Advanced practice nurses, registered nurses and medical practice assistants in new care models in Swiss primary care: a focused ethnography of their professional roles

Abstract

ObjectivesWe aimed to analyse roles and tasks of advanced practice nurses (APNs), registered nurses (RNs) without advanced practice education and medical practice assistants (MPAs) with regard to chronic care in Swiss primary care (PC). The objective of this study was to explore the potential of new care models, involving these health professionals, which could meet changing future healthcare needs.DesignAn ethnographic design comprising semi-structured interviews and non-participant observations was conducted.SettingHealth professionals who worked in 10 primary care practices in the German-speaking part of Switzerland were included in the study.ParticipantsIn total, 16 interviews were conducted with four APNs, six MPAs, two RNs and four general practitioners (GPs). Nine of the health professionals were subsequently observed in their primary care practice.ResultsAPNs and MPAs were both involved in chronic care in the PC practice. While APNs cared for older, multimorbid patients with more complex needs, MPAs were involved in counselling of younger patients with chronic disease such as type 2 diabetes. Additionally, APNs were involved in many home visits and visits in elderly peoples — and nursing homes. APNs worked with a high degree of autonomy while MPAs had worked mostly in delegation. Task division between GPs and APNs or MPAs was not clear in every case yet.ConclusionsAPNs and MPAs have a high potential to contribute to optimal care in new care models, which address needs of the elderly population. The experience from our sample may inform international health policymakers and practitioners about the tasks and responsibilities those health professionals can take over in PC when implementing new models of care. The practical experience with new models of care involving APNs and MPAs may also influence the future regulation with regard to the scope of practice of these health professionals in Switzerland.

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“…What studies do exist have tended to focus on the tasks undertaken by practitioners rather than report clearly on the processes by which tasks were distributed across clinical teams. 29 …”

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“…37 Moreover, other countrie’s experience with an integrated model that combines APNs and RNs shows that interdisciplinary care approaches are effective for the care of older adults. 38 Therefore, in this context, attention needs to be shifted from hospital to the primary health care to develop and optimize the gerontological nursing staff when implementing integrated care.…”

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“…1 [36]. Dieser hohe Grad an Autonomie von APN wurde auch in einer weiteren Studie beschrieben [14]. Auch auf die Zufriedenheit, das Wohlbefinden der Familienmitglieder von Patientinnen und Patienten von Intensivstationen hatten Verbindungs-und Koordinierungstätigkeiten von APN positiven Einfluss [23].…”