed globally. This involved major counties like Australia, the United Kingdom, and the United States of America. These gradual changes have been due to, controlling operating costs, the strategic location of health care service, developing technology. In addition, changing economic, political, and social aspects have contributed to these changes. The diversity of nursing literature puts it possible for learners to come together and interact. Many literature reviews have been written through literature reviewed here clearly reveals a global struggle to clarify a multitude of new and not so new nursing roles and styles of practice (Hanson & Hamric, 2003).
Many literature reviews have been done throughout the world on advanced nursing practice. They represent literature from such countries as New Zealand, the United Kingdom, the United States of America, Australia and Canada, and other countries. Opinions have suggested that there is a need for teaching concepts on nursing roles to anyone who is specializing in a nursing career despite the nursing field or level of study one is taking. Absorbing of different content of several specialties is advocated in nursing (Australasian Nurse Registering Authorities Conference, 1990). This broad study throughout the world has shown that many issues are interconnected. A professional issue affects everyone throughout the world. In advanced nursing practice matters and issues are related throughout. The world issues on nursing practice are related despite the diversity in the population. It signifies the importance of respecting each other’s variances while being ready to learn from others. According to Antrobus (1995), there is a need for nursing leaders to find their solutions to fit their contexts but with cognizance of available collective wisdom.
According to the International Council of Nurses (2001)
”increased competition in the global market and multi-skilling have impacted on health delivery by way of emphasis on cost-effectiveness and being able to work across disciplinary boundaries. Trends are not necessarily consistent: devolution and decentralization might apply in some countries while tighter government controls apply in others and each can influence the way health services are organized and health professionals fulfill their roles” (p.359)
In the United States of America, there is a need for understanding roles in nursing practice. There also is a need to understand the definition of advanced nursing practice. Nursing professionals have built a base for nursing practice in the United States of America. These professionals include anesthesia nurses, practioner nurses, medical nurses, and midwives (Monash University, 1998). In the United State advanced nursing practice has drastically gone through the following level: standard-setting, training new staff, and growth based on knowledge (Aggleton & Chalmers, 1985).
In Canada: “Canadian professional nursing has claimed clinical expertise to be a hallmark of advanced nursing practice. However, the nature of this expertise is elusive and unclear according to a recent overview of the Canadian perspective and is complicated by the expansion of nursing roles into the medical domain” (Antrobus, 1995).
According to Vernon (2000), “1998 marked a turning point in New Zealand when the Ministerial taskforce on Nursing acknowledged advanced practice as influencing greater effectiveness and efficiency in health care. The Taskforce also urged the development of a framework for nursing specialist competencies, linked to nationally consistent titles, so that all nurses using a particular title can be recognized as having particular competencies” (p.360).
Literature from Hong Kong reports the emergence of advanced practice nurses in nursing specialties with influencing factors from the United Kingdom, United States of America, and Australia (Girot, 1993).
In Australia’s advanced practice, history dates back to many past, years although it seems that the term nursing practioner is becoming more popular of late. This is not the case all over the world, however. In the United States of America, its use appears to be growing fast to include various specialty roles, comprising that of the nurse practitioner. Higher-level practice is a term used recently in the United Kingdom, supposedly for the short-term (Vernon, 2000; Arryer, 2002). Nursing practice in Australia was influenced by factors such as political, sociocultural, economic, and environmental. By adopting graduate and clinical level defined areas of practice in nursing (Fleschler & Luguire, 2002). For example, support workers are undertaking jobs previously done by nurses (Offredy, 1995).
Professional, theoretical and research literature related to advanced and expanded nursing practice roles in Australia.
There is a clear definition of role in whatever task nurses do. While accepting 1992, “International Council of Nurses definition of specialist nursing as a nurse prepared beyond the level of a generalist and authorized to practice as a specialist with advanced expertise in a branch of the nursing field” (International Council of Nurses, 1992, p.26). It consists more of the traditional aspect of nursing involving knowledge in nursing, facilitating professional growth, and highly autonomous practice, (Girot, 1993). “Expanded nursing practice tasks are such as acute care nurse practitioners, practice case managers, and clinical nurse specialists/nurse practitioners. Expansion of such roles in ambulatory and community settings is vital for proper service provision. Broadly, these roles are change agent, involving collaboration and consultation with health care providers and decision-makers” (Castledine, 2002).
