Background: Complex health care and doctor shortages have been identified as adversely affecting health care delivery in Australia. The Australian College of Nursing’s White Paper ‘A new horizon for health service: optimising advanced practice nursing’ proposes the use of specialist nurses working to full scope of practice as a partial solution. To date, the impact of specialist nursing roles on care of adult acute hospital patients is yet to be examined.
Aims: To characterise the impact of specialist nursing roles on improving outcomes for patients in Emergency Departments or acute inpatient areas and identify evidence gaps through a scoping review.
Methods: A search of studies published in English between 1 January 2009 to 31 December 2022 was conducted. Systematic reviews, randomised controlled trials (RCTs) and observational studies (cohort and cross-sectional) evaluating specialist nursing roles in treating adult patients with any condition in acute hospital settings were included. Qualitative synthesis of the data then was conducted.
Results: 27 articles were eligible (two systematic reviews, six RCTs and 19 observational studies) which included nurse practitioners, clinical nurse specialist and registered nurse roles.
Nine outcome measures were reported in evaluation of specialist nursing roles: length of stay (reported in n=15; 55.5% of studies), time to assessment (n=8; 30.8%), time to treatment (n=7; 26.9%), mortality (n=6; 23.1%), readmission (n=5; 19.2%), patient satisfaction (n=5; 19.2%), direct healthcare cost (n=3; 11.5%), diagnostic accuracy (n=3; 11.5%), complications (n=4; 15.4%) and documentation of assessment (n=1; 3.8 %). Apart from documentation of assessment, all outcomes demonstrated improvement with specialist nurse roles.
Conclusion: Specialist nursing roles improve a range of outcome measures in adult acute care settings without adversely affecting mortality and complications. Specialist nurses are uniquely placed to meet the demands of increasingly complex health care and provide a safe alternative for medically led health care models.