Whether planning to implement a new advanced practice nursing (APN) role such as a nurse practitioner (NP), or expanding an existing role, it is critical to consider evaluation from the outset. It is important to identify a service need and to collect baseline data prior to implementation, which allows role definition and the evaluation of effectiveness [1]. Clearly defined goals facilitate the identification and evaluation of outcomes and the impact of the APN role [1].
The NP role is often compared to physician care in terms of outcomes. This may lead to a devaluing and invisibility of the impact of nursing care and non-clinical roles of the APN [1], such as education, research and mentorship. In lieu of specific NP-sensitive quality indicators, the PEPPA (Participatory, Evidence-based, Patient-focused Process for Advanced practice nursing) framework [2]is often used as a reliable framework of choice for the implementation evaluation of NP services.
Each health-care setting is unique, and thus evaluation of successful implementation of NPs will vary. The following are some suggested tools to help each organization reflect on how authorizing NPs to work to their full scope has affected their desired outcomes [3].
Nursing Quality Indicators for Reporting and Evaluation® (NQuIRE®)
NQuIRE® is an international, nursing best practices indicator data system that collects, compares, and reports data on nursing-sensitive indicators reflecting the structures, processes, and outcomes of nursing care. NQuIRE® was designed specifically for national and international Best Practice Spotlight Organizations® (BPSO®) to systematically monitor their progress and evaluate their outcomes of implementing RNAO Best Practice Guidelines (BPG) in their organizations.
In the future, NQuIRE® may have the capacity to track NP-sensitive outcomes in order to help evaluate the implementation of NPs in hospitals. Using NQuIRE® and implementing RNAO BPGs may work synergistically with NP admit/treat/discharge to optimize quality patient outcomes.
For more information on NQuIRE®, please visit click here.
Worksheet for NP utilization (using PEPPA Framework)
Resources from McMaster University Chair in Advanced Practice Nursing CHSRF (Canadian Health Services Research Fund)/CIHR (Canadian Institutes of Health Research) including:
Canadian Nurses Association
This toolkit was developed in 2006 to assist in implementation/evaluation of NPs across Canada in diverse health-care settings. It is based on a literature review, best practices and stakeholder consultation and also incorporates the PEPPA framework [3]. It also provides an NP evaluation framework [3].
References
1. Bryant-Lukosius, D., et al., Advanced practice nursing roles: development, implementation and evaluation. Journal of Advanced Nursing, 2004. 48(5): p. 519-529.
2. Bryant-Lukosius, D. and A. DiCenso, A framework for the introduction and evaluation of advanced practice nursing roles. Journal of Advanced Nursing, 2004. 28(5): p. 530-540.
3. Canadian Nurses Association. Canadian Nurse Practitioner Initiative; Implementation and Evaluation Toolkit for Nurse Practitioners in Canada. 2006, Canadian Nurses' Association: Ottawa, ON.
[AB1]Hyperlink to Worksheet (once finalized)