Collegian
Volume 16, Issue 2 , Pages 85-97, April 2009

How do CNCs construct their after hours support role in a Major Metropolitan Hospital

  • Nancy Santiano, RN CCCert PGDipEd MclinNsg

      Affiliations

    • The Simpson Centre for Health Services Research, Sydney, Australia
    • Corresponding Author InformationCorresponding author at: The Simpson Centre for Health Services Research, Locked Bag 7103, Liverpool BC, NSW 1871, Australia. Tel.: +61 2 9612 0771; fax: +61 2 9612 0742.
    • ,
  • Lis Young, MBBS FFAFPHM

      Affiliations

    • The Simpson Centre for Health Services Research, Sydney, Australia
    • The University of New South Wales, Sydney, Australia
    • ,
  • La-Stacey Baramy, RN Grad Cert ENsg MBA

      Affiliations

    • The Simpson Centre for Health Services Research, Sydney, Australia
    • ,
  • Scott McDonnell, RN Grad Cert ENsg, Grad Cert Safety Science MRCNA

      Affiliations

    • Macarthur Health Service, Sydney, Australia
    • ,
  • Karen Page, RN Grad Dip Health Science (Nursing), Grad Cert Intensive Care, Degree of Health Science (Nursing)

      Affiliations

    • Macarthur Health Service, Sydney, Australia
    • ,
  • Rouchelle Cabrera

      Affiliations

    • The Simpson Centre for Health Services Research, Sydney, Australia
    • ,
  • Anna Chapman, RN Grad Dip Nursing Management

      Affiliations

    • Macarthur Health Service, Sydney, Australia

Received 15 September 2008; received in revised form 10 January 2009; accepted 17 March 2009. published online 23 April 2009.

Summary 

Aim

To explore how CNCs who provide hospital wide support after hours (AHCSs) construct their role.

Methods

This is an ethnographic study involving two AHCSs as participants. Audio visual data was collected in 2007 at a Major Metropolitan Hospital, Sydney during after hours shifts. The data was coded using the standards defined in the Nurse Practitioner (NP) competencies.

Results

Four hours of videotape (observed clinical practice) and 2h of audio tape (interviews) were coded. They performed procedures (22%), gathered information to identify at risk patients (21%), conducted patient assessments (20%) and relayed information/findings to ward nurses (12%) and doctors (12%). The roles/responsibilities of AHCSs were similar to those defined for NPs. For the domain “dynamic practice” 388 activities were identified. The two participants used advanced and comprehensive assessment skills and demonstrated a high level of proficiency in performing procedures/interventions. For the domain “professional efficacy” 174 activities were coded, for “clinical leadership” there were 135 activities. “Pro-actively identifying at risk patients in general wards” was added as a new performance indicator within the domain “clinical leadership”. An analysis of the interviews corroborated the results derived from the visual data.

Conclusion

A significant capacity for critical thinking and clinical decision making were the hallmarks of the performance of the two AHCSs; their style of practice was collaborative, flexible and autonomous. While their formal role were as CNCs the two participants operationalised their roles/responsibilities as would a Nurse Practitioner. Their practice demonstrated a new competency: “the pro-active identification of at risk patients”.

Keywords: Advanced practice, Nurse Practitioner, Competencies, Competency standards, Clinical support, Outreach

 

PII: S1322-7696(09)00026-2

doi:10.1016/j.colegn.2009.03.003

Collegian
Volume 16, Issue 2 , Pages 85-97, April 2009

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