- 1.Exploration and adoption of the role – making a decision to adopt an innovative role and developing a plan to implement that role.
- 2.Initial implementation of the role.
- 3.Full operation of the role (Fixsen et al., 2005).
3.1 Exploration and adoption
3.2 Initial implementation
3.3 Full implementation
|Clinical area/authors||Study design||Information about the nurse practitioner role or implementation of the role|
|Primary health care (mental health and aged care) (|
|Two mixed-method case studies, with data from interviews, administrative data, document review and observation of the nurse practitioners. Outcomes were not measured.||Detailed description of how and why the nurse practitioner (NP) positions (one in each case study) were established, the settings in which they worked, the activities of the NPs and how they linked with other services. Limited information about use of medications and diagnostic investigations.|
|General practice (|
Helms et al., 2015)
|Comparison of the costs of employing an NP with the revenue generated by the NP.||Details regarding the background of the NP, their scope of practice (types of patients seen, clinical interventions) and role in chronic disease management. Limited information about patients seen by the NP.|
|Emergency department fast track (|
Lutze et al., 2014)
|Convenience sample of patients in two fast track units, one staffed by doctors and one staffed by NPs, completed a patient satisfaction survey.||Limited information about the setting. Information about patients included demographic information and fast track inclusion criteria. Almost no information about NP scope of practice.|
|Emergency department (|
Li et al., 2013)
|Grounded theory study involving semi-structured interviews with NPs, senior doctors and five senior nurses in two large teaching hospitals to identify their perceptions regarding the impact of the NPs on emergency department functioning, other clinical roles and care delivery.||Some information about the setting and history of the role. No information about scope of practice, types of patients seen or the nature of interactions between NPs and patients.|
|Women's health clinic (|
Elmer and Stirling, 2013)
|Mixed-methods study based on a realist evaluation approach. Data collection included interviews and surveys involving key stakeholders and clients; and retrospective audit of client database. Outcome measures included health literacy and client satisfaction.||The report described the length of time the NP had been in the position, the focus of the position, the range of services provided (with supporting data), the nature of contact with clients and details about workload. The setting was described together with details of mechanisms underpinning the work of the NP.|
|Emergency department (|
Jennings et al., 2013)
|Retrospective audit of waiting time to be seen and length of stay for patients discharged home.||Description of the NP model, including details of scope of practice, number of NPs, mix of full-time and part-time NPs, hours of work, average workload per shift and length of time NPs have been established in the ED. Description of setting, including patient inclusion criteria.|
|Primary care in community pharmacies (|
McMillan and Emmerton, 2013)
|Semi-structured interviews with pharmacists, NPs and pharmacy assistants used to describe the role of NPs in a chain of pharmacies and how they work with other pharmacy staff. No measurement of outcomes.||Some general information about the setting and the NP role but no precise details (e.g. number of consultations, number and type of prescriptions). No information about clients seen or the nature of client/NP interaction.|
|Chemotherapy unit (|
Cox et al., 2013)
|Descriptive study described as an ‘initial evaluation’. The study collected data on unscheduled occasions of service to a chemotherapy unit, seen by the NP. Outcome measures included waiting time to be seen, second reviews within 7 days, and admissions to hospital within 7 days.||Brief description of the NP role and the setting, with details of when and why the role was introduced. Data are provided about the characteristics of patients seen by the NP.|
|Emergency department fast track unit (|
Dinh et al., 2012,
Dinh et al., 2013)
|Convenience sample of adult patients randomised to initial assessment and treatment by a doctor or emergency nurse practitioner. Outcome measures included patient satisfaction, adverse events and patient-reported health status.||Detailed information about the setting. Some general information about the NP and the nature of their role. Limited information about patients seen.|
|Community mental health (|
Longman et al., 2012)
|Mixed methods case study, including data from interviews and administrative data sets. Outcomes included mental health presentations to hospital.||Describes the setting and history of how the NP role was established, with data on client activity, source of referrals, referrals to other providers, and collaboration with other agencies.|
|Mental health outpatients clinic (|
Wand et al., 2011a,
Wand et al., 2011b,
Wand et al., 2011c,
Wand et al., 2012)
|Prospective, mixed-methods, study based on a realist evaluation approach, including interviews with patients and staff; and collecting data on patient self-report measures (e.g. self-efficacy, psychological distress).||Detailed information about the setting, role of the NP, patient characteristics (including presenting problems) and source of referrals.|
