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Citation Manager Abstract Supportive nursing leadership is important for the successful introduction and implementation of advanced practice nursing roles in Canadian healthcare settings.
For this paper, we drew on pertinent sections of a scoping review of the literature and key informant interviews conducted for a decision support synthesis on advanced practice nursing to describe and explore organizational leadership in planning and implementing advanced practice nursing roles.
Leadership strategies that optimize successful role integration include initiating systematic planning to develop the roles based on patient and community needs, engaging stakeholders, using established Canadian role implementation toolkits, ensuring utilization of all dimensions of the role, communicating clear messages to increase awareness about the roles in the organization, creating networks and facilitating mentorship for those in the role, and negotiating role expectations with physicians and other members of the healthcare team.
Leaders face challenges in creating and securing sustainable funding for the roles and providing adequate infrastructure support. Introduction Nursing leaders play a key role in shaping the nursing profession to be more responsive to our changing healthcare system.
In Canada, nursing leaders can be, but are not limited to, chief executives; frontline, middle and senior managers; administrators; professional practice leaders; leaders in regulatory bodies; government officials; and policy makers. Important qualities of effective nursing leaders include being an advocate for quality care, collaborator, articulate communicator, mentor, risk taker, role model and visionary Canadian Nurses Association [CNA] This is a challenging era for both nursing and healthcare because of complex issues such as inadequate funding, health human resource shortages and the increasing need for services for our aging population.
Effective planning and implementation of advanced practice nursing roles in healthcare settings have the potential to help address these challenges. Advanced practice nursing is an umbrella term for both clinical nurse specialist CNS and nurse practitioner NP roles.
NPs are "registered nurses with additional educational preparation and experience who possess and demonstrate the competencies to autonomously diagnose, order and interpret diagnostic tests, prescribe pharmaceuticals and perform specific procedures within their legislated scope of practice" CNA b: Core advanced nursing practice dimensions include direct patient care, research, leadership, consultation and collaboration CNAbut considerable variability exists across advanced practice nursing roles in terms of time spent in each activity.
CNSs and NPs work in a variety of practice settings and have gained some traction in the Canadian healthcare system since their first introduction in the s Kaasalainen et al. However, many obstacles continue to impede their full integration DiCenso et al. The integration of advanced practice nurses APNs into healthcare systems has relied heavily on nursing leaders at the national, provincial, regional and local organizational levels.
At the national level, nursing leaders in government and professional associations have supported the integration of APNs in Canada in a number of ways.
This paper will focus on the roles of nursing leaders at the organizational level in facilitating the integration of CNSs and NPs in healthcare settings. Methods This paper is based on a scoping review of the literature and qualitative interviews completed for a decision support synthesis that was conducted to develop a better understanding of advanced practice nursing roles, their current use, and the individual, organizational and health system factors that influence their effective development and integration in the Canadian healthcare system DiCenso et al.
The synthesis methods are described in detail in an earlier paper in this issue DiCenso et al. We conducted the scoping review using established methods Anderson et al. We conducted a comprehensive appraisal of published and grey literature ever written about Canadian advanced practice nursing roles, as well as reviews of the international literature from to In keeping with the tenets of scoping reviews, we did not exclude articles based on methodological quality.
To identify the relevant literature, we searched Medline, CINAHL and EMBASE, performed a citation search using the Web of Science database and 10 key papers, reviewed the reference lists of all relevant papers, and searched websites of Canadian professional organizations and national, provincial and territorial governments.
Teams of researchers extracted data from relevant papers and analyzed the data using a combination of descriptive tables, narrative syntheses and team discussions. We also conducted four focus groups with a total of 19 participants. We used purposeful sampling to identify participants with a wide range of perspectives.
When our synthesis was completed, CHSRF convened a multidisciplinary roundtable to develop recommendations for policy, practice and research. For this paper, we integrated findings from the Canadian literature that described the role of nursing leaders in facilitating the integration of APNs with interview data from those who identified leadership issues, especially the 11 Canadian nurse administrators.
These administrators came from five provinces and worked in academic teaching centres, regional health authorities, community care agencies and a rehabilitation and continuing care centre. International literature has been used to provide global context and for further discussion about key issues when relevant.
Results We highlight the most frequently mentioned themes that emerged from the literature and that were identified by our interview participants specific to leadership. We begin with a general description of the importance of organizational leadership in supporting advanced practice nursing roles and then focus on the leadership role specific to planning for and implementing these roles.
Senior nursing administrators play an important role in linking APNs to organizational priorities to improve nursing practice Bryant-Lukosius et al. They identified challenges related to clarifying the reallocation of tasks, managing altered working relationships within the nursing team, and continuing to manage the team as new issues emerged.
Based on these results, Reay et al. These strategies include 1 encouraging all team members to sort out "who does what," 2 ensuring that task reallocation preserves job motivating properties, 3 giving consideration to how tasks have been allocated when issues identified as "personal conflict" arise, 4 paying attention to all perspectives of the working relationships within the team, 5 facilitating positive relationships between team members, 6 leading from a "balcony" perspective, 7 working with the team to develop goals that are not overly focused on the NP and 8 regularly sharing with other managers the experiences and lessons learned in introducing NPs.Bain has a comprehensive tool kit and team of global experts to help companies break down organizational barriers and address decision inefficiencies to get to high performance.
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