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Making a difference – nurses’ role in advanced practice

David R Thompson PhD RN FRCN FESCProfessor of Nursing and DirectorThe Nethersole School of Nursing

The Chinese University of Hong KongHong Kong SAR

People’s Republic of China

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Happy 20th Anniversary

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Advanced nursing practice significant developments in AP proliferation of roles and titles lack of conceptualization inadequate definition and regulation lack of clarity about scope, authority, autonomy

(Thompson & Watson 2003 Int J Nurs Pract 9, 129-30)

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Two major issues

definitions of AP and competencies required

contribution of AP to patient outcomes

(Twinn et al. 2005 Health Soc Care Community 13, 11-20)

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Scope of practice

advanced clinical skills research teaching consultancy leadership

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Nurses

undertake comprehensive assessments

make diagnostic decisions

develop and evaluate individualized care plans

prescribe treatments

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Influence of AP on outcomes

difficult to ascertain

but, improved general health outcomes

and seem to be cost-effective

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Examples

pain anxiety

knowledge satisfaction

adherence

self-care

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Issues

different models used across specialties lack of consistency in academic / clinical preparation different job description, pay and conditions great expectations

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Debate

knowledge, skills, role preparation, educational requirements

influence of medicine, accusations of elitism, professional self interest

precise national critera and standards national system for accreditation and reg

ulation

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Does AP make a difference?

A hesitant Yes! Likely to be growing demand