Nurse Practitioner Special Interest Groups - Journal for Nurse

ORIGINAL RESEARCH

Nurse Practitioner Special Interest Groups: Effective or Not? Kathleen E. Tori, ENP, and Elizabeth Morley, CCRN ABSTRACT There is significant paucity of literature relating to nursing special interest groups, particularly at the advanced nursing level. How then is the effectiveness of such groups measured? This article discusses the action research project conducted with a nurse practitioner (NP) special interest group (SIG) in regional Victoria, Australia. The purpose of the research was to determine the effectiveness, if at all, of the NP SIG in meeting the members’ needs. The results found the group to be very effective in supporting and mentoring NPs, providing a sense of collegiality for NPs from a diverse range of specialty areas. Keywords: action research, mentoring in nursing, nurse practitioner, special interest groups © 2011 American College of Nurse Practitioners

ursing is a dynamic profession, and as such, roles and practices are continually evolving to meet changing nursing care delivery requirements. Along with increased clinical accountability, there is evidence of confusion regarding scope of practice issues and role ambiguity at all levels of nursing, particularly at the advanced level of practice.1,2 The advanced nursing role of the nurse practitioner (NP), although not a new concept in the United Kingdom (UK) and the United States (US), is a relatively new role in Australia. Consequently, the mechanisms to support and guide NP role development are in their infancy. In regional Victoria, Australia, 1 mechanism implemented to support NP role development has been the establishment of a NP special interest group (SIG). Contextually, in some countries the aim of SIGs may be to exert political influence. In Australia, however, nursing SIGs function to support improved clinical practice in a comprehensive range of speciality areas.3 The regional Victorian SIG provides a focused professional forum for participants to find information pertaining to all facets of the NP role. Endorsed NPs, NP candidates, other nurses working toward the NP role, and nurse managers are welcome to participate. While

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under the auspice of a major health care organization, the SIG is independent, and members are solely responsible for the coordination and conduct of the group’s activities. The group’s aim is to provide mentoring and support, education relevant to clinical and professional practice, activities to support endorsement applications, and activities that contribute to the broader development of the NP role in Australia. Members meet monthly, and the high participation rate in SIG activities suggests the group achieves its purpose and therefore could be deemed effective. In order for this assumption to be formally evaluated, a research project was undertaken. This article discusses the research methods, findings, recommendations in relation to the results, and opportunities for further research to evaluate the effectiveness of specific professional forums that aim to contribute to NP development. LITERATURE REVIEW The electronic databases searched included Pub Med, Ovid, CINAHL, Medline, ProQuest, Scopus, and Google Scholar, using the keywords special interest groups, nurse practitioner, nursing collaboratives, action research, support, and mentoring in nursing. Incidental The Journal for Nurse Practitioners - JNP

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relevant publications were identified when perusing Throughout the literature there is nascent evidence of professional journals for professional development reaSIGs in regard to nursing and NPs. Curry-Narayan17 sons. Reference lists of retrieved articles were manually describes a nursing SIG as a group for nurses who come scanned to identify other pertinent literature not together to share a common area of interest that can poslocated in initial electronic itively influence individual searches, and these articles were nursing practice. It is acknowlretrieved and assessed for curedged that other supportive rency and pertinence to study nursing endeavors do exist, but Support was found to be interests. The search was limthey are more likely to be initithe most important function ited to the past 12 years of ated from an organizational perof the NP SIG. publication. spective, such as professional After a thorough review of development courses.18 The litthe literature, it was identified erature mentions other formal that numerous articles have nursing mentoring programs7,8 been published on the topic of mentoring, mentoring in focused on enhancing and promoting professionalism nursing, and NPs as individual concepts in recent and within advanced nursing sectors. Campoy19 refers to a chronic disease SIG networking not-so-recent times.1,4-12 However, there is a paucity of published research regarding nursing SIGs and more session convened to discuss and plan care for patients and specifically in relation to NP SIGs. caregivers of patients with chronic renal disease. Conversely, The predominant thematic finding throughout the Fava20 referred unfavorably to 1 particular SIG’s members literature is that the concept of mentoring in nursing, as being the gatekeepers of information that “may be in while not new, is crucial to facilitate the transitional conflict with their interests.” A rather dated but pertinent phases of professional advancement.1,10 Indeed, some artiarticle17 highlights the perceived link between SIGs and the 6,11,12 cles purport a correlation between nurse mentor“shaping of professional practice,” noting it was from an ship and retention rates in addressing nursing workforce industrial nursing organizational perspective. shortages. According to the literature, mentoring relationA major nursing organization in Australia, the ships in nursing offer role socialization and a means of Australian Nursing Federation, supports a comprehenintra-professional nurturing, and they have been deemed sive range of nursing speciality SIGs to support crucial when used effectively during the transitional improved clinical practice.3 A study by Walsgrove and 2,5,8,9,13,14 phases of NP progression. Fullbrook21 looked at role development for advanced Mentoring as an opportunity to learn from those nurses by the use of a professional group as a support who are identified as experts or role models, such as mechanism during NP role development, implementaexperienced NPs, is often undervalued.14 Yet it is a sigtion, and evaluation stages. It was found that the supnificant means of offering guidance and support for cliniportive group “strengthened the NP voice”21 and cians who, although recognized as clinical experts in their contributed to the development of a conceptual framespeciality area, seek comprehension of their new role.2,14work focusing on the shared principles congruent with 15 Identified as a valuable resource, experienced NPs offer collaboration and participation. a “sense of inclusion and support”2 through mentorship It was apparent from the literature review there is a and leadership, effectively promoting professional netlack of evidence in relation to the role of SIGs in nursing works. Block et al6 concur that the mentoring process speciality areas. This finding validated the researchers’ “generates sustainable benefits,” encouraging advanceaspirations to conduct a study designed to determine if ment of novice practitioners when mentored in a collethe regional Victorian NP SIG was effective in providing gial environment. Acknowledged as prominent mentorship and individual NP role development support. components of professional development, mentorship and networking in nursing are methods of maintaining METHODOLOGY knowledge transference for future generations of profesParticipant action research was selected as the methodolsionals at all levels of nursing.16 ogy for the research project. This method was chosen 566

