Mapping advanced practice nurses’ scope of practice, satisfaction, and drivers of role performance
A Swiss cross-sectional survey
Abstract
Abstract:Background: Advanced Practice Nurse (APN) roles in Switzerland include Clinical Nurse Specialist (CNS), Nurse Practitioner (NP) and blended roles. The variety contributes to unclear profiles and scope of practice. Aim: To describe a) the performance of APN tasks according to Hamric’s competencies, b) job satisfaction, and c) barriers and facilitators to role performance. Methods: Nationwide cross-sectional survey among clinically working APNs. Inclusion criteria: academic degree, role with advanced nursing competency. Analysis of quantitative and qualitative data using inferential statistics and content analysis. Results: Of the 222 APNs, 49% (n = 108) described themselves as CNSs, 37% (n = 81) as working in a blended role, and 15% (n = 33) as NP. APNs provided the greatest proportion of their tasks in the competency direct clinical practice and the least in ethical decision-making. Group comparisons between roles revealed significant differences in the competencies: direct clinical practice, guidance and coaching, leadership, and evidence-based practice. Job satisfaction was high (76%, n = 165), most often described by the category work content/role (e.g., defined scope of practice). The most frequent barrier to role performance was the category scope of practice (e.g., unclear responsibilities); the most frequent facilitator was the category professional recognition (e.g., respect). Conclusion: The study highlights current APN scope of practice and can support the advancement of the role through clinical practice, educational institutions, and research.
Zusammenfassung:Hintergrund: Advanced Practice Nurse (APN)-Rollen in der Schweiz sind Clinical Nurse Specialist (CNS), Nurse Practitioner (NP) und gemischte Rollen. Diese Vielfalt trägt zu unklaren Profilen bei. Ziel: Beschreibung von a) APN-Tätigkeiten nach Hamric, b) Arbeitszufriedenheit, c) hinderlichen und unterstützenden Faktoren zur Rollenausübung. Methode: Nationale Querschnittserhebung bei klinisch tätigen APNs. Einschlusskriterien: akademischer Abschluss, Rolle mit erweiterter Pflegekompetenz. Analyse der quantitativen und qualitativen Daten mittels Inferenzstatistik und Inhaltsanalyse. Ergebnisse: Von den 222 APNs bezeichneten sich 49% (n = 108) als CNS, 37% (n = 81) als in einer gemischten Rolle tätig und 15% (n = 33) als NP. Die APNs erbrachten den größten Anteil ihrer Tätigkeiten in der Kompetenz direkte klinische Praxis, den geringsten in ethischer Entscheidungsfindung. Gruppenvergleiche zwischen den Rollen ergaben signifikante Unterschiede in den Kompetenzen: direkte klinische Praxis, Beratung und Coaching, Leadership und evidenzbasierte Praxis. Die Arbeitszufriedenheit war hoch (76%, n = 165), am häufigsten beschrieben durch die Kategorie Arbeitsinhalt/Rolle (z.B. definierte Tätigkeiten). Das häufigste Hindernis für die Rollenausübung war die Kategorie Tätigkeitsfeld (z.B. unklare Verantwortung), förderlich war die Kategorie professionelle Anerkennung (z.B. Respekt). Schlussfolgerung: Die Studie zeigt aktuelle APN-Tätigkeitsfelder und kann die Weiterentwicklung der Rolle durch klinische Praxis, Bildungsinstitutionen und Forschung unterstützen.
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