Background: Clinical specialist (CS) and advanced practitioner (AP) roles have increased in nursing and midwifery\ninternationally. This study explored clinical practice in sites with and without clinical nurse or midwife specialists or\nadvanced nurse practitioners in Ireland.\nMethods: Using a case study design, interview, observational and documentary data from postholding sites (CSs or APs\nemployed) were compared with data from non-postholding sites (no CSs or APs employed). Interviews and observations\nwere conducted with postholders (n = 23), and compared with data from healthcare professionals (nurses or midwives,\ndoctors) (n = 23) in matched services. Interviews were held with Directors of Nursing and Midwifery (n = 23), healthcare\nprofessionals (n = 41), service users (n = 41) with experience of receiving care or working with postholders, and nonpostholders\nin matched services. The data were analysed using Nvivo (Version 8).\nResults: The findings suggest that postholders� practice appeared to differ from non-postholders� in relation to case\nmanagement and service provision. Postholders were seen as having an impact on readmission rates, waiting lists/times,\ncollaborative decision-making, continuity of care and workload management. Postholders� autonomy to manage\ncaseloads was perceived to lead to smoother transition of patients/clients through the healthcare system. Service-users�\nself-reports appeared to appreciate the individualised holistic care provided by postholders. Postholders� role in facilitating\nperson-centred care and promoting inter professional team working, are essential elements in quality care provision and\nin global healthcare workforce planning.\nConclusions: To meet changing healthcare demands, promote person-centred care, and improve service delivery, more\nspecialist and advanced practice posts in nursing and midwifery should be developed and supported within healthcare.
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