The global increase in advanced nurse practitioner (ANP) roles has been driven by medical workforce shortages, as well as a desire by nurses for career progression and to improve patient care. In the UK, the role has experienced widespread ambiguity regarding titles, educational standards, scope of practice, and regulation. One healthcare setting that has recently introduced the ANP role is the emergency department (ED). EDs are under increasing pressure due to our aging population and subsequent increase in long-term conditions.
Knowledge mobilisation (KM) research aims to understand how knowledge is created and adapted to the local context, how it is implemented in practice and factors that influence those processes. Knowledge may be formal (research and guidelines), or informal (experiential and contextual). Clinicians are more likely to use new knowledge if it is relevant to their practice and processed through discussions with colleagues.
The objectives of this PhD study were to understand the ANP role in the ED context, to explore processes of KM and identify factors that facilitated KM in discharge decision-making by ANPs. An ethnographic methodology was used in order to gain rich, in-depth data, in context. Observations and semi-structured interviews were undertaken in an ED in a large teaching hospital in the north of England. Five ANPs were observed in their clinical work over a 10-month period and ANPs, senior nurses, and ED consultants were interviewed (n=13). Data was transcribed and analysed thematically.
A theoretical framework was developed to help explain the findings, incorporating clinical mindlines, boundary blurring, and legitimate peripheral participation. Findings are presented in three key themes; knowledge in practice, knowledge in boundary blurring, and knowledge in situated learning. The findings will inform ANPs, employers, educators, researchers, and policy makers about the mechanisms used by ANPs to access knowledge, the importance of local agreement on the position of ANPs on a boundary blurring continuum, and the facilitators of situated learning in an inter-professional community of practice.
