Blending Specialist and Practitioner Roles in Psychiatric Nursing: Experiences of Graduates

BACKGROUND: Blended roles in advanced practice nursing have generated much discussion but little study. As role modifications emerge in nursing, there is a need to explore their implementation. OBJECTIVE: This descriptive study examined the experiences of nurses who were implementing blended roles as psychiatric clinical specialists and adult nurse practitioners. DESIGN: Four master of science in nursing and 10 postmasters nurses who had been practicing in blended roles for 1 to 2 years were interviewed about their experiences in implementing their roles. Interviews were tape recorded, transcribed, and content analyzed. RESULTS: Respondents believed they were practicing holistically, were able to appropriately integrate physical and psychological care of the patient, and found chronic psychiatric patients to have more complex physical illnesses than they had anticipated. In addition, the advanced practice nurses were satisfied with their roles, felt supported by their physician preceptors, and described cross-consultation with physicians and nonpsychiatric nurse practitioners. CONCLUSIONS: There are roles for advanced practice nurses who blend clinical specialist and adult nurse practitioner skills in the care of psychiatric and primary care patients.

Documenting Patterns of Nursing Interventions Using Cluster Analysis

Use of inferential statistics in research applications of the Nursing Intervention Classification has been rare, yet use of these statistical techniques is needed to answer questions related to intervention patterns. Using data from a descriptive study of 3,733 visits documented by 19 adult nurse practitioner students, hierarchical agglomerative cluster analysis was used to determine whether meaningful nursing intervention patterns could be depicted. Eight intervention clusters were derived, replicated, and validated. Clusters of intervention classes differed in the type of nursing and medical diagnosis, amount of time the nurse spent during the visit, cost of visit, and the age of the patient. Clustering supported the utility of standardized nursing diagnosis and intervention typologies to identify actual practice patterns of adult nurse practitioner students. Cluster analysis is a valuable data analysis strategy when analyzing multiple related variables.