It is not often that a research question has the potential of provoking different reactions from two separate professions. However, the quest for answers to this important question is not sought by asking physicians nor nurses with advanced and specialist skills nor persons with heart failure (HF). It is undertaken by a systematic and careful research methodology which gives credence to this welcome and timely review. By reviewing and analysing existing research papers, answers relating to the following five important aspects of care were examined: mortality; hospital admissions and length of stay; HF diagnosis and management; quality of life and patient satisfaction, as well as self-assessment and self-care.
It could be said that there were too few studies of sufficient methodological quality to draw definitive conclusions. However, one key conclusion was that there was no evidence suggesting that nurse-led services are any less effective or less safe than physician-led services. Equally significant is the evidence that clinical nurse specialists (CNSs) and advanced nurse practitioners (ANPs) compared to physicians have a superior impact on patients who live with HF in terms of facilitating and supporting them individually.
To be able to make an informed comparison of ANPs’ and physicians’ impacts on people with HF, an understanding of the dimensions of the roles of ANPs is required. The paper demonstrates the importance of this as well as standards which are achieved through experience and education by referring to the UK’s Royal College of Nursing (RCN) accreditation and credentialing work. Its demanding standards make this a valuable benchmark for employers; however, not every ANP is seeking to be accredited by the RCN. Considering that the paper will be reaching out across countries, it should be noted by the reader that the Nursing and Midwifery Council (NMC), which is the regulator of nursing and midwifery in the UK, does not have a register for ANPs.
The review refers to two nursing job titles: CNS and ANP, whose impact on patients with HF can be compared with those of a physician. The authors make a valid attempt to state the difference between the two roles and recognise that there is yet no conformity about their scope of responsibility, level of experience and education across the UK and further afield. This can lead to confusion amongst employers and has the potential to increase risk by substituting ‘working in a speciality’ with ‘being a specialist’ which contributes to the undervaluing of the status ANPs (or CNSs).
Despite the narrow but important focus on outcomes affecting only persons with HF, this review demonstrates that the five aspects of care that were examined are relevant and have led to important key points for future policy, practice and/or research to be considered. A further benefit of the research is that the outcomes could equally inform or be adapted for future research to other ANPs and CNSs working in different specialist fields.
Biography
Jacqueline Filkins works as an independent nursing advisor within Europe. She has worked in Switzerland, Africa, Madagascar, the UK as Senior Clinical Nurse, Director of Nursing, Dean of Faculty.