Nurse Practitioner - Case Study Example

NURSE PRACTITIONER INTRODUCTION Just like any other profession, nursing is an evolving profession that is continuously creating niche and finding ways with which it will be able to provide quality care to its core and primary stakeholder - the patients. And one such event happened during the 60’s. Experiencing an increasing demand for public health access in communities which are underserviced and underprivileged, United States created nursing practitioners who are tasked to be the primary line of health care provider in such communities. (Wilson & Shifaza, 2008) Basically the driving ethos of nursing practitioners is summed up in these words, a commitment to advanced autonomy to make a difference to the quality of patient care. (Gardner et al, 2006) The merits of this inspiring move have paved the way for the launching of nurse practitioners across the globe. The inception of nursing practitioner is relatively new in Australia. (Wilson & Shifaza, 2008; Gardner et al, 2006; Gardener & Gardner, 2004; Gardner et al, 2008) It originated in the women’s movement but it is only during 1999 that South Australia launched its nurse practitioner project developing nurse practitioner roles in its State. (Wilson & Shifaza, 2008) And it is the context of nurse practitioner in Australia which will be the focus of this paper. The aims of this paper are the following: to clarify the concept of nurse practitioner as it is defined and understood in Australia, to identify the impact of nurse practitioner from socio-political and cultural perspective and its stakeholders, and to raise possible challenges that nurse practitioner proffers to the nursing profession. And in order to achieve these aims this paper will try to address the following questions. First, what is the definition of nurse practitioner? What are the roles of nurse practitioner? Second, what is the impact of nurse practitioner in the nursing practice in Australia from socio-political and cultural perspective? And third, what are the future challenges that nurse practitioner posit to nursing practice in Australia? NURSE PRACTITONER: IN FOCUS A nurse practitioner “is a registered nurse educated and authorised to function autonomously and collaboratively in an advanced and expanded clinical role. The nurse practitioner role includes assessment and management of clients using nursing/midwifery knowledge and skills and may include but is not limited to: • the direct referral of clients to other health care professionals • prescribing medications • ordering diagnostic investigations. The nurse practitioner role is grounded in the nursing profession’s values, knowledge, theories and practice, and provides innovative and flexible health care delivery that complements other health care providers. The scope of practice of the nurse practitioner is determined by the context in which the nurse practitioner is educated, competent and authorised to practise. (Queensland Nurse Practitioner: Implementation Guide, 2008) The development of nurse practitioner’s definition is one of the achievements of Australian government as it is the first which laid down the points that clearly identify the roles and functions of a nurse practitioner and at the same time delineate and differentiate the nurse practitioner from other practicing nurses. Moreover, it should be noted that in Australia “nursing is regulated at the State rather than the National level (Gardner & Gardner, 2004; 133) thus, striking a common definition of nurse practitioner in Australia is already recognizing a commonality in the midst of plurality. As such, this should be taken as a big step towards recognizing the important role that nurse practitioners play in the delivery of health service across Australia. The formation of nurse practitioner is part of the government and nursing institution’s response to the following rising concerns. First, demand for improvement in the quality of health care service. Second, the problem of ageing population which Australia is now facing. It is claimed that as the population is ageing, the need for health services are altered and that this alteration is not only felt in the changing health needs but also affects the workforce as the workforce itself becomes aged. Thus, becoming one of the factors that influence the continuous shortage of health care workers. (Segal & Bolton, 2009) Third, the cost of health care is a perennial issue and services are focused on introducing approaches to care that maintain safety while taking advantage of less expensive clinicians. Fourth, consumer demand for access to specialty services, particularly in previously underserviced and resources areas, for example, mental health, drug and alcohol services, and rural health, has contributed to the evolution of this new role for nurses. Fifth, an extended practice role for nurses is now supported by their increased depth and breadth of knowledge, augmented by critical thinking and problem-solving skills developed from undergraduate and postgraduate courses offered by tertiary institutions. (Middleton et al, 2007) These reasons are of primordial significance as it necessitates an immediate action. However, both the government and the nursing institutions have exercised prudence and extra care in the selection and creation of nurse practitioners in order to ensure that the nurse practitioners are fully qualified in the fulfilling of their functions and that the services that they will provide the community meets its needs and are safe and effective. (N³ET Myth Busters, 2006). Being such, the following standards are provided and it serves as the characteristics that a nurse practitioner ought to posses. These standards are: standard 1 is Dynamic Practice which includes Clinical knowledge and skills, Practice in complex environments and Currency of clinical knowledge. Standard 2 is Professional Efficacy is manifested by a nursing model of extended practice, partnerships and cultural awareness and autonomous and accountable practice. And Standard 3 is Clinical Leadership which is exhibited by clinical leadership, critique and influence at systems level of health-care and collaborative practice. (Gardner et al 2006) These standards serve as the measure with which nurse practitioners are evaluated. Brett Williams (2006) in an interview shared his opinion regarding the process of becoming a nurse