|Acute pain management for patients undergoing major surgery, trauma or caesarean section (|
|Prospective descriptive study. Outcomes included timeliness of assessment and non-pharmacological interventions for pain management.||Description of how the NP role evolved and the nature of the role at the time of the study. Some information about the characteristics of the NP. The results include details of medications prescribed and brief reference to the range of non-pharmacological interventions employed by the NP.|
|Emergency department fast track service (|
Considine et al., 2010)
|Retrospective medical record audit of waiting time by triage category and length of stay in the emergency department||Description of the setting. Some information about patients seen. Very little information about the scope of practice of the NPs and the nature of their interaction with patients.|
|Minor injuries in an adult emergency department (|
Wilson and Shifaza, 2008)
|Retrospective medical record audit (of waiting time by triage category) and prospective, self-administered, patient satisfaction survey.||Description of the setting. Some information about patients seen by the NP, their presenting injuries and the use of diagnostic and therapeutic interventions.|
|Emergency department fast track service (|
Jennings et al., 2009)
|Prospective, self-administered, patient satisfaction survey, comparing results for patients treated by doctors and NPs.||Description of the setting. Information about the role of the NP limited to one sentence which states that NPs were responsible for a continuum of care from initial assessment through to disposition. Brief description of patients seen by the NPs.|
|Emergency eye clinic (|
Kirkwood et al., 2005)
|Prospective, descriptive, study of consecutive new patients attending the clinic, comparing diagnosis and treatment by NP and ophthalmologist.||Description of the setting. Description of the NP scope of practice, supported by data on conditions assessed and treated, assessment tools used, medications initiated and administered, and diagnostic tests ordered.|
|Colorectal cancer screening clinic (|
Morcom et al., 2004)
|Retrospective medical record audit. Outcome measures included depth of insertion of flexible sigmoidoscope, client discomfort scores, pathology findings and client satisfaction.||Description of how the role was established and the role of the NP in screening (using faecal occult blood testing and flexible sigmoidoscopy), patient education and follow-up.|
3.4 Nurse practitioners leading a service
- •The content or elements of the intervention (techniques) – in the case of nurse practitioners, this equates to their scope of practice.
- •Characteristics of the nurse practitioner.
- •Characteristics of patients seen by the nurse practitioner.
- •Characteristics of the setting, both the physical setting (e.g. hospital, community-based clinic) and the organisational setting (e.g. the team or group of clinicians with whom the nurse practitioner works, any overarching model of care of which the nurse practitioner is a part).
- •The mode of delivery (e.g. face-to-face).
- •The intensity (e.g. contact time).
- •The duration (e.g. number sessions with each patient over a given period).
- •Fidelity e.g. was the nurse practitioner able to function as intended? What mechanisms are in place to monitor the performance of the nurse practitioner?
|Characteristics of the nurse practitioner||The nurse practitioner previously worked as a clinical nurse consultant in the local area and was well known to general practitioners and other clinicians before commencing in the role.|
Six months previously, the nurse practitioner moved to the area to take up a newly-created position.
|Characteristics of patients seen by the nurse practitioner||Children between the ages of 0 months and 18 years who attend the emergency department in triage categories 3, 4 or 5.|
People over the age of 65, residing either in their own home or a residential aged care facility, at risk of hospital admission.
|Characteristics of the setting||The nurse practitioners work in the emergency department fast track unit which operates in a designated area. Nurse practitioners provide the core staffing of the unit, with career medical officers and medication endorsed enrolled nurses.|
|Mode of delivery||The nurse practitioner is part of a larger team and provides one-to-one consultations for any clients booked to attend the clinic on their designated days. The nurse practitioner also provides a consultation/liaison service to the hospital wards.|
|Intensity and duration||The nurse practitioner manages all aspects of patient care over a typical 3–4 h stay in the emergency department.|
Patients are booked for an initial half-hour clinic appointment, with follow-up appointments arranged according to patient need. The total time spent with each patient ranged from 0.5 h to 16 h.
|Fidelity||Number of referrals to the nurse practitioner less than anticipated due to resistance from some general practitioners.|
It was intended that the role would operate outside normal business hours but this has not eventuated because of concern at the cost of paying penalty rates.
