Role development in Advanced Nursing Practice in a university hospital Marieke Schreuder-Cats, MSc, RN, MANP, Dennis de Bie, RN, MANP Dr. Sigrid Vervoort Msc. MANP and Dr. Harmieke van Os Msc. University Medical Center Utrecht The Netherlands 29-08-2018
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UMC Utrecht 2.200 nurses 11.268 1.042 3.600 218 EMPLOYEES BEDS STUDENTS PhD GRADUATES Facts 2014
ANP network UMC Utrecht Where nurse practitioners and nurse scientists meet and share and exchange expertise and experience 123 members (of which 65 ANP s) 40 ANP in 2014, 65 ANP in 2017, 8 students graduate this month! Aim is to stimulate role development and to be an ANP advocate Positioning statement ( The advanced nurse practitioner in the University Medical Center Utrecht 2014) Vision in positioning and educating nurses towards master level is needed Vision in positioning ANP in our organisation is needed
Purpose Questionnaire Insight into current position, tasks and role fulfillment Wishes of ANP s about near future position and role development
Method Cross-sectional study Online questionnaire: 38 descriptive quantitative questions 13 open (qualitative questions) Part of the quantitative questions were based on the questionnaire of Laurant et al., 2014*. *Een studie naar functieprofielen, taken en verantwoordelijkheden van Physician Assistants en Verpleegkundig Specialisten. Dr. Miranda Laurant, Drs. Kalinka van de Camp, Drs. Linda Boerboom, Drs. Nancy Wijers. Nijmegen, oktober 2014.
Results Total of ANP s working in our clinic was 65 (November 2017) In addition there were 16 students ANP (November 2017) Response N=51 43 ANP s (66%) responded 8 ANP students (50%) responded
Characteristics ANP respondents (mean, sd; range) 45.8 (10.2; 28-64 y) Male 12;24% Female 39;76% Working years in UMC Utrecht (mean, sd; range) 16.5 (9.9; 1-39y) Working percentage 60-80% 10 (20%) 80-100% 41 (80%)
Characteristics ANP respondents MANP education: University of Applied Sciences Utrecht (HU) Other Dutch MANP 39 (80%) 10 (20%)
In which department are you working? Departments ANP 31% 2% 27% 14% 22% 4% Cancer Center Surgery Internal diseases and dermatology Cardiology and lung diseases Neurology or psychiatry Children department
Where are you working? Outpatient clinic 49% 45% Clinical ward 6% Combinations (OPC,C,Consultations,day treatment)
Who is your manager? Manager of ANP 2% 2% 20% 76% Medical doctor Nursing background Ambulant working Manager
In case of absence, who is substituting you? Substitution in case of absence ANP 12% 3% 3% 18% 8% 3% 10% 43% ANP Physicians Residents Interns Physician assistant Specialized nurse No substitution Other
How is your working time distributed? 100% Time distribution tasks ANP 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1-20% 20-40% 40-60% 60-80% 80-100% na 1-20% 20-40% 40-60% 60-80% 80-100% na 1-20% 20-40% 40-60% 60-80% 80-100% na 1-20% 20-40% 40-60% 60-80% 80-100% Niet van toepassing 1-20% 20-40% 40-60% 60-80% 80-100% na Medical tasks Complex nursing tasks (master level) Nursing tasks (bachelor level) Administrative tasks Non patient-related tasks
How is your working time distributed? 37 %of the respondents are spending 20-40% of their working time at medical tasks 18 %of the respondents are spending 40-60% of their working time at medical tasks 45% are spending 20-40% of their time at complex nursing tasks (master level) 24 % spend 40-60% and 60-80% of their time at these complex nursing tasks.
How is your working time distributed? Burden of administrative tasks Almost half of the respondents (49%) spend 20-40 per cent of their time at administration 24 % even 40-60% of their time. 59 % per cent of the respondents only spend 1-20% of their time at non-patient related tasks (e.g. teaching, research, innovation and quality of care ) 33% 20-40% of their time.
Qualitative questions Questions e.g.: What 4 aspects for your position as ANP needs to be addressed in our hospital in the new network positioning paper? What threats do you see in the development of the ANP role? What are the dreams you have as an ANP for our future/role development?
Results Thematic analysis What 4 aspects for your position as ANP needs to be addressed in our hospital in the new network positioning paper?» Themes : Research and innovation Quote:..that the ANP may spent 20% of working time at research.
Results Thematic analysis What 4 aspects for your position as ANP needs to be addressed in our hospital in the new network positioning paper?» Themes : Finance Quote:..for every ANP a fixed budget for training/education throughout the hospital.
Results Thematic analysis What 4 aspects for your position as ANP needs to be addressed in our hospital in the new network positioning paper?» Themes : Positioning/profiling Quote:.. doubling the amount of ANP s within our organization. Quote:..ANP is a well known independent professional who has a clear place in our organization...
Results Thematic analysis What threats do you see in the development of the ANP role?» Themes : Employability/ undefined tasks Quote:..within our department it s unclear how the ANP can be employed..... Risk of being used as handyman..
Results Thematic analysis What threats do you see in the development of the ANP role?» Themes : Competition Quote:..within our department doctors are unwilling/reluctant to substitute tasks to the ANP... And:.. Too much residents, we have to guard our position..
Results Thematic analysis What are the dreams you have as an ANP for our future/role development?» Themes : Conditions/ positioning/profiling/cooperation/research Quote:.a better and visible position for the ANP who is actively involved in practice based research, and easily approachable as a contact for patient and caregivers....
Conclusion Implementation of ANP is successful in our hospital! ANP s are performing all tasks Further role development in patientcare, research and education is needed Advocacy important! Working on profile and positioning of the ANP is work in progress!
Work in progress
Discussion Do you recognize the friction between substitution of tasks and the need for ANP s to get more time for research/quality of care/education and innovation? If so: How do you address this development in your organization? Does your organization have hybrid functions (like a NP clinicianscientist) function? If so 80-20 percentage? Do you also have a network within your organization?