University Nursing Report: Foundation of Nurse Practitioner Practice

This report provides a comprehensive overview of the Nurse Practitioner (NP) role, tracing its historical development from its origins to its current status in Australia and internationally. The report explores the NP's pivotal role in providing evidence-based care, as endorsed by the Nursing and Midwifery Board of Australia (NMBA), and examines the developmental stages of the NP role, including infancy, independence, and consolidation. The report delves into the implementation of the NP role, outlining the four stages: initiation, planning, implementation, and evaluation. It highlights the enhanced patient care and specialized services provided by NPs, emphasizing their attentiveness, responsibility, competence, and responsiveness. Furthermore, the report discusses the regulatory measures, standards, and guidelines governing NPs in Australia, as well as social determinants affecting indigenous health, and the role of NPs in addressing these barriers to healthcare access. The report concludes with a discussion of key health topics for indigenous people and the importance of culturally safe practices.

Running head:FOUNDATION OF NURSING PRACTICE
FOUNDATION OF NURSING PRACTICE
Name of the student
Name of the university
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Nurse practitioner (NP) has a pivotal role in the health care system in providing
evidence-based care and endorsed by the NMBA, participating in health promotion and
prevention of disease. The endorsed nurse practitioner has direct link to clinical contact and
practises under the title of nurse practitioner legislatively by National Law. The nurse
anaesthetist is the earliest role of nurse practitioners who have now developed into the
advanced practice role. The role was then developed into nurse-midwife in which some
additional information an educated is added and then a concept of a trained nurse with more
information gained its importance. The next step of the advance role as a clinical nurse
specialist to provide advanced patient care. The latest and the final stage of the advanced
practice role is developed as nurse practitioners (Walsgrove, 2019). The developmental stage
of nurse practitioners are as follows:
 Infancy (learning role)
 Establish independence (autonomy)
 Expanding (initiative)
 Consolidation (industry)
 Rebellion (identity)
 Reaching out(generativity)
 Integrity
Implementation of the NP role is designed such that it becomes systematic, evidence based
and collaborative approach. The implementation process is divided into four stages :
Stage 1- Initiation (Establish the need)- Define patient and patients condition, describe a
present model of care, identify existing service plans and identify and engage key
stakeholders, identification of required modification in existing plans, identification of
clinical nursing role.

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Stage 2- Planning- Establishing network, process to lead role, identifying support
requirements, developing person-specific employment contract.
Stage 3-Implementation – Develop links to mentorship, education, professional development,
referral pathways documents, provide a supportive environment, establishing an NP
implementation support group, developing a sustainable plan, developing options for the NP
to engage them in clinical leadership.
Stage 4- Evaluation- evaluation the role of NP and a new model of care, role integration, role
sustainability, ANMV competency.
On recruiting Nurses practitioners in the healthcare system, the service is enhanced
and the patient gets specialised care thus improving their chronic condition efficiently. Nurse
practitioner's service provides four elements of caring:
Attentiveness- NP assess patients condition and ensure that the attentiveness policies like
hourly rounding and ‘NO pass zones” are followed properly to meet the patient’s needs.
Responsibility- NP ensures that the patients under their care know the treatment, medical
options and medication that they are provided.
Competence- NP grows professionally daily through their experience and can gain
knowledge by enrolling them in relevant programs.
Responsiveness of the patients- the recovery of the patient depends on both patient and
family so the nurse practitioners must keep track of the patient’s family and the patient.
A endorsed Nurse Practioner in Australia is an experienced clinical registered nurse
who holds a masters degree in nursing recognised by the Nursing and Midwifery Board of
Australia (NMBA) and also fulfils the requirements of NMBA (Gardner et al., 2004). Along
with Australia, other countries have some other education credentials and scope of practice.
Australian Nurse Practitioners abide by the NMBA Standards for the Registered Nurse and
Code of Conduct (Gardner et al., 2019).