The authors particularly advocated that advanced practice was a way to re-establish a focus on the client and the nurse-client relationship. The notion of specialist practice being different from advanced and expert practice was extended. The researcher pointed to the trend in Australia for nurse practitioner roles to evolve around designated specialty practice. As such, a multisite Australian, study into research directions for specialist emergency nursing practice supports this feeling. Australian literature relating to advanced nursing practice appears to be merging into and being overtaken by that on nurse practitioners, with consideration of overseas experiences. Special pilot projects and trials have been conducted or are proceeding in all Australian states and territories to legitimately introduce nurse practitioners to the health workforce in a way that will them to practice comprehensively. In mid-2003 that the Australian scene was changing very fast and with incredible scope, and associated with this, there was confusion about the definition of ‘nurse practitioner’ in different states and settings (Dunn 2003; United Kingdom Central Council for Nursing, Midwifery, and Health Visiting, 1998).
The issue of competency indicators for registered nurses in Australia was addressed in a national project commissioned by the Australian Nursing Council in 1997. Despite extensive consultation at all levels of the profession, no new ideas regarding what might constitute an indicator of continuing competence were forthcoming (Hamric & Spross,1989). According to the same authors, confusion over levels of competence, echoed throughout the data, with participants often starting to talk about specialist, advanced practice, and then, in a contradictory manner, referring back to beginning or core competencies (Castledine, 2002; Nursing Council of New Zealand, 1996). Researchers in Australia elaborated the process of identifying advanced nurse practitioners (Dunn, 2000).
Critical analysis
Competency standards in Australia that apply to the registration of nurses and midwives undertake and ensure high-quality care through safe effective work practices. It should provide broad practice and performance guidelines (Nursing Council of New Zealand, 2002).
Research findings should provide insight into and into the complexity of emergency practice and challenges experienced by nurses.it increases insight into nursing practice through research factors that determine behavior and interaction that are made transparent and provide further insight on this subject (Institute of Nursing Executives of New South Wales, 1998).
There is a need for management research need to deconstruct the context of care and in a particular dimension of policy adherence. Shifting context care such as patient overcrowding compromises policy adherence and leads to aggression, violence, and bullying in the workplace. Responsible nursing practice needs to be achieved of discipline it contributes toward greater consistency within the practice and improves patient outcome.
There are increased challenges in leadership and management in meeting service provision, demand, and consumer expectations. Such as sustainable access to planning, overcrowding, staff recruitment, and redesign of model care to include emergence role, referral, and redirecting care options.
Poor planning has to lead to increased congestion in hospitals, increased time of stay and mortality, poor hospital process, poor infection control, patients not being placed in the rightward. The complexities of staff recruitment, retention, and the development of emergency nursing roles must be made explicit to enable strategic planning to sustain or enhance nursing work face.
There is a need to increase resuscitation practices in rural and remote health centers. The health system should be restructured.
Practice cultural context of sharing knowledge including values, beliefs, and way to provide understanding bring meaning to activities.
Nursing specialization is important to assist emergence nurses in gaining depth in knowledge and clinical experience. Tertiary programs should be developed to articulate with specialist certificate courses. The nurse should increase their effectiveness in reducing workload and improving patient satisfaction. There should be a professional organization such as the emergency nurses association should be established. They help promote clinical, educational, and professional development. Advanced nursing practice should be shaped to address complex and dynamic health care system need and demands for flexibility.
In terms of workforce management, it is essential for more effort on the promotion of the practice of nursing, it is necessary to establish clear career pathways along which they can progress.
Professional issues related to advanced and extended nursing practice roles
The role of a nurse has issues sounding the appropriate role of a nurse in both overall care and nursing discipline. There is a need to clearly define the nursing practice.
The nursing role should involve nursing addresses, intervention in respect to a problem in nursing, scientific intervention, the outcome of nursing intervention (Richardson, 2002).
Lack of clear role of definition by nursing poses a great danger to the profession in terms of maintenance and control of finance or control policies. The challenge must be handled not limit nursing policy or prevent adapting to rapid change occurring. The nursing profession to advance it should move away from a traditional approach and towards describing nursing practice (Leddy & Pepper, 1998).
A nurse has a global trend toward the reciprocal licensing board of professionals who ease their movement across the border through issuing of nursing licenses. Nursing association revises their nursing standards and guidance on decision-making.
Expanded roles of a nurse: nursing scope of practice should not be expanded but be fully utilized in the scope of nursing practice. Challenge is to define the scope of nursing practice in a way that does not limit practice or advanced expert practice. They involve being at the forefront in improving the cost-effectiveness of health care. Utilization of full scope of nursing care may be an appropriate response to demand expanded roles. There is pressure from inside and outside nursing to ensure that the definition of the scope of nursing practice enables the practice of a nurse practitioner. Some nurses fear that expanding the practice of nursing into is that overlap with the medicine will increasingly place nurses in the harmful potential of nursing practice (Ramirez, 1996).
