The influence of practice experiences on feelings of role proficiency in emergency nurse practitioners: A phenomenological study

Monk, Daniel (2021) The influence of practice experiences on feelings of role proficiency in emergency nurse practitioners: A phenomenological study. Doctoral thesis, Northumbria University.

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Abstract

The evolution of this research emerged from experiences in the researcher’s clinical practice as a nurse practitioner in a variety of urgent care facilities, and the personal queries raised regarding the consistency of the level of practice and evidenced competency of clinical staff in emergency and unplanned care using the title “practitioner”. These realities are apparent as at present in the UK no legislative requirement exists for nurse practitioners (NPs) to gain formal preparation or qualification. Guidance and direction have been seen in The Advanced Care Practice framework (HEE,2017), yet legislative protection remains absent. Such legislative protection is however seen in other healthcare systems across the world, such as Australia and the US.

This research looked at the journey towards proficiency, the competency to proficiency journey, that is experienced by NPs as they qualify to become NPs, and how they move on in that journey. It incorporated the concepts of role identity, competency, capability and confidence, all of which have been researched in relative isolation. This study explored the NP’s practice experiences by bringing these concepts together, focusing on emergency nurse practitioners (ENPs), and how these experiences influence or effect their feelings of role proficiency, from the perspective of the autonomous and clinically proficient ENP. The research question “how do ENPs’ experiences in practice influence their feelings of role proficiency?” was addressed with the objectives to examine and understand the meaning of role proficiency to ENPs, to identify practice experiences that influence role proficiency and identify and understand how these practice experiences influence ENPs’ feelings of role proficiency.

A hermeneutic phenomenological methodological approach was used to interpret the lived experience of the ENPs in practice. A purposive sample of 10 ENPs was interviewed, and a three-stage interpretive process was used to gain access to the object of investigation and interpret its meaning and lived experience for the ENPs.

Six themes emerged from the data extraction process: the meaning of role proficiency, relationships, confidence, learning and knowledge, exposure and experience, and care. An analytical category tool identified five key outcomes for discussion that linked the themes to the research question: being good at the job, central role of confidence, relationship issues, coping strategy and the influence of care.

This study highlights the need to give attention to the experiences that lead the ENP to feelings of proficiency and their inclusion in clinical educational programmes. The importance placed on the connection of the components required for being good at the job, and how this is constructed by the ENP and should be incorporated, will be presented. Attention was also paid to the influence of confidence and the impact that relationships have upon feelings of proficiency. An increased focus was given to the development and management of relationship experiences, alongside the traditional competency-based clinical achievement frameworks. A direct approach, assessment, enablement and focused development of emotional intelligence and coping strategies was found to facilitate and maintain feelings of proficiency. Acknowledgement is made that not only is care the focus from the patient’s perspective but, alongside this, that care is the central motivating factor of the ENP, driving the elements that contribute to feelings of proficiency. This underpins the emotional intelligence required to perform the role and achieve feelings that allow the ENP to remain in their zone of proficiency to deliver the care the role focuses on.

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