Background

The Faculty of Nursing and Midwifery, one of a few nursing and midwifery faculties worldwide, was established in 1974 by Ms Mary Frances Crowley, for post graduate nursing education, and is situated within the Royal College of Surgeons in Ireland, University of Medicine and Health Sciences (RCSI). The RCSI operates through a network group of university hospitals: Beaumont, Connolly, Drogheda, Cavan/Monaghan, Rotunda Maternity hospital and Cappagh Orthopaedic. Combined these hospitals have registered and candidate ANP/AMPs and caters for general, psychiatric, children and maternity patients/clients.

Literature review

The SCAPE report [1] identified research as the single domain that was under developed within the ANP/AMP role. The drive to establish the forum between the Faculty of Nursing and Midwifery, RCSI and the hospitals within the university hospital network group was capacity building among advanced practitioners as intelligent consumers of evidence-based research and practice. The Nursing and Midwifery Board of Ireland [2] highlighted research as a vital component of the ANP role in its standards for advanced nurse practice. The Institute of Medicine [3]. Report on the future of nursing recognises that barriers exist with respect to advanced practice nurses being able to practice to the full extent of their capabilities. Advanced practice has broadened to include most nursing disciplines and care givers. Advanced nurse practitioners have demonstrated their expertise in several areas. These include exploration of the role of ANPs in leadership [4]; evaluation of clinical nurse and midwife specialist and advanced nurse and midwife practitioner roles in Ireland [1]; barriers to sepsis care [5]; collaboration between a university and hospital network [6]; nursing from the international historical perspectives [7]; ANPs innovative developments in cardiac care [8,9]; nursing regulations [2,10]; nursing fundamentals [11]; and advanced practitioners roles in gerontological nursing and healthy ageing [12].

Grand Rounds has been associated with the medical community since the 19th century when John Hopkins Medical School, USA introduced teaching at the bedside [13]. Doctors learned from colleagues and the multidisciplinary team at the bedside about diagnosis and treatment of various conditions [14]. Participation increased, with the increase in attendance the learning environment had to change, hence the introduction of Grand Rounds in an auditorium as we know it today [15]. However, while medical grand rounds have been in existence since the early 19th century, Nursing Grand Rounds have only been in existence since 1960’s with limited literature published in this area [16,17].

Study Purpose:  These collaborative initiatives between academia and a hospital group depict the journey from the development of the advanced nurse and midwife practice network forum to the formation of the centre for nursing and midwifery advancement to the introduction of nursing grand rounds. The purpose of this academic/clinical practice initiative is to support advanced practitioners in their research, education, and professional development through collaborative engagement between the university and its hospital network. The development of the Advanced Nurse Practice Forum set the seeds for the setting up of the Centre for Nursing and Midwifery Advancement within the Faculty of Nursing and Midwifery RCSI where the Forum was then situated. The third initiative leading from the Forum and Centre was the introduction of Grand Nursing Rounds by Beaumont Hospital, the lead hospital associated with the university. 

Study Aims: The aims are to introduce an advanced nurse and midwife practice network forum and centre for nursing and midwifery advancement to support advanced practitioners working in the university hospital group in their education and professional development, expand their knowledge base through practice-based enquiry and research and act as a conduit for interactions between advanced nurse and midwife practitioners by keeping them up to date with practice and research. This process subsequently led to the introduction of nursing grand rounds in the hospitals.

Methods

Several research methods were employed which led to educational and clinical initiatives being developed and introduced.Braun & Clarkes’ six-step process was the initial research method which was followed by a three phased design incorporating the Initiation, Implementation and Evaluation phases. Focus groups and individual interviews were held.

Phase 1: Initiation Phase incorporated a survey of needs and review of evidence.

Phase 2: Implementation or Scoping Phase was undertaken by face-to-face interviews by the forum coordinator with advanced nurse and midwife practitioners in the clinical environments. Following this Braun & Clarkes’ six-step thematic analysis process was undertaken.