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because it is well-suited to the nursing practice setting, working toward an NP role. Participants had to have 22 and Whitehead argues it ought to be a foundation of been actively involved in the regional NP SIG. nursing research activity. Action research is based on the Members who did not meet the inclusion criteria premise that research participants elect to work collecwere not invited to participate as the research was tively, using self- and collective reflection to investigate a specifically focussed on determining how effective the theory or problem for the purpose of seeking an answer NP SIG was in supporting individuals in their NP role or solution.23 Researchers and participants develop an progression. alliance for the purpose of planning, implementing, and The researchers acknowledge the sample group was disseminating results throughout the research process.23 small, so in order to protect participant confidentiality, The methodology encompasses a cyclic process of reflecdemographic and clinical speciality information has not tion, planning, acting, and observing to achieve the been provided here. research aims. The research can commence at any stage in the cycle.24 DATA COLLECTION The ability of action research to bring the NP SIG A set of questions was developed that deliberately omitmembers and investigators together in the research ted the actual terms mentoring and support. This was to process was considered a principal advantage of using this ensure participants responded without undue influence. methodology, likewise the capacity of action research to SIG members who met the inclusion criteria were promonitor the process and change vided with the questionnaire management dynamics of the shown in Table 1. There was a NP SIG for to improve the 75% return rate. All data were 25 support and mentoring role. de-identified and securely Mentorship and networking stored in accordance with the in nursing are methods of ETHICAL CONSIDERATIONS ethical requirements. maintaining knowledge Ethics approval for the research project was sought and approved DATA ANALYSIS transference for future by the appropriate human Data were organized using generations of professionals research ethics committee. Nvivo,™ a qualitative software at all levels of nursing. program designed to assist PARTICIPANTS with coding themes during In Australia the title “nurse the interpretation phase.27 To practitioner” is legislated and thus can be used only by a avoid bias the researchers conducted the initial lineregistered nurse who has met the requirements of the by-line data analysis independently. Subsequent to the national regulatory authority, the Nursing and Midwifery initial data analysis, the researchers collaborated and Board Australia. Upon meeting the board’s requirements, identified definitive themes. In accordance with action an “endorsement” is placed on the nurse’s registration. In research principles, the themes were presented at an the state of Victoria, Australia, the term “NP candidate” NP SIG meeting. is used to describe a nurse who has completed or is working toward an accredited master’s program13 and is FINDINGS working in a NP model of practice while receiving Intuitively, it was expected that the sharing of common 26 appropriate clinical supervision. In other states of interests and forming collegial relationships would feature Australia, the term “transitional” NP, as opposed to candiin the results. However, it was particularly evident that, date, is used. A nurse who has completed or is undertakdespite the diverse clinical speciality practice areas of SIG ing specific NP studies with the view to seeking an NP members, there were other commonalities identified in candidacy in the future is considered to be working the responses. A synopsis of the identified themes is reptoward an NP role. resented in Figure 1. Participant inclusion criterion in the research was Respondents acknowledged the opportunity to underconfined to endorsed NPs, NP candidates, and nurses take learning and educational opportunities, networking, www.npjournal.org


