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Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers

Author

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  • Gerard M Fealy
  • Mary Casey
  • Denise F O'Leary
  • Martin S McNamara
  • Denise O'Brien
  • Laserina O'Connor
  • Rita Smith
  • Diarmuid Stokes

Abstract

Aims and objectives To collate, synthesise and discuss published evidence and expert professional opinion on enablers and barriers to the development and sustainability of specialist and advanced practice roles in nursing and midwifery. Background Expanded practice is a response to population health needs, healthcare costs and practitioners’ willingness to expand their scope of practice through enhanced responsibility, accountability and professional autonomy. Design This discursive paper is based on a rapid review of literature on enablers and barriers to the development and sustainability of specialist and advanced practice roles and is part of a wider policy analysis. Methods We analysed and synthesised of 36 research articles, reviews and discussion papers on enablers and barriers in the development and sustainability of expanded practice roles. Results Several factors enable role expansion, including: role clarity; credentialing and endorsement; availability of education for expanded roles; individual practitioners’ dispositions towards role expansion; support from peers, other professionals and the work organisation; and costs. Where limited or absent, these same factors can constrain role expansion. Conclusions Enabling nurses and midwives to practice to their full scope of education and expertise is a global challenge for disciplinary leadership, a national challenge for professional regulation and a local challenge for employers and individual clinicians. These challenges need to be addressed through multistakeholder coordinated efforts at these four levels. Relevance to clinical practice This discursive paper synthesises empirical evidence and expert professional opinion on the factors that enable or hinder the development and sustainability of specialist and advanced practice roles. Providing a critical appraisal of current knowledge, it provides a reference source for disciplinary debate and policy development regarding the nursing and midwifery resource and informs clinicians of the myriad issues that can impact on their capacity to expand their scope of practice.

Suggested Citation

  • Gerard M Fealy & Mary Casey & Denise F O'Leary & Martin S McNamara & Denise O'Brien & Laserina O'Connor & Rita Smith & Diarmuid Stokes, 2018. "Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(19-20), pages 3797-3809, October.
    • Handle: RePEc:wly:jocnur:v:27:y:2018:i:19-20:p:3797-3809
    DOI: 10.1111/jocn.14550
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    References listed on IDEAS

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    1. Karen Donelan & Catherine M. DesRoches & Robert S. Dittus & Peter Buerhaus, 2013. "Perspectives of Physicians and Nurse Practitioners on Primary Care Practice," Mathematica Policy Research Reports b66c95bc1f9d4d5483168c4be, Mathematica Policy Research.
    2. Gerard M Fealy & Daniela Rohde & Mary Casey & Anne‐Marie Brady & Josephine Hegarty & Catriona Kennedy & Martin McNamara & Pauline O'Reilly & Geraldine Prizeman, 2015. "Facilitators and barriers in expanding scope of practice: findings from a national survey of Irish nurses and midwives," Journal of Clinical Nursing, John Wiley & Sons, vol. 24(23-24), pages 3615-3626, December.
    3. Marie-Laure Delamaire & Gaétan Lafortune, 2010. "Nurses in Advanced Roles: A Description and Evaluation of Experiences in 12 Developed Countries," OECD Health Working Papers 54, OECD Publishing.
    4. repec:mpr:mprres:7786 is not listed on IDEAS
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    1. Julia van Kraaij & Catharina van Oostveen & Hester Vermeulen & Maud Heinen & Anita Huis & Marian Adriaansen & Jeroen Peters, 2020. "Nurse practitioners’ perceptions of their ability to enact leadership in hospital care," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(3-4), pages 447-458, February.
    2. Ingrid Taylor & Pia Bing‐Jonsson & Sigrid Wangensteen & Elisabeth Finnbakk & Leiv Sandvik & Brendan McCormack & Lisbeth Fagerström, 2020. "The self‐assessment of clinical competence and the need for further training: A cross‐sectional survey of advanced practice nursing students," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(3-4), pages 545-555, February.

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