Overlap and shared roles; closely related issues and trends overlap with shared roles among professional groups and within the nursing discipline and overlapping with the other disciplines. These issues overlap the transfer of function and delegation of nursing tasks. They rise and evolve, driven by such factors as new technology, which demands various practitioners and skills (IDee &Auger, 1983).
Some roles do overlap within the nursing profession. There is role confusion in nursing because the tasks are easily shared among more than one group. The role of nursing practices distinguishes the practice of a registered nurse and other nurses.
Legal and regulatory issues related to Study Books Used in Class
Credentialing is a process that designates individuals, programs, institutions to establish under given standards set by the government (government or non-government) recognized to carry out a task. Licenses registration, a crediting approval certification, recognition, and endorsement are used in description.its a marking of quality (Dunn, 2003; Calvin & Clark, 2002).
Licensure the government grants permission to individuals acceptable for the practice of a profession and prohibits all others from legally doing it. It permits the use of particular titles and defines the scope and sets boundaries of practice in the profession. It also involves giving an individual a property right. Certification; a process by which a non-governmental agency or association grant recognition after qualification (Antrobus, 1995; Monash University, 1998).
Privileges are used to monitor the clinical activities a provider is authorized to perform in that facility. It is a process of authorizing a health care professional to perform specific diagnostic or therapeutic services. Granting of privileges is based on the following practice of act, agency regulation, license, training, experience competence, health status, and judgment. Order instruction to other health care providers to administer or perform specific diagnostic or therapeutic services (Offredy, 1995)
References
Aggleton, P., & Chalmers, H. (1985). Critical examination. Nursing Times, 81(14), 38- 39.
Antrobus, S. (1995). Teachers play the triangle. Nursing Management, 1(9), 12-13.
Arryer, J. (2002). The nurse practitioner role: A process of evolution. Nursing New Zealand, 8(10), 23.
Australasian Nurse Registering Authorities Conference. (1990). Nursing competencies assessment project Report. Australasian Nurses Registering Authorities Conference, 23(2), 56-78.
Australian Nursing Council. (1993). National competencies for the registered and enrolled Nurse in recommended domains. Australasian Nurses Registering Authorities Conference, 22(2), 57-69.
Calvin, A.O., & Clark, A.P. (2002). Legal and ethical dimensions of CNS practice: How are you facilitating advanced directives in your clinical nurse specialist practice? Clinical Nurse Specialist, 16(6), 293-294.
Castledine, G. (2002). Higher-level practice is in fact advanced practice, British Journal of Nursing, 11(17), 1166.
Dunn, S. (2003). Nurse practitioner. Connections, 6(2), 34-40.
Fleschler, R., & Luguire, R. (2002). Advanced practice role of the outcome manager. Outcome Management for Nursing Practice, 2(2), 54-57.
Girot, E. (1993). Assessment of competence in clinical practice – a review of the literature. Nurse Education Today, 13, 83–90.
Hamric, A.B., & Spross, J.A. (1989). The clinical use specialist in theory and practice. New York: McGraw Hill.
Hanson, T., & Hamric, A. (2003). Advanced practice nursing and conceptual models, Nursing Science, 17, 135-138.
IDee, V., & Auger, J.R. (1983). A patient classification system based on the behavioral system model of nursing, Journal of Nursing Administration, 13(5), 18-23.
Institute of Nursing Executives of New South Wales. (1998). Nurse practitioners: Another perspective. Health Management Bulletin, 4, 6–8.
Leddy, S., & Pepper, J. (1998). Conceptual bases of professional nursing. Philadelphia: Lippincott.
Monash University. (1998). The history and development of key competencies. Web.
Nursing Council of New Zealand. (1996). Discussion paper: Performance-based practicing certificates: A means to ensure public confidence in the continuing competence of nurses and midwives. Nursing Canal Of New Zealand, 8(12), 25.
Nursing Council of New Zealand. (2002). Nurse practitioner. Journal of the Nursing Council of New Zealand, 2(2), 22-25.
Offredy, M. (1995). Personal narratives of young people working in a caring environment. The Vocational Aspect of Education, 47(3), 309–328.
United Kingdom Central Council for Nursing, Midwifery, and Health Visiting. (1998). Higher-level practice. Agendum, 6(4), 23-27.
Ramirez, E. (1996). A personal perspective: Nurse practitioner in the emergency department. Journal of Emergence Nursing, 22(6), 538–540.
Richardson, D. (2002). The access-block effect. Medical Journal of Australia, 177(9), 492–495.