practitioner. He said that the minimum requirement in the educational level of the nurse practitioner is that he/she should be a MA holder, aside from years of actual experience and other degrees such as pharmacology. He also mentioned that the nurse practitioner should possess critical thinking, leadership and should be prepared to undergo continuous training, must have creativity and the willingness to embark in sharing his/her experiences with her colleagues through publication. His story tells us that becoming a nurse practitioner, the process itself and the standards set, are very rigorous. His story is attested by N³ET Myth Busters, 2006 when they itemized the requirements and the steps that must be followed before one can be accredited as a nurse practitioner. And these strict requirements are necessary as nurse practitioner in Australia is a protected title which means that the nurse has to be registered in her State or Territory before she can be called as nurse practitioner. This is necessary for in Australia they want the patient to be certain that the nurse practitioner that will be attending to his/her need is qualified and ready to provide the quality care that the patient needs. (N³ET Myth Busters, 2006) From this perspective, it can be seen that the government is taking all the necessary legal steps in order to guarantee the improvement of health service across the country. Thus, certain legislations are at placed. These are the Nursing Act of 1992 which set the mechanism for title protection. The Health Act of 1937 The Health (Drugs and Poisons) Amendment Regulation (No.1) 2004 allows for nurse practitioners, endorsed as such by the Queensland Nursing Council, to prescribe and give written and oral instructions for the administration/supply of medications according to a Drug Therapy Protocol. Radiation Safety Regulation 1999 allows nurse practitioners to request plain film diagnostic radiography under the diagnostic radiography protocol, and the Workers’ Compensation and Rehabilitation Act 2003 which is still being work out. (Queensland Nurse Practitioner: Implementation Guide, 2008) Much attention has been given in the clarification of the definition, role, status, characteristics, education, process and legal frameworks that surrounds nurse practitioner. This is crucial for it is only in removing built misconceptions that a better appreciation of nurse practitioner can be attained. NURSE PRACTITIONER’S IMPACT The development of nurse practitioner can be seen as the affirmation of the integral role of nurses in providing health services. And that this new role of nurses posits an impact in the society, specially, in its socio-political and cultural arena. In the socio-political arena, nurse practitioner has opened the doors for an innovative health care delivery to people. (Gardner et al, 2006)As nurses become the front liners in the health care service and primary care providers, it creates a new perception and appreciation of the nursing function and at the same expands the horizon with which nurses may perform their nursing functions. Moreover, as nurse practitioners reach far flung communities and rural areas in Australia and provide health service to underserved sectors, they have become “the solution to community demands for access” (Middleton et al, 2007; 132) Likewise, the government’s move to provide the legislative framework that will serve as the buttress with which nurse practitioners define their role (Queensland Nurse Practitioner: Implementation Guide, 2008) shows that the government and the nursing institutions are serious in not only finding a balance among the many concerns in health care system, but their joint effort mark the conscientious endeavor in providing “improvement in career structure and professionalization for nursing” (Williams, 2006; 4) Furthermore, as nursing evolves in response to the current status of the health care system, nurse practitioners put to the fore the importance of “collaborative work from the government, nursing institutions , professional and regulatory authorities in order to promote the well being and health of Australians".(Daly & Bryant, 2007;27) And finally as new factors such as increasing levels of income and wealth, emergence of new technologies, changing disease profiles, changing public health priorities and a focus on the prevention of chronic disease (Segal & Bolton, 2009) coupled with ageing population and workforce affect the health care system, the development of nurse practitioner affirms the commitment for a quality care service to all Australians. In the same manner, the cultural impact of nurse practitioners is moving from utility to pragmatic benefits and new paradigms in the standard of care. It is undeniable that the roles of nurse practitioners serve as the solution for the improvement of the health care delivery (Williams 2006) and it is from this view that utility of their function is highlighted. But at the same time, the practicality of the approach enables health care delivery to be given to rural and remote areas where access to health is often difficult (Middleton et al 2007) And finally, it is in this condition of cultural utility and pragmatism, that nurse practitioner becomes the new paradigm for quality care – it is autonomy, flexibility, efficiency, leadership, technical skills and knowhow and being a good nurse in a holistic sense. (Gardner & Gardner 2004; Watson 2008; Fagerström 2006) The whole concept of the impact of nurse practitioner in the socio-political and cultural arena is made clearer if the perspectives of the stakeholders are assessed. In this case, there are five stakeholders. These are the government, the professional organizations, the community, the nurse practitioner and the patient. Although in Australia nursing is regulated at State rather than National level, the concerted effort by the government in coming up with a clearer role, functions, standards, definition and nature of nurse practitioner is a boost to the nurse practitioner in particular and to nursing institutions in general. The laying down of the legal frameworks shows that nurse practitioners are authentically seen as the most viable solution in addressing the problem of health cost, quality care and health access of people who are less capable of accessing the health care they need. And as Australia alone has made the nurse practitioner title protected