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Figure 1. Participant Responses

sharing of resources, and mentoring from members more advanced in their professional endeavors. • Respondent 1: [The NP SIG] “helps nurses to explore opportunities to develop sustainable professional clinical roles with the support of colleagues within a changing and evolving multidisciplinary health care context.” • Respondent 3: “A collective group of like-minded professionals ensures information shared is consistent and accurate.” The respondents were asked what they hoped to gain from belonging to the regional NP SIG. Support and mentoring roles were evident in the responses, as shown in the following extracts: • Respondent 2: “The mentoring approach is positive, supportive, and non-threatening.” • Respondent 3: “The SIG has supported and guided my professional practice…” • Respondent 4: “[The NP SIG is a] place for sharing of experiences throughout the NP process; guide and support for continuing in the NPC [NP candidate] role … a means of being able to debrief with each other when times were not that good.” • Respondent 5: “Support and sharing information and networking opportunities” • Respondent 6: “[Wanted to gain] support and discussion from enthusiastic clinicians in a similar position” One respondent stated that not only was the group effective in meeting members’ expectations, it had in fact “surpassed expectations.” 568


Respondents were asked to list the words they found most applicable to belonging to the NP SIG; again, the responses were remarkably similar in that the terms support (or truncations of), networking, resourcing, mentorship, collegiality, professional, encouragement, leadership, and friendship were repeated by nearly all the respondents. When questioned as to whether they could identify any disadvantages of belonging to the SIG, time was found to be a concern: time to attend the meetings and the timing of the meetings. Given that all the group members work different shifts/days per week, it was hard, particularly initially, to identify a time and day that would suit the majority of the members to schedule meetings. It was noted this was particularly hard for those with a high clinical workload to arrange either time away from direct clinical contact (getting off the floor) or for coverage during their absence. Others found meetings scheduled over lunch breaks suited both the members and their employers as it was not seen to “be taking them away from real work.” Some respondents were unable to identify any disadvantages of belonging to the SIG. One respondent was concerned that stronger personalities of some members may override those that are not so outspoken. The respondent urged the group to foster and maintain a positive focus and environment where expressions of negative experiences could be undertaken in a debriefing atmosphere without fostering negativity toward the overall NP role. Another respondent thought that member negativity may be a deterrent for new Volume 7, Issue 7, July/August 2011

Table 1. Nurse Practitioner Special Interest Group (SIG) Action Research Project Questionnaire 1.

How did you find out about the SIG?

2.

What did you hope to gain from the SIG?

3.

Can you list the words to describe the advantages/benefits of belonging to the SIG?

4.

In one sentence can you describe the most significant benefit/advantage for you personally?

5.

Can you identify any disadvantages of belonging to the SIG?

6.

In one sentence can you describe, if any, the most significant disadvantage of belonging to the SIG?

7.

Do you think the activities of the SIG will/have helped prepare you for the endorsement process? a. If yes, what specific activities have helped; if no, why not?

8.

Would you recommend the SIG to other nurse practitioners or potential nurse practitioners? a. If yes, why; if no, why not?

9.

Does the SIG meet your expectations?

10. Are the any areas in which we can improve the SIG? 11. Do you have any other comments you would like to make regarding the SIG?

members, while another suggested the greater perceived knowledge by some may intimidate others. DISCUSSION The findings reveal the SIG provides members with support, learning and educational opportunities, networking, sharing of resources, and mentoring. This is in accordance with Jipson and Paley’s15 findings, who claim group members benefit from other members’ professional curiosities, subsequent to the group evolving into 1 of critical friends providing support, mutual guidance, and an entrenched culture of collaboration. However, support was found to be the most important function of the NP SIG; support for the members, support by the members, and organizational support. This is congruent with the literature,2,14,15 which identified support as a valuable resource for the professional nurse making the transition to an advanced nursing role. While the negative responses were minimal, they are not to be disregarded. Interpersonal relationships and individual personality types may influence active participation in SIGs, and Lee and Fitzgerald13 found communication can be problematic in mentorship relationships. These are important concepts to be taken into consideration as they may, indeed, hinder a group’s effectiveness. As a result of the research findings, changes to how the NP SIG conducts its activities have been made to further enhance the support and mentoring roles. This is in accordance with the cyclic processes of the action research methodology. www.npjournal.org

LIMITATIONS The sample for this research project was small because the purpose of the project was to determine the effectiveness of a specific NP SIG. In order to attain more definitive conclusions and support for the research findings, a further study would need to be replicated with a larger group. It is anticipated the inclusion of demographic and speciality practice area information would enhance future research in this area of inquiry. CONCLUSION There is a paucity of literature and research in the area of SIGs, particularly those specifically supporting NP role development. While it is recognized that the sample for this research project was small, the participants’ responses support the original assumption that the NP SIG was effective. The findings could be further supported with larger studies that ultimately contribute to the body of nursing knowledge in relation to specific professional forums that aim to further NP development.

