How does government policy influence the employment and training of nurse practitioners and physician assistants? A realist analysis using qualitative interviews

Abstract

Aims:The aim of this study was to develop insights into how and why Dutch government policies on deployment and training of nurse practitioners and physician assistants have effect and under what circumstances.Design: A realist analysis using qualitative interviews. Methods: Data analysis of 50 semi-structured interviews conducted in 2019 with healthcare providers, sectoral and professional associations, and training coordinators. Stratified purposive and snowball sampling were used. Results: Policies stimulated employment and training of nurse practitioners and physician assistants by: (1) contributing to the familiarity of participants in the decisionmaking process in healthcare providers with and medical doctors' trust in these professions; (2) contributing to participants' motivation in employment and training; and (3) eliminating barriers perceived by medical doctors, managers and directors. The extent to which policies affected employment and training was largely determined by sectoral and organizational circumstances, such as healthcare demand and complexity, and decision-makers in healthcare providers (medical doctors or managers/ directors). Conclusion: Effectuating familiarity and trust among participants in the decisionmaking process is a crucial first step. Next, policymakers can motivate participants and lower their perceived barriers by extending the scope of practice, creating reimbursement opportunities and contributing to training costs. Theoretical insights into nurse practitioner and physician assistant employment and training have been refined. Impact:The findings highlight how governments, health insurers, sectoral and professional associations, departments, councils, healthcare providers and professionals can facilitate and support nurse practitioner and physician assistant employment and

Slack Is Needed to Solve the Shortage of Nurses

“…Upskilling refers to situations where nurses must perform the tasks of, e.g., physicians. A Dutch study about the introduction of nurse practitioners showed the great variety between the types of healthcare institutions that work with nurse practitioners [67]. The main explanation is the lack of knowledge in healthcare organizations about the possibilities to transfer tasks from physicians to nurses (nurse practitioners).…”