UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
School of Hospitality Management and Tourism, Dublin Institute of Technology, Dublin, Ireland.
J Clin Nurs. 2018 Oct;27(19-20):3797-3809. doi: 10.1111/jocn.14550. Epub 2018 Jul 23.
To collate, synthesise and discuss published evidence and expert professional opinion on enablers and barriers to the development and sustainability of specialist and advanced practice roles in nursing and midwifery.
Expanded practice is a response to population health needs, healthcare costs and practitioners' willingness to expand their scope of practice through enhanced responsibility, accountability and professional autonomy.
This discursive paper is based on a rapid review of literature on enablers and barriers to the development and sustainability of specialist and advanced practice roles and is part of a wider policy analysis.
We analysed and synthesised of 36 research articles, reviews and discussion papers on enablers and barriers in the development and sustainability of expanded practice roles.
Several factors enable role expansion, including: role clarity; credentialing and endorsement; availability of education for expanded roles; individual practitioners' dispositions towards role expansion; support from peers, other professionals and the work organisation; and costs. Where limited or absent, these same factors can constrain role expansion.
Enabling nurses and midwives to practice to their full scope of education and expertise is a global challenge for disciplinary leadership, a national challenge for professional regulation and a local challenge for employers and individual clinicians. These challenges need to be addressed through multistakeholder coordinated efforts at these four levels.
This discursive paper synthesises empirical evidence and expert professional opinion on the factors that enable or hinder the development and sustainability of specialist and advanced practice roles. Providing a critical appraisal of current knowledge, it provides a reference source for disciplinary debate and policy development regarding the nursing and midwifery resource and informs clinicians of the myriad issues that can impact on their capacity to expand their scope of practice.
整理、综合并讨论已发表的证据及专家专业意见，阐明在护理和助产学中发展和维持专业和高级实践角色的促进因素和障碍因素。
扩大实践是对人口健康需求、医疗保健成本以及从业者通过增强责任、问责制和专业自主权扩大实践范围的意愿的一种回应。
本文是基于对有关发展和维持专业和高级实践角色的促进因素和障碍因素的文献进行快速回顾的基础上撰写的一篇论述性文章，是更广泛的政策分析的一部分。
我们分析和综合了 36 篇关于扩大实践角色发展和可持续性的促进因素和障碍的研究文章、综述和讨论文件。
有几个因素可以促进角色扩展，包括：角色明确；认证和认可；提供扩展角色的教育；从业者对角色扩展的态度；来自同行、其他专业人员和工作组织的支持；以及成本。在这些因素有限或不存在的情况下，同样的因素会限制角色扩展。
使护士和助产士能够充分发挥其教育和专业知识的实践能力，这是学科领导力面临的全球性挑战，是专业监管面临的国家挑战，也是雇主和个体临床医生面临的地方挑战。这些挑战需要通过多利益相关者在这四个层面上的协调努力来解决。
本文综合了有关促进或阻碍专业和高级实践角色发展和可持续性的因素的经验证据和专家专业意见。对现有知识进行批判性评估，为护理和助产资源的学科辩论和政策制定提供参考资料，并使临床医生了解可能影响其扩大实践范围的众多问题。
