The role of a clinical nurse consultant in an Australian Health District: a quantitative survey

Leading from the bottom: The clinical leaders roles in an HIV primary care facility in Eldoret, Kenya

BACKGROUND

Clinical leaders in health systems play critical roles in making decisions that impact patient care and health system performance. Current literature has focused on the importance of clinical leaders' roles in healthcare settings and has not addressed the leadership aspect that clinical leaders engage in day-to-day decision-making in HIV facilities while providing HIV patient care. Therefore, identifying the leadership roles that wclinical leaders perform at HIV primary facilities is of critical importance.

PURPOSE

The study explored the views of healthcare providers working in AMPATH-MTRH HIV facility on what they perceived as the roles of clinical leaders at the HIV primary care facility.

METHODS

We conducted a qualitative exploratory study between December 2019 to May 2020, involving in-depth interviews with (n = 22) healthcare providers working in AMPATH-MTRH HIV facility, who were purposively and conveniently sampled to participate in in-depth interviews to explore perceptions regarding the leadership roles of clinical leaders. The collected data were analyzed thematically and Nvivo vs.12 software was used for data management.

RESULTS

The following themes were identified from the analysis regarding perceived clinical leaders' roles in an HIV primary care facility: 1) Strategic roles: providing direction and guidance, ensuring goals and objectives of the department are achieved within the set timelines, planning, and budgeting for adequate resources to support patient HIV care 2) Interconnecting health systems levels and supervisory oversight roles: a link between management, staff, and patients, solving problems, organizing and attending departmental meetings, facilitate staff training, accountable, collaborating with other departments and leaders, defines and assigns responsibilities, ensure quality patient service, coordination, and management of daily activities 3) Research roles: data collation, analysis, generation, review and reporting to the management.

CONCLUSION

Clinical leaders in the HIV care system perform leadership roles that are characterized by strategic, middle-level, supervisorial and research which reflects the model of the leadership and management style of the HIV care system. The understanding of these roles contributes valuable insights to HIV leaders and managers to recognize the important contribution of clinical leaders and consider reviewing Standard Operating Procedures to include these leadership roles and strengthen their capacity to maximize clinicians' contribution to improve HIV care and enhance responsive health systems.

Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers

AIMS AND OBJECTIVES

To collate, synthesise and discuss published evidence and expert professional opinion on enablers and barriers to the development and sustainability of specialist and advanced practice roles in nursing and midwifery.

BACKGROUND

Expanded practice is a response to population health needs, healthcare costs and practitioners' willingness to expand their scope of practice through enhanced responsibility, accountability and professional autonomy.

DESIGN

This discursive paper is based on a rapid review of literature on enablers and barriers to the development and sustainability of specialist and advanced practice roles and is part of a wider policy analysis.

METHODS

We analysed and synthesised of 36 research articles, reviews and discussion papers on enablers and barriers in the development and sustainability of expanded practice roles.

RESULTS

Several factors enable role expansion, including: role clarity; credentialing and endorsement; availability of education for expanded roles; individual practitioners' dispositions towards role expansion; support from peers, other professionals and the work organisation; and costs. Where limited or absent, these same factors can constrain role expansion.

CONCLUSIONS

Enabling nurses and midwives to practice to their full scope of education and expertise is a global challenge for disciplinary leadership, a national challenge for professional regulation and a local challenge for employers and individual clinicians. These challenges need to be addressed through multistakeholder coordinated efforts at these four levels.

RELEVANCE TO CLINICAL PRACTICE

This discursive paper synthesises empirical evidence and expert professional opinion on the factors that enable or hinder the development and sustainability of specialist and advanced practice roles. Providing a critical appraisal of current knowledge, it provides a reference source for disciplinary debate and policy development regarding the nursing and midwifery resource and informs clinicians of the myriad issues that can impact on their capacity to expand their scope of practice.

An Exploratory Study on Exemplary Practice of Nurse Consultants

PURPOSE

To examine the exemplary practice of nurse consultants (NCs) and derive a model to illustrate the highest level of advanced nursing practice.

DESIGN

A descriptive study was conducted to examine the practice and outcomes of seven NC roles in varied clinical specialties in Hong Kong. Exemplary practice was examined in relation to competencies for advanced practice nursing in Hong Kong and the United Kingdom.

METHODS

Data about NC characteristics and their practices were collected using a structured questionnaire and analyzed using descriptive statistics. Health service documents and clinical notes were analyzed using the framework approach.

FINDINGS

All NCs demonstrated the competence expected of an advanced practice nurse with impacts on patients, nursing profession, and the organization as identified in the advanced nursing practice framework in Hong Kong. NCs also performed at the highest level of practice delineated by Skills for Health in the United Kingdom. They were involved in diagnostic and therapeutic practice, and identified patient satisfaction and symptom management as key outcomes.

