To understand the issues surrounding mentorship for specialist practitioners, it has been necessary to split the two concepts in order to review the literature. This was a necessary decision as a widespread literature review found little information relating the mentorship for specialist practitioners. However, there was a large amount of literature relating to mentorship and within the domain of nursing, paramedic practice and business.
It is prevalent for the purpose of this literature review to understand what a specialist practitioner is and how this role compares from the traditional paramedic role, thus highlighting the need for an examination of a specialist practitioner mentorship program. If it is at all possible separating differences in roles, practice and scope it is prudent that further support in the form of a mentorship program might be useful when taking on expanded roles and responsibilities. This review will collate, acknowledge and critique the literature surrounding mentorship and advanced practice. Separating and examining both two concepts should allow for them to be fully explored before collating them two together to generate new understanding and knowledge.
Literature Search Strategy/Methods
The literature review was undertaken to investigate and identify problems that might have existed within a small subsection of a unit that I work within. It was envisaged that the information generated would build upon already existing structures that coexisted. It was also envisaged that the literature review provides the reader with background knowledge of specialist practice. Whilst the study advances results from the research can be linked back to current literature to determine comparisons (Burns and Grove 2005). Journal databases were utilized as an initial starting point for the literature review due to them providing vast amounts of information (Murphy 2005).
Electronic journals were accessed through MEDLINE and CINAHL, both of these searches initially dated back to 1980 up to the current day; the ease of access to the full journal and them being current makes them a valuable source of information (Ridley 2008). Key words using smart text were first used and these consisted of “advanced practitioner”; “paramedic” and “mentorship or mentor” this search produced a result of 13,725 articles. To narrow down the search a more advanced search was utilized which consisted with ‘+’ within the searches for example “paramedic+mentor” “advanced+practitioner+mentor” and lastly “specialist+paramedic+mentor” which all gave be more systematic response.
The same process was used on the university website SUMMONS which also looked at texted books relating to advanced practice and mentorship. Initially literature that was over 15 years old was excluded, however it quickly became evident from my search that a lot of the authors were frequently referring to original works. Due to this it was decided that original texts would be included in the work. Abstracts were read online and if they were relevant to this dissertation they were taken in full. To this end, Chain-referral sampling also known as snowballing was adopted. This entailed reading articles that seemed relevant and from that article it led to other relevant works/articles. Lastly the same keywords were used via the internet on the Department of Health website and any relevant documents were sought and used
In January 2000 Douglas Chamberlain, then Chairman of the Joint Royal Colleges Ambulance Liaison Committee highlighted that there was a short fall of provisions in the prehospital setting and that there was a need for an advanced practitioner role in emergency care, Douglas Chamberlain envisaged advanced practitioners would work in advanced autonomous positions and provided healthcare at an advanced level, (Scott and Carney 2004). Health Education England also describe Advanced Clinical Practitioner/Specialist Practitioners as professionals with an enhanced knowledge base that can decipher complex decision making, obtaining and maintaining clinical competencies for extended autonomous scope of practices (Sujan et al. 2017).
Since the Douglas Chamberlain report, the title Paramedic has advanced somewhat from its initial set up and has crossed many interprofessional boundaries in that time. Its role has produced numerous titles in the last decade for example Critical Care Paramedic (CCP), Emergency Care Practitioner, Advanced Paramedic, Helicopter Paramedic and Hazardous Area Response Team (HART) Paramedic (Seel and Turner 2016).
The concept of advanced practice, the role remains high on the national and global agenda, with practitioners participating in a variety of different roles which improving patient outcomes. Studies have shown that specialist practitioners improve patient care, patient outcomes, and patient satisfaction and improve departmental health care delivery (Litaker et al. 2003).
Still to this day there remains a compounded problem in that there is not a conclusive definition of what an advanced clinical practitioner should be, or the standards required to be one. What compounds the argument further is that confusion still exist surrounding job roles and titles of advanced practitioners as nationally there is a variance on the range of titles and clinical skills one can perform (Woollard 2015).
This can lead to confusing other health care professionals and patients (Martin 2007). The future of Advanced Clinical Practice is currently still in its infancy as at a national level titles and roles remain varied. However, advanced practice continues to grow in response to the influences of health service reforms and the overview of health care policies directed towards developing patient-led services situated in primary care and changes in working conditions (McGee 2009).
Advanced practitioners working within these levels understand there are a range of differing titles and there is a lack of standardisation of what an advanced practitioner should be. The common theme that stands out is that these individuals should possess a higher level of education and should be experienced in their area of practice.
Advanced clinical practitioners/specialist practitioners are now becoming well established throughout the NHS to have an active role in implementing and working towards sustainability and transformational programmes. They can have a direct impact on the development and implementation of local plans to address sustainability and quality issues of the general/emergency practice they work in, including workforce and workload issues (Thomas 2016) The sustainability of the role has still some way to go before it is fully imbedded nationally, organisational support of the role is crucial for it to be successful as in the past this has been highlighted as one of the major barriers of advanced clinical practice sustainability. Funding including frameworks and clinical governance are also seen as vital steps towards the sustainability of the role. Lastly mentorship programmes have also been highlighted to be a valuable method of ensuring that role progression occurs (Keating et al. 2010).
“Organizations are most effective when the teams responsible for the organization’s success are performing to their maximum potential. If the relationships within a team work well, and all team members have a clear focus, this has a significant positive impact on achieving goals and delivering results” (Hawkins 2014).
(Mason et al. 2006) has indicated that there have been 17 operational trials that have taken place nationally, from which paramedics/nurses have had their skills extended through educational programs. The feedback has been promising from the areas where the schemes have been managed accordingly, indicating that providing clinicians with the appropriate knowledge and skills improves patient care and satisfaction. (Halter et al. 2006) states that advanced care that is provided is better than the standard care a paramedic can provided due to the thoroughness of assessments and options available. (Castledine and McGee 1998) state that demonstrating an extended breadth and depth of knowledge requires more than just experiential knowledge but also requires a level of critical thinking and analysis.
The Scottish Executive (2008) has simplified the terminology stating that a clinician operating at an advanced level can be either a specialist or generalist. It states that it is the level that the clinician is practicing at that determines if they are advanced or not. So, a specialist practitioner can be classified as being advanced-specialist or advanced-generalist, the significant aspect of this is not what job/role they have but whether they have the educational and experiential backing to verify they are indeed advanced. In terms of HART specialist practitioners, most of the team members have a wealth of operational experience but lack in further education in terms of post graduate qualifications, as this has never been a necessity in HART.