Introduction of nurse practitioners in A&E : knowledge and attitudes of doctors and nurses

Abstract

This research study explored the knowledge and attitudes of A&E doctors and nurses on the Emergency Nurse Practitioner (ENP) in Mater Dei Hospital. An explorative cross-sectional survey design utilizing triangulation (questionnaires and semi-structured interviews), was adopted. The questionnaire sample included 15 doctors (SHOs and Registrars) and 39 practicing nurses, all working at A&E. Semi-structured interviews were carried out with 6 purposeful selected participants: 3 'senior' nurses and 3 'senior' doctors. Questionnaires consisted of professional and demographic questions, a slightly modified version of the Northern Emergency Nurse Practitioner Staff Survey (Considine and Martin, 2005) and a section on attitudes, benefits and difficulties towards the introduction of the ENP role. Semi-structured interviews consisted of professional and demographic questions, questions on knowledge and attitudes on the ENP role, and a section on attitudes, benefits and difficulties towards the introduction of the role. Analysis of the data was done for each section of the questionnaire and interview, mainly by calculating median values for the Likert Scale items, and using content analysis for the open-ended questions and qualitative data. Overall, nurses reported further knowledge than doctors regarding the ENP role, however such difference was not noted amongst the interviewees. Most doctors and nurses expressed positive attitudes towards the ENP role (nurses having more positive attitudes, especially on extended roles). In fact, doctors perceived that the ENP would require feedback from doctors in certain aspects. Nevertheless, almost all participants agreed to the introduction of the ENP role, in order to improve services for the benefit of patients. Most doctors and nurses agreed that this role will 'decrease waiting times', 'reduce doctors' workload' resulting in 'a more efficient A&E service', yet most nurses (unlike doctors) identified 'resistance from doctors' in introducing the ENP role. Other most perceived difficulties were: 'managerial difficulties', 'clients' traditional view', and 'difficulties regarding recruitment and training'. The main recommendations are to: educate A&E staff on the ENP role; raise awareness amongst the public on advanced nursing practices; establish ENP's clear role boundaries; identify any resistant forces prior to the implementation process; carefully plan the change process, so as not to result in bottlenecks and failure in implementation of the ENP role.