Nurses make up the largest segment of the health care profession, with 3 million registered nurses in the United States. Nurses work in a wide variety of settings, including hospitals, public health ...centers, schools, and homes, and provide a continuum of services, including direct patient care, health promotion, patient education, and coordination of care. They serve in leadership roles, are researchers, and work to improve health care policy. As the health care system undergoes transformation due in part to the Affordable Care Act (ACA), the nursing profession is making a wide-reaching impact by providing and affecting quality, patient-centered, accessible, and affordable care.
In 2010, the Institute of Medicine (IOM) released the report The Future of Nursing: Leading Change, Advancing Health , which made a series of recommendations pertaining to roles for nurses in the new health care landscape. This current report assesses progress made by the Robert Wood Johnson Foundation/AARP Future of Nursing: Campaign for Action and others in implementing the recommendations from the 2010 report and identifies areas that should be emphasized over the next 5 years to make further progress toward these goals.
Aims
The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for ...Australian general practice nurses.
Background
Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting.
Design
Concurrent mixed methods design.
Methods
Data collection was conducted during 2013–2014 and involved two online surveys of Registered and Enrolled Nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts.
Findings
Data collection enabled the development of 22 Practice Standards separated into four domains: (i) Professional Practice; (ii) Nursing Care; (iii) General Practice Environment and (iv) Collaborative Practice. To differentiate the variations in enacting these Standards, performance indicators for the Enrolled Nurse, Registered Nurse and Registered Nurse Advanced Practice are provided under each Standard.
Conclusion
The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These Standards are also an important means of articulating the role and scope of the nurses’ practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance.
General practice has an important role within the Australian healthcare system to provide access to care and effective management of chronic health conditions. However, people with serious mental ...illness experience challenges associated with service access. The current paper seeks to examine drivers of access to general practice for people with common and serious mental disorders, compared with people who access care for type II diabetes, a common physical health problem managed in general practice. The Bettering the Evaluation and Care of Health (BEACH) programme provides the most comprehensive and objective measurement of general practitioner activity in Australia. Using BEACH data, this study compared general practice encounters for depression, anxiety, bipolar disorder, schizophrenia, and type II diabetes during a 10-year period between 2006 and 2016. Analysis revealed more frequent encounters for depression compared to anxiety, and a higher representation of women in encounters for bipolar disorder compared to men. The relationship between number of encounters and patient age was strongly associated with the life course and mortality characteristics associated with each disorder. The findings highlight specific challenges associated with access to primary care for people with serious mental illness, and suggest areas of focus to improve the ability of these patients to access and navigate the health system.
It was once common for pharmaceutical companies and medical device makers to treat doctors to lavish vacations or give them new cars; companies would do virtually anything to buy influence so that ...their medications or devices would be used in a doctor’s office or hospital. But with growing public scrutiny of kickbacks to doctors, the huge giveaways have disappeared. In Infiltrating Healthcare , Quinn Grundy shows that sales representatives are working instead behind the scenes. It is to nurses that these companies now market. Nurses, Grundy argues, are the perfect target for sales reps: their work is largely invisible and frequently undervalued, yet they wield a great deal of influence over treatment and purchasing decisions. Furthermore, there are no legal restrictions on marketing to most nurses. Grundy describes how, under the guise of education or product support, and through gifts and free samples, sales representatives influence nurses in the course of day-to-day clinical practice. Grundy argues that the very presence of sales reps in operating rooms, purchasing committee meetings, and patient care units blurs the boundaries between patient care and medical sales. Helpfully, she also describes ways that nurses can be aware of (and resistant to) their influence. Infiltrating Healthcare is a call to action to protect the clinical spaces where we are at our most vulnerable—and the decisions that take place there—from the pursuit of profit at any cost. This is a timely book that shines a light on a practice that often goes unseen, and which has tangible implications for healthcare policy and practice.
Random practice results in more effective motor learning than either constant or blocked practice. Recent studies have investigated the effects of practice schedules at the neurophysiological level. ...This study aims to conduct a literature review of the following issues: (a) the differential involvement of premotor areas, the primary motor cortex, the dorsolateral prefrontal cortex and the posterior parietal cortex in different types of practice; (b) changes in the participation of these areas throughout practice; and (c) the degree of support that current neurophysiological findings offer to strengthen the behavioral proposition that distinct cognitive processes are generated by different practice schedules. Data from 10 studies that investigated associations between practice structures and neurobiological substrates were analyzed. The participation of the indicated areas was found to depend on practice structure and varied during the learning process. Greater cognitive engagement was associated with random practice. In conclusion, distinct neural processes are engendered by different practice conditions. The integration of behavioral and neurophysiological findings promotes a more comprehensive view of the phenomenon.
Aims
To provide an overview of the practice patterns of advanced practice nurses and to explore their perceptions of their role in Singapore.
Background
Role expansion of advanced practice nurses is ...increasingly popular in healthcare systems. However, their practice patterns remain variable, thereby introducing role ambiguity. Uncertainty revolves around how advanced practice nurses perceive their practice, competency and readiness for role expansion.
Methods
A nationwide survey of advanced practice nurses was conducted in Singapore. Statistical analyses of closed‐ended responses and content analysis of open‐ended responses were undertaken.
Results
A total of 87 participants were surveyed (42.8% response rate). Significant discrepancies existed between current practices and their expectations. Readiness for and acceptance of role expansion were discerned but multiple barriers to practice have remained.
Conclusion
This pioneering study in Asia provides important evidence to support the call for greater clarity in the role of APNs and for review of existing institutional practice restrictions. It provides insights into healthcare systems in similar developmental stages of advanced practice nursing.
Implications for nursing management
When outlining the goals and role priorities of advanced practice nurses APNs, nurse administrators can consider their best contributions in practice. This allows for long‐term sustainability of their role.
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