Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
Another significant and positive aspect of role expansion is the
advocacy of responsibility, autonomy and accountability in nursing
practice. Wiles et al (2001) found that nurses working in the unit
perceived the high level of autonomy and responsibility had led to
enhanced skills and confidence in their ability to make decisions
regarding their patients’ care. Wilson-Barnett et al’s (2000)
observation of the Advanced Nurse Practitioner roles found that
nurses believed that a major change in their role involves the
enhanced level of clinical autonomy and responsibility in not only
the care of the patients, but also in initiatives to develop and
improve the clinical environment, such as development of new
protocols, encouraging the use of evidence-based practice and the
professional development in colleagues.
However, nurses are also expressing concerns in relation to these
new roles. Studies into nurses’ views of role extension and
expansion have presented indication of confusion regarding the
concepts (An Bord Altranais 1999, Bowler and Mallik 1998). In An
Bord Altranais (1999) study, nurses had difficulty in articulating
precisely the difference between role extension and role expansion.
This finding is supported by Bowler and Mallik’s (1998) qualitative
study, which showed that respondents were unable to provide a
clear definition and differences between the concepts.
In addition, studies have shown that nurses believed that the
developments of nursing roles have been in response to changes in
other healthcare professions, especially medicine (Richardson and
Cunliffe 2003, Calpin-Davies and Akehurst 1999). Crinson (1995)
found that role expansion was also developed as a response to
providing medical cover for junior doctors who were reducing their
working hours. The findings from Crinson’s study are supported by
An Bord Altranais (1999) review which highlighted nurses’ views
that the development and expansion of nursing roles should be
orientated around the philosophy of nursing rather than as a
reaction to changes in other professions, which has occurred to
date.
Another barrier to the development of nursing roles through role
extension and role expansion is the perception of increased
litigation in performing these new roles (Jowett et al 2001, Tye and
Ross 2000, William and Sibbald 1999, Bowler and Mallik 1998,
Edwards 1995). Tye and Ross (2000) found that nurses as well as
doctors recognized the pressure that Emergency Nurse
Practitioner’s experience in ensuring that they practice safely in
order to avoid legal claims of negligence from patients. Both
professions felt that nurses were more at risk of this then the
doctors.
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