An inductive qualitative approach to explore Nurse Practitioners views on leadership and research: An international perspective

Abstract

Aims and objectives To explore the ways in which Irish and Australian Nurse Practitioners (NPs) implement leadership and research in their roles and whether there is a difference in how leadership and research are demonstrated between NPs in Ireland and Australia. Background The original concept of the NP role was to expand nursing practice in order to provide high‐quality, accessible health care to patients. This placed NPs at the crux of changes to healthcare delivery. Implementing these changes requires leadership. Research demonstrates the effects of these changes to healthcare delivery and contributes to healthcare knowledge from the nursing profession. Design In the qualitative phase of a mixed methods study, an interpretative descriptive approach was used to draw on participant experiences. Methods Thirty‐eight respondents agreed to be interviewed following an online survey. Ten interviews were recorded and transcribed verbatim. Data were analysed using Braun and Clarke thematic analysis method. The research complied with the consolidated criteria for reporting qualitative research, COREQ. Results Ten participants, five NPs from Ireland and five from Australia were interviewed. Four themes emerged from the analysis: (a) Innovative leadership, which included the categories of leadership activities, the work of NPs and trailblazers; (b) Optimism, incorporating pride in achievements, the future outlook for the role and continued innovation of NPs over time; (c) Research, which included the NP research role, research challenges, support and research leadership; and (d) Resilience, which included overcoming resistance, isolation and seeking positive support systems. Conclusion Nurse Practitioners are clinical leaders focused on improving healthcare delivery for patient populations. There is a lack of understanding of the NP role. Nurse Practitioners lack confidence to be independently research active. Research by NPs requires support from nurses in academia. There is no difference in the role in Ireland and Australia. Relevance to clinical practice Nurse Practitioners are engaged in healthcare transformation. Nurse Practitioners require support from research experts in academia to make a significant contribution to nursing knowledge in healthcare delivery.

An integrative review to identify evidence of nurse practitioner‐led changes to health‐care delivery and the outcomes of such changes

“…Gerrish et al (2012) highlighted that APNs needed support from nursing management to fulfil this complex leadership role in implementing EBP in clinical areas. Research from Australia, Canada and Ireland (Lamb, Martin-Misener, Bryant-Lukosius, & Latimer, 2018;Ryder et al, 2019) confirmed that NPs have the leadership capabilities to lead health-care teams in focusing on improving access to health-care for specialist patient groups, which supports the findings in this review.…”

“…The research role of the NP in the selected literature is unclear. Ryder et al (2019) reported that NPs believed that undertaking research was demonstrating leadership in their role; however, NPs expressed a desire for assistance from nursing management and academics with such research. Ryder et al (2019) explained that NPs fear research and the research process; however, the authors identified an appetite among NPs to research their role and outcomes of their activities.…”

“…Ryder et al (2019) reported that NPs believed that undertaking research was demonstrating leadership in their role; however, NPs expressed a desire for assistance from nursing management and academics with such research. Ryder et al (2019) explained that NPs fear research and the research process; however, the authors identified an appetite among NPs to research their role and outcomes of their activities. The small volume of NP research literature does not reflect the length of time that NPs have been part of the health‐care team and the increasing numbers of NPs in practice.…”

“…NPs are licensed independent practitioners, educated to blend clinical expertise, and diagnose and treat conditions, including the prescription of medications, within agreed clinical settings (International Council of Nurses, 2020). They are clinical leaders at the forefront of changes to health‐care delivery (Elliott, Begley, Sheaf, & Higgins, 2016; Ryder, Jacob, & Hendricks, 2019). Understanding the leadership capabilities of frontline nurses provides an opportunity to evaluate their influence and ability to implement changes to health‐care practices (Byers, 2017).…”

“…The NP role, conceived in the United States over 50 years ago, has been seen to include both leadership, by implementing quality patient care practices, and research, by investigating the outcomes of care provided (Ford, 2015; Lowe, Plummer, & Boyd, 2018; Ryder et al, 2019). Leadership outcome indicators for NPs identified by Elliott et al (2014) include research in the form of research application, evaluation and knowledge generation.…”