as it is sanctioned by laws, the assurance of a safe, effective and quality health care service is assured to all Australians. (Queensland Nurse Practitioner: Implementation Guide, 2008) In terms of professional organizations and regulatory bodies, they play an integral part since they provide the strategic planning, health service provisions, health service alliances and policies and procedures that are to be followed (Burley & Greene, 2007) from recruitment to the creation of NPs, to source funding and providing continuous training and education to nurses the organizations are involved. Moreover, they make certain that nurse practitioners are apt and capable in fulfilling their functions. Even though much is being done, there are questions regarding the ‘readiness’ of the system in undertaking this momentous career structure that nurse practitioner is opening to nurses. (Pringle, 2007) The seeming limitedness of available evidence-based research pertinent to this issue of readiness adds to the doubt whether they can really handle new dynamics proffered by nurse practitioners. Nurse practitioners are most effective in the performance of their functions within the context of collaborative work. In this concern, there are technically two communities – the community where the nurse practitioner serves and the smaller community of health care providers where the nurse practitioner is seen as a member of the team. In terms of the larger community which is served by the nurse practitioner, there are evidences that show that are effective and are really capable of providing the primary health care that patients require. (Queensland Nurse Practitioner: Implementation Guide, 2008; Burley & Greene, 2007; Offredy 2000; Wilson & Shifaza, 2008; Segal & Bolton; N³ET Myth Busters, 2006) In fact, nurse practitioners are encouraged to tell their stories via publishing in peer reviewed journals. In fact, it is one of the competencies required for a nurse practitioner. (Middleton 2007) In terms of the team, it is known that the work of a nurse practitioner is attained in the context of a multidisciplinary environment. (Gardner & Gardner 2004) the recognition of the recognition of the importance of the coming together of different disciplines and yet autonomous is the model of collaborative work. In this regard, there are studies which affirm the large and effective contribution of nurse practitioners. This is clear. However, there are claims that on the side of the medical field there seems to be ambivalence regarding their perception of nurse practitioners. They do not deny that nurse practitioners are effective and efficient but what concern them are boundaries of the functions which might lead to confusion (Pringle 2007; Cartier & Chochinov, 2007; Keleher et al 2007) aside from funding. Until these issues are resolved the feeling of ambivalence may not be removed. The individual nurses themselves are happy with the expansion of their jobs. (Senior, 2008; Mills & Fitzgerald 2008) Nurse practitioner is technically a development in career structure for nurses and a chance to create their own identity in the realm of health care. Moreover, this is one sure solution for nurses to feel that they are needed and that their services are of equal importance comparable with all the other members of the health team. This becomes important as one of the reasons that nurses often raise why they leave nursing is because they feel that they are not needed and properly appreciated. (Corley et al, 2005) But with nurse practitioner, this is addressed. Finally the patient, numerous accounts have been done affirming the satisfaction of the patient with the quality of nursing care that they have received from a nurse practitioner. (Cartier & Chochinov, 2007; Watson 2008; Queensland Nurse Practitioner: Implementation Guide, 2008; Burley & Greene, 2007; Offredy 2000; Wilson & Shifaza, 2008; Segal & Bolton; N³ET Myth Busters, 2006; Middleton 2007) It’s undeniable that nurse practitioners have brought closer health access, health care to people who are vulnerated and less privileged in the society. With this, it is now apt to ask, what the future challenges are for nurse practitioners? THE FUTURE CHALLENGES In the improvement of the career structure and professionalization of nursing as realized in nurse practitioners, the following are perceived future challenges to nurse practitioners in particular and nursing in general. 1. To continuously harness working in a multidisciplinary team as this is the most efficient and most effective way in providing quality health care to patients 2. To maintain and sustain the high level of excellence which is clearly manifested in the clinical competence, technical skills, decision making, in the creative and non-standard approach in providing quality care. 3. To provide advocacy for the rights of the patients for health, well being and health care access any time that they need or want it. 4. To provide alternative model of service delivery 5. To become the leaders of the institution itself and mentors for younger nurses who are inspired by their stories of quality care and service to patients and the community 6. To offer viable solutions to the appropriation of limited resources in the midst of increasing health demands 7. To do researches on how nurse practitioner can be further improved and developed 8. To capitalize the nurse led care management as the transition for a new paradigm of healthcare. CONCLUSION Nurse practitioner is the response to the demand for improvement of the quality of health care system and the need to make health care accessible to remote and rural areas and less privileged persons in Australia. Australia’s move in making nurse practitioner title protected, safeguards and ensures that Australians will be receiving safe, secure, and effective quality care services from eligible leaders of the nursing institution itself. As studies are affirming the numerous benefits being received from nurse practitioners in terms of health costs, quality care, access, delivery of services and nursing care; challenges regarding the continuous demand for excellence and development should be consistently address as nurse practitioner is the embodiment of the commitment to advanced autonomy to make a difference to the quality of patient care. REFERENCE: Burley, M.B., & Greene, P. 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