Phase 3: Evaluation of outcomes was undertaken to gain greater understanding of the role, and advanced practice requirements.

Results and Discussion

The Initiation Phase 1 incorporated a survey of needs and review of evidence. The survey of needs was undertaken by the university executive director and hospital director of nursing. The survey was undertaken with advanced nurse and midwife practitioners, clinical nurse managers in the largest hospital in the university group. A sample of 70 nurses responded on-line. Findings indicated the need for:

• Greater acknowledgement of the role of the advanced nurse practitioner
• Harnessing the leadership potential of early and middle career nurses
• Developing the management potential of clinical nurse managers
• Focusing on the governance role of directors of nursing
• Engaging the community of nurses and midwives across the Hospital group through Faculty Fellowship and Membership awards.

The evidence review

A literature review was undertaken by the forum coordinator after which journal articles were analysed and summarised. Abstracts from fifty studies and forty full texts from peer reviewed journals were read. Studies related to the importance of research for the ANP/AMP role, the importance of regulators in advanced practice standards and development and the barriers existing to advanced practitioners being able to practice to the full extent of their capabilities. Capabilities and competencies for practice were explored. The introduction of nursing grand rounds and their importance was explored. However, there is limited literature published in this area.

Phase 2 Advanced nurse and midwife forum network: implementation

Following completion of phase 1, the Forum Network was launched in late October 2017, in the Faculty of Nursing and Midwifery and included hospital advanced nurse and midwife practitioners from the RCSI Group Hospitals. The forum coordinator (MC) was appointed. She highlighted the communication strategy proposed for the Advanced Practice Forum. From its initiation in 2017 to the present day the forum coordinator provides:

• Educational, academic and practice related research by facilitating professional enquiry and research-based material. Research is being accessed through EBSCOS library support and includes Cinahl and PubMed publications.
• Professional and informal relationship developments through seminars presented by expert advanced nurse practitioners.
• Advanced practitioners with supports in fostering and linking professional networking within the forum. 
• Research knowledge advancement by providing research articles that support clinical practice through regular Research Newsletters (Table 1). 

Table 1: Advanced Nurse and Midwife Practice Network Forum.

Phase 3 Scoping for Centre for Nursing and Midwifery Advancement

In 2019, Prof. Thomas Kearns, Executive Director of the Faculty of Nursing and Midwifery proposed the development of a Centre for Nursing and Midwifery Advancement (the CFNMA) to the Board of the Faculty. This proposal was accepted and in September of that year, a Steering Group meeting of key stakeholders from across the Hospital Group was convened to determine the feasibility of the proposed center. Arising from the Steering Group meeting, a detailed scoping exercise was deemed the most appropriate research method across hospital sites by the ANP Forum coordinator. 

Scoping Review

A Scoping review was chosen as it can provide important insights into the evidence obtained, concepts or terms used and reported upon to highlight knowledge gaps and identify areas for subsequent evidence syntheses as engagement with stakeholders during the interview process would enhance effective knowledge translation [19] Including a consultation exercise in this study and using thematic analysis to interpret and analyse findings should enhance the results thus making them more relevant to nurse practitioners and other stakeholders [18]. Thematic analysis is a flexible research method that organises qualitative data into themes [19] that respond to the purpose of the study research. There are various approaches to conducting thematic analysis, but the most common form follows a six-step process which is used in this study (1) familiarisation which is reading through the text and taking initial notes, and looking through the data to get familiar with it (2) coding means highlighting sections of text, usually phrases or sentences and coming up with codes to describe their content (3) generating themes (4) reviewing themes by comparing themes with text and (5) writing up analysis of the data. An inductive approach was used as it allows the data to determine themes [19].

Method

This involved 8 focus group meetings with 42 nurses, midwives, managers, clinical specialists, advanced practitioners, and clinical educators. Ten interviews were also conducted with Directors of Nursing and Midwifery, Directors of Nursing and Midwifery Planning and Development Units, Project Officers, and Educational Technologists.

