Saying What We Mean and Doing What We Say: The Evolving Case of

Clarity in Australian Advanced Practice in Nursing

Andrew Cashin

Objectives

• Discuss Scenario Based Modelling • Consider the existing nursing language

crimes • Outline the potential of the new Nursing

and Midwifery Board of Australia Nurse Practitioner Standards in terms of their

contribution to clarity • Critique other assorted tasty titbits

Thing one and thing two revisited The patient lay dreaming of frustrated screaming

All he had asked was who is doing my care and two nurses stood preening

I am a APN, a Nurse Practitioner said nurse one, and I am an APN too announced nurse two

Oh two NPs thought the patient this all makes sense

But then came the explanation and it was way to dense

I am a NP said nurse one, and I am a consultant said nurse 2

The patient was so frustrated they begun to turn blue

Please said the patient, just do it now,

What will you do, just tell me how.

Nurse one glared down, but it all should be clear

Two things can be one, and we are both here

I can order tests, prescribe and refer

Nurse two said I can’t do these things, consult I prefer

Nurse one said I can lead your episode of care

Nurse tow opened their mouth but the patient was in despair

If we just talk of scope, what can be done is clear

The patients will know that which is dear

Who will do what the patient at last shouted

Nurse one and two their advancedness had flouted

I am a registered nurse at last said nurse two

I am a NP said nurse one so you know what I do

The patient relaxed as will planners of services too

When it is clear what worker will do the do

Unlike the sneetches teach us stars and beaches

It is important to know what is in each workers reaches

The word advance fits into one of the foundational metaphors of our age, the

directional metaphor (Lakoff and Johson, 1980.). Advance signifying the flowing nature

of reality and movement in a forward direction. The Australian Oxford dictionary defines advanced as, “far on in progress” (Australian Oxford dictionary, 2004, p.18).

“Nursing is responsible for articulating and disseminating clear

definitions of the roles nurses engage in and the professions scope of practice”.(International Council of

Nurses, 2004.).

scenario modelling that attempts to match work to be done with those capable and credentialed

to do it

As Health Workforce Australia moves to scenario planning, incremental cost benefit of differing approaches (involving different roles) to meet

health system needs will occur. Data on efficacy and efficiency is needed for this modelling and

sensitivity analysis.

• it is estimated that at least 70 countries either have, or are considering introducing advanced practice

roles (International Council of Nurses ICN Nurse Practitioner/Advanced Practice Nursing Network, 2012).

• Pulcini, Jelic, Gul& Loke (2010) identified that only 23 of 32 countries surveyed formally recognised the NP/APN

role. Of these, 48% (11 countries) have licensure maintenance/registration or renewal requirements. While 71% of countries had some form of NP/APN

education, only 15 identified the Masters Degree or equivalent as the most prevalent credential. Further,

even within individual countries there can be variability.

• Huge variably

Circularity

Many definitions conflate advanced practice nursing and advanced

nursing practice and use interchangeably

Many definitions rely on extension and expansion

Side bar conversation registration standard

Quick examples USA

Advanced Practice = particular scope Advanced Practice Nurse CRNA; CNM; or CNP=Registered

Nurse + Extended Scope of Practice Nurse Practitioner One type of Advanced Practice Nurse

Regulation —all Advanced Practice Nurse titles legislatively protected

Qualifications required —accredited graduate level course; passed

national certification exam and obtained license to practice

Uk

Advanced Practice = a level of practice

Relationship between EP; APN; ANP; NP = not stipulated

Regulation—titles are not regulated or protected

Qualifications required—no specific qualifications required:

Canada Advanced Practice = Level of practice

Advanced Practice = Registered Nurse Scope of Practice

OR Registered Nurse and Extended Scope of Practice

Nurse Practitioners = Registered Nurse Scope of Practice

OR Registered Nurse and Extended Scope of Practice

Regulation = Nurse Practitioner title regulated Qualifications —master degree recommended:

New Zealand Advanced Practice = level of practice

Advanced Practice = Registered Nurse Scope of Practice

or Registered Nurse and Extended Scope of Practice Nurse Practitioner

Nurse Practitioner = Registered Nurse and Extended Scope of Practice

Regulation —Nurse Practitioner title regulated Qualifications —a master degree recommended:

Advanced nursing practice (ANP): ANP is a continuum along which nurses develop their professional knowledge, clinical reasoning and judgement, skills

and behaviours to higher levels of capability (that is recognisable). Nurses practising at an advanced level incorporate professional leadership,

education and research into their clinically based practice. Their practice is effective and safe. They work within a generalist or specialist context and they are responsible and accountable in managing people who have complex health care requirements. Advanced nursing practice is a level of practice and not a

role. It is acknowledged that advanced nursing practice is individually attributed within a regulated nursing scope (Enrolled Nurse, Registered Nurse or Nurse

Practitioner).

Advanced practice nursing (APN): APN in the Australian nursing context identifies the additional legislative functions of an endorsed Nurse Practitioner

that are outside the contemporary Registered Nurse scope of practice. Advanced practice nursing as a Nurse Practitioner is a qualitatively different level

of advanced nursing practice to that of the Registered Nurse due to the additional legislative functions and the regulatory requirements. The

requirements include a prescribed educational level, a specified advanced nursing practice experience; and continuing professional development.

NMBA (2013). Australian Nurse Practitoner Standards for Practice http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-

Statements/Codes-Guidelines/nurse-practitioner-standards-of-practice.aspx

Further Nurse Practitioner: A Nurse Practitioner is an Advanced Practice Nurse endorsed by the Nursing and Midwifery Board of Australia

to practise within their scope under the legislatively protected title ‘Nurse Practitioner’

AND

UNDER THE APN Definition

[Advanced practice nursing should not be confused with the term ‘practice nurse’ that is used colloquially to describe nurses working

in the general practice setting.]

The patient said phew

I know who is nurse one and nurse two

What is more the planner knew too

We all know what is done by nurse one and nurse two

The two lovely nurses who certainly do the do

References Australian National Dictionary Centre (2004). The Australian Oxford

Dictionary (2nd ed). Melbourne:Oxford University Press.

International Council of Nurses ICN Nurse Practitioner/Advanced Practice NursingNetwork, 2012. Frequently Asked Questions.

Lakoff and Johnson.(1980). Metaphors we live by. Chicago: The University of Chicago Press.

Pulcini, J., Jelic, M., Gul, R., & Loke, A. Y. (2010). An international survey on advanced practice nursing education, practice, and regulation. Journal of

Nursing Scholarship, 42(1), 31-39.

Scanlon, A., Cashin, A., Watson, N., & Bryce, J. (2012). Advanced nursing practice hours as part of endorsement requirements for nurse practitioners in Australia: A definitional conundrum. Journal of the American Academy of

Nurse Practitioners, 24(11), 649-659.

Stasa, H., Cashin, A., Buckley, T., & Donoghue, J. (2014). Advancing advanced practice—Clarifying the conceptual confusion. Nurse education

today, 34, 356-361.