Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review

From a policy perspective, we conclude that bibliographic analysis of the indexed literature is a useful technique that can augment our understanding of key regulatory issues such as scope of practice. However, the overemphasis on advanced practice in the scope of practice literature coupled with the increased interest in task shifting to support-personnel as governments pursue the goal of universal health coverage may leave nursing inadequately prepared to inform any evidence-based policy change.

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“…The Changing Regulatory Environment tends to be addressed least, and is often cited as a barrier to change (Figueroa ; Xue et al. ).…”

Section: Discussionmentioning

confidence: 99%

A bibliographic exploration of nursing's scope of practice

Benton¹,

Cusack

Jabbour

et al. 2016

International Nursing Review

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“…36,37 Further, fewer restrictions on the scope of practice for nurse practitioners is associated with an increase in the number of nurse practitioners practicing in rural or medically underserved populations. 38 Nurse practitioner-physician comanagement in rural or medically underserved populations allows primary care physicians to free time up for additional appointments, as well as provide patients with more one-on-one time during patient visits to address individual patients' needs.…”

Section: Consequences Of Comanagementmentioning

confidence: 99%

Nurse Practitioner–Physician Comanagement: A Theoretical Model to Alleviate Primary Care Strain

Norful

Jacq

Carlino³

et al. 2018

Ann Fam Med

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PURPOSE Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is comanagement of patients by more than 1 primary care clinician. Comanagement has been investigated in acute care with surgical teams and in outpatient settings with primary care physicians and specialists. Because nurse practitioners are increasingly managing patient care as independent clinicians, our study objective was to propose a model of nurse practitioner-physician comanagement. METHODSWe conducted a literature search using the following key words: comanagement; primary care; nurse practitioner OR advanced practice nurse. From 156 studies, we extracted information about nurse practitioner-physician comanagement antecedents, attributes, and consequences. A systematic review of the findings helped determine effects of nurse practitioner-physician comanagement on patient care. Then, we performed 26 interviews with nurse practitioners and physicians to obtain their perspectives on nurse practitioner-physician comanagement. Results were compiled to create our conceptual nurse practitioner-physician comanagement model. RESULTSOur model of nurse practitioner-physician comanagement has 3 elements: effective communication; mutual respect and trust; and clinical alignment/ shared philosophy of care. Interviews indicated that successful comanagement can alleviate individual workload, prevent burnout, improve patient care quality, and lead to increased patient access to care. Legal and organizational barriers, however, inhibit the ability of nurse practitioners to practice autonomously or with equal care management resources as primary care physicians.CONCLUSIONS Future research should focus on developing instruments to measure and further assess nurse practitioner-physician comanagement in the primary care practice setting. Ann Fam Med 2018;16:250-256. https://doi.org/10.1370/afm.2230. INTRODUCTIONW ith imminent staffing shortages in the health care profession and an increase in the volume of patients seeking primary care services, patient loads are increasing rapidly, thus making it difficult for a single primary care professional to manage all patient care needs effectively and efficiently.1-4 Therefore, policy makers are calling for new primary care delivery models to meet the increased demands for care, especially due to patients with multiple comorbidities requiring more complex primary care visits. Different models of care delivery have been proposed, including team-based care, yet these models often have variability in task allocation and professional roles.5 Identifying innovative models of care delivery is increasingly important to meet these demands in primary care.One proposed care delivery model includes having more than 1 primary care professional comanaging the same patient and sharing the workload responsibilities or care management tasks. Researchers have explored comanagement of patients by 2 physicians in primary care, 6 and by a physician and a nonphysician ...

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“…While the authors found that NP autonomy was associated with an increase in the number of NPs and expanded health care utilization, none of the included studies examined quality of care as the primary outcome (Xue et al. ). This study is intended to fill this gap.…”

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confidence: 99%