References 1. Barker ER. Mentoring: A complex relationship. J Am Acad Nurs Pract. 2006;18(2):56-131. 2. Valdes-Pierce C. Mentoring and networking as survival strategies for novice nurse practitioners. Adv Nurs Pract. 2004;12(11):45-48. 3. Australian Nursing Federation. Special interest groups. Aust Nurs J. 2011:18(5)(suppl-On the Record):2S. 4. Andrews M, Wallis M. Mentorship in nursing: a literature review. J Adv Nurs. 1999;29(1):201-207. 5. Hayes EF. Factors that facilitate or hinder mentoring in the nurse practitioner preceptor/student relationship. Clin Excellence. 2001;5(2):111-118. 6. Block LM, Claffey C, Korow MK, McCaffrey R. The value of mentorship within nursing organisations. Nurs Forum. 2005;40(4):134-140.


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7. McCloughen A, O’Brien L, Jackson D. Positioning mentorship within Australian nursing contexts: a literature review. Contemp Nurs. 2006;23:120-134. 8. Kopp E M, Hinkle JL. Understanding mentoring relationships. J Neurosci Nurs. 2006;38(2):126-131. 9. Hayes EF. Approaches to mentoring: how to mentor and be mentored. J Am Acad Nurs Pract. 2005;17(11):442-445. 10. Doerksen K. What are the professional development and mentorship needs of advanced practice nurses? J Prof Nurs. 2010;26(3):141-151. 11. Mills J, Francis K, Bonner A. Walking with another: rural nurses’ experiences of mentoring. J Res Nurs. 2010;13(1):23-35. 12. Thorpe K, Kalischuk RG. A collegial mentoring model for nurse educators. Nurs Forum. 2003;38(1):5-15. 13. Lee GA, Fitzgerald L. A clinical model for the nurse practitioner programme. Nurse Educ Pract. 2008;8:397-404. 14. Hockenberry-Eaton M, Kline NE. Who is mentoring the nurse practitioner? J Pediatr Health Care. 1995;9:94-95. 15. Jipson J, Paley N. Because no one gets there alone: collaboration as comentoring. Theory into Practice. 2000;39(1):36-42. 16. Tracey C, Nicholl H. Mentoring and networking. Nurs Manage. 2006;12(10):28-32. 17. Curry-Narayan M. Special interest groups: shaping professional practice. Home Healthcare Nurs. 1998;16(11):784. 18. Hicks C, Hennessy D. An alternative for evaluating the effectiveness of continuing professional development courses for health care professionals: a pilot study with practice nurses. J Nurs Manage. 2001;9:39-49. 19. Campoy S. Chronic kidney disease (CKD) special interest group (SIG) networking session. Nephrol Nurs J. 2005;32(4):446-448. 20. Fava G. Unmasking special interest groups: the key to addressing conflicts of interest in medicine. Psychother Psychosom. 2010;79:203-207. 21. Walsgrove H, Fulbrook P. Advancing the clinical perspective: a practice development project to develop the nurse practitioner role in acute hospital trust. Issues Clin Nurs. 2005;14:444-455. 22. McIntyre A. Participatory Action Research. Thousand Oaks: Sage Publications Inc; 2008. 23. Whitehead D. Commentary. J Clin Nurs. 2005;14(8):1032. 24. Stringer E, Genat W. Action Research in Healthcare. Upper Saddle River: Merrill Prentice Hall; 2004. 25. Schoo AMM, Stagnitti KE, McNamara KP. The evolution of a statewide continuing educational programme for allied health professionals. Int J Therap Rehab. 2008:15(2):60-66.

26. Nursing in Victoria. Nurse practitioner fact sheet page. Available at: http://www.health.vic.gov.au/nursing/furthering/practitioner/nursepractitioner-frequently-asked-questions. Updated September 10, 2010. Accessed December 20, 2010. 27. Welsh E. Dealing with data: using NVIVO in the qualitative data analysis process. Forum Qualitative Social Research. Available at: http://nbnresolving.de/urn:nbn:de:0114-fqs0202260. Accessed December 13, 2010.

Kathleen E. Tori, ENP, BHSc, MHSc, CCRN, GradDipVET, MRCNA, MACNP, is a senior lecturer in nursing in the Nursing and Midwifery Section of La Trobe Rural Health School and La Trobe University in Bendigo, Victoria, Australia. She can be reached at [email protected]. Elizabeth Morley, BN, CCRN, GradDip (Critical Care), GradDip(Ed), is Clinical Informatics Specialist, Loddon Mallee Rural Health Alliance, in Bendigo, Victoria, Australia. In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest. Acknowledgment The authors thank the regional Victorian NP SIG members. 1555-4155/11/$ see front matter © 2011 American College of Nurse Practitioners doi:10.1016/j.nurpra.2011.04.003

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