Developing the Nurse Practitioner role in a rural Australian hospital ‐ a Delphi study of practice opportunities, barriers and enablers

Objectives To gain a consensus view of potential roles for Nurse Practitioners (NPs) in a rural Australian hospital and identify the barriers and enablers in their development and implementation. Developing the Nurse Practitioner role in a rural Australian hospital ‐ a Delphi study of practice opportunities, barriers and enablers Design A three round Delphi study. Setting A rural hospital. Participants Twenty eight nurses, five doctors, four consumers, two health service managers, two allied health practitioners, one midwife, three community workers, two administrators and three others with hospital affiliation. Main Outcome Measures Consensus at 75% level of agreement or greater, identifying service gaps which might benefit from NPs and the barriers and enablers impacting on the success of developing and implementing the role. Results Introduce mental health, aged and critical care NPs initially. Barriers and enablers identified as impacting on the development and implementation of the role were: Educational access for isolated rural nurses ‐ local cohort learning with employment contracts encompassing fee assistance and designated study time. Acceptance from doctors ‐ supported role provided the proposed service is sustainable. Small teams of NPs would achieve this. Inappropriate Recruitment ‐ NP role matching service need, not individual. Policy and Funding Constraints ‐ clients are best served by NPs working across the care continuum. Co funding by acute and community providers could overcome the current constraints of commonwealth/state payment. Conclusion In developing and implementing NP roles at a rural health service the issues of access to tertiary education, creating a sustainable number of NP positions and financial cooperation from community and acute providers must be taken into account. Only then can nurses who wish to take on this NP role in a rural health service have the possibility of success.