CONCLUSIONS

This study provides new insight into levels of advanced practice and illustrates the exemplary work of NCs to demonstrate how they have developed and shaped services to bring about positive patient and organizational outcomes. Career laddering that places NCs at the highest level of advanced practice is important for making the best use of nursing expertise to achieve optimal patient and organizational outcomes.

CLINICAL RELEVANCE

This study addresses a knowledge gap to enrich our current understanding of the impact of advanced practice nursing roles by linking NC role practices and competencies to key outcomes.

Supporting clinical leadership through action: The nurse consultant role

AIMS AND OBJECTIVES

To evaluate the effectiveness of an action learning set to enhance clinical leadership and extend their scope and confidence more strategically.

BACKGROUND

As the most senior clinical role in most healthcare systems, the consultant nurse role is a solitary one. They are required to develop personal resilience, commitment and a belief in their ability to lead, with new consultants needing a strong support network to succeed.

DESIGN

Following a 2-year action learning set, four nurse consultants, one therapy consultant, and a university educationalist engaged in a cooperative inquiry approach using four cycles of discussion, reflection, analysis and action over an 18-month period from March 2015-July 2016, to learn how to change and enhance their working practices. Data were analysed thematically.

RESULTS

Four themes emerged where the action learning set (i) offered structure and support, (ii) enabled a wider influence and (iii) empowered them to lead. The cooperative inquiry helped them realise how much they had gained from their collective learning and they felt empowered to lead.

CONCLUSION

Their motivation to "make a difference" remains palpable. The outcomes of the cooperative inquiry included an enhanced understanding of the importance of openness and trust and a willingness to share and learn from each other in a respectful and confidential environment with a receptiveness to change. Self-leadership has clearly been accepted and embraced, and their collaboration has improved communication across the organisation, enhanced their strategic leadership capability and given confidence to disseminate externally.

RELEVANCE TO CLINICAL PRACTICE

The action learning set offered structure to support these clinical leaders to keep them focused across the breadth of their role. Additionally, peer review with external facilitation has enabled these clinical leaders to gain a wider influence and empowered them to lead.

The role of the breast care nurse in patient and family care

AIMS AND OBJECTIVES

To describe the role of the breast care nurse in caring for patients and families.

BACKGROUND

The breast care nurse is an expert clinical nurse who plays a significant role in the care of women/men and their families with breast cancer. The role of these nurses has expanded since the 1990s in Australia.

DESIGN

Descriptive study.

METHODS

An online survey was sent to breast care nurses using peak body databases (n = 100). The survey consisted of nineteen nurse roles and functions from a previous Delphi technique study. Nurses rated the importance and frequency of role elements using a five-point Likert scale and four open-ended questions relating to role.

RESULTS

There were 89 respondents. Most of the sample were from remote (n = 37, 41%) and rural areas (n = 47, 52%). The majority of responses regarding importance and frequency of the BCN role had a mean score above 4, which corresponds to 'moderately important' and 'occasionally as needed'. There were significant differences between the level of importance and frequency on 10 items. Four role themes arose from the thematic analysis: Breast care nurses as patient advocates, patient educators, care coordinators and clinical experts.

CONCLUSIONS

This study delineated the important nurses role in caring for patients and families during a critical time of their life. Further, it details the important nursing roles and functions undertaken by these nurses and compared this to the frequency with which these nurses perform these aspects of their role.

RELEVANCE TO CLINICAL PRACTICE

This study further delineates the important role that the nurses play in caring for patients and families during a critical time of their life. It extends further the frequency and importance of the supportive care and the need to educate their nurses on their role in providing spiritual care and research.

Work-based learning using action learning sets

Elizabeth Rosser, Deputy Dean (Education and Professional Practice) and Professor of Nursing at Bournemouth University reflects on the concept of action learning, and the benefits of being part of an action learning set.

Treading the clinical pathway: a qualitative study of advanced practice nurses in a local health district in Australia

Background

Career planning in nursing is often haphazard, with many studies showing that nurses need personal motivation, education, and the support of workplaces, which are often dominated by political and fiscal agendas. Nurses often need institutional and personal support to plan their careers and make decisions regarding their career aspirations.

Method

A descriptive qualitative design was used. Data were gathered using semi-structured digitally recorded interviews and analysed for common categories. Twenty seven (n = 27) participants were interviewed.

Results

There were four categories revealed by the participants who described their career progression experiences: moving up the ladder, changing jobs for career progression, self-driven and the effects of institutional environments.

Conclusion

Many of the participants’ careers had been shaped serendipitously. Similar to other studies, these nurses felt political, institutional and financial factors impacted on their career opportunities. There are implications for nursing managers with more support required for nurses to plan their career trajectories. In addition to an organisation centred approach to career planning, nurse leaders and managers must take into account the personal and professional requirements of their nurses. Nurses themselves also need to take personal responsibility for career development. Greater support for nurses’ career planning and personal drive will help organisations to plan their future workforce needs.