title: Experiences of working as an advanced practice nurse in Finland--the substance of advanced nursing practice and promoting and inhibiting factors.
abstract: BACKGROUND
  Evaluation of new advanced practice nursing roles, from different angles, is strongly recommended in the literature. New nurses' experiences of working in an advanced role may highlight problems and/or factors that promote or inhibit a successful implementation of new advanced nursing roles.
  
  
  OBJECTIVE
  To explore advanced practice nurses' experiences of the content of their nursing care and to describe promoting or inhibiting factors for working with a full scope of advanced nursing practice.
  
  
  METHODS
  The study design was explorative and descriptive. A total of 24 advanced practice nurses participated in focus group interviews (two were interviewed individually) about the processes, structure and outcome of working as advanced practice nurses. Qualitative manifest content analysis was used for data analysis.
  
  
  RESULTS
  The substance of advanced practice nursing can be described with three main themes: a broader and deeper holistic view of patients' state of health, an independent and responsible manner of working and knowing own limits. Promoting factors were an identity as a nurse with advanced competency, feedback from satisfied patients and fruitful teamwork is a necessity. Inhibiting factors were a lack of organisational understanding for advanced nursing practice, poor planning leads to unsatisfactory advanced practice nursing models and advanced practice nurses' lack of courage in adopting new advanced roles.
  
  
  CONCLUSIONS
  The participants experienced both a personal inner transition and a role transition that were either supported or opposed. Vague or nonexistent definitions and concepts, insufficient knowledge, insufficient support and undefined roles hindered participants' role transition. Two main strategies should be employed. The first is the realisation of more strategic leadership and support from organisations on all management levels, including nursing organisations/unions, while the second is to more realistically prepare future advanced practice nurses for the challenges they will face, through mentorship programmes and continuous further training.
authors: Vaasa Central Hospital, Vaasa, Finland.|Åbo Akademi University, Vaasa, Finland.
authors: Carola
authors: C
authors: Wisur-Hokkanen
authors: Novia University of Applied Sciences, Vaasa, Finland.
authors: Ann-Louise
authors: AL
authors: Glasberg
authors: Vaasa Central Hospital, Vaasa, Finland.
authors: Carita
authors: C
authors: Mäkelä
authors: Buskerud and Vestfold University College, Drammen, Norway.|Åbo Akademi University, Vaasa, Finland.
authors: Lisbeth
authors: L
authors: Fagerström
mesh_terms: D000328:Adult; D057179:Advanced Practice Nursing; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005260:Female; D005387:Finland; D017144:Focus Groups; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role / Q000523:psychology*; D009741:Nursing Staff, Hospital / Q000523:psychology*
keywords: advanced nursing practice; competence; content analyses; focus groups; holism; responsibility; role transition