The nurse practitioner is functioning to the full extent of their scope of practice.
|Scope of practice (content of the intervention)|
|Capacity to admit and discharge||Can send people home from the emergency department without referral to the VMO/GP.|
Temporary admission rights (up to 72 h) for acute patients in local multi-purpose service.
|Diagnostic investigations||Plain X-rays, urine culture and sensitivity, wound swabs, throat swabs, vaginal swabs, nasopharyngeal aspirations, electrolytes, troponin, blood gases.|
The absence of an MBS provider number means that pathology can only be ordered in collaboration with general practitioners (in the case of a community-based nurse practitioner).
|Prescription of medications prescribed||Most commonly prescribed medications are antibiotics and oral contraceptives.|
Has individual PBS number. Can prescribe PBS-subsidised medication for patients seen in their own home or community-based clinic.
Can prescribe medications on an inpatient medication chart.
|Therapeutic interventions||Crisis management, counselling, cognitive behaviour therapy, medication review, patient education.|
Local anaesthesia, wound repair, removal of foreign body, intravenous fluids for rehydration, replacement of suprapubic catheters, splinting and plastering (back slabs).
|Referrals||Receives referrals from the local emergency department, hospital wards, paramedics, general practitioners and residential aged care facilities.|
Initiates referrals to sexual health, mental health and dental clinic.
- The ACT Nurse Practitioner Project: Final report of the Steering Committee.ACT Department of Health, Canberra2002
- An evaluation of a community aged care nurse practitioner service.Journal of Clinical Nursing. 2005; 14: 1202-1209
- Nurse practitioner led services in primary health care in rural NSW – Two case studies.The University of Sydney, Master of Philosophy2014
- A Nurse Practitioner initiated model of service delivery in caring for people with dementia.Contemporary Nurse. 2010; 36: 49-60
- Report of an evaluation of a Nurse-led Dementia Outreach Service for people with the behavioural and psychological symptoms of dementia living in residential aged care facilities.Perspectives in Public Health. 2011; 131: 124-130
- A meta-analysis of nurse practitioners and nurse midwives in primary care.Nursing Research. 1995; 44: 332-339
- A conceptual framework for implementation fidelity.Implementation Science. 2007; 2
- The core role of the nurse practitioner: Practice, professionalism and clinical leadership.Journal of Clinical Nursing. 2007; 16: 1818-1825
- A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department.Canadian Journal of Emergency Medicine. 2007; 9: 286-295
- An evaluation of the nurse practitioner role in a major rural emergency department.Journal of Advanced Nursing. 1999; 30: 260-268
- Effect of clinician designation on emergency department fast track performance.Emergency Medicine Journal. 2010; 27: 838-842
- Defining the scope of practice of the emergency nurse practitioner role in a metropolitan emergency department.International Journal of Nursing Practice. 2006; 12: 205-213
- Emergency nurse practitioner care and emergency department patient flow: Case–control study.Emergency Medicine Australasia. 2006; 18: 385-390
- Doctors’ and nurses’ perceptions of interdisciplinary collaboration in the NICU, and the impact of a neonatal nurse practitioner model of practice.Journal of Clinical Nursing. 2004; 13: 105-113
- Nurse-led supportive care management: A 6-month review of the role of a nurse practitioner in a chemotherapy unit.Australian Health Review. 2013; 37: 632-635
- Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science.Implementation Science. 2009; 4
- Evidence-based behavioral medicine: What is it and how do we achieve it?.Annals of Behavioral Medicine. 2003; 26: 161-171
- How nurse practitioners implement their roles.Australian Health Review. 2012; 36: 22-26
- Clinical nurse specialists and nurse practitioners in Canada: A decision support synthesis.Canadian Health Services Research Foundation, Ottawa2010
