The cardiac nurse's role: an Australian Delphi study perspective

In Australia, as in many parts of the Western world, technological advances in healthcare have affected the roles of healthcare professionals, including nurses. Cost constraints, efficiency, and effectiveness measures also influence staffing numbers, roles, and skill mix. Specialty nurse education programs are changing, and many are moving from the hospital environment to the higher education sector. Initiatives to introduce the American Advanced Nurse Practitioner role in some environments have begun, although the current advanced practice roles are proving problematic. Specialist professional groups are striving to develop competencies or standards for practice. An understanding of what is required of expert clinicians for practice in complex technological environments such as cardiac care would be useful for both practitioners and academics. A national Delphi study was undertaken to determine what knowledge, skills, and attitudes were required of expert cardiac nurses in relation to technology in the cardiac care environments in both the "real" and the "ideal" worlds of practice. Separate panels of 28 cardiac educators and 42 cardiac nurse clinicians were given a questionnaire of 107 items and asked to indicate on a 6-point Likert scale the importance of each item to the nursing roles in both the "real" and "ideal" worlds. On the final, third round, respondents ranked the three most important items in each of the 13 thematic groups. Overall, the clinicians accepted all 107 items as important to their role, and for the majority of these they, felt that they were performing quite close to their "ideal." This article presents the 32 items for which the clinicians felt the "real" world was quite far from the "ideal" as represented by a gap of > or = 2 between the real and ideal medians. Also, despite being accepted as part of the role through the ideal scores, 21 items achieved a real world median of 3.5 or less, which indicates that in the real world these aspects of nursing are not being valued or practiced to the level clinicians would like. These two sets of items should be of greatest interest to clinicians currently in the role and to those interested in specialty education at all levels.