Findings from Scoping Exercise

Scoping exercise results indicate that nurses and midwives across the RCSI Hospital Group fully support this initiative. Findings from focus groups and interviews resulted in eight key themes and recommendations.

• Support for the initiative to set up the Centre for nursing and midwife advancement
• The goal of the Centre should be based on supporting hospital nurses in their professional development
• Support advanced nurse and midwife practitioners in research and publication of their research
• The core competences of the Centre should incorporate values and ethical approaches to care
• Focus on engagement, retention, recognition, and reward
• Focus on encouraging all grades of staff to participate in ongoing learning
• Focus on life-long learning through education and research
• Continued development of nurses and midwives of all levels. Under each of these eight areas, initial focus areas were identified.

Aims of Centre for Nursing and Midwifery Advancement

The Centre aims to ensure that nursing and midwifery initiatives are encouraged, recognised and effectively advanced for the betterment of the professions and society. This aim is supported by the Institute of Medicine Report on the future of nursing [3] which suggests that nurses and midwives will benefit from expanding opportunities to lead. The Centre aims to support the continued expansion of competence and capability of nurses and midwives in the RCSI Hospital Group. This will be achieved by diffusing and disseminating collaborative improvement initiatives in supporting interdisciplinary and multi-disciplinary collaboration and in sharing knowledge across the hospital group [20]. 

The Centre will promote accountability, involvement, commitment and excellence in clinical practice, an aim also supported by the Nursing Now Campaign. The Centre will support and develop nursing and midwifery practice while highlighting and celebrating nursing and midwifery success about patient care quality improvements, CPD, Leadership, Practice Development and Research and which will be shared across the Hospital group through coordination by the Centre.

Next Steps:

The next steps extended the ANP/AMP Network Forum by its inclusion in the RCSI Centre for Nursing and Midwifery Advancement, within the Faculty of Nursing and Midwifery, in 2022. A further survey of senior nurse and midwife managers from across the hospital group was undertaken to rate individual areas of focus identified in the initial scoping exercise according to importance and urgency. Results indicated that a focus on recruitment and retention, continuing the specialist and advanced practice forum, and providing supports with publishing were the most highly rated areas of focus.

Based on the results of this survey and guided by the Steering Group and Directors of Nursing and Midwifery from across the Hospital Group, the Centre set about promoting a participatory, partnership and collegiate collaboration across the Group, Faculty, and partner services. This iterative approach was intended to compliment the current work of partners including the Nursing and Midwifery Planning and Development Units (NMPDUs), individual hospitals and Hospital Centres for Nursing and Midwifery Education, whilst also engaging the interdependencies of other Faculty functions such as the mCPD project, e-portfolio, and Centre for Research Excellence. It was envisaged that the Centre would support and develop nursing and midwifery practice while highlighting and celebrating success by ensuring that nursing and midwifery initiatives are encouraged, recognised and effectively advanced for the betterment of the professions and society [6].

Introducing Nursing Grand Rounds

The final initiative developed by Forum ANPs was the introduction of Nursing Grand Rounds. Beaumont Hospital’s Advanced Nurse Practitioner (ANP) Network developed an educational platform for Advanced Nurse Practitioners (ANPs) and Clinical Nurse Specialists (CNSs) in 2021, called “ANP & CNS Grand Rounds”.

Approval was obtained from the Nursing and Midwifery Board of Ireland (NMBI) and the Director of Nursing. The sessions take place in the traditional ‘Grand Round’ format, accompanied initially with a virtual component, in 2021, thus allowing for social distancing but then maintained to allow colleagues to participate when off the hospital site. These sessions involve ANP / CNS speakers presenting in an auditorium on their service, scope of practice, governance, and case studies. Expert guest speakers are periodically invited. Grand Nursing Rounds are held bi-monthly, organised by ANPs in the forum hospitals and attended by clinical nurse specialists. The ANP Network Forum coordinator supports Grand Rounds by her attendence and presentation of research newsletters. An email is sent fortnightly to all ANPs, and CNSs outlining upcoming speakers and includes a virtual link. On arrival at each session, a QR code is scanned by each attendee which captures attendee numbers and allows for administering continuing educational credits (CEU) 6 monthly.

