Integrating nurse practitioners into Canadian emergency departments: a qualitative study of barriers and recommendations

Abstract

Objective: The objective of this study was to identify the facilitators and barriers associated with integrating nurse practitioners (NPs) into Canadian emergency departments (EDs) from the perspectives of NPs and ED staff. Methods: We conducted 24 semi-structured interviews with key multidisciplinary stakeholders in 6 Ontario EDs to gain a broad range of perspectives on implementation issues. Data were analyzed using a grounded-theory approach. Results: Qualitative analysis of the interview data revealed 3 major issues associated with NP implementation: organizational context, role clarity and NP recruitment. Organizational context refers to the environment an NP enters and involves issues related to the ED culture, physician reimbursement system and patient volume. Role clarity refers to understanding the NP's function in the ED. Recruitment issues are associated with attracting and retaining NPs to work in EDs. Examples of each issue using respondent's own words are provided. Conclusion: Our study identified 3 issues that illustrate the complex issues involved when implementing NPs in EDs. The findings may inform policy makers and health care professionals in the future development of the role of NPs in Canadian EDs. RÉSUMÉObjectif : Cette étude visait à identifier les éléments de facilitation et les obstacles liés à l'intégra-tion des infirmières praticiennes (IP) dans les services d'urgence du Canada, du point de vue des IP et de celui du personnel des urgences. Méthodes : Nous avons effectué 24 entrevues semi-structurées avec les principaux intervenants multidisciplinaires de six urgences en Ontario pour obtenir un large éventail de perspectives sur les enjeux de l'affectation. Une théorie à base empirique a servi à l'analyse des données. Résultats : L'analyse qualitative des données des entrevues a révélé trois principaux enjeux liés à l'affectation des IP : contexte organisationnel, clarté du rôle et recrutement des IP. Le contexte organisationnel est le milieu où arrivent les IP et comprend des enjeux liés à la culture du service d'urgence, au système de rémunération des médecins et au nombre de patients. La ORIGINAL RESEARCH • RECHERCHE ORIGINALE ADVANCES

Difficulties Encountered in Collaborative Care: Logistics Trumps Desire

“…56,57 Lack of understanding of scope of practice and practitioner competence is a recurring theme in many studies of interprofessional care. 58 -61 This study demonstrates that when role is better defined, as it was at the 6-month point, physicians had less concern about NPs' scope of practice and liability.…”

Evaluating new roles within emergency care: A literature review

“…Because of the small numbers involved in the studies (although some authors talk about saturation sampling) (Fisher et al, 2006) the findings are not safely generalisable to the wider national or international health care population. Despite this, the findings of Tye and Ross (2000) have been echoed in subsequent studies (Currie and Crouch, 2008;Thrasher and Purc-Stephenson, 2007) although Fisher et al (2006) did report some findings which countered those of Tye and Ross (2000) in that the ENPs interviewed thought of the role as an 'easy life', and thought that a positive recruitment issue would be the ability of senior nurses to get away from working night and weekend shifts.…”

“…Nine studies were identified that explicitly examined the perceptions of healthcare professionals regarding non-medical roles in emergency care (see Table 4) (Currie and Crouch, 2008;McGee and Kaplan, 2007;Thrasher and Purc-Stephenson, 2007;Lee and Bailey, 2007;Mason et al, 2007;Fisher et al, 2006;Griffin and Melby, 2006;Martin and Considine, 2005;Tye and Ross 2000). A characteristic of the majority of studies is that they involve small numbers of staff apart from the studies which used a validated questionnaire using a Likert scale which measured attitudes and knowledge of the new roles Bailey, 2007, Griffin andMelby 200 andConsidine, 2005).…”

“…Another theme identified was the potential tension the role of the ENP had with other emergency nurses. Thrasher and Purc-Stephenson, 2007 identified that tensions arose when other nurses were asked to carry out treatments for patients seen by ENPs. While the nurses interviewed felt it was within their role to carry out treatments for patients seen by doctors, they felt that ENPs should carry out their own treatments 'they are not doctors they can't tell me what to do'.…”

Perceived barriers to the sustainability and progression of nurse practitioners

“…Lack of the awareness of the NP role by nurses, doctors, allied health and patients is perceived as a barrier to role progression and sustainability throughout the literature (Appel and Malcolm, 2002;Clarin, 2007). For example, a study by Thrasher and Purc-Stephenson (2007) found that some registered nurses found it difficult performing tasks for patients being cared for by a NP citing confusion surrounding the NP role as the cause of the disagreement. Our results indicated that this was not the case within Victorian EDs.…”