DELINEATION of specialized and advanced practice nursing ROLES
Litle bit about myself
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
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)
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
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 2.9.2018 6
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
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
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 344 24.0 NP 521 36.3 SRN 571 39.7 10
1. Demographic Characteristics slide 1/2 All % (mean) CNS % (mean) NP % (mean) SRN % (mean) Working in clinical role Yes 83 70 97 79 Current age (46) (48) (45) (46) Female 93 94 93 93 Highest level of education Undergraduate 42 25 11 80 MSc or PhD 58 75 89 20 CNA certification Yes 61 68 23 90 # of yrs as RN (21) (24) (19) (21) # UEF of // yrs University as APN of Eastern Finland (6) (8) (8) (2)
Demographic Characteristics Slide 2/2 All % (mean) CNS % (mean) NP % (mean) SRN % (mean) Practice setting Hospital 53 65 40 60 Primary and Community Based Care 38 23 56 32 Other 8 13 5 8 Current title Staff Nurse 23 10 1 51 Clinical Nurse Specialist 15 61 0 1 Nurse Practitioner 36 1 96 2 Advanced Practice Nurse 3 5 2 2 Other 19 23 1 33
2. APRD Summative Domain Scores Series1 Series2 Series3 100 80 60 40 20 0 1 2 3 4 5 = p 0.001
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
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 2.9.2018 15
REFERENCES 1. CIHI 2016,, Canadian Institute for Health Institution. Available: https://www.cihi.ca/en 2. CNA. Canadian Nurses Association. Available: https://nurseone.ca/en 3. World Health Organization. Global Strategy on Human Resources for Health: Workforce 2030. 2015 4. 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: 131-1140 6. Duffield C, Gardner G, Chang AM et al. Advanced nursing practice: A global perspective. Collegian 2009; 16: 55-62. 7. Ackerman MH, Norsen L, Martin B et al. Development of a model of advanced practice. Am J Crit Care 1996; 5: 68-73. 8. Gardner G, Duffield C, Doubrovsky A et al. Identifying advaced practice: A national survey of a nursing workforce. Int J Nurs Stud 2016; 55: 60-70. 2.9.2018 16
Thank you! Krista.jokiniemi@uef.fi