Phase 3: Evaluation by Focus groups and interviews

Outcomes from Advanced Nurse Practice Network Forum:

Findings suggest that ANP/AMPs wish to enhance their research capability but due to their heavy workload burden and sometimes difficulty in accessing research they face challenges in doing so.

Research indicates that advanced practitioners are working in complex clinical environments. Findings also indicate that they welcomed the development of an initiative that promotes research, is relevant to their practice and is easy to access. Following this positive response a Steering Group was set up amongst leading nurses and midwives in the Network Group Hospitals to maintain momentum and make decisions regarding future speakers and educational and research initiatives.

Outcomes from Centre for Nursing and Midwifery Advancement for the RCSI Hospital Group

Outcomes include:

Supporting the leadership potential of early career nurses and midwives through initiatives such as the Nursing and Midwifery Challenge and through ANP Forum research newsletters which regularly track leadership developments occurring in advanced nurse and midwife practice.

Enhancing recognition of the contribution of nurses and midwives through the DAISY awards and development of the midwifery award, presented for excellence in clinical care delivery.

Engaging the community of nurses and midwives across the Hospital group through faculty Fellowship and Membership awards and programme of events, all of which are promoted and discussed during Nursing Grand Rounds and in newsletters.

Empowering practice, innovation, and advocacy by supporting nurses and midwives to work to the full extent of their competence through initiatives such as the Clinical Bursary Awards.

Supporting interdisciplinary collaboration and the generation, sharing, and disseminating of knowledge through initiatives such as Advanced Nurse Practice Grand Rounds and PhD Scholarship awards (Figure 1).

Figure 1: Outcomes from Centre for Nursing and Midwifery Advancement for the RCSI Hospital Group.

Outcomes from Nursing Grand Rounds: Multiple benefits have been observed from this educational platform: the most obvious being an uncomplicated way to incorporate continuous professional development into the nurse’s week. For the novice public speaker, it is a friendly forum to begin their presenting career where confidence and competence regarding the art of public speaking can grow and flourish [21-24]. It is also a place where seasoned ANPs and CNSs can provide mentorship, advice, and guidance to those starting on their journey as ANPs or CNSs.

Conclusion

Advanced nurse and midwife practitioners seek to extend their research capability and welcomed this collaborative initiative as enhancing research and practice innovation. Advanced nurse and midwife practitioners acknowledge that the ANP Forum and Centre for Nursing and Midwifery Advancement supports them in their clinical practice, education and research and that the Grand Nursing Rounds and newsletters are relevant to practice. ANP/ AMPs and CNSs acknowledge the work of the Forum as supporting them in their clinical practice, education and relevant research.

RCSI strategic hospital group managers welcome this resource as being strategic, supportive, and relevant to ANP/AMPs and to their practice. Outcomes include supporting interdisciplinary collaboration and the generation, sharing, and disseminating of knowledge through initiatives such as the Advanced Nurse Practice Network Forum, Centre for Nursing and Midwifery Advancement and Advanced Nurse Practice Grand Rounds.

Implications for Nurses and Managers

The ANP Forum, Centre for Nursing and Midwifery Advancement and Nursing Grand Rounds demonstrates the importance of having a collaborative university-hospital based approach in supporting advanced practitioners in their professional nursing practice and serves to enhance patient care through advanced education and research. 

Acknowledgements

The university and hospitals extend thanks to all grades of nurses and midwives who gave their time to take part in the focus groups, individual interviews and meetings involved in the development of this innovative model of collaboration. Thanks also to the Faculty of Nursing and Midwifery Deans and Board members, and Faculty administration for their continued support.

Ethical

Approval was not needed as patients were not involved at any stage. Staff gave their approval by participating in the study.

Funding

There were no funding implications or requirements.

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