Marie Carney

Regulation of advanced nurse practice: its existence and regulatory dimensions from an international perspective

AIM To explore the regulation of advanced nurse practice internationally and to identify differences and commonalities. BACKGROUND Regulation of advanced practice nursing does not occur in many countries. Ireland is currently in the minority in regulating advanced practice at a national level. KEY ISSUES Lack of regulation poses difficulties for national governments and for society due to uncertainty in advanced practice concept and role. METHODS A literature review of 510 scholarly nursing papers published in CINAHL, PubMed and MEDLINE between 2002 and 2013 and 30 websites was undertaken. RESULTS There is a lack of consistency in legislative systems internationally. Nursing organisations have recognised advanced nurse practice by regulation in some countries and by voluntary certification in others. CONCLUSIONS Research has demonstrated that care delivered by advanced nurse practitioners has enhanced patient outcomes yet regulation of advanced practice is not undertaken in most countries. IMPLICATIONS FOR NURSE MANAGER Nurse managers need to know that criteria for the regulation of advanced practice are in place and reflect the minimum requirements for safe practice.

Public health nurses perception of clinical leadership in Ireland: narrative descriptions

AIM The aim of the study was to identify how clinical leadership skills are perceived by Public Health Nurses in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery. BACKGROUND Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles. METHOD Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery. RESULTS Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective. CONCLUSIONS Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor. RELEVANCE TO NURSE MANAGERS: Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.

Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland.

AIM The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring. BACKGROUND Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times. EVALUATION Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the studys aim. KEY ISSUES Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money. CONCLUSIONS In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices. IMPLICATIONS FOR NURSING MANAGEMENT As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.

Models of initial training and pathways to registration: a selective review of policy in professional regulation.

AIM To provide a synthesis of literature on international policy concerning professional regulation in nursing and midwifery, with reference to routes of entry into training and pathways to licensure. BACKGROUND Internationally, there is evidence of multiple points of entry into initial training, multiple divisions of the professional register and multiple pathways to licensure. EVALUATION Policy documents and commentary articles concerned with models of initial training and pathways to licensure were reviewed. Item selection, quality appraisal and data extraction were undertaken and documentary analysis was performed on all retrieved texts. KEY ISSUES Case studies of five Western countries indicate no single uniform system of routes of entry into initial training and no overall consensus regarding the optimal model of initial training. CONCLUSIONS Multiple regulatory systems, with multiple routes of entry into initial training and multiple pathways to licensure pose challenges, in terms of achieving commonly-agreed understandings of practice competence. IMPLICATIONS FOR NURSING MANAGEMENT The variety of models of initial training present nursing managers with challenges in the recruitment and deployment of personnel trained in many different jurisdictions. Nursing managers need to consider the potential for considerable variation in competency repertoires among nurses trained in generic and specialist initial training models.

Leadership in nursing: current and future perspectives and challenges

This issue of the Journal of Nursing Management is devoted to Leadership, its interpretations, styles and trends from an International perspective. Researchers writing in this issue explore leadership from their respective clinical experiences and leadership discourses and from existing and emerging theories. Nurses are often ill prepared for their roles as clinical, administrative and academic leaders and often assume this role without academic preparation and with a lack of organizational support for their work and often with the underlying assumption that nurses will be good leaders through a process of osmosis as a result of their previous experiences. Shirley (2007) in extending Benner s novice to expert approach says that early experience of leadership and support for, and in the role are important for future success in the leadership role. The authors of papers in this themed issue present discourses on issues and challenges of leadership styles, ineffective styles, related matters such as job satisfaction and the effects of shortage of nurses on job satisfaction, and leadership approaches in patient care delivery. They stress the importance of support mechanisms for nurses being in place in their organizations for the development of effective leadership. Several papers focus on the global nursing shortages and the lack of skilled nurses to care for the global ageing populations. Some focus on the measures needed to retrain nurses, others focus on the importance of organizational support for nurses in leadership roles such as education for leadership and for the supervisory role. Other authors focus on the need for effective and usable measurement tools to measure workforce planning and nursing workload management systems and the need for evidence based human resource management from the nurse leaders resource allocation perspective. Finally, some new approaches are presented that detail the challenges facing nurse academics, the lessons nursing can learn from non nursing educators in general education and some new approaches to networking. Vesterinen et al. explore the leadership styles of Finnish nurse managers by exploring their perceptions of their leadership styles. The authors focus on the challenges for nurse managers in retaining nurses in hospitals and in ensuring a high quality of care in nursing practice. They focus on leadership styles and the importance of leadership in providing nurse managers with tools to reflect on their own leadership style. They identify five categories of leadership style: discerned: visionary, coaching, affiliate, democratic, commanding and say that Finnish nurse managers use a variety of leadership styles. The study demonstrates the importance of knowledge about leadership styles. An American study by Rouse (2009) explores leadership from the perspective of ineffective nurse leadership with an emphasis on absenteeism by nurses from work. This study undertaken in an intensive care unit explores ineffective participation and perceived incompetent nurse leadership. The author found dissatisfaction with nurse leaders who were perceived as being frequently absent or ill prepared for their role and the difficulties encountered in communicating with such nurses. They stress the importance of communications and participation by nurses and advise that senior managers should recruit and develop supervisors with effective participation skills. They also found the need to develop communication skills for future nurse leaders. A paper by Italian nurses also focuses on the shortage of nurses and the effects of this on patient care. In their paper on workplace empowerment, job satisfaction and job stress among Italian mental health nurses Lautizi et al. investigate the relationship between staff nurses, structural empowerment, work stress and job satisfaction in Italy, using Kanter s Empowerment Theory. The authors focus on the current scarcity of economic resources and shortage of nurses and say it is essential to empower nurses to perform at a high level to ensure high-quality patient care. They emphasize that health care organizations must make efforts to create structures and systems that empower nurses to practice according to professional standards thereby optimizing the use of their leadership knowledge and expertise in care delivery. Effective leadership leads to patient satisfaction and is a requirement for effective care delivery (Chan & Cheng 1999; Chen et al. 2005). Remaining with the workplace and the need for effective human Journal of Nursing Management, 2009, 17, 411–414