In Quebec, as in the rest of Canada, the increasing service demands placed on emergency departments (EDs), and the dwindling resources of physicians, nurses and trainees, have obliged those managing EDs to question whether new roles need to be introduced. Increasing acuity and complexity of care, coupled with rising numbers of pediatric patients seeking care for non-urgent health issues, have created a need to address long waiting times for non-urgent patients, as well as more standardized care (using approved and evidence-based protocols) for acutely ill patients during their ED stay. Presently, the nurse practitioner (NP) role may be operationalized in Quebec EDs, as recent legislation has cleared the path for its introduction.
Some theorists view the development of a new role such as the NP's as a dynamic process of shared conceptualizations (i.e., expectations and conceptions) that help maintain stable interaction. To succeed in introducing the NP role, and to minimize conflict in the post-implementation phase, it is important to understand the conceptualizations of those most closely involved: the stakeholders. Given the lack of Canadian literature on this subject, a qualitative descriptive design was effected to identify stakeholders' conceptualizations of the paediatric emergency nurse practitioner (ENP) role in the early stages of development. Stakeholders described it as a largely clinical role with other responsibilities, including teaching and mentoring, and minimal research responsibilities to ensure a clinical focus. The stakeholders agreed that they must be involved in the role development process, i.e., implementation must not be a top-down initiative. The results of this study support the view that stakeholders have conceptualizations of the role itself and of the role development process, and that these conceptions guide expectations of both the role and the process. It is imperative for those developing new roles to be well informed about stakeholders' conceptualizations during the early planning phase.
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