Developing Standards for Specialist Heart Failure Nurses: A Delphi Study

Background: Currently there are 23 funded heart failure (HF) programs across Queensland employing specialist HF nurses. However, the role and scope of practice of HF nurses varies considerably and there are no Australian competency standards to guide this area of specialist nursing. Aim: Through professional consensus, the aim of this study was to identify HF specialist nurse standards of practice. Methods: All 47 Queensland HF specialist nurses were invited to participate in a Delphi Study. Data from a focus group were used to inform development of the survey tool. Consensus statements were grouped within seven domains, and data collected in a three-round survey. Pre-survey consensus was set at 80%. Results: Response rate was 99%. Two survey rounds reached consensus in six domains. These related to required knowledge of: (i) aetiology and pathophysiology of HF, (ii) cardiovascular assessment, (iii) HF guidelines, (iv) diagnostic investigations, (v) device therapy and (vi) specialist HF nursing role. Within the seventh domain, medication management, there is consensus that HF nurses have a role. However, opinions differ regarding independent adjustment of medications. This highlights the need to develop appropriate educational strategies and clarify scope of practice surrounding medication management. Consensus for graded competency standards for HF nurses was achieved. Conclusions: Use of these results to inform the development and evaluation of heart failure nursing standards and education requirements will in turn improve the standard of care for persons with heart failure. Clarification of the role of specialist HF nurses will also assist performance review and career planning.