title: Managing the wait: clinical initiative nurses' perceptions of an extended practice role.
abstract: BACKGROUND
  The Clinical Initiative Nurse (CIN) is a role that requires experienced emergency nurses to assess, initiate diagnostic tests and treat and manage a range of patient conditions. In 2010, the New South Wales Ministry of Health redefined the focus of the CIN role to be on waiting room patients. The new CIN role was now focused on the waiting room and to 'communicate the wait', initiate diagnostics and or treatment and follow-up for waiting room patients. While new models of care are often introduced the perceptions of those undertaking the roles are often absent from evaluation. We aimed to explore emergency nurses' perceptions of the extended practice role known as the Clinical Initiative Nurse.
  
  
  METHODS
  This was a multicentre study and formed part of a larger qualitative exploratory study of the CIN role.
  
  
  RESULTS
  Thirty-six interviews were conducted across the three sites. There was no statistical difference between groups for hospital site, ED experience or Clinical Nurse Specialist grade. Three main themes were identified from the data and included (i) managing the waiting room patient; (ii) benefits of being the CIN; and (iii) situational barriers impacting on the CIN role.
  
  
  CONCLUSIONS
  We have provided a deeper understanding of the CIN role and of contextual factors operating in everyday practice. Further research is needed to determine how nursing roles can be sustained, learned, enjoyed and optimised to meet future healthcare goals.
authors.affiliation: Faculty of Nursing, Midwifery and Health University of Technology, Sydney, Australia. margaret.fry@uts.edu.au
authors.forename: Margaret
authors.initials: M
authors.lastname: Fry
authors.forename: Kate
authors.initials: K
authors.lastname: Ruperto
authors.forename: Kate
authors.initials: K
authors.lastname: Jarrett
authors.forename: Janet
authors.initials: J
authors.lastname: Wheeler
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Fong
authors.forename: Wendy
authors.initials: W
authors.lastname: Fetchet
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003441:Crowding; D016529:Emergency Nursing; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006291:Health Policy; D006801:Humans; D007400:Interprofessional Relations; D007588:Job Satisfaction; D008297:Male; D009517:New South Wales; D009722:Nurse Practitioners / Q000523:psychology*; D024802:Nurse's Role / Q000523:psychology*; D009741:Nursing Staff, Hospital / Q000523:psychology*; D062072:Patient Acuity; D017009:Professional Autonomy; D036301:Qualitative Research; D019984:Quality Indicators, Health Care; D014850:Waiting Lists; D016526:Workload / Q000523:psychology