DELINEATION ROLES. of specialized and advanced practice nursing. UEF // University of Eastern Finland

Transcription

1 DELINEATION of specialized and advanced practice nursing ROLES

2 Litle bit about myself

3 RESEARCH TEAM: Jokiniemi K, University of Eastern Finland Carr M, Carr CNS Consulting Kilpatrick K, Université de Montréal Martin-Misener R, Dalhousie University Roussel J, Canadian Nurses Association (CNA) Tranmer J, Queen s University Rietkoetter S, McMaster University Bryant-Lukosius D, McMaster University

4 Presentation Objectives v Share the results of our study examining specialist and advanced practice nursing roles in Canada v Describe and compare the practice patterns of specialized registered nurses (SRNs), clinical nurse specialists (CNSs), and nurse practitioners (NPs)

5 Background Canada: 2016: Registered Nurses = 293,911 ¹ 2016: Nurse Practitioners = 4,832 ¹ 2018: Certified Nurses in 20 specialties = 16,779 ² APN roles have existed for more than 40 years Need for specialized and advanced practice nurses to act as leaders in healthcare through collaborative clinical practice ³ ⁴ Lack of role clarity is a key barrier to the effective development, utilization, and evaluation of the APN roles ⁵ ⁶ ⁸

6 Study objectives ü Identify & compare the practice activities of SRNs, CNSs, and NPs ü Identify and compare the proportion of time nurses in SRN, CNS, and NP roles spend in recognized domains of advanced practice

7 Study design Method: comparative descriptive cross-sectional study in 2017 Sample: SRNs (n=571), CNSs (n=344) and NPs (n=521) Recruitment: CNA Certification Program and national specialty and advanced practice nursing organizations Data Collection: Advanced practice role delineation tool ⁷ ⁸ (English, French) Analysis: Descriptive statistics to describe sample and practice patterns One-way analysis of variance (ANOVA, post-hoc tests) to compare group differences regression analysis to explore predictors of practice patterns

8 Direct compreh. care Hands on activities such as assessments, providing physical care ect. Advanced Practice Role Delineation -tool (APRD) (⁷ ⁸) Three sections: 1. Demographic characteristics 2. Identification of practice activities in five domains: Direct comprehensive care (15 items) Support of systems (8 items)...promote innovative dissemination of Education patient care and - (6 items) knowledge by Research facilitate the (6 optimal items) education, informal staff progression of development, and Professional patients through leadership the formal (6 presentations items) 3. Perceptions of time spent overall in each of the domains 5-point Likert scale (0 = not at all to 4 = a very great extent) Support of systems Education Research Professional leadership system support the generation of knowledge and promote the use of creativity and innovative problem-solving strategies allow for sharing and dissemination of knowledge that is beyond the individual s institutional setting

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10 Results 1. Demographic characteristics 2. Practice activities in 5 domains: 3. Regression analysis to examine predictive factors of activities Response rate 35% (n=1436/4098) Position category # of respondents % of respondents CNS NP SRN

11 1. Demographic Characteristics slide 1/2 All % (mean) CNS % (mean) NP % (mean) SRN % (mean) Working in clinical role Yes Current age (46) (48) (45) (46) Female Highest level of education Undergraduate MSc or PhD CNA certification Yes # of yrs as RN (21) (24) (19) (21) # UEF of // yrs University as APN of Eastern Finland (6) (8) (8) (2)

12 Demographic Characteristics Slide 2/2 All % (mean) CNS % (mean) NP % (mean) SRN % (mean) Practice setting Hospital Primary and Community Based Care Other Current title Staff Nurse Clinical Nurse Specialist Nurse Practitioner Advanced Practice Nurse Other

13 2. APRD Summative Domain Scores Series1 Series2 Series = p 0.001

14 3. APRD: Regression analysis Stepwise regression: to determine factors predictive of consistent involvement in advanced practice competencies Dependent variables: Summative domain * scores Independent variables: Position category (CNS, NP, SRN) Education (Undergraduate/Postgraduate), CNA certification (Yes/No) # of years as an APN Employment status (Full-time/Part-time) Region (urban/non-urban) Province grouped (BC/Prairies/Ontario/Quebec/East/Territories) Practice setting (hospital/all others) % variance for which these accounted for was low: 12.6% to 21.6% * Domains: Direct comprehensive care, Support of systems; Education; Research, Professional leadership

15 Conclusion ØAPRD tool has been able to articulate different types of advanced and non-advanced roles in multiple countries ØNPs were significantly more involved in direct comprehensive care than CNS and RNS ØCNSs were more involved in all other non-clinical role domains. There were some overlap with CNS and RNS roles. ØThe information discerning specialist and APN roles may be used to clarify role differentiation and guide evidence informed decisionmaking on workforce planning and optimal utilization of various roles

16 REFERENCES 1. CIHI 2016,, Canadian Institute for Health Institution. Available: 2. CNA. Canadian Nurses Association. Available: 3. World Health Organization. Global Strategy on Human Resources for Health: Workforce Maier CB, Aiken LH & Busse R. Nurses in advanced roles in primary care. 5. Dowling M, Beauchesne M, Farrelly F et al. Advanced practice nursing: A concept analysis. Int. J Nurs Pract 2013; 19: Duffield C, Gardner G, Chang AM et al. Advanced nursing practice: A global perspective. Collegian 2009; 16: Ackerman MH, Norsen L, Martin B et al. Development of a model of advanced practice. Am J Crit Care 1996; 5: Gardner G, Duffield C, Doubrovsky A et al. Identifying advaced practice: A national survey of a nursing workforce. Int J Nurs Stud 2016; 55:

17 Thank you!