Think and think again! Clinical decision making by advanced nurse practitioners in the Emergency Department

Smyth, Olivia; McCabe, Catherine

doi:10.1016/j.ienj.2016.08.001

Cited by 13 publications

(15 citation statements)

References 11 publications

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“…This nonparticipant observational study is drawn from a larger exploratory sequential mixed methods doctoral study examining the nursing role in ED waiting rooms. Mixed methods research combines two or more different approaches to data collection and analysis in a single study (Tashakkori & Teddlie, ), and uses the strengths while counteracting the weaknesses of the different approaches (Creswell, ). Exploratory sequential design is used when little is known about a topic and places an emphasis on qualitative data followed by the collection of quantitative data to explain and quantify the results (Creswell, ).…”

Section: Methodsmentioning

confidence: 99%

Emergency department waiting room nurses in practice: An observational study

Innes

Elliott

Plummer

et al. 2018

Journal of Clinical Nursing

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Section: Methodsmentioning

confidence: 99%

Emergency department waiting room nurses in practice: An observational study

Innes

Elliott

Plummer

et al. 2018

Journal of Clinical Nursing

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“…Barnes et al (2022) reported registered nurses' experience as neither an inhibitor nor promoter of the NP transitioning into the role. Clinical guidelines, protocols and competencies are necessary for all healthcare professionals to ensure safe practice (Lockwood et al, 2021;Smyth & McCabb, 2017). However, over-reliance on these guidelines/protocols is not NP clinical autonomy.…”

Section: It Takes Time To Grow Intrinsicallymentioning

confidence: 99%

Factors Influencing the impact of nurse practitioners’ clinical autonomy: a self determining perspective

Lockwood,

Schober

2024

International Nursing Review

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AimTo explore factors that influence the impact of nurse practitioners’ clinical autonomy with a self‐determining perspective.BackgroundWorldwide, there is a significant demand for healthcare professionals such as the nurse practitioner in meeting some healthcare needs across patients’ lifespans. Factors influencing nurse practitioners clinical autonomy can impact the full utilisation of the role in practice.IntroductionLimited evidence exists that describes or researches nurse practitioner clinical autonomy. Instead, there is a focus in the literature on strategic debates, role confusion and nurse practitioners reporting the straddling between nursing, allied heath professionals and medicine in the provision of healthcare services.DesignA cross‐sectional study design was used in a purposive sample in a national sample of nurse practitioners in Ireland across a full range of healthcare settings. Additionally, the survey included open comments sections to capture qualitative comments by the nurse practitioners themselves.MethodsSelf‐determination theory is rooted in an organismic dialectical stance. This study used a convenience sample of n = 148 from a total sample of n = 448 (33%) of the population. The Dempster Practice Behavioural Scale and an initially validated advanced nursing practice clinical autonomy scale were used. Open comments were analysed by thematic analysis. STROBE Standards guidelines for cross‐sectional studies were followed, and COREQ guidelines were followed for writing qualitative research.ResultsThe study findings demonstrated that the more clinical experience the nurse practitioner had, the higher their levels of clinical autonomy. The previous length of nursing experience did not impact nurse practitioner clinical autonomy levels. However, average experience of nurse practitioner' in this study was 3–10 years. No significant differences existed between the reported gender, nurse practitioners’ clinical autonomy and decision‐making. 1:40 female and 1:9 male nurse practitioners undertook a doctorate or PhD‐level education. No advanced nurse practitioner identified as non‐binary. Gender and organisational culture considerations can influence nurse practitioners clinical autonomy.Implications for nursing and health policyThis study highlights intrinsic motivators that support nurse practitioners in providing innovative healthcare: competence, relatedness and clinical autonomy. Countries credentialing, regulations professional standards and healthcare policy positively influence nurse practitioner clinical autonomy. Nurse practitioners' clinical autonomy is championed when health policy and organisational stakeholders intrinsically collaborate. A disconnect between health policy organisational culture extrinsically influences lower levels of nurse practitioners’ clinical autonomy.ConclusionThe findings underline the positive impact of nurse practitioner clinical autonomy. A recommendation of this study is to continue to measure impact of clinical autonomy and develop nurse practitioners’ self‐determination strategies around the role and integrity of their levels of intrinsic clinical autonomy.

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“…The intuitive approach is based on observation and uses heuristics (rule of thumb) that represent previous experience, and intuition often serves the individual well. According to Smyth and McCabe (2017), working in a busy environment such as an ED, there is an automatic tendency towards the intuitive decision-making process to be very vigorous and robust and is often exposed to the influence of cognitive bias. Likewise, this may lead to errors concerning how people perceive risk in providing care that is not evidence-based.…”

Section: Introductionmentioning

confidence: 99%

Clinical decision‐making processes among graduate nurses, specialist nurses and nurse practitioners A collaborative international study

Levy‐Malmberg,

Boman,

Lehwaldt

et al. 2024

International Nursing Review

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AimTo explore clinical decision‐making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland.BackgroundClinical decision‐making in an emergency department environment is a complex process often occurring in times of crisis. It is an important aspect contributing to the quality of care. However, empirical research is limited regarding the decision‐making process in different nursing roles.MethodsIn accordance with the consolidated criteria for reporting qualitative research, a qualitative and observational study was conducted to explore clinical decision‐making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. Six Registered Nurses, six Nurse Specialists and six Nurse Practitioners were observed. A total of 40 hours of observation was made at each setting according to a structured observation guideline, followed by clarifying questions. The data material was analysed by means of a qualitative manifest and latent content analysis.ResultsThree themes arose: acting in accordance with routines, previous experience and intuition; considering patient experience; and facilitating new alternatives based on critical thinking. The Registered Nurses mainly used the first approach, the Nurse Specialists used the first and the second approaches, and the Nurse Practitioners used all three approaches.ConclusionsThe results highlight the differences in decision‐making processes between these groups. Nurse Practitioners were the only group that facilitated and evaluated new alternatives using their clinical autonomy, such as stepping up and making independent and collaborative decision‐making.ImplicationThe results can be used in countries developing advanced practice nursing education and defining their scope of practice to inform stakeholders.

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Think and think again! Clinical decision making by advanced nurse practitioners in the Emergency Department

Cited by 13 publications

References 11 publications

Emergency department waiting room nurses in practice: An observational study

Emergency department waiting room nurses in practice: An observational study

Factors Influencing the impact of nurse practitioners’ clinical autonomy: a self determining perspective

Clinical decision‐making processes among graduate nurses, specialist nurses and nurse practitioners A collaborative international study

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