- Determinants of patient satisfaction in an Australian emergency department fast-track setting.Emergency Medicine Journal. 2013; 30: 824-827
- Evaluating the quality of care delivered by an emergency department fast track unit with both nurse practitioners and doctors.Australasian Emergency Nursing Journal. 2012; 15: 188-194
- Advanced nursing practice: A global perspective.Collegian. 2009; 16: 55-62
- Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation.American Journal of Community Psychology. 2008; 41: 327-350
- Evaluation of the Nurse Practitioner role at the Hobart Women's Health Centre.University of Tasmania, 2013
- Implementation research: A synthesis of the literature.University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network, Tampa, FL2005
- A 12-month evaluation of the impact of Transitional Emergency Nurse Practitioners in one metropolitan Emergency Department.Australasian Emergency Nursing Journal. 2011; 14: 4-8
- The Transitional Emergency Nurse Practitioner role: Implementation study and preliminary evaluation.Australasian Emergency Nursing Journal. 2009; 12: 32-37
- The status of Australian nurse practitioners: The first national census.Australian Health Review. 2009; 33: 679-689
- The Nurse Practitioner Research Toolkit.Australian Nurse Practitioner Study (AUSPRAC), 2009
- Bridging the gap between the intensive care unit and general wards – The ICU Liaison Nurse.Intensive and Critical Care Nursing. 2004; 20: 133-143
- Financial viability, benefits and challenges of employing a nurse practitioner in general practice.Australian Health Review. 2015; 39: 205-210
- Nurse practitioners: An evaluation of the extended role of nurses at the Kirketon Road Centre in Sydney, Australia.Australian Journal of Advanced Nursing. 2001; 18: 20-28
- Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors.British Medical Journal. 2002; 324: 819-823
- Evaluating new roles within emergency care: A literature review.International Emergency Nursing. 2011; 19: 125-140
- The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: A systematic review.International Journal of Nursing Studies. 2015; 52: 421-435
- A survey of patient satisfaction in a metropolitan emergency department: Comparing nurse practitioners and emergency physicians.International Journal of Nursing Practice. 2009; 15: 213-218
- Evaluating patient presentations for care delivered by emergency nurse practitioners: A retrospective analysis of 12 months.Australasian Emergency Nursing Journal. 2013; 16: 89-95
- Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne, Australia.Journal of Clinical Nursing. 2008; 17: 1044-1050
- National evaluation of nurse practitioner-like services in residential aged care services: Final report.Commonwealth of Australia, Canberra2007
- Implementation and evaluation of an ophthalmic nurse practitioner emergency eye clinic.Clinical and Experimental Ophthalmology. 2005; 33: 593-597
- Role of the gerontological nurse practitioner in Australia.Doctor of Philosophy, University of Adelaide, Adelaide2009
- A comparative study of patients who did not wait for treatment and those treated by Emergency Nurse Practitioners.Australasian Emergency Nursing Journal. 2006; 9: 179-185
- The impact of nurse practitioners on care delivery in the emergency department: A multiple perspectives qualitative study.BMC Health Services Research. 2013; 13
- Role development and effective practice in specialist and advanced practice roles in acute hospital settings: Systematic review and meta-synthesis.Journal of Advanced Nursing. 2005; 49: 191-209
- An evaluation of the Nimbin Integrated Services Project – Final Report.University of Sydney, Lismore, NSW, Australia2012
- A review of the Transitional Emergency Nurse Practitioner.Australasian Emergency Nursing Journal. 2011; 14: 226-231
- Patient perceptions of emergency department fast track: A prospective pilot study comparing two models of care.Australasian Emergency Nursing Journal. 2014; 17: 112-118
- Rapid review of the nurse practitioner literature: Nurse practitioners in NSW ‘Gaining Momentum’.NSW Ministry of Health, North Sydney, NSW, Australia2014
