Nurse practitioner candidates: Shifting professional boundaries

Background: In many countries the introduction of emergency nurse practitioners has been one initiative implemented by governments to address service gaps due to staff shortages: this has particularly been the case in regional and rural areas where the labour skill shortage is most acute. Even in areas where the nurse practitioner role is well established, studies have repeatedly shown enmity among health care professionals around scope of practice and work role boundaries. Aim: The purpose of this study was to determine the impact of a new emergency nurse practitioner model of practice from the perspective of health care professionals most closely involved, and to identify the drivers and challenges to the role implementation. Method: A descriptive exploratory survey was used to explore staff perceptions of the emergency nurse practitioner role. Results: Participants (N = 37) reported that the model improved collaboration and team dynamics, aided in professionalism in nursing, improved efficiencies/quality of care, enhanced job satisfaction and affected the workload of medical staff and managers. Participants perceived that the demand for the service was high and the Emergency Nurse Practitioner Candidates' existing qualities helped to develop the role. In addition, implementation of the role was perceived to be supported by extensive marketing, evidence-based protocols, the use of a project officer and Department of Human Services funding. Regular reviews and engagement of relevant key stakeholders was also viewed as central to the success of the role. Challenges to the role were perceived to relate to a number of factors including: professional territorialism, limited marketing to some groups of staff, lack of access to education for the Nurse Practitioner Candidates and to some areas of supervised practice, a protracted endorsement process and lack of funding for a sustainable model. Conclusion: Contrary to previous studies, this study showed that the majority of medical, nursing and affiliated staff strongly supported this model of practice, with little enmity evident amongst the health care professionals. Recommendations are made to help further refine the model for future practice. (C) 2007 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.