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In other counties like the United States, Medicare and Medicaid programs were
incorporated where nurses stepped in to take care of the low-income families and older
people. Recently the Affordable Care Act helped the nurse practitioners to gain importance.
In recent years National Health Service contributes to healthcare policy, increased consumer
demands and changing workforce.
However, other countries like America, the NP model was structured for primary
healthcare settings and secondary, tertiary settings and they are termed as APNs. Four distinct
APNs roles are nurse anaesthetists, clinical nurse specialists and nurse practitioners. Here
physicians are the first line in primary care (Buppert, 2000). The regulatory measures of
Canada are territorial legislation and of Unites states is State legislation; however, in
Australia, the regulatory measure is state/territorial legislation (Maier et al., 2016).
The endorsed nurse practitioners regulations and guidelines and policies prevailing in
Australia are:
 Australian Health Practioner Regulation Agency (APHRA)
 Codes and Guidelines. Nursing and Midwifery Board of Australia
 Nurse Practitioners PBS Prescribing, Nurse practitioner standards for practice.Nursing
& Midwifery Board of Australia.
 Nursing and Midwifery Board of Australia (NMBA)
The standards are as follows (Cashin et al., 2017):
Standard1: Assess during diagnostic capability
Standard 1: Plans care and engage others
Standard 3: Prescribes and implements therapeutic interventions
Standard 4: Evaluates outcomes and improves practice.
Social determinants that affects the indigenous health in Australia are:

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The connection between socio-economic and health status- Poverty was a clear linkage
between poor health status. Poor infant diet and smoking is linked with lower socio-economic
status (Gee et al., 2014)
The connection between perceptions of control and chronic disease- Racism,
intergenerational poverty trigger chronic stress which in turn affects the body’s immune
system, metabolic function and is regarded as the greatest killer of indigenous people in
Australia (Barrett et al., 2015)
Evidence of the health impact of indigenous community control of health services
Traditional ownership of land and health status
It is necessary to follow the guiding principles for decision making for aboriginal
health and wellness services which includes
 Respecting indigenous approaches to health and well being
 Self-determination,
 Self-governance
 Controlling health planning and ensuring equitable resourcing
 Incorporation of Ownership control access and possession principles
The AHAC model will improve the condition and give access to primary healthcare for the
indigenous patient (Muise, 2016). The key health topic of indigenous people is diabetes,
traditional healing, home and community care, palliative care, mental health and addictions
and cultural safety. Addressing social determinants that are the barriers to accessing health
service like access to affordable transportation can improve their health condition. The nurse
practitioners are responsible for giving palliative care, develop a plan to increase self-
identification, organise medicine walks and develop community education tools.

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References
Barrett, E., Salem, L., Wilson, S., O'Neill, C., Davis, K., & Bagnulo, S. (2015). Chronic
kidney disease in an Aboriginal population: A nurse practitioner‐led approach to
management. Australian Journal of Rural Health, 23(6), 318-321.
Buppert, C. (2000). "Measuring outcomes in primary care practice." Nurse Pract25(1): 88-92,
95-88.
Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., ... & Fisher, M. (2017).
Standards for practice for registered nurses in Australia. Collegian, 24(3), 255-266.
Gardner A., Gardner G., Coyer F., Gosby H. & Helms C. (2019). The nurse practitioner
clinical learning and teaching framework: A toolkit for students and their supervisors.
doi:10.6084/m9.figshare.9733682 (Provided as pdf below)
Gardner, G., et al. (2004). "Nurse practitioner education: a research-based curriculum
structure." Journal of Advanced Nursing47(2): 143-152.
Gee, G., Dudgeon, P., Schultz, C., Hart, A., & Kelly, K. (2014). Aboriginal and Torres Strait
Islander social and emotional wellbeing. Working together: Aboriginal and Torres
Strait Islander mental health and wellbeing principles and practice, 2, 55-68.
Maier, C. B., Barnes, H., Aiken, L. H., & Busse, R. (2016). Descriptive, cross-country
analysis of the nurse practitioner workforce in six countries: size, growth, physician
substitution potential. BMJ open, 6(9), e011901.
Muise, G. M. (2016). Running header: IMPLEMENTING AN INDIGENOUS HEALTH
MODEL (Doctoral dissertation, Royal Roads University).
Walsgrove, H. (2019). An exploration of advanced nursing in a hospital context: people,
processes, frameworks (Doctoral dissertation, Bournemouth University).