An activity analysis of Dutch hospital-based physician assistants and nurse practitioners

Abstract

BackgroundThe physician assistant (PA) and the nurse practitioner (NP) were introduced into The Netherlands in 2001 and 1997 respectively. By the second decade, national policies had accelerated the acceptance and development of these professions. Since 2015, the PA and NP have full practice authority as independent health professionals. The aim of this research was to gain a better understanding of the tasks and responsibilities that are being shifted from Medical Doctors (MD) to PAs and NPs in hospitals. More specifically in what context and visibility are these tasks undertaken by hospital-based PAs and NPs in patient care. This will enable them to communicate their worth to the hospital management.Study designA descriptive, non-experimental research method design was used to collect and analyze both quantitative and qualitative data about the type of tasks performed by a PA or NP. Fifteen medical departments across four hospitals participated.MethodsThe patient scheduling system and hospital information system were probed to identify and characterize a wide variety of clinical tasks. The array of tasks was further verified by 108 interviews. All tasks were divided into direct and indirect patient care. Once the tasks were cataloged, then MDs and hospital managers graded the PA- or NP-performed tasks and assessed their contributions to the hospital management system.FindingsIn total, 2883 tasks were assessed. Overall, PAs and NPs performed a wide variety of clinical and administrative tasks, which differed across hospitals and medical specialties. Data from interviews and the hospital management systems revealed that over a third of the tasks were not properly registered or attributed to the PA or NP. After correction, it was found that the NP and PA spent more than two thirds of their working time on direct patient care.ConclusionsNPs and PAs performed a wide variety of clinical tasks, and the consistency of these tasks differed per medical specialty. Despite the fact that a large part of the tasks was not visible due to incorrect administration, the interviews with MDs and managers revealed that the use of an NP or PA was considered to have an added value at the quality of care as well to the production for hospital-based medical care in The Netherlands.

The cost-effectiveness of physician assistants/associates: A systematic review of international evidence

“…In none of the articles did the researchers relate the SoP to the fourth goal in the “quadruple aim” of healthcare (i.e., taking care of health professionals) [ 60 ]. That raises the question of whether the performance of any procedure contributes to the experience of joy in their work as healthcare professionals [ 61 ]. However, the analysis of a half-century of PA job satisfaction literature suggests that almost all PAs find their role satisfying [ 62 ].…”

Willingness of medical students to refer patients to a physician associate or a doctor based on clinical scenarios when time is a trade-off

“…[26,27] In some settings the focus is more on task shifting. [28] Thus, PAs are included as part of the solution to workforce shortages. [29] The flexibility of the PA role, where he or she is able to step in for doctors to allow them more time on direct patient care, was evaluated as a key benefit for multidisciplinary teams, and concurs with other PA research.…”

“…[29] The flexibility of the PA role, where he or she is able to step in for doctors to allow them more time on direct patient care, was evaluated as a key benefit for multidisciplinary teams, and concurs with other PA research. [26,[28][29][30] The PA can provide a range of medical skills to support the clinical team allowing the right person to see the right patient, e.g., freeing the consultant or senior doctor up to see more complex patients. In addition the PA can be flexible with taking over the duties of junior doctors who are required to attend training sessions.…”

Napredno timsko delo v zdravstvu, kombinacija znanja in spretnosti: pregled literature

“…Often, a higher number of registered nurses is associated with a positive patient experience (Oppel and Young, 2018) and better quality of patient care (Bridges et al, 2019). Nurses with advanced degrees are included in teams with medical assistants and take on more complex tasks (van den Brink et al, 2019). Other personnel is also involved in patient care teams, such as neonatal health assistants (Leary and Punshon, 2019), laboratory technicians, pharmacists, environmental experts (Rumisha et al, 2020), physiotherapists (Hall et al, 2021) and others.…”