- Nurse practitioners: An insight into their integration into Australian community pharmacies.Research in Social and Administrative Pharmacy. 2013; 9: 975-980
- Specifying and reporting complex behaviour change interventions: The need for a scientific method.Implementation Science. 2009; 4
- Identifying measures for evaluating new models of nursing care: A survey of NSW nurse practitioners.International Journal of Nursing Practice. 2007; 13: 331-340
- Establishing an Australian nurse practitioner-led colorectal cancer screening clinic.Gastroenterology Nursing. 2004; 28: 33-42
- Maternal and neonatal health outcomes following the implementation of an innovative model of nurse practitioner-led care for diabetes in pregnancy.Journal of Advanced Nursing. 2014; 70: 1150-1163
- Advanced practice nurse outcomes 1990–2008: A systematic review.Nursing Economic. 2011; 29: 230
- Reframing professional boundaries in healthcare: A systematic review of facilitators and barriers to task reallocation from the domain of medicine to the nursing domain.Health Policy. 2014; 117: 151-169
- Nurse Practitioner Project Stage 3. Final report of the Steering Committee.NSW Health Department, Sydney1996
- Nurse practitioner standards for practice.Nursing and Midwifery Board of Australia, Canberra2013
- Researching the sexual health nurse practitioner scope of practice: A blueprint for autonomy.Australian Journal of Advanced Nursing. 2003; 21: 33-41
- An evaluation of mental health services in the Whyalla Hospital Accident and Emergency Department: A comparison of a new and old model of care.Master of Nurse Practitioner, University of Adelaide, Adelaide2011
- Victorian Nurse Practitioner Project: Evaluation of eleven Phase 1 demonstration projects.The University of Melbourne, Melbourne2000
- Independent evaluation of the nurse-led ACT Health Walk-in Centre.Australian Primary Health Care Research Institute, The Australian National University, Acton, ACT2011
- Nurse practitioner project: Phase 2 – External evaluation.School of Nursing and Midwifery, La Trobe University, Melbourne2004
- An international survey on advanced practice nursing education, practice, and regulation.Journal of Nursing Scholarship. 2010; 42: 31-39
- Nurse practitioner project report.Queensland Health, Brisbane2003
- The complexities of defining nurse practitioner scope of practice in the Australian context. 23(1). Collegian, 2015: 129-142 (in press)
- Two hundred days of nurse practitioner prescribing and role development: A case study report from a hospital-based acute pain management team.Australian Health Review. 2011; 35: 444-447
- Advancing advanced practice – Clarifying the conceptual confusion.Nurse Education Today. 2014; 34: 356-361
- Evaluation of a nurse practitioner-led extended hours mental health liaison nurse service based in the emergency.Australian Health Review. 2014; 39: 1-8
- Realistic evaluation of an emergency department-based mental health nurse practitioner outpatient service in Australia.Nursing & Health Sciences. 2011; 13: 199-206
- An emergency department-based mental health nurse practitioner outpatient service: Part 1. Participant evaluation.International Journal of Mental Health Nursing. 2011; 20: 392-400
- An emergency department-based mental health nurse practitioner outpatient service: Part 2. Staff evaluation.International Journal of Mental Health Nursing. 2011; 20: 401-408
- Outcomes from the evaluation of an emergency department-based mental health nurse practitioner outpatient service in Australia.Journal of the American Academy of Nurse Practitioners. 2012; 24: 149-159
- An evaluation of the effectiveness and acceptability of nurse practitioners in an adult emergency department.International Journal of Nursing Practice. 2008; 14: 149-156
- The clinical effectiveness of nurse practitioners’ management of minor injuries in an adult emergency department: A systematic review.International Journal of Evidence-Based Healthcare. 2009; 7: 3-14
- Nurse practitioners’ experiences of working collaboratively with general practitioners and allied health professionals in New South Wales, Australia.Australian Journal of Advanced Nursing. 2005; 23: 22-27