Developing a nurse practitioner role for hip fracture care: A journey of challenges

The establishment of the nurse practitioner (NP) role in the Canadian health care system has been challenged by many issues including inconsistent educational preparation, lack of sustainable funding and inadequate planning and implementation. Although the climate for NP role initiation has improved over the last decade, challenges continue for those who currently wish to initiate the role (Kilpatrick et al., 2010). For successful initiation of a NP role, it is important to consider what steps are required and the potential for nurse practitioner care to influence the clinical outcomes of specialized populations. In this paper, a case example of the initiation of the NP role in the orthopedic service of a British Columbia (BC) tertiary care hospital outlines significant steps along an often difficult pathway to successful completion. The main goal of NP role initiation was to improve the clinical outcomes of the hip fracture population. Discussion includes development of the role, a description of how the role is actualized in clinical practice and the initial impact of the role on the acute length of stay of hip fracture patients. Facilitators and barriers to role initiation are discussed including strategies to overcome specific political and health care system obstacles involved in the NP role initiation. Early findings following the initiation of the NP role include a substantial decrease in acute length of stay for hip fracture patients. Results of a questionnaire that explores the perceptions of other health care professionals of the NP role 12 years post initiation shows significant support for the role. (C) 2012 Elsevier Ltd. All rights reserved.