Expanded practice roles for community mental health nurses in Australia: Confidence, critical factors for preparedness, and perceived barriers

As the momentum for nurse practitioner roles rapidly increases in Australia, little scholarly attention has been directed towards barriers to role expansion, the confidence necessary to undertake expanded practice roles (other than prescription of medication), or the educational preparation required for expanded roles. This paper reports on community mental health nurses' views regarding confidence to undertake expanded roles, their opinions regarding the necessary preparation for such roles, and barriers to role expansion. An questionnaire was administered to 296 community mental health nurses employed in metropolitan and rural settings in Victoria, Australia. In regards to various domains of expanded practice, nurses were least confident about prescribing but more than half (54%) reported that they would either "definitely" or "probably" feel confident. Over 90% reported "probably" or "definitely" feeling confident to make recommendations for involuntary treatment. Eighty-four percent and 79% reported similar levels of confidence in relation to ordering diagnostic tests and referring patients to medical specialists, respectively. Most (95%) agreed that extra educational preparation was necessary in relation to undertaking expanded practice roles successfully. Factors considered most strongly as barriers to expanded nursing practice included the medical profession, followed by fear of litigation, and government departments and policies.