title: Cardiovascular disease management: time to advance the practice nurse role?
abstract: OBJECTIVE
  More than two-thirds of health expenditure is attributable to chronic conditions, of which a significant proportion are related to cardiovascular disease. This paper identifies and explores the factors cited by practice nurses as impacting on the development of their role in cardiovascular disease management.
  
  
  METHODS
  Sequential mixed methods design combining postal survey (n = 284) and telephone interviews (n = 10) with general practice nurses.
  
  
  RESULTS
  The most commonly cited barriers to role extension were legal implications (51.6%), lack of space (30.8%), a belief that the current role is appropriate (29.7%), and general practitioner attitudes (28.7%). The most commonly cited facilitators of role extension were collaboration with the general practitioner (87.6%), access to education and training (65.6%), the opportunity to deliver primary health care (61.0%), a high level of job satisfaction (56.0%) and positive consumer feedback (54.6%).
  
  
  CONCLUSIONS
  Australian government policy demonstrates a growing commitment to an extended role for general practice in primary health care and cardiovascular disease management. In spite of these promising initiatives, practice nurses face a range of professional and system barriers to extending their role. By addressing the barriers and enabling features identified in this investigation, there is potential to further develop the Australian practice nurse role in cardiovascular disease management.
authors.affiliation: School of Nursing, University of Western Sydney, Locked Bag 1797, Penrith South DC, Sydney, NSW 1797, Australia. e.halcomb@uws.edu.au
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Halcomb
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
authors.forename: Rhonda
authors.initials: R
authors.lastname: Griffiths
authors.forename: John
authors.initials: J
authors.lastname: Daly
mesh_terms: D000328:Adult; D001315:Australia; D002318:Cardiovascular Diseases / Q000451:nursing*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role