A primary health care team's views of the nurse practitioner role in primary care

Abstract

The study reported here is one part of a wider study, evaluating the role of the nurse practitioner (NP) in primary care This part of the study focussed on the views of the primary health care team (PHCT) regarding their experience of working with two NPs. A project to place Master's prepared nurse practitioners (NP) in general practitioner practices was undertaken with the intention of more fully meeting the needs of practice populations in a deprived inner city area. The roles were supported and funded by the health authority and the placements were intended to be time limited with placement and funding to be reviewed. The project incorporated a planned evaluation of the role and this included a study of consultation patterns, caseload and this particular element, a study of PHCT members' attitudes to and experiences of the role. A purposive sample of 27 staff were interviewed using a partially structured interview format. Each interview lasted around 30 minutes with two researchers undertaking both collection and analysis of the interview data. Subsequently, an additional six staff were also interviewed in an opportunistic manner, at their request. The ndings identi ed two main foci of the NP; as an 'extra pair of hands' and as a colleague undertaking a different, valuable and complementary service to existing staff. The pivotal role of the receptionist in the integration of the new role in to the practice and the acceptance of it by patients was clear. General practitioners (GPs) exhibited paradoxical views, particularly with respect to problems of throughput; the NP having longer appointments and therefore usually undertaking fewer consultations than GPs in any session, leading to perceptions of an expensive and perhaps less effective service in terms of its effect on the workload. Within the same interview however, GPs discarded throughput as an effective measure of patient care and highlighted the many bene ts of NP consultation. This tension between cost and effectiveness would bene t from more effective analysis and evaluation. The members of the PHCT express many different views, often related to their professional priorities, but all appear to support the NP role enthusiastically, considering it a positive step which bene ts the team, patient care and choice. IntroductionThis paper focuses on a project undertaken in an inner city area, with high levels of socio-economic deprivation, located in the north west of England. The former health authority responsible for primary health care services was concerned that these services were increasingly failing to meet the needs of its local populations. This was felt to be partly due to dif culties in recruiting general practitioners (GPs), and in response to these dif culties, a nurse practitioner (NP) role was conceived as one which might add to the range of services and, thus, choice available for patients. Four GP practices were selected after a bidding process to pilot the development of this role. The pilot project was supported and funded by the health au...

Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care – an integrative review

“…Most considered themselves liable for the care provided by the NP [19,58,60,61,63-65]. An equal amount of findings identified effective communication [70,71,73] as crucial to collaboration.…”

“…In terms of responsibilities, some MPs perceived that NPs were not prepared to take on the level of responsibility appropriate to the NP role [64]. In general, a high level of NP autonomy was a crucial component to collaboration, because limitations in the NP’s autonomy; in particular their inability to prescribe or order diagnostic tests was found to increase the MPs workload and consequently negatively influence collaborative practice [61,65,69,72]. …”

“…Marsden & Street [65] found that MPs valued the benefits for patients of longer consultations with the NP but simultaneously were concerned about the cost effectiveness of those consultations. In a study by Dutch researchers [73], MPs stated that prescribing authority for NPs would be more practical for their collaborative practice but they were hesitant to grant their collaborating NP this right.…”

“…Nurse practitioners were acknowledged as an extra resource for the MPs [69,79] and one MP perceived the NP as a colleague to discuss patients, specifically their psychosocial needs [65]. Medical practitioners in particular valued NPs’ educational and interpersonal skills [17,65,68]. …”

Nurse practitioners in Canada: Beginnings, benefits, and barriers

“…Many of the studies investigating the acceptability of NPs as primary healthcare providers have focused on patients’ views (Enggist & Hatcher, 1983; Hooke, Bennett, & Dwyer, 2001), although some researchers have also carried out focus groups (Wilson, Pearson, & Hassey, 2002) or interviews (Marsden & Street, 2004) with physicians and other healthcare team members. However, it is proposed here that the presence of NPs in the healthcare system will only be beneficial in the long term if the individuals who take on this new role are not only given the means to be effective but also feel themselves to be effective as healthcare providers.…”