Book Review
Nurse Practitioners: Developing the role in the hospital setting
Shirley Reveley, Mike Walsh and Alison Crumbie
ISBN: 0-750647-61-2; 2001; 168 pages; Butterworth-Heinemann;
Diane J Tofts
Senior Lecturer, School of Nursing and Midwifery,
De Montfort University, Leicester, United Kingdom
It was interesting to read a book about Nurse Practitioners (NP's) which is claimed to be a celebration of the role which has come of age in the United Kingdom. Some practitioners and academics would no doubt challenge this claim as although there have been developments in the introduction of NP's there is still a long way to go. As admitted by the authors this is a role not fully recognised by the UKCC and many nurses adopt this title with no formal degree level educational preparation.
The book is structured into three parts: Part 1 provides an overview of the development of the role in the context of policy initiatives, Part 2 is where nurse practitioners discuss their role and Part 3 looks at the issues of marketing, education and evaluating the role.
In Part 1 the history of the role is explored with particular emphasis on its development in the USA and situates the role within the new NHS as envisioned by the current Labour government. Discussion surrounding the professional and change theory in relation to the role uses well know theories and references and is useful in thinking about these issues about the NP role. In particular the relationship between medicine and nursing is explored with an emphasis on the difference and goals of the two in relation to patient care. It is clear the authors believe the NP role to complement that of medicine rather than be subsumed within it.
The second part of the book is probably the most interesting and gives the reader a true insight into the highs and lows of the role as experienced by two NP's. The first two chapters are written from interviews conducted with the two NP's and include the development of their role, relationships with the other nurses and medical staff and the problems encountered along the journey of their emerging new role. These nurses were the first in their Trusts and so had no benchmarks to work from or experienced people to mentor them and as highlighted it is still senior medical staff who perform the mentoring role. It was also valuable to have the comments from a consultant anaesthetist and CEO on the impact of the role but as a balance the views of other nurses would have been equally valuable.
The last two chapters there is discussion on the plans to introduce a paediatric nurse practitioner and a discussion of the role of the NP in the Accident and Emergency (A&E) setting. The discussion on the development of the paediatric NP role was valuable in highlighting many of the issues and provided useful information for others to consider. The commentary by the American paediatric lecturer was useful to contrast with the UK issues. The discussion of the role in the A&E setting was interesting but would have been improved with anecdotal evidence from a NP working within the area, particularly as this is where the role first developed.
The final part is thought provoking in that it opens up discussion on some of the issues surrounding the nurse practitioner role. The first issue is that of education and recognition by the UKCC. There are vast differences in the levels of education for NP's and until some standardization occurs there will be no benchmarks from which to evaluate the role. The second issue is that of marketing the role and this uses marketing theory to explore the role of the NP encouraging them to audit themselves on a micro and macro level. The final issue is that of evaluating the role to see if what we believe is true. Does this role complement nursing or is it just an extension of medicine? Both qualitative and quantitative research methodologies are discussed along with relevant areas to be included within any project conducted. This needs to be on a large scale to be valid and reliable. A final chapter summarises the conclusions that can be drawn from the book.
Overall this will be a valuable addition to the growing literature base on the role of the NP within the UK. Although aimed at the role within the hospital setting it will also be of value to community practitioners as many of the issues they face are similar in nature. It was easy to read and has a comprehensive index at the front so that the reader can choose which chapters are relevant. It is also a book that you can dip in and of rather than needing to read the whole book to gain any sense of the aim and content.
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