Experiences of working as an advanced practice nurse in Finland - the substance of advanced
nursing practice and promoting and inhibiting factors
Sammanfattning
Background: Evaluation of new advanced practice nursing
roles, from different angles, is strongly recommended in
the literature. New nurses’ experiences of working in an
advanced role may highlight problems and/or factors that
promote or inhibit a successful implementation of new
advanced nursing roles.
Aim: To explore advanced practice nurses’ experiences of
the content of their nursing care and to describe promoting
or inhibiting factors for working with a full scope of
advanced nursing practice.
Methods: The study design was explorative and descriptive.
A total of 24 advanced practice nurses participated
in focus group interviews (two were interviewed individually)
about the processes, structure and outcome of
working as advanced practice nurses. Qualitative manifest
content analysis was used for data analysis.
Findings: The substance of advanced practice nursing can
be described with three main themes: a broader and deeper
holistic view of patients’ state of health, an independent
and responsible manner of working and knowing
own limits. Promoting factors were an identity as a nurse
with advanced competency, feedback from satisfied
patients and fruitful teamwork is a necessity. Inhibiting
factors were a lack of organisational understanding for
advanced nursing practice, poor planning leads to unsatisfactory
advanced practice nursing models and advanced
practice nurses’ lack of courage in adopting new
advanced roles.
Conclusion: The participants experienced both a personal
inner transition and a role transition that were either
supported or opposed. Vague or nonexistent definitions
and concepts, insufficient knowledge, insufficient support
and undefined roles hindered participants’ role transition.
Two main strategies should be employed. The first is the
realisation of more strategic leadership and support from
organisations on all management levels, including nursing
organisations/unions, while the second is to more
realistically prepare future advanced practice nurses for
the challenges they will face, through mentorship programmes
and continuous further training.