The impact of reducing junior doctors' hours on nursing

Finding the balance: living with memory loss

Since the late 1980s, it has been increasingly recognized that the experiences of people with dementia have been omitted from research in the area of dementia and memory loss. More recently, it has been accepted that people with dementia have insight into their condition and, therefore, the ability to contribute to research. A qualitative research project was undertaken with nine participants to explore the experiences and coping strategies of people with dementia. Interviews were undertaken and the data analysed using thematic analysis. Three major themes emerged: coming to terms with memory loss, maintaining control and independence, and the impact of illness on relationships. Understanding the reality for people is essential given that representations of the catastrophic impact of dementia generate high levels of anxiety and depression. Implications for nurses' practice include the need for skilled, well-paced, sensitive and ongoing information about the condition, along with the need to recognize and support the active coping strategies of people with memory loss.

The extent and nature of emergency nurse practitioner services in Scotland

Emergency Nurse Practitioners (ENPs) are being used in an increasing proportion of A&E departments across England and Wales. This paper reports the findings of a postal survey sent to all (94) A&E departments in Scotland including the smaller GP run units. The aim of the study was to document the extent and nature of ENP services in Scotland. Nurses were found to be practising as ENPs in 47% of Scottish A&E departments. The majority (70%) of nurses practising as ENPs had been educated for the role on courses for ENPs. Nurses working as ENPs were being paid at all grades ranging from the lowest grade for a staff nurse (D-grade) through to H-grade. ENPs are practising in all types of A&E department. Most ENPs have been formally trained for the role, however huge variation exists in educational preparation and in remuneration for this expanded nursing role.

Complementary therapies as a means of developing the scope of professional nursing practice

The development of the extended role in nursing has been seen by some as primarily a means for nurses taking on tasks that have traditionally been the work of junior doctors. Others object to this view and ascribe to the 'new nursing' perspective of Salvage. She sees the extended role as moving towards increasing autonomy and operating in a professional rather than a bureaucratic occupational model. This view militates against the development of nurses as mini-doctors. This paper discusses the controversy surrounding the development of the extended role, focusing particularly on the use of complementary therapies as a legitimate component of the 'new nurses' role.

The perceptions of registered nurses on role expansion

In 1992, the statutory body for nursing in England, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC), acknowledged the continuing changing environment that practitioners were working in and published the 'Scope of Professional Practice' (UKCC 1992). This document is arguably the emergent result of the last three decades of change in nursing and could be cited alongside modification in medical training, as well as recruitment and retention problems, as reasons why nurses were expanding their role. However, the effects of these changes and the impact of 'Scope' have yet to be assessed in clinical practice. In this paper a qualitative study investigating the perceptions of nurses working in a regional cardiology centre of their role changes is reported, and offers an insight into the demands of nurses and the impact of the changing practice environment. This paper is a synopsis of a presentation given at a Royal College of Nursing (RCN) conference on 17 October 1997 in Birmingham.

The emergency nurse practitioner role in major accident and emergency departments: professional issues and the research agenda

The emergency nurse practitioner (ENP) is a rapidly developing role within emergency health care provision in the United Kingdom (UK). This paper explores some of the available literature concerning the development of the role in the context of major accident and emergency departments. The professional and legal implications of this shift in role boundaries are discussed. The current inconsistencies in educational provision and the potential consequences for practice in this area, are highlighted. The relative plethora of rigorous evaluation studies of ENP role effectiveness in North America, is contrasted with the current paucity of empirical data available in the UK. A number of methodological issues concerning the evaluation of ENP services are identified. The need for research in this area, alongside a programme of continuing local audit to guide and inform evidence-based practice, is emphasized.

Advanced practitioners: the hidden agenda?

Changes in health-care provision and the increased expectations of clients have precipitated major developments throughout the service. The trend towards specialist and advanced practitioners has been embraced by nurses as the route to professional recognition and increased status. The focus of this paper is consideration of the factors influencing these developments, observing the concurrent erosion of nursing values and strength. Health service management, ill-informed of nurses' function within the service, conclude that task distribution will be cost-effective. To this end, health-care assistants with National Vocational Qualifications (NVQs) performing nursing duties and nurses undertaking junior doctors' work, thereby reducing their hours, have been actively encouraged. Nurses, preoccupied with continuing debates surrounding new titles and improving status through the acquisition of medico-technical skills, have failed to consider the effects of advancing practice without first affirming their own unique identity. Nurses should appreciate the increasing risk to their own profession caused by lack of clarity and apparent compliance, which contribute to the management view of nurses as doctors' assistants--or handmaidens.

The role of the clinical nurse specialist in tissue viability

The development of tissue viability clinical nurse specialists in the UK has occurred rapidly and haphazardly over the last decade. Lack of role definition has created ambiguity and additional demands which are not so apparent within more established specialist nurse roles. Many specialist nurses in tissue viability are currently practising without adequate supervision frameworks which may compromise both personal and professional role satisfaction. Evaluation of the specific contribution of tissue viability specialist nurses is problematic for a variety of reasons. These, together with the identification of those factors thought to contribute to role conflict, will be discussed.

Quality and quality assurance in the health care setting: an equitable life?

Research studies alluding to quality and quality assurance within the health care arena are increasingly utilized to justify management initiatives, particularly in relation to the provision and resourcing of patient services, both within the institutional and community setting. The following paper considers the role and utility of quality indicators and presents a critical analysis of the literature pertaining to the concept of quality as it applies to the provision and organization of health care and the relationship between quality assurance and patient satisfaction per se. The paper concludes with a dual challenge not only to nurses to better understand and articulate the specific contribution of the discipline, particularly in relation to positive patient outcomes, but also to current, narrow focused interpretations of quality assurance and calls for definitions of quality to reflect an appreciation of the particular involvement and role of the patient in determining policy affecting care provision.

Competency through being: the enemy within?

Nurses are taking on more medical tasks but is this appropriate? If so, does this advance nursing practice? The issue hinges on the nurse's competency which is central to professional nursing practice.